Instruction: Generate impression based on findings.

Input: History of HCV, cirrhosis, and cholangiocarcinoma. No ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from right segmentectomy are again present. The large fluid collection in the right lobe of the liver (series 8, image 12) measures 6.2 x 10.9 cm, not significantly changed. Additional small loculated fluid collections along the right hepatic lobe (series 8, image 18) have also not significantly changed. The previously described and previously enhancing lesion along the lateral margin of the right hepatic lobe subjacent to the aforementioned fluid collection again demonstrates intermediate T2 signal and restricted diffusion. The lesion measures approximately 1.2 x 3.7 cm on T2-weighted images (series 8, image 12) previously 1.2 x 4.1 cm when similar measurement technique used. No new lesions are identified.There is no biliary ductal dilatation.SPLEEN: Cystic lesion in spleen is unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Evaluation is somewhat limited without intravenous contrast. 2.Within this limitation, lesion along the hepatic resection margin which possibly represents a marginal recurrence has not significantly changed in size. No new lesions are identified.


Instruction: Generate impression based on findings.

Input: Personal history of left breast lumpectomy in 2005 for DCIS followed by radiation and Arimidex therapy. Family history of breast cancer in her paternal cousin and ovarian cancer in her mother. There is heterogeneous amount of fibroglandular tissue in both breasts.There is motion artifact which is a signification limitation to this exam.

Output: Exam is non-diagnostic due to motion artifact. The exam should be repeated.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: R - Technical Repeat Views.


Instruction: Generate impression based on findings.

Input: 52 year old female with breast cancer (metastatic). Please evaluate disease. On chemotherapy. No evidence of metastatic disease to the brain or the leptomeninges is identified. An expansile and suspected of hypervascular mass is identified in the left occipital bone. This mass measures approximately 43 mm in transverse axis and 25-mm in AP axis. This is highly suspected of a metastatic skull lesion. The mass minimally expands into the epidural space and is suspected of producing vasogenic edema of the left occipital lobe. There is significant extra osseous spread of tumor into the soft tissues of the scalp. For further evaluation and in particular for better evaluation of the status of brain parenchymal under this tumor an MRI is recommended.

Output: 1.No evidence of intracranial brain parenchymal or leptomeningeal metastases.2.Expansile destructive and suspected of highly vascular tumor in the left occipital bone with vasogenic edema left occipital lobe.3.Further evaluation with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Ulnar sided wrist pain. Evaluate wrist for ligament/TFCC tear. Contrast opacified the radiocarpal joint in the expected manner. No contrast was seen extending into the distal radioulnar joint to indicate a triangular fibrocartilage tear. No contrast was seen entering the midcarpal joint to indicate a scapholunate or lunotriquetral ligament tear. Please refer to the subsequent MRI report for further information.EXPOSURE TIME: 1 minute, 59 seconds.

Output: Successful injection of contrast into the radiocarpal joint, without evidence of ligament or TFCC tear.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of tongue, unspecified site. Malignant neoplasm of soft palate. Malignant neoplasm of retromolar area. Secondary malignant neoplasm of bone and bone marrowClinical question: h/o HNC, CRT, and bone mets, compare to previous, measurements please There is redemonstration of a 55 mm superior-inferior length x 9 mm thickness x 38 mm AP dimension mass centered at the T7 and T8 vertebral body levels which is anterior lateral to the right aspect of these vertebral bodies. It previously measured 55 mm superior-inferior length 37 mm and AP dimension and 8 mm in thickness.From C1 down to T3 the marrow signal within the spine is high signal. From T4 through T12 is predominantly low signal on T1-weighted imaging with the exception of T11 which is predominantly high signal but heterogeneous. On postcontrast imaging there is redemonstration of an enhancing lesion within the T10 vertebral body measuring 20 mm in one in the T11 vertebral body measuring 11 mm. Within the T9 vertebral body measures 9 mm one in the T8 vertebral body measures 17 mm one in the T7 vertebral body measures 6 mm smaller lesions are present at T5,T4 and T3. Compared to the prior exam lesions have not changed in size.The cystic lesion present within subcutaneous lesions at the level of the T6 spinous process which most likely represents a sebaceous cyst.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.There is a right anterolateral paraspinous lesion centered at the T7 and T8 vertebral body levels which is minimally larger on the current exam when compared to the prior exam.2.There are multiple lesions scattered throughout the thoracic spine which are stable in dimensions when compared to the prior exam.3.There is no compromise of thoracic spinal cord or spinal canal identified.


Instruction: Generate impression based on findings.

Input: History of left breast DCIS status post partial mastectomy and re-excision in 2015. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Post operative distortion at the surgical site is present, but there is no suspicious nodular enhancement in that region. The scattered foci previously seen elsewhere in each breast are not significantly changed. No abnormal axillary lymph nodes are identified in either axillary region.High T2 hepatic lesions are likely cysts or hemangiomas.

Output: No MRI evidence for malignancy. Expected post surgical changes in the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Straightening of the cervical spine is seen. There is surgical fusion at C6-C7. There is nonspecific heterogenous marrow signal. T2 high signal due to endplate degenerative changes is seen at C5-C6.C2-C3: Shallow central disc protrusion with no spinal or foraminal compromise.C3-C4: Broad based posterior disc-osteophyte complex with mild spinal stenosis and bilateral mild-moderate foraminal stenosis. There is hypertrophy of the left uncovertebral joint.C4-C5: There is a posterior disc-osteophyte complex and a right paracentral prominence of the disc. There is moderate spinal stenosis with flattening of the right ventral cord and moderate bilateral foraminal stenosis. There is hypertrophy of the right greater than left uncovertebral joint.C5-C6: Moderate posterior disc-osteophyte complex with mild spinal stenosis. There is moderate to severe left foraminal stenosis and moderate right foraminal stenosis.C6-C7: Previous fusion, with no spinal canal stenosis or foraminal narrowing.C7-T1: There is minimal posterior disc-osteophyte complex with no spinal compromise. Mild right foraminal narrowing.There is prominence of the central canal within the visualized cervical cord, measuring up to 2 mm. This extends beyond the lowest visualized T2-T3 level.

Output: 1. Mild moderate degenerative disc disease of the cervical spine as described above. Up to moderate central spinal stenosis at C4-C5. Worst foraminal stenosis is seen on the left at C5-C6 where it is moderate-severe in degree. No significant interval change from prior exam.2. Stable appearance of trace prominence of the spinal canal within the cervicothoracic cord, extending beyond the visualized T2-T3 level. Dedicated MR of the thoracic spine may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: Dysarthria and dysphagia. A few T2-hyperintense subcortical lesions in the frontal white-matter have minimally increased since the January 2013 examination. The brain parenchyma and pituitary gland appear unremarkable otherwise. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and sulci are unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the ethmoid sinuses. There are degenerative changes involving the right temporomandibular joint, with associated enhancement.

Output: 1.A few nonspecific frontal white-matter lesions have minimally increased since January 2013 and may represent chronic microvascular ischemia, among other potential etiologies.2.No evidence of intracranial hemorrhage, mass, or acute infarct.3.Degenerative changes involving the right temporomandibular joint with apparent associated inflammation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 66-year-old male with history of astrocytoma presenting with headache. Extensive vasogenic edema bilaterally appears similar when compared to recent MRI. No evidence of intracranial hemorrhage. The right subdural hematoma that is seen on prior MRI is no longer identified on current study. The ventricles and basal cisterns are normal in size and configuration. Postoperative changes of the calvarium remain unchanged. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable vasogenic edema. No acute intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 15-year-old male baseball player with right elbow pain. Evaluate for ulnar collateral ligament insufficiency. The study is slightly limited due to the inability to optimally position patient due to pain and claustrophobia and inability to fully extend the arm.LIGAMENTS: The collateral ligament appears intact. The radial collateral ligament complex is grossly intact.TENDONS: The common flexor tendon appears intact. The common extensor tendon appears intact. The triceps tendon appears intact. The biceps and brachialis tendons appear intact.ARTICULAR SURFACES AND BONE: There is edema within the medial epicondyle as well as widening of the underlying physis compatible with physeal injury as suggested on prior radiographs. The bone marrow signal intensity is otherwise within normal limits. There is no evidence of an osteochondral defect. There are no loose bodies within the joint.SURROUNDING STRUCTURES: The remaining visualized soft tissue structures are within normal limits.ADDITIONAL

Output: Medial epicondyle physeal injury with intact ulnar collateral ligament.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of connective and soft tissue of thorax [C49.3], Reason for Study: ^Reason: History of soft tissue sarcoma,e valuate for local recurrence History: surveillance Redemonstration of postoperative changes of thoracic right paraspinal soft tissue lesion, unchanged since prior scan.There is no evidence of abnormal signal intensity.No evidence of abnormal enhancement.There is normal thoracic kyphosis The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow demonstrate a normal MR appearance. The signal of the visualized cord is normal. T1 and T2 hyperintensity in the left third and seventh ribs compatible with small hemangiomas, unchanged since prior scan. Degenerative changes including mild spinal stenosis at the level of T11-12 and neuroforaminal narrowings bilaterally at the level of T9-10 and T10-11 are again seen, unchanged.

Output: 1. No evidence of recurrent disease.2. Unchanged postoperative findings and multi-level degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: 47 year old woman with non ischemic cardiomyopathy, referred for further evaluation of underlying etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 28%, the LV end diastolic volume index is 137 ml/m2 (normal range: 65+/-11), the LVEDV is 307 ml (normal range 109+/-23), the LV end systolic volume index is 97 ml/m2 (normal range 18+/-5), the LVESV is 218 ml (normal range 31+/-10). There is regional variation in segmental contraction. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of acute inflammation or edema on T1 or T2 imaging.Left AtriumThe left atrium is enlarged. Right VentricleThe right ventricle is normal in size with lower normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 54 ml/m2 (normal range 69+/-14), the RVEDV is 120 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 28%. There is dyssynchronous contraction. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Additionally there is no evidence of acute inflammation or edema on T1 or T2 imaging.2. The right ventricle is normal in size with lower normal systolic function. The overall RV ejection fraction is 54%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pain. MENISCI: Globular intermediate signal abnormality is seen in the posterior horn and body of the medial meniscus. Superimpose multidirectional complex tearing is present with horizontal and vertical components. Radial tear is question toward the root of the medial meniscus. Morphology and signal characteristics of the lateral meniscus are within normal limits without evidence of discrete tear.ARTICULAR CARTILAGE AND BONE: There is grade IV chondromalacia of the articular cartilage of the medial femoral condyle. Grade II to III chondromalacia is seen with the lateral femoral condyle. Grade IV chondromalacia of the lateral patellofemoral articulation is also noted. Mild reactive bone marrow edema is seen in the medial femoral condyle and diffusely in the tibial plateau.LIGAMENTS: Thickening and intermediate signal of the ACL suggests partial tearing. The PCL is intact. Increased fluid signal surrounding the medial collateral ligament may reflect medial compartment pathology. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Multidirectional complex tearing of the medial meniscus.2.Grade IV chondromalacia of the medial femoral condyle and lateral patellofemoral articulation.3.Partial ACL tear.


Instruction: Generate impression based on findings.

Input: 25 year old male with a history of syncope, and concern for noncompaction. Left VentricleThe left ventricle is is normal in size and systolic function. There is no evidence of noncompaction. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 226 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 92 ml (normal range 47+/-19), the LV mass index is 67 g/m2 (normal range 85+/-15), and the LV mass is 157 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 221 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. Normal left ventricular size and systolic function (LVEF 59%). No evidence of LV noncompaction. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. Normal right ventricular size and systolic funciton (RVEF 59%)I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up lumbar spinal stenosis. Signs and symptoms: Pain and tingling. Nonenhanced lumbar MRI:T10-T11, T11-T12, T12-L1 levels are unremarkable other than mild degenerative changes.L1-L2 demonstrate moderate disc disease and loss of disc height, mild broad-based bulging disc, asymmetric (R>L) ligamentum flavum hypertrophic changes and mild facet disease. There is interval progression of degenerative disease at this level since prior exam. Constellation of changes results in mild central spinal stenosis and moderate to severe right lateral recess compromise. Linear increased T2 signal intensity within the annulus of the disc on the left and far laterally consistent with an annular fissure is noted. There is highly suspected early development of a right sided synovial cyst dissecting into the right ligament and contributing to right lateral recess compromise. No neural foraminal compromise.L2-L3 demonstrate mild disc disease and loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and moderate bilateral facet hypertrophic changes. There is interval progression of disease and resultant moderate to severe central spinal stenosis and mild left neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height and moderate bilateral facet and ligamentum flavum hypertrophy and including the right facet effusion. There is progression of disease since prior exam. New since prior exam however is a large left sided disc extrusion with superior migration behind the vertebral body of L3 on the left. There is resultant significant mass effect on the thecal sac on the left and the deviation to the right as well as significant central spinal stenosis. Moderate left neural foraminal compromise and patent right.L4-L5 demonstrate mild disc disease and loss of disc height, severe left and mild right facet and ligamentum flavum hypertrophic changes are present. There is progression of degenerative changes since prior exam. There is central shallow broad-based disc protrusion at this level which is new since prior exam and with resultant subtle flattening deformity of the thecal sac. There is mild central spinal stenosis, significant left lateral recess compromise, significant left neural foraminal compromise and patent right neural foramen.L5-S1 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. Without significant change since prior exam. There is no neural foraminal or central spinal stenosis.

Output: 1.At L3-L4 there is a large left-sided disc extrusion with superior migration behind the body of L3 which in combination with extensive degenerative changes results in significant central spinal stenosis and moderate left neural foraminal compromise as detailed. There is progression of degenerative changes at this level.2.Interval progression of degenerative disease at L1-L2 with resultant significant right lateral recess compromise as detailed.3.Please review progression of degenerative disease at other levels as detailed per level above.


Instruction: Generate impression based on findings.

Input: Male, 36 years old, with history of GBM, off all therapy now, follow-up exam. Redemonstrated is evidence of right-sided craniotomy and resection of a tumor from the right frontal lobe. The resection cavity is stable in size and morphology. Minimal T2 hyperintensity surrounding cavity is unchanged. Minimal extra-axial thickening and enhancement along the posterior lateral craniotomy margin is unchanged and likely postoperative in nature. No new or masslike areas of enhancement are seen. Elsewhere, the cerebral parenchyma demonstrates normal signal characteristics. The ventricular system is stable in size and morphology.

Output: Stable postoperative findings with no evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Possible CNS involvement in patient with MF: visual loss and decrease in visual acuity. There is no evidence of mass lesions or abnormal enhancement in the cervical spine. There is enhancement along the oculomotor nerves. 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 multilevel degenerative cervical spondylosis, with a disc-osteophyte complex at C3-4 that abuts the spinal cord. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of mass lesions or abnormal enhancement in the cervical spine. However, there is enhancement along the oculomotor nerves. Please refer to the recent brain MRI report for additional details.


Instruction: Generate impression based on findings.

Input: Otalgia, right ear [H92.01] / Headache [R51], Reason for Study: ^Reason: assess for possible right neuralgia or other pathology History: right sided facial pain Motion artifact degraded exam quality.There is no evidence of acute ischemic lesion.There is no evidence of mass. There is no evidence of abnormal enhancement.Internal auditory canals identified without evidence of any abnormal enhancing lesion.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 mastoid air cells are clear. There is fluid collection on the left maxillary sinus.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: Reason: Left foot osteomyelitis History: Left foot ulcer and SIRS There is soft tissue irregularly along the dorsal and lateral aspect of the fifth MTP joint consistent with the patient's history of ulceration. There are foci of signal void within the subcutaneous tissues in the surrounding area likely representing gas. There is enhancing signal abnormality within the subcutaneous tissues that extends to the level of the fifth MTP joint with resultant bone marrow signal abnormality within the proximal phalanx of the fifth toe and fifth metatarsal head, consistent with osteomyelitis. There is synovial enhancement and fluid within the fifth MTP joint likely reflecting a septic arthritis. There is also enhancement of the subcutaneous tissue along the dorsal aspect of the fifth MTP joint which may reflect early abscess formation/phlegmon. No drainable encapsulated collection is identified. There is deformity of the second and third metatarsal head with erosion of the third metatarsal head which may reflect prior trauma or infection. An additional soft tissue ulceration is identified along the dorsal and medial aspect of the first MTP joint. There is enhancing signal abnormality which extends along the medial and plantar aspect of the first metatarsal head which may reflect additional phlegmon/early abscess formation, however, no bone marrow signal abnormality is identified in the adjacent first metatarsal or sesamoids. No drainable collection is identified. The remainder of the imaged musculature and soft tissues of the foot are unremarkable.

Output: Multiple soft tissue ulcers as described above. Findings indicating osteomyelitis of the head of the fifth metatarsal and proximal phalanx of the fifth digit. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 69-year-old female presents with biopsy proven right breast carcinoma (two sites), locally advanced to lymph nodes. There is scattered fibroglandular tissue with mild background parenchymal enhancement noted bilaterally.In the far posterior slightly lower outer left breast, there is a 3.4 x 3.3 x 3.1 cm circumscribed enhancing mass which contained susceptibility artifact from biopsy clip, compatible with the patients known malignancy at the 9 o'clock position. This resides approximately 0 .4 cm anterior to the pectoralis muscle. A second mass is present within the central slightly upper outer right breast measuring 1.4 x 1.0 x 1.2 cm, corresponding to the patient's known malignancy at the 10 o'clock position. Non-mass enhancement is present extending anterior and lateral to the masses, spanning 7.8 cm AP. Total AP extent of enhancement inclusive of masses and non-mass enhancement is 11.4 cm.Multiple prominent right axillary lymph nodes are present. One node contains a Hydromark clip from prior biopsy. Of note, prominent nodes are appreciated at the lateral border of the pectoralis muscle. No areas of abnormal enhancement are present within the left breast. No enlarged lymph nodes are present within the left axilla.

Output: 1. Two enhancing masses within the upper outer right breast, compatible with the patient's known malignancy. Non-mass enhancement is noted extending anterior and lateral the the masses. Total extent of enhancement in the right breast is 11.4 cm AP. 2. Multiple prominent right axillary lymph nodes, one of which contains a biopsy clip.3. No MRI evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: 62-year-old female with metastatic Phyllodes tumor to spine. Signs and symptoms: Back pain. Non-enhanced CT lumbar spine:Examination demonstrate a large destructive lytic lesion involving the vertebral body of L5 on the right with involvement and extension across the right pedicle into the right facet complex and transverse process of L5 vertebrae. The overall length of this lesion measures 56-mm in transverse axis and 37-mm in AP axis. This lesion also partially involve the right lamina. There is partial extra osseous extension of tumor into the right neural foramina at L5 -- S1 and minimally at L4 -- L5. There is no distinct evidence of extension of mass into the spinal canal. For detailed evaluation an MRI is significantly more sensitive for detection of extent of tumor. Minimal bulge of disk, degenerative change and vacuum phenomenon of L4 -- L5 disk is noted. The a small additional separate foci of low-attenuation in the left paramedian of L5 vertebrae is also present. This finding also could represent a small additional metastatic lesion and measures 7-mm times 11-mm in size. Minimal sclerotic changes along the inferior endplate of L2 is believed to be secondary to degenerative changes. No additional lytic or sclerotic metastatic lesions are identified. The alignment of the lumbosacral spine remains within normal.CT of cervical spine:A large lytic / sclerotic destructive bony lesion is noted involving the left aspect of vertebral body of C6 with involvement of left transverse process, pedicle, facet complex and left lamina. The overall transverse axis of this tumor measures 34-mm and 22.5-mm in AP axis. There is small extra osseous spread of tumor into the left paraspinal space. There is shallow epidural spread of tumor along the ventral aspect of the canal on the left and along the lamina on the left. This tumor also appears to involve the left foramina transversarium. The normal alignment of vertebral column is maintained. A very small entirely intraosseous a foci of low density within the anterior aspect of body of C4 vertebrae may also in indicate a second metastatic foci. This lesion measures on the 3.5 x 2.5-mm in size.

Output: 1.Large destructive lytic metastatic lesions of vertebral bodis, pedicles, transverse process and lamina of C6 and L5 as detailed above. There is a small extra osseous spread of tumor into the soft tissues of cervical spine and epidural space of the lumbar spine. Please see above detailed report.2.Possible two very small entirely intraosseous additional metastatic foci.3.The alignment of vertebral column and cervical and lumbosacral spine remains within normal.


Instruction: Generate impression based on findings.

Input: Low back pain, right leg pain. History of discectomy in December Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge. Mild bilateral neural foraminal narrowing. No spinal canal stenosis. Mild facet arthropathy.L4-L5: Status post right-sided laminectomy and discectomy. Diffuse disc bulge, facet arthropathy, and ligamentum flavum thickening are seen on the current study with at least moderate spinal canal stenosis. Mild clumping of the cauda equina nerve roots is also noted compatible with arachnoiditis. There is mild to moderate bilateral neural foraminal narrowing which appears worse since prior. Postcontrast images demonstrate enhancement along the dorsal aspect of the disc bulge compatible with granulation tissue as well as enhancing tissue involving the right epidural space and paraspinous soft tissues also compatible with granulation tissue. No recurrent disc protrusion or extrusion is evident. There is effacement of the lateral recesses.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues demonstrate postsurgical changes without significant fluid collections and otherwise unremarkable.

Output: Interval postsurgical changes of right L4-L5 laminotomy and discectomy are seen. No (focal) recurrent disc herniation is evident. However, there is residual diffuse disc bulge with granulation tissue, facet arthropathy, and ligamentum flavum thickening which in combination result in at least moderate degree of spinal canal stenosis. There is also mild to moderate neural foraminal stenosis at L4-L5 which appears slightly worse than prior.There is mild clumping of the cauda equina nerve roots suggestive of mild arachnoiditis.


Instruction: Generate impression based on findings.

Input: 4-year-old male with a prolonged seizure, history VPS. Intracranial VP shunt catheter tubing is intact. Catheter tubing traverses the right parietal lobe, through the atria of the right lateral ventricle, and terminates with tip in the body of a mildly dilated left lateral ventricle. No change in the position or course of the catheter compared to previous examination. The right lateral ventricle remains collapsed and unchanged from previous exam, and the left ventricle also appears grossly unchanged compared to most recent brain MRI allowing for differences in the two modalities. Significant brain volume loss consistent with periventricular leukomalacia as well as abnormal callosal thinning. There is no evidence of periventricular edema to suggest elevated ventricular pressures. There is no evidence of intracranial hemorrhage, mass, or edema. The bones of the calvaria are thin and there is triangulated appearance of the skull, consistent with mild trigonocephaly. The brain may be small for age, correlate clinically for microcephaly. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.No significant change in ventricular size or configuration allowing for difference in technique between CT and MRI.2.PVL and callosal abnormality. refer to most recent MRI for further morphologic description.3.trigonocephaly with possible small size to the brain. Clinically correlate for microcephalus.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, with history of right sphenoid wing meningioma. Follow-up exam. Again seen is a homogeneously enhancing extra-axial mass within the right middle cranial fossa. As before, the lesion demonstrates a broad base of contact along the greater sphenoid wing, lateral margin of the right cavernous sinus and right anterior clinoid process. Since the prior examination, there has been no significant interval change in the size or morphology of this lesion.The adjacent parenchyma of the right temporal lobe and inferior frontal lobe is displaced by this lesion, but no parenchymal edema is detected. The lesion abuts the terminal right ICA but with preservation of the flow void. The right optic nerve passes along the medial margin of the lesion but does not appear to be severely impinged.Numerous patchy periventricular and subcortical T2 hyperintensities are again seen, not significantly changed from the prior examination. No evidence of restricted diffusion is detected.No parenchymal edema or new mass effect is seen. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are within normal limits for size.

Output: 1.Stable presumed meningioma within the right middle cranial fossa with a broad base of contact along the sphenoid wing, lateral cavernous sinus wall and anterior clinoid process.2.Stable sequela of moderately advanced chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Again seen is a large enhancing extra-axial mass along the planum sphenoidale in the midline which is T1 isointense to brain parenchyma and somewhat heterogeneous on T2-weighted images. There is evidence of minimal gradual enlargement, with the mass for example measuring 38 x 47 x 30 mm in the AP, transverse, and craniocaudal dimensions compared to 34 x 42 x 28 mm on prior post gadolinium study from 10/23/2013. There is significant interval increase in FLAIR hyperintensity in the subcortical right frontal lobe and to a lesser degree in the left frontal lobe. Local mass effect on the bilateral frontal horns is stable to minimally worse. Mass is again noted to abut the right prechiasmatic optic nerve.Again seen is background of bilateral periventricular and subcortical T2/FLAIR hyperintensity compatible with chronic small vessel ischemic disease and evidence of encephalomalacia in the left posterior frontal lobe likely related to prior infarct. There is global parenchymal volume loss commensurate with patient's advanced age. Prominence of the ventricular system is likely related to the volume loss. Prominent mineralization/iron deposition of the basal ganglia again noted. Foci of susceptibility again seen in the left frontal lobe peripherally, adjacent to the anterior body of the left lateral ventricle, and medial to the left atrium, likely representing chronic microhemorrhages. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures with some displacement of the A2 segments of the anterior cerebral arteries.

Output: 1. Minimal gradual enlargement of planum sphenoidale meningioma, which measures 38 x 47 x 30 mm in the AP, transverse, and craniocaudal dimensions compared to 34 x 42 x 28 mm on the prior post gadolinium study from 10/23/2013. There is also interval increase in the surrounding vasogenic edema in the frontal lobes.2. Moderate chronic small vessel ischemic disease and chronic left posterior frontal lobe infarct again seen.


Instruction: Generate impression based on findings.

Input: Posterior circulation stroke: dizziness. Brain MRI: There is a subcentimeter area of restricted diffusion and high T2 signal in the superior cerebellar vermis. The brainstem and supratentorial brain are otherwise unremarkable, aside from minimal nonspecific T2 hyperintensity in the left frontal lobe white matter. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the maxillary sinuses.Brain MRA: There is apparent paucity of flow-related enhancement of the distal portion of the right PICA. The segment of the left vertebral artery distal to the left PICA is markedly diminutive. There is a fetal left PCA. There is an azygous left ACA. The rest of the intracranial arteries are grossly unremarkable and there is no evidence of saccular cerebral aneurysms.Neck MRA: The exam is non-diagnostic due to suboptimal contrast bolus timing.

Output: 1. Small acute infarct involving the superior cerebellar vermis.2. Apparent paucity of flow-related enhancement of the distal portion of the right PICA may indicated steno-occlusive disease versus artifact. 3. The segment of the left vertebral artery distal to the left PICA is markedly diminutive, which may be developmental. 4. The neck MRA is non-diagnostic due to suboptimal contrast bolus timing.


Instruction: Generate impression based on findings.

Input: Male 33 years old Reason: 32 y/o with large soft tissue mass in R upper medial thigh, hernia? malignancy? History: large upper medial thigh mass Large multilobulated soft tissue mass in the medial right thigh measures approximately 13.1 x 6.4 cm in axial dimensions and approximately 13 cm in craniocaudal dimension (series 8, image 9; series 4, image 47). This mass follows fat signal intensity, however on STIR sequences there is some increased T2 signal, as well as some stranding on T1 sequences, suggesting that this is an atypical lipoma. Pre and postcontrast images are suboptimal secondary to poor fat saturation, however no definite enhancement is identified.

Output: Large multilobulated soft tissue mass in the medial right thigh most likely represents an atypical lipoma.


Instruction: Generate impression based on findings.

Input: Left orbital rhabdomyosarcoma partially resected in March 2014 and treated with chemotherapy and proton beam therapy, now off therapy. The patchy high T2 signal and enhancement in the left lacrimal fossa and the superior and lateral extraconal aspects of the left orbit has slightly diminished and there is no evidence of a measurable tumor. There is also minimal residual signal abnormality in the region of the sphenoid triangle. The rest of the left orbit is unremarkable. The right orbits is intact. The imaged portions of the brain appear unremarkable. There is interval increased paranasal sinus mucosal thickening and secretions. There is bilateral tympanomastoid fluid.

Output: 1. Post-treatment findings in the left orbit without evidence of locally recurrent tumor.2. Increased diffuse paranasal sinus inflammation.3. Nonspecific inflammatory changes in the bilateral mastoid air cells may represent mastoiditis.


Instruction: Generate impression based on findings.

Input: Syncope, evaluate for structural lesions. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Low-lying cerebellar tonsils are incidentally noted, particularly on the right, measuring up to 6 mm below the foramen magnum. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.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: 1. No evidence of intracranial mass, mass effect, or recent infarct. 2. Cerebellar tonsils are low-lying without clear evidence of Chiari 1. 3. Few scattered nonspecific foci of T2/flair hyperintensity in the supratentorial white matter. MRI of the brain is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 77 years Male (DOB:5/1/1939)Reason: mass seen in pituitary, headache and dizziness History: headachePROVIDER/ATTENDING NAME: JAMES J WALTER MRI pituitary:The pituitary is enlarged measuring 20 x 18 mm sagittal dimensions and extends into the suprasellar cistern where it displaces the optic chiasm superiorly. The cavernous sinuses are intact bilaterally.MRI of the brainThere are multiple punctate foci of diffusion restriction present in the frontal lobes bilaterally as well as the occipital lobes, right thalamus, and cerebellar hemispheres.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the left maxillary sinus associated with coastal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The left A1 segment is hypoplastic. The posterior communicating arteries are very small. The left vertebral artery is larger than the right vertebral artery.

Output: 1.Findings are available multiple diffusely distributed microinfarcts in both hemispheres and the posterior fossa. This consistent with an embolic shower2.There is a compatible with a pituitary macroadenoma which displaces the optic chiasm.3.No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 55 years, Female, altered mental status, tremors, cranial nerve deficits, evaluate for paraneoplastic disease. Examination is moderately motion degraded. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Borderline low cerebellar tonsils again seen. Brain parenchyma is otherwise unremarkable for age. Minimal mucosal thickening in the paranasal sinuses. Incidentally noted is absent nasal septum and partial absence of the inferior turbinates as seen on recent CT. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are otherwise unremarkable.

Output: 1. Examination is motion degraded. Within this limitation, there is no evidence of acute infarct, intracranial mass or mass effect, or parenchymal signal abnormality to suggest encephalitis. Absence of gadolinium limits evaluation for leptomeningeal disease and cranial nerve involvement as mentioned in the history; lumbar puncture can be considered as clinically indicated. 2. Absence of the nasal septum and small turbinates may be related to prior surgery, granulomatous disease, or given history of substance abuse, can be seen with cocaine use.


Instruction: Generate impression based on findings.

Input: Visual field defect, unspecified [368.40], Reason for Study: ^Reason: Bitemporal hemianopia History: Bitemporal hemianopia Orbit MRIThe globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement. Optic chiasm appears to be normal.Brain MRI No evidence of acute ischemic or hemorrhagic lesion on the scan.Scattered high signal intensities on FLAIR imaging on periventricular white matter indicate nonspecific small vessel ischemic disease.There is a well-circumscribed about 7 mm sized pineal gland cyst without evidence of mass effect toward surrounding structures.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection, hemorrhage, restricted diffusion/acute ischemia or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickening on bilateral maxillary sinuses, frontal sinus and ethmoid sinuses and there is small retention cyst on the right maxillary sinus.

Output: 1. Normal orbit MRI scan.2. No evidence of acute ischemic or hemorrhagic lesion on the scan. No abnormal enhancement.3. Minimal nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Evaluate for medial meniscus tear. McMurray positive. Joint line tenderness. Not responding to conservative treatment. Pain for many months. Worse with activity. Swelling. MENISCI: There is intermediate globular signal abnormality in the body and posterior horn of the medial meniscus. Distinct loss of the apical aspect of the body of the medial meniscus extending to the posterior horn is noted, likely representing an oblique tear. Signal characteristics and morphology of the lateral meniscus are unremarkable.ARTICULAR CARTILAGE AND BONE: There is no significant abnormality of the articular cartilage. Increased marrow signal in the medial tibial plateau and intercondylar region of the femur suggest bone contusions.LIGAMENTS: There is near complete tearing of the anterior cruciate ligament with mild retraction and some fibers seen anterior to the tibial attachment.. Posterior cruciate ligament is intact. EXTENSOR MECHANISM: There is mild redundancy of the patellar tendon without definite underlying signal abnormality, of uncertain clinical significance.ADDITIONAL

Output: Near complete ACL tear, as above.Degenerative signal abnormality with superimposed oblique tear in the body and posterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images of left breast (4/15/14) and breast MRI (4/15/14) performed at Advocate Good Shepherd Hospital. For comparison, digital mammographic images of left breast (4/4/13) are available. Patient is 54 year old male with history of left mastectomy in 2008 for breast cancer. DIGITAL MAMMOGRAPHIC IMAGES (4/15/14):The breast parenchyma is mostly fatty, unchanged from prior study. A marker clip is present in the retroareolar region.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. BREAST MRI (4/15/14):MRI was performed with a protocol outlined in the outside radiology report.Status post right mastectomy.A metallic artifact is present in the left retroareolar region.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 mammographic or MR evidence of malignancy. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Intractable seizures status post laser ablation. There are findings related to right occipital approach laser ablation of the medial right temporal lobe. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues areunchanged.

Output: Expected postsurgical findings related to right medial temporal lobe laser ablation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: disturbance of skin sensation There is 13mm x 9mm x 5mm sized lesion with ectatic venous structure indicating arteriovenous malformation on the left middle posterior temporal gyrus possibly within the left lateral occipital sulcus. There is no associated hemorrhage or surrounding edema.No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate enlarged left MCA angular branch with vascular blushing on the left temporo occipital lobe area indicating AVM.Otherwise unremarkable brain MRA.

Output: Possible left temporo-occipital AVM without evidence of hemorrhage or surrounding edema supplied from the left MCA angular artery.


Instruction: Generate impression based on findings.

Input: 63-year-old male who presents with right leg spasticity for the past 2 months. Brain:There is supratentorial and infratentorial volume loss, which is greater than expected given the patient's age. There is also probably a component of hypoplasia involving the inferior cerebellar vermis. There are scattered areas of periventricular and subcortical white matter T2 hyperintensities which is compatible with moderate chronic small vessel ischemic disease. No evidence of acute infarct or hemorrhage. No abnormal extra-axial fluid collection is identified. There is no midline shift. Normal flow-voids are demonstrated in the major intracranial vascular structures. There are no areas of abnormal enhancement.The bilateral optic nerves and optic chiasm appear small. The paranasal sinuses are clear. The visualized mastoid air cells are clear. Cervical spine:The craniocervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow signal is benign. No abnormal signal within the cervical cord or volume loss is appreciated. No abnormal enhancement.There is congenital narrowing of the mid cervical spinal canal with superimposed degenerative changes. At C4-5, there is a disc osteophyte complex eccentric to the right with moderate right greater than left central spinal canal stenosis and mild bilateral neuroforaminal stenosis. At C5-6, there is minimal disc bulge and ligamentum flavum thickening with mild to moderate central spinal canal stenosis and mild-to-moderate bilateral neuroforaminal stenosis. There is otherwise no significant central spinal canal or neuroforaminal stenosis within the cervical spine. The paraspinal soft tissues are unremarkable.

Output: 1. Diffuse global supratentorial and infratentorial volume loss, which is greater than expected given the patient's age. There is also probable component of hyperplasia involving the inferior cerebellar vermis. 2. Multiple foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but compatible with moderate chronic small vessel ischemic changes. 3. No abnormal enhancement is seen within the brain or cervical cord to suggest an active inflammatory or active demyelinating process.4. Bilateral optic nerves and chiasm are small which may be related to prior injury but nonspecific.5. Degenerative changes in the cervical spine with up to moderate spinal canal stenosis at C4-C5 and C5-C6 as detailed above.


Instruction: Generate impression based on findings.

Input: Gastroesophageal cancer and multiple episodes of syncope. Thre is a punctate focus of enhancement in the superior right postcentral gyrus grey-white junction. There is no evidence of intracranial hemorrhage or acute infarct. There are a few nonspecific punctate foci of cerebral white matter T2 hyperintensity. There is a cystic lesion that measures up to 10 mm in the anterior right temporal lobe. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a non-enhancing ovoid lesion in the left occipital scalp that measures up to 22 mm, which likely represents an inclusion cyst. There is an intrinsically T1 hyperintense lesion in the left parietal calvarium, which may represent a hemangioma.

Output: 1. A punctate focus of enhancement in the superior right postcentral gyrus grey-white junction may represent metastatic disease. 2. A cystic lesion that measures up to 10 mm in the anterior right temporal lobe may represent a neuroglial cyst or prominent perivascular space, for example.


Instruction: Generate impression based on findings.

Input: 40-year-old man with history of pancreatic pseudocyst status post US guided cyst-duodenostomy. ABDOMEN:LIVER, BILIARY TRACT: There is a 10 x 8 mm T2 hyperintense, peripherally enhancing lesion in segment 2 (series 15, image 9), compatible with hemangioma. The liver otherwise appears normal. The patient is status post cholecystectomy. The previously seen extra hepatic biliary duct dilatation is decreased and there is no significant intrahepatic biliary duct dilatation.SPLEEN: The spleen is normal.PANCREAS: The patient is status post cyst-duodenostomy. The previously seen pseudocyst in the head of the pancreas is no longer visualized. The remainder the pancreas appears normal without significant pancreatic duct dilatation. An appropriate secretin response is noted, no abnormal extraluminal contrast accumulation to suggest a leak identified, contrast seen reaching the third portion of the duodenum status post secretin administration.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Resolution of previously seen pseudocyst. Improved biliary duct dilatation.


Instruction: Generate impression based on findings.

Input: 76 years Female (DOB: 6/17/1940)Reason: etiology of progressive R sided radiuclopathic arm/hand pain History: R sided paresthesia, painPROVIDER/ATTENDING NAME: DIONNE J. BLACKMAN DIONNE J. BLACKMAN The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is mild loss of disc space height, disc desiccation and disc bulge at this level. There is mild hypertrophy of the ligamentum flavum at this level. There is only partial effacement of spinal fluid ventral and posterior the spinal cord at this level.At C4-5 there is loss of disc space height, disc desiccation, diffuse disc bulge and ligamentum flavum hypertrophy with partial effacement of spinal fluid ventral and posterior the spinal cord there is uncovertebral osteophyte formation present predominantly in the right side associated with some facet hypertrophy which is associated with encroachment of the right-sided exiting nerve roots at this level.At C5-6 there is loss of disc space height, disc desiccation and diffuse disc bulge as well as mild posterior subluxation of C5 on C6. There are bilateral uncovertebral osteophytes and some endplate osteophytes at this level associated with encroachment of the exiting nerve roots within the neural foramina bilaterally. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine with encroachment of the right-sided exiting nerve roots at C4-5 and encroachment of the exiting nerve roots bilaterally at C5-6. There are only mild degrees of spinal stenosis present.


Instruction: Generate impression based on findings.

Input: Reason: r/o cord compression History: b/l leg numbness/pain and lower back pain; urinary frequency The patient is assess anterior fusion at C5, C6 and C7. There are degenerative changes present in the upper cervical spine mainly at C3-4 and C4-5 where there are findings that suggest spinal stenosis at these levels. Compared to 2011 this does not appear to have changed substantially.There are multilevel degenerative changes present in the lower lumbar spine which were also present on exam from 10/20/14. These are mainly in the form of disk bulge and facet hypertrophy at multiple levels with spinal stenosis and encroachment of the exiting nerve roots within the neural foramina at L2-3, L3-4, L4-5 but worse at L3-4. Based on the available information there does not appear to be any gross change however .

Output: This is a limited exam specific for the exclusion of acute cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities or degenerative change. No cord compression is identified. Rather there are degenerative changes present in the cervical spine with spinal stenosis at the C3-4 and C4-5 as well as at L2-3, L3-4 and L4-5. There is no substantial change appreciated when compared to previous exams.Due to the screening nature of this protocol, details are not as evident on imaging as on dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Syncope and collapse [R55] / Dizziness and giddiness [R42] / Headache [R51], Reason for Study: ^Reason: Eval for mass or ischemia History: Syncope, dizziness, vertigo There is a focal T1 high signal intensity with subtle or no enhancement on post Gad axial image (about 3mm x 4mm on axial post-enhanced scan) on the left frontal lobe deep white matter just lateral aspect of genu of the left caudate nucleus. There is no other enhancing lesion seen on this scan. The lesion is not seen on other image sequences. There is no MR evidence of surrounding edema. The lesion is not conspicuous on other imaging sequences. In addition, the lesion is not seen on the thin section T1 weighted 3D sequence either. Therefore, this lesion is likely to be an artifact. However, short term follow up imaging is recommended to exclude possibility of other diagnostic possibilities such as tumorous or infectious lesion. Underlying brain shows multifocal scattered FLAIR high signal intensity lesions which are non specific. Comparing to prior scan, the numbers of FLAIR high signal intensity lesions appear to be increased since prior scan indicating progression of non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. 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.

Output: 1. About 3mm sized focal T1 high signal intensity lesion with subtle or no enhancement on the left frontal lobe deep white matter, likely represent an artifacts. However, short term follow up is recommended to exclude other possibilities.2. No evidence of acute ischemic or hemorrhagic lesion.3. Non specific small vessel ischemic disease slightly progressed than prior scan.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for stenosis or myelopathy. Signs and symptoms: Finger and toe paresthesia, back pain, slight bilateral ankle clonus and increased LLE tone. Pre-and post-enhanced cervical MRI:Foramen magnum is unremarkable.C2 -- C3 demonstrate mild degenerative changes with resultant moderate left neuroforaminal compromise.C3 -- C4 demonstrate degenerative disk disease with asymmetric ( R > L) uncovertebral hypertrophic changes resulting in significant right and mild left neural foraminal compromise. Mild central spinal stenosis is also present.C4 -- C5 demonstrate moderate disk disease and loss of disk height, mild bilateral (L > R) facet hypertrophy changes. This finding results in significant bilateral (R > L) foraminal compromise.There is a large central and bilateral paramedian disk protrusion resulting in mass-effect, flattening and posterior displacement of the cord and significant central spinal stenosis. There is highly suspected cord increased T2 signal intensity at this level. The signal change of the cord extends inferiorly to approximately the C6 level. At C6 level there is suggestion of decreased cord caliber suggesting myelomalacia. C5 -- C6 demonstrate moderate disk disease and loss of disk height, and mild bilateral facet hypertrophic changes. Findings results in significant bilateral (R > L) neural foraminal compromise. There is a large ventral epidural low signal intensity defect which is a slightly larger on the right and is believed to represent a disk and osteophyte complex. The finding results in mass effect, flattening deformity and posterior displacement of the cord and moderate to severe central spinal stenosis. There is cord T2 signal intensity at this level with decreased cord caliber suggesting myelomalacia. There is posterior longitudinal ligament hypertrophic changes more noticeable at C4 through C6 levels present also.C6 -- C7 demonstrate moderate disk disease and loss of disk height, mild bilateral facet hypertrophy changes and no central spinal stenosis. Moderate right and mild left neural foraminal compromise is presentC7 -- T1 is unremarkable.Post-enhanced images are negative for any abnormal enhancement of the cord or the leptomeninges. Is also no detectable abnormal enhancement the vertebral column.Pre-and post enhanced thoracic MRI:T1 -- T2 demonstrate mild degenerative changes of the result in moderate left neural foraminal compromise.T2 -- T3 is unremarkable other than mild degenerative changes.T3 -- T4 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.T4 -- T5 demonstrate mild degenerative disk disease and mild to moderate asymmetric left facet hypertrophic changes. No spinal stenosis and mild left neural foraminal compromise.T5 -- T6 demonstrate moderate disk disease and loss of disk height small central disk protrusion which results in subtle flattening deformity of the cord without detectable signal abnormality. No spinal stenosis or neural foramina compromise.T6 -- T7 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.T7 -- T8 demonstrate moderate disk ease and loss of disk height, small central disk protrusion with resultant effacement of the ventral subarachnoid space and subtle flattening deformity of the cord, mild central spinal stenosis and no neural foraminal compromise.T8 -- T9 demonstrate mild degenerative changes without spinal or neural foraminal compromise.T9 -- T10 demonstrate mild to moderate degenerative changes resulting in mild to moderate right neural foraminal compromise.T10 -- T11 demonstrate moderate disk is some loss of disk height, a right lateral small disk protrusion partially extends into the right neural foramina and with resultant moderate stenosis.T11 -- T12 demonstrate moderate disk disease and loss of disk height and mild bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.T12 -- L1 is unremarkable.Post enhanced images are unremarkable.

Output: 1.MRI examination of cervical spine demonstrates extensive degenerative disk disease and to a lesser degree hypertrophic changes of posterior elements. Significant central spinal stenosis and bilateral neural foraminal compromise at C4 -- C5 secondary to degenerative disease and large central disk protrusion. Spinal stenosis and neural foraminal compromise at C5 -- C6 secondary to degenerative disease and a disk osteophyte complex as detailed. Increased T2 signal intensity of the cord extending from mid C4 to mid C6 levels as detailed. Extensive degenerative changes at other levels with multilevel neural foraminal compromise (some significantly) as detailed per level above. Unremarkable post enhanced images.2.MRI examination of thoracic spine also demonstrates extensive degenerative disk disease and to a lesser degree hypertrophic changes of posterior elements throughout the spine. There are small central disk protrusion at multiple levels with resultant mild central spinal stenosis suspected only at T7 -- T8. No detectable cord signal abnormality. Multi-level neuroforaminal compromise as detailed per level above. Unremarkable post enhanced images.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: No significant abnormality noted. There is mild degenerative cystic change noted in the humeral head posteriorly.SUPRASPINATUS OUTLET: There is mild osteoarthritis and edema within the acromioclavicular joint. There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Increased signal within the anterior labrum which likely represents tearing but further characterization is limited absent intra-articular contrast. Alignment of the glenohumeral joint is normal. There is mild cartilaginous thinning of the glenohumeral joint, particularly of the humeral head.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Mild osteoarthritis of the acromioclavicular joint.2. Suspected superior and anterior superior labral tearing.


Instruction: Generate impression based on findings.

Input: Reason: Rule out pancreatitis History: elevated amylase lipase, continued abdominal pain/weight lossEXAMINATION: Pancreas MRI and MRCP without and with IV contrast 06/11/15 at 14:45 ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intra- or extrahepatic biliary dilatation, the common bile duct measures approximately 4 mm in greatest diameter. No cholelithiasis or evidence of cholecystitis. Incidental note is made of a relatively low insertion of the cystic duct into the common hepatic duct.SPLEEN: A small splenule is noted at the splenic hilum, measuring approximately 2.5 cm in diameter.PANCREAS: No evidence of pancreatic/peripancreatic inflammation. No pancreatic ductal dilatation. No loculated fluid, abscess, or pseudocyst is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal examination. No evidence of pancreatitis.


Instruction: Generate impression based on findings.

Input: Right lower extremity weakness, concern for cord compression. History of type B AAA s/p TEVAR with Nitinol Graft. The exam is limited by artifacts, such that the spinal cord is not well-delineated and apparent high T2 signal in the conus medullaris may be artifactual. However, there does not appear to be extrinsic compromise of the spinal cord. The vertebral bodies are appropriate in the overall alignment and height. The known aortic dissection is partially imaged.

Output: 1. Assessment of the spinal cord is limited and therefore a subtle spinal cord infarct cannot be excluded. If clinically warranted, repeat imaging of the spinal cord including diffusion weighted sequences may be useful. Nevertheless, no extrinsic compression of the spinal cord is apparent.2. The known aortic dissection is partially imaged. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are bilateral diagnostic mammogram dated February 23, 2015, Right post-procedural mammogram dated February 24, 2015, MRI and right axillary ultrasound dated February 26, 2015 and MRI dated February 27, 2015 performed at Northwestern Memorial Health Care. For comparison, prior mammograms and ultrasounds dating back to August 29, 2012 are available. BILATERAL DIAGNOSTIC MAMMOGRAM (2/23/2015): Two standard views of both breasts, and two spot magnification views of the right breast were obtained. The breast parenchyma is extremely dense ,which limits the sensitivity of the mammogram, unchanged in pattern and distribution. Two loosely grouped clusters of pleomorphic calcifications are present within the lower inner right breast. The anterior grouping of calcifications spans 1.9 cm, and the posterior grouping spans 1.6 cm. Total extent of calcifications in the lower inner right breast spans 6.5 cm AP x 3.1 cm transverse x 4.4 cm craniocaudal. The most anterior extent of calcifications resides approximately 2.7 cm from the nipple base. No dominant mass or areas of architectural distortion are noted in either breast. RIGHT POST-PROCEDURAL MAMMOGRAM (2/24/2015): Per outside report, stereotactic needle biopsy was performed at two sites within the lower inner right breast. Images from the stereotactic biopsy are not submitted, and thus appropriateness of targeting cannot be assessed.An hourglass-shaped biopsy marking clip is present within the anterior lower inner right breast, corresponding to the anterior biopsy site. An X-shaped biopsy marking clip is present within the posterior lower inner right breast, corresponding to the posterior biopsy site.BILATERAL BREAST MRI (2/26/2015): Bilateral breast MRI was performed without and with gadolinium per outside hospital protocol. This examination was non-diagnostic and was repeated the following day.RIGHT AXILLARY ULTRASOUND (2/26/2015): A targeted right axillary ultrasound was performed. Multiple normal morphology lymph nodes are present within the right axilla.BILATERAL BREAST MRI (2/27/2015): Bilateral breast MRI was performed without and with gadolinium per outside hospital protocol.A circumscribed enhancing mass is present within the upper slightly inner left breast measuring 0.7 x 0.6 x 0.6 cm. This mass demonstrates hyperintense signal on STIR sequences and benign persistent kinetics, highly suggestive of fibroadenoma. This likely corresponds to a benign morphology, hypoechoic lesion visualized on prior ultrasound examination dated February 19, 2014. Multiple scattered foci of enhancement are present throughout the left breast, compatible with background parenchymal enhancement.Within the right breast, there is susceptibility artifact from a biopsy clip within the anterior lower inner breast with mild surrounding enhancement. Susceptibility artifact from a second biopsy clip is noted within the more posterior lower inner right breast, also demonstrating mild surrounding enhancement. An area of linear, clumped non-mass enhancement is present extending posterior and inferior to the posterior biopsy clip, measuring 2.9 cm AP x 2.5 cm transverse, extending to the level of the pectoralis muscle. No enhancement is noted within the pectoralis muscle to suggest muscular involvement. Total extent of enhancement within the lower inner right breast is 4.8 cm AP x 3.6 cm transverse. A 1.9-cm fluid collection is noted adjacent to the posterior biopsy clip, compatible with hematoma from recent biopsy. Elsewhere in the right breast, scattered foci of background parenchymal enhancement are present.Incidentally noted are two T2 hyperintense lesions within the liver, likely representing cysts.PATHOLOGY: Per outside reports, the anterior biopsy site (hourglass shaped marking clip) resulted DCIS. The posterior biopsy site (ex-shaped marking clip) resulted IDC with DCIS.

Output: 1. Extensive calcifications within the lower inner right breast with corresponding non-mass enhancement on MRI. Biopsy clips from the two malignant biopsies are present near the anterior and posterior extents of the non-mass enhancement. Total extent of calcifications on mammogram is 6.5 x 3.1 x 4.4 cm (AP x ML x CC).2. Circumscribed, T2 hyperintense, subcentimeter enhancing mass within the upper inner left breast, likely representing a fibroadenoma. This mass is felt to correspond to a benign morphology mass on ultrasound examination dated 2/19/2014, and demonstrates stability dating back to 8/29/2012. Per outside reports, this lesion has demonstrated stability dating back to 2009.BIRADS: 6 - Known cancer. RECOMMENDATION:T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: Posterior osteophyte disc complex and bilateral uncinate hypertrophy, there is mild left and mild-to-moderate right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex and uncinate hypertrophy without stenosis.C6/7: UnremarkableC7/T1: Unremarkable

Output: C4/5: Mild left and mild-to-moderate right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Possible choledocholithiasis on CT. Evaluate biliary ductal system. Patient with abdominal pain and acute pancreatitis. LUNG BASES: Mild dependent atelectasis.ABDOMEN:LIVER, BILIARY TRACT: There is moderate intrahepatic biliary ductal dilatation. The common bile duct is dilated to 9 mm with a rounded filling defect just proximal to the ampulla consistent with choledocholithiasis. There are numerous small gallstones in a distended gallbladder with a small amount of pericholecystic fluid suggesting mild acute cholecystitis.Mild loss of liver parenchymal signal on out of phase images suggests fatty infiltration.No focal hepatic lesion is evident.SPLEEN: No significant abnormality noted.PANCREAS: Mild diffuse restricted diffusion of the distal pancreatic body and tail which appears edematous/focal. There is minimal peripancreatic fluid. These findings are compatible with acute pancreatitis. No discrete fluid collection. Limited noncontrast evaluation for vascular complications shows no abnormality.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild left lateral abdominal wall subcutaneous edema.OTHER: No significant abnormality noted.

Output: 1.Choledocholithiasis resulting in intra and extrahepatic biliary ductal dilatation.2.Numerous small gallstones within a distended gallbladder. Small amount of pericholecystic fluid. Again these findings suggest mild cholecystitis.3.Mild restricted diffusion of the pancreatic body and tail which appears full with mild peripancreatic nonloculated fluid compatible with mild pancreatitis, especially given the setting of elevated lipase.


Instruction: Generate impression based on findings.

Input: 25-year-old male with ankylosing spondylitis. Right hip pain. Evaluate for sacroiliitis. Normal bone marrow signal is seen throughout the visualized pelvis. No evidence of bone marrow edema. No focal osseous lesion is present. No evidence of sacroiliitis.

Output: No evidence of sacroiliitis.


Instruction: Generate impression based on findings.

Input: Dysphagia, recurrent vallecular cyst. There is a cystic lesion near the midline of the tongue base, slightly eccentric to the right, which measures up to approximately 25 mm. The lesion also extends into the root of the tongue. There is no significant airway narrowing. The cervical lymph nodes are not particularly enlarged. The thyroid and salivary glands are unremarkable, The osseous structures are intact. The orbits and imaged intracranial structures are unremarkable.

Output: Findings compatible with a vallecular cyst that measures up to approximately 25 mm, with extension in to the root of the tongue.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with left lumbar radiculopathy. Trace anterolisthesis of L4 relative to L5 is seen. Otherwise, spinal alignment is anatomic. Vertebral body height and morphology are within normal limits allowing for degenerative endplate changes at L5-S1. No suspicious marrow replacement is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: Minimal facet arthropathy. No spinal canal or foraminal stenosis. L2-3: Unremarkable. L3-4: Minimal facet arthropathy. No spinal canal or foraminal stenosis. L4-5: Advanced facet arthropathy with a facet effusion on the left. Ligamentum flavum thickening. Minimal disc bulging. Findings contribute to produce a mild spinal canal stenosis. Moderate to severe narrowing of the left neural foramen. Moderate narrowing of the right neural foramen. L5-S1: Facet arthropathy. Ligamentum flavum thickening. Disc bulging with a superimposed shallow left paracentral protrusion. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing.

Output: Moderate degenerative findings are seen in the lower lumbar spine. Most notably at L5-S1, the combination of advanced facet arthropathy, ligamentum flavum thickening and disc bulging causes mild spinal canal stenosis, moderate to severe left and moderate right foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Reason: 86 yo female with history of pancreas divisum s/p minor sphincterotomy and stent placement as well as major papilla sphincterotomy and balloon dilation in November 2014, now with recurring pancreatic type pain. MRI/MRCP w/ secretin to rule out sphincter re stenosis, also rule out pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are identified. The gallbladder is surgically absent. There is mild central intrahepatic ductal dilatation. There is also extrahepatic ductal dilatation up to 16 mm in diameter with dilation nearly up to level of the ampulla.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is not dilated and measures up to 4 mm in diameter. There appears to be mild stricturing of the main pancreatic duct at the level of the pancreatic head. The major duct courses inferiorly at the level of the common bile duct and then ascends and empties into the minor papilla. The minor duct is nondilated and drains into the ampulla. These findings are consistent with pancreatic divisum. There is a 5 mm cystic focus in the pancreatic body which appears in continuity with the main pancreatic duct (series 4, image 17) and which may reflect a dilated side branch or a side branch IPMN. There is an additional similar lesion in the pancreatic tail also in continuity with the main duct (4, image 16) measuring 5 x 10 mm. There are additional similar smaller lesions within the uncinate process.Post-secretin images demonstrate reduced compliance of the pancreatic duct with satisfactory exocrine function.The pancreatic parenchyma appears atrophic with decreased T1 signal suggesting chronic pancreatitis. No discrete pancreatic masses are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst with thin septations, not significantly changed. Additional renal cysts are present bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pancreas divisum and findings consistent with chronic pancreatitis. Diminished pancreatic duct compliance. Satisfactory pancreatic exocrine function.2.Mild stricturing of the main pancreatic duct at the level of the pancreatic head without significant dilation of the main pancreatic duct.3.Several new small cystic lesions along the pancreatic ducts which may reflect dilated side branches or IPMNs. 4.Persistent dilation of the common bile duct up until the level of the ampulla.


Instruction: Generate impression based on findings.

Input: Reason: r/o advanced stage cervical cancer History: cervical cancer - adeno PELVIS:UTERUS, ADNEXA: There is a lesion along the posterior aspect of the cervix measuring 2.7 x 2.1 cm in transverse dimension (13 oh 1/38), and 1.6 cm in craniocaudal dimension (901/25), suspicious for cervical cancer. This lesion extends 1 cm beyond the posterior wall of the cervix into the posterior parametrial tissues particularly on the right side. There is a small amount of adjacent free fluid. No evidence of rectal, bladder or pelvic side wall invasion. No vaginal wall invasion. A small amount of T2 hyperintense signal along the anterior aspect of the lesion (901/24) may represent cystic debris within the canal or intraluminal extension of tumor.BLADDER: No hydronephrosis.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free fluid in the pelvis.

Output: 1.Cervical lesion measuring up to 2.7 cm with extension into the parametrial tissues as above, suspicious for cervical cancer.2.No pelvic sidewall, bladder, rectal, or vaginal wall invasion. No hydronephrosis.3.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: NMO clinical trial. Orbits: The optic nerves, extraocular muscles, globes, and orbital fat are unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The T2 hyperintensity in the inferior medulla has nearly resolved. The brain parenchyma and cerebellum otherwise 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There is decrease in the degree of T2 hyperintensity and swelling involving the majority of the cervical and thoracic spinal cord, with a few remaining patchy areas of signal abnormality. The cauda equina nerve roots are unremarkable. The vertebral column alignment is unchanged. 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 unremarkable.

Output: The edema involving the medulla has nearly resolved and the edema in the spinal cord has further diminished.


Instruction: Generate impression based on findings.

Input: Altered mental status; agitation. Also dysphagia and abnormal gait prior to admission. Rule out brain infarct. There is no diffusion restriction to indicate recent infarct. There are multiple tiny CSF intensity foci with T2 FLAIR rim involving the basal ganglia reflecting chronic lacunar infarcts. There is also mild prominence of the perivesical spaces. There is extensive confluent and patchy bilateral cerebral hemispheric white-matter T2 FLAIR hyperintensity along with similar finding in the pons which is nonspecific but most compatible with chronic small vessel ischemic disease. There are foci of susceptibility artifact underlying the posterior right frontal craniotomy flap near the vertex in addition to focal mild dural thickening and underlying minimal encephalomalacia. Otherwise, there is no intracranial hemorrhage. There is no midline shift or brain herniation. The ventricles along with the other CSF-containing spaces are enlarged, reflecting moderate global brain volume loss. Though ventricular enlargement is more pronounced than sulcal enlargement, this is still most probably related to brain volume loss. The flow voids of the major intracranial vessels are preserved, reflecting gross patency. Following contrast injection, there is no abnormal brain or leptomeningeal contrast enhancement. Contrast enhancement in the mildly thickened right frontoparietal dura underlying the craniotomy flap near the vertex is probably postoperative in nature. Asymmetric contrast enhancement in the pterygoid muscles is probably related to asymmetry of the pterygoid venous plexus.There is partial opacification of the bilateral mastoid air cells, partial opacification of the paranasal sinuses, and fluid in the nasopharynx. These findings are likely, at least in part, related to presence of endotracheal tube.

Output: 1.Moderate to severe chronic small vessel ischemic disease. No evidence of acute infarct.2.Prior right frontal craniotomy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male; 81 years old. Reason: hx left vocal cord paralysis, concern for RLN injury, special attention to LEFT RLN History: hx left vocal cord paralysis, concern for RLN injury, special attention to LEFT RLN CHEST:LUNGS AND PLEURA: Redemonstration of a left upper lobe lobectomy and accompanying post surgical changes with volume loss, bronchiectasis, and pleural thickening, similar when comparing to prior CT on 8/11/14. In retrospect, there was mild interval increased fibrotic changes in the left apex when comparing CT from 1/28/14. Dense left paramediastinal post radiation fibrotic changes, similar when comparing to prior CT on 8/11/14.Pleural thickening and fibrotic changes demonstrate mild contrast enhancement and restricted diffusion, but there is no focal, suspicious lesion seen.No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Cardiac size is normal without evidence of pericardial effusion.No hilar or mediastinal lymphadenopathy.Small hiatal hernia.CHEST WALL: As described on MRI neck exam from 4/13/15, there is T2 hyperintense lesion within the central canal at the level of T7, most likely due to an arachnoid cyst and similar in size when comparing to prior CT.UPPER ABDOMEN: Stable small, nonspecific cystic lesions in the pancreatic body, which may be due to sidebranch IPMN(s). Small, faint T2 hyperintense splenic lesion, most likely benign in etiology.

Output: 1. No evidence of residual or recurrent disease. 2. Stable postoperative and radiation changes in the left upper thorax since prior CT on 8/11/14. 3. No specific finding to account for the patient's symptoms, though as described above, there was mild interval increased fibrotic changes in the left apex when comparing CT from 1/28/14 .


Instruction: Generate impression based on findings.

Input: 78-year-old female with episodes of speech arrest for 5 hours. Evaluate for metastases from breast cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered periventricular and subcortical white matter T2/FLAIR hyperintensities which is nonspecific and unchanged compared to the previous exam. The brain parenchyma and pituitary gland appear unremarkable. There is a tiny enhancing nodule in the left occipital lobe at the end of the calcarine sulcus which was present on the prior exam, has not significantly changed and remains nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of metastatic disease, intracranial hemorrhage, or acute infarct. 2.Mild unchanged chronic likely small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of benign prostatic hyperplasia. Patient requested MRI for outside hospital study. PELVIS:PROSTATE/SEMINAL VESICLES: 4.9 x 2.7 x 3.4 cm. No discrete peripheral zone lesion on this nondedicated MRI of the pelvis. Multiple small nodules within the central gland with medial gland hypertrophy extending into the base of the bladder.BLADDER: Partially distended urinary bladder.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: Changes of BPH with predominantly medial lobe hypertrophy.


Instruction: Generate impression based on findings.

Input: Comatose, intracranial hemorrhage, evaluate for structural lesions. MRI brain: Again seen is intra-parenchymal hematoma centered within the pons measuring approximately 32 x 37 x 47 mm. There is surrounding edema and partial effacement of the fourth ventricle. Again seen is tiny amount of hemorrhage within the ventricular system, layering within the occipital horns. Small foci of susceptibility within the bilateral basal ganglia are compatible with mineralization versus chronic hemorrhage. Minimal extra-axial blood products are noted along the right parietal convexity. Tiny focus of susceptibility seen within the left cerebellar hemisphere, image 33/212, left thalamus, image 118/212, and medial temporal lobes.There is no significant change in mild ventriculomegaly compared to CT. Right transfrontal EVD catheter is in place with small amount of edema as well as small subarachnoid hemorrhage along the catheter tract. There is periventricular FLAIR hyperintensity compatible with transependymal flow. Small perivascular spaces in the basal ganglia. Minimal scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild age related white matter changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is diffuse opacification of the bilateral mastoid air cells. Mucosal thickening involving the maxillary sinuses and patchy opacification of the ethmoid and sphenoid sinuses again seen. Bone marrow signal and extracranial soft tissues are within normal limits. MRA head: Examination is slightly motion degraded. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. Incidentally seen is a hypoplastic left A1. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. Intracranial right vertebral artery is hypoplastic. No evidence of aneurysms or vascular malformations.

Output: 1. Large hematoma centered within the pons is again seen. No associated masses or abnormal enhancement is appreciated. Follow-up evaluation once hematoma resolves may be helpful to exclude possibility of underlying lesion if clinically indicated.2. Few tiny foci of susceptibility as detailed above including the left cerebellar hemisphere and left thalamus which are nonspecific but may represent chronic microhemorrhages; correlate for history of chronic hypertension. Additional foci in the bilateral basal ganglia may represent additional foci of chronic hemorrhages versus mineralization which is not evident on CT.2. MRA demonstrates no aneurysms or vascular malformations. No significant stenosis is appreciated.3. Unchanged mild ventriculomegaly with right transfrontal EVD in place.


Instruction: Generate impression based on findings.

Input: Mass within distal forearm Within the superficial ulnar soft tissues of the distal forearm approximately 3 cm from the distal radius/ulna is a well-circumscribed, T1 isointense/T2 hyperintense solid mass which measures approximately 1.3 x 1.2 x 1.4 cm in the greatest transaxial and craniocaudal dimensions. There are some areas of low signal internally on the T2 sequences. The mass enhances relatively homogeneous with scattered areas of low signal on postcontrast sequences as well. The mass is in close proximity to the basilic vein which appears to run through or over the lesion.No additional soft tissue masses are identified. The osseous structures of the forearm are normal.

Output: Superficial soft tissue mass within the volar the cutaneous tissues of the distal forearm further described above. The imaging findings are nonspecific in nature with some differentials including a vascular lesion or peripheral nerve sheath tumor.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate rotator cuff and biceps for impingement syndrome ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor muscles and tendons are intact without evidence of tearing. The muscle tone is normal without evidence of atrophy.SUPRASPINATUS OUTLET: Mild degenerative changes affect the acromioclavicular joint. There is a small acromial to look with mild downward sloping and mild to moderate tendinopathy of the supraspinatus tendon without focal tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is abnormal signal in the anterior inferior labrum without definite discrete tearing (series #3/14). There is no joint effusion.BICEPS TENDON: The biceps tendon is intact without evidence of tearing. ADDITIONAL

Output: 1. Findings consistent with mild to moderate supraspinatus tendinopathy without discrete tear.2. Abnormal signal in the anterior inferior labrum. If there is concern for labral abnormality, dedicated imaging is recommended.


Instruction: Generate impression based on findings.

Input: 49-year-old female with history of right breast invasive ductal carcinoma status post lumpectomy in June 2016, now presents with left breast pain x 3 weeks. Per ordering clinician, there is a palpable abnormality in the left breast. The patient states that the site of left breast pain corresponds to the area of palpable abnormality. A targeted left breast ultrasound was performed for the patient’s area of concern and in the area of palpable abnormality as marked by the ordering clinician. There is a 0.5 x 0.5 cm vague hypoechoic area in the area of concern. This has no internal vascularity. Note is made that her recent MRI was negative in the left breast, including at this site.

Output: A 0.5 x 0.5 cm vague avascular hypoechoic area in the left breast, corresponding to the area of palpable abnormality and left breast pain. Given this appearance and the recent negative MRI, the finding is considered low suspicion and a 6-month follow-up ultrasound and surgical clinic follow-up physical exam can be considered if physical exam findings are also of low suspicion.Case was discussed with Dr. Jaskowiak and her team will communicate a follow up plan to the patient. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).