Instruction: Generate impression based on findings.

Input: Smoldering multiple myeloma. Assess for myelomatous involvement. THORACIC SPINE: There is multilevel degenerative cervical spondylosis that is better assessed on the recent cervical spine MRI, including minimal anterior subluxation of C7 relative to T1. Otherwise, the thoracic sagittal alignment is preserved. The vertebral body heights are preserved. Mild multilevel degenerative disc desiccation and height loss are most pronounced at T10-T11, where a small posterior central disc protrusion mildly narrows the spinal canal. There is also a small right foraminal disc protrusion along with right facet arthropathy resulting in mild T10 and T11 right neural foraminal stenosis. There is no other significant spinal canal stenosis. The vertebral bone marrow signal is unremarkable, accounting for mild degenerative signal anteriorly and T5-T6 and T10-T11. The spinal cord displays normal signal and morphology. There is no abnormal contrast enhancement. Apparent contrast enhancement in T7-T8 disc probably represents intrinsic T1 shortening rather than real enhancement. The esophagus is patulous. The paravertebral soft tissues are unremarkable.LUMBAR SPINE: There is a leftward convex curvature. Sagittal alignment is relatively preserved. The vertebral body heights are preserved. While the intrabody herniation in the inferior L1 has not changed, new intrabody herniations have developed at L2-L3 associated with mild subjacent contrast-enhancing marrow edema. This is associated with increased right-sided L2-L3 disc height loss and increased posterolateral, paracentral disc bulge resulting in left subarticular recess stenosis and moderate left neural foraminal stenosis while the mild right neural foraminal stenosis is unchanged. Otherwise, the vertebral bone marrow signal remain heterogeneous but without significant focal lesion. Focal contrast enhancement subjacent to the superior L3 endplate on the right correlates with small focal T2-hyperintensity, which is unchanged since the prior examination. The other levels show unchanged disc desiccation and height loss. The mild central and left paracentral canal stenosis at L3-L4 are unchanged, as well as the mild bilateral neural foraminal stenoses. Lower lumbar facet osteoarthritic changes along with small joint effusions are present. There is no significant spinal canal stenosis. The conus medullaris displays normal signal and morphology and its tip lies at lower L1 level. Heterogeneous pelvic marrow signal is not significantly changed from the prior MRI of May 17, 2016 and probably reflect posttreatment findings.

Output: 1.Thoracic spine: No definite myelomatous involvement in the thoracic spine. Mild multilevel degenerative spondylosis but no significant spinal canal stenosis or cord compression. Apparent contrast enhancement in T7-T8 disc probably represents intrinsic T1 shortening rather than real enhancement. 2.Lumbar spine: No definite myelomatous involvement in the lumbar spine. Multilevel degenerative spondylosis is most pronounced at L2-L3, where increased posterolateral, paracentral disc bulge results in left subarticular recess stenosis and moderate left neural foraminal stenosis. There has not been significant change of the multilevel spondylosis otherwise. 3.Heterogeneous pelvic marrow signal is not significantly changed from the prior MRI of May 17, 2016 and may reflect treatment effects. Please refer to the recent pelvis MRI for additional details.4.The esophagus is patulous, which may be associated with gastroesophageal reflux.


Instruction: Generate impression based on findings.

Input: 66-year-old woman with history of Crohn's and left-sided abdominal pain. Patient is status post ileocecectomy and hysterectomy. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: Spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Patient is status post ileocecectomy. There is a short segment of concentric small bowel wall thickening involving approximately 5 cm of the neoterminal ileum (series 5, images 14-17) with mild postcontrast enhancement. There is mild fatty proliferation surrounding the neoterminal ileum. The small bowel and colon are otherwise normal. There is no evidence of obstruction.BONES, SOFT TISSUES: Postsurgical artifact noted in the ventral mid abdomen.OTHER: The patient is status post hysterectomy.

Output: 1. Thickwalled neoterminal ileum (located in right hemipelvis and involved segment seen directed towards the left, area of involvement measures approximately 5 cm) with decreased distensibility and mild postcontrast enhancement, suspicious for acute on chronic inflammation.


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. There is a aneurysm proximal to the left ophthalmic artery origin likely involving the left distal cavernous internal carotid artery, which measures approximately 4 mm in height and 4 mm at the base, and projects medially.MRA NECK

Output: 1. No significant stenosis in the intracranial circulation or the extracranial circulation in the neck.2. 4 mm left distal cavernous ICA aneurysm.


Instruction: Generate impression based on findings.

Input: Left knee instability MENISCI: There is maceration of the lateral meniscus with only a small remnant of the anterior horn remaining. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is severe full-thickness cartilage loss of the medial compartment of both the femoral condyle and tibial plateau. There is associated degenerative marrow edema in the underlying subchondral bone. There is moderate thinning of the articular cartilage of the medial compartment with areas of near full-thickness degeneration as well. There is heterogeneity and partial-thickness loss of the medial patellar facet and associated femoral trochlea. The articular cartilage of the lateral patellar facet is preserved.LIGAMENTS: The anterior cruciate ligament is absent. PCL is intact. The MCL is intact. The lateral collateral ligament complex is performed. EXTENSOR MECHANISM: There is increased signal and thickening of the distal portion of the patellar tendon with osteophyte formation of the anterior tibia. The quadriceps tendon is intact.ADDITIONAL

Output: 1. Ruptured ACL.2. Maceration of the lateral meniscus.3. Severe osteoarthritis of the lateral compartment with moderate changes noted in the medial and patellofemoral compartment.4. Rupture of the lateral collateral ligament complex.5. Large joint effusion and Baker's cyst containing small foci of low signal intensity which likely reflect a combination of synovitis and/or debris/loose bodies. 6. Thickening and increased signal of the distal portion of the patellar tendon which may reflect partial tearing or tendinosis.


Instruction: Generate impression based on findings.

Input: There are postsurgical findings related to right neck dissection and resection of the posterior right hemimandible with hardware fixation and flap reconstruction of the right-sided pharyngeal soft tissues. There are also radiation effects in the nasopharyngeal region with mild swelling and mucositis, as well as edema in the right retromolar trigone region, but no measurable residual tumor within the right nasopharynx. There is also no significant cervical lymphadenopathy. There are denervation changes in the right tongue. There is a small area of high T2 signal and enhancement in the soft tissues posterior to the right mandibulectomy margin. The thyroid and remaining salivary glands appear unchanged. The imaged intracranial structures are unremarkable.

Output: Post-treatment effects in the right nasopharyngeal region and right neck without definite measurable residual or recurrent locoregional tumor. A small area of high T2 signal and enhancement in the soft tissues posterior to the right mandibulectomy margin may be inflammatory in nature.


Instruction: Generate impression based on findings.

Input: Ms. Kim is 38-year-old BRCA2 positive woman with personal history of left breast invasive carcinoma status post mastectomy and right breast lumpectomy for DCIS. She developed liver metastasis in 2013. She submitted outside studies for review which include mammograms (2/22/2016; 2/24/2026) and MRI (2/23/2016) performed at M.D. Anderson Cancer Center. There are no comparisons study available. MAMMOGRAM 2/22/16: The patient is status post left mastectomy and therefore right mammograms are submitted. Three standard and spot magnification views of the right breast were obtained. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There are postsurgical/posttreatment changes in the upper outer quadrant. Calcifications are noted in upper outer quadrant. These persist on the spot magnification views and appear amorphous and a loosely grouped to segmental distribution. No suspicious masses identified in the right breastMRI 2/23/16:Axial T1, and fat saturated axial and sagittal postcontrast as well as diffusion weighted sequences were submitted. There is moderate heterogeneous fibroglandular elements in the right breast. Minimal background enhancement is present. There is no suspicious mass or non mass enhancement. Specifically, there are no abnormal findings and distribution of the calcifications seen on mammogram in the upper outer quadrant.There are postsurgical changes of left mastectomy and reconstruction. There is no suspicious enhancement in the mastectomy bed or chest wall.No gross axillary lymphadenopathy.MAMMOGRAM 2/24/2016:Static images from right breast stereotactic biopsy targeting the calcifications in the upper-outer quadrant were submitted. Targeted and is appropriate. Biopsy marking clip was applied. Postbiopsy mammograms demonstrate the clip to be in good position in the upper outer quadrant of the right breast, along with postbiopsy changes, about 1 cm displaced from some residual calcifications. Specimen radiograph showed calcifications.Pathology report is not available at this time.

Output: Status post stereotactic biopsy of low suspicion right breast calcifications. Correlation with biopsy pathology is recommended. A benign result could be considered concordant based on the low level of suspicion and negative MRI. Status post previous left mastectomy with reconstruction and previous right lumpectomy. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: history of fracture History: assess previous fracture. BONE MARROW: Linear T2 hyperintense signal with the bilateral sacral wings compatible with bilateral insufficiency fractures. Otherwise bone marrow signal is diffusely T1 hypointense compatible with red marrow likely secondary to chemotherapy given patient's history. SOFT TISSUES: Diffuse fatty muscle atrophy. Diffuse muscle edema. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Bilateral sacral insufficiency fractures and other findings as described above.


Instruction: Generate impression based on findings.

Input: 70 years, Male, vision loss out of proportion to exam. Evaluate for CNS pathology including optic nerves, chiasm. Vision loss left greater than right eye. Brain: No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. There is a punctate focus of susceptibility in the left temporal white matter as well as in the the right anterior pons/midbrain junction consistent with chronic microhemorrhages and are nonspecific in distribution. There are patchy areas of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic disease. Multiple lacunar infarcts are evident involving the posterior right frontal centrum semiovale and corona radiata as well as the right thalamus. No hydrocephalus. No extra-axial collections. There is mild global parenchymal volume loss. Sella is grossly unremarkable. Major flow-voids are preserved. Paranasal sinuses and mastoid air cells are grossly clear. No lesions involving the calvarium.Orbits: There is no mass within the bilateral orbits. No lesion involving the orbital apices, cavernous sinuses, parasellar region, or optic chiasm. There is motion degradation on multiple sequences which limits assessment of signal abnormality involving the optic nerves. There is question of volume loss involving the bilateral optic nerves.

Output: 1. There is no evidence of intracranial mass or mass effect. Note examination is limited to noncontrast sequences due to patient's severe renal insufficiency and is also motion degraded. 2. Examination quality is inadequate for assessment for optic nerve signal abnormality. There is however no intraorbital mass or mass effect on the optic nerves or chiasm. There is suggestion of volume loss involving the bilateral optic nerves.3. Chronic small vessel ischemic disease with multiple lacunar infarcts as described above. There are also two small foci of chronic microhemorrhage in a nonspecific distribution.


Instruction: Generate impression based on findings.

Input: BRAIN: There are numerous T2 hyperintense lesions within the supratentorial white matter. Some have resolved or decreased in size while others have increased in size or occurred in the interval since the prior exam; with the most prominent new lesion located in the deep right frontal white matter extending into the genu of the corpus callosum. Many of these new lesions enhance and many of the larger lesions have associated T1 hypointensity. There are no posterior fossa lesions identified. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are two unchanged punctate foci susceptibility effect within the right parietal lobe. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mild mucosal thickening within the left maxillary sinus.CERVICAL SPINE: There are several ill-defined T2 hyperintense lesions throughout the cervical spine without associated cord expansion. These appear grossly decreased in signal intensity and number while an enhancing lesion at the C3 level has resolved. There are however two new bilateral enhancing T2 hyperintense lesions at the C6 level. There is minimal unchanged myelomalacia at the level of C4. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1.Numerous intracranial lesions isolated to the supratentorial compartment. Some have resolved or decreased in size, while some are new or have increased in size. 2.Numerous cervical spinal cord lesions. Some have resolved or decreased in size, while there are two new enhancing lesions at the C6 level. There is also unchanged mild myelomalacia at C4.


Instruction: Generate impression based on findings.

Input: 33-year-old female with right patellofemoral syndrome and chondromalacia. Prior arthroscopy with chondroplasty many years prior. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is a partial-thickness articular cartilage fissuring along the medial facet of the patella. There is thinning and irregularity of the articular cartilage along the medial facet of the patella which may represent postsurgical changes versus articular cartilage degeneration or a combination of both. There is subchondral bone marrow signal abnormality within the patella, likely degenerative in etiology. There is relative sparing of the articular cartilage of the medial and lateral compartments.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Partial-thickness articular cartilage fissure along the medial facet of the patella. Thinning and irregularity of the articular cartilage along the medial facet may reflect postsurgical changes versus articular cartilage degeneration as described above.2. Small to moderate size joint effusion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Neck pain with C6 inflammation, right arm pain, 1 year follow up eval for changes. There are multiple unchanged vertebral segmentation anomalies, including congenital fusion of C3 through C6 with a "wasp-waist" morphology and a dysmorphic dens. There are also postoperative findings at C1-2 posterior fusion with cerclage wire and screws. There is an apparent punctate focus of high T2 signal in the spinal cord at the C2 level with associated mild volume loss. The cervical vertebral column alignment is unchanged. There is a mild posterior disc-osteophyte complex and ligamentous hypertrophy at the level of C6-C7 that results in mild spinal canal narrowing and moderate right neural foramen narrowing. There is also a mild posterior disc-osteophyte complex at C2-3 with mild right spinal canal and moderate right neural stenosis. There is a partially-imaged cystic space superior to the cerebellar vermis, which appears flattened.

Output: 1. Unchanged postoperative findings at C1-2 and multilevel vertebral segmentation anomalies.2. A posterior disc-osteophyte complex and ligamentous hypertrophy at the level of C6-C7 results in mild spinal canal narrowing and moderate right neural foramen narrowing.3. A posterior disc-osteophyte complex at C2-3 results in mild right spinal canal and moderate right neural stenosis.4. A partially-imaged cystic space superior to the cerebellar vermis may represent an arachnoid cyst. A brain MRI may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Wedge-shaped abnormalities on CT scan. HCV Cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with left and caudate lobe hypertrophy and mild diffuse fibrotic changes. Fibrosis and atrophy of the anterior segment of the right hepatic lobe without a focal lesion or biliary ductal dilatation.No suspicious liver lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder. The vessels are patent.SPLEEN: Splenomegaly measuring 19.7 cm in craniocaudal dimension with numerous Gamna-Gandy bodies.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Extrarenal pelvis bilaterally.RETROPERITONEUM, LYMPH NODES: Upper abdominal collateral vessel formation.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver with fibrotic changes of the anterior segment of the right hepatic lobe without a suspicious lesion.


Instruction: Generate impression based on findings.

Input: 89-year-old female with mental status changes and recent falls. There is no evidence of intracranial hemorrhage, mass or edema. Previously described left posterior parietal stroke appear stable without evidence of hemorrhage or interval acute cortical stroke. Multiple areas of patchy hypodensity in a periventricular distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for new acute ischemia, 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: Nonhemorrhagic cortical stroke in the left posterior parietal region without interval change.


Instruction: Generate impression based on findings.

Input: Clinical question: Multiple sclerosis. Please perform multiple sclerosis protocol. Signs and symptoms: Multiple sclerosis progression. Pre and post enhanced brain MRI:Examination is performed utilizing dedicated Dr. Javed's multiple sclerosis protocol.Precise comparison difficult due to significant technique difference between the 2 exam. Current exam is performed utilizing dedicated multiple sclerosis protocol and prior study is a routine brain MRI examination.Within this limitation there is no detectable demyelinating disease in the posterior fossa.Images through the supratentorial space demonstrate findings consistent with mild chronic demyelinating disease. No detectable abnormal enhancement.Examination demonstrates mild interval progression of disease since prior exam. Several tiny new lesions are identified however none without evidence of enhancement. Note should be made that 2 mm slices on current exam could conceivably demonstrate larger number of lesion compared to prior study.Cortical sulci and ventricular system are within normal and with maintained midline.The signal void of major intracranial arterial branches are identified.

Output: 1.Negative diffusion weighted series.2.Mild chronic changes of demyelinating disease only in the supratentorial space with subtle interval progression since 2013 as detailed above.


Instruction: Generate impression based on findings.

Input: HCV cirrhosis, HCC screening ABDOMEN:LIVER, BILIARY TRACT: Slightly nodular hepatic morphology without arterially enhancing lesions. The hepatic vasculature is patent. No biliary duct dilation. The gallbladder is normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Duodenal diverticulum.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.No arterially enhancing lesions to suggest HCC.


Instruction: Generate impression based on findings.

Input: History of renal carcinoma and vertebral compression fractures. Thoracic spine: The expansile, lobulated metastatic lesion involving the left side of the T3 vertebra is overall slightly smaller, with almost complete resolution of the mass-effect on the thecal sac. In the axial plane, the mass along with its left paraspinal component measures 5.7 cm x 5.4 cm compared to 6.7 cm x 6.0 cm, previously. Obliteration of the left T2-T3 and T3-T4 neural foramina persists. The T7-L3 posterior fixation hardware, which is composed of bilateral transpedicular screws at T7, T8, T11, T12, L2 and L3 and dual posterior rods remain grossly unchanged. The metastatic, expansile lesion involving T9 and the smaller T10 vertebral body lesion are also improved with almost complete resolution of the mass-effect on the thecal sac at T9. The mild right T9 vertebral body compression fracture is unchanged or minimally increased. Vertebral body heights across the fused segment also remain preserved. The thoracic spinal cord shows normal signal and shape.Lumbar spine: There is an expandible cage is present in the right corpectomy defect at L1. Epidural extension of tumor at this level has virtually resolved. There is no significant change in a subcentimeter enhancing lesion in the inferior L5 vertebral body. There is no significant spinal canal stenosis at any of the lumbar spine levels. The L2 through L5 vertebral body heights are preserved. The metastatic, expansile lesions involving the right sacral ala are slightly smaller with less impingement on the epidural fat and nerve sleeves of the right first and second sacral nerves. Another lesion involving the left iliac crest is better defined and perhaps slightly larger and now contains foci of central T2-hyperintensity and peripheral T2-hypointensity. There are changes of previous left nephrectomy. The right adrenal mass is not completely imaged, while the left adrenal mass is not significantly changed in size, but shows central T2-hyperintensity, which may reflect necrosis.

Output: 1.The expansile metastatic lesions at T3 and T9 are overall smaller with almost complete resolution of the mass-effect on thecal sac. Also, the smaller T10 vertebral body lesion has regressed since January 2016. Mild right sided T9 vertebral body compression fracture is unchanged or minimally increased.2.The minimally expanded metastatic lesion at L1 vertebral body is slightly improved, with no significant impingement upon the lumbar spinal canal.3.A metastatic lesion involving the right sacral ala is also slightly smaller, with less impingement on the sacral neural foramina, while the left iliac crest metastatic lesion appears to be slightly larger, but may also feature treatment effects. 4.The left adrenal mass now demonstrates necrosis, while the right adrenal lesion is not completely imaged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is chronic loss of white matter volume with associated gliosis bilaterally, most notable involving frontoparietal and parietal lobes, associated with ex vacuo dilatation of the lateral ventricles as well as thinning of the corpus callosum. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Fluid is present within a few paranasal sinuses as well as pooling within the nasopharynx, consistent with intubation. There is no abnormal enhancement within the brain.

Output: 1.There is chronic loss of white matter volume with associated gliosis bilaterally, most notable involving frontoparietal and parietal lobes, associated with ex vacuo dilatation of the lateral ventricles as well as thinning of the corpus callosum from remote ischemia.2.No Chiari malformation.


Instruction: Generate impression based on findings.

Input: Fatigue, paresthesias and urinary frequency. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or mass effect. There are a few unchanged scattered nonspecific punctate foci of T2hyperintensity 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, and scalp soft tissues are grossly unremarkable. There are subcentimeter probable retention cysts in the maxillary sinuses.

Output: Few unchanged scattered nonspecific punctate foci of T2hyperintensity in the cerebral white matter.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: Evaluate for L MCA territory ischemia History: dysarthria Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal scattered bihemispheric susceptibility lesions are seen, unchanged since prior scan suggesting chronic petechial hemorrhage or mineralization.Multifocal lacunar infarcts involving bilateral basal ganglia, thalami, and pons are again seen, unchanged.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate complete occlusion of left MCA M1 segment. Otherwise, unchanged right ACA A2 occlusion, significant luminal stenosis of the left ACA P segment and irregularity of bilateral PCA P2 segments.No evidence of intracranial arterial aneurysm.

Output: 1. No evidence of acute ischemic or new hemorrhagic lesion on the scan.2. Multifocal susceptibility lesions on bilateral hemisphere, brainstem and cerebellum are again seen, unchanged.3. No evidence of abnormal enhancement.4. Left MCA M1 segment and right ACA A2 segment occlusions as well as multifocal intracranial arterial luminal stenosis indicating intracranial arthrosclerotic changes are again seen, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: BRAIN: There is a large confluent region of T2 hyperintensity within the right frontal and parietal subcortical and deep white matter centered around the central sulcus. There is mild associated T2 hyperintensity of the corticospinal tracts extending into the internal capsule posterior limb. There is no associated mass effect, susceptibility effect, diffusion restriction, or enhancement. There is no evidence of intracranial hemorrhage 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable. SPINE: There is abnormal T2 hyperintensity extending the length of the spinal cord but most prominent in the cervical region extending from C2 through C7 where there is cord expansion. There is a 3-mm rounded focus of intramedullary enhancement within the conus at the L1 level. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The conus terminates at L2. The paravertebral soft tissues are unremarkable. The bladder is distended.

Output: Large confluent focus of signal abnormality involving the right frontal and parietal white matter as well as signal abnormality throughout the spinal cord, most prominent within the cervical cord where there is cord expansion. These findings are most compatible with a demyelinating process such as ADEM. Follow-up is recommended to ensure improvement.


Instruction: Generate impression based on findings.

Input: Reason: Possible persistent tendonitis versus FCU tendon tear at the level of the forearm and into the wrist History: pain with activity Bone marrow signal intensity is normal. The signal intensity of the musculature is normal on the T1 and fat suppressed T2-weighted images. However, there is slight increased signal intensity of the abductor pollicis longus and extensor pollicis longus muscles as well as of the brachioradialis, flexor carpi radialis and palmaris longus muscles following contrast administration. The clinical significance of this finding is uncertain. The flexor carpi ulnaris muscle and tendon appear normal. Please note that this study is not optimal for evaluation of the tendinous and ligamentous structures of the elbow, but we see no elbow joint effusion. Additionally, we see no soft tissue masses.

Output: Minimal enhancement of a few of the anterior and posterior compartment muscles as described above, which is of questionable clinical significance. We see no abnormality of the flexor carpi ulnaris muscle or tendon or other specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Male, 37 years old, with left-sided numbness, burning lesion noted on outside MRI. An oval, T2 hyperintense and mildly diffusion restricting lesion is evident within the white matter adjacent to the posterior body and atrium of the right lateral ventricle. The lesion measures 29 x 23 mm on axial images and has not significantly changed in overall size. On postcontrast images, this lesion demonstrates incomplete ring enhancement with the open end of the ring oriented away from the ventricle. The pattern of enhancement is similar to that seen on the prior examination, though it is somewhat better defined on today's study.The lesion exerts only mild local mass effect. The right lateral ventricle is of smaller caliber than the left but this is felt to be due to anatomic variation rather than the lesion as this asymmetry involves the entire ventricle.Multiple additional small foci of T2 hyperintensity are seen elsewhere in the periventricular regions. These are most notable in the left periatrial white matter.No evidence of any intracranial hemorrhage or significant susceptibility artifact is seen. No abnormal extra-axial collections are detected. Parenchymal enhancement is otherwise unremarkable.Single and multi voxel spectroscopic assessment of the dominant right periventricular lesion shows mildly to moderately reduced NAA, and mildly elevated choline. Portions of the lesion show significant lipid resonances along with a smaller quantity of lactate. No unusual resonances are identified. Normal-appearing tissue immediately adjacent to the lesion shows normal spectra or only mild alterations of the expected metabolite patterns.On perfusion imaging, relative CBV is reduced over a majority of the dominant lesion with only small scattered areas of elevated relative CBV along the periphery of the lesion.

Output: A lesion is redemonstrated in the periventricular white matter along the right lateral ventricle which shows little significant interval change. Lesion location and morphology, and particularly the incomplete ring pattern of enhancement, along with the presence of additional smaller white matter lesions on the left, are most suggestive of a demyelinating process.The MR spectroscopic pattern of this lesion, while nonspecific, is compatible with a significant inflammatory process such as demyelination. The pattern is not supportive of a high-grade neoplastic process, and no specific features of either bacterial or fungal infection are seen. Perfusion imaging is reassuring for a benign process as a majority of the lesion demonstrates reduced rCBV. Alternate diagnostic considerations, including low-grade neoplasm or infection, are considered less likely at this time.


Instruction: Generate impression based on findings.

Input: Unspecified abnormalities of gait and mobility, evaluate for hemorrhagic lesion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter and in the pons. There is no abnormal intracranial enhancement. The ventricles and cortical sulci are mildly prominent compatible with mild volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal mucosal thickening in the anterior ethmoidal air cells. The skull, and scalp soft tissues are grossly unremarkable. There is a left lens implant.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Scattered bilateral cerebral and pontine white matter hyperintensity including pons may relate to mild chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 65-year-old male with cirrhosis. Evaluate biliary tree for obstruction. Total bilirubin of 35.9 mg/dL. ABDOMEN:Limited exam due to patient's body habitus, ascites, and respiratory motion artifact.LIVER, BILIARY TRACT: Cirrhotic pathology of the liver. Small simple cyst of the posterior right hepatic lobe. No normal flow void is identified in the left portal vein, and there is an incomplete flow void within the main pulmonary vein (axial series 5 image 29). No definite intra or extrahepatic biliary ductal dilatation is identified, however the exam is limited due to the patient's body habitus, ascites, and respiratory motion artifactSPLEEN: Splenomegaly measuring 21.3 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large volume ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Suboptimal evaluation due to lack of intravenous contrast and artifacts related to ascites and body habitus. No definite intrahepatic biliary ductal dilatation. The lack of a normal left portal vein flow void and incomplete flow void of the main portal vein are concerning for thrombus, however further evaluation with postcontrast imaging is recommended. Additionally, parenchymal lesions cannot be excluded.


Instruction: Generate impression based on findings.

Input: Enlarged orbital muscles: proptosis. Orbits: There is interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior rectus muscle. There is mild protosis bilaterally, right more than left, which appears to be attributable to diffuse prominence of the orbital fat. Otherwise, the bilateral globes, lacrimal glands, and optic nerves bilaterally are intact. There is no evidence of orbital mass lesions.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are nonspecific punctate foci of T2 hyperintensity in the right parietal lobe white matter. The brain, brainstem, and cerebellum otherwise appear unremarkable. There is no abnormal meningeal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior rectus muscle, which may be related to evolution of an inflammatory process, such as sarcoidosis. Otherwise, mild protosis bilaterally, right more than left, appears to be attributable to diffuse prominence of the orbital fat.2. Mild thickening of the pituitary infundibulum may represent an inflammatory process as well, such as sarcoidosis.3. No evidence of intracranial hemorrhage, mass, or acute infarct. Punctate foci of T2 hyperintensity in the right parietal lobe white matter are nonspecific, but may represent chronic small vessel ischemic disease, for example.


Instruction: Generate impression based on findings.

Input: History of olfactory groove meningioma resection on 2/25/15: surveillance. There are postoperative findings related to recent bifrontal craniotomy with areas of confluent T2 hyperintensity and scattered foci of susceptibility along the margins of the resection cavity. There is an enhancing mass in the posterior aspect of the resection cavity, adjacent to the anterior cerebral arteries, that measures up to approximately 20 mm. There is also unchanged enhancement tumor along the left planum sphenoidale that measures up to 10 mm in thickness, adjacent to the left optic nerve. The ventricles are unchanged in size and configuration. There is no evidence of acute territorial infarction.

Output: Postoperative findings related to olfactory groove meningioma resection with no significant interval change in size of the residual tumor in the posterior aspect of the resection cavity and along the left planum sphenoidale.


Instruction: Generate impression based on findings.

Input: Inflammatory myositis The exam is limited by motion artifact and by patient's body habitus.Left: The muscles of the thigh are normal in caliber and signal. There is no abnormal enhancement following contrast administration. The marrow signal of the femur is normal.Right: The muscles of the thigh are normal in caliber and signal. There is no abnormal enhancement following contrast administration. The marrow signal of the femur is normal.

Output: Normal appearance of the thigh musculature.


Instruction: Generate impression based on findings.

Input: Reason: S/P uterine artery embolization History: uterine fibroids, s/p uterine artery embolization. PELVIS:UTERUS, ADNEXA: Enlarged uterus with innumerable heterogeneous T2 hypointense enhancing masses compatible with fibroids has decreased compared to prior. Previous reference largest left subserosal mass measures 11.7 x 7.7 x 12.9 cm (series 1001 image 44, series 1201 image 12), previously 14.6 x 8.7 x 15.9 cm. Previous referenced largest right subserosal mass measures 7.5 x 6.4 x 7.1 cm, previously 8.8 x 8.0 x 9.8 cm. The largest fibroids, which previously enhanced homogeneously, no longer demonstrate enhancement. Some of the smaller fibroids continue to demonstrate enhancement.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval decrease in size and enhancement of uterine fibroids compatible with some treatment response.


Instruction: Generate impression based on findings.

Input: 66 years Male (DOB:2/5/1950)Reason: rule out stroke History: L facial droop, dysarthriaPROVIDER/ATTENDING NAME: JAMES J. WALTER DAVID G. BEISER MRI of the brainPatchy foci of diffusion restriction are present in the right centrum semiovale, body of the caudate nucleus and lateral aspect of the precentral gyrus with some punctate foci of diffusion restriction in the right parietal lobe. There is associated T2 and FLAIR signal hyperintensity with the diffusion restriction.The right medullary veins and cortical veins are asymmetrically larger compared to their left sided counterparts.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The right MCA is occluded at its origin.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, left middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is ACA triplication with a median artery. There is fetal origin of the left PCA. The left P1 segment is small. The right PCOMA is not readily visualized. The right vertebral artery is small.

Output: 1.Right MCA occlusion at its origin.2.Subacute infarction along the right MCA territory as detailed above3.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: Back pain and h/o multiple myeloma and pathologic fracture History: Low back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multi-level vertebral body compression fractures including L2, L3 and L4.The L2 shows about 50% and L3 shows about 30% of height loss with minimum retropulsion of fractured fragment. The L3 vertebral body shows signal void area which corresponds to injected PMMA.The L4 shows focal 20% (mainly posterior fragment) height loss with high signal intensity on STIR images, minimal or no retropulsion is seen.The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L2-L3: diffuse bulging of disc, minimal bilateral neuroforaminal narrowing is seen. no evidence of spinal stenosis. L3-L4: diffuse bulging of disc with bilateral ligamentum flavum thickening results moderate spinal canal stenosis. L4-L5: diffuse bulging of disc with bilateral ligamentum flavum thickening results moderate spinal canal stenosis.. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multi-level compression fractures including L2, L3 and L4 as described above.2. Post PMMA injection status of L3.3. Multi-level various degree degenerative changes of lumbar spine as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Personal history of malignant neoplasm of other and unspecified parts of oral cavity and pharynxClinical question: h/o HNC, please compare to previous measurements 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 demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Neck:The patient is status post left submandibular gland removal.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.The right jugular digastric node measures 11 x 8 mm axial dimensionsThere is a 7 x 9 mm axial dimension right retropharyngeal node of Rouviere present it previously measured 9 x 5 mm axial dimensions.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the right submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are degenerative changes in the cervical spine with endplate and uncovertebral osteophytes at C4-5 and C5-6 with only mild narrowing of the spinal canal .

Output: 1.Compared to the prior exam the patient's examination has not changed. There are number of lymph nodes in the right suprahyoid neck which are stable and compared to the previous exam and do not meet size criteria for adenopathy.2.There is no evidence for brain metastases or perineural spread..


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 18 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 26 seconds

Output: Successful image guided injection of the right hip followed by MR arthrogram; MRI report to follow.


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings related to left parietal craniotomy for resection of a left frontal lobe mass with associated susceptibility effect in and adjacent to the resection cavity compatible with chronic blood products. Additional small scattered areas of susceptibility artifact, for example in the left frontal lobe, may be related to development of cavernous malformation from prior radiation treatment. Since current exam was performed in 3T MRI, those lesions appear to be more conspicuous than prior exam performed in 1.5T on Mar 2016. Considering the difference in magnet strength, there is no significant interval difference in terms of numbers and distribution. There is a persistent extra-axial fluid collection subjacent to the craniotomy flap. There is unchanged confluent T2 hyperintensity without associated mass effect within the left frontal white matter, in the region of the treatment bed. However, there is no enhancement in the region of the resection cavity. There is no evidence of acute infarct likely related to gliosis. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are unremarkable.

Output: 1. MRI of the brain with and without contrast is negative for tumor progression. 2. A few scattered areas of gradient susceptibility may be related to chronic hemosiderin deposition versus developing cavernous malformations from prior radiation treatment, unchanged since prior scan considering the difference in examining magnet strength.


Instruction: Generate impression based on findings.

Input: Clinical question: New daily headaches. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.There is normal anatomical morphology and signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal parenchymal, leptomeningeal or calvarial enhancement. Unremarkable images through the orbits and including axial fat sat post enhanced series.There is complete opacification of the larger right chamber sphenoid sinus with intense mucosal enhancement and consistent with chronic sinus disease. Mild bilateral maxillary sinus mucosal thickening consistent with chronic sinusitis is also present. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.Unremarkable pre-and post enhanced brain MRI.2.Complete opacification of larger right chamber of sphenoid and bilateral maxillary mucosal thickening consistent with chronic sinusitis.


Instruction: Generate impression based on findings.

Input: Locally recurrent endometrial cancer, now noticing "tingling" at vertex and pain at back of head when laying down. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal scattered cerebral white matter T2 hyperintensity, which is nonspecific. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a subcentimeter probable hemangioma in the let frontal bone. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 65-year-old man with history of cirrhosis, evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in morphology with increased parenchymal signal on opposed phase images. No focal hepatic lesions are identified. The portal vein is occluded and the SMV is not visualized. There is evidence of nonocclusive thrombus in the portal collateral vasculature (series 1001, image 59).The gallbladder is distended with a gallstone at the neck. No evidence of cholecystitis.SPLEEN: The spleen is mildly enlarged. Numerous splenic varices are noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Subcentimeter hyperintense T2 foci in the kidneys likely represent cysts. The kidneys are otherwise normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted of the partially visualized small bowel and colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic morphology of the liver without suspicious focal hepatic lesion.2.Portal vein occlusion, SMV occlusion, collateralization with thrombus, and mild splenomegaly.


Instruction: Generate impression based on findings.

Input: Male, 5 years old, with history of tectal plate juvenile pilocytic astrocytoma, status post biopsy and subtotal resection with third ventriculocisternostomy at an outside hospital, status post laser ablation in 5/15, with progressive growth of the lesion, status post repeat ablation. T1 postcontrast imaging was acquired before and after laser ablation of the tectal plate lesion. Preablation images demonstrate positioning of the right frontal approach laser probe within the heterogeneously enhancing tumor. Post ablation images demonstrate increased confluent enhancement which appears to completely encompass the original lesion. A right frontal approach Ommaya catheter is in place with its tip terminating in the region of the right caudate. The lateral and third ventricles remain dilated similar to prior.

Output: Expected findings status post laser ablation of the tectal plate tumor.


Instruction: Generate impression based on findings.

Input: Hand, foot, and tongue sensorimotor areas mapped to their expected locations along the pre- and post-central gyri. Language activity is left dominant but with some mild contribution from the right. Dominant Wernicke's area activity is present on the left along the superior temporal sulcus, with mild activity on the right. Less robust but detectable Broca's area activity activity is seen in the inferior frontal lobe, left side more than right. There is strong secondary language within the left middle frontal gyrus on all tested paradigms.

Output: 1.Language activity is left dominant but with some mild contribution from the right hemisphere as well. 2.Sensorimotor activity maps as expected along the pre- and post-central gyri.


Instruction: Generate impression based on findings.

Input: There is exaggeration of cervical lordosis with persistent 4-mm retrolisthesis of C3 on C4. There is incomplete fusion of C5-6 vertebral bodies. The bone marrow signal is within normal limits. The imaged cord shows normal caliber and signal intensity. There is multilevel disk desiccation and loss of disk height at C3-4, C4-5 and C6-7.C2-3: No disk herniation or spinal stenosis.C3-4: 4-mm retrolisthesis of C3 on C4 with ligamenta flava thickening causing mild spinal canal stenosis, and moderate left and mild right neural foraminal stenosis.C4-5: No disk herniation or spinal stenosis.C5-6: Incomplete fusion of C5 and C6 with no significant disk/endplate degenerative changes or spinal stenosis.C6-7: No disk herniation or spinal stenosis. C7-T1: No disk herniation or spinal stenosis.

Output: No significant interval change in multilevel cervical spondylosis as detailed above with moderate spinal canal stenosis at C3-4.


Instruction: Generate impression based on findings.

Input: 43-year-old female with knee pain for months with sharp pain and catching and giving out with stairs, fast walking and twisting. History of prior lateral release and scope and history of arthritis. MENISCI: There is a complex tear of the posterior horn of the medial meniscus with both horizontal and vertical components. The anterior horn of the medial meniscus appears normal. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: There is subchondral bone marrow edema within the medial femoral condyle and medial tibial plateau compatible. There is generalized thinning of the articular cartilage along the medial femoral condyle and medial tibial plateau with areas of full-thickness intermediate signal intensity defects extending to the subchondral bone with associated bone marrow edema. There is generalized thinning of the articular cartilage of the patella.LIGAMENTS: There is edema surrounding the medial collateral ligament compatible with sprain. The lateral collateral ligament appears normal. The anterior and posterior cruciate ligaments appear normal. EXTENSOR MECHANISM: The extensor mechanism appears normal.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus with both vertical and horizontal components.2. Subchondral bone marrow edema within the medial femoral condyle and medial tibial plateau. There is a moderate joint effusion about the knee.3. Medial collateral ligament sprain.4. Articular cartilage thinning and degeneration as described above.


Instruction: Generate impression based on findings.

Input: 48-year-old female with breast cancer, in need of evaluation. Patient participating in ISPY2 study. MRI #1 for ISPY2. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a heterogenously enhancing mass at the 5:00 position, posterior depth in the left breast, which demonstrates heterogeneous intrinsic signal, with areas of distinct high and low T2 signal, suggesting recent biopsy, and consistent with biopsy-proven breast cancer. The mass measures 3.4 x 3.6 x 2.8 cm (AP X ML X CC), without significant associated nonmass enhancement. No definite associated clip artifact is noted. No additional suspicious enhancing lesions are seen within the left breast.No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1.Enhancing left breast mass consistent with biopsy-proven breast cancer as detailed above.2.No abnormal enhancement in the right breast.3.No evidence of axillary lymphadenopathy.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Suprasellar tumor. The study is very limited by artifact related to dental braces. The diffusion and gradient/SWI images are nondiagnostic.The patient did have a right frontal craniotomy and subfrontal approach to the mass. Small, heterogeneous collection overlying the right frontal lobe causes no significant mass effect.There is a large, lobulated, well-circumscribed suprasellar mass (separate from the pituitary gland). The mass measures in the coronal plane 3.7 cm x 3.3 cm. Anterior posteriorly, it measures 2.2 cm on the sagittal plane. The mass is heterogeneously T2 hyperintense and shows intense but heterogeneous contrast enhancement. The mass is heterogeneously T1-hypointense relative to gray matter with focus of intrinsic T1 shortening in the dependant part of the cystic component of the mass (which happen to be more intensely T2 bright as well and are new since the previous, preop MRI). These focus might be related to layering postbiopsy hemorrhage and measures axially 3 x 17 mm. The mass is associated with compression of the third ventricle and splaying of the thalami superiorly. There is also edema-like signal along the adjacent left optic tracts. It also stretches the optic chiasm from posteriorly. It laterally displaces without circumferentially encasing the supraclinoid internal carotid arteries as well as the A1 segments. It causes similar mass effect on the tip of the basilar artery and the P1 segments. Compared to the preoperative examination, the very anterior-inferior part of the mass has been resected. The remainder of the mass has not changed. Intracranial major vessels remain patent. There is incidental posterior left frontal developmental venous anomaly.The paranasal sinuses and the mastoid air cells remain clear.

Output: 1.Large suprasellar mass is most compatible with a craniopharyngioma. The mass has relationship to adjacent structures as described above.2.Since the examination of August 9, 2015, the mass has been partial resection as described above.3.Dependent, layering focal T1/T2 hyperintensity within the mass is new and may represent minimal intralesional hemorrhage.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with memory decline. Numerous scattered foci of T2 hyperintensity are seen within the white matter of the cerebral hemispheres. These are primarily juxtacortical, and to a lesser degree periventricular in distribution. No significant involvement of the basal ganglia, brainstem or cerebellum is seen.There is no evidence of restricted diffusion. No parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or abnormal extra-axial fluid collections are noted. The lateral ventricles may be slightly prominent. The cerebral sulci in general are of normal caliber, though the sylvian fissures appear mildly prominent.

Output: 1.Numerous, likely chronic, scattered small white matter lesions are seen in the cerebral hemispheres, largely juxtacortical in location but with mild involvement of the periventricular regions as well. The basal ganglia, brainstem and cerebellum are spared. The distribution is somewhat atypical for small vessel ischemic disease though correlation with risk factors is suggested. Other considerations would include sequelae of prior inflammation, demyelination or vasculitis.2.No definite acute intracranial abnormality is seen nor are there any other specific findings which would account for the patient's memory decline. The lateral ventricles appear to be slightly prominent and there may be some prominence of the sylvian fissures suggesting a component of mild parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with weakness, numbness, cramping and tremor. Brain:No definite parenchymal signal abnormality is seen. Brain morphology is within normal limits. No evidence of edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected. There are no abnormal extra-axial fluid collections. The ventricular system is normal in size and morphology.C-spine:Alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow replacement seen.The visualized spinal cord shows normal signal intensity and morphology throughout. No focal lesions are detected. No epidural pathology is suspected.C2-3: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Mild facet hypertrophy. No significant spinal canal or foraminal stenosis. C4-5: Unremarkable. C5-6: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. Slight effacement of the ventral thecal sac but no significant spinal canal stenosis. No significant spinal canal stenosis. C6-7: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation. Slight effacement of the ventral thecal sac but no significant spinal canal stenosis. Mild left foraminal narrowing. C7-T1: Unremarkable.

Output: 1.Unremarkable evaluation of the brain with no focal lesions or additional specific findings to account for the patient's symptoms.2.Mild degenerative findings in the cervical spine without high-grade spinal canal or foraminal stenosis. No focal cord lesions are seen.


Instruction: Generate impression based on findings.

Input: 15-year-old female with diffuse midfoot sprain/swelling who is unable to walk. Evaluate for stress fracture. Patchy increased STIR signal within the talus with associated T1 hypointensity. Findings consistent with bone contusion. There is mild soft tissue edema at the dorsum of the ankle and a subtalar joint effusion. No evidence of a fracture line or malalignment.

Output: Findings consistent with talar contusion.


Instruction: Generate impression based on findings.

Input: Clinical question: AVM. Signs and symptoms: Follow-up AVM post treatment. Nonenhanced brain MRA:The measurement of AVM demonstrate no significant change in the size of the patient's high convexity left frontal AVM.The AVM measures approximately 15 mm in cranial cephalad axis similar to prior study. It measures 9 mm on transverse axis compared to prior study remeasurement of approximately 11.4 mm. Enlarged caliber of left anterior cerebral artery similar to prior exam and indicating feeding pedicle.The lesion however on brain MRI demonstrated decreased size of AVM.

Output: 1.Left hemispheric AVM measuring approximately 15 x 9 mm in size compared to prior exam re-measurements of 15 x 11.4 mm.2.Unremarkable brain MRA otherwise.


Instruction: Generate impression based on findings.

Input: 52 yo female with C2 cavernoma. Right lower extremity numbness. Focus of increased T2 signal with hemosiderin rim in the ventral left cervical cord at the C2 level measures 5 x 6 x 8 mm and not appreciably changed allowing for differences in measurement technique. T2 hypointensity is again noted to extend inferiorly down to the C3-C4 level in the left ventral aspect of the cord. T1 hyperintensity as well as mild enhancement are also unchanged.Cervical spine alignment is anatomic. Vertebral body heights are normal. Mild multilevel degenerative changes are again seen with central disk protrusion at the C3-C4 level with mild associated flattening of the ventral cord similar to prior. No associated cord signal abnormality. There is mild to moderate left neural foramina stenosis on the left at C3-C4 related to facet arthropathy and uncovertebral hypertrophy. Mild disc bulge at C6-7 also unchanged without significant spinal canal or neural foraminal stenosis. T1 hyperintense focus at the T2 vertebral body compatible with hemangioma.

Output: 1. No appreciable change in left ventral C2 cavernous malformation across multiple prior studies dating back to 6/29/2012.2. Mild multilevel degenerative changes including central disc protrusion at C3-4 with mild spinal canal stenosis and mild to moderate left neural foraminal stenosis is also not significantly changed.


Instruction: Generate impression based on findings.

Input: 50 years Female (DOB:1/13/1966)Reason: 3 t scanner optic nerve sheath meningioma left and right History: vision loss left more sever than rightPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is optic nerve sheath enhancement appreciated within the intracanalicular portions and orbital apex portions of the optic nerves which appears worse on the left side. There is eccentric dural thickening compressing the left optic nerve, however, some enhancement of the left optic nerve along its intracanalicular portion may also be represent or some compression of the optic nerve. Differentiation may not be possible due to spatial resolution limitations of this exam. The suprasellar cistern is intact .Some mucosal thickening is present in the maxillary sinuses.

Output: 1.Optic nerve sheath enhancement within the intracanalicular and orbital apex portions of the optic nerves encasing the optic nerves. 2.Findings suggest either left optic nerve enhancement or compression. Differentiation may not be possible due to spatial resolution limitations of this exam.


Instruction: Generate impression based on findings.

Input: 57-year-old woman with recurrent right breast triple negative invasive ductal carcinoma gr 3, recently switched her care from OSH to University of Chicago. Patient submitted outside study for review. Submitted for review are breast MRI (11/2/2015) performed at Advocate Lutheran General Hospital. No comparisons are available. BREAST MRI: There are scattered fibroglandular tissue in both breasts. Mild amount of background parenchymal enhancement is seen bilaterally.RIGHT BREAST: Posttreatment/postsurgical changes are seen in the right breast which include architectural distortion, periareolar skin thickening, and small volume of the right breast. Additional scattered foci of susceptibility artifact are seen and may be related to surgical clips from prior lumpectomy as well as post biopsy changes.Within the central breast at the lumpectomy site near the 12:00 location, there is a spiculated heterogeneously enhancing mass, with susceptibility artifact noted at the anterior aspect of mass, consistent with the biopsy-proven recurrent cancer. The mass measures approximately 3.4 x 2.7 cm in AP and transverse dimension, respectively. There is is loss of the fat planes between the mass and the pectoralis muscle posteriorly, with associated tenting/pulling of the pectoralis muscle, and pectoralis muscle involvement cannot be excluded. Also in the right breast in the subareolar region, there is a an irregular enhancing mass measuring 1.2 x 0.9 cm in AP and transverse dimension, respectively, suspicious for malignancy.There is an enhancing focus in the right subpectoral region, measuring approximately 5 mm, indeterminate, and could be a lymph node. Given the location, this area may be difficult to evaluate on ultrasound and may not be amenable to ultrasound-guided biopsy.LEFT BREAST: There is no discrete enhancing mass or suspicious morphology in left breast. No suspicious findings in the left axilla.OTHER: There is a T2 bright lesion in the right hepatic lobe which is incompletely characterized and statistically could represent a cyst or hemangioma. Further evaluation with a triphasic CT scan of the abdomen with contrast or MRI of the liver with contrast could be obtained for further evaluation as clinically indicated. It could also be evaluated on PET.

Output: (1) Spiculated heterogeneously enhancing mass in the right central breast with possible pectoralis involvement measuring up to 3.4 cm consistent with the biopsy-proven recurrent cancer.(2) Additional irregular enhancing mass measuring up to 1.2 cm in the right retroareolar region, suspicious for malignancy.(3) Small right subpectoral lymph node. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Cervical spine alignment is within normal limits without sagittal subluxation. Vertebral body heights are grossly maintained without wedge compression deformities. Bone marrow signal is somewhat heterogenous without suspicious focal lesions. There is mild-moderate loss of disc height at C4-C5 and C5-C6. The cervical discs are desiccated. There is mild flattening of the mid cervical spinal cord most pronounced at C4-C5. There are no definite cord signal abnormalities.There is redemonstration of patchy increased T2 signal within the pons appearing grossly similar to 4/7/2015 MRI. A mildly prominent lymph node is present within the right upper mediastinum.C2-C3: No significant central canal or foraminal stenosis.C3-C4: No significant central canal or foraminal stenosis.C4-C5: Small posterior disc osteophyte complex with superimposed left paramedian disc protrusion resulting in mild flattening of the left ventral cord and mild central canal stenosis. Mild left foraminal stenosis.C5-C5: Small posterior disc osteophyte complex and uncovertebral osteophytes. No significant central canal stenosis. Mild right neuroforaminal stenosis.C6-C7: Small posterior disc osteophyte complex. Thickening of the ligamentum flavum. Mild flattening of the left ventral cord. Mild-moderate central canal stenosis. Mild left foraminal stenosis.C7-T1: No significant central canal or foraminal stenosis.

Output: 1.Degenerative changes of the cervical spine most pronounced at C4-C5 and C6-C7 where there is foraminal narrowing and mild-moderate central canal stenosis.2.Abnormal signal within the pons likely reflecting chronic small vessel ischemic changes appearing grossly similar to 4/7/2015 MRI.3.Mildly prominent nonspecific upper mediastinal lymph node. In the appropriate clinical setting, could be further evaluated with CT chest.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate left hip for acetabular labral tear, CAM lesion, Pincer lesion. History: Left hip and groin pain with flexion ACETABULAR LABRUM: Increased signal intensity traverses the anterior superior labrum at approximately the 2 o'clock position, indicating a tear. The posterior labrum appears intact. The superior labrum appears intact. ARTICULAR CARTILAGE AND BONE: We see no fluid-filled articular cartilage defects. There is minimal prominence of the anterior aspect of the femoral head/neck junction with a borderline alpha angle of 55 degrees. We see no morphologic features of pincer-type impingement. The bone marrow signal intensity is within normal limits.SOFT TISSUES: The imaged musculature of the left hip is normal in appearance. ADDITIONAL

Output: 1. Tear of the anterior superior labrum.2. Minimal prominence of the anterior femoral head/neck junction with a borderline alpha angle of 55 degrees.


Instruction: Generate impression based on findings.

Input: 19-year-old male with history of T-cell lymphoma and chronic osteomyelitis. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There are numerous geographic lesions with serpentine and sclerotic borders within the distal femur, proximal tibia, and proximal fibula likely representing avascular necrosis appearing similar to prior.Within the proximal tibia in an area of superimposed AVN, there is a large irregular heterogeneous area of signal abnormality consisting of decreased T1 and increased T2 signal abnormality with avid enhancement after contrast administration. This lesion breaks through cortex laterally and extends into the soft tissues where there is extensive increased T2 signal abnormality (image 14 of series 1001). There is periosteal reaction about the proximal tibia. Marked edema type signal abnormality about the subcutaneous fat of the proximal lateral lower leg.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Large heterogeneous lesion within the proximal tibia in the background of chronic AVN. There is new cortical breakthrough laterally as well as a small soft tissue component. While osteomyelitis is a diagnostic consideration, the lesion does not appear as fluid, but actually enhancing soft tissue. Given this, a malignant lesion must be entertained. Further evaluation with nuclear medicine could be useful or consider tissue sampling.2. Avascular necrosis of the distal femur and proximal tibia/fibula appearing similar to prior.


Instruction: Generate impression based on findings.

Input: Female, 88 years old, with altered mental status and seizure, nonfocal exam. No restricted diffusion is seen. Moderately extensive confluent periventricular T2 hyperintensity is noted without mass effect. There is no evidence of parenchymal edema. No acute intracranial hemorrhage or abnormal extra-axial fluid collections are detected. The ventricles and sulci are prominent compatible with underlying volume loss. A focus of susceptibility is seen in the right pons indicating chronic microhemorrhage. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected. Focal thickening of the right parietal bone is noted likely indicating a benign osteoma. The osseous structures are otherwise unremarkable.

Output: 1.Moderately advanced chronic small vessel ischemic disease.2.Global parenchymal volume loss.3.No evidence of acute ischemia or any other definite acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: The study is somewhat degraded by respiratory and vascular motion.The common carotid arteries are patent. The internal carotid bulbs are prominent in length bilaterally, likely a normal variant. The vertebral arteries are patent. The origin of the right vertebral artery is not well visualized. There is no flow-limiting stenosis or aneurysm.

Output: The cervical arterial circulation is unremarkable within limitations of artifact.


Instruction: Generate impression based on findings.

Input: Female, 9 years old, with increased seizure frequency (left leg stiffening). The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The pattern of enhancement is within normal limits.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. The medial temporal lobe structures are symmetric and free of signal abnormality. The corpus callosum is fully formed and intact. The pituitary gland is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed and unremarkable. The pattern of white matter myelination is mature.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: Unremarkable evaluation with no acute findings or structural abnormalities to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease with worsening perianal pain. Evaluate for perianal abscess/fistula. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Most contracted urinary bladder.LYMPH NODES: No pelvic lymphadenopathy. Small inguinal lymph nodes.BOWEL, MESENTERY: The visualized small and large bowel is normal in caliber without wall thickening or abnormal enhancement. Colonic diverticulosis.BONES, SOFT TISSUES: Again seen are inflammatory changes along the left gluteal cleft within a thin communication to the rectum at approximately the 5 o'clock position, without a drainable fluid collection and similar to the prior study. A seton appears to be in place.No focal suspicious osseous lesion. Lower lumbar facet joint degenerative changes. Degenerative disk disease.OTHER: No significant abnormality noted.

Output: Stable appearance of the inflammatory changes along the left gluteal cleft with a thin communication with the rectum at approximately the 5 o'clock position. No drainable fluid collection.


Instruction: Generate impression based on findings.

Input: Ms. Martin is a 40-year-old female with a family history of breast cancer in sister (diagnosed at the age of 33) and paternal grandmother. Known BRCA2 mutation. She is enrolled in a recent breast cancer screening study for high risk individuals. There is scattered fibroglandular tissue in both breasts. Minimal background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 69-year-old male with a history of metastatic small cell lung cancer s/p chemoradiation and surgery (off chemo since June 2015) presents with an abnormal PET and weakness, evaluate for brain metastases. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are and sulci are prominent compatible with volume loss, which is advanced for age. Extensive patchy areas of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter which are grossly similar to the prior examination. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is trace mucosal thickening involving the paranasal sinuses and mild opacification of the left mastoid air cells. Note is made of a right lens implant. Subtle postsurgical changes are noted in the left parietal scalp at the vertex. No discrete underlying lesion is evident. Adjacent calvarium is intact.

Output: 1. No evidence of intracranial metastatic disease. No evidence of acute infarct or intracranial mass effect. 2. No significant change in extensive signal abnormality involving the supratentorial white matter which may reflect posttreatment related leukoencephalopathy and/or chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Paresthesias involving both arms, brisk reflexes, up going left toe. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild loss of cervical lordosis, alignment is otherwise maintained.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or left neural foramina. Mild uncovertebral hypertrophy on the right with minimal right neural foraminal narrowing.C4-5: There is prominent uncovertebral osteophyte with mild to moderate right neural foraminal stenosis. No significant compromise to the spinal canal or left neural foramen.C5-6: Uncovertebral hypertrophy and mild disc bulge with effacement of the ventral thecal sac. Dorsal thecal sac is preserved without significant spinal canal stenosis at this level. There is minimal right neural foraminal narrowing. C6-7: Mild uncovertebral hypertrophy with minimal narrowing of the right neural foramen. No spinal canal or left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative changes in the cervical spine, as detailed above. No significant spinal canal stenosis at any level or cord signal abnormality. There is up to moderate right neural foraminal stenosis at the C4-C5 level.


Instruction: Generate impression based on findings.

Input: 72-year-old with history of lung and pancreatic cancer found down at home. Multiple areas of ischemic infarcts noted on recent noncontrast MRI. MRI brain:No foci of abnormal enhancement in the brain. Stable appearance of the very small subdural hematoma overlying the right parietal lobe. Ventricles are normal in size and configuration. No evidence of mass effect, midline shift, or herniation. MRI cervical spine:No abnormal enhancement in the vertebral bodies, epidural space, or cervical spinal cord. Multilevel spondylitic changes are seen which were better evaluated on the noncontrast MRI performed on the same day; see separate report for further details. There is asymmetrically enhancing soft tissue at the right lung apex which may reflect posttreatment change and better assessed with chest CT.MRA brain:Atherosclerotic irregularity of the cavernous internal carotid arteries without significant stenosis. There is an intact circle of Willis. Partial fetal morphology of the right posterior cerebral artery. Left dominant vertebrobasilar system with narrowing and irregularity of the distal extracranial right vertebral artery. No significant intracranial aneurysm. No high-grade steno-occlusive disease in the anterior circulation.MRA neck:The carotid artery origins are widely patent. There is mild atherosclerotic irregularity of the right carotid bulb without significant associated stenosis. There is mild narrowing of the left internal carotid artery beginning at the bulb and extending to the more cranial cervical segment. The right vertebral artery is narrowed at its origin with improved caliber in its mid cervical segment. The left vertebral artery is normal in caliber and contour throughout.

Output: 1. Postcontrast images of the brain show no evidence of intracranial metastatic disease. Please refer to separate brain MRI report for additional findings including small infarcts and trace right parietal subdural hematoma.2. Postcontrast images of the cervical spine show no abnormal enhancement in the vertebral bodies, epidural space, cervical spinal cord. Please refer to separate noncontrast cervical spine MRI report for details of multilevel degenerative changes.3. Mild multifocal irregularity involving the nondominant right vertebral and left proximal cervical internal carotid artery likely related to atherosclerotic disease. No high-grade stenosis in the intracranial or extra cranial circulation the neck.


Instruction: Generate impression based on findings.

Input: 76 year old female status-post fall. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity in a periventricular and subcortical white matter distribution is consistent with small vessel disease, age indeterminate. Right frontal encephalomalacia. Left middle carotid artery appears slightly dense which in light of lack of adjacent ischemic changes may simply represent atherosclerotic calcifications, however if, there is clinical concern for acute ischemia, an MRI may be considered. Vascular calcifications affect the cavernous carotid bilaterally.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: Diffuse hypodensity in a periventricular and subcortical white matter distribution consistent with 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: 60-year-old female with history of right flank pain and possible dominant polycystic kidney disease. Study is limited due to lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Multiple nonenhancing small simple cysts, slightly increased in size compared to prior.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts of varying sizes have increased when compared to prior. Some of these cysts contain internal high T1 signal abnormality likely representing a hemorrhagic or proteinaceous component.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small left T12 perineural cyst. Bilateral Tarlov cysts.

Output: Limited exam due to lack of IV contrast. Findings compatible with polycystic kidney disease with enlarging bilateral renal cysts without suspicious features.


Instruction: Generate impression based on findings.

Input: 55 years, Male, Reason: H/O NHL with spinal stenosis and back pain in need of MRI of pelvis. Please compare to prior. History: Back pain, spinal stenoisis, NHL. PELVIS: MalePROSTATE, SEMINAL VESICLES: Bilateral hydroceles.BLADDER: No significant abnormality notedLYMPH NODES: Overall decreased size of multiple pelvic lymph nodes. Reference left external iliac node measures 1.9 x 1.2 cm (9/25), previously 4.1 x 3.0 cm. Reference left femoral node measures 2.1 x 1.5 cm (9/33), previously 3.3 x 2.2 cm. Reference left inguinal node measures 3.4 x 2.9 cm (9/72), previously 5.1 x 4.1 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild edema in the right paraspinal musculature is unchanged.OTHER: No significant abnormality noted

Output: Improved lymphadenopathy.


Instruction: Generate impression based on findings.

Input: The exam is markedly limited due to motion artifact and susceptibility artifact due to braces.BRAIN: The ventricles and sulci are more prominent than expected for the patient's age indicating volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or abnormal intracranial enhancement within the visualized structures. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. The DWI sequence is nondiagnostic due to artifact the SWI are near nondiagnostic.MRA/MRV:Within the limitations described above, the following observations are made. There is no gross stenosis or occlusion within the vertebral arteries, basilar artery and proximal PCAs. The more distal anterior cerebral arteries and visualized A1 branches appear normal. Portions of the M1 segments of the MCAs appear normal but there are areas not visualized secondary to artifact. There is no gross evidence of high-grade stenosis or large aneurysm within these visualized arteries.The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. There is no evidence of venous thrombosis.

Output: 1.Limited MRA due to susceptibility motion artifacts. Within this limitation there is no gross stenosis or occlusion within the visualized arteries. Recommend repeat MRA once braces are removed.2.Normal MRV.3.Limited evaluation of the brain parenchyma is normal without gross evidence of ischemia however, within limitations of nondiagnostic DWI.


Instruction: Generate impression based on findings.

Input: Female, 27 years old. Status post ACL reconstruction, possible medial and lateral meniscectomies in 2004 at OSH. Pain. MENISCI: There is branching signal abnormality within the posterior horn of the medial meniscus extending to both the tibial and femoral articular surfaces, indicating a complex tear. The tear does not appear to fill with fluid, and it is possible that this is a chronic healed tear. There is mild extrusion of the body of the medial meniscus. There is blunting of and abnormal signal within the posterior horn of the lateral meniscus, likely representing a combination of prior surgery and tearing. There is also vertically oriented signal abnormality within the anterior horn of the lateral meniscus extending to the tibial articular surface, indicating a tear of uncertain chronicity.ARTICULAR CARTILAGE AND BONE: There is tricompartmental cartilage degeneration with multiple sites of full thickness degeneration, most notably along the weightbearing portion of the medial femoral condyle. There are multiple sites of subchondral edema that are presumably degenerative.LIGAMENTS: The patient has undergone ACL reconstruction. The graft appears intact, although there is bowing of the intraarticular portion of the graft and increased signal within the anterior fibers which may represent impingement. The PCL is intact. There is thickening of and edema along the proximal fibers of the MCL, which could represent a sprain in the proper clinical context. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Surgical changes of ACL reconstruction with possible impingement of the anterior portion of the graft.2.Medial and lateral meniscal tears and probable postsurgical changes as described above. Please note, we cannot determine the chronicity of these tears.3.Tricompartmental osteoarthritis.4.Possible sprain of the medial collateral ligament.5.Large joint effusion.


Instruction: Generate impression based on findings.

Input: Cervical lymph node enlargement. Neck Mass. CT of the soft tissues of the neck with infusion:Images through the skull base, cavernous sinuses, paranasal sinuses and petrous bones are free of malignancy and unremarkable.Previously noted right tonsillar mass is no longer identified. There is no evidence of any measurable mass. Very minimal soft tissue thickening however still is present.A necrotic right-sided lymph node is again identified. This finding measures 23.5-mm x 21.5-mm (axial image 38 of 82) in transaxial dimension. The measurement of this node on the prior examination was 22.9-mm times 20.9-mm.This node is at the level of the right carotid bifurcation and appears to partially encase right internal carotid artery, right carotid bifurcation and possibly of the proximal right external carotid artery. The overall appearance of this finding (although not typical), its location and relation with carotid and lack of any interval change since prior examination also raises the possibility of a thrombosed carotid aneurysm. Extreme close proximity of this finding with the carotid warrants further evaluation in particular with an MRI.There is no evidence of any new lymphadenopathy.Limited images through the mediastinum are intact.Limited images through the apices of the lungs are unremarkable. 100 cc of Omnipaque 350 was utilized for the above study.

Output: 1.No evidence of a mass in the soft tissues of the neck. Previously noted soft tissue mass in the right tonsil is no longer identified.2.Unusual appearance of the right cervical lymph node with very close proximity and encasement of the carotid as detailed above. This finding demonstrates no interval change since prior study. Its overall unusual appearance, close proximity to the carotid, no appreciable interval change since prior exam warrants further evaluation with an MRI examination to entirely exclude possibility of a vascular abnormality (aneurysm).3.A message was left on Dr. Joyner office number regarding the findings on this patient.


Instruction: Generate impression based on findings.

Input: Female, 20 years old. Dorsal radial wrist pain There is moderate fluid within the radiocarpal joint. A bilobed cystic structure is located dorsally centered on the radiocarpal joint, measuring proximately 6 x 3 x 4 mm (series 501, image 13; series 801, image seven). Additionally some focal intermediate signal along the dorsal aspect of the radiocarpal joint may reflect synovitis.The osseous structures are unremarkable, with normal cortical thickness and marrow signal. The visualized muscles and tendons are normal. The ligaments and triangular fibrocartilage complex are intact.

Output: 1.Small cystic structure centered on the dorsal radiocarpal joint as described above.2.Additional focal intermediate signal within the dorsal radiocarpal joint may reflect synovitis.


Instruction: Generate impression based on findings.

Input: History of BRCA mutation, status post lumpectomy at outside hospital in March 20, 2015 with calcifications near the medial margin, dense breasts, evaluate for residual disease and contralateral breast There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Seroma/hematoma cavity in the left upper outer quadrant posterior depth measures 31 x 16 x 24 mm best seen on the T1-weighted sequence. Area of thick irregular enhancement (measuring 7 mm in thickness) is seen along the anterolateral margin of the seroma cavity which could represent area of fat necrosis versus residual disease.3 lobulated homogeneously enhancing similar morphology masses are identified two in the left breast and one in the right breast as follows:Left breast 1:00 position measuring 8 x 12 x 13 mm (bilobed)Left breast 7:00 position measuring 9 x 7 x 8 mmRight breast 3:00 position measuring 7 x 5 x 6 mm.No abnormal lymph nodes are identified in either axillary region.

Output: 1. Area of irregular thick enhancement along the anterolateral aspect of the seroma cavity could represent area of fat necrosis versus residual disease.2. Three similar most likely benign morphology masses in both breast as described above for which MR directed ultrasound is recommended. If the masses are not seen on ultrasound, six-month follow-up MRI is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 55-year-old male with right index finger pain, concern for collateral ligament disruption. There is increased signal intensity within the proximal fibers of both the medial and lateral collateral ligaments of the proximal interphalangeal joint on the short TE images compatible with injury. However, we see no frank disruption of the ligaments on the T2-weighted images. These findings are most compatible with sprain. There is a small proximal interphalangeal joint effusion. Mild osteoarthritis affects the distal interphalangeal joint. The metacarpophalangeal joint is unremarkable. There is a small amount of fluid within the tendon sheath of the flexor apparatus as it passes under the metacarpal head and volar to the proximal interphalangeal joint, but the tendons otherwise appear normal. We see no findings to suggest pulley disruption. There is a small cyst in the head of the metacarpal, but otherwise the bone marrow signal is within normal limits.Small subchondral cysts are also noted within the interphalangeal and metacarpophalangeal joints of the thumb as well as at the proximal interphalangeal joint of the middle finger.

Output: Sprain of the collateral ligaments of the proximal interphalangeal joint of the index finger without frank disruption, and other findings as above.