Instruction: Generate impression based on findings.

Input: 58-year-old with known left breast DCIS with close inferior and deep margins. There is scattered fibroglandular tissue in both breasts. There are scattered high T2 signal cysts in each breast. Additionally, a 4 cm high T2 signal seroma is present in the left outer breast at the site of recent surgery.Mild parenchymal enhancement is noted bilaterally.Along the posterior slightly lateral aspect of the seroma cavity, there are 2 areas of mild nodular enhancement measuring 4 mm. Elsewhere along the seroma there is thin peripheral enhancement with no significant nodular areas. No abnormal enhancement is seen in the right breast or elsewhere in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Mild nodular enhancement along the posterior aspect of the seroma in the left breast could represent postoperative change versus residual DCIS. No suspicious enhancement elsewhere along the seroma or in either breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Dizziness, near-syncope, headaches, nausea/vomiting, numbness/tingling in hands and feet, and feel "hot". Brain: The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum and display pointed morphologies. Nevertheless, there is biphasic flow of cerebrospinal fluid across the foramen magnum, both anteriorly and posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology. There is lack of the usual cervical lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are small posterior disc-osteophyte complexes at multiple levels, but no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum and display pointed morphologies, which can represent a manifestation of Chiari type 1 malformation. Nevertheless, there is biphasic flow of cerebrospinal fluid across the foramen magnum2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Family history of breast cancer in her mother, sister, maternal aunt, and maternal cousin. BRCA1. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Stable left lobe liver cysts.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease status post ileostomy takedown and ileocecal resection. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity without a focal lesion. No intra or extrahepatic ductal dilatation. Partially contracted gallbladder.SPLEEN: The spleen is normal in morphology size and signal intensity.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach appears distended to the second portion of the duodenum without a discrete obstructive mass; similar appearance to prior.Post-surgical changes from ileocecectomy with good visualization of the neo-terminal ileum. The small bowel is adequately distended with oral contrast.The small bowel fold pattern is maintained.The small bowel is normal in appearance without bowel wall thickening, abnormal signal intensity/enhancement, restricted diffusion or perienteric inflammatory changes.No fixed luminal narrowing or associated prestenotic/upstream dilatation to suggest fibrostenotic disease.No evidence of sinus tract or fistula formation.No free or loculated fluid collection. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted. Nabothian cyst formation. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See BOWEL, MESENTERY section above. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific evidence of active bowel inflammation, fibrostenotic disease or fistula formation.2.Distension of the stomach without an obstructive masslesion may reflect slowed gastric emptying. Correlation with patient's clinical history recommended and if indicated, further assessment with dedicated nuclear medicine gastric emptying study may be performed.


Instruction: Generate impression based on findings.

Input: 83 years, Male, transient alteration of awareness (unresponsive and aphasic). Image quality is moderately degraded due to motion. No restricted diffusion to suggest acute ischemia. No acute intracranial hemorrhage. Multiple foci of susceptibility effect are seen which appear to be predominantly in a peripheral distribution although assessment is limited with severely degraded susceptibility weighted sequence. No intracranial mass or mass-effect. The ventricles and other CSF spaces are proportionately enlarged, consistent with advanced cerebral volume loss.There are small areas of FLAIR hyperintensity with suggestion of volume loss in the posterior right frontal and right parietal lobes suggesting remote cortical infarcts. Confluent and patchy areas of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Major flow-voids are preserved on T2 weighted imaging.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Please note examination is moderately motion degraded which limits assessment.1. No evidence of acute infarct.2. Multiple predominantly peripheral foci of chronic microhemorrhage are suggested on the significantly degraded susceptibility weighted sequence which may be related to cerebral amyloid angiopathy.3. Remote cortical infarcts are suggested in the posterior right frontal and parietal lobes. 4. Moderate to severe chronic small vessel ischemic changes and cerebral volume loss.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified disorders of muscle. Cerebral infarction, unspecifiedClinical question: stroke evaluation.Signs and Symptoms: L-sided facial droop and slurred speech, s/p thrombectomy There is a area of diffusion restriction present involving the right middle frontal gyrus which extends into the right precentral gyrus, right inferior frontal gyrus and a small portion of the adjacent right insular cortex. It measures approximately 55 x 39 mm axial dimensions. A couple punctate foci of diffusion restriction present along the right cuneus and precuneus. Another punctate focus of diffusion restriction is present in the gray matter at the left superior frontal sulcus.Within the right middle frontal gyrus there is a small focus of susceptibility effect without T1 signal hyperintensity. It measures approximately 9 mm x 4 mm on axial T2 imaging.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Patchy T2 and FLAIR hyperintense lesions are also present in the brainstem. These are also present on the prior exam from 2010.There is fusiform dilation of the basilar artery.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Subacute infarction involving the right frontal lobe with a small focus of hemorrhage.2.A couple punctate foci of microinfarct are present in the right cuneus, right precuneus and the left frontal lobe.3.Fusiform mild aneurysmal dilation of the basilar artery.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. These were also present on the 2010 exam.5.Patchy lesions in the brainstem are also likely vascular related and were also present on the previous exam from 2010


Instruction: Generate impression based on findings.

Input: Acute worsening of right hemiparesis. History of cocaine abuse with recurrent strokes. Per technologist note, patient refused to complete the examination because of nausea. Only diffusion, axial T2, axial FLAIR and sagittal T1 sequences were obtained.There is a small diffusion positive lesion along the right corona radiata, which at least partly seems to correlate with ADC reduction. This correlates with focal T2-hyperintensity and may represent a subacute infarct. Otherwise, there is no territorial diffusion restriction. There is no gross intracranial mass or mass-effect. There is no midline shift or brain herniation. There is relatively moderate burden of patchy T2-hyperintense lesions in the frontal white-matter, thalami right more than left, and brainstem. There is also confluent periventricular T2-hyperintensity. These findings are nonspecific but likely reflect microvascular ischemia.The major intracranial vascular flow voids are preserved. The orbits are grossly unremarkable. There is trace anterior ethmoid mucosal thickening.

Output: 1.Limited, incomplete examination given patient intolerance, as described above.2.Focus of diffusion hyperintensity and T2 hyperintensity involving the right corona radiata which is suspected to represent a subacute infarct. There is otherwise no evidence of acute infarct. 3.Moderate cerebral white-matter, thalamic and brainstem nonspecific T2-hyperintense lesions likely reflect microvascular ischemia.Dr. Monther Qandeel discussed the above findings with Dr. Reeti Raychaudhuri at pager 1844 over the phone on 6/8/2016 at 4:35 PM.


Instruction: Generate impression based on findings.

Input: Male, 29 years old, history of neurofibromatosis type I with plexiform neurofibroma of the spinal cord, presenting with back pain and headaches. Assess for any change in plexiform tumor and any nerve root enhancement. Cervical:Mild prominence of a number of the spinal nerve roots is again seen in the cervical region appearing similar to prior exam. Nerve root enhancement is most conspicuous at C3-4 and C4-5 bilaterally.No pathologic spinal cord signal is seen. No intraspinal mass is detected. Incidental note is made of a round T2 hyperintense lesion within the left cerebellar hemisphere which is stable and likely reflective of a FASI of neurofibromatosis.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No worrisome marrow abnormalities are detected. No disc disease, spinal canal stenosis or neuroforaminal narrowing is detected.Scattered small nodules are evident within the paraspinal and superficial soft tissues.Thoracic:In the thoracic region, only the left T7-8 foraminal nerve root appears to be convincingly thickened and this finding is unchanged. There is questionable mild bilateral nerve root thickening at lower thoracic levels.Postcontrast images are somewhat degraded by motion, but no additional mass lesions are suspected.The visualized spinal cord demonstrates normal signal intensity and morphology. No intraspinal masses are seen.Spinal alignment is anatomic allowing for mild scoliotic curvature. No concerning marrow abnormalities are seen. No significant disc disease, spinal canal stenosis or neuroforaminal narrowing is detected.Scattered small nodules are evident within the paraspinal and superficial soft tissues.Lumbar:The cauda equina appears to be peppered with numerous very small nodules (no more than 2 to 3 mm in size, best seen on sagittal images) which are unchanged from the prior exam.An enhancing intraspinal mass is again demonstrated centered at the L5/S1 level. This lesion measures 31 mm CC x 27 mm TV x 20 mm AP and is unchanged in size. The lesion fills the spinal canal and even scallops into the S1 and S2 vertebral bodies. The lesion extends in plexiform fashion along the sacral spinal nerve roots into the sacral foramina.Bilateral thickening of the foraminal nerve roots is seen most conspicuously at lower lumbar levels, a finding which is unchanged. Nerve root thickening continues extra foraminally along the neurovascular bundles as well.Spinal alignment is anatomic. Vertebral body morphology is unremarkable. No worrisome marrow abnormalities are detected. No significant degenerative disc disease, spinal canal stenosis or neuroforaminal narrowing is detected.

Output: 1.Plexiform disease of the lower lumbar and sacral nerve roots is redemonstrated appearing similar to the prior examination. This includes a large canal filling mass centered at the L5-S1 level with foraminal and extraforaminal extension.2.A peppering of small nodules is also suspected along the cauda equina more superiorly, and this is unchanged.3.In the thoracic region, only the left T7-8 nerve root shows convincing evidence of tumoral thickening and this is unchanged.4.In the cervical region, bilateral nerve root thickening is evident at several levels appearing similar to the prior exam.5.No evidence of any definite new intraspinal, foraminal or paraspinal mass is detected.


Instruction: Generate impression based on findings.

Input: 18-year-old male with sickle cell, now presents with numbness and tingling in face. Evaluation slightly limited by motion artifact on several series.There is no evidence of acute infarct, intracranial hemorrhage, or mass. There are scattered foci of increased T2 signal in the subcortical and periventricular white matter, without significant interval change when allowing for differences related to motion degradation. There is no abnormal intracranial enhancement within the limits of motion degraded study. 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. There is diffusely decreased T1 marrow signal within the skull and upper cervical spine, which is nonspecific and may relate to chronic anemia. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute infarct, acute intracranial hemorrhage, mass, or abnormal intracranial enhancement.2. Grossly unchanged scattered foci of increased T2 signal in the subcortical and periventricular white matter, which are nonspecific but may represent chronic small infarcts.


Instruction: Generate impression based on findings.

Input: Reason: evaluation of right leg soft tissue mass History: right leg soft tissue mass Skin markers were placed along the lateral aspect of the lower leg presumably corresponding to the patient's palpable area of concern. There is a mass within the peroneal musculature adjacent to the tendons, measuring 2.6 x 1.6 cm in the transverse dimension and 3.3 cm in the craniocaudal dimension. It is iso- to hypo-intense to skeletal muscle on T1-weighted images, hyperintense on fluid sensitive sequences and demonstrates thick irregular peripheral enhancement on postcontrast sequences with no enhancement identified centrally. Fat is noted along the superior and inferior margins, but not within the mass. The mass does not abut the underlying fibula. The remaining visualized soft tissues and bone marrow signal intensity are normal.

Output: Mass within the peroneal musculature as described above. Its signal characteristics are nonspecific and referral to orthopedic oncology is recommended.


Instruction: Generate impression based on findings.

Input: There is mixed response to therapy with increasing number of enhancing lesions in the cerebellum, and decreasing size of pre-existing supratentorial enhancing lesions. In the cerebellum, there are greater than 10 punctate foci of enhancement in the bilateral middle cerebellar peduncles and in the inferior cerebellar hemispheres today as compared to less than 6 lesions on the prior exam (series 13 images 38 -- 56). Many of these lesions show associated punctate foci of T2 hyperintense signal.In the supratentorial brain there is interval decrease in size/prominence of the enhancing lesions. For example, there is a punctate lesion in the right periatrial white matter on series 13 image 90 which measured 5 mm previously. A punctate right basal ganglia lesion on series 13 image 100 measured 4 mm previously. A punctate left parietal subcortical lesion on series 13 image 104 measured up to 7 mm previously. A cluster of small enhancing lesions in the left superior frontal gyrus is less prominent on current exam. However, on series 13 image 134, there is a small focus of enhancement in the left posterior frontal lobe medially measuring up to 3 mm, not clearly present on the prior examination, and suspected to be new.There is no acute infarct, mass effect or midline shift. There is no hydrocephalus.There is persistent moderate left mastoid and mild ethmoid sinus mucosal thickening.

Output: Mixed response to interval therapy with increasing number of punctate cerebellar lesions and decreasing size of pre-existing supratentorial lesions. A 3-mm posterior left frontal lobe enhancing lesion is not definitely present on the prior exam, and is suspected to be new.


Instruction: Generate impression based on findings.

Input: Reason: 63 yo F with history of pancreatic cystic lesions, last MRI in 2012. MRI/MRCP for surveillance History: pancreatic cystic lesion. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Previously seen two cystic lesions in the pancreatic body are unchanged. No new lesion. No pancreatic ductal dilatation.ADRENAL GLANDS: Minimal left adrenal nodularity without focal nodule, unchanged.KIDNEYS, URETERS: Left parapelvic cysts, unchanged compared to prior.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: Two 2 mm cystic lesions in the pancreatic body; stability over 3 years favors benign etiology. No further follow up is recommended.


Instruction: Generate impression based on findings.

Input: History of cervical DJD, chronic neck pain Examination is mildly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Disc osteophyte complex and uncovertebral hypertrophy contribute to mild to moderate spinal canal stenosis. There is mild to moderate left neural foraminal stenosis. Minimal right neural foraminal narrowing.C5-6: Minimal disc osteophyte complex. No spinal canal or right neural foraminal stenosis. Mild left neural foraminal narrowing.C6-7: Disc osteophyte complex and mild uncovertebral hypertrophy. No significant spinal canal or right neural foraminal stenosis. Minimal left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.There is also mild generalized facet arthropathy, greater on the left. Left vertebral artery flow-void is diminutive which is at least in part developmental but raises possibility of stenosis. Paraspinous soft tissue structures appear within normal limits.

Output: Mild multilevel degenerative changes in the cervical spine as described above. There is mild to moderate spinal canal stenosis at the C4-C5 level without cord signal abnormality. There is also mild to moderate left neural foraminal stenosis at this level. Additional details as above.


Instruction: Generate impression based on findings.

Input: Abdominal bloating and distention. History of ovarian cysts. Prior endometrial biopsy showing inactive endometrial glands, per medical record. ABDOMEN:LIVER, BILIARY TRACT: Several liver cysts noted. Otherwise no enhancing focal hepatic lesions. No biliary ductal dilation. Normal appearance of the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, some demonstrating high T1 signal compatible with hemorrhage.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal appearance of the bowel loops, without dilation, wall thickening, or abnormal enhancement. No intra-abdominal fluid collections.BONES, SOFT TISSUES: Partially imaged T2 hypointense foci in the breasts bilaterally; correlation with any mammography or dedicated breast imaging is recommended.PELVIS:UTERUS, ADNEXA: 13 mm intramural uterine fibroid noted in the fundus. The endometrium is indistinct. Subcentimeter nabothian cysts noted.Bilateral nonenhancing adnexal cysts, which are predominantly subcentimeter, except for a 2.4 x 2.0 x 2.2 cm left adnexal cyst. No soft tissue component is evident.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: Trace nonspecific pelvic free fluid noted, possibly reactive.

Output: 1.No specific bowel pathology to account for the patient's symptoms.2.2.4 cm left adnexal cystic lesion, with an appearance favoring benign etiology.3.Partially imaged T2 hypointense foci in the breasts bilaterally; correlation with any prior or future mammography is recommended.


Instruction: Generate impression based on findings.

Input: Cellulitis, gangrenous right lower extremity. Question of osteomyelitis. There is mild thickening of the skin of the anterior aspect of the lower leg and ankle with nonenhancing edema of the underlying subcutaneous fat. There is also mild edema and enhancement between the peroneal musculature and lateral aspect of the soleus muscle extending to the fibular cortex. However, we see no rim enhancing fluid collection to suggest abscess or bone marrow abnormality to suggest osteomyelitis. A small collection of fat within the distal gastrocnemius muscle may represent focal atrophy or a lipoma.

Output: Mild soft tissue inflammation without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Pituitary lesion. There is perhaps mildly heterogeneous enhancement in the pituitary gland, with apparent slightly more hypoenhancement in the right lobe. Otherwise, there is no evidence of discrete mass lesions and the pituitary gland is not enlarged or atrophic, measuring up to 6 mm in craniocaudal dimension. The pituitary stalk is situated in the midline and is not enlarged. The cavernous sinuses and optic apparatus are intact.

Output: Possible nonspecific mildly heterogeneous enhancement in the pituitary gland, which may be related to a treated microadenoma. Otherwise, there is no evidence of discrete mass lesions and the pituitary gland is not enlarged or atrophic.


Instruction: Generate impression based on findings.

Input: 37 year old female with a history of congenital pulmonary valve stenosis, status post surgical valvotomy as an infant. Referred for research cardiovascular MRI to evaluate right ventricular volume and pulmonary valve function. Patient is referred for a limited cardiac MRI as part of a clinical trial. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 70 ml/m2 (normal range: 65+/-11), the LVEDV is 110 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 41 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 69 g (normal range 114+/-24). There is diastolic flattening of the interventricular septum, suggesting increased RV volumes.AtriaThe left atrium is normal in size. Normal right atrial size. No obvious inter-atrial septal defect; however, first pass contrast imaging was not performed. Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 128 ml/m2 (normal range 69+/-14), the RVEDV is 201 ml (normal range 110+/-24), the RV end systolic volume index is 56 ml/m2 (normal range 22+/-8), and the RVESV is 87 ml (normal range 35+/-13). The shape of the right ventricle is distorted by the pectus excavatum of moderate severity (Smallest AP dimension = 78mm). There is no evidence of hemodynamic significance of the distorted RV shape. The RV outflow tract is aneurysmal.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve leaflets are thickened and trileaflet; however, they open widely. MPA is mildly dilated, measuring 33 mm. There is severe pulmonic regurgitation.Forward flow volume: 106 mLRegurgitant flow volume: 40 mLRegurgitant fraction: 38%Pulmonary Arteries:Branch pulmonary arteries are normal in size, with no evidence of stenosis.RPA 15 mm, LPA 16 mm.RPA received 45% of forward flow.LPA received 55% of forward flow.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsTrace pleural effusions. Pectus excavatum noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size and systolic function (LVEF 63%)2. Severely dilated right ventricle with normal systolic function (RVEDVi 127 mL/m2, RVEF 56%). 3. The right ventricular outflow tract is aneurysmal. 4. The shape of the right ventricle is distorted by the pectus excavatum of moderate severity. There is no evidence of hemodynamic significance of the distorted RV shape.5. Thickened pulmonic valve leaflets with severe pulmonic regurgitation. 6. Mild dilation of the main pulmonary artery.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Lobular mucosal thickening is present within the left maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. Note is made of a couple postinflammatory cysts in the nasopharynx. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. There are degenerative bone marrow endplate changes at the C6-C7 level. There is disc desiccation with mild to moderate loss of intervertebral disc height at the C3-C4 and C6-C7 levels. There is a well-defined focus of increased STIR signal in the left aspect of the spinal cord at the C3-C4 level. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: No significant abnormality.C2/3: Mild disc osteophyte complex. No significant spinal canal or neural foraminal stenosis.C3/4: Mild disc bulge and small disc osteophyte complex causes moderate spinal canal stenosis, moderate right and mild left neural foraminal stenoses.C4/5: Mild disc bulge and small disc osteophyte complex causes mild spinal canal stenosis and minimal narrowing of the neural foramen bilaterally.C5/6: Mild disc bulge, disc osteophyte complex and bilateral facet arthropathy causes moderate to severe bilateral neural foraminal stenoses. There is mild narrowing of the spinal canal, predominantly on a developmental basis. There is very mild edema associated with the bilateral facet arthropathy.C6/7: Mild disc bulge and prominent uncovertebral osteophyte formation causes mild to moderate spinal canal stenosis, severe left and moderate to severe right neural foraminal stenoses.C7/T1: Mild disc bulge and bilateral facet arthropathy causes mild to moderate left and mild right neural foraminal stenoses. No significant spinal canal stenosis.Ovoid cystic lesion in the midline posterior subcutaneous tissues at the C4-C5 level may represent a sebaceous cyst but is nonspecific and can be correlated with examination.

Output: 1. Multilevel degenerative changes of the cervical spine, including moderate spinal canal stenosis at the C3-C4 level and to a lesser degree at the C4-C5 and C6-C7 levels.2. Focal T2 signal abnormality in the left aspect of the spinal cord at the C3-C4 level is favored to represent myelomalacia.


Instruction: Generate impression based on findings.

Input: 53 year-old female with chronic low back pain, sciatica, and morbid obesity. Evaluate for spinal lesion. Sagittal T1 and postcontrast images are degraded by motion artifact. Five lumbar type vertebral bodies are presumed to be present which are appropriate in height. There is minimal 4 mm anterolisthesis of L4 on L5. The conus medullaris on sagittal imaging is grossly intact.At L1-2 there is disk desiccation, loss of disk height, and enhancing central annular fissure. No significant compromise to spinal canal or neural foramina is present.At L2-3 there is trace disk bulge, mild ligamentum flavum hypertrophy and facet hypertrophy. There is no significant central canal or neuroforaminal stenosis.At L3-4 there is mild disk bulge with prominent proximal left foraminal component, ligamentum flavum hypertrophy, and facet arthropathy. Mild to moderate central canal stenosis as well as mild to moderate left neuroforaminal stenosis are present.At L4-5 there is uncovering of the disk, superimposed disk bulge and severe facet hypertrophy. Mild central canal stenosis as well as mild left neuroforaminal stenosis are present.At L5-S1 there is right paracentral to far right lateral enhancing annular fissure, mild disk desiccation, and severe facet hypertrophy, right greater than left. There is moderate right neuroforaminal stenosis.

Output: Multilevel degenerative changes. Most prominent changes include mild to moderate central canal stenosis at L3-4 as well as moderate right neuroforaminal stenosis at L5-1, and to a lesser degree at other levels as detailed above.


Instruction: Generate impression based on findings.

Input: There are innumerable T2 hyperintense periventricular and subcortical foci, several of which are perpendicular to the ventricles, several which also have T1 hypointensity. A subtle similar appearing lesion is also present within the medial left middle cerebellar peduncle.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Innumerable multiple sclerosis plaques as described in detail above.


Instruction: Generate impression based on findings.

Input: Male 29 years old with generalized abdominal pain and bloating. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion, biliary ductal dilation, or ascites.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 abnormal bowel wall enhancement or diffusion restriction. No evidence of stricture, fistula or abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of acute or chronic bowel wall inflammation.


Instruction: Generate impression based on findings.

Input: History of endocervical polyp. Menometrorrhagia. Evaluate for adenomyosis. PELVIS:UTERUS, ADNEXA: Anteflexed uterus measuring 8.3 x 4.3 cm in the sagittal plane. There is a 1.1 cm left fundal/body intramural fibroid. There is an anterior right body submucosal/intramural 1.2 cm fibroid.The inner myometrium/junctional zone is normal in thickness measuring 8 mm and is well defined without cystic or hemorrhagic foci to suggest adenomyosis.The endometrium/endometrial cavity measures 1.5 cm in thickness and is mildly heterogeneous. On postcontrast imaging there is a polypoid enhancing lesion extending from the fundus measuring 1.8 x 1.3 cm. An additional smaller focus extends into the endometrial canal from the right fundal wall.The right adnexa contains several simple cysts and physiologic follicles. The left next is unremarkable.Multiple nabothian cysts are noted.Note is made of bilateral right greater than left T2 hyperintense subcentimeter foci near the vaginal cuff/internal cervical os with intrinsic T1 weighted hyper intensity internally which likely represents small nabothian cysts with internal hemorrhagic debris. No suspicious postcontrast enhancement.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 evidence of adenomyosis as clinically questioned.2.Well-defined enhancing polypoid lesions extending into the endometrial cavity compatible with endometrial polyps as clinically reported.3.Two small uterine fibroids measuring less than 1.5 cm each.


Instruction: Generate impression based on findings.

Input: 67 year old male with a history of hypertension, smoker with exertional dyspnea, new diagnosis of heart failure with reduced ejection fraction. MEDICATIONS: Atorvastatin, Furosemide, Lisinopril, Metoprolol First Pass PerfusionDuring hyperemia, no perfusion defects were present. The basal segment are not well visualized. Viability/ Myocardial ScarThere was small area of sub-endocardial late gadolinium enhancement of the apical to mid inferior wall suggesting prior myocardial infarction. These territories have an intermediate probability of viability. Additionally there is a mid-wall stripe of late gadolinium enhancement of the mid to basal septal, inferior walls that is not typical of infarction and may represent a second process such as myocarditis, inflammation, fibrosis, or infiltrative disease.Left VentricleThe left ventricle is severely dilated and with severely reduced ejection fraction. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 194 ml/m2 (normal range: 74+/-15), the LVEDV is 311 ml (normal range 142+/-34), the LV end systolic volume index is 127 ml/m2 (normal range 25+/-9), the LVESV is 204 ml (normal range 47+/-19), the LV mass index is 40 g/m2, and the LV mass is 63 g. There is severe hypokinesis of the apical inferior and mid inferior, inferolateral, and lateral walls.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with low-normal ejection fraction. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 106 ml/m2 (normal range 82+/-16), the RVEDV is 170 ml (normal range 142+/-31), the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9), and the RVESV is 79 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is at least mild-moderate aortic regurgitation. The regurgitation is eccentric. There is thickening and calcification of the aortic valve. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. The left ventricle is severely dilated and with severely reduced ejection fraction (LVEF 34%). 3. There is severe hypokinesis of the apical inferior and mid inferior, inferolateral, and lateral walls.4. There was small area of sub-endocardial late gadolinium enhancement of the apical to mid inferior wall suggesting prior myocardial infarction. These territories have an intermediate probability of viability. Additionally there is a mid-wall stripe of late gadolinium enhancement of the mid to basal septal, inferior walls that is not typical of infarction and may represent a second process such as myocarditis, inflammation, fibrosis, or infiltrative disease.5. The right ventricle is normal in size with low-normal ejection fraction (RVEF 53%). 6. There is at least mild-moderate aortic regurgitation. The regurgitation is eccentric. There is thickening and calcification of the aortic valve. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 62-year-old female with right breast atypical ductal hyperplasia and atypical lobular hyperplasia for high risk lesion research MRI study. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right retroareolar breast there is clip related artifact at the site of stereotactic biopsy with associated post biopsy changes but no suspicious enhancement.Approximately 1.5 cm superior and posterior to the biopsy site there is a 9 x 6 x 5 mm (AP x transverse x CC) focal lobulated enhancing mass. No other areas of abnormal enhancement are noted in either breast.Normal morphology lymph nodes are identified in both axillary regions.

Output: Enhancing mass in the right breast superior and posterior to the biopsy site as described above for which second look ultrasound is recommended. If lesion not seen on ultrasound, MRI guided biopsy is recommended. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 37-year-old male with L5 enhancing lesion seen on MRI. CT for further evaluation. Alignment of the lumbar spine is within normal limits. Morphology of the vertebral bodies and intervertebral disk spaces is within normal limits. No evidence of fracture or malalignment. No evidence of spinal stenosis or lumbar disk herniation.L5 vertebral body appears unremarkable without discernible lesion or abnormal post contrast enhancement.Given the enhancement characteristics seen on recent MRI scan and lack of benign findings on this current examination further evaluation with lumbar biopsy may be considered as clinically warranted.

Output: 1. Unremarkable CT examination of the lumbar spine.2. Biopsy of L5 vertebral body lesion for further evaluation may be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: 43-year-old female with a fall backwards in March 2015 with right shoulder stiffness greater than left. ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus tendon indicating mild tendinosis. The supraspinatus muscle appears intact. There is a partial-thickness articular surface tear of the anterior fibers of the infraspinatus tendon, involving greater than 50% of the tendon width, measuring approximately 7 mm in AP dimension, without significant retraction. There is intermediate signal intensity and thickening of infraspinatus tendon indicating moderate tendinosis. The infraspinatus muscle appears intact. The teres minor and subscapularis muscles.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. The acromioclavicular joint alignment is anatomic.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Although this examination was not protocoled for evaluation of the glenoid labrum, the glenoid labrum appears intact. No fluid-filled defects are identified.BICEPS TENDON: The long head of biceps tendon appears intact. There is circumferential fluid within the tendon sheath of long head of the biceps which may represent fluid extends from the glenohumeral joint. ADDITIONAL

Output: Partial thickness articular surface tear of the infraspinatus without significant retraction as described above.


Instruction: Generate impression based on findings.

Input: Tethered cord, Benign lipomatous neoplasm of other sites, history resection, please do with tethered cord protocol History: yearly followup. There are postoperative findings related to tethered cord release with transection of a filar fibrolipoma, with wide separation of the caudal and cranial components. The conus medullaris remains positioned at the L2 level. There is an unchanged ventriculus terminalis that measures 6 mm in diameter. The rest of the imaged spinal cord displays normal signal and morphology. There appears to be translation of the conus medullaris between supine and prone positioning. 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 stenosis. The paravertebral soft tissues are unchanged.

Output: Stable postoperative findings related to tethered cord release with transection of a filar fibrolipoma and unchanged ventriculus terminalis.


Instruction: Generate impression based on findings.

Input: Male 28 years old with knee pain for 6 weeks after Frisbee injury. Joint pain, clicking, lateral and posterior medial joint line pain. Also pain over the medial hamstring. MENISCI: There is a horizontal tear of the posterior horn of the medial meniscus with extension to the superior articular surface. The anterior horn of the medial meniscus and the lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: Low T1 and increased T2 signal is seen in the posterior tibial plateau compatible with a bone contusion. There is no evidence of acute fracture.The articular cartilage in all 3 compartments is intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Tear of the posterior horn of the medial meniscus.2.Baker's cyst.3.The cruciate and collateral ligaments are intact.


Instruction: Generate impression based on findings.

Input: 40 years, Female, Reason: 40yo female with Crohn's ileitis. Evaluate extent of involvement History: abdominal pain and diarrhea. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a 2.6 x 2.6 lobulated lesion in in segment 4b which is isointense on T1, mildly hyperintense on T2 and demonstrates delayed enhancement and diffusion restriction.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: The distal terminal ileum is mildly patulous with mucosal hyperenhancement and fibrofatty proliferation but no significant edema, likely representing chronic inflammatory changes. No abscesses or fistulas are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Tarlov cysts within the right sacral foramen

Output: 1.Findings of chronic inflammation of the terminal ileum.2.Enhancing hepatic lesion. Focal nodular hyperplasia is favored, however an adenoma may also be considered. If further characterization is required, evaluation with dedicated liver MRI including the hepatobiliary agent may be considered.


Instruction: Generate impression based on findings.

Input: 7-year-old female with a first time generalized seizure. Need to evaluate for abnormality. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. Fluid is again noted within the sphenoid sinuses but the remaining visualized portions of the paranasal sinuses and mastoid air cells are clear.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct or other findings might explain the patient's symptoms.2.Fluid within the sphenoid sinuses are again seen and stable.


Instruction: Generate impression based on findings.

Input: History of low risk prostate cancer. Recent biopsy at outside hospital biopsy demonstrated bilateral Gleason grade 3 + 3 = 6 adenocarcinoma. PELVIS:PROSTATE:Prostate Size: 5.7 x 4.7 x 5.8 cm.Peripheral Zone: There is heterogeneous signal intensity within the peripheral zone. Two well-circumscribed T2 hypointense nodules are present within the right peripheral zone (series 801, images 30 and 21). There is a focus of abnormal signal within the right peripheral zone at the apex (series 801, image 18) which measures approximately 5 mm and demonstrates associated decreased signal on ADC images (series 604, image 324).Central Gland: Moderate benign prostatic hypertrophy without suspicious focal lesions.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: There is asymmetric atrophy of the right rectus abdominous muscle.OTHER: No significant abnormality noted.

Output: 5 mm focus of abnormal signal within the right peripheral zone apex suspicious for prostate carcinoma without evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Left knee effusion, pain and popping; concern for meniscal injury MENISCI: There is globular signal within the anterior horn and body of the lateral meniscus indicating intrasubstance degeneration with extrusion of mucoid material into the adjacent soft tissues resulting in formation of tiny parameniscal cysts. Best seen on the T2-weighted sagittal series is additional linear signal abnormality extending to the femoral articular surface indicating a horizontal tear. I suspect that there is mild fraying of the free edge of the posterior horn of the lateral meniscus, but I see no discrete tear of the posterior horn. The lateral meniscus appears normal for age.ARTICULAR CARTILAGE AND BONE: There is focal but full-thickness delamination of the articular cartilage of the medial femoral condyle just anterior to the posterior horn of the medial meniscus, and an additional small full-thickness articular cartilage defect is noted slightly more anteriorly. There is superficial degeneration of the articular cartilage of the weightbearing portion of the medial tibial plateau with tiny foci of degenerative signal abnormality in the underlying subchondral bone. The articular cartilage of the lateral and patellofemoral compartments is relatively well preserved, appearing normal for age. There are small osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Degenerative tearing of the anterior horn and body of the medial meniscus with formation of tiny para meniscal cysts.2.Cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with epilepsy status post laser ablation. Please note that only a partial examination was obtained due to inability to gain IV access and patient's wish to terminate the study early.An area of parenchymal distortion and mild hemosiderin staining is seen within the medial right temporal lobe compatible with the site of ablation. No additional parenchymal lesions are suspected. No areas of edema or mass effect are seen. Mild scattered periventricular T2 hyperintensity is a nonspecific finding and unchanged. No abnormal extra-axial collections are present. The ventricles are normal in size and morphology allowing for mild effacement of the right temporal horn.

Output: Partial examination demonstrating expected findings status post ablation of the right medial temporal lobe.


Instruction: Generate impression based on findings.

Input: Cervicalgia. Cervical spondylosis Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild anterolisthesis of C3 on C4 and minimal anterolisthesis of C6 on C7. Alignment is otherwise maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.There are multilevel degenerative changes including disc height loss, worst at the C4-C5 level. Individual levels as below:C2-3: There is a central disc extrusion. No significant compromise to the spinal canal or neural foramina.C3-4: Mild anterolisthesis and uncovertebral hypertrophy. There is bilateral facet arthropathy. There is moderate right and mild left neural foraminal stenosis. No significant compromise to the spinal canal.C4-5: Small disc osteophyte complex with bilateral uncovertebral hypertrophy. There is mild narrowing of the bilateral neural foramina. No spinal canal stenosis.C5-6: Small disc osteophyte complex and mild uncovertebral hypertrophy. There is mild narrowing of the left neural foramen. No significant spinal canal or right neural foraminal narrowing.C6-7: Small disc osteophyte complex and minimal anterolisthesis. No significant spinal canal stenosis. There is moderate left and mild right neural foraminal stenosis related to uncovertebral hypertrophy. 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.

Output: Multilevel degenerative changes in the cervical spine. There is no significant spinal canal stenosis. Varying degrees of neural foraminal stenosis as detailed above.


Instruction: Generate impression based on findings.

Input: History of snowboarding injury now with medial swelling, pain, limited extension, and inability to bear weight. MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears intact. Streaky foci of increased signal intensity seen on fluid sensitive sequences within the lateral tibial condyle likely represent confluence of blood vessels. Bone marrow signal intensity is otherwise within normal limits.LIGAMENTS: The cruciate ligaments appear intact. Edema along the superficial band of the MCL indicates a sprain. Edema extends along the medial retinaculum likely representing additional sprain injury. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: MCL sprain and joint effusion.


Instruction: Generate impression based on findings.

Input: Male, 2 years old, with history of skull fracture and seizures. Assess for structural abnormality. A mild residual deformity of the left parietal bone is seen corresponding to the site of a prior depressed fracture. This deformity very slightly indents the adjacent parenchyma of the left parietal lobe, but there is no evidence of any parenchymal signal abnormality or encephalomalacia in this location.Brain morphology is otherwise within normal limits. No pathologic signal abnormality is detected. The pattern of white matter myelination is appropriate for age. The pituitary, brain stem cerebellar vermis and cerebellar hemispheres are all within normal limits. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.

Output: 1.Mild residual deformity corresponding to a healed left parietal bone fracture. This deformity slightly indents the adjacent brain parenchyma, there is no evidence of any significant injury to that parenchyma.2.Otherwise, the evaluation is within normal limits.


Instruction: Generate impression based on findings.

Input: Headache. MS. Street renal transplant. No intracranial bleed. Mildly prominent extra-axial space and sulci. Moderate patchy periventricular and subcortical white matter low-attenuation are again seen. Gray-white differentiation is preserved. Basal cisterns are patent. Ventricles are symmetric and normal in size. Visualized paranasal sinuses and mastoid air cells are clear.

Output: No acute intracranial abnormality. No significant interval changes in the appearance of the brain since prior exam, allowing for comparison with the previous study a different modality, brain MRI October 28, 2009.


Instruction: Generate impression based on findings.

Input: Malignant tenosynovial giant cell tumor following resection, evaluate for local recurrence There are extensive surgical changes of the knee resulting from patellar resection and soft tissue reconstruction. The medial head of the gastrocnemius has been transposed as a flap along the anteromedial aspect of the proximal tibia. This graft is contiguous with a reconstructed extensor mechanism which can be traced to its insertion on the tibial tuberosity distally and the quadriceps tendon proximally. The reconstructed tendon appears thickened with heterogeneous increased signal on short TE sequences, which may represent degeneration or tendinosis; although we cannot exclude partial-thickness tearing, there is no abnormal fluid signal on STIR sequences to suggest full-thickness disruption. There is mild thickening and enhancement of the skin of the knee. Additionally, there is bandlike enhancing tissue traversing the subcutaneous fat of the knee which likely represents scarring. Heterogeneous enhancement of the reconstructed extensor tendon is noted with additional amorphous enhancement anterior to the biceps femoris muscle. Although it is impossible to exclude small tumoral deposits, we suspect these changes are also related to scarring and there is no dominant focus of nodular enhancement to confirm recurrence.Metallic susceptibility artifact is seen along the anterior tibial tuberosity. There is a moderate-sized joint effusion with thickening and enhancement of the synovium indicating synovitis. The underlying bone marrow is of normal signal. There is diffuse edema of the subcutaneous fat.Although not tailored for the evaluation of the internal structures of the knee, the menisci and collateral ligaments appear intact. A small full-thickness cartilage defect is noted of the femoral trochlea inferiorly.

Output: Extensive surgical changes due to soft tissue reconstruction of the knee with amorphous enhancing soft tissue further detailed above. Although it is impossible to exclude small tumoral deposits, it is suspected that this enhancement reflects scarring as there is no dominant nodular focus of enhancement to confirm recurrence.


Instruction: Generate impression based on findings.

Input: Glioblastoma. Status post resection on January 28, 2016. Initially presented with right to astrocytoma in 2012. Resected twice and treated with radiation treatment. On last partial resection in 2016, pathology revealed glioblastoma. The previous examination from the outside institution is a functional MRI and does not provide adequate anatomic detail to allow adequate comparison.There are changes from the previous left frontal craniotomy and partial tumor resection. A small surgical cavity, measuring up to 2.1 cm, is present in the anterior-medial aspect of the left frontal lobe. Deep to the cavity, there is extensive heterogeneous contrast enhancement in the left frontal parenchyma, which measures 6.9 cm x 5.0 cm axially and 4.9 cm craniocaudally. The contrast enhancement extends posteriorly along the external capsule and there are adjacent small ring-enhancing lesions in the left basal ganglia next to the posterior limb of the internal capsule. The contrast enhancement also extends along the frontal horn of the left lateral ventricle as well as the genu of the corpus callosum. The contrast enhancement is associated with extensive surrounding infiltrative FLAIR hyperintensity (related to tumor and vasogenic edema) and causes mass-effect on adjacent structures, with associated subfalcine and uncal herniations. The infiltrative signal also extends into the right frontal lobe. There are numerous foci of susceptibility artifact in the left frontal lobe likely represent microhemorrhages and posttreatment change. There is no acute infarct, accounting for the hemorrhage.On dynamic susceptibility-weighted, contrast-enhanced MR perfusion imaging, there is elevated cerebral blood volume correlating with the contrast enhancement in the left frontal lobe.A multiloculated cystic lesion involving the anterior left temporal lobe may reflect focal encephalomalacia from a more remote surgery. This shows contrast enhancement only on its anteromedial border which may represent an extension from the large contrast enhancement in the left frontal lobe. Dural enhancement underlying the left craniotomy flap is expected postoperative change. There is no destructive skull lesion. There is trace mucosal thickening in the paranasal sinuses.

Output: 1.Extensive areas of heterogeneous contrast enhancement in the left frontal lobe with associated elevated cerebral blood volume are suspected to represent extensive residual glioblastoma. It is associated with extensive infiltrative FLAIR hyperintensity (related to tumor and vasogenic edema) and associated mass-effect causing subfalcine and uncal herniations. Tumor also involves the genu of the corpus callosum, and the enhancement extends to the subependymal surface of the frontal horn of the left lateral ventricle.2.Resection cavity in the anterior left temporal lobe reflects the more remote surgery. The contrast enhancement extends from the left frontal lobe towards this temporal surgical cavity.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, history of multiple myeloma, status post stem cell transplant with worsening back and leg pain. Outside hospital imaging in November 2015 showed lesions at T12 with no compression. Cervical:Grade 1 retrolisthesis of C3 relative to C4 is seen. Vertebral body height and morphology are within normal limits. No concerning marrow replacement is seen. No pathologic marrow enhancement is evident.The spinal cord demonstrates normal signal intensity throughout. No abnormal intramedullary or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Posterior disc-osteophyte complex formation. Moderate spinal canal stenosis with slight flattening of the ventral cord. Moderate left foraminal narrowing. No interval changes.C4-5: Posterior disc-osteophyte complex formation. Mild spinal canal narrowing. No significant foraminal narrowing. No interval changes.C5-6: No spinal canal stenosis or neuroforaminal narrowing. C6-7: Posterior disc-osteophyte complex formation. Mild spinal canal stenosis. Mild right foraminal narrowing. No interval changes.C7-T1: No spinal canal stenosis or neuroforaminal narrowing.  Thoracic:Alignment is anatomic. Vertebral body heights are preserved. T1 isointense and T2 hyperintense signal within the left T3 vertebral body is unchanged and probably represents an atypical hemangioma.The spinal cord demonstrates normal signal intensity throughout. No pathologic intramedullary or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.Scattered facet arthropathy and minimal disc degeneration is seen through the thoracic spine. No areas of high-grade spinal canal or foraminal stenosis are detected.An enhancing nodule in the right retrocrural space at T12 measures up to 28 x 11 mm in the axial plane. The lesion is relatively dark on T2-weighted images which would suggest chronic blood products, mineralization or a fibrous component. There has been no significant interval change.Lumbar:A transitional L5 vertebral body is seen. Vertebral body morphology is otherwise unremarkable. Marrow signal is generally somewhat heterogeneous but there are no suspicious areas of marrow replacement or enhancement.The distal spinal cord, conus and cauda equina are unremarkable except as discussed below. No epidural abnormalities are suspected. No leptomeningeal enhancement is seen.L1-2: Facet arthropathy. Minimal disc bulging. Mild generalized spinal canal stenosis with slight crowding of the cauda equina. No significant foraminal narrowing. No interval changes. L2-3: Facet arthropathy. Mild disc bulging. Moderate generalized spinal canal stenosis with crowding of the cauda equina. Mild bilateral foraminal narrowing. No interval changes. L3-4: Facet arthropathy. Minimal bulging disc. Moderate generalized spinal canal stenosis with crowding of the cauda equina. Moderate bilateral foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Minimal bulging disc. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No interval changes. L5-S1: No significant spinal canal stenosis or neuroforaminal narrowing.

Output: 1.An enhancing nodule in the right retrocrural space at T12 is redemonstrated showing no significant interval change. This lesion could represent a pathologic lymph node, or given the history of multiple myeloma, a plasmocytoma.2.No definite pathologic marrow space lesions are seen. Signal abnormality within the T3 vertebral body is favored to represent an atypical hemangioma. Vertebral body morphology is within normal limits. There are no compression deformities.3.Scattered degenerative findings are noted as discussed above. Areas of mild to moderate spinal canal stenosis are seen. No significant interval change is noted.


Instruction: Generate impression based on findings.

Input: Asymptomatic pancreas tail mass. ABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver. Cholelithiasis within a contracted gallbladder without specific evidence of acute gallbladder inflammation.The liver has normal morphology, signal intensity and enhancement. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: Mild splenomegaly with the spleen measuring 14 cm in craniocaudal dimension.PANCREAS: The cystic lesion in the tail of the pancreas now measures approximately 3.2 x 2.9 cm (series 7/19), compared to 2.4 x 2.1 cm previously. The lesion has a lobular contour and is composed of numerous small cysts the largest of which measures less than a centimeter. There is postcontrast enhancement of the septations without a discrete enhancing mural nodule. There is no associated pancreatic ductal dilatation or pancreatic parenchymal atrophy. The lesion does not appear to communicate with the main pancreatic duct.ADRENAL GLANDS: Stable subcentimeter left adrenal nodule demonstrating signal loss on out of phase imaging compatible with a benign lipid rich adrenal adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine. Tortuous abdominal aorta.OTHER: No significant abnormality noted.

Output: Mild interval growth in the cystic pancreatic lesion, appearance most suggestive of a serous cystadenoma. Given the interval growth, further evaluation and possible histologic sampling should be considered, particularly as an atypical mucinous neoplasm cannot be excluded.


Instruction: Generate impression based on findings.

Input: 83-year-old male with bilateral lower extremity weakness following history of fall. Rule out cord compression. Multilevel spondylitic changes are noted throughout the cervical and lumbar spine without evidence of acute cord compression. The spinal cord grossly has normal signal characteristics and overall morphology.

Output: Multilevel spondylitic changes throughout the cervical and lumbar spine without acute cord compression. Please note that this is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities.


Instruction: Generate impression based on findings.

Input: 64-year-old man with history of renal cell carcinoma status post nephrectomy now presents with bilateral lower extremity weakness and fatigue. Please note that this is a limited examination for evaluation of acute cord compression.There is no evidence of acute spinal cord compression. The marrow signal is benign. There are degenerative changes in the upper cervical spine with chronic-appearing moderate central spinal canal stenosis. There are also degenerative changes in the lower lumbar spine with bilateral neural foraminal stenoses.

Output: 1.No acute cord compression.2.Chronic appearing degenerative changes in the upper cervical spine and lower lumbar spine with central spinal canal and neural foraminal stenoses.


Instruction: Generate impression based on findings.

Input: VHL and multiple hemangioblastomas. The evaluation for tumors is limited due to the lack of intravenous contrast. There are postoperative findings related to left transmastoid surgery with fat grafting, suboccipital craniotomy, as well as left enucleation with prosthesis. There are unchanged areas of confluent T2 hyperintensity in the bilateral cerebellar hemispheres with sulcal effacement. There is unchanged focal expansile T2 hyperintensity in the right cerebellar tonsil. There is also an unchanged focus of T2 hyperintensity in the left medulla. There are unchanged mild scattered foci of T2 hyperintensity in the cerebral white matter. There is a new fluid-fluid level within the right globe. The layering fluid measures up to 7 mm in thickness and is hypointense on T2 sequences and isointense on T1-weighted sequences, likely reflecting blood products. There is a right lens implant. There is no evidence of acute infarct. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The paranasal sinuses are unremarkable.

Output: 1. Persistent signal abnormality in the bilateral cerebellar hemispheres and left medulla may represent edema related to residual hemangioblastomas, although the lack of intravenous contrast limits evaluation.2. No definite evidence of recurrent endolymphatic sac tumor, although the lack of intravenous contrast limits evaluation.3. New fluid-fluid level in the right globe, which likely represents vitreous hemorrhage, perhaps related to an underlying hemangioblastoma, although the lack of intravenous contrast limits evaluation.


Instruction: Generate impression based on findings.

Input: 8-week-old female status post ECMO found to have subdural hemorrhage on MRI. Please evaluate interval change. Again seen are subdural fluid collections overlying the right frontal, temporal, and occipital regions and interhemispheric fissure as seen on recent MRI, grossly unchanged. No high density material is seen to suggest acute hemorrhage. The underlying cerebral and cerebellar hemispheres are unchanged in appearance. The ventricles are midline, with normal morphology and volume.Extensive soft tissue edema is seen about the skull. There is opacification of several ethmoid air cells. No definite skull fracture is evident.

Output: Stable subdural hematomas and extensive soft tissue edema, with no evidence of acute hemorrhage.


Instruction: Generate impression based on findings.

Input: Female; 32 years old. Reason: duodenal stricture, s/p multiple dilations, evaluate for small bowel Crohn's or other strictures History: duodenal stricture 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: Wall thickening with submucosal edema and increased enhancement of the second portion of the duodenum. No focal masses. No evidence of gastric outlet obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Blooming artifact is seen at the anterior aspect of the uterine body, most likely due to prior surgical change.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Remainder of the small bowel is normal. The terminal ileum is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild pelvic free fluid, likely physiologic.

Output: Wall thickening and enhancement of the second portion of the duodenum.


Instruction: Generate impression based on findings.

Input: 73-year-old male patient with history of prostate cancer with possible future focal ablation.He underwent a prostate biopsy in September 2014 which was prompted by abnormal DRE (right sided nodule) and PSA of 4.0.Prostate biopsy (6 cores total) from 9/2014 revealed 1 core of Gleason 3+3 15% LB1 core Gleason 4+3, 90% RB1 core Gleason 3+4, 40% RM PELVIS:PROSTATE:Prostate Size: 5.3 x 3.2 x 3.8 cm (ML x AP x CC).Peripheral Zone: In the base and mid right peripheral zone there is a 2.0 x 11.1 cm (series 1004 image 284) focus of decreased T2 and ADC signal. Additionally, in the mid left peripheral zone there is a focus of decreased T2 and ADC signal that measures 0.6 x 0.5 cm (series 901 image 16).Central Gland: No suspicious lesions.Seminal Vesicles: The right sided lesion appears to abut the base of the right seminal vesicles.Extracapsular Extension: There right capsular border is indistinct (series 9 image 19) and there is invasion of the neurovascular bundle at this level. BLADDER: No significant abnormality noted.LYMPH NODES: There is a left external iliac lymph node that measures 1.2 x 0.8 cm (series 1301 image 32). There is a mildly enlarged right external iliac lymph node (series 1301 image 32). There is a small subcentimeter lymph node at the aortic bifurcation (series 2201 image 164).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a cystic lesion at the left prostate base adjacent to the prostatic urethra that measures 1.2 x 1.0 x 1.1 cm.

Output: 1.Right base and mid peripheral zone cancer with extracapsular extension, invasion of the neurovascular bundle, and abutment of the right seminal vesicles.2.Small lesion in the mid peripheral zone compatible with additional focus of cancer.3.Mildly enlarged bilateral external iliac lymph nodes and subcentimeter node at the aortic bifurcation.4.Probable left apex prostatic retention cyst.


Instruction: Generate impression based on findings.

Input: 39-year-old female. Right knee pain, swelling, decreased rom. Lateral knee pain. MENISCI: Medial and lateral menisci are intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Tibiofemoral and patellofemoral compartment cartilage is normal in thickness and signal intensity. No bone contusion.LIGAMENTS: ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Unremarkable right knee MRI.


Instruction: Generate impression based on findings.

Input: Neck pain, numbness and tingling down right arm Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild loss of cervical lordosis with minimal retrolisthesis of C4 on C5 and C5 on C6. Alignment is otherwise maintained. Bone marrow signal is benign with T1 hyperintense focus involving anterior/superior C7 vertebral body compatible with a small hemangioma. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal left neural foraminal narrowing related to uncovertebral hypertrophy. No significant compromise to the spinal canal or right neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: Mild left neural foraminal narrowing related to uncovertebral hypertrophy. No significant compromise to the spinal canal or right 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.

Output: Minimal degenerative changes in the cervical spine as described above without significant spinal canal or neural foramina stenosis on the right.


Instruction: Generate impression based on findings.

Input: Decubitus ulcer. Evaluate osteo-. There is gas within the soft tissues extending along the greater trochanter and subtrochanteric femur. The margins of the adjacent greater trochanter are indistinct compatible with osteomyelitis as seen on the recent MRI examination. Heterotopic mineralization superior to the greater trochanter has perhaps increased slightly when compared with the prior study. Additional gas density is noted in the soft tissues more posteriorly, appearing to extend to the inferior pubic ramus/ischium. The inferior pubic ramus/ischium are sclerotic with adjacent bone formation, compatible with chronic osteomyelitis. Overall, the bones appear demineralized. Mild osteoarthritis affects both hips. The lower sacrum and coccyx are not well visualized due to demineralization and overlying bowel contents. Facet joint osteoarthritis and degenerative disc disease affect the lower lumbar spine. Overall the findings are similar to those seen on the pelvis radiograph from November 28 accounting for positional and technical differences.

Output: Soft tissue ulceration/gas with radiographic features of osteomyelitis of the left greater trochanter and inferior pubic ramus/ischium appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: Ataxia There is focal low signal intensity lesion on both T1 and T2 weighted images on the left cerebellar hemisphere with surrounding FLAIR high signal intensities indicating associated encephalomalacia. The gradient echo images were non diagnostic to characterize this lesion due to significant metallic artifacts. Comparing to prior MRI in 2003, the lesion's MR characteristics have not changed. The possibility of this lesion is likely to be chronic hemorrhagic lesion such as cavernoma or calcifications.There are extensive patch high signal intensities on FLAIR imaging on periventricular white matter brainstem, and bilateral cerebral hemispheres indicating moderate to severe nonspecific small vessel ischemic disease.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.There is multilobulated relatively well circumscribed mass on the right parotid gland superficial lobe, the size was measured around 13.8 mm x 24.6 mm x 21 mm. The lesion shows high signal intensity on T2 and low signal intensity on T1 weighted images. Diagnostic possibility is benign parotid gland lesion such as pleomorphic adenoma.

Output: 1, Moderate to severe nonspecific small vessel ischemic disease, as described above.2, No evidence of acute ischemic or hemorrhagic lesion on this scan.3. Left cerebellar hemispheric lesion, either cavernoma or calcifications, no change since 2003.4, Benign appearing right parotid gland superficial lobe mass lesion most likely representing pleomorphic adenoma.


Instruction: Generate impression based on findings.

Input: 32 year old female with RLQ abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: 4.2 x 3.2 mass in the liver at axial image 39 61 43 with central hypoattenuation displaces adjacent liver parenchyma and vessels. Incompletely characterized on this examination. If clinically indicated, dedicated liver CT or MRI examination may be helpful for further evaluation. This most likely represents focal nodular hyperplasia. No biliary duct dilatation. The hepatic vasculature is intact.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple foci of hypo-attenuation in the right kidney with lower pole striated nephrogram are seen best on coronal image 51/92 and axial image 63/143. These findings are most compatible with pyelonephritis. No hydronephrosis was found.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 4-cm diameter hepatic parenchymal lesion may be due to FNH, but this examination is insufficient for complete characterization. Right pyelonephritis without evidence of abscess or hydronephrosis.


Instruction: Generate impression based on findings.

Input: Left tibia lesion. Evaluate characteristics. There is an elongated lesion within the proximal tibial diaphysis measuring approximately 11 cm in longitudinal dimension and occupying the width of the medullary space of the bone. The lesion is of heterogeneous signal intensity on T1-weighted images, predominantly iso- or slightly hypointense to skeletal muscle, but containing small foci of signal void, likely reflecting calcification, as well as higher signal intensity foci which may reflect small islands of spared fat. On fat-suppressed T2-weighted images the lesion is predominantly hyperintense, with components of relatively low signal intensity that may reflect calcification as seen on radiographs. Following intravenous contrast administration, there is thin rim enhancement peripherally, as well as nodular and ringlike enhancement centrally. The proximal and distal margins of the lesion are slightly nodular. There may be slight thinning of the cortex from expansile remodeling, but I see no focal cortical invasion or cortical signal abnormality. The remaining marrow signal intensity of the tibia is unremarkable, and the fibula appears normal. The musculature of the leg is normal. Please refer to the knee MRI report from the same date dictated under a separate accession number for details involving the menisci and articular cartilage. Degenerative arthritic changes affect the right knee as seen on the large field of view coronal images.

Output: Proximal tibial lesion as described above most compatible with a cartilaginous neoplasm, most likely a benign enchondroma; while I cannot exclude the possibility of a low-grade chondrosarcoma the basis of this single imaging study, I see no aggressive features to suggest malignancy. Follow-up with radiography and consultation with orthopedic oncology may be considered.


Instruction: Generate impression based on findings.

Input: Reason: MS; f/u progression History: paresthesias MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and right cerebellar punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. When compared to the prior exam these have not changed compared there is no associated contrast enhancement.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The right maxillary sinus is very small compared to the left suggesting atelectasis of the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.Redemonstration and no change of peri-ventricular white matter lesions and a right cerebellar lesion which are stable when compared to the prior exam and compatible patients known clinical history of demyelination2.no convincing evidence for thoracic spinal cord involvement of a demyelination.


Instruction: Generate impression based on findings.

Input: 63 year old with history of right lumpectomy at an outside hospital in 2005 for IDC and right simple mastectomy in February 2013 for recurrent IDC. Status post right mastectomy.There is heterogeneous amount of fibroglandular tissue in the left breast.Minimal parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or right mastectomy bed. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Male, 56 years old, generalized weakness. Evaluate extent of disseminated nocardia. Cervical:No discrete spinal cord lesion or cord edema is detected. The AP caliber of the spinal cord is subjectively smaller than typical. No epidural abnormality is seen.The usual lumbar lordosis is reversed. Sagittal alignment is otherwise unremarkable. Mild degenerative vertebral body loss of height is seen at C6 and C7. No pathologic marrow replacement is detected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild facet hypertrophy. No spinal canal stenosis. No significant foraminal narrowing. C4-5: Facet hypertrophy. No significant spinal canal stenosis. No significant foraminal narrowing.C5-6: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing. C6-7: Right facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Thoracic:No discrete spinal cord lesion or cord edema is detected. As above, the AP diameter of the spinal cord may be somewhat smaller than typical. No epidural abnormalities are suspected.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality is detected. The intervertebral discs are preserved. No spinal canal or foraminal compromise is seen.A large left pleural effusion and left lower lobe opacification is partially visualized. A nodule in the right upper lobe is better assessed on CT as well.Lumbar:The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No intrathecal lesions are detected. No epidural abnormality is suspected.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement is seen. Intervertebral disc height is preserved. Mild disc bulging is seen at L4-5 causing mild to moderate foraminal narrowing but no significant spinal canal compromise. Elsewhere, no significant spinal canal or foraminal narrowing is seen.A thoracic duct cyst is suspected at the L1 level. The native kidneys are severely atrophic. A renal transplant is seen in the right pelvis.

Output: 1.No convincing evidence of any lesions in the spine to suggest nocardia involvement.2.The AP caliber of the spinal cord is subjectively somewhat small. This could simply represent an anatomic variation, though the possibility of chronic cord volume loss is not excluded.3.Scattered degenerative disease and other incidental findings as discussed above.


Instruction: Generate impression based on findings.

Input: Reason: Bx-proven atypical dermatofibroma of R 3rd finger w/persistent pain out of proportion to exam, concerning for bony involvement History: Pain as above. A marker was placed at the tip of the third finger presumably representing site of patient's pain. There is a small focus of intermediate signal intensity on T1-weighted images within the subcutaneous fat of the fifth finger tip situated volar and distal to the tuft of the distal phalanx, measuring approximately 5 mm in diameter, extending from the skin to the volar surface of the tuft of the distal phalanx, but does not appear to involve the bone. There is minimal increased signal intensity within this lesion on fat-suppressed T2-weighted images and minimal, if any, contrast enhancement on post gadolinium T1 weighted images. Small focus of signal void along the periphery of the lesion may represent site of biopsy.The remainder of the soft tissues of the middle finger are normal.Bone marrow signal intensity is normal.The joints appear normal.

Output: Small focus of signal abnormality within the finger tip presumably represents site of biopsy of patient's dermatofibroma, but we cannot determine to what degree this reflects postbiopsy changes or the lesion itself. We see no signal abnormality in the underlying bone to suggest osseous involvement.


Instruction: Generate impression based on findings.

Input: History of multiple myeloma: lower extremity weakness. Cervical Spine: There is lack of the usual cervical lordosis. There are multilevel cervical posterior disc-osteophyte complexes, with associated mild indentation upon the spinal cord at C4-5. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal. The paravertebral soft tissues are unremarkable.Thoracic Spine: There is no significant interval change in the infiltrative tumor involving the right aspect of the T7 vertebra with epidural extension, but no spinal cord compression. The focus of enhancement in the posterior T4 vertebral body is less conspicuous. The thoracic spine alignment is anatomic and the vertebral body heights are preserved, aside from minimal anterior wedging of the T11 vertebral body. Lumbar Spine: There is a partially-imaged heterogeneous mass containing areas of probable necrosis within the right sacrum. There is considerable extension of tumor into the spinal canal at the S2 level. There is relatively high T1 signal in the vertebral bone marrow surrounding the tumor, which is likely attributable to prior radiation therapy. There is unchanged mild anterolisthesis of L4 on L5. There is multilevel lumbar degenerative spondylosis. In particular, there is moderate to severe right neural foraminal stenosis at L5-S1 due to a combination of tumor and the degenerative findings. Otherwise, there is no significant spinal canal stenosis in the lumbar spine and the lumbar vertebral body heights are preserved.

Output: 1. Partially-imaged mass involving the right sacrum, with considerable extension into the spinal canal at the S2 level. Please refer to the separate pelvis MRI report for additional details.2. No significant interval change in the infiltrative tumor involving the right aspect of the T7 vertebra with epidural extension, but no spinal cord compression.3. The focus of enhancement in the posterior T4 vertebral body is less conspicuous than in April 2015.4. Multilevel cervical posterior disc-osteophyte complexes, with associated mild indentation upon the spinal cord at C4-5. 5. Multilevel lumbar degenerative spondylosis, including moderate to severe right neural foraminal stenosis at L5-S1 due to a combination of tumor and the degenerative findings.


Instruction: Generate impression based on findings.

Input: Acute on chronic back pain x3 weeks after "snap" in lower back, bilateral, w/ bilateral sciatica. There is mild disc bulging at L5-S1, but no significant spinal canal or neural foramen stenosis. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Mild disc bulging at L5-S1, but no significant spinal canal or neural foramen stenosis.


Instruction: Generate impression based on findings.

Input: 60 year-old male with history of left nasal vestibule is squamous cell carcinoma involving left lateral nasal wall. Now status-post left medial maxillectomy and ethmoidectomy. Has granulation tissue, possible requirements left superior/anterior nasal area. Please evaluate and stage. Enhanced CT of soft tissues of neck:In comparison with prior examination there is interval resolution of previously noted soft tissue densities within the left frontal sinus and left ethmoid sinus region which is leave to have represented mucosal thickening and inflammatory changes. There is no definitive evidence of interval new bony changes.Images through the nasal cavity demonstrate overall decrease in the amount of soft tissue density that was present in the left nasal cavity. On coronal reformatted image 14 in the most anterior aspect of the left nasal cavity the soft tissue within the nasal cavity demonstrate subtle enhancement. This finding measures approximately 12 mm in cranial cephalad access and 7-mm in transverse axis. Although this finding may represent postop scarring considering the provided clinical data it may represent recurrence of tumor. This finding could be better evaluated with a dedicated MRI of maxillofacial region. On axial image 16 this tissue appears to extend beyond the confinement of nasal cavity and into the soft tissues of the nose. There is no detectable new bony changes since prior study.Residual mucosal thickening within the left maxillary sinus.Images through the skull base remain unremarkable.Images through the neck demonstrate multiple small nonenhancing and not pathologic by CT size criteria lymph nodes which were present and read no detectable change since prior study from 2009. There is no evidence of any pathologic lymph nodes in the neck.No evidence of osseous or cartilaginous erosion.Heterogeneously enlarged right lobe of thyroid is consistent with goiter. This finding was also present on prior study.Limited images of the apices of the lungs and mediastinum are negative.Enhanced CT of brain:There is no evidence of intracranial metastatic lesion. Calvarium is intact.Findings consistent with small vessel disease are again identified and made no gross interval change since prior study from 2009.80 CT of Omnipaque 350 was administered for the above studies.

Output: 1.Interval decrease in the amount of soft tissue within the left nasal cavity compared to prior nonenhanced CT of the maxillofacial region. A small enhancing tissue in the anterior aspect of the left nasal cavity may represent recurrence of tumor as detailed above. Further evaluation with a dedicated enhanced MRI is recommended since this finding could also conceivably represent postoperative scarring. This finding is not associated with any new bony changes.2.Stable CT examination through the rest of soft tissues of neck and with no evidence of pathologic adenopathy.3.No evidence of metastatic disease to the brain or calvarium. Findings of small vessel disease remains grossly stable since prior study.


Instruction: Generate impression based on findings.

Input: Male, 16 years old, with history of ligamentous injury to the neck in 2008, status post halo fixation and fusion from the axis to C3, now presenting with new neck pain. Cervical spine:Posterior fusion instruments are evident from the occiput to the C3 level. Osseous fusion of the craniocervical junction is demonstrated with incorporation of the basiocciput, odontoid process, lateral masses of C1 and C2 and the anterior C1 arch, as well as the posterior occiput and the posterior elements of C1-C3.Apart from the fusion-induced straightening of the cervical lordosis, sagittal alignment is otherwise unremarkable. Vertebral body heights are preserved. No evidence of marrow edema or marrow replacement is seen.The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are suspected. The paraspinal and ligamentous soft tissues are unremarkable.At C7-T1, loss of disc T2 signal is demonstrated as well as a small left foraminal protrusion. The spinal canal is not significantly compromised. However, there is moderate left and mild right foraminal narrowing. The remaining levels are free of significant stenosis.Brain:Brain parenchymal morphology and signal characteristics are within normal limits. No focal lesion, edema or mass effect is detected. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.

Output: 1.Findings compatible with successful osseous fusion of the craniocervical junction.2.No evidence of any acute cervical spine injury. Disc degeneration at C7-T1 results in moderate left and mild right foraminal narrowing.3.Unremarkable evaluation of the brain.


Instruction: Generate impression based on findings.

Input: 81-year-old male status post fall. Hit head. Evaluate for bleeding. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse patchy hypodensities in the periventricular and subcortical white matter distribution consistent with microangiopathic changes. Right MCA distribution hypodensity consistent with previous infarct. No acute cortical strokes are noted. If there is clinical concern for acute ischemia, an MRI may be considered.Proportional prominence of the ventricles and sulci.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 17-year-old female with history of right knee pain. MENISCI: There is mildly increased signal intensity within the inner aspect of the posterior horn of the medial meniscus near its root which may represent focal degeneration or mild fraying, but we see no discrete tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is unremarkable. Bone marrow signal intensity is normal.LIGAMENTS: There is deformity and increased signal intensity of the posterior cruciate ligament compatible with a high-grade partial thickness or full thickness midsubstance tear.EXTENSOR MECHANISM: The extensor mechanism is unremarkable.ADDITIONAL

Output: 1.Tear of the PCL.2.No evidence of meniscal or cartilage injury.


Instruction: Generate impression based on findings.

Input: 81 years Female (DOB:10/21/1934)Reason: ataxia evaluate cerebellum History: as abovePROVIDER/ATTENDING NAME: SCOTT STERN SCOTT STERN The CSF spaces are appropriate for the patient's stated age with no midline shift. There are small bilateral subdural effusions present which are most likely related to atrophy. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. On susceptibility imaging is a punctate focus of susceptibility effect along the medial right temporal lobe adjacent to the temporal horn of the right lateral ventricle. In isolation this is of little clinical significance.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction and no abnormal mass lesions are identified to explain the patient's ataxia.