Instruction: Generate impression based on findings.

Input: Oral ulcers. Evaluate for small bowel disease. 11/13/2015: Colonoscopy biopsies demonstrated focal nonspecific chronic enteritis of the terminal ileum. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Note is made of a partially duplicated right collecting system with the upper and lower pole moiety ureters merging at the pelvic inlet.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained.The terminal ileum is well seen. There is no abnormal small bowel wall thickening, enhancement or restricted diffusion. No perienteric inflammatory changes such as fibrofatty proliferation.The small bowel is normal in caliber. No fixed luminal narrowing or prestenotic/upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation.No free fluid or loculated fluid collection.The colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: No active perianal disease is identified.OTHER: No significant abnormality noted.

Output: No findings to suggest active small bowel inflammation, fibrostenotic or fistulous disease.


Instruction: Generate impression based on findings.

Input: 33-year-old male status post osteotomy as a child for Blount's disease. Evaluate left knee for ligament integrity and meniscal pathology. MENISCI: Note is made of linear increased signal abnormality traversing the posterior horn of the medial meniscus which extends to the femoral and tibial articular surfaces consistent with a vertical tear. There is deformity of the posterior horn extending into the body of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is articular cartilage degeneration along the lateral facet of the patella. Note is made of deformity of the medial aspect of the proximal tibia consistent with the patient's history of Blount's disease, status post osteotomy. No bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Vertical tear of the posterior horn of the medial meniscus with parameniscal cyst formation as described above.


Instruction: Generate impression based on findings.

Input: 8 year-old female with posterior neck mass There is a lobulated heterogeneous well-circumscribed hypervascular mass measuring up to 3 cm in long axis present within the subcutaneous tissues of the posterior midline upper neck. The vascular waveforms are predominantly venous, although at least one arterial wave form is evident. No cystic areas are seen within the mass.

Output: Hypervascular mass in the subcutaneous soft tissues of the posterior midline neck most consistent with a hemangioma.


Instruction: Generate impression based on findings.

Input: Radiculopathy, cervical region [M54.12], Reason for Study: ^Reason: eval for radiculopathy, myelopathy History: neck pain and left sided radicular pain There is straightening of cervical spine. The cranial-cervical junction is normal. There is minimal fluid collections on the atlanto axial joint indicating inflammatory changes including osteoarthritic changes. There is no evidence of atlanto axial subluxation.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. Degenerative changes are specified by the intervertebral level as follows: C2-C3: disc dessication, no neuroforaminal narrowing or spinal stenosis. C3-C4: disc dessication, no neuroforaminal narrowing or spinal stenosis. C4-C5: there is broad based central to left disc protrusion which abuts thecal sac, no neuroforaminal narrowing or spinal stenosis. C5-C6: disc dessication,, diffuse bulging of disc which abuts thecal sac, no neuroforaminal narrowing or spinal stenosis. C6-C7: disc dessication, broad based disc protrusion which abuts thecal sac and minimal obliteration of the left lateral recess, no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multi-level various degree disc degenerations as described above.2. Disc herniations at the level of C45 and C67 as described above. Disc bulging at the level of C56.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Worsening gait. Evaluate for progression. Numerous juxtacortical and periventricular T2 hyperintense lesions are seen in both cerebral hemispheres becoming nearly confluent in the periatrial regions and along the temporal horns. Lesions are also evident within the pons, along the margins of the fourth ventricle, and in the cerebellum. There is questionable elevated T2 signal within the dorsal spinal cord at the C2 level, but this is equivocal and not adequately assessed on the present examination.The immediate prior examination was obtained with significantly different imaging technique which complicates precise comparison. However, given this caveat, no definite or significant interval changes are seen. When comparison is made to the older examination from 2013, most of the lesions show no significant interval change, but at least one lesion in the left centrum semiovale has become less conspicuous.No evidence of significant parenchymal edema or mass effect is seen. No abnormal extra-axial fluid collections are detected. The ventricular system remains within normal limits for size and morphology. Multiple nonspecific subcentimeter right parotid nodules are evident.

Output: A substantial burden of supratentorial and infratentorial white matter lesions is again demonstrated compatible with the history of multiple sclerosis. Although the immediate prior examination was obtained with different imaging technique which complicates precise comparison, no definite or significant interval changes are appreciated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Please evaluate for. Signs and symptoms: Headaches, lethargy and on anticoagulant Nonenhanced CT of brain: Examination demonstrates a large area of low-attenuation primarily in the subcortical white matter of right posterior frontal -- parietal with atrophic changes of overlapping cortex. This finding could represent an ischemic stroke however the appearance may also be secondary to edema from malignancy. There is no definitive mass effect with the above finding and to exclude other possibilities an MRI examination is recommended. There is no evidence of hemorrhage, mass effect, midline shift or hydrocephalus.

Output: 1.Area of low-attenuation in the subcortical white matter of right posterior frontal could represent an old stroke however to exclude possibility of an underlying malignancy MRI examination is recommended.2.There is no evidence of intracranial hemorrhage midline shift or hydrocephalus.


Instruction: Generate impression based on findings.

Input: 41 year old female with right shoulder pain. Evaluate for labral tear. Evaluation is slightly limited due to the inability to properly position the patient.ROTATOR CUFF: There is mild increased signal intensity of the supraspinatus and infraspinatus tendons, suggesting mild tendinosis. Additionally, gadolinium appears to undercut the articular surface fibers of the rotator cuff at its insertion, in particular, the posterior fibers of the supraspinatus and anterior fibers of the infraspinatus. This may represent partial thickness stripping of the articular surface fibers from the bone, however, there is no full-thickness rotator cuff tear. There is perhaps mild undersurface fraying of the subscapularis tendon. We see no evidence to suggest a full-thickness tear.SUPRASPINATUS OUTLET: There is perhaps a trace amount of fluid within the subacromial subdeltoid bursa, but we see no evidence of frank bursitis. Intra-articular gadolinium does not enter the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint with thinning of the articular cartilage of the glenoid, particularly along its anterior and superior aspect with a full-thickness articular cartilage cleft identified. Gadolinium enters the superior labrum, indicating a SLAP tear, which does not definitively extend to involve the tendon of the long head of the biceps. The anterior superior labrum appears at least partially detached from the glenoid which may represent extension of the labral tear. There is fraying of the anterior inferior glenoid labrum.BICEPS TENDON: There is a small focus of low signal intensity within the tendon sheath which may represent a loose body, but the tendon of the long head of the biceps is otherwise normal.

Output: 1. SLAP tear as described above with additional tearing/fraying of the anterior glenoid labrum.2. Moderate osteoarthritis affects the glenohumeral joint.3. Probable stripping of the undersurface fibers of the supraspinatus and infraspinatus tendons from the greater tuberosity but no full-thickness rotator cuff tear is evident.4. Loose body in biceps tendon sheath.


Instruction: Generate impression based on findings.

Input: 66-year-old man status post heart transplant with right upper and left lower extremity neuropathic pain. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Loss of the normal cervical lordosis may be in part positional. Bone marrow signal is normal. The cervical spinal cord has normal signal characteristics and overall morphology. The cervical canal is congenitally narrow, particularly between C4 and C6.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: There is a disc osteophyte complex without spinal canal stenosis. There is mild to moderate right neural foraminal stenosis and mild left neural foraminal stenosis.C4-5: There is a disc osteophyte complex with mild spinal canal stenosis, particularly on the right. There is moderate bilateral neural foraminal stenosis.C5-6: There is a disc osteophyte complex with mild spinal canal stenosis, particularly on the left. There is moderate to severe bilateral neural foraminal stenosis.C6-7: There is a disc osteophyte complex without spinal canal stenosis. There is mild right and mild-to-moderate left neural foraminal stenosis. C7-T1: There is a disc osteophyte complex without significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. There is prominent fat in the subcutaneous and deeper soft tissues. The soft tissue structures are otherwise appear within normal limits.

Output: 1.Multilevel degenerative disease with spinal canal and neural foraminal stenoses. Overall this is worst at C5/C6, right greater than left. Please see additional details above.2.Please note that this examination only evaluates the cervical spine. If there is concern for brachial plexus abnormality, a dedicated brachial plexus MR can be obtained.


Instruction: Generate impression based on findings.

Input: Reason: is there any abnormality? History: term infant with hx perinatal depression and subarachnoid bleed, now s/p therapeutic hypothermia. There is a large, extra-periosteal fluid collection underlying the posterior scalp compatible with caput succedaneum with minimal hemorrhage, overall increased in size from 8/12/2016 CT. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is signal abnormality compatible with trace extra-axial blood product including scattered mild subarachnoid hemorrhage along the anterior temporal lobes as well as trace subdural blood along the parietal lobes, occipital lobes, and along the transverse sinuses. There is patchy T1 hyperintensity within the bilateral basal ganglia in a pattern that is not consistent with normal myelination and which is concerning for hypoxic ischemic encephalopathy. There is no associated restricted diffusion, edema, or mass effect. The brain parenchyma otherwise appears well formed; sulcation and myelination patterns are appropriate for age. The pituitary, brainstem, and cerebellum appear within normal limits. The paranasal sinuses and mastoid air cells are not yet aerated.

Output: 1.Scattered extra-axial hemorrhage without associated significant mass effect.2.Patchy signal abnormality in the bilateral basal ganglia concerning for sequela of hypoxic ischemic encephalopathy. Due to the timing of this examination at approximately 1 week postnatally, these imaging findings may underestimate the true extent of injury, and therefore follow-up imaging in one to two weeks can be considered as clinically warranted.3.Large caput succedaneum.


Instruction: Generate impression based on findings.

Input: Evaluate filling defect within the proximal descending thoracic aorta as seen on recent CTA. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Demonstrated again is a peripheral filling defect within the proximal descending thoracic aorta which is pedunculated in appearance distally and adherent to the anteromedial inferior distal aortic arch wall. The pedunculated component measures approximately 1.0 x 0.8 cm (series 2201/69). There is no contrast enhancement of this lesion and the pedunculated component appears slightly decreased in size compared to the recent CTA. The lesion demonstrates intrinsic T1-weighted hyperintensity favoring blood product.CHEST WALL: No significant abnormality noted.LUNG BASES: Small right greater than left pleural effusion.

Output: The peripheral filling defect within the proximal descending thoracic aorta demonstrates T1-weighted hyperintensity, no contrast enhancement and short interval decrease in size favoring adherent bland thrombus.


Instruction: Generate impression based on findings.

Input: Ms. Skoog is a 54 year old female with recent MRI performed on 5/2016 demonstrating a diffuse area of abnormal enhancement in the left upper outer breast. Subsequent ultrasound-guided biopsy demonstrated periductal inflammation with histocytes and rare poorly-formed granulomas on 5/2016. She presents today for short term reevaluation of this area. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.There has been complete interval resolution of previously identified diffuse abnormal enhancement in the left upper outer breast. Biopsy marker clip is stable in the left breast. There is no abnormal enhancement seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Reason: Evaluate left knee for medial meniscus tear History: Medial joint line pain x 4 weeks. MENISCI: There is mild intrasubstance signal within the body and posterior horn of the medial meniscus suggesting intrasubstance degeneration, but we see no discrete tear. Linear signal intensity within the anterior horn of the lateral meniscus extends through the peripheral fibers. While it is conceivable that this could represent a horizontally oriented tear, it is not necessarily of any clinical significance.ARTICULAR CARTILAGE AND BONE: There is fraying and partial-thickness clefting of the articular cartilage of the lateral facet of the patella. We see no fluid-filled defects of the tibiofemoral compartments. There is a small focus of subchondral edema within the medial femoral condyle that is nonspecific and may be degenerative in etiology or represent a peculiar contusion.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small focus of bone marrow edema in the medial femoral condyle is of uncertain etiology but could be degenerative or perhaps represent a peculiar contusion.2. Mild degeneration of the articular cartilage of the patella.3. No medial meniscus tear. Possible small tear of the anterior horn of the lateral meniscus, which is not necessarily of any clinical significance.


Instruction: Generate impression based on findings.

Input: 69 years, Male, history of metastatic RCC to brain, status post SRS and WBRT. There is no significant change in size of treated, hemorrhagic lesion adjacent to the trigone of the left lateral ventricle measuring approximately 19 x 25 mm in the axial plane. There is mild peripheral enhancement which is not significantly changed.6 mm hemorrhagic right parietal lesion remains unchanged. There are unchanged additional foci of susceptibility effect related to chronic blood products at the site of prior lesions. Also unchanged postoperative appearance of the right frontal lobe resection bed including minimal curvilinear enhancement.No significant change in multifocal areas of FLAIR hyperintensity likely related to combination of posttreatment change and chronic small vessel ischemic disease. No new mass or mass affect. No new foci of abnormal enhancement to suggest disease progression in the brain. No hydrocephalus. No midline shift or herniation.Enhancing lesion involving the left masticator space demonstrates enlargement measuring approximately 19 x 18 mm, previously 14 x 10 mm.

Output: 1. Compared to 2/9/2016, there is no evidence of progression of metastatic disease in the brain. Multiple treated lesions are again seen, including a relatively larger left peritrigonal lesion.2. Enlarging soft tissue metastasis in the left masticator space.


Instruction: Generate impression based on findings.

Input: 84 year old female with mental status changes status post fall. Rule out subdural hematoma. There is no evidence of intracranial hemorrhage, mass or edema. Low-attenuation in the periventricular white matter is consistent with small vessel ischemic disease of indeterminant age. The ventricles and basal cisterns are normal in size and configuration.In the brainstem, there is a tortuous basilar artery partially obscuring the brainstem. This finding is unchanged. If there is a clinical suspicion of stroke, MRI may be considered.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No evidence of acute intracranial abnormality.2. Moderate small vessel ischemic disease of indeterminant age, unchanged.3. Unchanged tortuous basilar artery partially obscuring the brainstem. If there is a clinical suspicion of stroke, MRI may be considered.


Instruction: Generate impression based on findings.

Input: Follow-up of her left-sided trigeminal schwannoma that has been debulked twice: once in 2010 and the second time in 2012. She has undergone fractionated radiotherapy and is here for a 1-year follow-up of that. There are postoperative findings related to left pterional craniotomy. There is no significant change in the subcentimeter nodular enhancing foci within the left prepontine cistern and Meckel's cave surgical bed with mild remodeling of the adjacent sphenoid bone. There is no evidence of intracranial hemorrhage or acute infarct. There is also unchanged encephalomalacia in the adjacent left pons and medial left temporal lobe. The ventricular system is unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is moderate mucosal thickening in the bilateral maxillary sinuses. There is volume loss of the left sided muscles of mastication due to denervation.

Output: 1. No significant change in the enhancing foci within the left prepontine cistern and Meckel's cave surgical bed and the appearance of the surrounding brain parenchyma.2. Unchanged appearance of the shunted ventricular system.


Instruction: Generate impression based on findings.

Input: Reason: R/O progressive white matter abnormality History: Turner syndrome, intellectual disability, ADHD and behavior disorder Please note that gradient echo sequences are limited due to significant susceptibility artifact.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several scattered punctate T2 hyperintensities in the subcortical white matter of the frontal lobes bilaterally. 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 pineal gland is prominent measuring 9 mm. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable.

Output: 1.Several scattered punctate subcortical T2 hyperintensities are nonspecific. 2.Incidentally noted prominent pineal gland which is probably benign and of no clinical significance.


Instruction: Generate impression based on findings.

Input: Metastatic tonsil cancer with brain lesion on CT. MRI necessary for radiosurgery treatment planning. Brain: There is a heterogeneously enhancing mass in the left inferior temporal gyrus that measures up to 12 mm with surrounding vasogenic edema. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Neck: There are stable post-treatment findings in the neck. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are grossly unremarkable. The right internal jugular vein is absent. There is multilevel degenerative spondylosis with moderate spinal canal stenosis at C3 through C6. There is a partially-imaged left apical pulmonary consolidation.

Output: 1. A mass in the left inferior temporal gyrus that measures up to 12 mm likely represents metastatic disease.2. Post-treatment findings in the neck without evidence of measurable mass lesions or significant cervical lymphadenopathy.3. Multilevel degenerative spondylosis with moderate spinal canal stenosis at C3 through C6.


Instruction: Generate impression based on findings.

Input: 38 years Female (DOB: 6/14/1978)Reason: assess for demyelinating disease History: intermittent paresthesiasPROVIDER NAME: KOUROSH REZANIA KOUROSH REZANIA MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level associated with some mild ligamentum flavum hypertrophy.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level associated with some mild ligamentum flavum hypertrophy.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No convincing evidence for demyelinating disease involving the brain or cervical spine on this exam.2.There is some minor degenerative changes present in the cervical spine.


Instruction: Generate impression based on findings.

Input: 66-year-old female with pancreatic cystic lesions with high CEA, abdominal pain, weight loss. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. Common bile duct is normal in caliber. Common bile duct has a bulbous appearance at the level of the ampulla which may represent a small choledochocele.SPLEEN: Splenule.PANCREAS: Numerous T2 hyperintense foci, the largest within the the uncinate process, head and body of the pancreas. An elongated cystic lesion in the head of the pancreas is appears multiseptated measuring 3.9 x 1.5 cm.. The main pancreatic duct is normal in caliber.ADRENAL GLANDS: Left myelolipoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Soft tissue nodule in the abdominal subcutaneous wall measuring 1.9 x 1.9 cm.OTHER: No significant abnormality noted.

Output: 1.Large multiseptated, lobular, elongated cystic mass in the head of the pancreas. Differential includes a side branch type IPMN, serous cystadenoma, or possibly a mucinous cystadenoma.2.Cystic lesion in the body of the pancreas is felt to represent a sidebranch type IPMN. Additional small cystic lesions are also felt to represent side branch type IPMN.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer: Headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Reason: cuff tear History: pain ROTATOR CUFF: There is a near complete tear of the supraspinatus at its insertion measuring approximately 2.3 cm in AP direction with 2.2 cm of retraction. This also involves the anterior fibers of the infraspinatus where there are regions of full thickness and partial thickness tearing. Fluid is seen within the subacromion subdeltoid bursa. There is partial-thickness articular surface tearing of the subscapularis at its insertion. Teres minor is intact. Atrophy of the supraspinatus, infraspinatus and subscapularis is noted.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular jointGLENOHUMERAL JOINT AND GLENOID LABRUM: Tiny osteophytes are present at the glenohumeral joint. There is increased T2 signal at the greater tuberosity which is likely reactive. Evaluation of coronal images is limited due to patient motion, however the glenoid labrum is grossly intact.BICEPS TENDON: The intra-articular portion of the biceps tendon is not well visualized.ADDITIONAL

Output: Near complete tear of the supraspinatus tendon involving the anterior portions of the infraspinatus. Partial thickness tear of the subscapularis tendon. Resultant atrophy of the infraspinatus, supraspinatus and subscapularis.


Instruction: Generate impression based on findings.

Input: Other myelitis [G04.89], Reason for Study: ^Reason: ?MS History: R arm pain Brain MRI:No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal enhancement.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.C-Spine:There is ill defined somewhat patchy high signal intensity on the cervical spinal cord around C2 level on T2 weighted and STIR image. However, the lesion was not seen on either axial T2 weighted image. Thus, the lesion could represent an artifact or subtle spinal cord lesion such as demyelination lesion. Follow up scan might be necessary if clinically indicated. Patchy and ill defined high signal intensity lesion on sagittal FLAIR images at the level of C3 to C5 is most likely artifacts since those lesions are not appreciable on T2 weighted images or gradient echo images.There is normal cervical lordosis. The cranial-cervical junction is normal. On Gad enhancement, there is no evidence of abnormal enhancement.Degenerative changes are as follows;C23: within normal limitsC34: disc dessication. Otherwise unremarkable.C45: disc dessication. Diffuse bulging of disc which abuts thecal sac. C56: within normal limits.C67: within normal limits.

Output: 1. Normal brain MRI2. Subtle patchy high signal intensity on T2 weighted image at the level of C2 could represent either an artifact or subtle demyelination lesion. Follow up scan can be considered if clinically indicated.3. Diffuse disc bulging at the level of C56 as described above.4. No evidence of neuroforaminal narrowing of spinal stenosis.


Instruction: Generate impression based on findings.

Input: 54 years, Male, anaplastic astrocytoma, on Avastin. This will be second MRI on Avastin. There is interval increase in masslike T2/FLAIR hyperintensity and enhancement involving the posterior body of the corpus callosum on the right and crossing to the left. There is also interval increase in masslike T2/FLAIR hyperintensity and enhancement involving the lateral aspect of the right thalamus. There is also mild increase in T2/FLAIR hyperintensity and enhancement in the right temporal lobe surrounding the right temporal horn extending into the right periatrial region. These findings are progressed compared to 5/20/2016 as well as 2/2/2016. These areas also demonstrate mild restricted diffusion.Remainder of the extensive patchy FLAIR signal abnormality involving the right greater than left cerebral hemispheres, centered in the right parietal lobe extending into the right temporal lobe with patchy areas of enhancement are not significantly changed. T2/FLAIR hyperintensity extending along the right corticospinal tracts is also not significantly changed. There is mild effacement of the right lateral ventricle which appears slightly worse in the interval. No significant midline shift. No uncal herniation. No hydrocephalus. Prior postsurgical changes including prior right-sided craniotomy are again seen. The right-sided mastoid air cells are opacified as before. Major flow-voids are preserved.

Output: Findings suspicious for tumor progression in the setting of Avastin therapy with increased areas of masslike T2/FLAIR hyperintensity with enhancement including the right posterior body of the corpus callosum and crossing the midline, right lateral thalamus, as well as along the right temporal horn.


Instruction: Generate impression based on findings.

Input: Massive retroperitoneal sarcoma resection 12/2012. 12/1/2015 MR demonstrate increased enhancement in the right retroperitoneum recess adjacent to the right diaphragmatic crus. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy.RETROPERITONEUM, LYMPH NODES: The soft tissue lesion adjacent to the right diaphragmatic crus measures approximately 2.2 x 1.2 cm (series 14/58), compared to 2.5 x 1.1 cm previously. The lesion measures approximately 3.0 cm in the craniocaudal dimension.The previously seen nodule lateral to the above stated lesion adjacent to the liver is no longer visualized and may have represented averaging from an adjacent colonic diverticula.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Stable small cardiophrenic angle lymph nodes.

Output: Relatively stable enhancing right retroperitoneal soft tissue adjacent to the right diaphragmatic crus, remains suspicious for recurrent disease and continued surveillance imaging is recommended. The previously seen nodule lateral to this lesion adjacent to the liver is no longer visualized.


Instruction: Generate impression based on findings.

Input: 57-year-old male with altered mental status, history of stroke, assess for acute stroke There is no restricted diffusion to suggest the presence of acute ischemia. A tiny foci posteriorly in a left paramedian location demonstrating apparent DWI hyperintensity (image 200, series 306) lies outside the brain parenchyma is felt to be related to underlying vascularity and prominent venous lake.Redemonstrated are multifocal susceptibility artifacts without surrounding edema on bilateral hemispheres, basal ganglia, brain stem and especially on the left side midbrain indicating prior hemorrhagic foci and chronic petechial parenchymal hemorrhages, as well as involving the cerebellum. There is been no interval change since prior scan. Redemonstrated is extensive T2 hyperintensity within the periventricular white matter and centrum semiovale bilaterally indicating advanced nonspecific small vessel ischemic disease. Similar T2 hyperintensity is also noted within the thalami, pons, medulla, left cerebellum. There is been no interval change since prior scan. The ventricles, sulci and cisterns are prominent which could be related to volume loss, which is stable in appearance. There is no mass, mass effect, or midline shift. Normal flow voids are identified in the major intracranial vessels. Fluid is noted within a few right mastoid air cells. The paranasal sinuses and left mastoid air cells are clear.

Output: 1.There is no restricted diffusion to suggest the presence of acute ischemia.2.No change of multifocal susceptibility artifacts as well as extensive non specific white matter lesions.3.Fluid is noted within a few right mastoid air cells.


Instruction: Generate impression based on findings.

Input: 43-year-old female with a history of a right mastectomy for IDC/DCIS in 2011. She has a family history of breast cancer in her paternal grandmother diagnosed in her 80s and paternal aunt diagnosed in her 60s. Status post right mastectomy and reconstruction.There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in the left breast or in the reconstructed right breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate spinal anatomy for possible fusion. Signs and symptoms: Pain and weakness. Non-enhanced CT of lumbar spine:Examination redemonstrates destructive changes of the L1 vertebral body with collapse of more than 50% of one. There is fragmentation of the body of L1 vertebrae with expansion into the spinal canal posteriorly. These findings are similar to what was noted on prior MRI of lumbar spine. There is compromise of the AP diameter of thecal sac secondary to retropulsion of fragments into the canal. There is widening of the articulating facets space between T12 -- L1 and L1 -- L2 levels.There is evidence of minimal lytic changes of the inferior endplate of T12 vertebrae as well. This is result of patient's known diskitis/osteomyelitis. The T12 vertebral body and its pedicles are otherwise unremarkable.Very advanced degenerative disk disease throughout the rest of the lumbar spine with significant loss of disk height and sclerotic changes of the adjacent endplates as well as vacuum phenomenon. The alignment of vertebral column is otherwise unremarkable. There is no evidence of any abnormality of the pedicles of the lumbar spine except for partial involvement of pedicles of L1 with technique changes. Very extensive hypertrophic changes of articulating facets bilaterally are noted throughout the lumbar spine. Multilevel mild neural foramina compromise secondary to degenerative changes are suspected.Nonenhanced CT of thoracic spine:A small leak change along the inferior endplate of T12 is consistent with patient's known osteomyelitis/diskitis noted on multiple prior MRI exams. The density of vertebral column in the thoracic spine is otherwise unremarkable. There is no evidence of sclerotic or lytic changes of the rest of thoracic spine. Could the exception of hypertrophic changes no additional abnormality of the facets or the pedicles are detected.The alignment the vertebral column is within normal limits.Mild-to-moderate degenerative disk disease and hypertrophic changes of posterior elements throughout the thoracic spine is noted.

Output: 1.Lytic/destructive changes of L1 vertebrae with retropulsion of fracture body of L1 into the spinal canal and resultant central spinal stenosis. There is also lytic changes involving the anterior aspect of L1 pedicles bilaterally which is also result the patient's osteomyelitis.2.Extensive degenerative changes of lumbar spine of both disks and posterior elements and with multilevel neural frontal compromise as detailed. There is no evidence of any bony defect in the rest of lumber spine other than L1 level.Degenerative changes of disk and posterior elements in thoracic spine. Minimal lytic changes of the inferior endplate of T12 related to patient's known osteomyelitis. Unremarkable CT of thoracic spine otherwise.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: There is marked tendinopathy of the supraspinatus and infraspinatus tendons at the insertion upon the greater tuberosity. There is a small focus of full-thickness tearing involving the distalmost fibers of the supraspinatus tendon. The supraspinatus and infraspinatus muscles are preserved. The teres minor tendon and muscle and tendon are intact. There is mild insertional tendinosis of subscapularis tendon. The subscapularis muscle is intact.SUPRASPINATUS OUTLET: There is severe arthrosis of the acromioclavicular joint. A trace amount of fluid is present in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is slightly high riding. Mild osteoarthritis affects the glenohumeral joint. There is marked irregularity and abnormal morphology of the anterior labrum likely the result of chronic degenerative tearing. There is no joint effusion.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Rotator cuff tears involving the supraspinatus and infraspinatus tendons as described above.2. Severe osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with synovial sarcoma metastatic to the spinal cord status post resection, three-month surveillance examination for recurrence. Brain:A few scattered foci of parenchymal T2 hyperintensity are demonstrated, a finding which is stable and nonspecific. No evidence of edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is observed. No intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology.Cervical spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or enhancement is seen. The visualized spinal cord shows normal signal intensity and morphology. No intramedullary or leptomeningeal enhancement is detected. The intervertebral discs are preserved no evidence of significant spinal canal or foraminal stenosis.Thoracic spine:Evidence of laminectomy is again seen from T4 through T6. Epidural and paraspinal fluid has decreased in the operative region. A cavity-like area of T2 hyperintensity is seen within the spinal cord at the T4-5 level representing the site of tumor resection. There is minimal surrounding edema and prominence of the central canal spinal cord above and below this cavity. No pathologic enhancement is seen at the operative site or elsewhere along the thoracic spinal cord.The thoracic kyphosis is slightly exaggerated but sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are compatible with prior radiotherapy. No suspicious focal or enhancing marrow space lesions are seen. The intervertebral discs are preserved with no evidence of significant spinal canal or foraminal stenosis.Volume loss of the right hemithorax is seen. There is pleural thickening and an area of probable round atelectasis in the right lower lobe. Defects in several right sided ribs are seen likely reflecting prior surgery. However, an enhancing lesion which measures up to 15 mm in size is seen along the posterior ribs at the T5 level appears to be new from prior.Lumbar spine:There is a mild scoliotic curvature of the lumbar spine. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or pathologic marrow enhancement is seen. The visualized spinal cord, conus and cauda equina are within normal limits. No pathologic intrathecal enhancement is detected. The intervertebral discs are preserved with no definite bulging or herniation seen and no significant spinal canal or foraminal stenosis. Moderate facet arthropathy develops at lower lumbar levels.The right paraspinal musculature is edematous in the upper lumbar region. In addition, there are at least two enhancing nodules within or adjacent to the right paraspinal musculature. The larger lesion is located posterior to the right kidney and measures up to 15 mm. These lesions appear to be new from prior.

Output: 1.Resolving postoperative findings are seen compatible with resection of a tumor from the thoracic spinal cord.2.At the site of tumor resection, there is a small cavity and mild edema in the surrounding cord, but no pathologic enhancement to suggest residual or recurrent tumor.3.New enhancing soft tissue masses are seen along the right posterior ribs at the T5 level, as well as several enhancing nodules within the right lumbar paraspinal region. These are concerning for new metastatic deposits. Dedicated chest and abdominal imaging is suggested to better assess the extent of disease.4.No evidence of metastatic disease is seen in the cervical spine or the brain.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, with new left sided headaches and eye pressure. A number of scattered punctate FLAIR hyperintense foci are seen in the cerebral white matter. The cerebral and cerebellar hemispheres and brainstem otherwise show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. On post-contrast images, no pathologic parenchymal or extra-axial enhancement is seen. Signal intensity of the bone marrow is unremarkable. Trace mucosal thickening is present in the sphenoid sinuses.

Output: Scattered punctate foci of FLAIR hyperintensity may represent sequelae of migraine headache, vasculitis, small vessel disease or gliosis from prior inflammation among other etiologies. No definite acute findings are seen.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: 58 year old female with left hip pain, assess for left hip arthritis Lumbar spine: 5 views of the lumbar spine show mild degenerative disc disease predominantly affecting L3/L4 and L4/L5. Mild to moderate facet joint osteoarthritis particularly affects the lower lumbar spine. Alignment is within normal limits.Left hip: Single view of the left hip shows moderate osteoarthritis.Pelvis: AP view of the pelvis shows moderate osteoarthritis of the hips, slightly more advanced on the left. Mild chronic appearing enthesopathic changes are noted along the iliac wings. Focal cortical prominence along the medial aspect of the proximal femora bilaterally likely reflect sights of muscle attachment, however if there is clinical concern for stress fractures, MRI may be considered for further evaluation.

Output: Degenerative arthritic changes as described above.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are:Ultrasound of the right breast dated 9/2/2016, ultrasound-guided core biopsy of the right breast dated 9/7/2016, performed at AMita health care institute. Bilateral breast MRI dated 9/19/2016 performed at Loyola hospital.For comparison,none are available. 1: Ultrasound of the right breast dated 9/2/2016:As per the report diagnostic mammogram was performed of both breast which are not submitted. Patient has history of a palpable mass in the right breast. Ultrasound demonstrates an irregular hypoechoic mass that measures 2.4 x 2.9 x 3.6 cm with apical blood flow corresponding to the palpable abnormality at 11:00 position 11 cm from the nipple. Located at 12:00 position 3 cm from the nipple is another suspicious hypoechoic mass with irregular margins, taller than wide that measures 1.7 x 1.5 x 1.3 cm with apical blood flow. This mass also demonstrates some anterior intraductal extension with hyperechoic areas possibly calcifications within it, labeled at right breast 12:00 2 cm from the nipple with apical blood flow.2. Ultrasound of the right breast dated 9/7/2016:Patient underwent ultrasound-guided core biopsy of the index mass, palpable in the right breast 11:00 position 11 cm from the nipple. 5 cores were obtained. Targeting appears adequate, clip coil was placed as per the imaging. Second site at 12:00 position 2 cm from the nipple was biopsied, 5 cores were obtained, ribbon clip was placed. Postprocedure mammogram was obtained as per the biopsy report however not submitted for review. Specimen radiograph was obtained from the cores of the biopsy sites (which site is not specified) and calcifications were noted at the biopsy site.Final pathology indicates DCIS grade 3 solid type at both sites.3: Bilateral breast MRI dated 9/19/2016:MRI images were uploaded on to Dyna CAD for postprocessing and were interpreted on Dyna CAD.Heterogenous dense breast parenchyma noted bilaterally. Moderate parenchymal enhancement noted bilaterally.Right breast 11:00 position palpable mass corresponds to biopsy-proven DCIS. A clip artifact is noted within the mass. The mass is irregular in shape with heterogenous enhancement and irregular margins, measuring 33 x 29 x 41 mm (AP X ML X CC). Second biopsy-proven area of DCIS is located anteriorly, approximately 19 mm anterior and medial to the previously described index mass. It presents as an irregular heterogeneously enhancing mass with a clip artifact within it that measures 22 x 24 x 31 mm (AP X ML X CC) located at 12:00 position anterior depth.Multiple additional masses are identified in the right breast that are located medial, posterior and anterior to the index mass. The posterior-most mass is located 2.5 cm posterior to the index cancer and approximately measures 9 x 8 x 13 mm (AP X ML X CC), located at 12:00 position posterior depth. There is non mass enhancement adjacent to the masses seen extending anterior to the anteriormost biopsy-proven area of DCIS reaching up to the nipple.Total extent approximately measures 11.6 x 7.2 x 8.4 cm (AP X ML X CC).No abnormality noted within the left breast. No suspicious bilateral axillary lymph nodes noted.

Output: 1. Multicentric right breast cancer, with maximum extent measuring up to 11.6 cm on MRI. 2 sites biopsied at outside hospital with results consistent with DCIS. The palpable mass in the right breast 11:00 position is highly worrisome for invasive cancer and multiple additional masses also appear very some for invasive cancer.2. No abnormality noted within the left breast or bilateral axillary lymph nodes.3. Diagnostic mammogram or postprocedure mammograms have not been submitted.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 76-year-old male status post head injury; evaluate for ICH There is no evidence of acute intracranial hemorrhage, mass or edema. Extensive areas of nonspecific patchy and confluent hypoattenuation are seen in the periventricular and subcortical white matter, likely representing small vessel ischemic disease of indeterminant age.There is an extra-axial soft tissue density in the interhemispheric fissure measuring 7 x 8 mm (image 11, series 3) and 11 mm in height on the sagittal images. The soft tissue density appears to be connected to the left internal carotid artery and may represent an anterior communicating artery aneurysm. Recommend MRI/MRA for further evaluation. The ventricles and basal cisterns are normal in size and configuration.Soft tissue swelling is seen overlying the left frontal region. The calvaria and skull base are radiographically normal without evidence of fracture. The visualized paranasal sinuses, middle ear cavities and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial hemorrhage. Extensive small vessel ischemic disease of indeterminate age. 2. Left frontal soft tissue swelling without underlying fracture. 3. Soft tissue density in the interhemispheric fissure as described above suspicious for ACOM aneurysm. Recommend MRI/MRA for further evaluation.These findings were discussed with the emergency room (#56807) at the time of dictation.


Instruction: Generate impression based on findings.

Input: 68 year old female status post fall 2 weeks ago, headache Low-attenuation in the right frontal and parietal region consistent with prior infarct. Additional subcortical and periventricular areas of patchy low attenuation consistent with small vessel ischemic disease of indeterminant age. There is no evidence of bleed or acute infarct. If evaluation for acute ischemia is clinically warranted, MRI is recommended.There is no evidence of intracranial hemorrhage or mass.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.There is soft tissue density superficial to the right parietal bone which may represent a hematoma in the setting of acute trauma. In the absence of acute trauma, infection should be considered.

Output: Findings consistent with prior infarct in the right frontoparietal region. No evidence of acute ischemic process or hemorrhage. If evaluation for acute ischemia is clinically indicated, MRI is recommended.


Instruction: Generate impression based on findings.

Input: relapsed Multiple myeloma Exam is severely limited by motion and artifact. Study was incompletely acquired as patient did not want repeat images.Within this limitation, there is widespread osseous lesions consistent with history of myeloma. There are multiple bilateral pelvic myelomatous deposits including lesion in the left acetabulum. There are multiple myelomatous deposits in the bilateral femurs, most prominently in the diaphysis.

Output: Severely limited study. Widespread osseous lesions as above.


Instruction: Generate impression based on findings.

Input: 71-year-old female with non-small cell lung cancer. Status post several cycles of treatment. New T5 lesion. Back pain and urinary incontinence. Restaging. LUNGS AND PLEURA: Slight interval decrease in right-sided pleural effusion. New atelectasis in the anterior right lung. Multiple pleural based nodules are grossly similar in size. New suspicious pulmonary nodules in right upper lobe measure 7 mm in diameter at images 43 and 44 of series 3. Probable new segmental right upper lobe atelectasis at image 44 of series 3 with ill-defined mass at major fissure. MEDIASTINUM AND HILA: Stable right paramediastinal nodular thickening at the level of the carina measures 34 x 9 mm, (image 32, series 3). Paraesophageal lymph node is stable measuring 25 x 16 mm, (image 64, series 3). Aortic calcifications. Stable subcentimeter left thyroid gland hypodense lesion.CHEST WALL: Lytic lesion in left T5 vertebral body and pedicle at axial image 26 of series 3.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic hypodensities are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild lumbar spine degenerative disease.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Diffuse round calcifications in the left adnexa at axial image 162 of series 3.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: Multiple enhancing focal lesions seen throughout the spine and sacrum on the recent MRI exam, concerning for metastatic involvement, are not detected on this CT exam.

Output: 1. Pleural-based nodules and right pleural effusion.2. Increased atelectasis anteriorly in the right lung.3. New 7-mm right upper lobe nodules. Lytic lesion in left T5 pedicle.


Instruction: Generate impression based on findings.

Input: Migraine with aura new onset. No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: 51-year-old female with anorectal pain. Concern for rectovaginal fistula. PELVIS:UTERUS, ADNEXA: The uterus is normal in size. The endometrial stripe measures 5.4 mm. A metallic artifact of the left lower uterine segment is noted, and there is no metallic density of the pelvis identified on the 3/7/2013 CT exam.There is a 1.1 cm Nabothian cyst (sagittal series 7 image 21).There is a 0.8 cm Gartner's cyst (sagittal series 7 image 16).Normal right ovary containing a 1 cm follicle. The left ovary is not clearly visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No discrete evidence for a rectovaginal fistula.On the postcontrast series, there is a linear enhancing structure continuing from the 7:00 position of the annulus and continuing to the adjacent midline skin (axial series 11 image 76). No correlation T2 hyperintense signal is identified in this region to suggest an active tract.BONES, SOFT TISSUES: Lower lumbar hypertrophic facet arthropathy.OTHER: Small fat-containing umbilical hernia.

Output: 1.No evidence for rectovaginal fistula.2.Findings suggestive of a chronic/fibrotic perianal enterocutaneous fistulous tract. No correlation T2 hyperintense signal is identified to suggest that this is an active tract.3.Metallic artifacts of the left lower uterine segment of unknown etiology. No metallic density was present in this region on the 3/7/2013 CT abdomen and pelvis exam. Clinical correlation is needed.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out bleed, hydrocephalus or mass effect. Clinical question: Progressive dizziness, gait disturbance, urinary symptoms. Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The cortical sulci and ventricular system appear slightly prominent however this may be still within normal range for patient's stated age of 87. Prior MRI examination indicates a small vessel disease however on this exam no definitive small vessel disease is detected.

Output: Essentially unremarkable non-enhanced CT of brain.


Instruction: Generate impression based on findings.

Input: Hemangioma of intracranial structures [228.02], Reason for Study: ^Reason: possible pontine infarct History: pt not waking up Brain MRIInterval near total excision of the left tegmentum cavernous malformation. While the area of susceptibility effect at the resection bed is slightly larger than the original resected cavernous malformation (measuring 14 mm in transverse now compared to 11 mm previously), this does not been certainly reflect actual expansion especially given the lack of significant change in the minimal rightward deviation of the aqueduct of Sylvius. Just anterior to the area of susceptibility effect related to the resection bed of the cavernous malformation, there is a focal diffusion restriction on the left side of midbrain anterior to aqueduct and extends anteriorly to the region of the mesial aspect of the left side red nucleus and just proximal to the left substantia nigra (series 400, image 13/32). These findings are associated with edema in the midbrain which is new compared to the baseline examinationThere is also linear tract-like susceptibility abnormality in the posterior aspect of the left superior/mid temporal lobe which was not present on the preoperative images and therefore most likely procedure related. Cervical MR angiography: 3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The right vertebral artery is small throughout its course, most probably congential. Otherwise, there is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Cranial MR Venography:3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus. The inferior sagittal sinus is not visualized but this was not changed since the baseline examination and is likely a normal variation of very small or absent inferior sagittal sinus.Cervical spine MRI:The cranial-cervical junction is normal. There is straightening of the normal cervical lordosis which may reflect patient position. The cervical spine alignment is otherwise anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs are notable mild loss T2 intensity and height at C5-C6 which is associated with disc-osteophyte complex mildly narrowing the spinal canal but not touching or displacing the cord. The height and T2 signal are preserved at the other discs. The paraspinal soft tissues are notable for mild edema surrounding the intubated airway which is nonspecific.Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: no neuroforaminal narrowing or spinal stenosis. C4-C5: no neuroforaminal narrowing or spinal stenosis. C5-C6: Shallow disc-osteophyte complex is slightly more prominent on the right and causes mild spinal canal narrowing. Uncovertebral proliferative changes slightly more pronounced on the left causing minimal left neural foraminal narrowing. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1.Blood products at the resected cavernous malformation in the mid brain tegmentum is likely to be residual blood products of the cavernous malformation. 2.New edema has developed around the resection bed along with small focus of diffusion restriction which may represent tiny midbrain infarct.3.Hemorrhagic tract is present in the posterior superior left temporal lobe and most likely procedure related as described above.4.Right frontal ventriculostomy has been placed with its tip near the right foramen of Monro. Ventricle size is stable.5.The cranial and cervical MR angiography as well as cranial MR venography show no significant abnormalities.6.Cervical spine shows mild degenerative C5-C6 osteophyte complex but no significant spinal canal or foraminal narrowing.Dr. Monther Qandeel discussed the above findings over the phone with the Neuro ICU resident Dr. Robin a. Buerki on September 18, 2015 at 0850 hours.


Instruction: Generate impression based on findings.

Input: 37 years, Male, multiple sclerosis, evaluate disease burden. Paresthesias. Brain: There are approximately 20 T2/FLAIR hyperintense lesions in the supra and infratentorial white matter with morphology and distribution consistent with known demyelinating disease. Several lesions involving the juxtacortical white matter in the bilateral frontal and parietal lobes are seen. Several periventricular lesions are seen along the bilateral temporal horns. There are also several pericallosal lesions as well as infratentorial lesions including along the nerve root entry zones of the trigeminal nerves and the right cerebellar hemisphere. Some of these lesions demonstrate low T1 hypointensity. Brain parenchymal volume is grossly preserved for age.No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. There is mild to moderate mucosal thickening involving the maxillary and frontal sinuses as well as patchy opacification of the bilateral ethmoid air cells. Extracranial soft tissues are otherwise unremarkable.Cervical spine: There are multiple T2 hyperintense lesions throughout the cervical cord. These lesions include the C2 level in the midline anteriorly, right dorsal C3, dorsal C4 right greater than left, left lateral C4-C5 and right ventral C4-C5, bilateral C5 where there is also focal volume loss, left C5-C6, and right ventral C7-T1 levels.Mild degenerative changes are seen throughout the cervical spine including disc protrusions at C3-C4 and C6-C7 and smaller bulges at C4-C5 and C5-C6 without significant spinal canal stenosis at any level. There is mild bilateral C4-C5 and right C5-C6 neural foraminal stenosis. There is mild multilevel facet arthropathy. Vertebral body heights and alignment are maintained. Bone marrow signal is benign. Paraspinous soft tissues are unremarkable.

Output: There is moderate burden of chronic appearing demyelinating lesions in the brain and cervical cord as detailed above. Comparison with prior studies can be made if made available.


Instruction: Generate impression based on findings.

Input: 36 years Male (DOB:1/12/1980)Reason: MS, follow up progression History: leg weaknessPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED Cervical spine:There are several T2 hyperintense lesions within the cervical spinal cord. One is present along the left hemicord at the C2-3 disc space level another one is present in the left hemicord at the C4-5 through C67 disc space level another one is plaque present in the posterior aspect of the cervical spinal cord at the C7 vertebral level and another one is present along the posterior aspect of the spinal cord at the C1 level.The cervical vertebral bodies are appropriate in overall alignment and height. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Incidental note is made of partial opacification of the sphenoid sinus which is only partly included on this examMRI thoracic spine:There are multiple patchy T2 hyperintense lesions throughout the thoracic spinal cord. These do not expand the spinal cord but do not involve a significant proportion of the thoracic spinal cord. More notable lesions are present at the right hemicord centered at T4 extending from the T3-4 to the T4-5 disc space and another one along the posterior portion of the spinal cord extending from the C6-7 T8-9 disc space while another one along the posterior aspect of the spinal cord extends from the T9-T10 to the T11-T12 disc space . Still another one is located at the conus medullaris. There are other smaller lesions intervening within the thoracic spinal cord.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is a disc bulge at T10-T11 with some reactive changes along the inferior endplate of T10There is no compromise of thoracic spinal canal or exiting nerve roots. There is a cystic lesion along the superior aspect of the left kidney.

Output: 1.There are multiple lesions scattered throughout the cervical and thoracic spinal cords which are compatible with demyelination. No prior studies are available for comparison.


Instruction: Generate impression based on findings.

Input: Lumbar radiculopathy, left-sided Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5 as well as minimal retrolisthesis of L5 on S1. There is moderate to severe disc height loss from the L2-L3 to the L5-S1 levels, particularly worse at the L2-L3 and L5-S1 levels. Bone marrow signal is benign with fatty endplate marrow signal changes evident on a degenerative basis at multiple levels, worst at the L5-S1 level. There is vacuum disc phenomena at the L4-L5 and L3-L4 levels. The conus medullaris is normal in position.Multilevel degenerative changes are further described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc height loss and disc bulge eccentric to the left. There is partial effacement of the left lateral recess. Otherwise no significant spinal canal stenosis. Neural foramina are patent. There appears to be contact of the left extraforaminal L2 nerve root with a prominent left lateral disc osteophyte complex.L3-L4: Disc bulge eccentric to the left and a small left foraminal/extraforaminal disc protrusion. Mild to moderate left neural foraminal stenosis. There is contact and displacement of the extraforaminal left L3 nerve root. There is no significant spinal canal or right neural foraminal stenosis. L4-L5: Grade 1 anterolisthesis with disc uncovering and disc bulge, eccentric to the right. There is also moderate bilateral facet arthropathy and ligamentum flavum thickening. There is moderate degree of spinal canal stenosis including effacement of the lateral recesses. There is moderate to severe right neural foraminal stenosis with possible impingement of the right L4 nerve root. Mild left neural foraminal stenosis.L5-S1: Severe disc height loss with associated fatty endplate marrow signal changes. There is minimal retrolisthesis and mild disc bulge, eccentric to the right, as well as mild bilateral facet arthropathy. There is no significant central spinal canal stenosis. There is partial effacement of the right lateral recess with contact of the right descending S1 nerve root. There is moderate left and mild right neural foraminal stenosis.Fatty atrophic changes are noted in the paraspinous musculature. Paraspinous soft tissues are otherwise unremarkable.

Output: 1. Moderate multilevel degenerative changes throughout the lumbar spine with significant disc height loss from the L2-L3 to the L5-S1 levels, worst at the L5-S1 level.2. There is grade 1 anterolisthesis at L4 on L5 with moderate degree of facet arthropathy at this level and moderate degree of spinal canal stenosis. 3. There are multilevel neural foraminal stenoses, worst at the right L4-L5 level. Additional details as above.


Instruction: Generate impression based on findings.

Input: 61-year-old woman with aphasia. Please evaluate progression of hematoma. The left temporoparietal junction parenchymal hemorrhage now measures 3.7 x 3.3 cm in the axial plane (series 2 image 13). Accounting for differences in patient positioning, this appears increased in size compared to previous scan on which it measured 3.4 x 3.0 cm. A rim of edema surrounds the hemorrhage. There is no appreciable midline shift. No new areas of hemorrhage are seen.There is mild mass effect upon the left lateral ventricle but no appreciable midline shift. The 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. Extensive soft tissue abnormality is present in the occipital region. This may represent sequela of prior soft tissue hemorrhage as seen on the MRI dated 1/17/2007.

Output: Interval enlargement of left parietal parenchymal hemorrhage as detailed above.


Instruction: Generate impression based on findings.

Input: 2 years, Male, nocturnal complex partial seizures. Right occipital discharges on EEG. There is very mild T2/FLAIR hyperintensity in the parieto-occipital white matter which is nonspecific and at least in part related to perivascular spaces and normal terminal zones of myelination. There is no significant parenchymal signal abnormality. No intracranial mass or mass effect. No findings to suggest cortical dysplasia, gray matter heterotopia, or other findings to suggest seizure focus. No intracranial mass or mass effect. Ventricles and sulci are within normal limits in size. No extra-axial collections. No midline shift or herniation. There is apparent punctate focus of low signal on the susceptibility weighted sequence along the surface of the superior temporal gyrus which is favored to be related to a vessel. No definite evidence of a hemorrhagic lesion. No evidence of ischemia.There is nonspecific opacification throughout the paranasal sinuses. Sella and orbits are grossly unremarkable. Calvarium and extra cranial soft tissues are grossly unremarkable.

Output: No structural abnormalities to suggest a seizure focus, including in the right occipital region, are appreciated. No significant parenchymal signal abnormalities.


Instruction: Generate impression based on findings.

Input: 8 year-old female status post cervical fusion. Examination again shows postsurgical changes of an occipital-cervical fusion, with an occipital plate, screw fixation device, cerclage wire and bone fusion material. There is redemonstration two of the occipital screws protruding deep to the inner table of the occipital bone. The previously seen Halo device fixation pin traversing the full thickness of the right frontal bone and resulting in fragmentation of bone has been removed. Four new Halo device fixation pins have been placed through the frontal bone outer table, and one new Halo device fixation pin through the right parietal bone outer table. There has been also relocation of the left parietal bone Halo device fixation pins. The brain is heavily obscured by streak artifact. Within this limitation, there is no gross hemorrhage , parenchymal lesion, or extra-axial fluid collection. However, the right frontal bone fixation pin area soft tissue detail is obscured by the streak artifact. There is no evidence of generalized mass effect, midline shift or basal cistern effacement. The ventricles and sulci are unremarkable where visualized.The paranasal sinuses demonstrate mucosal thickening. The debris in the nasopharynx is expected in an intubated patient. Mastoid air cells are clear. Orbital contents are unremarkable.

Output: 1. Stable postsurgical changes of occipital-cervical fusion, with an occipital plate, screw fixation device, cerclage wire and bone fusion material. 2. Interval adjustment and new placement of Halo device fixation pins, including the one protruding deep to the right frontal bone inner table, as above. 3. Intracranial contents are heavily obscured by the streak artifact arising from the Halo device.


Instruction: Generate impression based on findings.

Input: Stage IV T1N3bMx nasopharyngeal carcinoma treated with induction chemotherapy with carboplatin/taxol followed by 7/7 cycles of TFHX with daily RT completed on 5/27/16. There are post-treatment findings in the upper aerodigestive tract, but no evidence of measurable nasopharyngeal tumor. There is no evidence of significant lymphadenopathy in the neck. The salivary gland and thyroid appear to be unchanged. The osseous structures are unremarkable. The imaged intracranial structures and orbits are unremarkable/ There is fluid within the bilateral mastoid air cells, right more than left.

Output: 1. No evidence of measurable nasopharyngeal tumor or significant lymphadenopathy in the neck.2. Fluid within the bilateral mastoid air cells, right more than left, which may be related to Eustachian tube dysfunction.


Instruction: Generate impression based on findings.

Input: Female 49 years old Reason: eval pubic symphysis osteomyelitis versus sepsis History: TTP over symphysis w/ severe pain w/ bilateral hip ROM Bilateral hip joint effusions. No changes to suggest avascular necrosis or osteomyelitis. T2 hyperintense edema signal in the left obturator externus muscle. Mild bone marrow edema signal within the inferior medial aspect of the left femoral head. Synovial enhancement in the left hip joint on postcontrast images compatible with synovitis. No evidence of fracture. Submucosal fibroids. Heterogeneous enhancement about the cervix could be related to posttreatment changes/patient's history of cervical cancer. Small amount of free pelvic fluid.

Output: 1.No evidence of osteomyelitis or AVN.2.Bilateral hip joint effusions, and left hip joint synovitis.3.Mild bone edema in the inferior medial aspect of the left femoral head.4.Inflammation in the left obturator externus muscle.


Instruction: Generate impression based on findings.

Input: Sensorineural hearing loss. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. There appears to be thinning and possible dehiscence of the left superior semicircular canal. The inner ear structures, including the cochlea, vestibule, endolymphatic duct and sac, and semicircular canals otherwise appear unremarkable. There appears to be a small amount of retained secretions within the left mastoid air cells and pneumatized petrous apex.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of nonspecific T2 hyperintensity in the cerebral 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 orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Apparent thinning and possible dehiscence of the left superior semicircular canal. A temporal bone CT may be useful for further evaluation. No evidence of retrocochlear or inner ear lesions.2. Scattered foci of nonspecific T2 hyperintensity in the cerebral white matter may represent chronic small vessel ischemic disease. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 38 year-old male with hypertension and headache. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensities within the subcortical white matter and periventricular distribution consistent with small vessel disease, age indeterminate. If there is clinical 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 clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Clinical question: CVA. Signs and symptoms: Blindness. CTA of intracranial circulation:65 cc of Omnipaque 350 is administered for this study.Source images as well as 2-D reformatted images and 3-D reformatted images were utilized for interpretation of this exam.Vertebral -- basilar system:Vertebrobasilar system demonstrate patent bilateral vertebral arteries, bilateral pica branches, basilar artery, bilateral superior cerebellar arteries and posterior cerebral arteries with no evidence of vascular abnormality.Left internal carotid:Patent normal-appearing left internal carotid artery across the skull base. Patent left cavernous carotid however with vascular calcification. The left anterior and middle cerebral arteries and their branches are unremarkable.Right internal carotid: There is patent right internal carotid artery across the skull base and in its supraclinoid portion. There is an infundibulum shaped vascular outpouching at the expected location of right posterior communicating artery. The reformatted images demonstrate no posterior communicating artery at this site. However on source images a very minute right posterior communicating artery is identified. Although this finding may represent an infundibulum possibility of an aneurysm cannot be entirely ruled out. This finding measures 3.5 -mm at its base and 3.5-mm in height. The right anterior and middle cerebral arteries and their branches are unremarkable.CTA of the neck:No additional contrast was given for this portion of the exam.There is normal appearing bilateral vertebral arteries and including their origins.Right common carotid artery and including its origin is within normal limits. Very minimal atherosclerotic irregularity at the origin of the right internal carotid artery is noted. No vascular lumen compromise. The left common carotid artery and left internal carotid arteries are widely patent. Very minimal atherosclerotic irregularity at the origin of left internal carotid artery is however noted.Non-infused head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. As noted on MRI there is fullness of the left cavernous sinus and left Meckel's cave and a small soft tissue density immediately medial to the left anterior clinoid as detailed on MRI report.

Output: 1.CTA of intracranial circulation demonstrates very minute atherosclerotic irregularity at the origin of bilateral internal carotid arteries and the otherwise negative CTA of vasculature of the neck.2.CTA of intracranial circulation demonstrates an infundibulum at the expected origin of the right posterior communicating artery. There is a very minute size posterior communicating artery on this side. Although this finding likely represent an infundibulum possibility of an aneurysm cannot be entirely ruled out considering the very small size of right posterior communicating artery. CTA of intracranial circulation is otherwise unremarkable. 3.Nonenhanced head CT is negative for any acute intracranial findings. Please review report of MRI examination regarding the mass at the level of left anterior clinoid and mass within the left cavernous sinus/Meckel's cave.


Instruction: Generate impression based on findings.

Input: 19 year-old male with right lower quadrant pain. Rule out appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatomegaly. The liver measures more than 22 cm craniocaudally. No focal hepatic parenchymal lesions. Gallbladder is normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lateral subcapsular renal hematoma probably arises from a right lower pole multiloculated cystic lesion which measures approximately 3.5 by 4.5 cm at axial image 55/152 of series 3. A second similar lesion is in the anterior upper pole of the right kidney measuring 2.6 cm in diameter at axial image 37/152 of series 3. These lesions most likely represent benign angiomyolipomas, but this cannot be confirmed on a post contrast CT scan examination alone. Further evaluation with precontrast noncontrast views of the kidneys and/or MRI of the kidneys would be helpful for further evaluation. The left kidney is normal. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Difficult to identify the appendix with the presence of constipation involving the cecum and ascending colon, but no evidence of abscess, free air or local inflammatory changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: L5 vertebral segment is transitional with sacralization on the left side.OTHER: No significant abnormality noted

Output: Subcapsular hematoma in the right renal midpole, probably due to angiomyolipoma. This could be confirmed with noncontrast scan of the kidneys and/or kidney MRI examination. No definite evidence of appendicitis. Hepatomegaly. Transitional L5 vertebral segment, sacralized on the left.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (9/22/2016), ultrasound images of left breast (9/22/2016), images from ultrasound guided biopsy of left breast (9/28/2016), images from stereotactic biopsy of left breast with specimen radiograph and postprocedural left mammographic images (9/28/2016), breast MRI (10/3/2016), MR-directed ultrasound for left breast (10/13/2016), images from MRI-guided biopsy of left breast and postprocedural left mammographic images (10/13/2016) performed at outside institution. For comparison, digital mammographic images (10/9/2015) are available. DIGITAL MAMMOGRAPHIC IMAGES (9/22/2016):The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. There is a stable circumscribed mass at 12:30 position in the left breast.There are new clusters of calcifications at upper outer quadrant in the left breast. Each cluster measures less than 1 cm, and total measurement of these clusters is 48 x 19 mm on CC view (LR x AP)No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (9/22/2016):Clustered simple cysts are present at 12:30 position in the left breast measuring 26 x 6 mm, corresponding to the circumscribed mass seen on the mammogram.At 3:00 position, there is an ill-defined hypoechoic mass measuring 13 x 5 mm with surrounding hazy hypoechoic area. This lesion is associated with a few small hypoechoic masses.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST (9/28/2016):A needle biopsy was performed for the ill-defined hypoechoic mass at 3:00 position with an appropriate needle placement. A Bard Venus clip was placed to the target lesion. Per outside radiology report, the result was malignant; invasive lobular carcinoma grade 1, with lobular carcinoma in situ, classic and pleomorphic type.IMAGES FROM STEREOTACTIC BIOPSY OF LEFT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (9/28/2016):A stereotactic biopsy was performed for one of the clusters of calcifications at upper outer quadrant in the left breast. Specimen radiograph demonstrates target calcifications within sampled cores. X shaped clip was placed to the biopsy site.Postprocedural left mammographic images demonstrate X shaped clip from stereotactic biopsy and Venus clip from ultrasound-guided biopsy at 3:00 position in the left breast. Distance between the 2 clips is about 15 mm.Per outside radiology report, a result of the stereotactic biopsy was malignant; prominent lobular carcinoma in situ, classic and pleomorphic type with pagetoid spread into ducts, with focal microinvasion. BREAST MRI (10/3/2016):The study was performed with a protocol outlined in the outside radiology report. There is a segmental non-mass enhancement at lateral aspect of left breast near 3:00 position measuring 71 x 48 x 47 mm (AP x LR x CC). Marker clip from ultrasound-guided biopsy is identified at posterior aspect of this non-mass enhancement, and 16 mm hematoma from stereotactic biopsy at lateral posterior aspect within the non-mass enhancement. The non-mass enhancement extends anteriorly, close to the nipple.There is no abnormal enhancement in the right breast.No suspicious lymph nodes are seen in either axilla.MR-DIRECTED ULTRASOUND FOR LEFT BREAST (10/13/2016):MR directed ultrasound was performed for left retroareolar region. On the MRI, non-mass enhancement extended toward the nipple. No sonographic correlation was obtained.IMAGES FROM MRI-GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (10/13/2016):MR guided biopsy for the left breast at anterior central breast was performed. Postprocedural left mammographic images show a marker clip at anterior central aspect of the left breast. Per outside radiology report, the pathology was malignant, LCIS, pleomorphic and classic type. Distance between stereotactic biopsy clip and MR guided biopsy clip is approximately 45 mm.

Output: 1. Biopsy proven left breast cancer at three sites. MRI demonstrates extensive lesion in the left breast.2. No mammographic or MRI evidence of malignancy in the right breast3. No suspicious lymph nodes in either axilla on MRIBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Parkinsonism. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The bilateral nigrosome 1 regions are possibly abnormal. There are a few scattered nonspecific punctate foci of cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. The bilateral nigrosome 1 regions are possibly abnormal, which can be a manifestation of Parkinson disease.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with refractory epilepsy, imaging for guidance during laser ablation. Limited imaging sequences were obtained for guidance during the laser ablation procedure. The laser probe tip has been placed in the anterior medial left temporal lobe via a left occipital approach. Postcontrast images demonstrate a ring of enhancement surrounding the tip of the laser probe. These findings occur in a background of volume loss within the left medial temporal lobe from prior laser ablation. No additional enhancing lesions are seen.

Output: Expected findings are seen compatible with laser ablation of the anterior medial left temporal lobe.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: brain mets (breast primary) History: radiation planning Numerous various sized intra axial enhancing lesions on bilateral cerebral and cerebellar hemispheres as well as basal ganglia and deep white matter indicating multiple metastatic nodules. The largest one is on the left temporal lobe which is measured about 7mm indicating interval increase in size. Again the left thalamic developmental venous anomaly is seen, no change since prior scan.No evidence of acute hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multiple various sized metastatic nodules found on supra and infratentorially.2. Interval increase in size of enhancing lesions especially lesions at the left temporal lobe and the right basal ganglia since prior scan.


Instruction: Generate impression based on findings.

Input: Bilateral lumbar radicular symptoms, evaluate for change since prior MRI Five lumbar type vertebral bodies are presumed to be present. There is minimal depression involving the superior endplate of the L1 vertebral body similar to prior with a small Schmorl's node at this level also noted. Vertebral body heights are otherwise maintained. There is grade 1 anterolisthesis of L4 and L5 similar to prior. Alignment in the lumbar spine is otherwise maintained. Bone marrow signal is benign with small T1 hyperintense foci such as at the left aspect of the L4 vertebral body and posterior T10 vertebral body are compatible with small hemangiomas. The conus medullaris is normal in position.There is advanced facet arthropathy at the L4-L5 level with mild distention of the facet joints and mild edema involving the surrounding paraspinous soft tissues. Facet arthropathy with distention of the facet joints also noted at L3-L4. These facet effusions are slightly increased in the interval, particularly on the left. Additional details regarding multilevel degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: Mild disc bulge. Bilateral facet arthropathy with distention of the facet joints. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation with mild to moderate height loss is minimally worse in the interval. Grade 1 anterolisthesis and advanced bilateral facet arthropathy are similar to prior although there appears to be mild increase in adjacent soft tissue edema associated with the facet arthropathy. There is also mild disc bulge, ligamentum flavum thickening and mild prominence of the dorsal epidural fat. There is resulting moderate degree of spinal canal stenosis. There is also mild bilateral neural foraminal stenosis. These findings are stable to minimally worse in the interval.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Cysts in the inferior pole of the right kidney again seen. Multiple cysts in the liver better seen previously.

Output: 1. Multilevel degenerative changes, worst at the L4-L5 level where there is grade 1 anterolisthesis, advanced facet arthropathy, and moderate spinal canal stenosis which is stable to minimally worse since 3/13/2015. There is mild bilateral neural foraminal stenosis at this level similar to prior. 2. Multilevel facet arthropathy, worst at the L4-L5 level, with mild interval increase in facet effusions at the left L4-L5 and bilateral L3-L4 levels. There is also mild paraspinous soft tissue edema associated with the facet arthropathy which is increased in the interval.


Instruction: Generate impression based on findings.

Input: Progressive metastatic melanoma after Ipilimumab. The clivus appears heterogeneous and there is an enhancing lesion within in the partially imaged right aspect of C1. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a nonspecific non-enhancing subcentimeter nodule in the posterior upper neck subcutaneous tissues. There is scattered paranasal sinus mucosal thickening.

Output: 1. No evidence of intracranial metastases or hypophysitis.2. Findings suggestive of bone metastases involving the upper cervical spine and perhaps the skull base. Dedicated cervical spine imaging may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Hemorrhagic hereditary telangiectasia. MRI: There is an unchanged cavity with marginal hemosiderin staining in the left pons and middle cerebellar peduncle. There is a prior catheter tract with hemosiderin staining in the right frontal lobe. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are not enlarged, aside from slight ex vacuo dilatation of the fourth ventricle. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mucosal thickening in the right frontoethmoid recess region.MRA: There is no evidence of gross arteriovenous malformation, significant steno-occlusive lesions, or aneurysms. There is a diminutive right vertebral artery.

Output: 1. Unchanged cavity with marginal hemosiderin staining in the left pons and middle cerebellar peduncle.2. No evidence of gross arteriovenous malformation, significant steno-occlusive lesions, or aneurysms.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with lung cancer and metastasis to the brain, evaluate for progression. A 3 mm enhancing focus within the right frontal lobe (image 81 series 1201) shows no significant interval change from the prior examination. No significant associated edema is seen.No other areas of pathologic enhancement, focal edema or mass effect are detected. No intracranial hemorrhage or any abnormal extra axial fluid collection is observed. Patchy ill-defined periventricular white matter hypoattenuation has progressed from the prior examination. The ventricles are stable and normal in size.A focus of enhancement within the right parietal bone just off midline is unchanged and nonspecific.

Output: There has been no significant interval change. A very small focus of residual enhancement is unchanged in the right frontal lobe. No new intracranial lesions are suspected. Progression of ill-defined periventricular signal abnormality likely represents a treatment related effect.


Instruction: Generate impression based on findings.

Input: 56-year-old female status post ventriculoscopy for colloid cyst resection. There has been interval colloid cyst resection with no significant measurable residual mass noted. There is new T2 hyperintensity involving the adjacent corpus callosum as well as just inferolateral to the right frontal horn with restricted diffusion and ADC hypointensity suggestive of ischemia. Susceptibility hypointensity is noted involving the corpus callosal component. A small amount of susceptibility within the dependent occipital horns is consistent with a small amount of postprocedural hemorrhage. Redemonstrated is pneumocephalus. Ventricular sizes are unchanged.There are scattered punctate foci of T2 hyperintensity primarily within subcortical white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: There has been interval colloid cyst resection with no significant measurable residual mass noted. There is new T2 hyperintensity involving the adjacent corpus callosum as well as just inferolateral to the right frontal horn with restricted diffusion and ADC hypointensity suggestive of ischemia. Susceptibility hypointensity is noted involving the corpus callosal component, suggesting hemorrhage within postprocedural changes. A small amount of susceptibility within the dependent occipital horns is consistent with a small amount of postprocedural hemorrhage