Instruction: Generate impression based on findings.

Input: 49 year old female with a personal history of left breast lumpectomy in 2015 for DCIS followed by radiation and hormonal therapy. Family history of breast cancer in mother, diagnosed at the age of 56. She has no breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There are multiple small cysts in the right breast, and a 1 cm cyst at 12:00 position in the left breast.There is a postsurgical scar in the left breast at posterior 3:00 position with multiple metallic artifacts.Multiple metallic artifacts from benign biopsies are seen in both breasts.There is an enhancing mass measuring 6 x 5 x 8 mm (AP x LR x CC) in the right breast at anterior 3:00 position and an enhancing focus in the right breast at anterior 6:00 position. These lesions appear stable or slightly developed from prior study performed at outside institution on March 18, 2015.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. An enhancing mass and focus at anterior 3:00 position and 6:00 position in the right breast. Because the prior study was performed at outside institution, an accurate comparison of these lesions cannot be performed due to difference in techniques. Therefore six-month follow-up MRI is recommended.2. No mammographic evidence for malignancy in the left breast.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: 17-year-old male with pain posterior to the lateral malleolus, positive snapping of the peroneal tendons TENDONS: No significant abnormality noted. No abnormal signal. Peroneal tendons are within normal limits. LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No abnormal bone marrow signal. The articular cartilage is within normal limits.ADDITIONAL

Output: No findings to account for the patients pain.


Instruction: Generate impression based on findings.

Input: Pelvic mass. Ultrasound Report in EPIC: There is a heterogenous left ovarian lesion measuring 9 mm x 7 mm x 15 mm with both cystic and echogenic components with color flow doppler present, essentially unchanged when compared to the prior study on 4/16/15. This may represent a dermoid; other pathology cannot be excluded. PELVIS:UTERUS, ADNEXA: Anteflexed uterus. A T-type IUD is noted in expected position. The endometrium is normal in thickness. The junctional zone is normal in thickness. There is no focal uterine mass.The ovaries are normal in size and morphology containing numerous physiologic cysts.BLADDER: Normally 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: Normal uterus and right adnexa. No discrete lesion corresponding to the reported 1.5 cm left adnexal lesion reportedly seen on ultrasound.


Instruction: Generate impression based on findings.

Input: 62 years Female (DOB:2/21/1954)Reason: acute infarct History: slurred speech, AMS, h/o CVA, old lacunar infarct R caudatePROVIDER/ATTENDING NAME: JEANNE M. DECARA MRI of the brainNo diffusion weighted abnormalities are appreciated.There is encephalomalacia involving the right centrum semiovale and basal ganglia associated with some cystic components. There is slitlike appearance to the atrophy. There is associated susceptibility effect. There is ex vacuo effect along the right lateral ventricleThere is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Susceptibility weighted imaging is degraded by patient motion.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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. The right middle cerebral artery appears narrowed as along the mid M1 segment with approximately 70% stenosis measuring 1 cm in length.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The left P1 segment and left posterior communicating artery are similar in diameter. The right posterior communicating artery is very small The vertebral arteries are similar in size.

Output: 1.There is 70% stenosis present along the midportion of the right M1 segment along the 1 cm length segment of the vessel.2.No evidence for intracranial aneurysm.3.Encephalomalacia along the right basal ganglia and adjacent centrum semiovale is likely related to prior hemorrhage.4.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 5.Susceptibility weighted imaging is degraded by patient motion. This may lower the sensitivity for hemorrhagic lesions on this exam.6.Alphanumeric page was sent to Obada Shamaa pager 7582 at the time of this interpretation and the findings were reported to him.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with toxoplasmosis, follow-up examination. Currently asymptomatic. A lobulated lesion with diffusion restriction and moderate local edema is unchanged in the right occipital lobe. An oval lesion in the right corona radiata with ring restricted diffusion demonstrates slightly reduced FLAIR signal abnormality. Numerous additional small foci of FLAIR hyperintensity are redemonstrated in both cerebral hemispheres without significant interval change. As on the prior examinations, several of the intracranial lesions are associated with susceptibility effect but this is unchanged.No new lesions are seen. No significant generalized mass effect is detected. There are no abnormal extra-axial collections. The ventricular system is stable in size. Redemonstrated is ill-defined non-specific T2 hyperintense signal in the posterior medulla and pons showing no interval change. Opacification of the left ethmoid air cells and perhaps the adjacent nasal cavity is unchanged.

Output: 1.A lesion in the right occipital lobe which induces moderate local edema has not significantly changed.2.A small lesion in the right corona radiata has become smaller. Numerous additional scattered nonspecific lesions show no significant interval change. No new lesions are detected.3.Stable soft tissue opacification of the left ethmoid air cells.


Instruction: Generate impression based on findings.

Input: Ms. Balling is a 61 year old female with biopsy-proven left breast cancer and clinically positive lymph nodes status post neoadjuvant chemotherapy. Upon physical exam, there is vague nodularity identified in the left upper outer breast.A targeted left breast ultrasound was performed for the patient’s area of concern. In the left breast 2:00 location, approximately 5 cm from the nipple, there is an irregular hypoechoic mass measuring 3.7 x 1.8 x 2.8 cm. The irregular mass extends towards the nipple and measures approximately 4.5 cm in the posterolateral to anteromedial direction. There is minimal associated vascularity.In the left axillary tail, an irregular hypoechoic mass is identified measuring approximately 1.6 x 0.7 x 2.9 cm. This may represent one of the enlarged axillary lymph nodes that was identified on prior MRI from 05/2015.

Output: (1) Biopsy proven malignancy in the left breast, measuring slightly smaller when compared to prior MRI from 05/2015. (2) Abnormal soft tissue mass in the left axillary tail, which may represent an enlarged lymph node, as identified on prior MRI.An MRI may be more helpful for surgical planning/management as we would have an equivalent mode of comparison for the biopsy proven malignancy and enlarged axillary lymph nodes. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 16 years Female (DOB:5/3/2000)Reason: 16yo F with h/o nonruptured cerebral aneurysm coiled and stented 8/2015 and 7/2016 with 2 days of nausea and lightheadedness, new headache today History: 2 days of nausea and lightheadedness, new headache todayPROVIDER/ATTENDING NAME: DAVID HOWES DAVID HOWES MRI of the brainNo diffusion weighted abnormalities are appreciated. Comparing CSF flow artifacts in the fossa present. The change compared to 10/13/2015 overall pattern. Differences signal intensity arterial wall to differences in imaging parameters there is no change in the susceptibility artifacts adjacent to the aneurysm. Outside the confines of the appearing aneurysmal space is no convincing evidence for subarachnoid hemorrhage either. The aneurysm is known to have a calcified wall.There is a 42x33x36mm sagittal dimension premedullary and prepontine mass (thrombosed aneurysm with coils distally and proximally) with heterogenous signal on T1 and T2 associated with flow voids. Much of the signal is hyperintense on T1WI.The brainstem is displaced and compressed posteriorly by the mass and drapes over the mass. The inferior aspect of the 4th ventricle is narrowed and the foramina of Luschka are distorted. There is mixed signal along the periphery of the mass on SWI phase imaging with some bright signal and some dark signal some of which is opposite in signal on the corresponding magnitude SWI images (suggesting peripheral calcification). The vertebral arteries and basilar artery are contiguous with this mass.A similar signal characteristic well-circumscribe mass is present in the left upper carotid space measuring 16x22xmm. It is stable compared to the prior exam.The temporal horns of the lateral ventricles are dilated. Biventricular diameter on coronal imaging at the level of foramen of Monro is currently 38 mm October 40 1/3 ventricular diameter is currently 9 mm and was previously 11 mm.There are several supratentorial periventricular and subcortical white matter T2 and FLAIR hyperintense lesions without diffusion restriction.Normal vascular flow voids are present in the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The patient is status post embolic coil occlusion of a 46x36x35mm giant vertebrobasilar aneurysm and occlusion of the LVA intracranially. Stents are present in the RVA across the origin of the aneurysm. There is minimal opacification at the base of the aneurysmThere is a 26x26x16 mm LICA cervical segment aneurysm redemonstrated which has a different opacification pattern on the current exam relative to the prior exam.The anterior communicating artery is identified. The posterior communicating arteries are identified. There is extracranial origin of the right PICA. The LVA is diminutive distally. The left PICA has extracranial origin.

Output: 1.Status post stent assisted embolic coil occlusion of a vertebrobasilar junction giant aneurysm and embolic occlusion of the left vertebral artery (LVA) distal to the PICA. Since the prior exam there is no change. There is only minimal filling at the base of the aneurysm.2.The overall dimensions of the aneurysm and the mass effect remain stable compared to the prior exam. The ventricles are stable.3.Stable size of LICA cervical segment dissecting aneurysm.4.The lateral ventricles although mildly dilated are slightly smaller on the current exam when compared to the October exam.5.There is no convincing evidence for subarachnoid hemorrhage.6.A preliminary report was provided via text message to Anita Bhansali around midnight following the exam.


Instruction: Generate impression based on findings.

Input: 79 years Male (DOB:2/28/1937)Reason: Assess for foci for seizures and r/o structural brain disease History: Seizure, AMSPROVIDER/ATTENDING NAME: CORY S HENDERSON EHTASHAM G KHATTAK The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a minimal degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There is fetal origin of the posterior cerebral arteries bilaterally.The visualized portions of the paranasal sinuses are clear. There is osseous proliferation the floor of the left maxillary sinus. No associated contrast enhancement. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eye lens is thin

Output: 1.There is no evidence for acute cerebral ischemic infarction.2.There is no evidence for intracranial mass lesion to explain patient's seizures.3.Bony proliferation at the floor of the left maxillary sinus is nonspecific possibilities may include reaction to a prior injury or inflammation/infection. Please correlate with clinical history.4.Periventricular and subcortical white matter lesions of a minimal/mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Cyst inferior to right ear with extension into right ear lobe. Face: There is a well-defined ovoid cystic lesion in the right preauricular subcutaneous tissues, which measures up to 20 mm. The lesion is extrinsic to the parotid gland. Indeed, the major salivary glands are unremarkable. The imaged cervical lymph nodes are not enlarged. The orbits are unremarkable. There is a right maxillary sinus retention cyst. The imaged intracranial structures are unremarkable. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: A cystic lesion in the preauricular subcutaneous tissues measuring up to 20 mm may represent an inclusion or sebaceous cyst versus a first branchial cleft cyst.


Instruction: Generate impression based on findings.

Input: 47 year old woman with new wall motion abnormalities on TTE, referred for evaluation of myocarditis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 58 ml/m2 (normal range: 65+/-11), the LVEDV is 81 ml (normal range 109+/-23), the LV end systolic volume index is 20 ml/m2 (normal range 18+/-5), the LVESV is 28 ml (normal range 31+/-10). There are no regional wall motion abnormalities. There is no significant late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 48 ml/m2 (normal range 69+/-14), the RVEDV is 67 ml (normal range 110+/-24), the RV end systolic volume index is 19 ml/m2 (normal range 22+/-8), and the RVESV is 26 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.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 FindingsThere is a right lung paraspinal mass of unclear significance. Left lower lung opacity possibly due to edema, atelectasis or infiltrate . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%. 2. Normal LV wall motion. No delayed enhancement.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%.4. Extracardiac findings as noted above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Myelopathy: twitching/numbness. There is a C4-C5 anterior cervical discectomy and fusion with an intervertebral device. There is also anterior cervical discectomy and fusion of C5 through C7 with intervertebral disc grafts at C5-C6 and C6-C7. There is no evidence of fracture. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. However, there is a diffusely narrow spinal canal, which measures up to approximately 10 mm in anteroposterior dimension. At C2-3, there is a small uncinate spur with minimal left neural foramen stenosis. At C3-C4, there are small bilateral uncinate spurs, contributing to mild bilateral neural foramen narrowing, and a small posterior disc-osteophyte complex with mild left spinal canal stenosis. Likewise, at C4-C5, there are small bilateral uncinate spurs, contributing to mild left neural foramen narrowing. There is also a posterior disc-osteophyte complex at C6-7 with associated mild spinal canal stenosis. The spinal cord displays normal signal characteristics. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to C4-5 anterior cervical discectomy and fusion with a cage device as well as anterior cervical discectomy and fusion of C5 through C7 with intervertebral disc spacers at C5-C6 and C6-C7. 2. Mild degenerative cervical spondylosis with mild spinal canal stenosis at C3-4 and C6-7 superimposed upon a diffusely narrow spinal canal.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [M62.81] / Other specified urinary incontinence [N39.498], Reason for Study: ^Reason: 14 yo with ulcerative colitis, with new onset leg weakness/paresethesia, mild urinary incontinence, want to assess for lumbar lesion. Motion artifact degraded exam quality.For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: no neuroforaminal narrowing or spinal stenosis. L5-S1: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis.

Output: Minimal bulging of disc at the level of L5S1, otherwise unremarkable exam.


Instruction: Generate impression based on findings.

Input: Laser ablation of seizure focus. There are postoperative findings related to recent right temporal depth electrode removal and laser ablation of the right hippocampus. There is a right frontal convexity fluid collection that measures up to 10 mm in thickness, but is otherwise incompletely characterized. There is no midline shift. There is air and swelling in the right temporal scalp.

Output: 1. Postoperative findings related to recent right temporal depth electrode removal and laser ablation of the right hippocampus. 2. A right frontal convexity fluid collection that measures up to 10 mm in thickness is otherwise incompletely characterized.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: cervical cancer with Left DVT with left facial droop was on heparin drip R/o stroke History: left facial droop There are multiple scattered diffusion restriction lesions on the left hemisphere involving left frontal and left parietal lobes without evidence of hemorrhagic conversion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.A small retention cyst in the sphenoid sinus.

Output: Multifocal acute ischemic infarctions on the left frontal and parietal lobes without evidence of hemorrhagic conversion.


Instruction: Generate impression based on findings.

Input: Memory impairment, history of lung cancer, evaluate for metastasis. There is a 9 x 5 mm focus of extra-axial enhancement along the right frontal convexity abutting the right middle frontal gyrus. There is thickening of the adjacent calvarium and susceptibility which may be related to osseous protuberance versus dural based calcification. No significant intracranial mass effect. Otherwise, no abnormal parenchymal or meningeal enhancement. The ventricles are within normal limits in size and configuration for age with mild global parenchymal loss. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Major flow-voids are preserved.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age.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 metastatic disease.2. 9x5 mm focus of extra-axial enhancement along the right frontal convexity may represent a tiny meningioma. There is adjacent osseous protuberance versus dural calcification which could be better assessed with CT. Suggest comparison with prior MRI if available. No significant mass effect associated with this lesion.3. There is mild global parenchymal loss which appears appropriate for age.


Instruction: Generate impression based on findings.

Input: Facial droop and dysarthria. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and orbits are unremarkable. There is a 12 mm thick right occipital scalp lipoma. There is a subcentimeter left maxillary sinus retention cyst.

Output: Mild probable chronic small vessel ischemic disease, but no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Thoracic disc disease, bilateral numbness to lower extremity. There are small posterior disc-osteophyte complexes at T5-6, T6-7, and T7-8, which do not impinge upon the spinal cord. The spinal cord signal characteristics are normal. There is no evidence of tumors in the thoracic spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. Small posterior disc-osteophyte complexes at T5-6, T6-7, and T7-8, which do not impinge upon the spinal cord. 2. No evidence of spinal cord lesions.3. No evidence of tumors in the thoracic spine.


Instruction: Generate impression based on findings.

Input: Left upper extremity weakness, acute or subacute stroke. There are multifocal scattered restricted diffusion lesions involving bilateral frontal lobes, bilateral temporal occipital lobes and bilateral cerebellar hemispheres without evidence of hemorrhagic conversion.However, gradient-echo images which showed multifocal scattered signal void areas including bilateral thalamus and basal ganglia and brainstem indicating small chronic microhemorrhagic foci.On FLAIR imaging, there are patch high signal intensity lesions on bilateral periventricular white matter indicating underlying nonspecific small vessel ischemic disease.There is chronic ischemic infarct related encephalomalacia seen on the left PICA territory.38.8 mm x 10.9 mm sized midline frontal subgaleal lesion which show fat content signal intensity indicating subgaleal lipoma.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multiple bihemispheric, supra and infra tentorial acute ischemic infarctions without evidence of hemorrhagic transformation.2. Chronic ischemic infarction with encephalomalacia on the left cerebellar hemisphere, PICA territory.3. Extensive non specific small vessel ischemic disease.4. Multifocal scattered chronic microhemorrhagic foci.5. Midline frontal subgaleal lipoma, 38.8 mm x 10.9 mm.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE/RFA. Examination somewhat limited by technical factors including suboptimal postcontrast images.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. In hepatic segment 4A, there is a T1 hypointense structure with peripheral intrinsic T1 shortening overall measuring 3.3 x 3.2 cm (series 10, image 271) corresponding to the HCC ablation cavity. Along the posterior superior aspect of the ablation cavity, there is a small area of increased arterial enhancement (series 10, image 276) without washout on more delayed images which is nonspecific but may reflect posttreatment change or perfusional variation. No additional focal enhancing lesions are identified.There is a large (3.6 cm) gallstone. No pericholecystic inflammatory changes to suggest cholecystitis. No biliary ductal dilatation.Multiple perihepatic portosystemic collaterals.SPLEEN: No significant abnormality noted.PANCREAS: There is a 5 x 7 mm T2 hyperintense structure in the pancreatic body along the distribution of the pancreatic duct which is favored to reflect a sidebranch IPMN. 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.Examination mildly limited by technical factors including suboptimal postcontrast images.2.Posttreatment changes related to HCC ablation. Area of enhancement along the posterior superior aspect of the ablation cavity does not washout on more delayed images of this favored to reflect posttreatment change or perfusional variation rather than recurrence/residual tumor. However, continued attention to this area on follow-up examinations is recommended.3.Subcentimeter cystic lesion within the pancreas favored to reflect a sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: There is extensive degenerative disc disease affecting the entire cervical spine with abnormal kyphosis in the lower cervical spine. There are compression deformities with loss of vertebral body height of over greater than 50% at C6 and less than 50% at C7 and T1. The cervical and upper thoracic cord are normal in caliber and signal. The cervicomedullary junction is normal. The cerebellar tonsils and visualized portion of the posterior fossa are unremarkable. The visualized paraspinal structures are normal.C1/2: No significant stenosis.C2/3: There is moderate degenerative disc disease with moderate left neural foraminal stenosis. There is no significant spinal canal stenosis.C3/4: There is moderate degenerative disc disease with mild left neural foraminal stenosis. The subarachnoid space is mildly effaced anteriorly and there is mild spinal canal stenosis seen on the sagittal sequences.C4/5: There is grade 1 anterolisthesis of C4 on C5. There is advanced degenerative disc disease with loss of intervertebral disc height. There is a disc bulge, worse on the left with significant left neural foraminal stenosis, mild right neural foraminal stenosis, and moderate effacement of the anterior subarachnoid space with flattening of the cervical cord.C5/6: There is advanced degenerative disc disease with loss of intervertebral disc height. There is significant left neural foraminal stenosis. There is no significant right neural foraminal or spinal canal stenosis.C6/7: There is advanced degenerative disc disease with loss of intervertebral disc height. There is mild to moderate left neural foraminal stenosis. There is no significant right neural foraminal or spinal canal stenosis.C7/T1: There is grade 1/2 anterolisthesis of C7 on T1. There is advanced degenerative disc disease and loss of intervertebral disc heights. There is mild narrowing of bilateral neural foraminal. No significant spinal stenosis.

Output: Extensive degenerative disc disease and compression deformities of C6 through T1 with multilevel neural foraminal stenosis and mild spinal canal stenosis as described above. A CT of the cervical spine with 3-D reformatting can be considered for further evaluation, especially if presurgical planning is clinically warranted.


Instruction: Generate impression based on findings.

Input: Male 68 years old with elevated PSA and right nodule. Evaluate for prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.6 x 5.1 cmPeripheral Zone: A nodule in the right apex is dark on T2 and on ADC and may represent cancer. Central Gland: Benign nodules are noted. The transition zone is large.Seminal Vesicles: The seminal vesicles are unremarkable.Extracapsular Extension: There is no extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: A peripheral zone nodule in the right apex may represent cancer.


Instruction: Generate impression based on findings.

Input: 47-year-old female with a history of uterine fibroids, status post bilateral uterine artery embolization. PELVIS:UTERUS, ADNEXA: The uterus measures 8.6 x 8.1 cm, previously 9.2 x 8.6 cm (series 8; image 27). Multiple uterine fibroids are again seen, which appear grossly decreased in size to the prior study. The largest reference subserosal fibroid located in the fundus measures 4.9 x 4.9 cm, previously 5.7 x 5.7 cm (series 12, image 6), there is interval decrease in enhancement when compared to the prior study. There is a necrotic intramural fibroid along the anterior wall of the body of the uterus, which measures 4.8 x 4.1 x 4.2 cm, previously 6.0 x 5.1 x 5.1 cm, without significant enhancement on postcontrast sequences.BLADDER: No significant abnormality noted.LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Focus of nodular enhancement in the anterior abdominal wall may represent granulation tissue from prior laparoscopic surgery, unchanged.

Output: Interval decrease in size and enhancement of multiple intramural, subserosal and pedunculated uterine fibroids, consistent with the stated history of uterine artery embolization; there is also interval decrease in overall size of the uterus.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction. Dysarthria There are several punctate foci of diffusion restriction present in the left middle frontal gyrus adjacent to the precentral sulcus as well as in the left precentral gyrus lateral to the hand motor area.There is encephalomalacia present involving the left superior frontal gyrus and left cingulate gyrus anteriorly in an area of a prior infarction. There is associated susceptibility effect within this focus of encephalomalacia. On the 4/7/2013 exam there is diffusion restriction within this focus of encephalomalacia.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.T2 and FLAIR hyperintense punctate lesions are present in the brainstem and thalami.Punctate foci of signal loss on susceptibility imaging are present in the pons, midbrain and basal ganglia.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are several microinfarcts present in the left frontal lobe at the posterior most aspect of the left middle frontal gyrus and in the left precentral gyrus. The location could account for dysarthria based on the location of the motor tongue area.2.There is encephalomalacia involving the left superior frontal gyrus and left cingulate gyrus where there was previously cerebral infarction in the subacute stage in April3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Punctate lesions in the thalami and brainstem are compatible with lacunar infarcts.5.Findings are compatible with a few microhemorrhages in the brainstem and basal ganglia which is a distribution suggestive of hypertension


Instruction: Generate impression based on findings.

Input: Male; 65 years old. Reason: Please evaluate stage of disease in patient with probable rectal cancer. Please comment on the location of the disease relative to the peritoneal reflection. History: anemia, abdominal discomfort, hepatic mass likely abscess. Overall image quality: FairPROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: 9 x 8 mm lymph node in the right posterior mesorectal fascia on series 4, image 22. Lymph nodes outside the mesorectal fascia: Scattered bilateral external iliac lymph nodes are noted. BOWEL, MESENTERY: Rectal Tumor:Size: 5.9 x 4.7 x 3.0 cm (image 25/series 4, image 19/series 5)Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensity. Tumor location: Upper and middle third(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 4 cm (series 5, image 20). Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 4 cmCircumference of the rectum involved: 180 degreesRelationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): Does not invade prostate or seminal vesicles. MRI T-stage: T3b - Tumor invades 0.5cm to 1cm into perirectal fat or extramural.Tumor Distance to Mesorectal Fascia: 1.0 cm (image 25/series 4).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Extensive sigmoid diverticulosis. Dilated, blind-ending tubular structure extending into the pelvis likely represents a dilated appendix (series 4, image 17). This structure demonstrates restricted diffusion and some associated inflammatory changes.

Output: 1.Limited exam demonstrates asymmetric rectal wall thickening/soft tissue mass, compatible with rectal neoplasm at this site. Please see staging measurements above. 2.Abnormally dilated appendix with surrounding inflammation as described above.


Instruction: Generate impression based on findings.

Input: PSC. Evaluate for CCA and HCC. ABDOMEN:LIVER, BILIARY TRACT: Diffuse intrahepatic biliary ductal dilatation and irregularity with multifocal strictures, severe in the left hepatic lobe, consistent with PSC, not significantly changed. Increase in central intraductal debris and stones. Mild diffuse irregularity of the common duct with a focal mild stricture at Klatskin's point, unchanged. New 4 mm CBD stone (series 4, image 47). Unchanged mildly T2 hyperintense ill-defined focus with delayed enhancement and subtle capsular retraction in the lateral aspect of the right lobe, segment VI, consistent with confluent fibrosis.No new dominant enhancing stricture or suspicious hepatic mass. Cirrhotic liver morphology.Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged right renal cyst.RETROPERITONEUM, LYMPH NODES: Stable portocaval and periportal lymphadenopathy, BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small cystic foci at the neural foramina bilaterally at multiple thoracolumbar levels consistent with perineural cysts. Well-defined round cystic foci at the sacral foramina, likely Tarlov cysts.OTHER: No significant abnormality noted.

Output: No suspicious hepatic mass or new dominant enhancing stricture. Stable beaded dilatation of the biliary tree with increase in hepatolithiasis centrally as well as a new 4 mm common duct stone.


Instruction: Generate impression based on findings.

Input: Symptomatic pontine cavernous malformation, associated with venous anomaly. Symptoms abated for a number of years, then the lesion grew with new gaze symptoms in 2010. The cavernoma was exophytic at the fourth ventricular floor and was resected via a posterior fossa trans-vermian exposure.. There are postoperative findings related to suboccipital craniotomy and trans-vermian approach for resection of a posterior pontine cavernous malformation, where there is a crescentic area of susceptibility effect that measures up to 8 mm in length. There are multiple other punctate foci of susceptibility effect in the pons and midbrain. There is also a left pons developmental venous anomaly. There is diffuse cerebral white matter T2 hyperintensity, primarily in a periventricular distribution. There is also nonspecific patchy T2 hyperintensity in the medulla. The ventricles and basal cisterns are normal in size. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a nodular lesion in the left nasal bridge subcutaneous tissues that measures up to 12 mm and which likely represents an inclusion cyst. There is bilateral maxillary sinus mucosal thickening with fluid on the right side.

Output: 1. Postoperative findings related to resection of a posterior pontine cavernous malformation with an associated left pons developmental venous anomaly. Areas of susceptibility effect along the margin of the surgical bed may represent postoperative hemorrhage versus residual hemosiderin that comprised the periphery of the cavernous malformation. More precise characterization is otherwise limited without available preoperative imaging.2. Punctate areas of susceptibility effect in the pons and midbrain beyond the surgical bed may represent microhemorrhages or additional cavernous malformations.3. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: There is redemonstration of mild thickening and T2/FLAIR hyperintensity involving the cortex of bilateral insula, mesial temporal lobes, and anterior cingulate gyri right greater than left which has been seen on multiple prior studies. The degree of FLAIR hyperintensity however is less conspicuous than prior study.The right amygdala in particular demonstrates asymmetric increase in fullness compared to the left. There is blurring of the internal architecture involving the bilateral hippocampi, which can be better visualized on 3 Tesla. Hippocampal volumes are grossly maintained.The ventricles and sulci are mildly prominent, perhaps slightly advanced for age, but there is no evidence of hydrocephalus. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures are within normal limits. Unchanged appearance of the cerebellar tonsils which are borderline low, right greater than left without clear evidence of Chiari I. Moderate right and trace left mucosal thickening in the maxillary sinuses. The mastoid air cells are clear. Unchanged appearance of small cyst in the midline nasopharynx which may represent mucosal retention cyst or Thornwaldt cyst.

Output: As seen on multiple prior studies dating back to 7/27/2010, there is mild thickening and FLAIR hyperintensity involving the limbic structures including the medial temporal lobes, insula, and anterior cingulate gyri, right greater than left. The degree of FLAIR hyperintensity appears less prominent, perhaps related to technique. These findings may represent sequela of prior limbic encephalitis.


Instruction: Generate impression based on findings.

Input: Reason: 59yo female with simple endometrial hyperplasia, and severe cervical d ysplasia (CIN3), techinically difficult pelvic exam due to morbid obesity, r/o gross cervical lesion History: CIN3 on cervical biopsy PELVIS:UTERUS, ADNEXA:There is a soft tissue lesion which is isointense on T2-weighted images along the right aspect of the cervix which measures 1.1 x 1.5 x 1.5 cm (901/35, 601/39). This lesion is relatively hypoenhancing. There is no invasion into the upper vagina or the image field tissues. Low T1/T2 signal without enhancement within the cervical canal itself and upper vagina likely represents either air or old blood products.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent right external iliac node measures 1.6 x 0.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small soft tissue lesion along the right aspect of the cervix may represent cervical cancer. Targeted biopsy of this region may be considered. No parametrial or vaginal involvement.


Instruction: Generate impression based on findings.

Input: 15 year-old female. Foot pain after dance. Clinical differential diagnosis of stress fracture or tendinitis. Pain in dorsal midfoot. Edema type signal diffusely in the cuboid bone with intersecting T1 hypointense lines consistent with a nondisplaced comminuted fracture. Remainder of the bones are unremarkable.The tendons and ligaments of the ankle are normal in signal intensity and morphology without evidence of a tear or tendinopathy.

Output: Findings consistent with a comminuted, nondisplaced fracture of the cuboid.


Instruction: Generate impression based on findings.

Input: Left wrist fracture Note that the examination is limited by motion artifact.LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: There is fragmentation and abnormal signal intensity of the lunate compatible with avascular necrosis. The lunate demonstrates very homogeneous low T1 signal intensity with patchy areas of T2 hyperintensity dorsally. Following gadolinium administration, there are patchy areas of enhancement, particularly dorsally which is best appreciated on series 1201 image 5. There is additional soft tissue enhancement about the wrist likely reflecting mild synovitis.Additional areas of high T2 signal intensity are identified within the distal radius, capitate and triquetrum which may represent areas of contusion or degenerative change.The flexor and extensor tendons are unremarkable.

Output: Avascular necrosis of the lunate with patchy areas of enhancement and mild synovitis following contrast administration.


Instruction: Generate impression based on findings.

Input: Male 26 years old Reason: eval for loose bodies; chondromalacia; lateral meniscal tear History: knee pain for 2-3 years s/p dislocation; now more pain; clicking and posterior lateral joint line pain MENISCI: The anterior and posterior horns of both the medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Focal decreased signal in the substance of the articular cartilage at the junction the medial and lateral patellar facets may represent chondromalacia, but there is no evidence of a full-thickness defect.LIGAMENTS: The medial collateral and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Focal decreased signal in the substance of the articular cartilage at the junction the medial and lateral patellar facets may represent chondromalacia. No evidence of meniscal tear or loose bodies as clinically questioned.


Instruction: Generate impression based on findings.

Input: LUE and LLE numbness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia with gyriform susceptibility effect in the right posterior parietal and occipital lobes with ex vacuo dilatation of the right occipital horn. There is also mild scattered nonspecific cerebral white matter T2 hyperintensity. There is no midline shift or herniation. There is mild aneurysm dilatation of the left distal middle cerebral artery. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Encephalomalacia in the right posterior parietal and occipital lobes related to chronic infarction and mild scattered nonspecific cerebral white matter T2 hyperintensity that may represent chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Mild dilatation of the left distal middle cerebral artery.


Instruction: Generate impression based on findings.

Input: Continued right knee pain 6 months status post microfracture of patella, trochlea and medial femoral condyle. No improvement with surgery, physical therapy, injections. Evaluate healing of microfracture. MENISCI: The anterior horn and body of the lateral meniscus appear more attenuated on the current study that on the prior study which I suspect reflects interval partial meniscectomy, although I cannot entirely exclude the possibility of progression of attritional tearing. Persistent enlargement of the peripheral aspect of the body of the lateral meniscus may reflect displaced meniscal tissue in the lateral gutter, but this appears similar to that seen on the prior study. The posterior horn appears slightly attenuated, likely reflecting prior meniscectomy, appearing similar to the prior study.There is blunting of the anterior horn of the medial meniscus that appears similar to that seen on the prior study and may represent an old tear or partial meniscectomy. The signal abnormality seen within the anterior horn of the medial meniscus on the prior study, however, is less prominent on the current study which may reflect interval surgery. The remainder of the medial meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the patella lateral to the median eminence that appears more pronounced on the current study than on the prior study. There is also a full-thickness cleft through this degenerated cartilage, best seen on the sagittal images, that was not clearly evident on the prior study. I see no underlying bone marrow signal abnormality. Heterogeneity of the articular cartilage of the femoral trochlea centrally appears to have progressed when compared with the prior study, which may reflect interval surgery; however, there remain near-full-thickness/full-thickness clefts of the articular cartilage. Underlying bone marrow signal intensity is normal. Focal signal abnormality within the articular cartilage of the medial femoral condyle just posterior to the anterior horn of the meniscus with mild degenerative edema type signal in the underlying subchondral bone appears similar to that seen on the prior study, compatible with focal cartilage degeneration. The previously seen focus of full-thickness cartilage degeneration along the posterior aspect of the lateral femoral condyle with degenerative signal abnormality in the underlying subchondral bone is less pronounced on the current study on the prior study; however, there is new focal delamination of the articular cartilage of the lateral femoral condyle just above the free edge of the posterior horn of the lateral meniscus.LIGAMENTS: The anterior cruciate ligament graft appears intact. The previously seen presumably bioabsorbable anchor in the tibia is now partially replaced with fluid signal intensity. Signal abnormality within the marrow along the femoral tunnel appears similar to the prior study and is of doubtful significance. Intermediate signal intensity seen along the anterior aspect of the graft on the prior study is no longer evident, perhaps due to interval surgery. The posterior cruciate ligament appears intact. The medial collateral ligament appears intact. The lateral collateral ligamentous complex appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1.Tricompartmental cartilage degeneration as described above, with most of degenerative foci showing progression or no change when compared with the prior study.2.Meniscal abnormalities as described above that I suspect reflect prior meniscectomy; I see no definite new or recurrent tear.3.Anterior cruciate ligament reconstruction and other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke, hemorrhage. Signs and symptoms: Weakness and paralysis. Nonenhanced head CT:Examination demonstrates a large area of vasogenic edema in the left mid to high convexity frontal lobe with resultant effacement of all adjacent cortical sulci. Within the region of vasogenic edema there is a suspected mass measuring approximately 17 times 17-mm in size. Recommend further follow-up with an MRI exam. There are also several subcortical areas of low attenuation which may represent a small less ischemic disease although a possibility of additional lesions/metastases cannot be ruled out.Calvarium is intact. There is evidence of an NG tube and with resultant partial opacification of paranasal sinuses.Dr. Susan Lim on pager number 3345 was paged and covering individual Julia Rives from 59215 responded to page and was notified of the above findings.

Output: 1.Left frontal mass with extensive surrounding vasogenic edema. There is focal mass effect and with no evidence of midline shift. Recommend further follow-up with an MRI examination.2.Subcortical and periventricular low-attenuation white matter is suspected of small vessel disease. Possibility of additional masses/metastases cannot be entirely ruled out.3.Calvarium is intact.4.Extensive opacification of paranasal sinuses. Likely result of intubation.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: eval for acute ischemic stroke, morphology and territory of old CVA, any underlying lesions to explain seizure History: LOC There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Chronic ischemic infarct on the right parietal lobe with encephalomalacia is seen. Multiple lacunar infarcts on the left parietal lobe subcortical white matter, right caudate nucleus head and left external capsule are seen.Multifocal patch and scattered high signal intensity lesions on FLAIR imaging on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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 mastoid air cells are clear. Right maxillary sinus shows mucosal thickening.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. Chronic ischemic infarct involving right parietal lobe and multifocal lacunar infarcts with nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There is a slight rightward thoracic curve. Vertebral body heights are preserved. Two foci of T1 and T2 hyperintensity within the T8 vertebral body likely represent hemangiomas or focal fat. Bone marrow signal is otherwise within normal limits. There are no subluxations. There is no significant spinal canal stenosis or neural foraminal stenosis. The visualized paraspinal contents are unremarkable. There is a small 8x 6 mm oval T2 hyperintense lesion within the left thyroid lobe which may represent a cyst. Incidental subcentimeter hyperintense lesion within the right kidney likely represents a simple cyst.

Output: 1. No specific acute abnormality to account for the patient's symptoms. 2. Slight rightward thoracic curve. 3. Subcentimeter T2 hyperintense lesion within the left thyroid lobe may represent a cyst. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: pt had MRI previously L3-L5 bulging discs. No improvement in pain with patient has bulging worsened Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a formed disc at S1-S2. There is mild disc desiccation at L3-4 and L4-5 associated with mild loss of disc space height.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a broad-based central disc extrusion present at this level associated with some disc material tracking behind the superior endplate of L5. The fat at the lateral recesses sees is not effaced. The fat surrounding the exiting nerve roots within the neural foramina is not effaced.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina..At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Please note that there is a formed disc at S1-S2 which may confound enumeration of the vertebra2.There is a small central disc extrusion at L4-5 without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 28 year old with BRCA 1 mutation. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out stroke. Signs and symptoms: Slurred speech. Nonenhanced brain MRI:No detectable acute intracranial process and negative diffusion weighted series.Large focus of encephalomalacia extensively involving the right frontal, right basal ganglia and right anterior parietal lobe consistent with a large chronic ischemic stroke with resultant ex vacuo dilatation of the right lateral ventricle is noted.Minimal periventricular and subcortical foci of FLAIR hyperintensity consistent with mild chronic small vessel ischemic strokes are noted.Unremarkable intracranial contents otherwise.Signal void of major intracranial arterial branches are identified.Images through posterior fossa demonstrate a focus of encephalomalacia in the inferior aspect of right cerebellum with mild bulge of CSF signal in density at this site through a bony defect in the right paramedian occipital which is identical to prior head CT exam from 2013.

Output: 1.No acute intracranial process and negative diffusion weighted images.2.Large chronic right MCA territory ischemic stroke and minimal chronic small vessel ischemic strokes.3.Stable right median small right occipital calvarial defect and an underlying right cerebellar focus of encephalomalacia since prior head CT exam from 2013.


Instruction: Generate impression based on findings.

Input: 26-year-old male patient with alpha-1 antitrypsin deficiency. HCC screening. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour with hypertrophy of the left hepatic lobe. No suspicious hepatic lesion is identified. There is no intra- or extrahepatic biliary ductal dilatation. SPLEEN: Splenomegaly measuring 20 cm in the craniocaudal dimension. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic morphology of the liver without suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, with known stroke and intracranial hemorrhage. Since the prior MRI examination, the intensity of diffusion restriction along the bilateral cerebral watershed zones, right side more than left, has diminished compatible with expected evolution. However, one area of restricted diffusion within the paramedian right parietal lobe is new compared to prior.Faint susceptibility effect and T1 hyperintensity is seen along the affected gyri compatible with trace or petechial blood product. No large or discrete parenchymal hematoma is seen. No significant generalized mass effect is detected.A colloid cyst at the foramen of Monro is unchanged. Asymmetric dilatation of the right lateral ventricle is also unchanged. Ventricular size and caliber are stable relative to the prior examination. T2 hyperintensity in the basal ganglia is again seen which may reflect chronic lacunar ischemic disease or prominent perivascular spaces.

Output: 1.Since the prior MRI, the intensity of diffusion restriction in the areas of watershed infarction has generally diminished consistent with expected evolution. However, one small area of new gyriform restricted diffusion is seen along the paramedian right parietal lobe which may reflect some expansion of ischemic disease.2.Corresponding to the suspected blood product on CT, there is vague susceptibility effect and T1 hyperintensity along the gyri of the watershed infarctions. As before, this likely represents a small quantity of petechial blood product with mineralization a less likely consideration given the relatively quick time course of development. 3.No change in the appearance of a colloid cyst at the roof the third ventricle or asymmetric dilatation of the right lateral ventricle.


Instruction: Generate impression based on findings.

Input: New onset headache and history of subjective left-sided weakness. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are punctate foci of susceptibility including the right frontal lobe as well as the right occipital lobe compatible with chronic microhemorrhages. Few 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 appears otherwise within normal limits.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is mucosal thickening involving the right maxillary sinus and mild patchy opacification of the ethmoid air cells. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.

Output: 1. No evidence of acute infarct. No intracranial mass or mass effect.2. Two punctate foci of chronic microhemorrhage in the right frontal and right occipital lobe which are nonspecific. Brain parenchyma is otherwise unremarkable.3. Mucosal thickening in the right maxillary sinus with frothy secretions which may represent acute sinusitis in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Evaluate extent of cervical cancer involvement of adjacent structures, as well as lymphadenopathy. Postmenopausal bleeding. PELVIS:UTERUS, ADNEXA: There is a heterogeneously enhancing mass arising from the right cervix compatible with known cervical carcinoma, measuring approximately 3.2 x 2.0 cm axially (series 801, image 29) by 2.1 cm in sagittal dimension (series 701, image 25). The mass is slightly decreased in size from the prior CT. There is invasion into the right parametrium. The lesion abuts the bladder and rectum though there is no definite evidence of invasion. There is a mildly distended endometrial complex, which is decreased from prior exam.A small T2 hyperintense tubular structure in the right adnexa may represent mild hydrosalpinx (series 801, image 37); correlation with ultrasound may be considered. The uterus contains multiple fibroids, primarily submucosal and intramural.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple small pelvic lymph nodes are redemonstrated. These were noted to be mildly hypermetabolic on prior PET, but are not enlarged by size criteria. The previously measured right pelvic sidewall lymph node currently measures 1.6 x 0.6 cm (series 1301, image 336).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mass in the right aspect of the cervix is compatible with known cervical carcinoma, right-sided parametrial invasion present. Accounting for differences in technique/modality, mass is slightly decreased in size from prior CT. Also seen is improvement in degree of dilatation of endometrial complex. 2.No lymphadenopathy by size criteria.3.Tubular structure in the right adnexa may represent mild hydrosalpinx.


Instruction: Generate impression based on findings.

Input: Status post right craniotomy for cavernoma resection. There are new postoperative findings related to right pterional craniotomy for resection of a large cavernous malformation in the right basal ganglia and medial temporal lobe. There appears to be grossly total resection of the lesion. There is susceptibility lining the resection cavity related to chronic hemosiderin staining with local postoperative products in the resection cavity. There is a small amount of right extra-axial fluid and pneumocephalus, as well as minimal intraventricular blood products. There is decreased mass effect on the right medial temporal lobe. There is minimal restricted diffusion with associated T2 hyperintensity located superomedial to the resection cavity and involving the body of the caudate, compatible with cytotoxic edema/small infarct. Two additional separate foci of susceptibility located anteriorly and superiorly to the resection cavity appear similar to the prior study, and may reflect additional small cavernous malformations. For reference, a lesion involving the anterior putamen and subinsular region measures approximately 5 mm (series 601, image 19). Scattered predominantly subcortical T2 hyperintensity is nonspecific but compatible with mild small vessel ischemic changes.There is no significant midline shift. The ventricles and basal cisterns are normal in size and configuration. The midline structures and craniocervical junction are within normal limits.Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1. Expected postoperative findings related to right pterional craniotomy and resection of a cavernous malformation. There appears to be total resection of this lesion with hemosiderin staining surrounding the resection cavity. 2. A small area of restricted diffusion and T2 hyperintensity superomedial to the resection cavity is compatible with cytotoxic edema/small infarct.3. Two additional small areas of susceptibility located anteriorly and superiorly to the resection cavity are suspected to represent small additional cavernous malformations.


Instruction: Generate impression based on findings.

Input: Reason: eval for osteo of R cranial bone History: R parietal bone defect The patient is status post right-sided craniotomy. There is a redemonstration of some adjacent dural thickening which was also previously present adjacent to the right temporal lobe. This dural thickening appears to have to be stable compared to the previous exams. It currently measures 30 x 6 mm in axial dimensions.There is a redemonstration of encephalomalacia along the right parietal lobe in the right temporal lobe and right posterior frontal lobeThere is an extra-axial mass adjacent to the medial aspect of the right precentral gyrus which measures 11 x 16 mm coronal dimensions and previously measured 13 x 9 mm coronal dimensions.There is redemonstration of a left-sided extracranial mass currently measuring 15 x 18 mm and previously measuring 17 x 13 mm located adjacent to the the left subcentral lobule.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eyeball lens is thin.

Output: 1.The patient is status post right-sided craniotomy. The appearance of the craniotomy defect in the adjacent soft tissues is stable. There is no convincing evidence for osteomyelitis at this time.2.There is redemonstration of a two slowly growing extra-axial mass lesions suspected to represent meningiomas. One is located adjacent to the left subcentral lobule and the other one is located adjacent to the right paracentral lobule and precentral gyrus.3.There is encephalomalacia involving right posterior frontal, parietal and posterior superior temporal lobes.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. Few scattered foci of T2/FLAIR signal in the subcortical and periventricular white matter likely representing minimal chronic small vessel ischemic disease. Small chronic right caudate head lacunar infarct. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Left maxillary sinus mucosal thickening.

Output: 1.No evidence of brain metastases or other findings to account for patient's symptoms.2.Minimal chronic small vessel ischemic disease, essentially within normal limits for age.


Instruction: Generate impression based on findings.

Input: Clinical question: Hemorrhage? Infection? Signs and symptoms: Altered mental status. Nonenhanced head CT:Examination demonstrates a well demarcated high density lesion projecting into the left frontal horn and partial involvement of the septum pellucidum. This lesion measures 10.7 x 8.8-mm in size on axial image 12. Differentials for this lesion includes a cavernoma and less likely possibility of a colloid cyst cannot be entirely ruled out. There is no associated edema or any mass effect with this finding and no hydrocephalus is detected. Recommend unenhanced MRI examination for further evaluation.There is no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system and CSF cisterns as well as gray -- white matter differentiation all remain within normal.Calvarium, visualized paranasal sinuses, mastoid air cells, middle ear cavities and orbits are unremarkable.

Output: 1.Well demarcated high density mass measuring 10.7 x 8.8-mm in the left frontal horn with involvement of septum pellucidum as described. Recommend further follow-up with a pre-and post enhanced MRI of brain.2.The non-infused head CT is otherwise unremarkable.


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. There is diffuse T2 hyperintensity noted within the paraspinal musculature (best demonstrated with STIR technique).C2/3: Posterior osteophyte disc complex, mild right uncinate hypertrophy, and ligamentum flavum thickening. There are no significant stenoses.C3/4: Posterior osteophyte disc complex, right uncinate hypertrophy, and ligamentum flavum thickening. There is mild central and moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum of flavum thickening. There is moderate left neural foraminal and mild right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and ligamentum flavum thickening. There is moderate to severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, right uncinate hypertrophy, and ligamentum flavum thickening. There is mild right neural foraminal stenosis.C7/T1: Mild posterior osteophyte disc complex without stenosis.

Output: 1.There is diffuse T2 hyperintensity noted within the paraspinal musculature (best demonstrated with STIR technique) which is most suggestive of a diffuse myositis.2.C3/4: Mild central and moderate right neural foraminal stenosis.3.C4/5: Moderate left neural foraminal and mild right neural foraminal stenosis.4.C5/6: Moderate to severe bilateral neural foraminal stenosis.5.C6/7: Mild right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: assess for placenta accreta, 32w pregnancy currently History: see above PELVIS:UTERUS, ADNEXA:There is a single live intrauterine pregnancy which is grossly unremarkable. The placenta is identified along the left anterior aspect of the uterus without evidence of placenta previa. The myometrium is intact without disruption, focal bulging or other findings to suggest placenta accreta. Possible nuchal cord is identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No definite evidence of placenta accreta.2.Possible nuchal cord.


Instruction: Generate impression based on findings.

Input: There are no areas of abnormal signal. There is no diffusion abnormality. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRI CERVICAL SPINE

Output: 1. Unremarkable MRI of the brain. Specifically no evidence of Chiari malformation or syrinx.2. MRI of the cervical spine and thoracic spine are unremarkable.


Instruction: Generate impression based on findings.

Input: 59 year old male with a history of ischemic cardiomyopathy who underwent cardiac transplant in 2012, current history of hypertension who is referred for stress cardiac MRI.MEDICATIONS: Aspirin, Atorvastatin, Gabapentin, Lisinopril, Metoprolol XL, Tacrolimus. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is a mid-myocardial stripe of late gadolinium enhancement noted in the basalt to mid inferior and inferolateral walls. The pattern is atypical for prior myocardial infarction and suggests suggests the presence of fibrosis, inflammation, or infiltration.Left VentricleThe left ventricle is normal in size and systolic function. There is subtle hypokinesis of the mid inferolateral wall. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 185 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 35 g/m2, and the LV mass is 74 g. Pre-contrast native myocardial T1 relaxation times are normal (1018 ms).Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 213 ml (normal range 142+/-31), the RV end systolic volume index is 54 ml/m2 (normal range 31+/-9), and the RVESV is 119 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.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 mild tricuspid regurgitation.AortaThe aortic root is mildly dilated. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are present. There are either small bilateral infiltrates or atelectasis noted in lower lungs. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. There is a small amount of atypical LGE in the basal to mid inferior and inferolateral walls. The pattern is not consistent with prior myocardial infarction and suggest fibrosis, inflammation, or infiltration. If asymptomatic, this finding most likely represents an old episode of rejection. 3. Normal LV size and systolic function (LVEF 56%). 4. Normal RV size with mildly reduced systolic function (RVEF 44%).5. Mild aortic root and main pulmonary artery dilation.6. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 33-year-old female with knee instability, rule out ACL and medial meniscal tear MENISCI: There is a buckle handle tear of the medial meniscus with meniscal tissue displaced into the intracondylar notch, anterior to the PCL. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: We see no bone contusions. We see no fluid-filled articular cartilage defects.LIGAMENTS: The ACL appears disrupted at its femoral attachment which presumably represents a chronic tear given the lack of bone contusions. Additional ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: ACL tear and bucket-handle tear of the medial meniscus. These may be chronic given the lack of bone contusions.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type I, evaluate for change in glioma and right medullary mass. Again seen is an enhancing mass involving the left prechiasmatic optic nerve just anterior to the chiasm. Mass measures approximately 16 x14 x 11 mm in the AP, transverse, and craniocaudal dimensions and not significant changed since 6/2/2015 but clearly larger when compared to remote studies. There is mass effect on the chiasm and contact with the right prechiasmatic optic nerve.Again noted is nonenhancing exophytic T2/FLAIR hyperintense mass involving the right dorsal medulla extending to the cervical medullary junction. Mass measures approximately 12 x 13 mm and remains unchanged from recent prior. Areas of T2/FLAIR hyperintensity involving the right cerebral peduncle and bilateral globi pallidi are not significantly changed from recent prior. FLAIR hyperintensity involving the bilateral cerebellar hemispheres is also not significantly changed. When compared to remote study from 2/10/2012, there is clear decrease in size and associated FLAIR hyperintensity of lesion involving the right cerebral peduncle. Lesion involving the medulla extending to the upper cervical cord is also clearly smaller when compared to remote studies. Signal abnormality involving the bilateral globi pallidi is increased compared to remote priors. Signal abnormality involving the cerebellar hemispheres is minimally decreased since 2012.No evidence of acute ischemia or hemorrhage. No new intracranial mass. No extra-axial collections. No hydrocephalus. There is mild mucosal thickening throughout the paranasal sinuses with interval improvement in opacification of the sphenoid sinuses compared to 6/2/2015.

Output: 1. Compared to 6/2/2015, there is no significant change in enhancing left optic nerve glioma. There is clear enlargement when compared to remote prior studies. 2. There is also no significant interval change in nonenhancing expansile right dorsal medullary mass compared to more recent exam, although overall decreased ventral and caudal extent compared to more remote exams.3. Redemonstration of nonenhancing areas of focal abnormal signal intensity consistent with history of neurofibromatosis which are not significantly changed since recent prior study. Please see details above.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:6/27/1961)Reason: intracranial stenosis History: unexplained syncopal episodesPROVIDER/ATTENDING NAME: RIMAS V LUKAS RIMAS V LUKAS MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. Punctate focus of signal hypointensity is present along the left foramen of Luschka .It can be identified on a prior CT of the head from 3/30/2016 is a calcification. It could be part of the choroid.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 right transverse sinus is small. The right jugular vein is smaller than the left jugular vein.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 duplication of the right middle cerebral artery presentThere is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are small. The left vertebral artery is larger than the right vertebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is no evidence for acute ischemic cerebral infarction.4.There is no evidence for an intracranial mass lesion.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, with behavioral changes. Cortical gyriform restricted diffusion is seen throughout a majority of the right cerebral hemisphere, though particularly affecting the parietal, occipital and temporal lobes. Of note, the abnormality does not conform to any particular vascular territory. Scattered small areas of cortical restricted diffusion are seen in the left cerebral hemisphere. In addition, there is bilateral and symmetric restricted diffusion of the caudate nuclei and putamina. There may be minimal restricted diffusion along the dorsomedial thalami as well.Most of the above-mentioned areas demonstrate corresponding FLAIR hyperintensity. In addition, there are numerous scattered foci of white matter T2 hyperintensity which do not correlate with diffusion restricting lesions. No evidence of significant generalized mass effect is seen. No evidence of intracranial hemorrhage is detected. There are no abnormal extra axial fluid collections. Ventricular size and morphology are within normal limits. No pathologic intracranial enhancement is observed though postcontrast images are motion degraded.

Output: The constellation of findings, including cortical gyriform restricted diffusion, as well as restricted diffusion involving the caudate nuclei, putamina, and perhaps the dorsomedial thalami, is highly suggestive of CJD. Other infectious etiologies, particularly viral, may also be considered. An ischemic etiology is considered unlikely.


Instruction: Generate impression based on findings.

Input: Ms. Bracey-Mayberry is a 59 -year-old female with newly diagnosed left breast DCIS. Family history of breast cancer in maternal grandmother, maternal great aunt and maternal niece. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Susceptibility artifact from biopsy marker clip is identified in the left central breast, far posterior depth, corresponding to biopsy-proven malignancy. There is minimal surrounding enhancement identified (measuring up to 1.5 cm in the ML dimension), likely related to postbiopsy changes versus minimal residual enhancement. There is no additional abnormal enhancement seen in the left breast. No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.Incidental note is made of a subcentimeter T2 hyperintense nonenhancing cyst in the left hepatic lobe.

Output: Unifocal malignancy in the left central breast. No MRI evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: There are multiple nonspecific foci of T2 hyperintensity in the subcortical and periventricular white matter and in the pons. There is no abnormal intracranial enhancement. There is no evidence of intracranial mass lesions. There is no midline shift or herniation. There is evidence of no acute intracranial hemorrhage. There is mild diffuse cerebral volume loss. The vascular structures are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Nonspecific foci of T2 hyperintensities in the cerebral and pontine white matter may represent small vessel chronic ischemic disease.2. Mild diffuse cerebral volume loss without a specific pattern of neurodegenerative process.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Unspecified convulsionsClinical question: Rule out intracranial findingSigns and Symptoms: seizures on presentation The CSF spaces are appropriate for the patient's stated age with no midline shift. Myelination pattern is age-appropriate for 4 months there is myelination of anterior limb and posterior limb of the internal capsule as well as splenium in part of the body of the corpus callosum.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no intracranial mass lesion to explain the patient's convulsions..


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:2/3/1959)Reason: stroke History: aphasiaPROVIDER/ATTENDING NAME: KEME H CARTER AGNIESZKA A ARDELT There is diffusion restriction present along the left putamen and left caudate nucleus with extension into the adjacent left centrum semiovale associated with T2 and FLAIR signal hyperintensity. There is a small focus of susceptibility effect in the left putamen and another one in the right caudate body.Subcentimeter foci of diffusion restriction associated with T2 and FLAIR signal hyperintensity are present in the right middle frontal gyrus and the left cerebellar hemisphere.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are partly opacified.. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.

Output: 1.Subacute infarction is present in the left neostriatum associated with a small amount of blood products.2.Subcentimeter foci of the cerebral infarction is present in the right middle frontal gyrus and in the left cerebellar hemisphere. This suggests multiple embolic event consistent with cardiogenic sulcus.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific; they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 86 years Female (DOB:3/10/1930)Reason: Look for cause of dizziness History: vertigoPROVIDER/ATTENDING NAME: ADAM S CIFU IRSK JASON ANDERSON The CSF spaces are appropriate for the patient's stated age with no midline shift. There is vague T2 and FLAIR signal hyperintensity associated with T1 hypointensity present in the midbrain centrally at the expected location of the oculomotor nuclei, medial longitudinal fasciculus and periaqueductal gray which extends to the superior cerebellar peduncles suggesting that there is involvement of rubrocerebellar or cerebellothalamic tracts.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are likely of little clinical significance.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the left maxillary sinus and mucosal thickening in the right maxillary sinus with the partial opacification of the ethmoid air cells and frontal sinuses.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The eyeball lenses are thin.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.There is no evidence for intracranial mass lesion3.There is subtle signal change present in the midbrain and superior cerebellar peduncles as detailed above which is nonspecific. It is felt not to be artifactual. This could represent a neurodegenerative process, metabolic process or even paraneoplastic process. It is nonspecific.


Instruction: Generate impression based on findings.

Input: 58-year-old female with visual field defect, history of pituitary apoplexy, and mass resection. There is an enhancing lesion centered in the pituitary fossa extending superiorly which contains scattered areas of susceptibility effect likely related to prior hemorrhage. The mass measures up to 30 mm overall, but contains a cavity centrally that measures up to approximately 15 mm. The lesion extends into the bilateral cavernous sinuses, right more than left, completely encasing the right internal carotid artery. The lesion also likely encases the right optic nerve and the optic chiasm is atrophic and displays T2 hyperintensity. There are postsurgical findings related to right frontal craniotomy with high T2 signal in the right frontal lobe adjacent to the craniotomy defect, likely representing encephalomalacia and gliosis with mild ex vacuo dilatation of the right frontal horn of the lateral ventricle. There is no evidence of acute intracranial hemorrhage. Additional scattered subcortical T2 hyperintensities may reflect minimal small vessel ischemic disease. There are bilateral choroid plexus cysts. 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: Postoperative findings in the sell with residual macroadenoma that extends into the bilateral cavernous sinuses, right more than left, and compromise of the optic apparatus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 80 years Male (DOB:6/24/1936)Reason: structural lesion History: vertigoPROVIDER/ATTENDING NAME: JACQUELINE T. BERNARD THOMAS J KELLY 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.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are several punctate foci of signal loss present along the periventricular white matter and a couple along supratentorial subcortical white matter.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 minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 2.There are several microhemorrhages present periventricular and subcortical white matter. These are nonspecific


Instruction: Generate impression based on findings.

Input: 66-year-old male with ileal Crohn's disease status post ileocecectomy in 1976. ABDOMEN:LIVER, BILIARY TRACT: Scattered hepatic cysts. No suspicious hepatic lesions. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from ileocecectomy. There is alternating narrowing and mild dilation of the terminal ileum over a length of approximately 11 cm; this segment demonstrates mild wall thickening and increased enhancement. These findings are most compatible with active on chronic inflammatory bowel disease. A skipped lesion is seen in the distal ileum with narrowing, wall thickening, and increased enhancement measuring approximately 5.5 cm in length (series 15/70), most compatible with an additional area of active inflammatory bowel disease. More proximally in the mid ileum, there are additional skipped areas of narrowing without findings suggestive of active disease.No evidence of fistula or abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings most compatible with active on chronic inflammatory bowel disease of the distal and terminal ileum as detailed above.


Instruction: Generate impression based on findings.

Input: Male 10 years old Reason: Hx of perianal abscesses, R/O abscess reaccumulation and fistulae History: perianal abscess, anemia PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: A prominent perirectal lymph node is likely reactive (series 601/25). Slightly prominent inguinal lymph nodes are also likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: High signal is present within both gluteal folds, left greater than right, compatible with edema. Two fluid tracks are seen arising from the six o'clock position of the anus, one on the right and one on the left, which extends to the skin surface of the gluteal folds compatible with perianal fistulae (series 601/41-51). The left fistulous tract is larger in diameter than the right, measuring 5 mm in maximal thickness (series 601/48). There is an additional sinus tract, which arises off a more superior aspect of the anus, also at the six o'clock position, which appears to extend to the medial gluteal fold surface as well (series 601/36-41). OTHER: Small volume ascites.

Output: 1.Three perianal fistulae as detailed above.2.No evidence of abscess as clinically questioned.3.Small volume ascites.


Instruction: Generate impression based on findings.

Input: BRAIN: There are multiple punctate foci of restricted diffusion within the right periventricular white matter, right basal ganglia, left hemi-midbrain, and right cerebellar white matter. There is a T1 and T2 hyperintense area of signal abnormality within the left thalamus that measures 26 x 12 mm corresponding to the known recent hemorrhage, with surrounding susceptibility effect and FLAIR hyperintense vasogenic edema. There is stable mild mass effect upon the third ventricle and 6 mm rightward midline shift. There is also a prominent area of susceptibility effect within the medial right thalamus that may represent prior hemorrhage. There are multiple patchy foci of T2 hypertensity throughout the supratentorial and infratentorial white matter. There is a probable right frontal lobe developmental venous anomaly. There is no hydrocephalus. There is a partially empty sella. The major cerebral flow voids are intact. There is a chronic deformity of the left medial orbital wall.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1.Subacute left thalamic hematoma with unchanged mass effect and mild midline shift. Chronic right medial thalamic hemosiderin deposition, likely relating to hypertensive disease as well.2.Multiple supratentorial and infratentorial punctate foci of acute ischemia in multiple vascular distributions raising suspicion for emboli or vasculopathy.3.Chronic small vessel ischemic disease.4.Unremarkable MRA head.These findings were discussed with Dr. Hobbs on 6/6/2015 at 2:45 PM.