Instruction: Generate impression based on findings.

Input: Female, 67 years old, with bilateral lower back pain radiating to the lower extremities. With neck pain and myelopathy, new acute. Cervical spine:Mild reversal of the cervical lordosis is seen. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. Endplate edema is seen at C4-5 and to a lesser degree at C3-4, progressed from prior. No worrisome marrow replacing lesions are demonstrated. The visualized spinal cord shows normal signal intensity throughout. No epidural lesions are suspected.C2-3: Facet arthropathy, left more than right. No significant spinal canal or foraminal compromise. No interval changes.C3-4: Facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the left. Mild spinal canal narrowing. Severe left foraminal narrowing. No interval changes. C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation. Moderate spinal canal narrowing. Severe left and mild right foraminal narrowing. No interval changes. C5-6: Facet arthropathy. Mild posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Severe left foraminal narrowing. No interval changes. C6-7: Facet arthropathy. Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. Mild left foraminal narrowing. No interval changes. C7-T1: Facet arthropathy. No significant spinal canal or foraminal compromise. No interval changes. As visualized on sagittal images, disc bulging at T2-3 is probably not significantly changed with resultant foraminal narrowing.Lumbar:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The visualized distal spinal cord and conus are within normal limits. The nerve roots of cauda equina are unremarkable except as discussed below.L1-2: Facet arthropathy. Loss of disc height with disc bulging. Moderate to severe spinal canal narrowing with effacement of the CSF and crowding of the cauda equina. Mild bilateral foraminal narrowing. No interval changes. L2-3: Facet arthropathy, slightly progressed. Disc bulging, slightly progressed, with a new left paracentral inferiorly directed extrusion. New narrowing of the left lateral recess with perhaps mild mass effect on the transiting nerve roots. Mild right foraminal narrowing, mildly progressed. L3-4: Facet arthropathy. Ligamentum flavum thickening, right side more than left. Mild disc bulging with interval reduction in the size of a small right paracentral protrusion. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. No interval changes except as above. L4-5: Facet arthropathy. Ligamentum flavum thickening. Minimal bulging disc with interval improvement in a small right paracentral protrusion. Mild spinal canal narrowing, particularly in the transverse dimension. No significant foraminal narrowing. No interval changes except as above. L5-S1: Facet arthropathy. Disc bulging and osteophytic ridging. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. No interval changes.

Output: 1.Endplate edema has progressed at C4-5 likely indicating some worsening of degenerative disc disease. However, the degree of multilevel mild to moderate spinal canal stenosis is unchanged. Likewise, scattered foraminal narrowing, severe at some levels, is unchanged.2.Mildly progressive facet arthropathy is seen at L2-3. In addition, there is a new small left paracentral inferiorly directed disc extrusion at this level which could be causing some displacement of the transiting nerve roots including the left L3 nerve root. Degenerative findings at additional levels are stable or in some cases slightly improved as above. L1-2 is the most significantly affected level where there is a stable moderate to severe spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 19-year-old male with history of T cell lymphoma status post bone marrow transplant and right septic hip status post IR drainage. Now presents with knee pain. MENISCI AND LIGAMENTS: No significant abnormality noted.BONE AND MARROW: There are innumerable geographic lesions with serpentine boundaries that demonstrate hyperintense peripheral T2 signal and mild rim enhancement in the femur, tibia, and fibula of both knees. Findings are compatible with numerous bone infarcts. No bone marrow edema or enhancement in either knee to suggest infection.SYNOVIUM: No significant abnormality noted. No significant joint effusion in either knee.MUSCULATURE: No significant abnormality noted.ADDITIONAL

Output: Numerous bone infarcts in both knees as described above without joint effusions or specific evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 73-year-old female with right hip flexor weakness, foot drop. Suspect lumbar radiculopathy. Cord compression exam:On sagittal imaging, in the cervical spine, there are disc osteophyte complexes at multiple levels resulting in moderate to severe central canal stenosis, as detailed below in findings from dedicated imaging. There are mild degenerative disc findings in the thoracic spine, with moderate central canal stenosis at T10-11, also further discussed below. In the lumbar spine, there are bulging discs at multiple levels with moderate central canal stenosis at L4-5 and moderate bilateral foraminal narrowing at L5-S1. There is no evidence of epidural fluid collection or mass.Cervical spine:There is straightening of the normal cervical lordosis. The cervical vertebral bodies are appropriate in height. Mild degenerative endplate signal abnormality is seen at most levels.At C2-3 there is no significant compromise to spinal canal or neural foramina.At C3-4 there is disc bulge, posterior disc-osteophyte complex and uncovertebral arthropathy resulting in moderate central canal stenosis and mild mass effect on the ventral spinal cord with mild cord T2 hyperintensity. There is moderate right and moderate to severe left neuroforaminal stenosis. At C4-5 there is disc desiccation and loss of height, disc bulge, posterior disc-osteophyte complex with a prominent right paracentral component, and uncovertebral and facet arthropathy. These findings result in severe spinal canal stenosis with flattening of the ventral cord with cord T2 hyperintensity, as well as moderate to severe right and moderate left neuroforaminal stenosis.At C5-6 there is disc desiccation and loss of height, mild disc bulge, posterior disc-osteophyte complex, and uncovertebral arthropathy resulting in moderate central canal stenosis as well as mild right and mild to moderate left neuroforaminal stenosis.At C6-7 there is disc desiccation and loss of disc height, moderate central disc protrusion and uncovertebral arthropathy resulting in mild to moderate central canal stenosis, minimal deformation of the cord and minimal cord signal abnormality, as well as mild to moderate right and moderate to severe left neuroforaminal stenosis.At C7-T1 there is minimal disc bulge and facet hypertrophy, right greater than left, with no significant central canal stenosis and mild bilateral neuroforaminal stenosis.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is facet hypertrophy noted in the lower thoracic levels. At T10-11 there is additional moderate disc bulge with moderate central canal stenosis as well as moderate right and mild left neuroforaminal stenosis.

Output: 1.No evidence of acute cord compression.2.Multilevel chronic stenoses, severe at some levels in the cervical spine due to posterior disc-osteophyte complexes and posterior element hypertrophy. Patchy increased spinal cord signal in the cervical spine likely represents myelomalacia with or without mild superimposed edema. 3.Moderate central canal stenosis in the thoracic spine at T10-11.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foraminal stenosis at any level. The spinal cord displays normal signal and morphology with no evidence of cord compression. The paravertebral soft tissues are unremarkable.

Output: Normal MRI of the cervical spine with no evidence of spinal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for causes of back pain History: worsening back pain 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. A 1 cm lesion within the left half of the L5 vertebral body along its superior aspect is stable when compared to the prior exam it is bright on T1 and T2 imaging and most likely represents an atypical vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is moderate bilateral facet hypertrophy present at this level associated with some narrowing of the neural foramina left worse than right.At L4-5 there is no significant compromise to spinal canal or neural foramina. Since the prior exam the patient has undergone left-sided hemilaminotomy compared a left-sided ligamentum flavum cystic lesion as been removed. There is marked bilateral facet hypertrophy at this level associated with ligamentum flavum hypertrophy,a disk bulge, disk desiccation and mild loss of disk space height.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.Two cystic lesions along the right kidney are stable when compared to the prior exam and measure up to 12 mm in diameter.

Output: 1.Since the prior exam cystic lesion adjacent to the left L4-5 facet joint has been removed. The patient is status-post left-sided hemilaminotomy at this level.2.There are degenerative changes present in the lower lumbar spine mainly in the form of facet hypertrophy.3.Stable right kidney cystic lesions (most likely simple cysts)4.A 10 mm L5 vertebral body lesion is stable in size since 2010 . It is most likely benign.


Instruction: Generate impression based on findings.

Input: Cervical radiculopathy, neck pain and radiation. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis which appears to be positional. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Small central disc protrusion. Left-sided facet arthropathy with minimal left neural foraminal stenosis. Otherwise no significant compromise to the spinal canal or neural foramina. C3-4: Mild disc bulge. No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy, worse on the left.C4-5: Mild disc bulge. No significant compromise to the spinal canal or neural foramina.C5-6: Disc osteophyte complex including central disc protrusion with indentation of the ventral cord. There is mild to moderate spinal canal stenosis at this level. Neural foramina are patent. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.There are multiple nodules involving the thyroid gland, which are better assessed on prior ultrasound.

Output: Mild multilevel degenerative changes in the cervical spine as described above, not significantly changed since 5/6/2015. There is mild to moderate spinal canal stenosis at the C5-C6 level related to disc protrusion which indents the ventral aspect of the cord. There are also additional disc bulges more superiorly. No cord signal abnormality. No significant stenosis involving the neural foramina.


Instruction: Generate impression based on findings.

Input: 51-year-old with history of right breast excisional biopsy that showed mixed mammary carcinoma in situ. History of MR biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. There is globally increased enhancement within the right breast compared to the left. Scattered simple and complicated cysts are present.There is increased enhancement throughout the right breast, most notably near the site of prior MRI guided biopsy in the upper inner breast. Clip artifact is seen in the anterior aspect of an area of non-mass enhancement that now measures 3.7 x 1.4 x 2.9 cm, previously 3.1 x 1.6 x 1.9 cm. Additionally, scattered areas of focal and linear enhancement are present in the right breast, asymmetric when compared with the left. This includes two adjacent areas of linear enhancement in the upper inner breast measuring 1.3 and 1.7 cm, and another 1.2 cm area. Foci of left breast enhancement are not significantly changed, including a 5 mm focus in the left inner breast.No new abnormal axillary lymph nodes are identified in either axillary region. No change in previously noted right axillary lymph nodes. Subcentimeter high T2 signal hepatic lesions are most like cysts or hemangiomas.

Output: Asymmetric enhancement of the right breast compared to the left, most notably in the upper inner breast. Routine diagnostic mammogram and right breast MRI directed ultrasound for this area is recommended. If no suspicious correlate is seen sonographically, MRI guided biopsy should be performed. Note that additional focal and non-mass enhancement is present on the right, and additional MRI biopsy could be considered depending on management plans for the breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: There is marked attenuation of the left middle cerebral artery, with near-complete occlusion of portions of the M1 segment. The A1 segment of the right anterior cerebral artery is hypoplastic. The intracranial internal carotid arteries are normal in course and caliber. The distal right posterior cerebral artery is diminutive. The vertebral arteries, basilar artery, and left posterior cerebral artery are normal in course and caliber. No aneurysm is identified.MRA NECK

Output: 1.Acute/subacute infarctions in the bilateral MCA and PCA territories, left greater than right, likely of embolic etiology.2.Marked narrowing/stenosis of the left middle cerebral artery, particularly the M1 segment.3.Grossly stable appearance of focal stenosis of the left V1 segment of the left vertebral artery, mild narrowing of the proximal left carotid bulb, and moderate narrowing of the distal right common carotid artery and right proximal carotid bulb.


Instruction: Generate impression based on findings.

Input: Male; 36 years old. Reason: Patient with current multilobar necrotizing PNA, + strep pneumo, with questionable liver lesions on CT chest. Please evaluate, rule out hepatic abscesses. History: As above ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense lesions in both hepatic lobes and the caudate, correlating with previously seen hypoattenuating lesions on CT chest. These lesions demonstrate peripheral enhancement and fill with contrast on delayed phase images, most compatible with benign hemangiomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild body wall anasarca.OTHER: Extensive multifocal airspace opacities in the lung bases, partially visualized. Small right pleural effusion, increased since prior exam. Stable small left pleural effusion.

Output: 1.Multiple hepatic lesions, most compatible with benign hemangiomas.2.Increased right pleural effusion. Extensive multifocal airspace opacities, partially visualized.


Instruction: Generate impression based on findings.

Input: 33-year-old female with borderline ovarian tumor, endstage. Evaluate disease extent. Genital Herpes. CHEST:LUNGS AND PLEURA: Probable intrapulmonary lymph node at left major fissure.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Benign-appearing simple cyst in the peripheral right hepatic lobe.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple small lymph nodes are seen in the axial images. No significant lymphadenopathy. On the coronal images, pericaval elongated lymph nodes are seen with long axis of 2.5 cm. Cyst are present residual or latent.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Intrauterine device in the endometrial canal. No specific adnexal abnormality on CT. MRI would be more sensitive. No adenopathy. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Probable intrapulmonary lymph node. IUD in the uterus. No specific adnexal abnormality.


Instruction: Generate impression based on findings.

Input: Dysarthria, gait disorder. There is no evidence of intracranial hemorrhage, mass, or infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is a left lens implant. There is mild mucosal thickening in the left maxillary sinus.

Output: No evidence of acute or subacute infarct.


Instruction: Generate impression based on findings.

Input: Ms. Kendall submitted outside studies for review.Submitted for review are:-Screening mammogram dated 8/27/2016 performed at Palos Diagnostic and Women's Health Center-Left breast diagnostic mammogram dated 9/12/2016 performed at Palos Diagnostic and Women's Health Center-Post procedure left breast mammograms and specimen radiograph dated 9/15/2016 performed at Palos Diagnostic and Women's Health Center-Bilateral breast MRI dated 9/26/2016 performed at Palos Diagnostic and Women's Health Center-Right breast ultrasound dated 9/28/2016 performed at Palos Diagnostic and Women's Health CenterFor comparison, diagnostic right breast mammogram and images from ultrasound-guided right breast cyst aspiration dated 9/8/2015 are available. SCREENING MAMMOGRAM:Bilateral CC and MLO views, CC view of the left breast are submitted.The breast parenchyma is heterogeneously dense, which may obscure small masses.There are suspicious pleomorphic calcifications in the central lower left breast at anterior to mid depth. No dominant mass, suspicious microcalcifications, or architectural distortion in the right breast. Benign appearing lymph nodes are projected over both axillae.LEFT BREAST DIAGNOSTIC MAMMOGRAMAn ML and two spot magnification views of the left breast are submitted.The breast parenchyma is heterogeneously dense, which may obscure small masses. Again seen are suspicious pleomorphic calcifications in the central lower left breast at anterior to mid depth, spanning approximately 2.1 x 1.6 cm (AP x TV). No new mass or architectural distortion in the left breast.LEFT BREAST POSTPROCEDURE MAMMOGRAM AND SPECIMEN RADIOGRAPH:Postprocedure CC and MLO views of the left breast and specimen radiograph are submitted.Radiograph of the specimen cores demonstrates calcifications. Postprocedure mammograms demonstrate a lock-shaped clip in the central lower left breast at mid depth. There are residual calcifications extending 2.4 cm anterior to the biopsy marking clip.BILATERAL BREAST MRI:Multiple enhanced MR sequences are submitted per outside institution's protocol.There is heterogeneous fibroglandular tissue. There is mild background parenchymal enhancement bilaterally.There are postbiopsy changes in the central lower left breast at mid depth. There is focal nonmass enhancement along the anterior aspect of the biopsy cavity, measuring approximately 2.5 x 1.4 x 0.8 cm, likely corresponding to residual calcifications seen on mammogram. There are additional scattered enhancing foci in the left breast, compatible with background parenchymal enhancement.There is an indeterminate 8 x 5 x 10 mm enhancing mass in the retroareolar right breast. No additional enhancing foci or masses in the right breast.No axillary or internal mammary lymphadenopathy.RIGHT BREAST ULTRASOUND:Images from MR guided right breast ultrasound are submitted.Targeted right breast ultrasound images at the 12:00 position and retroareolar region demonstrate no sonographic correlate for the previously described MR finding in the right breast.OUTSIDE PATHOLOGY (per report):1. Left breast needle biopsy with calcifications:-Ductal carcinoma in situ, solid type with necrosis (comedocarcinoma) high nuclear grade.Estrogen receptor: Positive moderate nuclear staining 66%Progesterone receptor: Negative2. Left breast needle biopsy without calcifications: Negative for tumor.

Output: 1. Biopsy proven left breast DCIS. There is nonmass enhancement anterior to the biopsy site on MRI, corresponding to residual calcifications seen on mammogram. If breast conservation is desired, bracketed wire localization of the clip and residual calcifications can be performed. Continued surgical management is recommended.2. Indeterminate 10 mm enhancing mass in the retroareolar right breast. Repeat MR-directed right breast ultrasound is recommended. If no ultrasound correlate is identified, follow-up bilateral breast MRI in 6 months is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: There is globular increased signal of the medial meniscus, particularly the posterior horn and body, representing intrasubstance degeneration. Additionally, there is a small focus of linear increased signal at the junction of the posterior horn and body extending to the free edge which is thought to represent a new horizontal tear. The lateral meniscus is unremarkable. ARTICULAR CARTILAGE AND BONE: There has been progression of cartilage loss of the weightbearing portion of the medial femoral condyle with areas of new full-thickness loss. A small focus of near full-thickness loss of cartilage along the tibial plateau is also noted at the level of the posterior horn. There is focal partial-thickness cartilage degeneration of the weightbearing portion of both the lateral femoral condyle and tibial plateau. This has progressed from the prior exam. Additionally, there is progression of articular cartilage loss of the medial patellar facet with worsening cartilage loss of the medial femoral trochlea as well. LIGAMENTS: The cruciate and collateral ligaments are within normal limits. EXTENSOR MECHANISM: The extensor mechanism is within normal limits.ADDITIONAL

Output: 1. Progression of tricompartmental cartilage loss.2. Intrasubstance degeneration of the medial meniscus with new horizontal tearing at the junction of the posterior horn and body.


Instruction: Generate impression based on findings.

Input: A 48 year old male with recurrent atrial fibrillation after 2 pulmonary veins isolation procedures. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 172 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 76 ml (normal range 47+/-19), the LV mass index is 49 g/m2 (normal range 85+/-15), and the LV mass is 95 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is late gadolinium enhancement at base of the inferolateral and inferior segments. The pattern spears the endocardium and is not consistent with myocardial infarction. These findings are suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, such as old myocarditis. Left AtriumThe left atrium is moderately dilated (138ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9), and the RVESV is 97 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild 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. No pulmonary vein stenosis was noted. The pulmonary vein ostia measurements are below. Based on late gadolinium enhancement imaging, right superior and right inferior pulmonary veins are well isolated with circumferential LGE. There appears to be a large ablation gap (i.e. no LGE) along the superior margin of the left superior pulmonary vein and also along the superior and posterior margin of the left inferior pulmonary vein.Left upper pulmonary vein: 20x17mmLeft inferior pulmonary vein: 20x13mmRight upper pulmonary vein: 24x19mmRight inferior pulmonary vein: 24x22mmPulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 56%. 2. There is late gadolinium enhancement at base of the inferolateral and inferior segments. These findings are suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, such as old myocarditis. The pattern spears the endocardium and is not consistent with myocardial infarction.3. The right ventricle is normal in size with normal systolic function, the RVEF is 51%. 4. The left atrium is moderately dilated and the right atrium is mildly dilated.5. There is mild mitral regurgitation.6. All four pulmonary veins drain normally into the left atrium. No stenosis was noted.7. Based on late gadolinium enhancement imaging, right superior and right inferior pulmonary veins are well isolated with circumferential LGE around the ostia. There appears to be a large ablation gap (i.e. no LGE) along the superior margin of the left superior pulmonary vein and also along the superior and posterior margin of the left inferior pulmonary vein.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 33 years old with Hx of VHL and multiple hemangioblastomas s/p craniotomy and midline cerebellar mass resection (12/1/15) Post-operative occipital craniotomy with interval resection of midline posterior fossa cerebellar mass. Surrounding cerebellar edema as well as generalized leptomeningeal enhancement is likely post-operative in nature. There is decreased effacement and mass effect on the fourth ventricle and brainstem with the fourth ventricle AP diameter now measuring up to 1.3 cm. A cystic lesion with an enhancing mural nodule anterior and superior to the resection bed is again noted within the midline of the posterior fossa, which measures up to 1.9 cm in AP x 1.7 cm transverse x 1.7 cm in craniocaudal dimension, not significantly changed from prior 1.7 x 1.6 x 1.7 cm accounting for technical differences. Additional enhancing smaller lesions are noted in the bilateral cerebellar hemispheres appear similar in size to prior exam. The right splenium enhancing lesion also appears similar in size to prior exam and measures up to 0.7 cm in AP x 0.7 cm in transverse dimension. There is redemonstration of an enhancing intradural extramedullary nodule at the level C2 in the left thecal sac, which does not cause effacement of the spinal cord and appears stable from prior exam. Linear area of gliosis likely post-operative in nature noted within the right frontal lobe extending to the right lateral ventricle appears stable from prior exam.There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1) Interval suboccipital craniotomy with resection of a midline posterior fossa cerebellar mass with decreased mass effect and effacement of the fourth ventricle and brainstem.2) Additional enhancing lesions in the cerebellum, thecal sac, and corpus callosum appear stable from prior exam and are suggestive of additional hemangioblastomas.


Instruction: Generate impression based on findings.

Input: 35-year-old female with history of erosive sinusitis and Wegener's. Saddle nose.IMAGE ACQUISITIONS: Non-infused CT of the sinuses. Extensive bone destruction including the fovea ethmoidalis, ethmoid air cells, and medial wall and floor of the left orbit is again demonstrated, but not significantly changed in comparison with the previous exam. Thinning of the right lamina propecia also again noted. Complete opacification of the frontal, sphenoid and maxillary sinuses. Opacification of the remnant right maxillary sinus and right frontal sinus is slightly increased. Soft tissue extension to the orbit was noted previously and is again seen, with extension of granulation tissue and mass effect on the extraocular muscles. It does extend to the level of the inferior orbital foramen, although foramen has not changed in appearance since the previous exam to suggest further erosion. Extension through the fovea ethmoidalis as noted with a slight bulge superiorly could be evaluated with brain MRI clinically warranted.

Output: Stable extensive erosive sinus disease. Extension into the left orbit and into the fovea ethmoidalis are stable findings.


Instruction: Generate impression based on findings.

Input: Male, 28 years old, with seizure. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The medial temporal structures are symmetric and free of signal abnormality.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Brain bleed. There is a heterogeneous intermediate to high T1 signal and mixed low and high T2 signal lesion centered in the left middle cerebellar peduncle with diffuse central and peripheral susceptibility effect, which measures up to 20 mm. There is surrounding vasogenic edema. There is mild effacement of the fourth ventricle, but the third and lateral ventricles are not particularly enlarged. There is no evidence of acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a retention cyst in the left maxillary sinus.

Output: Findings most suggestive of a recently hemorrhagic left middle cerebellar peduncle cavernous malformation with associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: 34 years, Female, Reason: 34 yo with with PSC please screen for disease progfression Cca History: none. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT:Multiple areas of intrahepatic biliary ductal dilatation and stricturing appear similar to the prior exam. Stricturing in the proximal common bile duct is unchanged.No suspicious enhancing lesions are present. Status post cholecystectomy. Intrabiliary foci of intrinsic or T1 shortening are increased from the prior exam and may represent inspissated bile.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged biliary stricturing and dilatation consistent with primary sclerosing cholangitis. Slight increase in inspissated bile within the ducts.2.No focal liver lesions.


Instruction: Generate impression based on findings.

Input: VA and LP shunt with Chiari and pseudotumor cerebri. Evaluate for changes, chronic headaches. Restarted on Lasix for CSF. The cerebellar tonsils are slightly more caudal compared to prior study with the tip at the level of the superior aspect of the anterior arch of C1 as compared top previous tip of dens, without significant interval head position change. There are stable postoperative findings related to suboccipital craniectomy and posterior fossa shunting. There is no acute infarct, mass effect, or acute hemorrhage. There are slightly decreased minimal bilateral cerebral convexity subdural effusions. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged. There is hardware related susceptibility effect posteriorly. There is robust biphasic CSF flow along the ventral and dorsal aspects of the neo-foramen magnum, with minimal flow demonstrated dorsal to the tonsils.

Output: Slight increased caudal positioning of the cerebellar tonsils. Otherwise stable postoperative findings related to Chiari decompression.


Instruction: Generate impression based on findings.

Input: Persistent lower back, right leg and shoulder pain after a 55 mph MVC on 3/26/16. There are slight disc left foraminal protrusions and mild facet arthropathy bilaterally at L3-4 and L4-5, without apparent nerve root impingement or significant spinal canal stenosis. There is no appreciable intervertebral disc disease at T12 through L3 and L5-S1. The vertebral column alignment is within normal limits. The vertebral body and disc space 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: Slight disc left foraminal protrusions and mild facet joint arthropathy bilaterally at L3-4 and L4-5, without apparent nerve root impingement or significant spinal canal stenosis. No appreciable intervertebral disc disease at T12 through L3 and L5-S1.


Instruction: Generate impression based on findings.

Input: History of ALL with nasopharyngeal tumor, radiation to brain and spine: baseline surveillance exam. Brain: There is a right transfrontal Ommaya catheter that appears to terminate in the suprasellar cistern, with mild high T2 hyperintensity in the parenchyma surrounding the catheter that may represent gliosis or edema. The ventricles are otherwise normal in size and configuration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement.There is no midline shift or herniation. The major cerebral flow voids are intact. Face: The nasopharyngeal mucosa to be appears intact, without discernible mass lesions.The orbits and salivary glands are grossly unremarkable. There is mild heterogeneity of the sphenoid with predominantly fatty marrow and paucity of the sphenoid sinuses. LIkewise, the right maxillary and bilateral frontal sinuses appear to be non-pneumatized and the left maxillary sinus is hypoplastic.

Output: 1. Right transfrontal Ommaya catheter in position with mild surrounding gliosis or edema, but no evidence of acute intracranial hemorrhage, mass, or acute cerebral infarction.2. No evidence of nasopharyngeal mucosal mass lesions.3. Diffusely hypoplastic paranasal sinuses. A sinus CT may be useful for further assessment, if clinically warranted.


Instruction: Generate impression based on findings.

Input: Disorder of ligament of the left wrist. Occult scaphoid fracture. Evaluation is limited by patient motion artifact.LIGAMENTS: Motion artifact limits evaluation of the intrinsic ligaments. There is increased signal intensity within the membranous portion of the scapholunate ligament seen on a single image (image 7; series 901) that could be artifactual in etiology or represent a focal perforation, but this is of questionable clinical significance. Given the limitations of a non arthrogram study, the lunotriquetral ligament appears intact.TRIANGULAR FIBROCARTILAGE COMPLEX: There is a large tear of the articular disc of the triangular fibrocartilage situated approximately 3 mm medial to its radial attachment.TENDONS: There is a small amount of fluid within the tendon sheath of the extensor pollicis longus tendon as it courses dorsal to the tendons of the second compartment. There is also a small amount of fluid within the sheath of the extensor carpi radialis brevis at the same location. This is nonspecific and could represent the sequela of recent trauma, although this can also be seen in patients with distal intersection syndrome. The remainder of the tendons appear intact.BONES: There is a comminuted intra-articular fracture of the distal radius with the fracture fragments in near-anatomic alignment and minimal if any step-off along the articular surface. There is also focal subchondral edema within the dorsal aspect of the distal ulna with a poorly defined linear focus of signal intensity that could represent a nondisplaced fracture, but the ulnar styloid itself appears intact. The carpal bones including the scaphoid are intact.ADDITIONAL

Output: 1. Comminuted intra-articular fracture of the distal radius with the fracture fragments in near-anatomic alignment. Focal and poorly-defined signal abnormality within the dorsal aspect of the distal ulna may represent a bone contusion or an additional nondisplaced fracture.2. Tear of the articular disc of the triangular fibrocartilage.3. Fluid within the sheaths of the extensor pollicis longus and extensor carpi radialis brevis tendons could represent distal intersection syndrome.These findings were relayed to Dr. Vitello by phone at 9:19 am on 3/8/16.


Instruction: Generate impression based on findings.

Input: Female 84 years old Reason: Biliary stone, sludge, etiology of elevated lipase History: nausea, vomiting, pain on exam ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintensities in the liver are suggestive of hepatic cysts. Status post cholecystectomy.SPLEEN: T2 hyperintensity within the spleen without convincing enhancement likely represents a splenic cyst.PANCREAS: There is a focal area of hyperenhancement within the pancreatic head measuring 2.6 x 1.6 cm (series 1201, image 184). There is marked dilatation of the upstream pancreatic duct measuring up to 8 mm (series 1201, image 179). The pancreatic duct remains dilated apart from a segment of narrowing in the distal body/tail measuring approximately 2.6 cm where it is abnormally narrowed. There is no mural nodularity or enhancement of the pole. In the region of the abnormal ductal narrowing there is loss of the normal intrinsic T1 hyperintense signal within the pancreatic parenchyma. There is no normal restricted diffusion within the pancreas. There are no surrounding inflammatory changes to suggest acute pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts measuring up to 6.5 x 6.7 in the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Focal narrowing of the pancreatic duct with abnormal signal in the surrounding pancreatic parenchyma. The appearance is suggestive of chronic pancreatitis.2.Suspicious hypoenhancing focus within the pancreatic head with upstream pancreatic duct dilatation. While chronic pancreatitis could account for the duct dilatation the hypoenhancing focus is suspicious for a pancreatic neoplasm, although the lack of diffusion restriction is somewhat atypical. Consideration given to further evaluation with EUS/ERCP.


Instruction: Generate impression based on findings.

Input: Craniocervical junction appears within normal limits. Vertebral body heights and alignment are maintained. Marrow signal appears normal. The cord appears unremarkable.Mild degenerative changes are seen as described below:C2-C3: There is trace disc bulge with no spinal canal or neural foraminal compromise.C3-C4: There is broad-based disc bulge with effacement of the ventral thecal sac. There is no significant spinal canal stenosis or neural foraminal compromise.C4-C5: There is a minimal disc bulge with no spinal canal or neural foraminal compromise.C5-C6: There is mild disc bulge with no spinal canal or neural foraminal compromise.C6-C7: Minimal disc bulge with no spinal canal and foraminal compromise.C7-T1: No spinal canal or neural foraminal compromise.

Output: Minimal degenerative changes in the cervical spine with small multilevel disc bulges, relatively worse at the C3-C4 level. No significant spinal canal or neural foraminal stenosis at any level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (4/21/2016), ultrasound images of right breast (4/21/2016), breast MRI (5/5/2016) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (4/21/2016):The breast parenchyma is mostly fatty replaced (BiRADS Density Category A). A small benign-appearing, circumscribed round mass is present at upper outer quadrant in the right breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. ULTRASOUND IMAGES OF RIGHT BREAST (4/21/2016):Multiple images of right nipple are obtained. No abnormal findings are present within the provided images. One normal-appearing lymph node is visualized in the right axilla.BREAST MRI (5/5/2016):Breast MRI was performed with a protocol outlined in the outside radiology report. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.A small cyst is visualized on T2-weighted images at upper outer quadrant in the right breast, corresponding to the small benign-appearing round mass seen on the mammogram.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.Nipples are enhancing symmetrically, without any abnormal findings.

Output: No mammographic, sonographic or MR evidence for malignancy in either breast.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Elevated protein in CSF, evaluate for encephalitis versus infectious process. Patient has also history recent fall and now weakness. Evaluate for cervical cord lesion. Brain:There are foci of mildly restricted diffusion involving the right and left frontal lobe as well as the right occipital lobe. ADC values are isointense and favored to represent subacute infarcts.There are bilateral subdural collections which are predominately CSF intensity with areas susceptibility noted within the right frontal region. Collection measures up to 11 mm on the right and 9 mm on the left. There is mild associated mass effect. There is a subacute component in the bilateral frontal region with mild T1 hypointensity and T2 hypointensity. Tiny T1 hyperintense component is noted in the anterior left frontal lobe along the cortical surface which may represent a tiny cortical contusion. No significant change since CT dated 2/8/2015. There is global parenchymal volume loss, commensurate with patient's advanced age.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. No abnormal parenchymal or leptomeningeal enhancement. Minimal dural enhancement is seen. Major flow-voids are preserved.There is diffuse opacification of the bilateral mastoid air cells, which may related to intubation. There is moderate opacification throughout the paranasal sinuses, worst involving the left maxillary sinusCervical Spine:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is mild retrolisthesis of C5 on C6 retrolisthesis and minimal retrolisthesis of C6 on C7. Bone marrow signal is within normal limits. Artifact somewhat limits evaluation for cord signal abnormality however no definite cord signal abnormality is seen.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina. Ligamentum flavum thickening noted dorsally.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is disk osteophyte complex with effacement of the ventral thecal sac. Dorsal thecal sac is preserved. There is moderate left and mild right neural foramina narrowing.C6-7: There is disk osteophyte complex with effacement of the ventral thecal sac. Dorsal thecal sac preserved. There is moderate left and mild right neural foramina narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.Mild facet arthropathy is also seen in the cervical spine. There is mild edema involving the dorsal paraspinous soft tissues from C2 to C5. The anterior and posterior longitudinal ligaments are intact. Ligamentum flavum is also intact.

Output: 1. Tiny foci of mildly restricted diffusion involving the bilateral frontal and right occipital lobes likely representing tiny subacute infarcts. In the setting of infection, septic emboli may be considered.2. Bilateral subdural collections with signal features compatible with subacute on chronic subdural hematomas with mild local mass effect. Subacute subdural component is seen along the anterior frontal convexities. Tiny focus of hemorrhage along the cortical surface of the anterior left superior frontal gyrus may represent a contusion.3. No evidence of intraparenchymal abscess or empyema. No abnormal parenchymal or leptomeningeal enhancement is seen to suggest infection however CSF would be more sensitive if there is suspicion for meningitis. Minimal pachymeningeal enhancement is seen which may be reactive and related to the subdural collections.4. Artifact slightly limits evaluation for cord signal abnormality however no definite cord signal abnormality is appreciated. No evidence of intraspinal hematoma. 5. Degenerative changes in the cervical spine without evidence of high-grade spinal canal stenosis at any level. Mild to moderate neural foraminal narrowing at multiple levels as detailed above.6. Edema involving the posterior paraspinous soft tissues from C2 to C5 is nonspecific but given history of trauma, may suggest mild ligamentous injury involving the interspinous ligaments. The anterior and posterior longitudinal ligaments as well as ligamentum flavum are intact. Please note CT of the cervical spine is more sensitive for subtle fractures and can be considered if clinically warranted.Dr. Ali discussed findings with Dr. Cueva (neurology) at 1215 hrs on 2/10/2015.


Instruction: Generate impression based on findings.

Input: Male 13 months old Reason: Assess VSD Exam is degraded by motion artifact.Left VentricleThe left ventricle is mildly enlarged.. There are no regional wall motion abnormalities present. Large paramembranous VSD of 11 mm. Small mid muscular VSD of approximately 3 mm.Left AtriumThe left atrium mildly to moderately enlarged. Right VentricleThe right ventricle is normalRight AtriumThe right atrium is normal to minimally enlarged. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main pulmonary artery is normal in size. Stroke volume of the pulmonary artery is 29.19 mL. With no significant regurgitation.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.Extracardiac FindingsGastrostomy tube is present. Partial visualization of the hollow viscus and solid organs of the upper abdomen are normal. Bibasilar dependent atelectasis. Possible partial right anteromedial diaphragmatic eventration.

Output: 1. Paramembranous VSD of 11 mm. 2. Small mid muscular VSD of 3 mm.3. Mild left ventricle enlargement4. Mild to moderate enlargement of the left atrium.5. Normal right ventricle.6. Normal to minimally enlarged right atrium.7. Possible partial right anteromedial diaphragmatic eventration.


Instruction: Generate impression based on findings.

Input: Patient with AML and history of right hip pain status-post one month of antibiotics for gram-negative bacteremia. Reevaluate inflammation of right hip. Question of osteomyelitis/abscess. The signal within the musculature is within normal limits, previously noted abnormality has resolved. No fluid collection is evident. No joint effusion or evidence of synovitis. Again seen is increased marrow signal abnormality within the subtrochanteric femur that is predominantly isointense to muscle on T1-weighted sequences and hyperintense to muscle on T2 weighted sequences, which is nonspecific and could reflect the patient's known leukemia or sequelae of its treatment. The region of signal abnormality is similar compared to the prior study.

Output: 1. No muscle signal abnormality, fluid collection, or abscess.2. Marrow signal abnormality remains non-specific as described above, appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: Reason: r/o R ethmoid sinus herniating encephalocele seen on MRI There is a focal 9-mm defect along the right ethmoid sinus roof with apparent herniation of a small focal portion of the inferior right frontal lobe cortex into the defect. There is associated T2 signal change in the immediately adjacent cortex. The right olfactory and medial orbital sulci are effaced.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The pituitary fossa is enlarged and deformed. The right lobe of the pituitary is asymmetrically larger than the left.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the left maxillary and ethmoid sinuses which has improved since the prior exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings suggest a small encephalocele along the anterior cranial fossa extending into the ethmoid air cells. The patient will be brought back to obtain additional Coronal 3D Fiesta and coronal T2 2mm thin slices through the anterior cranial fossa which were not done and will be part of this study.2.The pituitary gland is asymmetrically enlarged along its right lobe.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Aphasia and left-sided weakness. Stenosis potentially requiring intervention. Brain MRI: Many of the sequences are degraded by patient motion. There are small areas of restricted diffusion and high T2 signal in the right superior and middle frontal gyri. There is underlying encephalomalacia in the right basal ganglia, middle frontal gyrus, and right corona radiata. There is also diffuse patchy cerebral white matter T2 hyperintensity without corresponding restricted diffusion. There is no evidence of intracranial hemorrhage or mass. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: The images are largely degraded by patient motion. There is paucity of flow-related enhancement in the right internal carotid vein. There is tenuous reconstitution of flow-related enhancement in the right middle cerebral artery at the circle of Willis, with a relative paucity of flow-related enhancement in the distal middle cerebral artery branches. There also appears to be asymmetrically less flow-related enhancement in the right anterior cerebral artery. There also appears to be irregular narrowing of the bilateral posterior cerebral arteries. The intradural vertebral arteries and Neck MRA: There is no discernible enhancement of the entire right internal carotid artery. The right common carotid and external carotid arteries appear to be patent. The left internal carotid, common carotid, and external carotid arteries also appear to be patent. However, there appears to be stenosis of the bilateral vertebral artery origins.

Output: 1. Acute right middle cerebral artery territory infarct superimposed upon chronic small vessel ischemic disease and chronic infarcts, without gross hemorrhagic transformation.2. Critical steno-occlusive disease at the origin of the right internal carotid artery. Further evaluation via Doppler ultrasound may be useful.3. Apparent stenosis of the bilateral vertebral artery origins. Discussed with Physician: AGNIESZKA A ARDELT at 2:40 PM on 10/28/15.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Progressive loss of vibration sensation. There are numerous supratentorial and infratentorial T2 hyperintense white matter lesions, which are unchanged. Many of the lesions are T1 hypointense, but are no enhancing lesions. There is no evidence of intracranial hemorrhage or acute infarction. The pituitary gland appear unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there are cosmetic fillers in the bilateral nasolabial folds.

Output: Multiple white matter lesions compatible with demyelinating disease do not appear to be significantly changed.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, 59 years old, with history of paraganglioma with worsening pain in the neck. An enhancing left carotid space mass is redemonstrated just below the level of the skull base. The lesion measures 25 x 22 mm (image 23 series 6), and has not significantly changed in size from the prior examination where it measured 25 x 23 mm. As before, the lesion displaces the carotid vessels medially but the vascular flow voids are preserved indicating patency.Multiple nodules are redemonstrated in the thyroid gland which do not appear to have changed significantly in size. The dominant nodule measures 25 x 20 mm, similar to prior. The salivary glands are unremarkable. No pathologic adenopathy is detected in the neck. Mild cervical spondylosis is seen. No concerning marrow signal abnormalities are detected.

Output: 1.Stable size of the left carotid space tumor compatible with the history of paraganglioma.2.No new lesions or other specific findings to account for the patient's increasing neck pain are seen.3.Multiple thyroid nodules are unchanged in size.


Instruction: Generate impression based on findings.

Input: 79-year-old female with HCV cirrhosis. Evaluate hepatic dome lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour with prominent fissure, compatible with cirrhotic morphology. Again noted is a 1.0 cm lesion demonstrating T2 hyperintensity, diffusion restriction, arterial enhancement (series 100, image 75) and washout with an enhancing capsule (series 9, image 271). There are additional subcentimeter arterially enhancing lesions in a cluster without washout, not changed (series 9, image 52). Previously noted segment 7 arterially enhancing lesion without evidence of washout is not present on this current examination; this was likely perfusional abnormality. SPLEEN: Mild splenomegaly and splenic varices are noted.PANCREAS: Pancreatic atrophy with ductal dilatation measuring up to 1.3 cm and side branch ectasia, unchanged compared to previous. Multiple cysts within the pancreatic head and body with the largest measuring 2.2 x 1.6 cm (series 3, image 12), unchanged. On the prior dedicated MRCP examination, this is noted to communicate with the main pancreatic duct and likely a combined type IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large hiatal hernia. Fat-containing umbilical hernia is present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Arterially enhancing and washing out hepatic dome lesion on the background of cirrhosis, diagnostic of hepatocellular carcinoma.2.Segment 7 arterially enhancing lesion is not visualized on the current examination was likely a perfusional abnormality.3.Additional arterially enhancing subcentimeter lesions without washout not significantly changed.4.Cystic lesion in the pancreatic head. This was noted to demonstrate communication with the main pancreatic duct on the previous MRCP examination and likely combined type IPMN. 5.Large hiatal hernia.


Instruction: Generate impression based on findings.

Input: 59-year-old female with history of HCC, HCV/alcohol cirrhosis. History of TACE and RFA. Active on the liver transplant list. Evaluate liver lesions, size and characteristics. Last scan was MRI on 3/16/2001. Evaluate vasculature. LUNG BASES: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: The liver has cirrhotic morphology. Numerous arterially enhancing lesions without washout are again seen throughout the liver, which appear similar to most recent MRI from 3/16/2011. Reference lesion in the inferior right hepatic lobe measures 1.4 cm; measuring 1.7 cm on prior MRI.However, there has been overall progression in size and number of lesions since MRI from 8/25/2010. For example, the aforementioned reference lesion in the inferior right hepatic lobe measured approximately 7 mm at that time.Segment 4 RFA cavity (series 11, image 25) measures approximately 2.6 x 1.1 cm, which is relatively stable on comparison to recent MRI when accounting for differences in technique. However, there is arterial enhancement seen along the superior margin of the RFA cavity (series 9, image 23; series 80613, coronal image 68) without definite washout on delayed images. This may represent marginal tumor recurrence.Gallstones.Portal and hepatic vasculature are patent. SPLEEN: No significant abnormality noted.PANCREAS: Coarse pancreatic calcifications, likely due to chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts bilaterally without areas of abnormal enhancement.RETROPERITONEUM, LYMPH NODES: Numerous small retroperitoneal lymph nodes. Previously described enlarged gastrohepatic lymph node measures 1.5 x 2.5 cm (series 11, image 36), which is relatively stable on comparison to recent MRI when accounting for differences in technique.BOWEL, MESENTERY: Mostly fat-containing ventral hernia (series 11, image 48) with a small amount of herniation of the anterior gastric wall at this level.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Small focus of arterial enhancement along the superior margin of the RFA cavity without definite washout on delayed phase imaging is suspicious for marginal tumor recurrence. The RFA cavity is otherwise stable in size. Patent hepatic and portal vasculature2. Numerous arterially enhancing lesions in the liver without washout appear similar to most recent MRI from 3/16/2011. However, when compared to MRI from 8/25/2010, there has been overall progression in size and number of these lesions.


Instruction: Generate impression based on findings.

Input: Female, 39 years old, with headache and dizziness, known pituitary mass. A nonenhancing, T1 hyperintense lesion is evident within the posterior aspect of the pituitary gland measuring up to 11 mm TV, 6 mm AP, and 7 mm SI. The normal pituitary glandular parenchyma appears to drape along the superior and anterior aspects of this lesion. The pituitary stalk sits at midline and is normal in appearance. The sellar contents protrude mildly into the suprasellar cistern, but there is no significant impingement on the optic apparatus. No evidence of cavernous sinus involvement is seen.

Output: A nonenhancing, T1 hyperintense lesion is evident within the posterior aspect of the pituitary gland. The differential diagnosis for this finding would include a Rathke cleft cyst, pars intermedia cyst, or perhaps less likely a cystically degenerated or hemorrhagic adenoma.


Instruction: Generate impression based on findings.

Input: 28-year-old female with right lower quadrant abdominal pain and B12 deficiency. Evaluate for small bowel Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No dilated bowel loops, focal wall thickening, or drainable fluid collection. No ascites. No abnormal wall enhancement. Greater than average stool volume.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No acute abnormality of the abdomen or pelvis. Specifically, no evidence for inflammatory bowel disease.2.Greater than average stool volume.


Instruction: Generate impression based on findings.

Input: Evaluate for SEGA, cortical tubers: Cardiac rhabdomyomas on fetal imaging. There are high T1 and low T2 signal nodules at the bilateral caudothalamic grooves, measuring 10 mm on the right and 8 mm on the left, but no evidence of hydrocephalus. There are also several subcentimeter high T1 and low T2 signal subependymal nodules scattered along the bilateral lateral ventricular margins. Furthermore, there are numerous, predominantly linear high T1 and low T2 signal lesions in the bilateral cerebral hemisphere white matter, oriented perpendicular to the lateral ventricles, which likely represent radial migration bands related to cortical dysplasia. The cerebellum and brainstem appear to be unremarkable. There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with tuberous sclerosis complex, including bilateral caudothalamic groove tumors, measuring up to 10 mm on the right side, which is suggestive of subependymal giant cell astrocytoma.


Instruction: Generate impression based on findings.

Input: 73 year old male patient with bilateral renal masses and previous left RFA. ABDOMEN:LIVER, BILIARY TRACT: A heterogeneously hyperintense T2 lesion within the superior pole of the left kidney which demonstrates enhancement has slightly increased in size measuring 2.3 x 2.3 cm (image 43, series 12), previously 1.8 x 1.6 cm. This remains concerning for malignancy.A T2 hypointense lesion in the right kidney with equivocal enhancement has not significantly changed in size measuring 1.6 x 1.3 cm (image 52, series 12), previously 1.6 x 1.4 cm. A T2 hypointense nonenhancing lesion in the posterior upper pole of the left kidney appears stable in size measuring 2.0 x 2.0 cm (image 42, series 12), previously 2.1 x 2 cm. This presumably represents the site of prior ablation. A left interpolar T2 isointense lesion with T1 hyperintensity may represent a proteinaceous or hemorrhagic cyst. Additional scattered subcentimeter T2 hyperintense lesions are too small to characterize.There is dilatation of the inferior left renal collecting system with renal cortical thinning. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A small retrocrural lymph node is not significantly changed in size measuring 1.1 cm. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left upper pole enhancing renal lesion is slightly increased in size; this is concerning for malignancy.2.Stable T2 hypointense lesion within the right kidney with indeterminate enhancement; continued attention should be paid on subsequent imaging.3.Stable dilatation of the left inferior pole collecting system.


Instruction: Generate impression based on findings.

Input: 72-year-old male with elevated PSA. Evaluate for prostate cancer. PELVIS:PROSTATE:Limited exam due to lack of contrast enhancement (related to the extravasation).Prostate Size: 4.9 cm in transverse, 3.7 cm in AP, and 4.2 cm in craniocaudal diameter.Peripheral Zone: In the right mid gland peripheral zone, there is a small focus of the hypointensity (axial series 604 image 164). Further evaluation is limited due to the lack of contrast enhancement (related to the contrast extravasation). Extensive stranding in the peripheral zone is suggestive of chronic prostatitis.Central Gland: Heterogenous appearance.Seminal Vesicles: No significant abnormality.Extracapsular Extension: None.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.Suspicious lesion in the right mid gland peripheral zone. The lack of contrast enhancement (due to extravasation) and background of chronic prostatitis limit further evaluation.Contrast extravasation description:Supervising radiologist: Julie Sanders, MDMinor or major extravasation: MinorContrast type:18.2 cc of MultiHance were administered. Amount extravasated: 18.2 ccLocation of extravasation: Right antecubitalSigns and symptoms: Erythema and swellingTreatment given: Ice packDischarge instructions given: Yes


Instruction: Generate impression based on findings.

Input: Reason: evaluate for possible malignant lesion History: elevated PSA, negative prostate biopsy. PSA to 5.69. PELVIS:PROSTATE:Prostate Size: 5.0 x 4.3 x 4.2 cm.Peripheral Zone: Heterogeneously decreased T2 signal is suggestive of prostatitis. There is a small focus of decreased ADC and T2 signal in the lateral aspect of the left apex/mid gland (series 401, image 52) measuring 5 x 5 mm which is suspicious for neoplasm.Central Gland: Hyperplastic nodules of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No specific evidence of extra capsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Normal variant synovial herniation pit left femoral head neck junction.OTHER: No significant abnormality noted.

Output: 5 mm focus of signal abnormality in the left apex/mid gland peripheral zone suspicious for neoplasm.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified site of unspecified female breast [C50.919] / Secondary malignant neoplasm of unspecified lung [C78.00], Reason for Study: ^Reason: r/o leptomeningeal disease History: unable to walk - hx of metastatic breast cancer There are multifocal various sized gadolinium enhancing intraparenchymal lesions with the surrounding edema at both supra and infratentorially.Several of enhancing lesions show susceptibility artifacts indicate intralesional hemorrhages.Although leptomeningeal enhancement is not prominent on the scan, there is about 16.6 mm x 16.1 mm sized enhancing lesion on the area of left side foramen of Monro which could represent ependymal and/or choroid plexus metastatic lesion .Multifocal enhancing lesions on skull and visualized cervical vertebral bodies may indicate metastatic lesions. The ventricular system size appears to be unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal various sized supra and infratentorial metastatic lesions with some intra lesional hemorrhages as described above.2. Intraventricular enhancing lesion on the right foramen of Monroe area which may indicate ependymal and/or choroidal plexus metastasis. 3. There is no evidence of abnormal leptomeningeal enhancement.


Instruction: Generate impression based on findings.

Input: 30-year-old male with right shoulder pain, rule out SLAP lesion ROTATOR CUFF: No evidence of rotator cuff tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a superior labral tear extending from posterior to anterior consistent with a SLAP Type 2 tear. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Findings compatible with a SLAP Type 2 tear. 2. Subchondral cyst in the posterior humeral head.


Instruction: Generate impression based on findings.

Input: Lumbago with sciatica, unspecified side. Low back pain. Evaluate for stenosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Minimal degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is disc desiccation with a right paracentral annular fissure and small protrusion. There is contact of the right S1 nerve root without clear impingement. There is no significant central canal or neural foraminal stenosis. There is mild bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Mild degenerative changes in the lumbar spine at the L5-S1 level. There is a small disc protrusion with contact of the right S1 nerve root in the lateral recess. There is otherwise no significant central canal stenosis or neural foraminal stenosis at any level in the lumbar spine.2. Mild facet arthropathy L5-S1 which may also be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Male 54 years old Reason: eval kidney cystic lesion History: lesion ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. The biliary tree is normal in caliber. Gallbladder is not distended.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is mildly dilated with multiple small cystic foci adjacent to the duct. Differential considerations include chronic pancreatitis vs. Small branch type IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild to moderate bilateral hydronephrosis and hydroureter partially imaged.There is a T2 hypointense lesion at the upper pole of the left kidney that measures 2.2 cm further characterization of the lesion is not possible without contrast.Cyst in the right kidney measures 2.1 cm. Cyst at the upper pole of the left kidney measures 2.4 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post surgical changes in the lumbar spine with a right paraspinal/right psoas gas fluid pocket. Postsurgical changes in the right flank. There is a lipoma involving the right posterior lateral body wall.OTHER: No significant abnormality noted.

Output: 1.Indeterminate 2.2 cm lesion in the left kidney which cannot be characterized without contrast.2.Mild to moderate bilateral hydronephrosis of unclear etiology.3.Mildly dilated pancreatic duct with multiple dilated side branches from chronic pancreatitis or side branch type IPMNs.4.Postsurgical changes in the lumbar spine with the right psoas muscle and right body wall fluid pockets.


Instruction: Generate impression based on findings.

Input: Pre-operative planning for choroid plexus papilloma. There are postoperative findings related to suboccipital craniotomy. There is a lobulated enhancing mass within the inferior portion of the fourth ventricle that measures up to 27 mm. There is persistent dilatation of the superior portions of the fourth ventricle, as well as the third and lateral ventricles, with associated diffuse periventricular T2 hyperintensity. There is a right transfrontal ventricular catheter that terminates in the left lateral ventricle. There is mild high T2 signal in the parenchyma surrounding the catheter. There is no evidence of acute cerebral infarction or intracranial hemorrhage. There is a 6 mm wide arachnoid cyst anterior to the anterior temporal pole. There is a retention cyst in the left maxillary sinus. Scalp fiducial markers are present.

Output: Preoperative planning MRI demonstrates a fourth ventricular choroid plexus tumor associated with persistent obstructive hydrocephalus and transependymal edema, with a right transfrontal ventricular shunt catheter in position.


Instruction: Generate impression based on findings.

Input: Epilepsy and headache. There is mild confluent periventricular white matter T2 hyperintensity, particularly in the bilateral occipital lobes, as well as a few scattered foci of T2 hyperintensity in the bilateral frontal lobe white matter. There is no evidence of heterotopia, hamartomas, medial temporal sclerosis, intracranial hemorrhage, mass, or infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right ethmoid sinus retention cyst.

Output: No evidence of heterotopia, hamartomas, medial temporal sclerosis, intracranial hemorrhage, mass, or infarct. Mild patchy areas of periventricular white matter T2 hyperintensity, particularly in the bilateral occipital lobes, as well as a few scattered foci of T2 hyperintensity in the bilateral cerebral white matter are nonspecific.


Instruction: Generate impression based on findings.

Input: Again seen is restricted diffusion involving the posterior limb of the right internal capsule consistent with acute infarct, and similar to recent MRI from 2/22/2016. There is minimal interval increase in FLAIR hyperintensity associated with it, which is compatible with slight evolution. There is no evidence of a new infarct. No intracranial mass or mass effect. There are multiple areas of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with chronic small vessel ischemic disease, which is advanced for age. Small chronic cortical infarct in the right parietal lobe is also again noted. Chronic left pontine lacunar infarct also noted. Small chronic right lateral cerebellar hemisphere infarct also suspected. Scattered small foci of susceptibility are compatible with chronic microhemorrhages and involve the basal ganglia, thalami, and brainstem as before. No hemorrhage associated with the recent infarct is appreciated.MRA HEAD

Output: 1. Slight evolution of recent lacunar infarct involving the posterior limb of the right internal capsule. No new infarct or hemorrhagic transformation associated with this lesion. Additional findings including multiple chronic infarcts, as above, which are unchanged since prior.2. Mild to moderate multifocal stenosis involving the intracranial posterior circulation as described above. No large vessel occlusion. No significant arterial stenosis in the neck.


Instruction: Generate impression based on findings.

Input: 52-year-old female with right hip pain. Evaluate for labral tear. ACETABULAR LABRUM: Best seen on series 901 is increased signal intensity at least partially traversing the anterior labrum from the 2 to 3 o'clock position, compatible with a nondisplaced tear. ARTICULAR CARTILAGE AND BONE: There is low signal intensity within the articular cartilage of the superolateral acetabulum which may represent chronic degeneration or even delamination. There is a small cyst within the anterior inferior aspect of the femoral neck. We see no frank CAM deformity and the alpha angle is within normal limits. There may be slight cranial acetabular retroversion but this is equivocal. There is abnormal signal intensity within the left femoral head likely representing avascular necrosis. The bone marrow signal intensity is otherwise normal.SOFT TISSUES: The imaged musculature of the right hip appears normal. The ligamentum teres appears intact.

Output: Acetabular labral tear and other findings as described above.


Instruction: Generate impression based on findings.

Input: Abnormal vaginal bleeding. Recent pelvic ultrasound concerning for arteriovenous malformation. PELVIS:UTERUS, ADNEXA: The uterus is normal in size and has an arcuate configuration. There is heterogeneous low T2 signal throughout the myometrium, but no focal mass lesion.The endometrium is normal in appearance. No evidence of retained products of conception or focal mass lesion. There is no dilatation of or fluid within the endometrial canal. The junctional zone is normal in thickness. There is some protrusion of the cervix into the vaginal canal. Layering dependently within a mildly dilated cervical canal is fluid with high T1 signal compatible with blood products. Note is made of a nabothian cyst.There are no abnormal flow voids within the uterus or vagina on the precontrast images. Postcontrast images show expected parametrial vessels without abnormal early venous drainage or other evidence of an arteriovenous fistula/malformation. The ovaries are normal in size and contain multiple simple cysts measuring up to 1.6 cm compatible with follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No findings to suggest an arteriovenous fistula/malformation involving the uterus, cervix, vagina.2.Retained blood products with a mildly dilated cervical canal. There is no hematometra, but correlate with physical exam findings of cervical stenosis.


Instruction: Generate impression based on findings.

Input: 15-month-old male with history of left ankle swelling. SOFT TISSUES: Immediately inferior and slightly anterior to the distal fibula, there is a soft tissue lesion demonstrating low T1 and high T2 signal abnormality measuring 11 x 6 mm in maximal axial dimensions. The lesion abuts, but is separate the underling peroneus tendon sheath which is abnormally thickened and of heterogeneous signal intensity. Surrounding the lesion there are inflammatory changes and edema extending medially into the ankle joint space in an infiltrative manner. Heterogeneous enhancement is appreciated both within the lesion itself as well as within the inflamed soft tissues. TENDONS: In the region of the aforementioned mass, the peroneus tendons are abnormally thickened and of heterogeneous signal intensity.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: The underling bone marrow signal is normal. ADDITIONAL

Output: Solid, enhancing soft tissue mass adjacent to the fibular tip as above. Thickening and heterogeneous appearance of the adjacent peroneus tendon is thought to be reactive in etiology. The differential diagnosis should include the spectrum of fibromatoses ranging from benign to malignant. Another consideration would be a ruptured ganglion or synovial cyst with surrounding reactive changes and inflammation, although this is felt to be less likely given the physical and clinical presentation.


Instruction: Generate impression based on findings.

Input: Altered mental status change and right arm weakness. There is no restricted diffusion to suggest acute infarction. An area of increased T2 signal with volume loss in left thalamus is compatible with a chronic infarct and evolved since prior. There are scattered punctate and confluent foci of increased T2/FLAIR signal within the periventricular and subcortical white matter which are nonspecific but compatible with chronic small vessel ischemic changes and appear similar to the 5/4/2015 examination. There is no evidence of acute intracranial hemorrhage. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is trace mucosal thickening within the paranasal sinuses as well as trace opacification of the mastoid air cells.

Output: 1.No evidence of acute infarction or other acute intracranial abnormality.2.Chronic left thalamic infarct.3.Mild-moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 33 years Female (DOB:3/12/1983)Reason: R/o lumbar spine etiology for b/l LE neuropathic pain History: bilateral neuropathic pain in LEPROVIDER/ATTENDING NAME: SARAH CHOXI SARAH CHOXI Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a 6 x 5 mm axial dimension focus of well-circumscribed T1 signal hyperintensity in the right iliac bone which most likely represents a small hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.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: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out malignant otitis, rule out abscess. Signs and symptoms: Right ear pain. Enhanced CT of the maxillofacial:Examination demonstrates a low-density mass within the left submandibular gland measuring 21.5 mm x 15.2-mm in trans-axial dimensions on image 14 and 32.3-mm in cranial -- cephalad axis on sagittal reformatted image 36. There is no detectable enhancement of this lesion. The left submandibular gland is expanded and surrounds this lesion however it be done CT of the remaining gland remains within normal limits. There is no evidence of any calcification with this finding. Recommend further follow all with an MRI examination for better characterization of this lesion. The finding although could represent a says possibility of a tumor is high and should be further evaluated. There is no associated lymphadenopathy with this finding on this limited view of upper neck. There is also no evidence of any inflammatory changes of the adjacent fascial planes. No evidence of any mass effect on the airway and no evidence of any osseous or cartilaginous erosion.Images through the oral cavity and floor of the mouth are otherwise unremarkable.Normal appearing bilateral parotid glands.Images through the skull base and bilateral petrous bones demonstrate well pneumatized mastoid air cells and middle ear cavities as well as external auditory canals bilaterally. The ossicular chain are unremarkable. There is no evidence of any inflammatory changes in the periauricular region. The external year and has normal density and morphology. The TMJs are well-visualized and unremarkable. The sphenoid sinus/sphenoid bone is within normal limits. Minimal chronic sinus disease of bilateral maxillary sinuses are noted. No detectable abnormality at the level of nasal findings, oral findings is detected.

Output: Examination demonstrates a low-density nonenhancing mass within the left submandibular gland measuring 21.5 x 15 times 32.3-mm in size. Follow up with an MRI examination is recommended. This lesion is not associated with any enhancement, inflammatory changes, abnormal calcification within the gland or the lesion and no evidence of any dilated ducts within the gland or any visible adenopathy on this exam. The left submandibular gland beyond the mass/cyst has normal density and pattern of enhancement. Enhanced CT of the maxillofacial is otherwise entirely unremarkable and in particular no evidence of otitis or mastoiditis is detected.


Instruction: Generate impression based on findings.

Input: 40-year-old male with severe pain and bruising of the right groin and medial thigh, please evaluate for abductor muscular tear. MRI pelvis:BONE MARROW: No significant bone marrow signal abnormalities visualized. Specifically, at the origin of the adductor muscular group at the pubic symphysis, no evidence of bone marrow edema or avulsion fracture. Further, the insertional site in the bilateral femurs appear within normal limits.SOFT TISSUES: There appears to be partial tearing of the origins sites of the pectineus along with the adductor muscular group with a small discrete fluid collection adjacent to the right anterior pubic symphysis and slight retraction of the muscles. There is further associated inflammation within the proximal muscular soft tissues, indicative of reactive inflammatory change. JOINTS: The bilateral hip joints are incompletely evaluated on this pelvic MRI, however within these limits. No significant abnormality including degenerative changes visualized in the bilateral hips.ADDITIONAL

Output: Partial tearing of the pectineus and adductor muscular group as outlined above. No evidence of avulsion fracture.


Instruction: Generate impression based on findings.

Input: Ms. Gattuso is a 36 year old female with a history of growing biopsy proven fibroadenoma of the right breast. She recently had a surgical excision of this mass with OSH final pathology of borderline phyllodes tumor with positive margins at the lateral and inferoposterior borders. She presents today for MR evaluation. There is extreme amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.In the right superior periareolar region, there is very minimal architectural distortion identified, likely related to recent surgical excision of biopsy-proven fibroadenoma (which appears to be a borderline phyllodes tumor on final surgical pathology). Few foci of susceptibility artifact are also seen in the right superior subareolar region, which may represent surgical clips. However, there is no residual post-surgical seroma nor is there any residual abnormal enhancement. There is moderate background parenchymal enhancement seen bilaterally, which precludes accurate measurement of previously characterized fibroadenomas. Of the four prior fibroadenomas that were measured on prior ultrasound examination, two are well seen on today's MRI:-right breast, 8:00 location measures approximately 1.1 x 0.9 x 0.8 cm (AP x ML x SI), previously seen to measure 1.1 x 0.6 x 0.9 cm-left breast, 3:00 location measures approximately 1.7 x 0.8 x 1.1 cm, previously seen to measure 1.3 x 0.7 x 1.0 cm. There is no abnormal enhancement seen in either breast. Multiple T2 hyperintense nonenhancing cysts are identified bilaterally, the largest of which measures approximately 1.0 cm in the right superior breast.No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Moderate background parenchymal enhancement, which limits the sensitivity of this examination.(2) Recent surgical excision of a borderline phyllodes tumor in the right superior breast with positive margins. No residual post-surgical seroma or abnormal enhancement is seen to suggest residual disease. Minor architectural distortion/possible surgical clips are seen in the right superior subareolar region. If pre-operative surgical guidance is needed, a right unilateral mammogram should be obtained now to ascertain the presence of surgical clips. If present, then this area with the clips can be mammographically localized prior to surgery.(3) No MRI evidence of malignancy in the left breastBIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: Left choroid fissure cyst: yearly follow up. There has been interval decrease in size of the left choroid fissure cyst that measures approximately 20 AP x 21 RL x 15 SI mm, previously 31 AP x 22 RL x 19 SI mm. Besides the mild regional mass effect, the brain parenchyma appears otherwise appears unremarkable, with a normal degree of myelination. There is no evidence of intracranial hemorrhage or acute infarct. There is no evidence of hydrocephalus. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The skull and extracranial soft tissues are unremarkable.

Output: Interval decrease in size of the left choroid fissure cyst.


Instruction: Generate impression based on findings.

Input: Multiple sequences are significantly motion degraded. Redemonstrated is a large left parietal mass with thick rim enhancement surrounding the posterior horn of the left lateral ventricle. This lesion again infiltrates the splenium of the corpus callosum, crossing to the contralateral side. The enhancement is slightly decreased in intensity although the extent is not significantly changed. There is also mild decrease in the T2/FLAIR hyperintensity involving the left frontal, parietal, and the left temporal lobes also consistent with Avastin effect. Areas of T2/FLAIR hyperintensity involving the right frontal lobe are unchanged. The right posterior insula and the right superior temporal gyrus T2/FLAIR hyperintensity is stable to mildly more prominent. Perfusion rCBV map again demonstrates elevated cerebral blood volume in the left parietal region. There is also abnormal enhancement tracking along the ependymal region of the temporal horn of the left lateral ventricle as well as the body of the left lateral ventricle. The multifocal leptomeningeal enhancement seen on the previous study is less prominent, which may be related to motion degradation in the current study.There is mass effect on the occipital horn of the left lateral ventricle which is stable to minimally improved. 5 mm midline shift is also stable to minimally improved. There is mild enlargement of the ventricular system since the previous study.Small blood products are seen along the left biopsy tract, unchanged. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening of the right maxillary sinus.

Output: 1. Mild interval decrease in extent of T2/FLAIR hyperintensity and enhancement associated with left parietal GBM compatible with Avastin effect. 2. Again seen evidence of leptomeningeal spread of disease which is less conspicuous on this study, which may be related to technique/motion degradation on the current study. 3. Additional foci of T2/FLAIR are seen in the right cerebral hemisphere similar to prior which are nonspecific. There is minimal increase in prominence of the slightly expansile area of FLAIR hyperintensity involving the right posterior insular region and the superior temporal gyrus. This area may represent an additional site of lower grade glial neoplasm.4. Slight enlargement of the ventricular system compared to the previous study.


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB:5/4/1975)Reason: new severe dizziness, hx of left arm weakness for 4-5 day last year History: as abovePROVIDER/ATTENDING NAME: KATARINA VESKOVIC KATARINA VESKOVIC The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated in the brain parenchymaThere is a T2 and FLAIR hyperintense lesion present along the right putamen of the lentiform nuclei which is not associated with contrast enhancement and not associated with susceptibility effect.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are common and probably of little clinical significance.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A small lesion is present in the putamen of the right internal capsule which is nonspecific. It is conceivable that this represents an old lacunar infarct