Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of lung. The patient has abnormal gait.Clinical question: With a history of newly diagnosed lung cancer and unsteady gait and a normal MRI brain there is concern that the cause of the abnormal gait is related to spinal metastasis. This patient had prior lumbar spinal injury 12 years ago. 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. No abnormal enhancing lesions are appreciated in the lumbar spine or within the lumbar spinal canal. The L3 and L4 vertebral bodies are partially fatty replacedAt L5-S1 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height, disc desiccation and a disc bulge at this level. There is a left-sided facet hypertrophy and to a lesser degree right-sided facet hypertrophy at this level. The fat surrounding the nerve roots at the lateral recesses is preserved at this level. The exiting nerve roots within the neural foramina are surrounded by fat.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a small central disc protrusion present at this level associated with loss of disc space height and some ligamentum flavum hypertrophy. The fat surrounding the nerve roots at the lateral recesses is preserved at this level. The exiting nerve roots within the neural foramina are surrounded by fat.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is obliteration of the disc space at this level and there are associated endplate reactive changes. There is mild facet hypertrophy present at this level. The fat surrounding the nerve roots at the lateral recesses is preserved at this level. The exiting nerve roots within the neural foramina are surrounded by fat.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge and bilateral facet hypertrophy at this level associated with some triangulation of the thecal sac. The fat surrounding the nerve roots at the lateral recesses is preserved at this level. The exiting nerve roots within the neural foramina are surrounded by fat.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is no evidence for metastases to the lumbar spine. 2.There are multilevel degenerative changes present in the lumbar spine as detailed above without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Metastatic RCC with history of brain metastases. History of MS. There is redemonstration of an irregularly marginated lesion in the right parietal centrum semiovale with an ill-defined, granular pattern of enhancement. There is associated susceptibility artifact compatible with hemosiderin staining. This lesion is not significantly changed compared to the most immediate prior study, however, does appear to have slightly fuller enhancement along the inferior margin when compared to older studies. The surrounding T2 hyperintensity is unchanged. There is redemonstration of an ill-defined lesion within the left paramedian cerebellum with a similar pattern of enhancement and susceptibility artifact to the right parietal lesion. The lesion has continued to increase in size, most predominately in the transverse dimension medially, now measuring approximately 16 x 10 mm (image 108, series 12), previously 11 x 10 mm. The surrounding T2 hyperintensity has increased as well. There is confluent white matter high T2 signal within bilateral cerebral hemispheres, right greater than left. Foci of high T2 signal within the right cerebellar hemisphere appear similar to the prior study. The ventricles are unchanged in size and shape. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. A hemosiderin stained, ill-defined enhancing lesion in the right parietal centrum semiovale is not significantly changed from the prior exam, but does demonstrate slightly fuller enhancement when compared to older studies. 2. Increased size of a similar-appearing smaller lesion within the the left paramedian cerebellum when compared to the most recent and older studies.


Instruction: Generate impression based on findings.

Input: 68 year old female with history of colon cancer. Has had acute mental status changes. Areas of enhancement on MRI one week ago resolved. Now with recurrent mental status changes. Need CT to evaluate. Vascular calcification of the pericardial vasculature of the vertebrals and carotids is noted.This examination is essentially within normal limits and in particular no evidence of hemorrhage, edema, mass effect, hydrocephalus or midline shift is detected. Further evaluation with an MRI is recommended.

Output: Unremarkable CT examination of brain.


Instruction: Generate impression based on findings.

Input: With history of mesothelioma. Status post radiation please evaluate for disease Using mesothelioma protocol and compared to previous study ABDOMEN:LUNG BASES: Linear scarring at the right lung baseLIVER, BILIARY TRACT: Hepatic cyst is unchanged. Fat deep air, free of the right lobe. There is a linear large hypodense area associated with nodular enhancement measuring 18 x 19 mm bested on image number 34, series number 3. This is more prominent compared to previous CT. MRI of the liver is recommended to differentiate between perfusion artifact versus intrahepatic or perihepatic lesion.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Linear large hypodense area at the periphery of the right lobe and possible focal enhancing lesion in the right lobe. MRI of the liver is recommended for further characterization of this heterogeneous area of the liver. Differential diagnosis includes perfusion abnormality, intrahepatic lesion versus perihepatic involvement in this patient with mesothelioma.


Instruction: Generate impression based on findings.

Input: Cervical spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Minimal degenerative changes without stenosis, unchanged.C3/4: Mild degenerative changes without stenosis, unchanged.C4/5: Mild degenerative changes without stenosis, unchanged.C5/6: Mild disc bulge, mild right facet hypertrophy, and mild right neural foraminal stenosis, unchanged.C6/7: Redemonstrated is a broad-based disc protrusion, eccentric to the left, which has minimally decreased in size. There remains associated mass effect and slight flattening of the anterior left hemicord, without intrinsic cord signal abnormality. Mild central and left foraminal stenosis is again noted.C7/T1: Unremarkable and unchangedThoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates a tiny left paracentral disc protrusion without significant mass effect or resulting stenosis.T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment.

Output: 1.C5/6: Mild right neural foraminal stenosis, unchanged.2.C6/7: Redemonstrated is a broad-based disc protrusion, eccentric to the left, which has minimally decreased in size. There remains associated mass effect and slight flattening of the anterior left hemicord, without intrinsic cord signal abnormality. Mild central and left foraminal stenosis is again noted.3.T3/4: A tiny left paracentral disc protrusion without significant mass effect or resulting stenosis.


Instruction: Generate impression based on findings.

Input: Concentration deficits, apathy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. A few scattered foci of T2 hyperintensity in the cerebral white matter are non-specific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Pituitary macroadenoma. There is an unchanged lesion in the right pituitary lobe that measures up to 14 mm in craniocaudal dimension, without evidence of mass effect upon the optic apparatus. There is disproportionate prominence of the third and lateral ventricles with a substantial CSF flow jet within the third ventricle. There appears to be a persistent rounded subcentimeter area of cerebrospinal fluid signal in the right anterior portion of the third ventricle that appears to be sharply demarcated from the cerebrospinal fluid flow artifact. In addition, there is disproportionate volume loss affecting the medial temporal lobes bilaterally. There is mild periventricular white matter T2 hyperintensity. The imaged portions of the sinonasal cavities are unremarkable.

Output: 1. Unchanged probable pituitary macroadenoma.2. Findings suggestive of Alzheimer's disease perhaps with superimposed normal pressure hydrocephalus.3. An apparent rounded subcentimeter area of CSF signal in the right anterior portion of the third ventricle that appears to be sharply demarcated from the CSF flow artifact, may be an artifact itself versus an arachnoid cyst or colloid cyst. If necessary, follow up with DRIVE or FIESTA sequences through this region may be useful for further elucidation.


Instruction: Generate impression based on findings.

Input: Female, 83 years old, with history of lung cancer, with abnormal findings on a prior head CT concerning for intracranial metastases. Post contrast images are degraded by motion artifact. Within this limitation, an irregularly marginated rim-enhancing mass is demonstrated at the junction of the right occipital and temporal lobes which measures up to 32 x 24 x 20 mm. Internally, this lesion is diffusion restricting with a few punctate foci of susceptibility suggesting microhemorrhage. This lesion induces moderate vasogenic edema which tracks through the temporal, occipital and parietal lobes. A 9 mm satellite nodule is also suspected more posteriorly within the right occipital lobe.Postcontrast images are unreliable for assessment of the posterior fossa. However, there are scattered areas of T2 FLAIR hyperintensity throughout both cerebellar hemispheres which are nonspecific.On diffusion weighted images, multiple scattered small hyperintense lesions are seen along the watershed zones of both cerebral hemispheres. At least one and probably several small diffusion restricting lesions are also evident in the cerebellar hemispheres. No detectable mass effect or enhancement is seen in association with these diffusion restricting lesions.Findings related to extensive prior microvascular ischemia are seen including patchy periventricular T2 hyperintensity. Chronic lacunar infarcts are also evident within the right thalamus and possibly the right basal ganglia. Numerous chronic small infarcts are seen within the cerebellar hemispheres. Susceptibility effect compatible with chronic microhemorrhage is seen in the cerebellar vermis.No abnormal extra-axial fluid collections are detected. The ventricular system is unremarkable with the exception of effacement of the right ventricular atrium due to mass effect.A mass is evident within the left parieto-occipital scalp measuring 50 x 50 x 20 mm. This lesion is composed of a substantial extracranial component in addition to a component which invades the underlying bone marrow extending all the way to the inner table. Contact with the underlying dura cannot be excluded, though there is no evidence of invasion into the adjacent brain parenchyma. Additional smaller osseous masses are seen including one within the posterior right frontal bone and one within the right occipital bone.

Output: 1.An irregularly marginated rim-enhancing masslike lesion is seen at the junction of the right occipital and temporal lobes which, given the history, is highly suspicious for an intracranial metastatic lesion. A subcentimeter satellite lesion is also noted somewhat more posteriorly.2.Multiple osseous metastatic lesions are also seen with a dominant lesion noted at the left parietal region. This tumor invades the underlying bone extending at least to the inner table if not the dura, but there is no evidence of invasion of the underlying brain.3.Due to the fact that postcontrast images were severely degraded by motion artifact, the possibility of additional smaller parenchymal metastatic lesions cannot be excluded. Areas of T2 signal abnormality within the cerebellum are nonspecific and could potentially just represent vascular lesions.4.Multiple scattered foci of restricted diffusion are seen in a fairly symmetric distribution along the watershed zones of the cerebral hemispheres. These are favored to represent small perfusional infarcts. One or perhaps several small acute infarcts are also suspected within the cerebellum in the context of fairly extensive chronic ischemic disease.


Instruction: Generate impression based on findings.

Input: Neck pain, low back pain, and paresthesias Cervical: Examination is slightly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is grade 1 anterolisthesis of C4 and C5 and minimal retrolisthesis of C5 on C6 and C6 on C7. Degenerative changes are seen with significant loss of disk height at the C5-C6 and C6-C7 levels. There is ankylosis of the left C3-4 facet joints. There are T2 hyperintense lesions at the T1 and T2 vertebral bodies with possible T1 hyperintensity and striations although images are motion degraded. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foraminal. There is prominent left-sided facet arthropathy.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: There is mild left neural foraminal stenosis related to prominent left-sided facet arthropathy. No significant compromise to the spinal canal or right neural foramina.C5-6: There is mild spinal canal narrowing related to disk osteophyte complex and ligamentum flavum thickening causing ventral and dorsal thecal sac effacement. No evidence of cord compression or cord signal abnormality. There is moderate right neural foraminal narrowing related to uncovertebral hypertrophy. There is mild left relatively greater than right facet arthropathy.C6-7: There is disk osteophyte complex and ligamentum flavum thickening resulting in partial effacement of the ventral and dorsal thecal sac and mild spinal canal stenosis. No cord compression or cord signal abnormality seen. There is uncovertebral hypertrophy with mild to moderate left and minimal right neural foraminal narrowing. Mild facet arthropathy. C7-T1: No significant compromise to the spinal canal or neural foramina. Bilateral facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar: Examination is slightly motion degraded. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is evidence of lumbar levocurvature. There is grade 1 anterolisthesis of L3 on L4 and minimal anterolisthesis of L4 and L5. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: There is a disk bulge with right paracentral disk extrusion component and resulting partial effacement of the right lateral recess. There is mild to moderate right and minimal left neural foramina narrowing. No significant central canal stenosis.L2-L3: There is loss of intravertebral disk height, mild bulge, and facet arthropathy. There is moderate right neural foraminal narrowing and minimal left neural foraminal narrowing. No significant spinal canal stenosis. L3-L4: There is loss of disk height, grade 1 anterolisthesis, as well as small bulge. There is also ligamentum flavum thickening and prominent facet arthropathy. There is resulting mild spinal canal stenosis. There is mild bilateral right worse than left neural foraminal narrowing. L4-L5: Minimal anterolisthesis and mild disk bulge. There is advanced bilateral facet arthropathy. There is mild right neural foraminal narrowing and moderate left neural foraminal stenosis. No significant spinal canal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. There is bilateral facet arthropathy.Paraspinous soft tissues are within normal limits. Left renal cyst incidentally noted.

Output: 1. Degenerative changes in the cervical spine with disk osteophyte complexes at C5-C6 and C6-C7 and ligamentum flavum thickening resulting in mild spinal canal stenosis at this level. No cord signal abnormality. 2. Moderate right C5-C6 neural foraminal narrowing. Additional levels of milder foraminal narrowing in the cervical spine as above.3. Multilevel degenerative changes in the lumbar spine as detailed above with mild spinal canal stenosis at L3-L4. There is degenerative spondylolisthesis at L3-L4 and to a lesser degree at L4-L5. There is multilevel neural foraminal narrowing relatively worse at the right L1-L2, right L2-L3, and left L4-L5 levels.4. Multilevel left greater than right facet arthropathy in the cervical spine as well as at multiple levels in the lumbar spine which may be contributing to patient's neck and back pain. 5. T2 hyperintense lesions at the T1 and T2 vertebral bodies with possible T1 hyperintensity are nonspecific and may represent atypical hemangiomas. Suggest comparison with priors.


Instruction: Generate impression based on findings.

Input: 35-year-old man with history of small bowel Crohn's status post resection and stricturoplasty in December 2014, now with poor appetite. ABDOMEN:LIVER, BILIARY TRACT: The liver is otherwise unremarkable. Multiple hepatic cysts are identified and unchanged, the largest of which measures 15 mm in segment IVb. The gallbladder and biliary tract are normal.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a 35 mm left upper pole renal cyst, otherwise the kidneys are unremarkable.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Patient is status post small bowel resection with corresponding decreased bowel volume. In the right lower abdomen (series 5, image 29) there is a persistent area of narrowing at the site of previously seen stricture, however the proximal bowel is not dilated. This finding may be secondary to underdistention or a nonflow-limiting focal chronic stricture.Proximal to this area of stricturing, there is an approximately 13 cm length of small bowel located in the left mid abdomen with concentric thickening. This loop of bowel is not T2 hyperintense and does not enhance significantly, apparent thickening appears to improve on other subsequent sequences, thus underdistention is favored. Correlation with patient's clinical history and/or point tenderness if any suggested. Fibrofatty proliferation in the mesentery is noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings suggestive of chronic inflammation of the small bowel as above without evidence of acute disease. No evidence of bowel obstruction.


Instruction: Generate impression based on findings.

Input: Clinical question: Demyelinating disease; follow progression. Signs and symptoms: Left hand weakness. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates interval progression of demyelinating disease since prior study. There is a new demyelinating plaque in the subcortical white matter of the left anterior temporal lobe with evidence of enhancement. The findings measures approximately 8.5 mm in transaxial dimensions.A second enhancing demyelinating plaque is in the subcortical white matter of the left posterior parietal measuring at 7.5 times 5.5-mm in transaxial dimensions. Additionally there are two small subcortical foci of flair hyperintensity with enhancement in the left superior temporal gyrus anteriorly.The lateral ventricles are slightly prominent for patient's stated age of 30 however without interval change since prior exam. Mild prominence of cerebral cortical sulci is also noted without change. Multiple previously seen demyelinating plaques are again identified.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits and including axial fat sat post enhanced series. All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Negative diffusion weighted images.2.Interval progression of demyelinating disease with multiple new enhancing plaques in the left temporal and right posterior parietal as detailed/measures above.


Instruction: Generate impression based on findings.

Input: Male, 25 years old, history of lymphoma, complaining of nighttime and morning pressure headaches and pins-and-needles tingling down the right arm. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. No abnormal parenchymal or extra-axial enhancement is detected. The ventricular system is normal in caliber and morphology. Bone marrow signal characteristics are unremarkable. A mucous retention cyst is evident in the right maxillary sinus.

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


Instruction: Generate impression based on findings.

Input: 66-year-old woman with erythema and swelling of the right third toe. Evaluate for osteomyelitis. There has been amputation of the second toe through the base of the proximal phalanx. There is swelling of the soft tissues of the third toe with osteolysis of the distal phalanx, representing osteomyelitis. The distal phalanx of the fourth toe is absent and only small fragments of the middle phalanx remain. We suspect this is due to prior surgery or longstanding infection. There appears to be a biphalangeal fifth toe with irregularity of the distal margins which is nonspecific, but we cannot exclude the presence of osteomyelitis. Findings of chronic osteomyelitis of the right tibia with overlying wound are noted, as seen on prior MRI studies.

Output: 1. Osteomyelitis of the distal phalanx of the third toe. 2. Other findings as described above suggesting additional sites of infection, perhaps chronic.


Instruction: Generate impression based on findings.

Input: Hip pain, evaluate for labral tear. ACETABULAR LABRUM: The labrum appears intact.ARTICULAR CARTILAGE AND BONE: The visualized bone marrow is within normal limits. The cartilage of the left hip is grossly intact.SOFT TISSUES: The musculature and other soft tissues appear unremarkable. ADDITIONAL

Output: 1.No evidence for labral tear.2.Please see CT 6/25/2015 for details regarding acetabular over coverage and exaggerated acetabular anteversion.


Instruction: Generate impression based on findings.

Input: 45 year old female with a history of COPD on oxygen, pulmonary hypertension, pulmonary sarcoidosis, found to have dilated aortic root with moderate-severe aortic regurgitation on echocardiography. Left VentricleThe left ventricle is moderately dilated with low normal systolic. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 106 ml/m2 (normal range: 65+/-11), the LVEDV is 179 ml (normal range 109+/-23), the LV end systolic volume index is 49 ml/m2 (normal range 18+/-5), the LVESV is 83 ml (normal range 31+/-10), the LV mass index is 59 g/m2 (normal range 67+/-11), and the LV mass is 99 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process though the images were difficult to interpret due to significant breathing artifact (patient unable to perform adequate breath holds). Pre-contrast native T1 mapping time = 1108 msLeft AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 32%, the RV end diastolic volume index is 94 ml/m2 (normal range 69+/-14), the RVEDV is 158 ml (normal range 110+/-24), the RV end systolic volume index is 64 ml/m2 (normal range 22+/-8), and the RVESV is 108 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve is tri-leaflet. There is thickening of the aortic valve leaflets. There is at least mild-moderate aortic regurgitation based on quantitative QFlow analysis (regurgitant fraction 20%) however this is likely underestimated based on qualitative assessment. Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild to moderate 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. Measurements made from 3D whole heart study which was of marginal quality.Aorta measurements:Sinus of Valsalva: 45x45x43 mm.Sinotubular Junction: 39x38 mm.Proximal Ascending Aorta: 45x41 mmAscending Aorta (immediately proximal to innominate artery): 38x40 mmAscending Aorta (immediately distal to innominate artery): 22x24 mmDescending Aorta: 22x23 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated (57x53 mm). Left PA 25x24 mm, right PA 26x27 mmVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with low normal systolic. The overall LV ejection fraction is 54%.2. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 32%3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 4. There is at least moderate-severe aortic regurgitation by quantitative analysis but this is likely underestimated based on visual interpretation which suggests moderate-severe aortic regurgitation. The stroke volume difference between the right and left heart (LV = 96 mL and RV = 50 mL also suggests moderate to severe aortic regurgitation.5. Dilated aortic root and ascending aorta with above measurements. 6. Dilated main PA with above measurements.7. Suggest repeat study to re-assess in 3-6 months or whenever clinically appropriate. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 49 year old female status post OHT done 11/2/2012, here for MRI post transplant. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 66%. The LVEDV is 72 ml (normal range 109+/-23), LV end diastolic volume index is 38 ml/m2 (normal range: 65+/-11), LVESV is 25 ml (normal range 31+/-10), and LV end systolic volume index is 13 ml/m2 (normal range 18+/-5). The LV mass is 114 g (normal range 114+/-24) and the LV mass index is 60 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement of the left ventricular myocardium to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is [1073 ]ms (borderline normal). Left AtriumThe left atrium has transplant morphology.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 45 ml/m2 (normal range 69+/-14), the RVEDV is 85 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 39 ml (normal range 35+/-13). Right AtriumThe right atrium has transplant morphology. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA 15x12mm nodule is noted in the left lower lung, correlation with chest CT suggested. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular structure and function with EF of 66% without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. Normal right ventricular structure and function with EF of 54%3. A 15x12mm nodule is noted in the left lower lung, correlation with chest CT suggestedI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left knee mass MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is thinning and degeneration of the articular cartilage of the medial femoral condyle anteriorly. There is moderate thinning of the articular cartilage of the lateral compartments as well. Extensive cartilage loss of the patellofemoral compartment is noted particularly along the lateral patellar facet and there is associated underlying reactive marrow changes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Articular cartilage degeneration and loss further detailed above which predominantly involves the patellofemoral compartment.2. Partial visualization of complex collection within the posterior compartment of the knee which is better evaluated on dedicated MRI of the leg from the same day.


Instruction: Generate impression based on findings.

Input: 61-year-old male with HCC status post TACE ABDOMEN:LIVER, BILIARY TRACT: Widening of the fissures consistent with cirrhotic morphology. Trace perihepatic fluid.Subcentimeter T2 hyperintense lesion in the right lobe of the liver likely reflects a cyst.Redemonstrated is a T2 hypointense treatment cavity in segment eight of the liver. There is a wedge-shaped arterially enhancing region adjacent to the treatment site. There is no definite focus of washout or persistent enhancement to suggest recurrent or residual disease. No new suspicious lesions are present.Hepatic steatosis is present. Mild intrahepatic biliary ductal prominence. Cholelithiasis is present.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense cyst in the left interpolar kidney. No hydronephrosis or perinephric inflammation.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.Status post TACE as described above without evidence of recurrent or residual disease.2.Wedge-shaped arterial enhancement adjacent to the treatment site likely perfusional changes related to treatment.


Instruction: Generate impression based on findings.

Input: Slurred speech [R47.81], Reason for Study: ^Reason: stroke protocol History: slurred speech, L facial droop Brain MRIThere is restricted diffusion lesion on the right internal capsule posterior limb without evidence of hemorrhagic conversion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.There is about 10mm (AP) x 7.1mm (RL) x 14mm (CC) sized T2 high signal intensity and T1 low signal intensity lesion on the right side posterior superior and lateral wall of nasopharynx indicating nasopharyngeal polyp. Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate no evidence of intracranial arterial luminal occlusion, significant stenosis normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Acute ischemic infarction without evidence of hemorrhagic conversion on the right internal capsule posterior limb.2. Right side nasopharyngeal polyp [10mm (AP) x 7.1mm (RL) x 14mm (CC) ]3. Normal brain MRA and normal neck MRA.


Instruction: Generate impression based on findings.

Input: THORACIC SPINE: There is no significant disc herniation, spinal canal stenosis or neural foraminal stenosis thoracic spine. There is a tiny central disc protrusion at C4-5 without significant spinal canal stenosis. The thoracic spinal cord signal is within normal limits. There is normal alignment and vertebral body height. There are scattered hemangiomas or focal fat in the thoracic vertebral bodies.LUMBAR SPINE: There are mild disc bulges at L2-3, L3-4 and L4-5 with mild to moderate degrees of bilateral facet arthropathy causing mild right neural foraminal stenoses at these levels. Additionally, there is moderate left L4-5 in mild left L3-4 neural foraminal stenosis. There is mild L3-4 and moderate L4-5 spinal canal stenosis as a result of the degenerative findings. There is a Schmorl's node in the superior endplate of L2 vertebral body. The conus terminates at L1-2. There is a distended gallbladder with a large gallstone which is incompletely imaged. There is an incompletely imaged right pelvic transplant kidney. The native kidneys are atrophic with multiple cystic lesions. In addition, there is exophytic heterogeneous cystic mass with probable foci of hemorrhage measuring up to 39 x 37 mm in the right kidney. There is also a low T1 and high T2 signal intensity lesion arising from the right adrenal gland that measures up to 20 mm.

Output: 1.Mild to moderate lumbar spondylosis associated with mild L3-4 and moderate L4-5 spinal canal stenosis with mild to moderate of neural foraminal stenoses.2.A right renal exophytic heterogeneous cystic mass is incompletely evaluated due to lack of IV contrast. Differential considerations include hemorrhagic cyst verus cystic neoplasm. Dedicated renal imaging may be useful for further evaluation of this lesion.3.Cholelithiasis in a distended gallbladder is incompletely imaged. A dedicated ultrasound exam may be useful for further evaluation.4.A lesion arising from the right adrenal gland that measures up to 20 mm is incompletely characterized. Dedicated imaging may be useful for further evaluation.Findings were discussed with Dr. W. James Chon over the telephone at 12:17 PM today.


Instruction: Generate impression based on findings.

Input: 45-year-old female patient with a left breast medullary cancer per outside hospital pathology, status post lumpectomy and complete axillary lymph node dissection 9/2014 with unoriented margins and 2 positive nodes. No adjuvant therapy. Assess for residual disease. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a mass in the 7 o'clock position of the left breast demonstrating heterogenous enhancement and a central focus of fat signal intensity, which may represent a component of fat necrosis. The mass measures 3.2 x 2.9 x 3.6 cm (AP x ML x CC) and is inseparable posteriorly from the pectoralis major muscle. There is associated skin thickening of the medial left breast, measuring up to 9 mm in thickness. An enlarged enhancing interpectoral lymph node measures 2.9 x 1.7 cm. There is soft tissue thickening along the left internal mammary chain that may represent an internal mammary lymph node with associated adjacent sternal enhancement. The soft tissue component measures 1.5 x 2.3 cm. There is an additional small area of peri-sternal enhancement superiorly that measures up to 1.2 x 1.0 cm. Post surgical changes in the left axilla compatible with lymph node dissection.There is no suspicious enhancement in the right breast. Note that evaluation of the right axilla is limited by patient motion artifact. Prominent right axillary lymph nodes are noted with diminished fatty hila, and with cortical thickening measuring up to 6 mm. There is an enhancing lesion along the inferior axillary skin may that represent an inflamed epidermoid inclusion cyst.

Output: 1.Large enhancing left breast mass compatible with recurrent or residual breast cancer with a possible component of fat necrosis. There is associated skin thickening. Enlarged left interpectoral node and left internal mammary enhancing tissue highly suggestive of metastatic breast cancer.2.Indeterminate right axillary lymph nodes. Prominent lymph nodes may be related to inflamed right axillary skin lesion versus metastatic disease. Suggest correlation with physical examination and consideration of right axillary ultrasound to evaluate for lymphadenopathy.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Right-sided numbness in face/arm/leg. Signs and symptoms: Same. CTA of intracranial circulation:55 cc of Omnipaque 350 is administered for this exam.3-D reformatted images were obtained from an independent workstation.There is patent bilateral internal carotid arteries across the skull base and in their supraclinoid components. The source and MIP images demonstrate presence of bilateral ophthalmic arteries. Proximal bilateral anterior and middle cerebral arteries are well visualized and unremarkable. The anterior communicating artery is identified and unremarkable. There are patent bilateral normal appearing posterior communicating arteries.There is a hypoplastic right vertebral artery and with a normal appearing right pica branch.A dominant and normal appearing left vertebral artery is identified. Right pica branch and including its origin is unremarkable.Basilar artery is patent. Excellent Normal visualization of bilateral superior cerebellar arteries. There is hypoplastic left P1 secondary to a dominant left posterior communicating artery. Posterior cerebral arteries are unremarkable.CTA of neck:Limited view of the aortic arch and the origins of the major vessels are unremarkable.Right brachial cephalic, origin of right common carotid artery, right common carotid artery are within normal limits. A small smooth and minimally calcific plaque at the origin of right internal carotid artery is noted. There is no hemodynamically significant lumen compromise. The right internal carotid artery is otherwise unremarkable.The left common carotid artery and including its origin are unremarkable. A shallow smooth and minimally calcified plaque at the origin of the left internal carotid artery is also present and bleed no evidence of compromise of lumen. The left internal carotid artery is otherwise unremarkable.Bilateral proximal external carotid arteries are unremarkable.Nonenhanced head CT:Examination demonstrates very subtle suspect that periventricular low attenuation of white matter concerning for possible minimal small vessel ischemic disease of indeterminate age. Recommend further follow-up with a dedicated MRI of brain.There is no evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.

Output: 1.Non-enhanced CT of brain demonstrates suspected minimal small vessel disease of indeterminate age. Recommend follow-up with a dedicated MRI of brain.2.Unremarkable CTA of intracranial circulation.3.Unremarkable CTA of neck.


Instruction: Generate impression based on findings.

Input: Neck pain and radicular pain to the right upper extremity. There are stable postoperative findings related to anterior cervical fixation at C4-C6. At other cervical levels, the vertebral body heights and the normal bone marrow signal are preserved. There is mild straightening of the normal cervical lordosis. Otherwise, alignment is anatomic. There is diffuse congenital narrowing of the spinal canal and multilevel degenerative spondylosis, including multilevel disc bulges and moderate ligamentum flavum hypertrophy. In particular, at C2-C3, there is an unchanged disc-osteophyte complex and ligamentum flavum and facet hypertrophy, resulting in moderate spinal canal stenosis with impingement upon the cord and bilateral neural foramen stenosis. At C3-C4, there is an unchanged slight disc-osteophyte complex and ligamentum flavum hypertrophy, resulting in mild spinal canal stenosis, but no significant neural foraminal stenosis. At C6-C7, there is an unchanged slight disc-osteophyte complex and ligamentum flavum hypertrophy, resulting in mild spinal canal stenosis and moderate bilateral neural foraminal stenosis. A C7-T1, there is an unchanged trace posterior disc-osteophyte complex and left uncovertebral joint hypertrophy with unchanged mild left neural foraminal narrowing. The spinal cord appears to be unremarkable. The paraspinal soft tissues are unremarkable.

Output: 1. Unchanged diffuse congenital narrowing of the cervical spine with superimposed degenerative spondylosis, that is most pronounced at C2-3, where there is impingement upon the spinal cord and at C6-7, where there is moderate bilateral neural foraminal stenosis. 2. Stable postoperative findings related to anterior cervical fixation at C4-C6.


Instruction: Generate impression based on findings.

Input: 35-year-old male rule out aneurysm. History of right frontal tumor resection. Rule out subarachnoid hemorrhage. Non-infused CT of brain.Examination demonstrates a large surgical cavity in the right frontal lobe representing site of previously resected tumor.Extensive vasogenic edema in the right hemisphere and to a lesser degree within the left cerebral hemisphere is noted. This is concerning for recurrence of tumor and a follow up exam with an MRI is recommended.No evidence of subarachnoid hemorrhage is detected. Slight high density within the sylvian fissure and interhemispheric fissure is secondary to low density of the adjacent brain parenchyma and not subarachnoid hemorrhage. MRV of intracranial sinuses.This examination is within normal limits and demonstrates normal augment renal venous sinuses.CTA of intracranial spiculation.CTA of the carotid system demonstrates patent bilateral internal carotid arteries across the skull base. There is good visualization of bilateral anterior and middle cerebral arteries with no evidence of pathology in particular no evidence of aneurysm.CTA of vertebral basilar system demonstrates patent bilateral intracranial components of the vertebral arteries with no pathology. Basilar artery and all of its branches are normal and demonstrate no pathology in particular no stenosis or aneurysm.

Output: 1.Increased edema surrounding the surgical cavity in the right hemisphere is highly concerning for recurrence of tumor and a follow up MRI with infusion is recommended.2.No evidence of subarachnoid hemorrhage on CT.3.Unremarkable MRV of intracranial venous sinuses.4.Unremarkable CTA of intracranial vasculature.


Instruction: Generate impression based on findings.

Input: Diagnosis: Localized swelling, mass and lump, neckClinical question: right supraclavicular mass , low grade vascular neoplasmSigns and Symptoms: eval extent of mass to vessels MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. MRI neck:There is a 48 x 28 mm heterogeneous mass centered in the right supraclavicular area which is surrounded by adjacent vasculature including the subclavian artery and vein as well as thyrocervical trunk. Along its superior medial aspect there is a 12 x 9 mm axial dimension fluid collection present there is infiltration of the surrounding fat planes. There are punctate foci of signal loss within this lesion with slight susceptibility effect. The skin surface superficial to the lesion is irregular and somewhat disrupted. Some blood products are present within the adjacent subcutaneous tissues.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis.

Output: 1.There is a right supraclavicular mass associated with surrounding inflammatory changes and findings suggesting recent surgery. No arterial blood supply is appreciated. A biopsy of this lesion indicates that this represents a hemangioma. Given this biopsy information, certainly the findings are consistent with a recent biopsy of a hemangioma. A follow-up cross-sectional exam after the inflammatory changes regress may help further evaluate this.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical spine with preserved vertebral body heights, benign marrow signal and normal cord signal. There is disk desiccation at essentially all levels in the cervical spine with loss of disk height most notably at C3-4 through C7-T1, similar to prior examination. There is resolved degenerative endplate edema at C4-5 and superior endplate of T1 with possible subtle low signal on all sequences.C2-3: No spinal stenosis, unchanged.C3-4: Disk osteophyte complex and bilateral uncovertebral hypertrophy causing moderate left and mild right neural foraminal stenosis. No spinal canal stenosis. These findings are unchanged.C4-5: Disk osteophyte complex and bilateral uncovertebral hypertrophy causing moderate left and mild to moderate right neural foraminal stenosis. No spinal canal stenosis. These findings are unchanged.C5-6: Disk osteophyte complex and left greater than right uncovertebral hypertrophy causing mild to moderate left and mild right neural foraminal stenosis. No spinal canal stenosis. These findings are unchanged.C6-7: Disk osteophyte complex and mild right uncovertebral hypertrophy causing mild right neural foraminal stenosis, and no significant spinal canal or left neural foraminal stenosis. These findings are unchanged.C7-T1: Disk osteophyte complex and bilateral uncovertebral hypertrophy causing moderate bilateral neural foraminal stenosis. These findings are unchanged.

Output: 1.Resolved degenerative endplate edema at C4-5 and superior endplate of T1 with finding suggesting progressive type III sclerotic endplate degenerative changes at these levels.2.Multilevel cervical spondylosis with no other significant change. Please see details above.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess brain lesions. Signs and symptoms: seizure. Non-enhanced CT brain:Examination demonstrate a well demarcated low attenuation lesion in the inferior right frontal lobe. There is effacement of adjacent cortical sulci and minimal indentation of right frontal horn. There is no interval change since prior examination of 5 -- 11 -- 2010.Additional small foci of low attenuation adjacent to the trigone of right lateral ventricle is also again identified and read no interval change. There are two additional apparent cortical based low attenuation in the left mid temporal lobes with no evidence of interval change. Subcortical low-attenuation in the right frontal lobe along to its interhemispheric aspect extends inferiorly to the level of previously described right frontal lobe lesion.These findings on MRI examination of brain on the same date do not have the appearance of stroke.There is bony thickening and new bone formation along the floor of anterior cranial fossa with possibly some internal lytic changes. This finding may represent fibrous dysplasia. This finding is immediately at the level of large right frontal lobe lesion and I can't be certain whether this finding is related to intracranial findings.CTA of intracranial circulation:Carotid system.Right internal carotid. Normal interval carotid artery across the cavernous sinus and in its supraclinoid portion. There is normal appearing right anterior and middle cerebral arteries and their branches. Review of coronal, sagittal and axial 2-D MIP images demonstrate no definitive evidence of any detectable abnormality in the distal branches of anterior and middle cerebral arteries that are not well visualized on the 3-D reformatted images.Left carotid.The left internal carotid artery across the cavernous sinus and its supraclinoid portion remains within normal. There is also normal visualization of the left anterior annular cerebral arteries and their branches. To evaluate the distal branches of left anterior and middle cerebral arteries which are not visualized on 3-D reformatted images the 2-D MIP images in coronal, sagittal and axial sequences were reviewed. These 2-D images fail to demonstrate any detectable abnormality of distal branches.Vertebral basilar system.There is normal visualization of bilateral vertebral arteries and their intracranial component. Basilar artery and all of its branches are well visualized and unremarkable.65 cc of Omnipaque 350 was administered for above study.

Output: 1.Stable unenhanced CT examination of brain since prior exam. Multiple intracranial findings are highly suspect for masses and unlikely to represent strokes.2.Expansile bony lesion of right frontal bone along the floor of the right anterior cranial fossa may represent fibrous dysplasia, however the large right frontal lobe lesion that abuts the inner table of the skull in the right frontal lobe may represent a combined osseous and intracranial pathology like a neoplasm. Patient had a nonenhanced MRI of brain however an enhanced MRI is highly recommended to further evaluate multiple unusual intracranial lesions. Please reviewed report of an enhanced MRI of brain.3.Negative CTA of intracranial vasculature.4.CTA is not in the appropriate test for detection of intracranial enhancement.


Instruction: Generate impression based on findings.

Input: Scout image demonstrates a mid-esophageal stent as seen on prior CT. Pigtail catheter overlies the right hilar region. Surgical clips are present over the mediastinum. There is destruction of the T7, T8, and T9 vertebral bodies similar to prior CT and MRI studies. Cervical fusion hardware is present.Single contrast evaluation of the esophagus demonstrates oral contrast traversing both through the esophageal stent and to the left of the esophageal stent in the nonstented portion of the esophagus as seen on recent CT. There is contrast extravasation originating from the posterior mid esophagus at the level of the distal portion of the stent best seen on cine clip series 8. The contrast extravasation approaches the pigtail catheter, however, no contrast is present in the pigtail catheter. No additional fistulae/sinus tracts are visualized.

Output: Contrast extravasation originating from the posterior midesophagus consistent with a persistent leak. The contrast extravasation approaches the existing right perihilar pigtail catheter.Findings discussed by telephone with the clinical service, Dr. Boyle, at 3:45 PM on 12/30/2016.


Instruction: Generate impression based on findings.

Input: 47 year old male patient with prolactinoma, stroke. Follow up examination. Brain: There is a focus of restricted diffusion with associated faint enhancement within the posterior left basal ganglia and internal capsule compatible with a subacute infarct. There is no associated susceptibility artifact to suggest hemorrhage. There is otherwise scattered foci of white matter T2/FLAIR signal abnormality in the frontal lobes compatible with chronic small vessel ischemic disease. The ventricles and basal cisterns are stable in size and configuration. The orbits and scalp soft tissues are grossly unremarkable.Pituitary:Redemonstration of an expansile sellar mass with suprasellar extension which encases the distal right ICA and involves the right aspect of the cavernous sinus, sphenoid sinus, clivus, and petrous apex. Compared to the prior study, the mass is less homogeneous in enhancement and decreased in size. The lesion measures 31 x 35 x 26 mm (AP x transverse x craniocaudal), previously 35 x 41 x 31 mm.

Output: 1. Evolving subacute infarct in the left basal ganglia.2. Decrease in size of a sellar/cavernous sinus mass.


Instruction: Generate impression based on findings.

Input: Redemonstrated is mild diffuse volume loss without a lobar predominant atrophy pattern. There are no findings of interval ventricular dilatation or for hydrocephalus. Also redemonstrated are scattered foci of T2 hyperintensity in the periventricular and subcortical white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: 1.Stable mild diffuse volume loss without a lobar predominant atrophy pattern.2.Stable mild chronic small vessel ischemic disease. 3.Otherwise negative MRI of the brain and internal auditory canals including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's left sensorineural hearing loss.


Instruction: Generate impression based on findings.

Input: 75-year-old female with history of multiple CVAs now presents with increased altered mental status and muscle twitches. Please evaluate for new bleed, mass effect or shift. Compared to previous to evaluate progression of CVA. There is no evidence of intracranial hemorrhage, mass or edema. The previously described there is low attenuation throughout the MCA vascular territory the left consistent with a subacute infarct but remains overall unchanged from the previous examination. Multiple other areas of hypodensity in the periventricular and subcortical white matter distribution is consistent with small vessel disease, age indeterminant. Multiple lacunar infarcts redemonstrated within the bilateral basal ganglia and cerebellum. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are stable in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Stable right frontoparietal subacute infarct. 2. Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Reason: meniscus tear vs. AVN History: right knee pain and swelling. MENISCI: There is a horizontal tear through the anterior body and anterior horn of the lateral meniscus with a parameniscal cyst adjacent to the anterior horn measuring 2 mm. The posterior horn of the lateral meniscus is intact.The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the patellofemoral and tibiofemoral compartments are intact.Serpiginous abnormal signal within the posterior aspect of the distal femoral diaphysis compatible with bone infarct.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Horizontal tear of the anterior body and anterior horn of the lateral meniscus with parameniscal cyst adjacent to the anterior horn of the lateral meniscus.2.Bone infarct in the distal femur.3.Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Status post meningioma resection 9/4/2013 and SRS treatment January 2015. Posttreatment follow-up. Thin cuts cavernous sinus. Fatigue, seizures, headaches. Again seen are postoperative findings related to left frontotemporal craniotomy with mild interval evolution. There is mild volume loss and gliosis involving the left anterior temporal lobe. Compared to 11/3/2014, there is been slight interval decrease in size of dural-based heterogeneously enhancing left parasellar mass that measures approximately 25 x 25 x 18 mm in the AP, transverse, and craniocaudal dimensions, previously 25 x 28 x 21 mm. Again seen is mass effect upon the adjacent left temporal and frontal lobes and left optic apparatus. There is mass effect on the left optic tract and to a lesser degree chiasm, slightly improved in the interval. The adjacent internal carotid artery, middle cerebral artery, and anterior cerebral artery flow voids do not appear to be significantly narrowed. Tumor contacts the pituitary gland without obvious mass effect. There appears to be some extension into the upper aspect of the left cavernous sinus. There is a peritumoral cyst laterally and minimal edema in the surrounding brain parenchyma which is improved. There is no evidence of new intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no significant midline shift or herniation. There are nasopharyngeal, maxillary, and right sphenoid sinus retention cysts.

Output: 1. Compared to 11/3/2014, there is mild interval decrease in size of left parasellar meningioma measuring approximately 25 x 25 x 18 mm, previously 25 x 28 x 21 mm. 2. Again seen is mass effect on the left optic tract and to a lesser degree chiasm but slightly improved in the interval. 3. Mass effect on the left inferior frontal and medial temporal lobes again seen. Gliosis in the left anterior temporal lobe consistent with postsurgical change.


Instruction: Generate impression based on findings.

Input: Reason: having pain in groin, and perianal area History: having pain in groin and perianal area Lumbar MRI is good There is increased signal abnormality on fluid sensitive sequences within the right gluteus maximus muscle. There is a 1.7 x 1.0 cm focus of fluid signal intensity with associated peripheral enhancement on postcontrast sequences (image 28; series 10). There is nonspecific enhancing subcutaneous edema along the posterior aspect of the right hemipelvis in the surrounding area. There is perhaps minimal skin thickening in the overlying area. No bone marrow signal abnormalities are identified. The imaged musculature of the pelvis is otherwise unremarkable. There is a small amount of fluid within the hips which is not necessarily of any clinical significance. The prostate appears enlarged. Mild osteoarthritis affects the hips. Mild degenerative disc disease affects the imaged lower lumbar spine.

Output: Enhancing signal abnormality within the right gluteus medius maximus and enhancing overlying subcutaneous edema. There is a 1.7 cm focus of peripherally enhancing fluid signal abnormality along the posteromedial aspect of the right gluteus maximus muscle as described above. These findings are suspicious for inflammatory change/myositis with small abscess formation in the correct clinical context. Alternatively, these could represent a muscle strain with interstitial tearing, particularly if there is a history of trauma.


Instruction: Generate impression based on findings.

Input: Postoperative evaluation for left ACL tear 4/11/2016.VIEWS: 2 views of the left knee, nonweightbearing. Postoperative findings including orthopedic sideplate within the lateral soft tissues adjacent to the distal femoral metaphysis. Osseous tunnels are visualized in the distal femur and proximal tibia. There is a joint effusion.

Output: Postoperative findings from ACL repair with sideplate within the lateral soft tissues.


Instruction: Generate impression based on findings.

Input: 54-year-old female with pain. Evaluate for rotator cuff tear. ROTATOR CUFF: There is a small interstitial insertional tear within the supraspinatus at the level of its insertion on the greater tuberosity. There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. No full-thickness rotator cuff tear is evident. There is diffuse fatty infiltration of the imaged musculature of the rotator cuff, appearing similar to minimally progressive compared to the prior study. The infraspinatus tendon appears intact. The subscapularis and teres minor tendons appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Moderate osteophytic changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum is normal in appearance within the limitations of this non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Small insertional tear of the supraspinatus as described above without evidence of full-thickness rotator cuff tear or retraction.2. Interval resolution of the previously described foci of bone marrow signal abnormality within the proximal humerus.3. Diffuse fatty infiltration of the musculature of the rotator cuff which appears similar to minimally progressed when compared to the prior study.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with diffuse large B-cell lymphoma. Thoracic:Exaggerated thoracic kyphosis is unchanged. Sagittal alignment is otherwise anatomic. Vertebral body heights are preserved. Scattered small Schmorl's node defects are unchanged. No evidence of pathologic marrow replacement, edema or enhancement is seen. The visualized spinal cord shows normal signal intensity and morphology and is free of pathologic enhancement. No epidural abnormalities are suspected. No significant spinal canal or foraminal stenosis is seen. The right kidney is not visualized and the left is large, similar to prior.Lumbar:Mild edema and enhancement along the L3 endplates is redemonstrated similar to prior. Minimal endplate degenerative signal abnormal is also seen at L4-5, slightly progressed from prior. No areas of pathologic marrow replacement are seen. Alignment is anatomic. Vertebral body height and morphology are within normal limits. Faint enhancement of the nerve roots of the cauda equina is suspected. This is new when compared to the prior examination, though such differences could at least in part be technical. No epidural abnormalities are seen. Mild disc degeneration and posterior element hypertrophy is redemonstrated without high-grade spinal canal or foraminal stenosis.

Output: 1.Faint enhancement of the nerve roots of the cauda equina is suspected, new when compared to the prior examination, though the differences may in part be technical. Nevertheless, given the known intracranial findings, this could represent a manifestation of the patient's lymphoma.2.No additional specific evidence of lymphomatous involvement is seen elsewhere in the lumbar spine or in the thoracic spine.


Instruction: Generate impression based on findings.

Input: 55-year-old female with one month into the left shoulder after dog pulled lesion. Examination concerning for suprasp and subscap. Evaluate for rtc tear. ROTATOR CUFF: There is mild intermediate signal intensity within the supraspinatus tendon near its insertion indicating mild tendinosis without clear tendonous thickening or discrete tear. The supraspinatus muscle appears normal. The remaining cuff including the infraspinatus muscle and tendon appear normal and intact. SUPRASPINATUS OUTLET: Mild osteoarthritic changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is trace fluid within the glenohumeral articulation with a more focal fluid focus adjacent to the joint which may be a small sub centimeter para labral cyst (series 4, image 8). The exam is limited in its evaluation of the glenoid labrum specifically, with the absence of augmentation. If there is concern for a labral abnormality clinically, dedicated imaging may be indicated..BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Mild tendinosis of the supraspinatus tendon2. Questionable para labral cyst, see detail provided.


Instruction: Generate impression based on findings.

Input: Systemic lupus erythematosus [710.0], Reason for Study: ^Reason: possible seizure History: as above No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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.Mucous retention cyst on the right side of sphenoid sinus and mucosal thickening on the posterior ethmoid sinus.

Output: No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal signal intensity on this MR scan.


Instruction: Generate impression based on findings.

Input: Lupus, seizures, being worked up for infection versus inflammation, presents with echolalia, slowed speech. Some of the sequences are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears grossly unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: 1. No evidence acute infarct, encephalitis, or intracranial abscess, although the evaluation is limited by the lack of intravenous contrast.2. Scattered paranasal sinus mucosal thickening may represent sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: left knee pain History: left knee pain MENISCI: There is linear increased signal abnormality which traverses the anterior horn of the lateral meniscus and extends to the tibial and femoral articular surfaces indicating longitudinal tear which may extend to involve the free edge of the body of the meniscus. The posterior horn appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is focal partial thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle above the body of the meniscus. There is a focal near full-thickness articular cartilage degeneration along the anterior aspect of the medial tibial plateau. The medial compartment articular cartilage otherwise appears intact. There is superficial fraying of the articular cartilage along the median evidence of the patella inferiorly.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Longitudinal tear of the lateral meniscus.2. Articular cartilage degeneration most pronounced along the lateral tibiofemoral compartment as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: 77 yo diabetic heart and kidney transplant recipient with gout and diabetes; has persistent left 5th finger swelling/pain with x-ray showing osteolysis-osteomyelitis vs tophaceous gout History: Pain, swelling of left 5th digit of hand; no improvement with prednisone. There is a mass replacing the majority of the middle phalanx of the fifth finger with sparing of its base as well as within the proximal half of the distal phalanx. The tuft of the distal phalanx appears spared, although there is marrow edema within the tuft on fluid sensitive sequences. The mass extends into the soft tissues predominantly along the dorsal and medial aspects of the bones. There is mild edema within the surrounding subcutaneous fat as well as mild thickening of the skin. While it is impossible to exclude infection, these findings are compatible with tophaceous gout. There are small foci of signal abnormality within the third metacarpal head in multiple carpal bones that may represent cysts or small chronic erosions. Although the wrist is not included in its entirety, there is increased signal intensity within the midcarpal joint which may represent a small amount of fluid or a mild synovitis. There is minimal fluid seen within the tendon sheaths of the flexor tendons which is probably of no clinical significance.

Output: Tophaceous gout involving the distal and middle phalanges of the fifth finger. While it is impossible to exclude a superimposed infection, the findings may certainly be due solely to gout.


Instruction: Generate impression based on findings.

Input: History of Crohn's, evaluate for diseaseEXAMINATION: MR enterography without and with IV contrast 2/5/16 Exam is significantly limited by motion artifact.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is round well-circumscribed nonenhancing isointense lesion measuring 7 millimeter in the mid left kidney. Differential diagnosis includes lipoma or other benign mass. Sonography may be helpful for further evaluation. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:No bowel obstruction or bowel wall thickening. No free fluid or free air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No bowel obstruction or bowel wall thickening. No free fluid or free air. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Normal appearing bowel.2.7 mm nonenhancing well-circumscribed lesion in the mid left kidney. Differential diagnosis includes lipoma or other benign mass. Sonography may be helpful for further evaluation.


Instruction: Generate impression based on findings.

Input: Again seen are greater than 20 foci of T2/FLAIR hyperintensity involving the periventricular and juxtacortical white matter with morphology and distribution consistent with known demyelinating disease. Few lesions within the posterior fossa are also evident such as in the left cerebellar hemisphere and the right pons. No new lesion is appreciated when compared to 6/2/2015. There is enhancement involving the lesions adjacent to the right temporal horn and the right pons which is slightly decreased in the interval. Apparent focus of enhancement in the left superior temporal gyrus is most likely artifact as there is no corresponding lesion on the FLAIR sequence. Multiple lesions with T1 hypointensity also again seen. Brain parenchymal volume is grossly preserved. No intracranial mass or mass effect. Ventricles are normal in size. Calvarium and extracranial soft tissues are grossly unremarkable.THORACIC SPINE

Output: 1. Multiple T2/FLAIR hyperintense lesions in the supratentorial and infratentorial white matter consistent with known demyelinating disease. No new lesion is demonstrated compared to 6/2/2015. There has been interval decrease in enhancement of the lesions adjacent to the right temporal horn and in the right pons compatible with recent active demyelination.2. No lesions within the thoracic cord are appreciated.3. Lumbar spine MRI appears within normal limits without evidence of significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease status post ileocecectomy with chronic obstructive symptoms, evaluate neoterminal ileum for inflammation or stricturing. ABDOMEN:LIVER, BILIARY TRACT: Liver demonstrates normal parenchymal signal intensity. There is a subcentimeter cyst in the posterior aspect of the right hepatic lobe (series 5, image 35). No suspicious hepatic lesions are identified.SPLEEN: No significant abnormality noted. A splenule is present.PANCREAS: Pancreas is mildly atrophic with fatty atrophy most notable in the pancreatic head.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Several mildly prominent mesenteric lymph nodes are present.BOWEL, MESENTERY: Postsurgical changes of ileocecectomy. The bowel is nondilated without evidence of high-grade obstruction. There is a small right anterior abdominal wall hernia (series 8, image 47) which contains bowel without evidence of associated obstruction. There is a stricture at or near the ileocolonic anastomosis (series 9, image 27 and series 18, image 42) which demonstrates enhancement (series 17, image 20), measures approximately 2.7 cm in length (series 18, image 42), and narrows down to approximately 9 mm in caliber. No additional definite sites of disease are identified in the small bowel or colon. No intra-abdominal fluid collections are identified.BONES, SOFT TISSUES: Degenerative changes affect the spine.OTHER: No significant abnormality noted.

Output: Stricture at or near the ileocolonic anastomosis with associated enhancement suggestive of active inflammatory disease. No associated high-grade bowel obstruction.


Instruction: Generate impression based on findings.

Input: Ms. Trimby is a 64-year-old female with biopsy proven malignancy in the right breast and node positive disease in a right axillary lymph node. Same day MRI performed earlier today demonstrates an additional suspicious lesion anterior to the index malignancy in the right upper outer breast along with an enhancing lesion in the right inferior breast. She presents today for the following examinations:-Ultrasound-guided research biopsy of the known malignancy in the right upper outer breast-Ultrasound and ultrasound-guided biopsy of MR detected satellite lesion in the right upper outer breast-Ultrasound of right inferior breast for possible correlate to the MR detected enhancing lesion-Ultrasound-guided clip placement of node positive right axillary lymph node -In the right breast 11:00 location, approximately 11 cm from the nipple, the biopsy-proven malignancy was reidentified. This malignancy measures 1.6 x 1.1 x 1.0 cm. A research guided biopsy will be performed of this lesion-In the right breast 10:00 location, approximately 6 cm from the nipple, a sonographic correlate is identified for the MR detected suspected satellite lesion, measuring 0.7 x 0.6 x 0.6 cm. An ultrasound-guided biopsy with clip placement will be performed.-In the right breast 6:00 location, approximately 5 cm from the nipple, no sonographic correlate is identified for the MR detected enhancing lesion.-In the right axilla, an enlarged axillary lymph node is identified measuring 3.6 x 1.8 x 3.1 cm. An ultrasound-guided clip placement will be performed for this node.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.ULTRASOUND-GUIDED RESEARCH BIOPSY FOR THE INDEX MALIGNANCY IN THE RIGHT BREAST:The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, six 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged excellent. Two core specimens were placed in the provided formalin container. Four core specimens were placed in the RNALater container. Specimens were sent with the research assistant with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. ULTRASOUND-GUIDED BIOPSY FOR THE SUSPECTED SATELLITE LESION IN THE RIGHT BREAST:Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, four 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged excellent. Two core specimens were placed in the provided formalin container. Four core specimens were placed in the RNALater container. Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. MR-DETECTED ULTRASOUND FOR THE ENHANCING LESION IN THE RIGHT BREAST: An MR directed right breast ultrasound was performed of the inferior right breast at the site of focal enhancing lesion. In the right breast 6:00 location, approximately 4 cm from the nipple, no suspicious cystic or solid mass was identified.ULTRASOUND-GUIDED CLIP PLACEMENT FOR THE DISEASE POSITIVE RIGHT AXILLARY LYMPH NODE:Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. Using continuous ultrasound-guidance a Hydromark clip was placed into the lymph node in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC, MLO and ML views revealed the following:-A Hydromark clip and dumbbell-shaped clip are identified in the index malignancy (the dumbbell shaped clip was placed at the outside hospital)-A Hydromark clip is seen in the right upper outer breast, at site of suspected satellite lesion detected by MRI. The two clips (index + suspected satellite) are separated by approximately 4 cm. -A Hydromark clip was placed in the central aspect of the right axillary lymph node. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy sites and ice packs positioned over the pressure dressings. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Sheth.

Output: (1) Successful ultrasound-guided research core biopsy of the known right breast malignancy with clip placement.(2) Successful ultrasound guided biopsy of an MR detected suspected satellite lesion in the right breast with clip placement. Pathology is pending at this time.(3) Successful ultrasound-guided clip placement of right axillary lymph node.(4) MR directed ultrasound in the right inferior breast at site of focal enhancing lesion did not demonstrate any sonographic correlate. Given the appearance on MR, a six-month follow-up MRI examination is recommended at this time to confirm stability of this finding. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: History of recurrent disseminated glioneuronal tumor treated with chemotherapy and radiation therapy: off therapy evaluation. Brain: There are postoperative findings related to left temporal craniotomy and tumor resection. The enhancing T2 hyperintense mass within the left middle cranial fossa surgical bed has not significantly changed. Likewise, there is unchanged is encephalomalacia surrounding the treatment bed. There is extensive enhancement within supratentorial and infratentorial sulci and basal cisterns, which has is overall similar in extend, but has increased within the bilateral internal auditory canal. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There is a right maxillary sinus retention cyst.Spine: There is diffuse linear and nodular leptomeningeal enhancement in the spinal canal. There is also unchanged enhancing tumor within the sacral spinal canal. The spinal cord signal otherwise appear normal. A left paracentral disc protrusion at L5-S1 and a mild disc bulge at C3-4 are also unchanged. The spinal column alignment is unchanged. The vertebral body morphology and signal characteristics are unremarkable.

Output: 1. Unchanged residual tumor in the left middle cranial fossa, but increased leptomeningeal tumor dissemination in the bilateral internal auditory canals.2. Unchanged drop metastases in the spinal canal.


Instruction: Generate impression based on findings.

Input: 28-year-old female with BRCA mutation and family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a small enhancing mass, measuring 7 x 5 mm, at 2 o'clock position in the left breast. This mass is new when compared to the prior studies. No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: New small mass in the left breast. MRI guided biopsy is recommended.No MRI evidence for malignancy in the right breastBIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 34 years Female (DOB:10/26/1981)Reason: Choric LBP History: Choric LBP on opiatesPROVIDER/ATTENDING NAME: ELIZABETH L TUNG ELIZABETH L TUNG Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is moderate facet hypertrophy at this level.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: There are some mild degenerative changes present along the lower lumbar spine without significant compromise to spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Clinical question: Cerebellar lesion. Signs and symptoms: same. Nonenhanced head CT:A high density mass or a hematoma is noted in the right cerebellum measuring 17 x 27 mm in its trans-axial dimensions.There is subtle surrounding vasogenic edema and mass effect on the fourth ventricle. The fourth ventricle however remains widely patent. There is no evidence of crowding at the level of foramina magnum or mass effect at the level of quadrigeminal plate cistern. Recommend follow-up with dedicated pre-and post enhanced MRI to further assess the lesion. This examination is otherwise unremarkable. The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Calvarium is intact. Positive cells, paranasal sinuses are unremarkable.

Output: 1.Right cerebellar mass or a hematoma measuring 17 x 27 -mm in size with several surrounding edema and mass effect.2.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Suspected right temporal meningioma. There is no significant interval change in the extra-axial lesion overlying the anterior right temporal lobe, which measures approximately 9 x 13 mm. There is slight mass effect upon the adjacent brain parenchyma. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in the extra-axial lesion overlying the anterior right temporal lobe, which may represent a meningioma.


Instruction: Generate impression based on findings.

Input: MRI brain: There is redemonstration of extensive linear and rounded foci of T2/FLAIR signal abnormality in the periventricular and to a lesser degree the subcortical white matter of the bilateral cerebral hemispheres. There is also an unchanged lesion in the dorsal aspect of the corpus callosum. There are patchy lesions also within bilateral thalami, pons, right middle cerebellar peduncle and minimally of the left cerebellar hemisphere. The lesion in the right aspect of the pons is more conspicuous compared to prior study and may be new. There is unchanged mild prominence of the sulci, greater than expected for patient age, which is consistent with underlying parenchymal volume loss. The ventricles are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is a small mucous retention cyst in the right maxillary sinus.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRI cervical spine: There is mild reversal of the normal cervical lordosis. The vertebral body heights are well-maintained. There is moderate loss of disc height at C-4-5, C5-6 and C6-7. No worrisome focal marrow signal abnormality is appreciated. There is diffuse, patchy increased T2/STIR signal throughout the cervical cord, most prominent at the right dorsal aspect of the cervicomedullary junction, the right dorsal aspect at the C2 level and right lateral aspect at the C4-5, C6-7, and C7-T1 levels. There is associated volume loss of the cervical cord at these levels, progressed from prior study. There are scattered cervical spondylotic changes, similar to prior study.

Output: 1. Findings compatible with known multiple sclerosis with a new right pontine lesion, but otherwise grossly stable intracranial lesion burden. 2. Diffuse, patchy increased T2/STIR signal throughout the cervical cord, likely unchanged in configuration, but interval progression of associated cord volume loss.


Instruction: Generate impression based on findings.

Input: Liver lesion. ABDOMEN:LIVER, BILIARY TRACT: Demonstrated again in the lateral aspect of segment VIII is a focal area of capsular retraction with an adjacent geographic wedge-shaped area of T2 hyperintensity demonstrating delayed contrast enhancement measuring approximately 3.1 x 2.1 cm (series 11/30), compared to 3.9 x 2.3 cm previously. The previously seen lesion in the lateral aspect of segment VI (series 4 image 17) also appears decreased in size. No associated biliary dilatation.The segment II arterial enhancing lesion is not seen on today's study, likely reflecting a THID. Otherwise, the liver is normal in morphology, size, signal intensity and enhancement. No intra or extrahepatic biliary ductal dilatation. Patient is status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Nonspecific subcentimeter right cardiophrenic lymph node, measuring 7 mm in short axis (series 4 image 6).

Output: 1.Indeterminate segment 8 and 6 geographic lesions with associated capsular retraction and delayed enhancement appear smaller compared to the prior study.2.Stable nonspecific mildly enlarged right cardiophrenic lymph node.


Instruction: Generate impression based on findings.

Input: 61-year-old female patient with AML, history of previous TIA, left-sided facial droop, history of chronic some left-sided weakness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is moderate patchy areas of periventricular and subcortical white matter abnormal T2 signal including the pons. The brain parenchyma appears otherwise unremarkable. 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. There are bilateral lens implants. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: N1. No evidence of intracranial mass or acute infarct.2. Patchy areas of periventricular and subcortical white matter signal abnormality as well as the pons, which are non-specific but likely represents moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female 53 years old Reason: suspected rectovaginal fistula, advanced stage fallopian tube cancer History: stool through vagina PELVIS:UTERUS, ADNEXA: Status post hysterectomy. There is masslike thickening of the vaginal vault measuring 5.5 x 4.3 cm (series 1302, image 417). There is fistulation between this mass and the right lateral wall of the rectosigmoid colon. The neck of the fistula measures 1.2 cm (series 501, image 43). There is loss of the normal fat plane between the mass and the posterior wall of the bladder suggesting focal invasion.BLADDER: Please see above.LYMPH NODES: Multiple necrotic lower aortocaval, common iliac, bilateral internal and external iliac lymph nodes are identified. An enlarged aortocaval lymph node measures 2.1 x 1.4 cm (series 1302, image 812). A reference left common iliac node measures 1.9 x 2.8 cm (series 1302, image 672). These demonstrate diffusion restriction and are suspicious for malignant involvement.BOWEL, MESENTERY: Please see above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is mass effect on the right external iliac vein by enlarged right pelvic sidewall lymph nodes. Nonocclusive organized filling defect within the right common femoral vein most likely representing chronic deep venous thrombosis.

Output: Necrotic mass in the vaginal vault suspicious for tumor recurrence with fistulation to the adjacent rectosigmoid colon. Multiple necrotic lymph nodes are suspicious for malignant involvement. There is also suspicion for focal invasion of the bladder wall.Findings discussed with Dr. Jean Rudnicki by myself Dr. Ward at time of dictation 03/31/15.


Instruction: Generate impression based on findings.

Input: 20-year-old male with a history of cerebral palsy with multiple pressure ulcers and persistent fevers. Evaluation is slightly limited due to the patient's foot contracture related to the stated history of cerebral palsy. A flex coil was used instead of a dedicated ankle coil resulting in slightly suboptimal image quality. There is ulceration along the posterior aspect of the ankle with thickening of the adjacent skin and intermediate signal intensity of the underlying subcutaneous fat which may reflect chronic scarring. There is minimal, if any, enhancement of the subcutaneous fat. We see no rim-enhancing fluid collection to suggest abscess formation. We see no underlying signal abnormality within the bone marrow to suggest osteomyelitis. There is also mild subcutaneous edema within the dorsum of the forefoot. We see no signal abnormality within the underlying bone to suggest osteomyelitis. There is diffuse atrophy of the musculature of the ankle and foot.

Output: 1. Soft tissue ulceration and superficial inflammatory changes of the foot and ankle without evidence of osteomyelitis.2. Contracture with ankle hyperextension and diffuse muscular atrophy compatible with the patient's history of cerebral palsy.These findings were relayed to Dr. Daum via phone at 12:55 pm on 8/7/15.