Instruction: Generate impression based on findings.

Input: 39-year-old male with history of sinus cavity tumor. There is complete opacification of the right maxillary sinus. There is no definite osseous destruction. These findings are nonspecific and may represent a benign process such as sinusitis or mucocele, however, recurrent tumor cannot be entirely excluded. Further evaluation by contrast-enhanced MRI may be considered if clinically indicated. Extensive post-surgical osseous changes are evident. The remainder of the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Complete right maxillary sinus opacification may represent a benign process such as sinusitis or mucocele. However, recurrent tumor cannot be entirely excluded. Correlation with prior examinations recommended. Recommend continued follow up as clinically indicated.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:6/16/1960)Reason: CCM Protocol, QSM, Permeability, 3T Scanner History: Solitary CCM, seizuresPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is redemonstration of a 16 x 21 mm axial dimension mass in the medial aspect of the left temporal lobe in the region of the amygdala which measures 21 x 18 mm coronal dimensions. It is unchanged compared to the previous exam from 10/26/2015. It has a heterogeneous appearance and a peripheral signal void and a popcorn-like appearance centrally on T1 and T2 imaging. There appears to be a small developmental venous anomaly associated with it. This abuts the temporal horn of the left lateral ventricle and also extends along the medial surface of the left temporal lobe abutting the suprasellar cistern.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a cerebral cavernous malformation present along the medial aspect of the left temporal lobe which is stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: 58-year-old male with shoulder pain. Evaluate rotator cuff. Evaluation is limited by patient motion artifact.ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus tendon just proximal to its insertion, suggestive of focal tendinosis, but we see no discrete tear. There is mild diffuse increased signal intensity of the supraspinatus muscle belly on the fluid sensitive sequences that could represent mild edema or early atrophy. There is very mild fatty infiltration along the myotendinous junction and perhaps slight loss of muscle volume. We see no masses within the suprascapular notch. The infraspinatus tendon appears intact, however, there is mild increased signal intensity within the infraspinatus muscle belly on fluid sensitive sequences, suggestive of edema or early atrophy. There is mild fatty infiltration along the myotendinous junction and perhaps mild muscle volume loss. The teres minor and subscapularis muscles and tendons are within normal limits.SUPRASPINATUS OUTLET: There is deformity of the distal clavicle compatible with the patient's history of a healing fracture. The distal clavicle is perhaps slightly elevated relative to the acromion. There is a trace amount of fluid within the subacromial/subdeltoid bursa of questionable clinical significance. The coracoclavicular ligament is thickened and heterogeneous which appears to correspond to posttraumatic calcification seen in the accompanying radiographs. There is mild edema within the medial aspect of the coracoid process at its base which may be related related to ligamentous injury or a healing fracture.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint without a frank joint effusion. There is increased signal within the superior labrum suggesting degeneration/tearing. The inferior labrum is grossly intact.BICEPS TENDON: The tendon of the long head of the biceps is intact.

Output: 1. Healing clavicle fracture and other posttraumatic findings as described above.2. There is mild supraspinatus tendinosis without evidence of rotator cuff tear. Mild edema-type signal abnormality within the supraspinatus and infraspinatus muscles. The muscle volumes appear slightly decreased which could represent early atrophy. We see no mass within the suprascapular notch. The possibility of Parsonage-Turner syndrome is also considered. 3. Heterogeneity of the superior labrum suggestive of degeneration/tearing.


Instruction: Generate impression based on findings.

Input: New dizziness, hypotension, bradycardia. Again seen is heterogeneous increased T2 signal intensity left carotid space mass with internal flow voids. This lesion up to 33 x 33 x 44 mm, previously measured as 32 x 29 x 41mm AP x TV x CC. The lesion displaces the left carotid arteries and bifurcation laterally, and the left internal jugular vein posterolaterally. Minimal effacement of the adjacent left oropharyngeal airway is again identified without appreciable change.No new lesions are identified. There are no pathologically enlarged lymph nodes noted.Moderate degenerative changes are seen in the cervical spine with multilevel disc osteophyte complexes, particularly C3-C4, C4-C5, and C5-C6 levels with up to moderate multilevel spinal canal and neural foraminal stenoses.Diminutive right vertebral artery flow-void is again seen which may be related to proximal high-grade stenosis. Vasculature is relatively better assessed on prior MRA neck study.

Output: Compared to 9/22/2012, there is minimal gradual enlargement of left carotid space mass, which is compatible with a carotid body tumor.


Instruction: Generate impression based on findings.

Input: 72-year-old female. HOP cystic mass. Evaluate for cystic lesion in head of pancreas. ABDOMEN:LIVER, BILIARY TRACT: A few small hepatic cysts. No suspicious hepatic mass. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Multilocular 2.7 x 1.8 cm cystic lesion in the pancreatic head with multiple thin septations (series 1301, image 16). The main pancreatic duct appears to communicate with this lesion (series 801, image 25), making it suspicious for a side-branch IPMN. No mural nodularity or enhancement on post-contrast sequences. Physiologic response of the pancreas to secretion. No main pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A few subcentimeter renal cysts bilaterally. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative disk disease of the lumbar spine with moderate to severe stenosis at L4-L5.OTHER: No significant abnormality noted.

Output: Multilocular cystic lesion in the pancreatic head is likely a side-branch IPMN. No significant internal nodularity or enhancement to indicate malignant degeneration.


Instruction: Generate impression based on findings.

Input: Multiple myeloma BONE: There is a diffusely heterogeneous pattern of the marrow signal throughout the pelvis and proximal forearm without discrete focus of T1 hypointensity. The previously described marrow signal abnormality within the proximal femoral diaphyses appears less conspicuous on the current exam. Again seen is a chronic compression deformity of the L5 vertebral body likely the result of myelomatous involvement. SOFT TISSUES: No significant abnormality noted. JOINTS: Mild osteoarthritis affects the hips.ADDITIONAL

Output: Diffusely heterogeneous pattern of the marrow signal without discrete myelomatous involvement. The areas of increased signal intensity in the proximal femora described on the prior exam appear less conspicuous currently suggesting treated lesions.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There is focus of diffusion hyperintensity in the right parietal subcortical white matter with suggestion of some areas with high ADC and low ADC. As such this may represent a subacute infarct. Otherwise no restricted diffusion in the remainder of the brain and no evidence of parenchymal edema. No intracranial mass or mass effect.Again seen is susceptibility artifact related to subdural hemorrhage involving the posterior falx and bilateral tentorial leaflets. Component of the subdural hemorrhage also demonstrates T1 hyperintensity.No evidence of intracranial mass effect. No hydrocephalus. Paranasal sinuses and mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are unremarkable.MRA BRAIN:There is intracranial internal carotid arteries are widely patent with no evidence of aneurysm or flow-limiting stenosis. The anterior, posterior, and middle cerebral arteries are widely patent. There is normal circle of Willis. The basilar artery and the bilateral vertebral arteries are widely patent. MRV BRAIN:MR venogram is technically limited and not adequate to exclude thrombosis. Major dural venous flow voids are not clearly identified to confirm patency.

Output: 1. Subdural hemorrhage along the falx and tentorial leaflets is again seen. No associated mass effect.2. Small focus of diffusion hyperintensity and T2/FLAIR hyperintensity with some component suggesting low ADC although part of it is definitely high on ADC. As such this may represent a subacute infarct. No definite evidence of acute infarcts in the remainder of the brain.3. No evidence of parenchymal hemorrhage or parenchymal edema. MR venogram is technically limited and not adequate to exclude thrombosis. Major dural venous flow voids are not clearly identified to confirm patency. Recommend MR venogram with contrast with inclusion of postgadolinium 3D FSPGR sequence to exclude venous sinus thrombosis.4. MRA demonstrates no evidence of flow-limiting stenosis or aneurysms in the intracranial circulation.Dr. Ali discussed findings with Dr.Derani at 925 hrs on 9/6/2015I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.3 x 5.0 x 5.0 cmPeripheral Zone: At the right base, there is a diffuse lesions demonstrating low T2 and ADC signal intensity measuring 2.0 x 0.8 cm. There is rapid enhancement and washout after contrast administration. The peripheral margins are somewhat indistinct which may indicate early invasion.A second, smaller lesion is present in the left base demonstrating low T2 and ADC signal intensity measuring 10 x 7 mm. No appreciable enhancement.A third lesion is present at the left apex with decreased T2 signal abnormality, however ADC values are normal. This lesion measures 6 mm.Central Gland: BPHSeminal Vesicles: Unremarkable.Extracapsular Extension: Questionable early invasion in the left peripheral zone, base of gland.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Suspicious lesion in the left base as above, extending to level of capsule. 2. Focal lesion in the right base is also suspicious for carcinoma.3. Nonspecific right apical lesion.


Instruction: Generate impression based on findings.

Input: Prostate cancer PELVIS:PROSTATE:Prostate Size: 3.1 x 5.3 x 3.4 cm.Peripheral Zone: Asymmetric T2 hypointensity involving the left central zone, most prominent on axial images (series 1201, images 14 and 15) without evidence of enhancement on postcontrast images. Additional punctate foci of T2 hypointensity involve the left mid and left apex Central Gland: Benign prostatic hyperplasia.Seminal Vesicles: No significant abnormality noted. Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Asymmetric T2 hypointensity involving the left central zone without evidence of enhancement; favor normal central zone tissue.


Instruction: Generate impression based on findings.

Input: 31-year-old male 2 weeks status post injury to the left knee while walking the dog. Presents with locking and catching on exam. The ACL feels stable. MENISCI: There is increased signal intensity within the posterior horn and body of the medial meniscus suggestive of mucoid degeneration, but we see no discrete tear. There is a small lobulated collection of fluid signal intensity between the lateral meniscus and IT band which may represent a small ganglion or parameniscal cyst, although we see no discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: There is mild heterogeneity of the signal intensity of the articular cartilage of the lateral tibial plateau suggestive of mild degeneration and possibly a small cleft beneath the posterior horn of the lateral meniscus. The articular cartilage otherwise appears normal for age. There is mild edema-type signal intensity within the lateral tibial spine which is nonspecific.LIGAMENTS: There is thickening of the proximal fibers of the PCL as well as increased signal intensity within the mid fibers, indicating a mid-substance rupture. The ACL appears intact. The collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Midsubstance tear of the PCL and other findings as described above. We see no discrete meniscal tear.


Instruction: Generate impression based on findings.

Input: 38-year-old male with chronic pain to the medial aspect of the knee at/near the insertion of the medial head of the quadriceps. Evaluate for tear or other injury. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is focal near full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus (image 21; series 5). No bone marrow signal abnormalities identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a small amount of fluid within the deep infrapatellar bursa.ADDITIONAL

Output: 1. Multiple lobulated foci of fluid signal abnormality about the vastus medialis and popliteus musculature consistent with ganglion formation.2. Focal near full-thickness articular cartilage degeneration along the medial femoral condyle as described above.


Instruction: Generate impression based on findings.

Input: 73-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 5.2 x 6.2 x 6.8 cm.Peripheral Zone: Low T2 signal focus with restricted diffusion and increased enhancement measuring up to 2.3 x 1.6 cm (series 604/2 24) in the left anterior mid gland, compatible with prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: Above-described tumor causes mild bulging of the anterior capsule, but there is no definite extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: There is a prominent nonspecific right external iliac lymph node measuring up to 9 mm in short axis (series 1601/107).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left anterior prostate gland cancer without definite extracapsular extension.


Instruction: Generate impression based on findings.

Input: Cirrhosis, evaluate for HCC ABDOMEN:LIVER, BILIARY TRACT: Liver contour: The liver contour is smooth.Features of portal hypertension: None. Portal vein: Patent. Hepatic veins: Patent.Hepatic artery: Conventional.Lesions: No suspicious arterially enhancing parenchymal lesions. Right hepatic lobe cysts.Status post cholecystectomy.SPLEEN: Status post splenectomy. Postsurgical changes and nodular enhancing foci in the left upper quadrant suggestive of splenosis. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Probable duodenal diverticulum. Postsurgical changes consistent with gastrojejunostomy.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No suspicious focal hepatic lesions to suggest HCC.


Instruction: Generate impression based on findings.

Input: 47 years Male (DOB:4/5/1969) PROVIDER/ATTENDING NAME: VARSHA S BILOLIKAR SERVICES ANCILLARY 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 loss of disc space height and a disc bulge at this level. This is stable compared to prior exam.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height and a disc bulge at this level. This is stable compared to prior exam.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 mild degenerative changes present in the lower lumbar spine without significant compromise spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Reason: 25 yo M with 1 documented episode of acute pancreatitis, s/p chole 2 years ago, also w/ reported biliary stricture s/p biliary stent at OSH, and chronic abd pain. MRI/MRCP w/ stent removed to assess bile ducts and pancreas for pathology., w/ secretin History: history of pancreatitis, chronic abdominal pain ABDOMEN:LIVER, BILIARY TRACT: The proximal common bile duct is mildly dilated up to 7 cm with a focus of short segment narrowing (901/17) of the mid common bile duct and irregularity distally. Minimal intrahepatic biliary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: Main pancreatic duct is mildly prominent measuring 3 mm. No dilated side branches. Normal signal on precontrast T1 images. Appropriate response to secretion administration. No edema or diffusion restriction to suggest acute pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild dilatation of the pancreatic duct without specific findings of acute or chronic pancreatitis.2.Short segment stricture of the mid common bile duct with distal irregularity and mild proximal dilatation


Instruction: Generate impression based on findings.

Input: History of ACL, twisting injury with swelling. Left knee pain. MENISCI: The medial and lateral menisci are intact. ARTICULAR CARTILAGE AND BONE: Post-surgical changes of an ACL graft. There is a focal defect of the midline patellar cartilage which goes down to the cortical bone. There is also fraying of the articular cartilage of the posterior medial femoral condyle. LIGAMENTS: There is a considerable amount of metal artifact from prior surgery that obscures the ACL graft which is probably intact as well as the PCL. The collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Considerable post-surgical artifact from the ACL repair; this obscures the ACL graft which is probably intact.2. Focal defect of the midline patellar cartilage down to the cortical bone. 3. Fraying of the posterior medial femoral condyle articular cartilage.


Instruction: Generate impression based on findings.

Input: 22-year-old female with right knee pain. Medial femoral condyle pain. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. The superior femoral trochlea appears shallow suggesting femoral trochlear dysplasia. There is increased signal abnormality within the medial aspect of the patella at the insertion site of the medial retinaculum, which may reflect prior transient patellar dislocation. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Findings suggesting femoral trochlea dysplasia as well as disruption of the medial patellofemoral ligament and prior transient patellar dislocation.


Instruction: Generate impression based on findings.

Input: The images are degraded by motion. There is no acute cord compression.

Output: No acute cord compression. Dedicated segment-specific MRI is recommended if symptomology localizes.


Instruction: Generate impression based on findings.

Input: 3 month laser ablation follow up for seizure focus. There has been expected evolution of postoperative findings related to laser ablation of the left medial temporal lobe lesion, where there is volume loss. There is a small amount of susceptibility effect along the left frontal and temporal surgical tracks. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. There is scattered paranasal sinus mucosal thickening and secretions. The skull and scalp soft tissues otherwise appear unchanged.

Output: Expected evolution of postoperative findings related to laser ablation of the left medial temporal lobe lesion.


Instruction: Generate impression based on findings.

Input: 68-year-old female with multiple myeloma, history of vertebral compression fractures, now with urinary retention. There is diffuse low T1 marrow signal which is nonspecific and may be related to chronic anemia or marrow infiltration related to tumor. There are multiple compression fractures involving the cervical, thoracic, and lumbar spine. There is moderate narrowing of the cervical spinal canal at the C2 level related to retropulsion/dorsally projecting osteophyte at C2. There is compression fracture involving the C7 vertebral body. Multiple thoracic compression fractures are seen including severe loss of height involving the T4 and T9 vertebral bodies. In the lumbar spine, there is compression fracture involving the L4 vertebral body with evidence of vertebroplasty at this level. There is possible T2 hyperintensity involving the cervical cord diffusely versus artifact.There is mild to moderate degree of stenosis involving the cervical and thoracic spine as well as mild to moderate narrowing of the lumbar spine at the L4 level. No significant osseous retropulsion is seen at a particular level to suggest acute cord compression or cauda equina syndrome.

Output: Multiple compression fractures involving the cervical, thoracic, and lumbar spine relatively worse at the T4 and T9 levels where there is severe loss of height. Findings are grossly similar to radiographs from 7/27/2015. There is up to moderate degrees of spinal canal stenosis in the spine at multiple levels including C2, mid to lower cervical spine, and at the T4 and T7 levels in the thoracic spine. There is also mild to moderate degree of spinal canal stenosis at the L4 level.There is possible T2 hyperintensity involving the cervical cord which may be artifactual but is not well evaluated. Please note, due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine and examination is not adequate to assess for cord signal abnormality. No significant osseous retropulsion is seen at a particular level to suggest acute cord compression or cauda equina syndrome but can be correlated with clinical findings.


Instruction: Generate impression based on findings.

Input: 29-year-old female with a history of trochlear microfracture in 2012. Evaluate healing. Evaluate for new chondral injury. Presents with left knee pain. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is focal irregularity of the surface of the medial facet of the femoral trochlea, presumably representing the site of prior microfracture. There is increased signal intensity within the overlying articular cartilage with what appears to be focal full-thickness cartilage loss that we suspect has progressed when compared to the prior study. There is also mild edema-type signal within the underlying bone. The lateral facet of the femoral trochlea appears normal. The articular cartilage of the patella appears intact. There is degeneration of the articular cartilage of the medial femoral condyle posterior to the anterior horn of the medial meniscus over a diameter of at least 1 cm, with new small foci of full-thickness degeneration and edema within the underlying subchondral bone. The articular cartilage of the lateral compartment is relatively spared. There are tricompartmental osteophytes. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Postsurgical changes of prior medial trochlear microfracture with overlying cartilage degeneration which appears to have progressed when compared to the prior study.2. Progression of degeneration of the articular cartilage along the medial femoral condyle with new small full-thickness defects.3. Loose bodies within the joint, posteriorly, as described above.


Instruction: Generate impression based on findings.

Input: 37-year-old male with history of cryptococcal infection with lower back and right hip pain. Assess for recurrence of infection and degenerative joint disease Right hip:There is a small amount of fluid within the right hip but no large joint effusion or surrounding inflammatory changes are identified to suggest infection. There are tiny foci of signal abnormality within the lateral aspect of the femoral head which are likely degenerative in etiology. Although this examination was not protocoled for detailed evaluation of the acetabular labrum, the superior acetabular labrum appears enlarged with intermediate signal intensity indicating degeneration. There is minimal edema along the greater trochanter which is of questionable current clinical significance. The musculature of the right hip is otherwise unremarkable.Left hip:There is a small amount of fluid within the left hip but no large joint effusion or surrounding inflammatory changes are identified to suggest infection. There are small foci of signal abnormality within the femoral head which are likely degenerative in etiology. Although this examination was not protocoled for evaluation of the labrum, the labrum appears to be enlarged indicating degeneration. There is also fluid signal intensity within the anterior superior labrum indicating tearing. There is mild edema along the greater tuberosity which is of questionable current clinical significance. The musculature of the left hip is otherwise unremarkable.Note is made of bilateral hydroceles. There is a renal transplant in the right iliac fossa. The sacroiliac joints are within normal limits. Mild degenerative arthritic changes affect the pubic symphysis. Please refer to the dedicated lumbar spine MRI report for additional details regarding the lumbar spine.

Output: Osteoarthritis of the hips and other findings as described above. We see no specific findings to suggest infection.


Instruction: Generate impression based on findings.

Input: 57 year old female with a family history of breast cancer in 3 sisters and paternal grandmother. History of melanoma diagnosed 13 years ago. Patient is on tamoxifen. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. A few scattered cysts are present. Moderate parenchymal enhancement is noted bilaterally.No new or suspicious enhancement is seen in either breast. Stable areas of parenchymal and focal enhancement are present, none suspicious. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 67-year-old male with metastatic squamous cell carcinoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. There is mild generalized cerebral parenchymal volume loss with prominence of the ventricles and sulci. There is no midline shift or herniation. The major cerebral flow voids are intact. There is trace mucosal thickening of the ethmoid air cells. The skull, and scalp soft tissues are grossly unremarkable. The left globe is small and deformed, with retinal detachment.

Output: 1. No evidence of intracranial metastases or acute infarct.2. Scattered punctate foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may representing chronic small vessel ischemic disease.3. Probable left phthisis bulbi.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 46 years old, with GBM status post re-irradiation now on temozolomide and bevacizumab, evaluate for progression. A large resection cavity contiguous with the right lateral ventricle is again seen incorporating portions of the right frontal and parietal lobes and a small portion of the the temporal lobe. The cavity is unchanged in size and morphology.Around the periphery of the resection cavity, there is a rind of thickened, T2 hyperintense tissue which has not significant changed from the prior examination. Scattered foci of susceptibility and patchy restricted diffusion within this tissue are also unchanged. The tissue surrounding the resection cavity shows mild patchy areas of intrinsic T1 hyperintensity with superimposed ill-defined enhancement, also unchanged. No new enhancing lesions are seen. A focus of enhancement within the left IAC has been stable over many prior exams and may represent a vascular structure. Ill-defined periventricular hypoattenuation, right side more than left, is unchanged and likely represents a posttreatment effect. Tract-like T2 hyperintensity conforming to the right corticospinal tract within the brainstem is also unchanged and may represent Wallerian degeneration. No new areas of parenchymal signal abnormality are seen. Ventricular size and morphology are stable.

Output: Stable examination with no change in the thickness or extent of mildly enhancing tissue which surrounds the large right-sided resection cavity.


Instruction: Generate impression based on findings.

Input: 16-year-old male with history of acute pancreatitis, strong family history of inflammatory bowel disease, cholelithiasis on ultrasound. Evaluate pancreas. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No evidence of cholelithiasis, gallbladder wall thickening, pericholecystic fluid, or choledocholithiasis. Common bile duct is normal in size.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is edematous with heterogeneous T1 signal. The pancreatic duct morphology is normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are dilated loops of jejunum adjacent to the pancreas measuring up to 2.4 cm.BONES, SOFT TISSUES: Small volume free fluid is present.OTHER: Small left pleural effusion with underlying atelectasis.

Output: 1.Findings consistent with acute pancreatitis.2.Focal ileus involving loops of jejunum adjacent to the pancreas.


Instruction: Generate impression based on findings.

Input: 44 year old female with known diagnosis of anaplastic astrocytoma. Redemonstrated is increased FLAIR/T2 signal intensity in the left parietal lobe precuneus extending through the left caudate nucleus to the left lateral ventricle wall appearing similar to prior study. There is persistent internal enhancement which overall appears stable or slightly decreased extent of enhancement especially along the anterior aspect of the tumor. There is some stable intrinsic T1 signal within the region of enhancement. There are some internal foci of low signal on susceptibility weighted imaging which appear similar to the prior study. No new intraparenchymal lesion, new enhancement or new signal abnormality is identified elsewhere in the brain. There is mild expansion of the trigone of the left lateral ventricle similar to prior exam with no mass effect or midline shift. The ventricles are otherwise unchanged. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Stable or slightly decreased extent of enhancement of the left parietal lobe precuneus located infiltrative lesion compatible with anaplastic astrocytoma. Subsequent follow-up exams should include dedicated perfusion imaging sequences.


Instruction: Generate impression based on findings.

Input: 52 years, Male, Reason: h/o HNC and CRT, recommended 2/2 findings on post CRT CT Chest/upper abdomen History: see CT Chest/upper abdomen report impression. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Common bile duct is mildly dilated to 8 mm to the level of the ampulla. No obstructing lesion, mass or stenosis is identified. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: There is an 11-mm cystic lesion in the pancreatic head which communicates with the pancreatic duct (9/6), suspicious for a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrostomy tube.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cystic lesion in pancreatic head likely represents a sidebranch IPMN. Six month MRI follow up is recommended.2.Mildly dilated common bile duct without obstructing lesion present.


Instruction: Generate impression based on findings.

Input: History of chronic pancreatitis and pancreatic pseudocyst status post stent placement for drainage. ABDOMEN:LIVER, BILIARY TRACT: Stable small right hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: There is a small fluid collection within the pancreatic body (series 9, image 16) measuring 9 x 11 mm, previously 8 x 8 mm. There is a stable cystic lesion within the pancreatic tail (series 9, image 14) measuring 9 x 9 mm which is suspicious for a side branch IPMN. There is no associated mural nodularity or significant enhancement. There is a new cystic lesion within the more proximal pancreatic tail (series 9, image 14) measuring 9 x 10 mm and which is most consistent with a new pseudocyst. The pancreatic parenchyma demonstrates loss of intrinsic T1 signal. There is pancreatic atrophy most prominent in the pancreatic body and tail, increased from the prior exam. The pancreatic duct is irregular and demonstrates mild dilation, slightly increase in the tail compared to the prior examination measuring up to 5 mm. Post secretin images demonstrate nonvisualization of the proximal pancreatic duct which may at least in part be due to a stent. There is fluid accumulation in the second and third portions of the duodenum that appears to traverse distally.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slight increase in size of pancreatic body pseudocyst now measuring up to 1.1 cm and formation of new 1.0 cm pseudocyst in the pancreatic tail.2.Suspected pancreatic duct stricturing of the pancreatic body with mildly increased ductal dilatation and atrophy involving the pancreatic tail.3.Stable cystic lesion in pancreatic tail, suspicious for sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: CT of the head and right paracervical spine. 56-year-old male with daily headaches x 2 years. Also mass right neck, positive cervical radiculopathy. CT of brain without infusion:No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. Calvarium, limited via paranasal sinuses, mastoid air cells and middle ear cavities are also within normal limits.CT of cervical spine without the infusion:The bony density and the alignment of cervical spine remains within normal limits. Degenerative disk disease including anteriorly projected bridging osteophytes, calcification and hypertrophic changes of posterior longitudinal ligament and bulging disks throughout the cervical spine are not. Degenerative changes at C3 -- C4 causes significant left neural foramina compromise and to a lesser degree of right neural foramina. A ventral hypertrophic spur at C5 -- C6 appears to be in contact with the cord with minimal posterior displacement of the cord. Heavy calcification of hypertrophy posterior longitudinal ligament posterior to C6 is noted. There is compromise of the left neuroforamina at C6 -- C7 level.There is no evidence of any destructive bony lesions. No evidence of any sclerotic bony changes. This examination is tailored primarily for CT of cervical spine and is not the appropriate test for evaluation of soft tissue masses ending at. Bilateral coarse soft tissue mass in the neck CT of the soft tissues of the neck with infusion or an MRI of the soft tissues of the neck is recommended.

Output: 1.Normal CT brain and calvarium without infusion.2.Degenerative changes of cervical spine with resultant multilevel neural foramina compromise as detailed.3.No evidence of any acute or sclerotic bony changes.4.This examination cannot evaluate for soft tissues of the neck since its tailored primarily for evaluation of cervical spine.5.If there is history of mass in the neck a dedicated CT of the soft tissues of the neck with infusion is recommended. 6.The findings were discussed with the clinical service pager # 4146( DR. Cathleen Mulcahy). Because a stated to the clinical service that this exam is not the appropriate test for detection of soft tissue mass in the neck. CT of the soft tissues of the neck with infusion is recommended for evaluation of possible mass in neck.


Instruction: Generate impression based on findings.

Input: 37-year-old male with history of right nephrectomy complains of diffuse back pain. Urinalysis shows moderate blood. Fever. Rule out infected stone. ABDOMEN: This examination is limited by the absence of oral and intravenous contrast.LUNG BASES: Mild bibasilar dependent atelectatic changes. No acute infiltrates or effusions.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The left adrenal mass has increased in size and currently measures 4.6 x 6 cm and axial image 56/181.KIDNEYS, URETERS: Status post right nephrectomy. Minimal left perinephric fat stranding. No renal calculus. No hydronephrosis. There is a left posterior mid pole circumscribed hyper density at axial image 65/21 which measures approximately 2.7 cm in diameter. This was seen on the prior examination and may represent a hemorrhagic cyst or solid neoplasm. Characterization with intravenous contrast-enhanced CT or MRI exam may be helpful for further evaluation, if indicated.RETROPERITONEUM, LYMPH NODES: The retroperitoneal mass seen in the prior examination has increased in size and now measures 6.6 x 8.8 cm and axial image 93/181. There is extensive retroperitoneal lymphadenopathy, which was present on the prior examination, but has diffusely increased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There has been interval development of numerous retroperitoneal mass and left adrenal mass consistent with metastases.OTHER: 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: Interval increase in the retroperitoneal mass, lymphadenopathy, left adrenal mass. These findings are compatible with progression of known metastatic disease. No hydronephrosis. No nephrolithiasis.


Instruction: Generate impression based on findings.

Input: History of a type I aortic dissection status post repair. CHEST:LUNGS AND PLEURA: No gross abnormality.MEDIASTINUM AND HILA: Postsurgical changes from a type A aortic dissection repair. The dissection flap extends into the left subclavian, proximal left common carotid and right brachiocephalic arteries, appearing similar in extent compared to the prior study. The aortic root measures 4.8 cm in AP dimension (series 1401/35), unchanged.The ascending aorta measures approximately 3.1 cm in AP dimension.The descending aorta measures 4.4 cm in AP dimension, unchanged. The abdominal aorta measures 3.5 cm in AP dimension, compared to 3.1 cm previously.The celiac, superior mesenteric and right renal arteries appear to arise from the true lumen. The left renal and inferior mesenteric arteries appear to arise from the false lumen. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Probable subcentimeter hepatic cysts. No focal suspicious liver lesions. No biliary ductal dilatation. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. See above for discussion of the aorta.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change in type A aortic dissection status post repair.


Instruction: Generate impression based on findings.

Input: Neuromyelitis optica 24294 Brain: Again seen are few scattered nonspecific foci of white matter T2 hyperintensity in the bilateral frontal and parietal lobes, which are unchanged. No new lesions. 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. Mild scattered paranasal sinus mucosal thickening. Calvarium and extracranial soft tissues are grossly unremarkable.Orbits: Again seen is volume loss of the left orbital segment of the left optic nerve with high T2 signal, similar to prior. No definite enhancement within the limits of motion degraded sequences. The right optic nerve appears to be unremarkable. No abnormal signal within the optic chiasm. The globes and extraocular muscles are otherwise unremarkable. There is no evidence of intraorbital mass lesions.Spine: Compared to 4/26/2015 and 12/2/2015, there is continued decrease in T2 signal in the cervical cord with mild residual patchy T2 signal extending primarily from the C2-3 to C4-5 levels. Again seen is enhancement associated with this lesion but not well assessed due to the motion degradation. Subtle T2 hyperintensity in the cervical cord at the C6 and C7-T1 levels may be artifactual. There is T2 hyperintensity involving the thoracic cord at the T1-T3 levels which was also present previously, and is not associated with enhancement. No new cord lesions. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a hemangioma in the T5 vertebral body. The vertebral bone marrow signal is otherwise unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. Again seen are multiple thyroid nodules.

Output: 1. Few nonspecific scattered supratentorial white matter lesions, which are unchanged. No new lesions or lesions with enhancement.2. Left optic nerve atrophy with T2 hyperintensity appears unchanged and compatible with history of NMO. No new lesions along the optic nerves or chiasm.3. Slight further decrease in size of enhancing cervical cord lesion. Please note examination is motion degraded. No new lesions in the cervical or thoracic cord are appreciated on the sagittal sequences.


Instruction: Generate impression based on findings.

Input: For the purposes of numbering, the last rib bearing vertebra is termed T12. There is suggestion of transitional lumbosacral junction, with right aspect of L5 appearing to articulate with the sacrum, and can be better assessed with CT if surgery is contemplated. There is a lumbar dextroscoliosis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology with the conus terminating at L1-L2. There is a subcentimeter left renal cyst. The paravertebral soft tissues are unremarkable.Degenerative changes, with individual levels as below.T12-L1: There is mild facet arthropathy and ligamentum flavum thickening without significant disc disease, spinal canal, or neural foraminal narrowing.L1-L2: There is minimal disc desiccation, mild facet arthropathy and ligamentum flavum thickening without significant spinal canal or neural foraminal narrowing.L2-L3: There is mild disc desiccation and mild asymmetric rightward disc bulge with mild facet arthropathy and ligamentum flavum thickening. There is no significant spinal canal or neural foraminal narrowing.L3-L4: There is minimal right lateral subluxation of L3 on L4. There is disc desiccation and a mild disc bulge as well as facet arthropathy and ligamentum flavum thickening. These findings result in mild spinal canal stenosis and minimal bilateral foramina narrowing. L4-L5: There is disc desiccation, mild loss of disc height, and mild disc bulge as well as facet arthropathy and ligamentum flavum thickening. In addition, there is a 7 x 12 mm T2 hyperintense structure in the right aspect of the spinal canal adjacent to the right facet joint that is most compatible with a synovial cyst. These findings result in moderate to severe spinal canal stenosis involving the right aspect of the thecal sac. There is moderate right and mild to moderate left neural foramina stenosis. L5-S1: There is grade 1 anterolisthesis of L5 on S1. There is disc desiccation, loss of disc height, mild disc bulge asymmetric to the right, and facet arthropathy. These findings result in severe right and mild left neural foraminal stenosis.

Output: 1.Lumbar dextroscoliosis and grade 1 anterolisthesis at L5-S1. Please see note regarding transitional anatomy above. 2.Advanced degenerative changes at the L4-L5 and L5-S1 levels. There is a right synovial cyst at L4-L5 which results in moderate to severe spinal canal stenosis involving the right aspect of the thecal sac (with possible impingement of traversing right L5 and sacral nerve roots). There is also moderate right neural foraminal narrowing at L4-L5 and severe right neural foraminal narrowing at L5-S1.3.Advanced facet arthropathy in the lower lumbar spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A 78 year old male with diabetes mellitus, hypertension, hyperlipidemia and a systolic murmur found to be secondary to aortic insufficiency by echo which showed an eccentric jet. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is mildly dilated with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVEDV is 259 ml (normal range 142+/-34), the LV end systolic volume index is 54 ml/m2 (normal range 25+/-9), the LVESV is 122 ml (normal range 47+/-19), the LV mass index is 72 g/m2 (normal range 85+/-15), and the LV mass is 162 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There are two regions of late gadolinium enhancement. The first is an atypical pattern of late gadolinium enhancement which spares the endocardium and involves the basal inferolateral wall. The second is a mid-wall stripe pattern involving the basal septum. Both of these patterns are atypical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Together this pattern has previously been described as a pattern of prior myocarditis.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 110 ml/m2 (normal range 82+/-16), the RVEDV is 247 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 103 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet and opens widely. There is moderate aortic regurgitation with regurgitant volume of 39ml and regurgitant fraction of 28%.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 ascending aorta is upper limits of normal without evidence of aneurysm or dissection. The measurements are:Sinus of Valsalva: 33x33x36mmSinotubular Junction: 31mmAscending Aorta: 39x39mmPulmonary 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 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. Mild left ventricular dilation with low normal systolic function (LVEF 53%).2. There are two regions of late gadolinium enhancement. The first is an atypical pattern of late gadolinium enhancement which spares the endocardium and involves the basal inferolateral wall. The second is a mid-wall stripe pattern involving the basal septum. Both of these patterns are atypical for prior myocardial infarction and suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Together this pattern has previously been described as a pattern of prior myocarditis.3. Normal right ventricular size and systolic function (RVEF 58%).4. Trileaflet aortic valve with moderate, central aortic regurgitation.5. No thoracic aortic aneurysm or dissection. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 60-year-old female patient with multiple vertebral fractures and focal pain in lumbar and thoracic spine. History of multiple myeloma. Thoracic Spine: Note that the patient has 11 thoracic type vertebrae and a transitional S1 vertebra. There is high T2 and T1 hyperintense lesion in T12 with peripheral enhancement and at least 50% compression deformity with slight focal kyphosis, but no significant retropulsion or neural foramen stenosis. There is diffusely abnormal signal within the bone marrow of the rest of the thoracic vertebral column and with multiple small foci of enhancement, but no evidence of associated pathological fractures elsewhere in the thoracic spine. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a septated left renal cyst. Lumbar Spine: There is an unchanged compression fracture of the L1 vertebral body with circumferential cortical step offs and cleft without significant spinal stenosis or neural foraminal compromise. There is unchanged compression fracture of L2 vertebrae with considerable loss of height and approximately 5 mm of retropulsion of the posterior vertebral body as well as contiguous disc material into the spinal canal with focal kyphotic angulation, but no significant spinal stenosis or neural foraminal compromise. The other lumbar vertebrae display heterogeneous signal characteristics, but no evidence of pathologic fracture. There is mild multilevel degenerative spondylosis in the lower lumbar spine and mild lumbosacral epidural lipomatosis without significant spinal stenosis or neural foraminal compromise.

Output: Diffuse involvement of the imaged axial skeleton by multiple myeloma with no significant change in the pathological fractures involving the T12, L1, and L2 vertebrae, but no evidence of spinal cord or cauda equina compression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Zachary is a 61-year-old female with a personal history of bilateral mastectomy in 2012 (right breast-IDC/DCIS, left breast-prophylactic). She completed radiation, chemotherapy, and Femara therapy. Family history of ovarian cancer in mother (diagnosed at the age of 70) and breast cancer in maternal aunt (diagnosed age of 70). She now presents with an enlarged mass in the left axilla. Patient is status post bilateral mastectomy with DIEP reconstruction. There is no abnormal enhancement seen in the right reconstructed breast or chest wall. There is a focal area of skin thickening and associated skin enhancement seen in the left lower outer breast, that measures approximately 3.2 cm in dimension. However, there is no abnormal enhancement seen within the left reconstructed breast or chest wall. No abnormal axillary lymph nodes are identified in either axillary region. Specifically, there is no abnormal enhancement seen in the left axilla, at site of palpable concern.

Output: (1) 3.2 cm span of skin thickening/enhancement in the left lower outer breast. Recommend clinical correlation with physical exam.(2) No MRI evidence for malignancy in bilateral reconstructed breasts and axillae.BIRADS: 3 - Probably benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: 76 are old female with left thalamic intracranial hemorrhage and portion right upper extremity weakness. There is no evidence of intracranial hemorrhage, mass or edema. Bilateral basal ganglia calcifications unchanged. Slight hyperdensity within the left thalamus may be residual calcification of prior hemorrhagic stroke. Diffuse periventricular and subcortical white matter hypodensities consistent with small vessel disease, age indeterminate. If there is concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 57 year old female with a history of myelofibrosis currently being screened for clinical trial protocol. ABDOMEN:LIVER, BILIARY TRACT: There is a focus of ill defined arterial enhancement in segment 7 of the liver, which does not persist or washout on portal venous or delayed contrast-enhanced sequences. This appears most consistent with a transient hepatic intensity difference.SPLEEN: Marked splenomegaly. The spleen measures approximately 22.9 cm in length. Multiple foci of increased T2 signal abnormality are identified within the spleen, without enhancement which are too small to characterize but may represent hemangiomas or cysts. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cysts are identified in the kidneys bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Note is made of multiple foci of increased signal abnormality with peripheral nodular enhancement within the L2 and L3 vertebral bodies, likely representing hemangiomas.OTHER: No significant abnormality noted.

Output: Marked splenomegaly with measurements provided above.


Instruction: Generate impression based on findings.

Input: Reason: eval adrenal incidentaloma History: adrenal incidentaloma ABDOMEN:LIVER, BILIARY TRACT: Diffuse loss of signal on out of phase images is suggestive of hepatic steatosisSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 2.5 x 1.9 cm (8/18) left adrenal lesion loses signal on out of phase images, consistent with an adenoma.KIDNEYS, URETERS: T2 hyperintense renal lesions, likely cysts.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.Left adrenal nodule is consistent with an adenoma.2.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: 73 years Male (DOB:6/30/1942)Reason: DDD History: back painPROVIDER/ATTENDING NAME: TARIQ MUSLIM MALIK TARIQ MUSLIM MALIK 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 loss of disc space height and a disc bulge present at this level associated with mild facet and ligamentum flavum hypertrophy.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with superimposed disc extrusion. Extruded disc material extends behind the L4 vertebral body. Extruded material was not present on the prior exam. There is bilateral facet and ligamentum flavum hypertrophy present at this level which is more on the left the right side. There is left lateral disc present at this level which extends into the left neural foramen and mildly encroaches on the left-sided exiting nerve root within the left neural foramen. T2 signal hyperintensity along the left facet joint within the ligamentum flavum is suspected to represent a ligamentum flavum cyst. There is effacement of the fat at the lateral recess at this level bilaterally but more on the left compared to the right side. Overall there is a moderate degree of spinal stenosis present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Since the prior examination the patient is developed a matted disc extrusion at the L4-5 level. There is a moderate degree of spinal stenosis present at L4-5 which appears slightly worse on the current exam compared to the prior exam as detailed above. There is some mild encroachment on the left-sided exiting nerve root at L4-5 due to disc disease.


Instruction: Generate impression based on findings.

Input: 61-year-old woman with history of alcoholic cirrhosis, please evaluate for underlying lesions and portal venous patency. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. No focal hepatic lesion identified.There is cholelithiasis. Mild gallbladder wall thickening is nonspecific in the setting of ascites. There is minimal intrahepatic biliary ductal dilatation.SPLEEN: There is mild splenomegaly.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: Large volume of ascites in the abdomen. Small bilateral pleural effusions with adjacent atelectasis.

Output: 1.Limited examination without contrast enhancement and with significant dielectric artifact from large volume ascites. As per discussion with Kara Davey by phone at 16:30 on 10/14/2016, patient has had paracentesis and will return for pre and postcontrast imaging.2.Grossly no focal hepatic lesion seen.


Instruction: Generate impression based on findings.

Input: 54-year-old male with fatty liver disease, liver and pancreatic lesion seen on outside CT scan. Assess for evidence of cirrhosis. Reassess liver and pancreatic lesions seen on outside CT scan. ABDOMEN:LIVER, BILIARY TRACT: Diffuse loss of signal of the hepatic parenchyma between the in and out of phase sequences compatible with hepatic steatosis. The subcentimeter nonenhancing T2 hyperintense focus in hepatic segment 6 (coronal series 6 image 42, axial series 12 image 29, axial series 19 image 310) correlates with the punctate hypodense focus on the outside CT exam and is most likely cystic. No intra or extrahepatic biliary ductal dilatation. The portal and splenic veins are patent. Unremarkable gallbladder. Normal liver morphology.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. The 0.6 x 0.5 cm cystic lesion of the pancreatic body (coronal series 600 image 24) is subadjacent to the main hepatic duct, however definite communication is not visualized.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple cysts. No hydronephrosis.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.Nonenhancing T2 hyperintense focus of hepatic segment 6 likely represents a punctate cyst. No suspicious hepatic lesions.2.The 0.6 x 0.5 cm cystic lesion of the pancreatic body is subadjacent to the pancreatic duct, however definite communication to the duct is not visualized. A sidebranch IPMN is favored versus a small mucinous cystic neoplasm.3.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Concern for optic neuritis: visual obscuration. Orbit: The optic nerves display normal signal characteristics. There is no abnormal intraorbital enhancement or mass lesions. The globes and ocular adnexa appear to be intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a subcentimeter focus of high T2 signal in the right frontal lobe white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No findings to suggest optic neuritis.2. Nonspecific punctate focus of signal abnormality in the right frontal lobe, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate left knee for medial meniscus tear vs. MCL tear History: left knee pain MENISCI: There is blunting and linear signal abnormality within the posterior horn of the medial meniscus which extends to the femoral articular surface indicating a horizontal tear, new from prior examination. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus measuring approximately 5 mm in the AP dimension. There is partial-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle, posteriorly. There is a near full-thickness to full-thickness articular cartilage cleft along the medial facet of the patella. There is superficial fraying of the articular cartilage along the lateral facet of the patella. There is subjective thinning of the articular cartilage affecting the patellofemoral articulation. There is increased signal abnormality within the medial femoral condyle and fluid sensitive sequences likely representing a bone contusion. No definite fracture line is identified at this time. There are tricompartmental osteophytes.LIGAMENTS: Note is made of postsurgical changes of prior ACL graft reconstruction. The graft appears intact. There is a very minimal amount of decreased signal abnormality along the anterior aspect of the graft which may represent minimal anterior arthrofibrosis, of questionable significance. The PCL is again noted to be buckled, but appears intact. The MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact. There is thickening and intermediate signal intensity within the proximal fibers of the patellar tendon likely related to the patient's history of ACL graft reconstruction.ADDITIONAL

Output: 1. Horizontal tear of the medial meniscus.2. Full-thickness articular cartilage defects and articular cartilage degeneration as described above.3. Bone contusion within the medial femoral condyle.4. Surgical changes of prior ACL graft reconstruction. The graft appears intact. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 26-year-old male with knee pain. Evaluate for medial meniscal tear. MENISCI: The medial and lateral menisci appear intact. ARTICULAR CARTILAGE AND BONE: No full-thickness articular cartilage defects are identified. No bone marrow signal abnormality is seen.LIGAMENTS: The medial collateral ligament appears intact. There is a small amount of fluid between the superficial and deep fibers of the MCL which could represent a mild bursitis, but this is of uncertain clinical significance. The LCL appears intact. The ACL and PCL appear intact. EXTENSOR MECHANISM: There is thickening of the proximal patellar tendon indicating tendinosis with a partial-thickness tear of the undersurface fibers at the patellar attachment. The quadriceps tendon appears intact.ADDITIONAL

Output: 1. No evidence of a meniscal tear.2. Partial-thickness tear of the undersurface fibers of the patellar tendon at the patellar attachment.3. Small focus of fluid signal intensity between the deep and superficial fibers of the MCL may represent a mild bursitis, but this is of questionable clinical significance.


Instruction: Generate impression based on findings.

Input: 50-year-old female with medial knee pain. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Note is made of linear increased signal abnormality within the medial facet of the patella consistent with a focal full-thickness articular cartilage fissure/cleft with delamination. The remainder of the cartilage of the patellofemoral joint appears spared. No bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Articular cartilage fissure/cleft along the medial facet of the patella as described above. Otherwise, no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 34-year-old woman with history of brisk reflexes and weakness. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics 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 foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is mild degenerative disc disease with disc space narrowing and a small disc osteophyte complex causing mild spinal canal stenosis. The neural foramina are patent.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild spinal canal stenosis at C5/C6, otherwise no significant abnormality.


Instruction: Generate impression based on findings.

Input: Reason: stage II B cervical CA, urinary retention History: stage II B cervical CA, urinary retention. PELVIS:UTERUS, ADNEXA: Large heterogeneous pelvic mass centered at the cervix with lobulated margins measures 12.3 x 10.4 x 15.9 cm (series 6 image 36; series 4 image 38) compatible with patient's history of cervical cancer. There is extension into the the uterus superiorly and into at least the upper vagina inferiorly. Large amount of fluid with fluid-fluid level within the endometrial canal suggestive of obstruction by the mass. The mass abuts the bladder, bilateral pelvic side walls, and rectum with loss of fat planes. There is invasion into the bladder with enhancing polypoid soft tissue within the bladder. There is probable invasion into the rectum (series 6 image 49).Additional small T2 hypointense masses compatible with fibroids.BLADDER: Foley catheter in place. Mass abuts the bladder with loss of fat plane. Enhancing polypoid soft tissue within the bladder compatible with invasion.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Fat-containing umbilical hernia. Probable invasion of the rectum (series 6 image 49) by cervical mass. Peritoneal nodules compatible with peritoneal carcinomatosis. Reference right lower quadrant nodule measures 1.2 x 1.4 cm (series 1001 image 66). BONES, SOFT TISSUES: Enhancing inflammatory focus adjacent to the greater trochanter with extension to the overlying skin surface, nonspecific. OTHER: Complex fluid collection within rim enhancement in the left adnexa, measuring 2.1 x 3.5 x 4.4 cm (series 6 image 24, series 5 image 38) with hypointense foci that correlates with gas seen on CT.

Output: 1.Large cervical mass compatible with history of cervical cancer with uterine, upper vaginal, bladder and probable rectal invasion. Peritoneal carcinomatosis. 2.Left adnexal fluid collection with foci of gas may represent an abscess or necrotic tumor.


Instruction: Generate impression based on findings.

Input: Diplopia. Right ocular pain. History of sarcoidosis, Hashimoto's thyroiditis, discoid lupus, and hypersensitivity pneumonitis. BRAIN:Few nonspecific punctate subcortical and confluent periventricular T2 FLAIR-hyperintense foci are present in both cerebral hemispheres. These are not significant change since the previous examination. A similar lesion involving the dorsal pons just medial to the left middle cerebellar peduncle was present previously. An additional lesion involving the medial aspect of the right middle cerebellar peduncle anterior to the right dentate nucleus was not present previously. This area is obscured by pulsation artifact related to the sigmoid sinuses on the post contrast imaging.There is increased T2 FLAIR signal along the callososeptal interface without separate, intrinsic callosal lesions. The corpus callosum is preserved in volume. There is no acute infarct. There is a linear area of T1/T2 FLAIR hyperintense signal along the undersurface of the left tentorium cerebelli (measures 5 mm x 2 mm on axial image #35 of series #801) which is unchanged since the previous examination and may represent a small meningioma that is calcified. Otherwise, there is no space-occupying or contrast-enhancing brain lesion. The pituitary gland is also within expected. The ventricles and CSF-containing spaces are normal in size. There is mild mucosal thickening involving the paranasal sinuses which is nonspecific. The mastoid air cells are clear.ORBITS:There is no orbital abnormality. Specifically, the optic nerves are symmetric in size and signal characteristics. There is no abnormal orbital contrast enhancement. Slightly prominent contrast enhancement around the optic nerve sheath complex in the posterior aspect of the orbits is unchanged. The optic chiasm is also unremarkable and there is no suprasellar mass.

Output: 1.Multiple cerebral and to a lesser extent cerebellar/brainstem white-matter lesions are nonspecific. One of the lesions which involves the right middle cerebellar peduncle is new since the September 2015 examination. However, enhancement characteristics of the lesion cannot be assessed given pulsation artifact as described above. The other lesions are not significant changed. Similarly, increased signal along the callososeptal interface without separate, intrinsic callosal lesions or volume loss is nonspecific.2.Orbital imaging shows no abnormality.3.Tiny linear area of abnormal signal along the the left tentorium cerebelli is unchanged since the previous examination and may represent a small meningioma that is calcified.


Instruction: Generate impression based on findings.

Input: Clinical question: Meningioma resection 2 years follow-up. Signs and symptoms: 2 year follow-up cco dizziness. Pre- and post enhanced brain MRI:Negative diffusion-weighted images.Examination demonstrates stable post operative changes of left frontal region with evidence of encephalomalacia and gliosis and adjacent ex vacuo dilatation of the cortical sulci. There is no detectable abnormal enhancement to suggest residual or recurrence of tumor. This is a similar finding as prior MRI exam from 2013. Expected minimal dural thickening and enhancement along the inner table of craniotomy flap is noted.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces otherwise for patient's stated age. Unremarkable images through the orbits, paranasal sinuses and mastoid air cells and unremarkable calvarium other than left frontal craniotomy changes

Output: 1.Stable post operative changes of left anterior frontal craniotomy without evidence of recurrence of tumor.2.Unremarkable pre and postcontrast enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: A 49 year old male with history of sickle cell disease including avascular necrosis, s/p bilateral hip replacement and high transfusion burden. A recent echocardiography study showed moderately reduces systolic function. Referred to cardiac MRI to evaluate cardiac function Left VentricleThe left ventricle is dilated with moderately reduced systolic function. The overall LV ejection fraction is 39%, the LV end diastolic volume index is 171 ml/m2 (normal range: 74+/-15), the LVEDV is 276 ml (normal range 142+/-34), the LV end systolic volume index is 105 ml/m2 (normal range 25+/-9), the LVESV is 169 ml (normal range 47+/-19), the LV mass index is 100 g/m2 (normal range 85+/-15), and the LV mass is 161 g (normal range 164+/-36). There is antero-septal and infero-septal hypokinesis at the base and middle segments. There is septal bounce. There is late gadolinium enhancement at the basal segment of the anterior wall. This finding suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracavitary thrombus.No myocardial iron overload (T2-star above 30ms).Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 105 ml/m2 (normal range 82+/-16), the RVEDV is 170 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 92 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumSmall amount of pericardial fluid.Extracardiac FindingsIron overload was noted in the liver (T2-star around 5ms). The spleen also appears more hypointense than the liver suggesting iron infiltration. Probable small left renal cyst. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is significantly dilated with moderately reduced systolic function, the LVEF is 39%. There is antero-septal and infero-septal hypokinesis at the base and middle segments. There is septal bounce. 2. There is late gadolinium enhancement at the basal segment of the anterior wall. This finding suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. No myocardial iron overload (T2-star above 30ms).4. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 46%. 5. The left and right atriums are moderately dilated.6. Iron overload was noted in the liver (T2-star around 5ms) with probable associated iron overload in the spleen, consistent with secondary hemochromatosis.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 with long-standing right hip pain, evaluate labrum. ACETABULAR LABRUM: Linear high signal is present within the anterior superior labrum (series 1001/14), which was equivocally present on the prior study, but is more distinct on today's examination.ARTICULAR CARTILAGE AND BONE: The bone marrow signal and articular cartilage is normal. SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Linear high signal within the anterior superior labrum concerning for a nondisplaced labral tear.


Instruction: Generate impression based on findings.

Input: Reason: Eval for pelvic mass/obstruction - pain with ejaculation and decreased ejaculate concerning for obstruction PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted. No prostatic lesion is identified. Homogeneous signal intensity of the bilateral testicles without evidence of testicular lesion. Imaged penile urethra appears normal.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large stool burden in the sigmoid colon, there is nonspecific pelvic free fluid adjacent to the sigmoid colon, stercoral colitis is a consideration, please correlate with history of bowel movement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Nonspecific pelvic free fluid.

Output: 1.No evidence of prostatic, testicular, or other pelvic mass. 2.Large stool burden in the sigmoid colon with nonspecific pelvic free fluid.3.Findings were discussed with pager 1572, Dr. Labbate.


Instruction: Generate impression based on findings.

Input: 23 years Female (DOB:8/31/1992)Reason: hyperprolactinemia, history of pituitary enlargement, pls assess for changes and lesions History: hyperprolactinemiaPROVIDER/ATTENDING NAME: COLLEEN MARY MAJEWSKI COLLEEN MARY MAJEWSKI MRI pituitary:There is a 4 mm lesser enhancing focus present within the left lobe of the pituitary gland. This is not clearly identified in the prior examThe infundibulum of the pituitary gland measures 3.5 mm in diameter near the median eminence and 2.5 mm at the midpoint but is unchanged. This at the upper limits of normal thickness.The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.

Output: A small lesion is suspected in the left pituitary lobe could correspond to a pituitary microadenoma.


Instruction: Generate impression based on findings.

Input: 51 yo female with C2 cavernoma. Surveillance. Cervical Spine: Focus of increased T2 signal abnormality with hemosiderin rim in the ventral left cervical cord at the C2 level measures 5 x 6 x 7 mm (AP x TR x CC), and unchanged allowing for differences in technique. This focus demonstrates associated T1 hyperintensity as well as mild enhancement and unchanged.Cervical spine alignment is anatomic. Signal intensity and morphology of the vertebral bodies are within normal limits. Mild degenerative changes are again seen with central disk protrusion at the C3-C4 level with mild flattening of the ventral cord. No associated cord signal abnormality. There is mild left neural foramina stenosis on the left at C3-C4 related to facet arthropathy and uncovertebral hypertrophy. Mild disc bulge at C6-7 also unchanged without significant spinal canal or neural foraminal stenosis. T1 hyperintense focus at the T2 vertebral body compatible with hemangioma.Brain:No intracranial mass or mass-effect. No lesions to suggest brain cavernous malformation. No intracranial hemorrhage. No restricted diffusion. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. There is diffuse mucosal thickening involving the left maxillary sinus.

Output: 1. Compared to 6/29/2012, no significant change in size of left ventral C2 lesion consistent with cavernous malformation. 2. Mild degenerative changes including central disc protrusion at C3-4 with mild spinal canal stenosis and mild left neural foraminal stenosis is also unchanged.3. Brain parenchyma is essentially unremarkable for age. No brain cavernous malformations.


Instruction: Generate impression based on findings.

Input: Clinical question: History of metastatic salivary gland cancer. Evaluate new pulmonary mass. Measurements please. Signs and symptoms: None Enhanced CT of soft tissues of neck:Limited images of the intracranial contents demonstrate a high density mass (likely an enhancing) in the right posterior temporal lobe measuring 12.2 x 12.4 millimeters in transaxial dimension (axial image 15 of 91) follow-up with dedicated CT or MRI exam is recommended.Images through the skull base, cavernous sinuses, bilateral petrous bones and paranasal sinuses are negative.Enhancement along the fascial planes in the left infratemporal fossa are likely result of anatomical venous and structures. This finding is best appreciated on axial image 23. This finding was also noted on prior study.There is evidence of complete right-sided parotidectomy with no evidence of recurrence of tumor.Extensive postoperative changes of neck are noted however no evidence of a mass is detected.There is a nonenhancing left-sided lymph node at the level of hyoid bone measures 8.8 x 6.3 mm in transverse axis and 16.8-mm in cranial -- cephalad axis. This node shows no interval change since prior exam.Images through the neck are otherwise unremarkable.There is limited images of the bases of the lungs demonstrate a large right apical mass measuring 43.5 x 31.3-mm in transaxial dimension and approximately 34 mm in cardial/cephalad axis. There is also a very large mediastinal mass which surrounds the trachea and is only partially visualized. This mass measures 55-mm in AP axis and 61-mm in transverse axis. Please review the dictated report of CT of the chest for more detailed information.60 cc of Omnipaque 250 is administered.

Output: 1.No detectable tumor in the neck. Nonenhancing lymph node in the left neck at the level of the high a bone measuring 8.8 x 6 in transaxial dimensions and 16.8-mm in cardial slice cephalad axis. There is no detectable change since prior examination from an outside institution as described above.2.Limited view of intracranial space demonstrate a high density mass measuring 12.4 x 12.2-mm in size in the right posterior temporal. This is highly suspected for intracranial metastatic lesion.3.Right upper lung field tumor measuring 43.5 x 31.3 in transaxial and 34-mm in cranial cephalad. Large additional right-sided mediastinal tumor measuring 61 x 54.5-mm in transaxial dimensions.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with right-sided weakness. Corresponding to the area of abnormality noted on prior CT, there is restricted diffusion involving the left operculum and insula, as well as the left frontoparietal junction, with smaller scattered foci of diffusion restriction in the left anterior frontal lobe, the temporal lobe and the occipital lobe. Mild T2 hyperintensity is seen corresponding to these areas of restricted diffusion. No significant generalized mass effect is detected. There may be minimal petechial blood product in the infarct region but no frank hemorrhagic conversion is seen.Elsewhere, scattered foci of T2 hyperintensity are seen within the cerebral hemispheres appearing similar to those noted on prior MRI. No abnormal fluid collections are detected. The ventricular system is normal in size and morphology.Abrupt occlusion of the inferior division of the left MCA is seen within the sylvian fissure. No other significant intracranial stenosis is suspected. No aneurysms are detected within the limitations of technique. The region of the ACOM artery is unremarkable. Prominent bilateral PCOM arteries are seen.In the neck, there is moderate narrowing of the right carotid bifurcation but no significant stenosis by NASCET criteria. The carotid system is otherwise unremarkable. The vertebral vessels of the neck are likewise free of significant vascular stenosis.

Output: 1.Findings compatible with acute left MCA stroke fusion infarction. No significant generalized mass effect or frank hemorrhagic conversion is seen.2.Abrupt occlusion of the inferior division of the left MCA is seen. Elsewhere, no significant intracranial vascular stenosis is detected.3.No significant vascular stenosis is seen in the neck.


Instruction: Generate impression based on findings.

Input: There is mild straightening of the normal cervical lordosis which remains unchanged. Minimal C5 on C6 retrolisthesis is not significantly changed. The vertebral body heights are preserved. Cervical cord is normal in signal and morphology. Ligamentous structures are intact. Degenerative changes are again seen in the cervical spine with moderate loss of disc height at the C5-C6 level with mild loss of disc height at the C4-C5 level. Associated endplate marrow changes are seen which are predominantly fatty involving the inferior aspect of C4 and edematous involving the C5 and C6 levels. These are not significantly changed. Small central disk protrusion and annular fissure is present at C3-4. Mild spinal canal stenosis is again noted at C4/C5 and C5/C6 secondary to posterior disk-osteophyte complexes and uncovertebral joint hypertrophy. There is thickening of the ligamentum flavum at C5-C6. There is stable mild neuroforaminal narrowing bilaterally at C4/C5 and stable moderate neural foraminal narrowing bilaterally at C5/C6. Paraspinous soft tissues are unremarkable.

Output: 1.No abnormal signal within the cord.2.Unchanged degenerative changes in the cervical spine worst at the C4-C5 and C5-C6 levels with mild spinal canal stenosis and mild to moderate neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: 28 year-old female with new onset worst headache in life. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Unremarkable contrast enhanced CT head.


Instruction: Generate impression based on findings.

Input: 69-year-old female with history of CLL presenting with tachycardia and AMS. Hypoattenuating area in the gray and white matter in the region of the right parietal lobe may represent a subacute infarction from ischemia. If further imaging is clinically warranted, an MRI may be obtained.Prominence of the ventricular system and cortical sulci are consistent with volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Hypoattenuating area in the region of the right parietal lobe consistent with a subacute infarction. Dr. Jeffrey Jacobson was notified of this finding at the time of dictation.


Instruction: Generate impression based on findings.

Input: There is no structural abnormality or mass. The parahippocampal gyri and choroidal fissures appear normal. The tip of the left temporal horn is slightly increased in size, but this can be a normal anatomic variant. There is no diffusion abnormality to suspect acute stroke. The ventricles and sulci are within normal limits. The basal cisterns are patent. The midline structures and craniocervical junction are within normal limits. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is scattered mucosal thickening in the paranasal sinuses. There is normal signal in the mastoid air cells.

Output: Normal MR brain without finding to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: Check for stress fracture, tendonitis History of right leg and ankle pain Lower leg and ankle: TENDONS: No significant abnormality noted. Specifically tendons and muscle compartments are well visualized and intact.LIGAMENTS: No significant abnormality noted. Specific attention was placed in the region of the ankle without acute abnormalityARTICULAR SURFACES AND BONE: No significant abnormality noted. Marrow and cortical bone signal are unremarkable. Specifically no findings to suggest stress fracture or periosteal cortical abnormality.ADDITIONAL

Output: Normal examI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient is a 42-year-old female with a family history of breast cancer and personal history of benign bilateral breast biopsies. She presents today for high risk screening MRI. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally, which may limit the activity of this study.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Shoulder weakness ROTATOR CUFF: There is branching increased signal intensity within much of the distal fibers of the infraspinatus tendon and adjacent supraspinatus tendon posteriorly that is suspected to represent a network interstitial tearing which extends to both the bursal and articular surfaces of the tendon. There is also interstitial tearing of the infraspinatus tendon more proximally along the myotendinous junction with additional mild tendinosis and bursal surface fraying affecting the distal supraspinatus tendon near the 12:00 position. There is no frank fluid-filled gap or retraction of either tendon however. The subscapularis and teres minor tendons are normal. There is mild fatty atrophy of the infraspinatus muscle along the myotendinous junction but the remaining rotator cuff musculature is intact.SUPRASPINATUS OUTLET: There is minimal osteoarthritis of the acromioclavicular joint and a trace amount of fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral alignment is normal. There are no significant arthritic changes. There is intermediate signal intensity within the superior labrum which may reflect degenerative tearing.BICEPS TENDON: No significant abnormality noted.

Output: Network of interstitial tearing predominantly involving the infraspinatus tendon at its insertion with extension to both the bursal and articular surfaces however there is no discrete fluid-filled gap or tendon retraction of the rotator cuff. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Male, 9 months old, with nystagmus. Evaluate optic chiasm from mass or other pathology. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. No pathologic parenchymal or extra-axial enhancement is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The globes are round and symmetric. The extraocular muscles show normal morphology and pattern of enhancement. No abnormal signal or enhancement of the optic nerves, chiasm or tracts is detected.The pituitary gland is normal in size and pattern of enhancement. No sellar or suprasellar lesions are seen. The pituitary stalk sits at midline and enhances normally. The cavernous sinus and Meckel's caves are within normal limits.The corpus callosum is fully formed and intact. The pattern of white matter myelination is appropriate for age. The brainstem, cerebellar vermis, and cerebellar spheres are normal. No lesions of the pineal gland or tectum are suspected.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Evaluation of the brain, orbits and pituitary is within normal limits. No specific findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 50 year-old female with history of right shoulder pain, concern for labral tear. ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. Intermediate signal intensity within the anterior distal fibers of the infraspinatus tendon suggests mild insertional tendinosis, however, no discrete tear is evident. The teres minor muscle and tendon are within normal limits. The subscapularis muscle and tendon are within normal limits.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral alignment is within normal limits. There are two suture anchors within the posterior/superior aspect of the glenoid and three additional suture anchors in the inferior glenoid. The anterior/inferior labrum appears slightly rounded, but otherwise intact. There is mild irregularity along the surface of the posterior labrum, that may reflect mild fraying, however, we see no contrast undercutting the labrum in this region. There is blunting and irregularity of the superior labrum that may in part reflect prior surgery, however, the degree of irregularity as well as gadolinium appearing to enter the substance of the labrum is suggestive of a re-tear or a new tear.Cartilage covering the superior half of the glenoid appears higher in signal than that covering the inferior half, while this is of uncertain significance, but may represent degeneration. Small foci of signal void within the anterior aspect of the joint likely reflects air injected during the arthrogram.BICEPS TENDON: The tendon of the long head of the biceps appears intact. Foci of low signal within the biceps tendon sheath likely represent air injected during the arthrogram.

Output: Postoperative changes as described above, with findings suggestive of tearing of the posterior/superior labrum.