Instruction: Generate impression based on findings.

Input: 60-year-old male with known degenerative disc disease presents with arm and leg weakness. Evaluate for cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is multi-level degenerative disc disease with associated narrowing of the central spinal canal, most pronounced at C7-T1. However, there is no evidence of acute cord compression.

Output: 1. No acute cord compression. Please note that this is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. 2. Multi-level degenerative disc disease, most severe at C7-T1.


Instruction: Generate impression based on findings.

Input: Small cell lung cancer, restaging and consideration of prophylactic cranial radiation . There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse cerebral white matter T2 hyperintensity bilaterally. There are also small areas of encephalomalacia in the bilateral cerebellar hemispheres. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The right internal carotid artery aneurysm is better depicted on the prior MRA. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastases.2. Chronic small vessel ischemic white matter disease and chronic bilateral cerebellar hemisphere lacunar infarcts.3. The right internal carotid artery aneurysm is better depicted on the prior MRA. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. 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. The paranasal sinuses and mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions, arteriovenous reformations, or aneurysms are identified. Incidental note is made of a tiny fenestration involving the proximal basilar artery. The right superior cerebellar artery appears diminutive and irregular with time-of-flight technique, however it normally fills with contrast and has a normal appearance on subsequent contrast enhanced neck MRA.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified. There is irregularity of the right subclavian artery distal to the right vertebral artery origin.

Output: 1.Negative MRI of the brain including gadolinium enhancement.2.Negative MRA of the brain.3.There is irregularity of the right subclavian artery distal to the right vertebral artery origin. Dedicated subclavian artery CT angiography is recommended to better characterize this finding, in this location, as well as to assess the adjacent soft tissues for possible impingement.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness, left more than right. Back pain and history of L4-L5 disc herniation. There is also currently suspicion of ALS. At L4-L5, a disc bulge with a right paracentral protrusion mildly narrows the right subarticular recess. The disc bulge and moderate facet arthropathy also result in mild-to-moderate right and mild left neural foraminal stenosis. The right facet arthropathy is associated with minimal fluid and synovial contrast enhancement. There is no significant spinal canal or foraminal stenosis at T12-L1, L1-L2, L2-L3, L3-L4, and L5-S1. The vertebral column alignment is within normal limits. The vertebral bone marrow signal is unremarkable. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is no abnormal spinal cord or nerve root contrast enhancement.

Output: Mild L4-L5 degenerative spondylosis is associated with right paracentral disc protrusion and mild-to-moderate right and mild left neural foraminal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female; 61 years old. Reason: 61 yo with cirrhosis please screen for HCC ABDOMEN:LIVER, BILIARY TRACT: Diffuse nodular surface contour, compatible with cirrhosis. No suspicious hepatic lesions. No biliary ductal dilatation. Hepatic and portal veins are patent.SPLEEN: Splenomegaly. Thin, curvilinear area of increased delayed enhancement at the anteroinferior aspect of the spleen (series 10/52) with no restricted diffusion, suggestive of benign etiology such as scar tissue and similar to prior studies dating back to 9/18/13.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left midpole renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: Stable mild gastrohepatic lymphadenopathy, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of abdominal ascites.

Output: 1.Cirrhotic liver sequela of portal hypertension including splenomegaly and mild ascites. 2.No suspicious hepatic lesion. 3.Probable scar tissue adjacent to the spleen.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. PELVIS:PROSTATE:Prostate Size: 3.4 x 5.1 x 4.7 cmPeripheral Zone: In the left medial base there is a 5 x 5 mm focus of T2 weighted hypointensity (series 901/18) with associated restricted diffusion (series 704/344) and equivocal arterial enhancement suspicious for a site of prostatic adenocarcinoma. No additional suspicious lesion. The peripheral zone is somewhat heterogeneous on T2-weighted imaging.Central Gland: Mild changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extraprostatic tumor extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific left obturator 6 mm lymph node. Nonspecific subcentimeter inguinal lymph nodes. BONES, SOFT TISSUES: Fat containing left greater than right inguinal hernia.OTHER: No significant abnormality noted.

Output: 1.5 x 5 mm focus in the left medial base peripheral zone suspicious for site of prostatic adenocarcinoma. No additional suspicious lesion.2. No evidence of seminal vesicle invasion or extraprostatic tumor extension. Nonspecific 6 mm left obturator lymph node.


Instruction: Generate impression based on findings.

Input: Right hip pain. No improvement with injection. Evaluate for AVN. ACETABULAR LABRUM: There is increased signal intensity within the superior labrum suggestive of a tear.ARTICULAR CARTILAGE AND BONE: There is superior and medial joint space narrowing of the right hip joint. There is near complete loss of the articular cartilage with underlying acetabular reactive edema.Bone marrow signal within the right femur is within normal limits.Metal artifact from a left total hip arthroplasty device obscures visualization of the left hip.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1. Moderate to severe right hip osteoarthritis without evidence of AVN. 2. Probable superior labrum tear.


Instruction: Generate impression based on findings.

Input: Gross hematuria. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in contour and morphology. No biliary ductal dilatation. Cholelithiasis, without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The bilateral kidneys are atrophic and contain multiple simple cysts. No suspicious lesion identified. No filling defect identified within the ureters. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Residual thoracoabdominal aneurysm, incompletely imaged. Status post abdominal aortic aneurysm measuring up to 4.6 cm, with iliac grafts. Persistent occlusion of the internal mesenteric artery.PELVIS:Motion artifact limits evaluation of the pelvis.PROSTATE/SEMINAL VESICLES: The prostate is enlarged measuring 5.5 x 5.2 cm. Canal prosthesis.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Avascular necrosis of the right femoral head.OTHER: Left inguinal inflammatory changes.

Output: 1.No renal or bladder mass identified. No filling defect identified within the ureters. Etiology of hematuria not evident.2.Enlarged prostate.3.Patent iliac grafts. Residual abdominal aortic and thoracoabdominal aortic aneurysms.4.Avascular necrosis of the right femoral head.


Instruction: Generate impression based on findings.

Input: There is mild scoliosis of the thoracic spine, otherwise alignment is within normal limits. There is mild concavity at the superior endplate of T4 vertebral body, likely chronic given lack of edema. Otherwise, the vertebral body and disk heights are well-maintained. The scout image demonstrates endplate degenerative marrow signal changes at L4-L5 level which is better visualized in the prior lumbar spine MRI.There are T1 hypointense foci adjacent to the superior endplate of T8 and T11 vertebral bodies, which demonstrate slightly increased T2 signal and associated enhancement, compatible with recent or developing Schmorl's nodes. No worrisome focal marrow signal abnormalities appreciated. The spinal cord is of normal caliber and signal. There is no pathological intraspinal enhancement .There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Evidence of possible acute Schmorl's nodes adjacent to superior endplates of the T8 and T11 vertebrae, which could potentially account for patient's symptoms.2. Mild concavity of the superior T4 endplate which appears to be chronic in nature. No other significant abnormalities in the thoracic spine.


Instruction: Generate impression based on findings.

Input: 83 year old female status post partial simple mastectomy, stage V chronic kidney disease on dialysis and diabetes, hypertension and anemia. Evaluate for possible CVA. There is no evidence of intracranial hemorrhage, mass or edema. Note is made of bilateral basal ganglia calcifications. Diffuse hyperdensity in the 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.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: Eval GBM. 1 mo post-RT MRI.Signs and Symptoms: GBM.Comments: GBM. 1 mo post RT. | There is an 80 by the 2 mm mm sagittal dimension heterogenously enhancing mass in involving the deep white matter of the right frontal lobe and the adjacent subcortical white matter of the right parietal lobe . This previously measured 61 x 40 mm sagittal dimensions. There is adjacentT2/FLAIR signal hyperintensity compatible with vasogenic edema in an area measuring 118 x 59 mm mm axial dimensions. This previously measured 97 x 62 mm axial dimensions. There are satellite foci of enhancement in the adjacent brain. There is susceptibility effect within the mass. There is T2 signal hyperintensity present in the right midbrain and pons on the current exam which was not clearly present on the prior. There is associated mass effect with approximately 13 mm shift of the midline towards the left on the current exam which was approximately 11 mm on the prior exam. There is associated uncal herniation which was also previously present. There is also associated dilation of the left lateral ventricle associated with subfalcine herniation and there is a mild degree of transtentorial herniation also present.The patient is status post recent right sided craniotomy. There is an underlying subdural collection measuring up to 5mm thickness.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 distal right vertebral artery appears to be hypoplasticThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam the patient's right hemispheric mass consistent with glioblastoma has enlarged and is associated with more mass effect on the current exam versus the prior exam. There is associated uncal, transtentorial and subfalcine herniation present. There appears to be some infiltration into the right upper brainstem on the current exam which was not previously present.2.A right-sided subdural collection is now smaller on the current exam.


Instruction: Generate impression based on findings.

Input: The previously demonstrated focus of restricted diffusion in the left corona radiata has resolved. The focus along the right posterior body of the corpus callosum has decreased in conspicuity. There may be subtle FLAIR hyperintensity in these locations. In addition, there is stable minimal nodularity along the left lateral atrial margin, also without corresponding enhancement or susceptibility (1101/80). Diffusion-weighted images do not demonstrate T2 shine through in this location. There are numerous foci of punctate susceptibility scattered throughout the brain parenchyma, most conspicuous along the right greater than left temporal and right occipital lobes peripherally, which are unchanged indicating prior microscopic hemorrhage.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. Extensive patchy abnormal T2/FLAIR hyperintensity is again seen throughout the periventricular and subcortical white matter, including anterior temporal tips, as well as the brainstem. Evidence of chronic lacunar infarcts are present along the basal ganglia bilaterally. No extra-axial fluid collection is identified.The right vertebral artery flow-void remains absent. Normal flow-voids are otherwise demonstrated in the major intracranial vascular structures. Incidental partially empty sella is again noted. The remainder of the midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening throughout the paranasal sinuses. There is at least moderate narrowing of the upper cervical spinal canal

Output: 1.No evidence of acute infarct. Normalized diffusion restriction in the left corona radiata and reduced diffusion hyperintensity in the right corpus callosum since 10/27/2016. 2.Persistent minimal nodularity along the left lateral atrial margin that demonstrates gray matter signal on all sequences may represent a small area of subependymal heterotopia.3.Redemonstration of extensive white matter disease with multiple areas of prominent chronic lacunar infarct. Findings again may represent advanced small vessel ischemic changes, although other possibilities such as CADASIL remain within the differential.


Instruction: Generate impression based on findings.

Input: Disorientation, unspecified [R41.0] / Other abnormalities of gait and mobility [R26.89], Reason for Study: ^Reason: eval for interval change, ischemic disease, mass, NPH History: loss of time, confusion, gait impairment No evidence of acute ischemic or hemorrhagic lesion on this scan.Patchy confluent FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating likely non specific small vessel ischemic disease are seen with more involved of the left hemisphere comparing to those of the right, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Extensive confluent white matter lesions of bilateral hemispheres (left worse than right) likely indicating non specific small vessel ischemic disease, unchanged since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Known basilar stenosis and right pontine lacunar infarct presenting with headache, vertigo and worsened left sided weakness and slurred speech. There is moderate cerebral white matter T2 hyperintensity bilaterally, particularly in a periventricular distribution. There is also encephalomalacia in the right pons with Wallerian degeneration in the right medulla. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits are grossly unremarkable. The skull appears to be intact. There is a 6 mm thick left temporal scalp lipoma.

Output: Findings suggestive of chronic small vessel ischemic disease and chronic right pons lacunar infarct, but no evidence of acute intracranial hemorrhage, mass, or acute infarct. Please refer to the prior CTA for details regarding the cerebral vasculature.


Instruction: Generate impression based on findings.

Input: Unspecified dementia without behavioral disturbance [F03.90], Reason for Study: ^Reason: small vessel disease extent History: memory changes No evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal scattered FLAIR/T2 high signal intensity lesions involving bilateral periventricular white matter, centrum semiovale as well as pons are seen, indicating nonspecific small vessel ischemic disease.There are localized round susceptibility lesions on the right side centrum semiovale without evidence of surrounding edema or mass effects indicating possible chronic petechial hemorrhage or calcifications on Gradient echo images.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Fluid collection seen on the right side sphenoid sinus.Bilateral lens are not seen indicating postoperative status.

Output: 1. Nonspecific small vessel ischemic disease as described above.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 57 year old man with a history of COPD and newly diagnosed heart failure. He is referred to evaluate etiology. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 21%, the LV end diastolic volume index is 143 ml/m2 (normal range: 74+/-15), the LVEDV is 236 ml (normal range 142+/-34), the LV end systolic volume index is 113 ml/m2 (normal range 25+/-9), the LVESV is 186 ml (normal range 47+/-19), the LV mass index is 79 g/m2 (normal range 85+/-15), and the LV mass is 130 g (normal range 164+/-36). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of myocardial iron overload.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 157 ml (normal range 142+/-31), the RV end systolic volume index is 66 ml/m2 (normal range 31+/-9), and the RVESV is 108 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is proximal esophageal dilation. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with severely reduced systolic function (LVEF 21%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size with moderately reduced systolic function (RVEF 31%).3. At least moderate mitral regurgitation.4. Moderate left atrial dilation.5. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Reason: eval for left hip labral pathology History: left groin pain ACETABULAR LABRUM: There is increased signal intensity within the undersurface of the anterior labrum at approximately the 2 o 'clock position indicating a partial thickness tear. There is mild increased signal intensity within the substance of the posterior labrum suggesting degeneration, but we see no discrete posterior labral tear.ARTICULAR CARTILAGE AND BONE: There is slight prominence of the anterolateral aspect of the femoral head/neck junction suggesting a borderline CAM deformity of approximately 55 degrees. There is a small synovial herniation pit within the anterolateral aspect of the femoral head/neck junction. The articular cartilage appears intact.SOFT TISSUES: The musculature of the hip is normal in appearance. ADDITIONAL

Output: Labral tear as described above.


Instruction: Generate impression based on findings.

Input: Lung cancer. There are a few subcentimeter intrinsically T1 hyperintense lesions at the grey-white matter interfaces of the left frontal and right occipital lobes, which may demonstrate minimal superimposed enhancement and are perhaps slightly larger in size than in February 2016. There is a background of mild nonspecific cerebral white matter T2 hyperintensity. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is a partially imaged hypointense lesion in the C2 vertebra.

Output: 1. Subcentimeter metastases in the left frontal and right occipital lobes are perhaps slightly larger in size than in February 2016. 2. Partially imaged metastasis in the C2 vertebra.


Instruction: Generate impression based on findings.

Input: Reason: right hip pain History: pain Surgical clips overlie the right hip and groin region. We see no cam deformity. The coronal center edge angle is 33 degrees. The anterior center edge angle is 42 degrees. The femoral neck shaft angle is 132 degrees. There is perhaps minimal osteoarthritis of the hip, which otherwise appears normal. There is also perhaps mild osteoarthritis of the left sacroiliac joint and left hip.

Output: Minimal osteoarthritis with measurements as above.


Instruction: Generate impression based on findings.

Input: Female, 4 years old, with stable urinary incontinence. Evaluate for tethered cord. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. There is a normal complement of lumbar vertebral bodies. No pathologic marrow replacement or marrow edema is seen.The distal spinal cord, conus and cauda equina are all within normal limits. The conus tip terminates at the L1 level which is normal. No evidence of a fatty filum terminale or other intraspinal fatty lesion is seen. On prone imaging, there is clear evidence of anterior displacement of the conus and cauda equina.The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is noted.

Output: Unremarkable evaluation with no evidence of tethered cord.


Instruction: Generate impression based on findings.

Input: Left shoulder pain and instability for several months. ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact.SUPRASPINATUS OUTLET: No significant degenerative changes of the acromioclavicular joint. No fluid is present within the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is irregularity of the anterior inferior labrum consistent with a cartilaginous Bankart lesion. The remainder of the labrum appears intact. There are no associated osseous fractures or deformities.BICEPS TENDON: Long head of the biceps tendon appears intact. ADDITIONAL

Output: Cartilaginous Bankart lesion. Rotator cuff is intact.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate left knee for healing, changes, loose body since MRI in 7/15 History: Recurrent left knee pain. MENISCI: The medial and lateral menisci appear intact. ARTICULAR CARTILAGE AND BONE: There is slight lateral translation of the patella relative to the femoral trochlea. There is convexity of the femoral trochlea superiorly indicating dysplasia. Again seen is a full thickness defect of the articular cartilage of the medial facet of the patella, with what appears to be degeneration and delamination of the adjacent articular cartilage as well as superficial defects of the articular cartilage of the lateral facet of the patella. This appears similar or perhaps slightly progressed when compared to the prior study, although the bone marrow edema within the underlying patella has resolved. The tibiofemoral articular cartilage appears intact. We see no bone marrow signal abnormalities. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact. The tibial tuberosity trochlear groove distance is approximately 17 mm, which is borderline abnormal.ADDITIONAL

Output: 1.Femoral trochlear dysplasia with slight lateral translation of the patella. Full thickness cartilage loss along the medial facet of the patella is again noted. Overall, the patellofemoral cartilage degeneration has perhaps progressed slightly when compared to the prior study. Small foci of low signal intensity within the joint anteriorly may represent loose cartilage fragments as suggested on the prior study.


Instruction: Generate impression based on findings.

Input: Other visual disturbances [H53.8], Reason for Study: ^Reason: rule out mets History: rule out mets There is a rim-enhancing nodular intra-axial lesion measured about 5.5 mm on the left anterior-inferior cerebellar hemisphere, the size and signal characteristics do not show any interval change since prior scan performed on October 24, 2015 orbit MRI. This lesion is consistent with metastatic nodule.Redemonstration of a 7 x 14 mm sized left intraorbital enhancing lesion, no change since prior scan.Choroidal detachment and orbital enhancement are again demonstrated, no change since prior scan. However, perirectal soft tissue enhancement appears to be slightly lessened than prior scan.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Retention cyst on the left maxillary sinus.

Output: 1. About 5 mm sized brain enhancing intra-axial lesion on the left inferior anterior aspect of cerebellar hemisphere, consistent with metastatic lesion.2. No interval change of left orbit enhancing lesion with choroidal detachment since prior scan. However, periorbital soft tissue enhancement appear to be slightly lessen since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 46-year-old male with left hip pain with sitting and stairs for many years. Had 1 prior dislocation. There is a linear band of gadolinium that separates the anterosuperior labrum from the underlying acetabulum at approximately the 1 to 3 o'clock position. We see no fluid-filled articular cartilage defects. There is a dysplastic "bump" along the lateral aspect of the femoral head, as seen on prior radiographs, which results in an alpha angle of 65 degrees on MRI, which was previously measured at 70 degrees on prior radiographs. There is also slight prominence along the anterior aspect of the femoral head/neck junction with the borderline alpha angle of 55 degrees. The ligamentum teres appears intact. The sacroiliac joints are within normal limits. A similar morphology affects the right femoral head/neck as seen on the large field-of-view images. The imaged musculature is normal in appearance.

Output: 1. Tear of the left acetabular labrum.2. Mild CAM deformities as described above. Please refer to the CT examination report for additional measurements.


Instruction: Generate impression based on findings.

Input: Possible right L5 herniated disc Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. Low T1 and T2 signal focus at the right S2 level may represent a sclerotic lesion such as bone island. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc desiccation and mild bulge. No significant spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation and mild bulge, eccentric to the left. There is mild narrowing of the neural foramina, left relatively greater than right. There is contact of the extraforaminal left L3 nerve root. No spinal canal stenosis.L4-L5: There is a disc bulge with a central protrusion. There is no significant spinal canal or neural foraminal stenosis.L5-S1: There is a relatively large right paracentral disc protrusion which contacts the descending right S1 nerve root. The neural foramina and central canal remain patent. Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes in the lumbar spine. There is a right paracentral disc protrusion at the L5-S1 level which may be impinging on the right S1 nerve root. Additional levels of degenerative disease as described above.


Instruction: Generate impression based on findings.

Input: Abdominal pain and CVA tenderness. RIGHT KIDNEY: The right kidney measures 8.8 cm with minimal hydronephrosis, similar to prior MRI. No shadowing nephrolithiasis. Minimal perinephric fluid as seen on MRI.LEFT KIDNEY: The left kidney measures 9.7 cm without hydronephrosis or shadowing nephrolithiasis.URINARY BLADDER: Normally distended urinary bladder. A right ureteral jet was noted.OTHER: No significant abnormalities noted.

Output: Minimal right sided hydronephrosis is similar to the prior MRI and may be physiologic given the patient's gravid state. No shadowing nephrolithiasis.


Instruction: Generate impression based on findings.

Input: There are post-surgical findings related to prior lipomyelomeningocele repair and laminectomies of the lower lumbar spine. The vertebral column alignment is unchanged in alignment. There is unchanged minimal anterior wedge deformities of the L1 and L2 vertebral bodies. There is mild to moderate loss of disc height at the T12-L1, L1-2, and L2-3 levels. There are scattered T1 hyperintense foci in the lumbar spine, which are consistent with focal fatty replacement or fat-containing hemangiomas. The vertebral bone marrow signal is otherwise unremarkable. There are multilevel degenerative changes without significant spinal canal stenosis. The conus terminates at the L3-4 level, unchanged from prior study. Redemonstrated is clumping of the cauda equina nerve roots, which appear inseparable from the dorsal aspect of the thecal sac at the lower lumbar levels. Prone imaging demonstrates no significant translation of the spinal cord. There are postoperative changes of the paravertebral soft tissues.

Output: 1. Post-surgical findings related to prior lipomyelomeningocele repair and laminectomies with persistent low lying spinal cord and clumping of the cauda equina nerve roots, which appear inseparable from the dorsal aspect of the thecal sac at the lower lumbar spine, without significant anterior translation of the distal cord on prone imaging, suggestive of arachnoiditis with cord tethering.2. Multilevel degenerative changes of the lumbar spine without significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Recently diagnosed prostate cancer on active surveillanceEvaluate for dominant lesion for biopsy. Biopsy dated 1/21/2016 showed 3+3 vessel 1 mm 5% focus in the right apex. PELVIS:PROSTATE:Prostate Size: 3.3 x 4.9 x 4.3 cmPeripheral Zone: Mild hemorrhage in the left mid gland/apex. 3 mm rounded left mid gland T2 hypointense focus, low ADC signal suggested (see key image, suboptimally assessed secondary to very small size), indeterminate but small neoplastic focus not excluded. Wedge-shaped areas of T2 hypointensity seen medially bilaterally at mid gland and apex (posterior to urethra) nonspecific but favored to be scarring given configuration. Central Gland: BPH, probable BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: Subchondral degenerative femoral cyst formation. Small right fat-containing inguinal hernia.OTHER: No significant abnormality noted.

Output: 3 mm left mid gland T2 hypointense rounded focus, low ADC signal suggested, indeterminate but tiny neoplastic focus not excluded. Wedge-shaped areas of T2 hypointensity seen medially bilaterally at mid gland and apex (posterior to urethra) nonspecific but favored to be scarring given configuration. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female; 61 years old. Reason: Hx of IPMN on MRCP with recommended f/u q2 yrs. Evaluate for changes or progression History: H/O pancreatic IPMN ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter hepatic cysts. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Redemonstration of a round, well marginated, T2 hyperintense lesion in the pancreatic tail which communicates with the main pancreatic duct and measures 1.0 x 0.8 cm (series 3/15), previously measured 1.0 x 0.8 cm. No mural nodularity or significant enhancement. No main pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral renal cysts. Retroaortic left renal vein, normal anatomic variant.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Stable lower pulmonary nodule measuring approximately 11 mm, unchanged. Additional bilateral small pulmonary nodules in the partially visualized lung bases, similar prior exam.

Output: 1. Stable pancreatic tail branch type IPMN. No main pancreatic ductal dilatation.2. Bilateral pulmonary nodules, similar to the prior study.


Instruction: Generate impression based on findings.

Input: Fetal congenital cystic adenomatoid malformation. PELVIS:UTERUS, ADNEXA: Gravid uterus with one fetus in vertex position facing posteriorly. The placenta is along the posterior fundus and body of the endometrial canal. No evidence of placenta previa or accreta. The cervix appears closed. Normal volume amniotic fluid.The neural axis is unremarkable.The heart apex and stomach are left-sided. Note is made of several cyst like structures in the left lung base with the largest measuring 1.5 x 1.0 cm and 1.1 x 0.8 cm. No obvious communication between the cystic structures is demonstrable. The extent of the subtle signal abnormality associated with these larger cysts measures approximately 4.1 x 2.6 cm in the sagittal plane (series 1 301/15) and approximately 3.3 x 2.9 cm in the coronal plane (series 1 101/12). No findings to suggest an intralobular sequestration such as vascular supply from the systemic circulation. The diaphragm appears intact.Unremarkable kidneys bladder bowel liver gallbladder and spleen. 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: Findings compatible with stated history of congenital pulmonary adenomatoid malformation with several macrocystic components visualized on MRI. The extent of the left lower lobe signal abnormality measures approximately 4.1 x 2.6 cm which includes the smaller cystic components. No specific findings to suggest a hybrid/combined-type CCAM and intralobar sequestration lesion.No additional fetal abnormality is identified.


Instruction: Generate impression based on findings.

Input: 39-year-old female patient with intermittent left-sided perianal drainage with mucus and blood. Please evaluate for fistula or abscess. PELVIS:UTERUS, ADNEXA: The patient is status post hysterectomy and bilateral oophorectomy. There is a fluid collection adjacent to the vagina in the left hemipelvis that measures approximately 9.6 cm in craniocaudal dimension without peripheral enhancement.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There are no fistulous tracts or fluid collections in the perianal region.OTHER: No significant abnormality noted.

Output: 1.No fistulous tracts or evidence of perianal abscess.2.Fluid collection in the left hemipelvis adjacent to the hysterectomy surgical bed most likely represents a lymphocele.


Instruction: Generate impression based on findings.

Input: Increased seizure frequency, catatonia, question of limbic encephalitis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The mesial temporal lobes are symmetric without evidence of signal abnormality. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral maxillary mucosal retention cysts. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: No stigmata of limbic encephalitis or evidence of potential seizure foci.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 24-year-old female with seizure, prior abnormal MRI and CT, evaluate for HIV encephalopathy, PML, or other. Several sequences are motion degraded. Given this caveat:Redemonstrated is bihemispheric T2 hyperintensity within the white matter and to a lesser extent basal ganglia and infratentorial structures. Globally, there has been overall reduction in the degree of T2 hyperintense abnormality, although this includes regions of improvement, regions of progression, and new signal foci in the other areas. For example the confluent nature of the centrum semiovale has significantly improved, and hyperintense abnormality within the basal ganglia remains significantly improved when compared to the older MRI of 10/11/2015. The previously noted more conspicuous rounded hypodense foci on the most recent CT correlates with a small focus of residual T2 hypointensity that has remained in a prior region of confluent abnormality. However, T2 hyperintensity has progressed within bilateral subinsular white matter. Additionally, T2 hyperintensity within the cerebellum is less conspicuous, however more confluent.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Scattered foci of mucosal thickening can be found throughout the paranasal sinuses without superimposed fluid levels. Mastoid air cells remain clear.

Output: Redemonstrated is bihemispheric T2 hyperintensity within the white matter and to a lesser extent basal ganglia and infratentorial structures. Globally, there has been overall reduction in the degree of T2 hyperintense abnormality, although this includes regions of improvement, regions of progression, and new signal foci in the other areas. Given the asymmetry, PML is considered most likely. CMV infection can also present involving the white matter with asymmetry. Primary HIV encephalopathy most often represents in a symmetric faction and thus is considered less likely.


Instruction: Generate impression based on findings.

Input: Myelopathic symptoms. The spinal canal appears to be congenitally narrow throughout. There is superimposed multilevel degenerative spondylosis. At C3-4, there is a posterior disc-osteophyte complex and uncovertebral joint hypertrophy bilaterally, which results in considerable compression of the spinal cord and severe bilateral neural foraminal narrowing. There is perhaps a punctate focus of T2 hypertensity in the spinal cord at this level. At C4-5, there is a posterior disc-osteophyte complex and uncovertebral and facet joint hypertrophy bilaterally, which results in slight compression of the spinal cord and severe bilateral neural foraminal narrowing. At C5-6, there is a small posterior disc-osteophyte complex that nearly abuts the spinal cord. However, uncovertebral and facet joint hypertrophy bilaterally, results in severe bilateral neural foraminal narrowing at this level. At C6-7, there is a small posterior disc-osteophyte complex that nearly abuts the spinal cord. However, uncovertebral and facet joint hypertrophy bilaterally results in severe bilateral neural foraminal narrowing at this level. A C7-T1, there is uncovertebral and facet joint hypertrophy bilaterally that results in mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. At T1-T2, there is a posterior disc-osteophyte complex that results in severe right and mild left neural foraminal stenosis. At C2-3, there is no significant spinal canal or neural foraminal stenosis. There is irregularity of the superior and inferior endplates of C5 and C6. The other vertebral body heights are intact. Aside from degenerative signal alterations are multiple levels, the vertebral bone marrow appears unremarkable. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative spondylosis, with spinal cord compression at C3-4 and C4-5.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with painful mass on the right side of the thoracic spine at approximately the T4 level. Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are normal. No evidence of marrow replacement or marrow edema is detected. No pathologic marrow enhancement is seen.The visualized spinal cord is normal in both signal intensity and morphology. No intraspinal lesions are seen. No pathologic intracanalicular enhancement is detected.The intervertebral disks are within normal limits. No significant spinal canal or neuroforaminal stenosis is suspected.Please note that this examination is tailored for the assessment of the thoracic spine and immediate paraspinal tissues. The anterior and lateral chest wall regions, including the scapulae, are not included within the field of view.The right lobe of the thyroid is diffusely enlarged and somewhat heterogeneous as visualized partially on the T1-weighted images.

Output: 1. No spinal or immediate paraspinal abnormality is seen which would account for the patient's symptoms.2. Please note that the anterior and lateral chest wall regions including the scapulae are not included within the field of view of this examination. If these areas require imaging assessment, consultation with chest or musculoskeletal radiology is suggested for guidance as to the most appropriate examination.3. Incidental note is made of a large and heterogeneous right thyroid lobe. If this has not been previously assessed, a dedicated thyroid ultrasound should be performed.


Instruction: Generate impression based on findings.

Input: Reason: RLE calf pain > 1 yr, eval for gastroc tear vs myopathy The osseous alignment is within normal limits. There is no evidence of acute fracture. There is no abnormal bone marrow signal. The muscles appear within normal limits. The Achilles tendon appears intact.

Output: Normal examination without evidence of myopathy or gastrocnemius tear.


Instruction: Generate impression based on findings.

Input: 61-year-old female with follicular lymphoma MRI brain:Again seen is a right transfrontal ventriculostomy/Ommaya catheter terminating in the right frontal horn laterally. There is a 15x24 mm focus of CSF intensity collection surrounding the catheter with extensive surrounding vasogenic edema, appearing similar in extent to recent CT study. This results in effacement of the adjacent cortical sulci and mild mass effect on the right frontal horn and mild midline shift to the left similar to prior study. The ventricular system caliber is not significantly changed from prior study, with transverse diameter of the left frontal horn of the lateral ventricle measuring 12 mm in caliber, unchanged, and the transverse diameter of the anterior third ventricle measuring approximately 10 mm, also unchanged. No evidence of infarct. No intracranial hemorrhage is identified. There is nonsuppression of CSF involving the bilateral frontoparietal sulci on the FLAIR sequence. No intracranial mass or mass effect. 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.Left maxillary mucous retention cyst. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The images are degraded by motion artifact. No intraconal or extraconal space mass is identified. The globes and extraocular muscles are intact. Evidence of left lens replacement.Cervical spine:Marked suboptimal evaluation of the cervical spine due to motion artifact. Within these limitations there is no obvious mass effect or compression of the spinal cord. No cord signal abnormality. Minimal degenerative changes are seen without significant spinal canal stenosis.

Output: 1. Please note examination is limited due to absence of intravenous contrast and limited sequences obtained of the brain, orbits, and cervical spine. Patient could not tolerate further imaging and examination was terminated prematurely. 2. No obvious intracranial mass or diffusion abnormality to suggest lymphoma. There is nonsuppression of CSF on the FLAIR sequence involving the bilateral frontoparietal sulci which may be artifactual, but can be seen with leptomeningeal disease; postcontrast sequences would be helpful for differentiation. Again seen is 15x24 mm CSF collection surrounding the Ommaya catheter with extensive surrounding vasogenic edema and associated mass effect, similar to recent CT from 5/30/15. 3. No obvious orbital mass or cervical cord signal abnormality on the limited sequences.


Instruction: Generate impression based on findings.

Input: Patient is a 31-year-old female with BRCA mutation and a strong family history of breast cancer. No current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Marked parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Multiple cysts are noted in the breasts. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of metastatic rectal carcinoid on octreotide and status post Y90 embolization in 2011. Evaluate for disease. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent inguinal lymph nodes are noted.BOWEL, MESENTERY: No evidence of enhancing lesions within the rectum and visualized colon to suggest disease recurrence.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of enhancing lesions within the rectum or the visualized colon to suggest disease recurrence.


Instruction: Generate impression based on findings.

Input: Follow-up surveillance evaluation. History of pituitary adenoma status post resection x 2. Again seen are postoperative changes related to prior pituitary tumor resections. There is stable to minimal enlargement of the residual pituitary adenoma involving the right aspect of the sella, for example measuring up to 16 mm in the transverse dimension and 10 mm in the craniocaudal dimension, coronal T2 image 10, previously 15 x 9 mm re-measured similarly. AP dimension of approximately 12 mm is not significantly changed. Diminished central hypoenhancement involving the mass is again seen and likely reflective of prior treatment. The optic chiasm is tented downward with the infundibulum rightward deviated, as seen before and consistent with postoperative change. Thinning of the optic chiasm is again demonstrated. No mass effect on the optic chiasm is present. The mass abuts the right aspect of the cavernous sinus without clear evidence of invasion.Partially imaged brain demonstrates scattered foci of T2 hyperintensity involving the periventricular and subcortical white matter grossly similar to prior and compatible with small vessel ischemic changes. No evidence of intracranial mass effect, midline shift, or hydrocephalus.

Output: Stable to minimal increase in size of the residual pituitary adenoma compared to 4/15/2015 involving the right aspect of the sella with measurements as above. No mass effect on the optic chiasm.


Instruction: Generate impression based on findings.

Input: Mid and low back pain now with saddle anesthesia. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are scattered focal fatty deposits in the vertebral bone marrow. There is also a subcentimeter area of high T2 signal in the T3 vertebral body. There are mild posterior disc-osteophyte complexes at C7-T1 and T8-9. In addition, there are minimal; disc bulges at L3-4 and L4-5 without significant neural foraminal stenosis. There is also a disc bulge at L5-S1 and facet hypertrophy with mild left and moderate right neural foraminal stenosis. However, there is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of spinal cord or cauda equina compression.2. A disc bulge at L5-S1 and facet hypertrophy is associated with mild left and moderate right neural foraminal stenosis.3. A subcentimeter area of high T2 signal in the T3 vertebral body is nonspecific, but may represent an atypical hemangioma, for example. Nevertheless, follow up via MRI with contrast may be useful.


Instruction: Generate impression based on findings.

Input: Female, 78 years old, status post right frontal craniotomy for tumor resection. Postoperative findings are seen consistent with right frontal craniotomy. Presumed packing material is evident within the frontal sinus and the underlying epidural space. A resection cavity is evident in the paramedian right frontal lobe containing a fluid-heme level. A majority of the previously demonstrated enhancing tumor has been resected. Residual enhancing tissue persists along the posterior cavity margin where it abuts the basal ganglia and ventricular margin.Restricted diffusion is seen surrounding the resection cavity including relatively thick diffusion restriction in the bilateral paramedian frontal lobes and wedgelike restriction in the right caudate head. T2 hyperintensity filling the right frontal lobe extending into the basal ganglia and insula appears similar to the preoperative study. The genu of the corpus callosum remains thickened with abnormal signal extending across midline to the left.Generalized mass effect is slightly improved though the right lateral ventricle remains effaced. Dilatation of the left lateral ventricle has slightly improved. The fourth ventricle is within normal limits. No new enhancing lesions are seen.

Output: Postoperative findings are seen compatible with near complete resection of the enhancing component of a right frontal lobe tumor. A small amount of residual enhancing tumor is suspected along the posterior surgical cavity. Restricted diffusion surrounding the cavity and within the right caudate head is suspected to represent a combination of postoperative cytotoxic edema and ischemic injury. Vasogenic edema in the right frontal lobe is grossly unchanged.


Instruction: Generate impression based on findings.

Input: Male 74 years old, evaluate left temporal lesion, episode of gait unsteadiness (resolved), small hyperdensity on CT Motion degrades sensitivity.There is redemonstration of a small left temporal lobe lesion with punctate central enhancement and mixed T2 signal measuring up to 7 mm (1701/156). The lesion demonstrates blooming on SWI with a complete peripheral T2 hypointense hemosiderin rim. No associated surrounding FLAIR hyperintensity or mass effect noted. An asymmetric branching area of susceptibility/enhancement posterior medially adjacent to the lesion is consistent with a developmental venous anomaly as seen on prior CTA dated 6/5/2016. Otherwise, the surrounding brain parenchyma demonstrates normal signal. Prominent curvilinear area of increased susceptibility (1001/91) along the left occipital sulci without an associated asymmetric vessel prominence on postcontrast images. There is no associated parenchymal abnormality. There are no other foci of abnormal susceptibility identified.Patchy areas of increased T2/FLAIR signal most prominent in the periventricular and subcortical areas suggestive of chronic white matter small vessel ischemic disease.There is no 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. Minimal fluid is present in the right mastoids. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Left temporal lobe cavernous malformation with associated developmental venous anomaly, consistent with findings noted on CTA dated 6/5/2016. No other cavernous malformations identified.2. Curvilinear area of increased susceptibility in left occipital sulcus without correlating asymmetric vessel prominence on postcontrast images, although images are limited by patient motion. Findings may represent the remote possibility of small thrombosed vessel, or could in part be artifactual. No associated parenchymal abnormality.


Instruction: Generate impression based on findings.

Input: Progression of multiple sclerosis symptoms. There is a punctate focus of nonspecific T2 hyperintensity in the right frontal lobe centrum semiovale. There is a small left frontal lobe white matter developmental anomaly. Otherwise, there is no abnormal intracranial enhancement. There is no evidence of intracranial mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst. There is a subcentimeter left adenoidal probable retention cyst as well.

Output: Minimal nonspecific cerebral white matter T2 hyperintensity.


Instruction: Generate impression based on findings.

Input: 48-year-old with history of BRCA1 carrier. History of benign left breast MRI guided biopsy in September 2012. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: increasing weakness RLE History: increasing weakness RLE There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12 level.The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Incidental finding of the left renal cyst (about 20mm in diameter).Degenerative changes are specified by the intervertebral level as follows: T11-T12: There is broad based disc protrusion toward right side neural foramen which results moderate to severe neural foraminal stenosis.T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Mild disc desiccation. Diffuse bulging of disc with bilateral ligamentum flavum thickening causing minimal spinal canal stenosis. Broad-based disc bulging toward left side neural foramen causing minimal neural foraminal stenosis on the left side. L4-L5: Disc desiccation. Diffuse bulging of disc with bilateral ligamentum flavum thickening causing mild to moderate spinal stenosis. L5-S1: Disc desiccation. Diffuse bulging of disc causing minimal spinal canal stenosis.

Output: 1. Spinal cord signal intensity is normal.2. Degenerative changes of lumbar discs. In particular, there is a broad-based disc protrusion toward the right side neural foramen at the level of T11-12.3. Degenerative various degree spinal canal stenosis at the level of L34, L45 and L5S1.


Instruction: Generate impression based on findings.

Input: 61-year-old male with h/o glioblastoma presents with weakness. Evaluate for intracranial bleed. There is no evidence of intracranial hemorrhage, mass, or edema. Post-surgical changes of a right-sided craniotomy and right temporal resection with encephalomalacia are similar to prior. Extensive confluent hypoattenuation involving primarily the white matter of the right cerebral hemisphere is similar to prior. Based on recent MRI findings, this is compatible with post-radiation changes.Hypoattenuating lesions in the left thalamus is seen on prior MRI and is compatible with lacunar infarct. It demonstrates increased hypodensity, compatible with expected evolutional changes. 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: No acute intracranial hemorrhage. Evolutionary change of lacunar infarct at left thalamus. Post-surgical and post-treatment changes similar to prior.


Instruction: Generate impression based on findings.

Input: History of stroke now presenting with left-sided hyperreflexia. Motion artifact mildly degrades the postcontrast images.Brain:Scattered small foci of increased T2 signal in the periventricular and subcortical white matter compatible with chronic small vessel ischemic disease. No acute ischemia. No abnormal enhancement is identified postcontrast images.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.Cervical spine:There is mild loss of vertebral body height involving multiple cervical vertebrae most notably at the C5 level where there is mild wedging deformity. Heterogeneous marrow signal is nonspecific and at least in part related to reactive endplate marrow changes. There is exaggeration of the cervical lordosis at C6-7 associated with minimal retrolisthesis of C6 on C7. There is loss of intervertebral disc signal throughout the visualized cervical spine compatible with desiccation. There is marked loss of intervertebral disc height from C4 to C6 and T2-T4. The visualized spinal cord is normal in signal and morphology throughout.Level by level findings are as follows:C2-C3: Mild disc osteophyte complex and hypertrophy of the ligamentum flavum. No significant spinal canal or neural foraminal narrowing.C3-C4: No disc bulge. Uncovertebral hypertrophy creates minimal right neural foraminal stenosis. No significant spinal canal or left neural foraminal stenosis.C4-C5: Small disc osteophyte complex. Minimal left neural foraminal narrowing. No significant spinal canal stenosis or right neuroforaminal narrowing.C5-C6: Small disc osteophyte complex and hypertrophy of the ligamentum flavum create minimal spinal canal stenosis. Moderate right and mild left neural foraminal stenosis.C6-C7: Moderate central disc osteophyte complex and prominent hypertrophy of the ligamentum flavum create a moderate spinal canal stenosis. Moderate to severe left neural foraminal stenosis. Mild right neural foraminal stenosis.C7-T1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.

Output: 1. Mild chronic small vessel ischemic changes in the brain.2. Multilevel spondylitic changes in the cervical spine which are most severe at C6-7 where there is moderate spinal canal stenosis and moderate to severe left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: History of primary sclerosing cholangitis/IPMN. Evaluate for cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Unchanged irregular beaded appearance of the intra- and extra- hepatic bile ducts, with stricturing at the common hepatic duct, proximal right and left hepatic ducts and the proximal common bile duct. Mild biliary dilatation is unchanged. No suspicious hepatic lesion is identified. Stable punctate segment 7 hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: Stable punctate cystic lesions are better identified on prior MRI, probable sidebranch IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unchanged multifocal biliary strictures compatible with history of primary sclerosing cholangitis, with no suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: Vision loss, evaluate left clinoid meningioma Again seen are postsurgical changes of left frontotemporal craniotomy for resection of previously seen extra-axial enhancing lesion in the left paraclinoid region. There is T2/FLAIR hyperintensity involving the left frontal lobe adjacent to the craniotomy which may represent retraction edema. There is also T2/FLAIR hyperintensity involving the posterior aspect of the left gyrus rectus and medial orbital gyrus compatible with edema in the surgical bed. No restricted diffusion to suggest infarct. There is linear enhancement at these sites. No discrete enhancing mass is evident to suggest residual tumor. Expected postsurgical changes include small amount of pneumocephalus and small extra-axial collection along the bilateral frontal and left anterior temporal convexity. Small intraventricular blood products in the right occipital horn also noted. Remainder of the brain demonstrates multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. No hydrocephalus. No evidence of mass effect, midline shift, or herniation. Major flow-voids are preserved. Evidence of bilateral intraocular lens replacement.

Output: Expected postoperative changes related to meningioma resection without evidence of residual tumor. There is focal edema involving the posterior aspect of the left gyrus rectus and medial orbital gyrus in the surgical bed. Focal edema is also noted along the surface of the left frontal lobe beneath the craniotomy which may be related to retraction. No large hemorrhage or new mass effect is appreciated. Please note if there are new visual symptoms and evaluation of the optic nerves is desired, suggest dedicated MRI orbit study.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: The intracranial internal carotid arteries demonstrate no signficant 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. No evidence of aneurysms or vascular malformations.MRV head: The dural venous sinuses and deep venous structures demonstrate normal flow related signal. No evidence of venous sinus thrombosis is seen.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Perirectal abscess ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left perirectal abscess measuring 2.6 x 2.5 cm. The abscess extends into the left ischiorectal fossae no fistula is to the skin intergluteal region. The size of the abscess in the is pararectal fossa is 4.5 x 2 cm. Inflammatory changes and possible fistulous tracts is also likely present on the right side. Further evaluation with pelvic MRI may be helpful for better depiction of the abscess and fistula tracts.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Left pararectal and ischiorectal abscess and fistula. Right perirectal inflammation. Further evaluation with a pelvic MR is recommended for better depiction of the fistula tracts.


Instruction: Generate impression based on findings.

Input: Adrenal mass seen on the prior CT. History of sweating, anxiety, hypertension. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal enlargement measuring 4.2 x 3.9 cm. This enlargement is predominantly cystic with internal fluid-fluid compatible with hemorrhage. The thin rim of adrenal tissue does not enhance suspiciously or have an associated soft tissue nodule/mass evident.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Punctate focus of diffusion restriction in the right psoas, partly imaged, likely represents a neurofibroma.OTHER: No significant abnormality noted otherwise.

Output: Left adrenal hemorrhage, without adrenal mass identified. A follow-up MRI in 3-6 months is recommended to assess for an underlying mass as a potential etiology for hemorrhage.


Instruction: Generate impression based on findings.

Input: 72-year-old female. Pain and weakness. Evaluate for rotator cuff tear. Images are somewhat degraded by motion artifact.ROTATOR CUFF: Slight increase in mild tendinosis of the infraspinatus and supraspinatus with a small subchondral cyst in the underlying humeral head. No discrete rotator cuff tear is evident. The supraspinatus, subscapularis, infraspinatus and teres minor muscles are intact.SUPRASPINATUS OUTLET: Trace fluid in the subacromial/subdeltoid bursa. Mild AC joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The glenoid labrum is grossly unremarkable within limitations of this non-arthrographic study.BICEPS TENDON: Postsurgical findings of biceps tenodesis with an orthopedic screw in the proximal humeral diaphysis. ADDITIONAL

Output: Supraspinatus and infraspinatus mild tendinopathy without a discrete tear.


Instruction: Generate impression based on findings.

Input: Leg pain, spinal stenosis, multilevel disc disease. Compare with prior. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There appears to be some levoscoliosis at the lower lumbar level which can be better assessed with standing radiographs. No significant spondylolisthesis. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T12-L1: Mild disc bulge and loss of disc height similar to prior. No significant spinal canal or neural foraminal stenosis.L1-L2: Loss of disc height and minimal bulge similar to prior. There is also mild facet arthropathy. No significant spinal canal or neural foraminal stenosis.L2-L3: There is loss of disc height, ligamentum flavum thickening, and bilateral facet arthropathy. There is also prominence of the dorsal epidural fat. There is moderate to severe spinal canal stenosis at this level which is slightly worse than prior. There is effacement of the right lateral recesses, right worse in left. There is moderate right neural foraminal stenosis which is worse. There is no significant left neural foraminal stenosis.L3-L4: There is disc bulge, and bilateral facet arthropathy resulting in mild spinal canal stenosis at this level which is slightly worse. There is mild to moderate right and mild left neural foraminal stenosis similar to prior.L4-L5: There is progression of disc height loss at this level as well as left greater than right facet arthropathy and ligamentum flavum thickening which have progressed resulting in moderate central canal stenosis, particularly involving the left aspect of the thecal sac. There is also effacement of the left lateral recess which appears slightly worse. There is severe left and mild to moderate right neural foraminal stenosis stable to minimally progressed on the left since prior. There is evidence of prior right-sided laminotomy.L5-S1: Tiny central disc protrusion similar to prior. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.Bilateral renal cysts again seen.

Output: Advanced degenerative changes in the lumbar spine with significant spinal canal stenosis at the L2-L3 and L4-L5 levels which has mildly worsened since 10/25/2011. There is also multilevel neural foraminal stenosis, worst at the right L2-L3 and left L4-L5 levels. Please see details above.


Instruction: Generate impression based on findings.

Input: Left hip pain Note that the patient terminated the exam prematurely and only coronal T1, coronal STIR, and axial T1 sequences were obtained.Within the limits of the exam, the marrow signal of the left hip is normal. The surrounding musculature of the left hip and pelvis is normal in caliber and signal.

Output: Limited examination demonstrates no obvious marrow or soft tissue abnormality of the left hip.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: eval GBM on Avastin+CCNU. History: GBM. Brain MRIThere again is the right frontal intra axial mass which shows mixed signal intensity on T2 and minimal peripheral enhancement. Previously the size of the lesion on T2 coronal scan was 18.6mm x 34mm and on axial scan it was 25.8mm x 33.4mm. Today, the corresponding scan showed increased in size since prior scan, the measured size were 25.5mm x 38.9mm on T2 coronal scan and 28.7mm x 31.7mm. The pattern of enhancement of the lesion appears to be slightly lessen especially on the lateral aspect of the mass, but overall it does not show significant interval change since prior scan.The extent of surrounding edema also does not show any significant interval change.No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.MR perfusionThere is focal increased rCBV and rCBF on the anterior superior aspect of the intra axial mass indicating active tumor burden or increased angiogenectic activity. Corresponding brain MRI shows focal enhancement which again support the evidence of active tumor.

Output: Interval increase size of the right frontal lesion with increased perfusion indicating interval progression of the tumor. There is no other lesion seen.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Neck pain, right arm tingles, has MS. There are few small T2 hyperintense lesions involving the cervical cord including the left lateral aspect of the cervicomedullary junction, right dorsolateral C2-C3 level, right dorsolateral C3-C4 level, as well as one at the left lateral C5-C6 level which is also associated with some volume loss. No large lesions are demonstrated. The above lesions are best seen on the axial T2* smFFE as well as proton density sequences. Vertebral body heights are normal. There is mild loss of cervical lordosis. Mild degenerative changes are seen including small central protrusion at the C3-C4 level and a small disc bulge at the C5-C6 level. There is no significant spinal canal stenosis at any level. The cervical neural foramina are also patent.

Output: Multiple small lesions are suspected in the cervical cord as described above and compatible with demyelinating plaques. No lesions with enhancement.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with memory loss, consent for history of strokes. Signs and symptoms: As above. Nonenhanced brain MRI:Negative diffusion-weighted images.There are several small foci of FLAIR and T2 hyperintensity in the periventricular and subcortical white matter of cerebral hemispheres and minimally in the left basal ganglia as well as pons which considering patient's stated age of 83 likely representing chronic microvascular ischemic changes without evidence of hemorrhagic changes.The cerebral cortex as well as cortical sulci and ventricular systems remain within normal for stated age and with maintained midline.Signal void of major intracranial arterial branches are identified. The signal intensity of the intracranial venous sinuses are unremarkable.Unremarkable calvarium, orbits and mastoid air cells. Extensive left maxillary chronic sinus disease and unremarkable paranasal sinuses otherwise.

Output: 1.No acute intracranial process.2.Mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter and minimally of the left basal ganglia and pons.3.Unremarkable brain MRI otherwise for stated age.4.Left maxillary sinusitis and unremarkable other paranasal sinuses


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for herniated disc or spinal stenosis. Signs and symptoms: Worsening sciatica. Nonenhanced lumbar MRI:Examination demonstrates moderate to advanced degenerative disc disease of the lumbar spine with resultant mild reversal of lumbar lordosis.The signal intensity of vertebral column demonstrate changes secondary to degenerative disease and unremarkable otherwise.The alignment of vertebral column remains anatomical.Limited view of the lower thoracic spine demonstrate moderate left neural foraminal compromise due to DJD at T11-T12 and no central spinal stenosis.T12-L1 is unremarkable.L1-L2 demonstrate moderate disc disease and loss of disc height, asymmetric (left greater than right) bulging disc with resultant subtle mass effect on the thecal sac is noted. No spinal stenosis or neural foraminal compromise.L2-L3 demonstrate advanced disc disease with significant loss of disc height, moderate bilateral ligamentum flavum and mild facet hypertrophic changes are present. Shallow broad-based bulging disc is also noted. There is resultant mild central spinal stenosis and moderate right neural foraminal compromise.L3-L4 demonstrate advanced disc disease and loss of disc height, diffuse bulging disc more prominent on the right is noted. There is also moderate bilateral ligamentum flavum and mild bilateral facet hypertrophic changes present. Mild central spinal stenosis and significant right and moderate left neural foraminal compromise is noted.L4-L5 demonstrate advanced disc disease and loss of disc height, broad-based bulging disc more prominent on the left, moderate bilateral ligamentum flavum and moderate left facet and mild right facet hypertrophy changes are present. There is no convincing evidence of central spinal stenosis however significant left neural foraminal and left lateral recess compromise is noted.L5-S1 demonstrate mild disc disease and moderate bilateral ligamentum flavum and mild facet hypertrophic changes without central spinal stenosis. Mild bilateral neural foraminal compromise is however present.

Output: 1.Extensive degenerative changes of lumbar spine with a slightly alternative pattern of degree of degenerative changes likely secondary to mild scoliosis as detailed.2.There is mild central spinal stenosis at L2-L3 and L3-L4 levels as detailed.3.There are multilevel neural foraminal and lateral recess compromise (some significantly) as detailed per level above.4.Lower most visualized thoracic spine demonstrate asymmetric left-sided facet hypertrophic changes with resultant significant left neural foraminal compromise at T11-T12 level and no central spinal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: right shoulder pain History: right shoulder pain ROTATOR CUFF: There is a full-thickness near-complete/complete tear of the supraspinous tendon with retraction of fibers to the level of the glenohumeral joint. A few anterior fibers may extend to the greater tuberosity, but this is equivocal. There appears to be mild loss of supraspinatus muscle volume. There is also a complete tear of the infraspinatus tendon with similar retraction as well as moderate fatty atrophy of the infraspinatus muscle. There is moderate fatty atrophy of the teres minor muscle, although the tendon appears to extend to its insertion on the greater tuberosity. Mild thickening of the distal subscapularis tendon suggests tendinosis with a small linear undersurface tear of its superior fibers. The subscapularis muscle appears intact.SUPRASPINATUS OUTLET: Mild osteoarthritis of the acromioclavicular joint, with hypertrophy of the distal end of the clavicle. There is a small amount of fluid in the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding with slight posterior translation relative to the glenoid. There is subchondral cyst formation in the posterior aspect of the glenoid. Intermediate signal intensity and fluid undercuts the anterior labrum, suggesting a partial tear. There is attenuation of the posterior superior labrum, suggesting a tear. A small collection of fluid signal intensity along the posterior glenoid scapula neck may represent a paralabral cyst. There are a few ossicles within the superior aspect of the glenohumeral joint, suggestive of loose bodies, perhaps attached to the distal end of the torn rotator cuff.BICEPS TENDON: There is mild increased signal intensity within the tendon of the long head of the biceps at its transition from the rotator interval to the intertubercular groove.

Output: Full-thickness retracted rotator cuff tear and other findings as described above.


Instruction: Generate impression based on findings.

Input: 65 year old with biopsy proven DCIS at two sites of lower outer quadrant in the right breast, presents for staging MRI. There is also a biopsy proven fibroadenoma in the right breat. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.RIGHT BREAST: There is a clip artifact at anterior 9:00 position at the site of recent fibroadenoma biopsy, and there are two clip artifacts at posterior 8:00 position, each from DCIS biopsy, in the right breast. Distance between these two clips at posterior 8:00 position is 15 mm.There is 15 mm slowly enhancing area around the clip artifact at anterior 9:00 position, at the site of proven fibroadenoma. This enhancement is likely post-biopsy changes.At the site of proven DCIS, there are only small post-biopsy seromas (less than 5 mm), without abnormal enhancement.A normal intramammary lymph node is present in the right lower outer quadrant.Elsewhere, there is no abnormal enhancing lesions.LEFT BREAST:No abnormal enhancement is seen in left breast. AXILLAE:No abnormal lymph nodes are identified in either axillary region.

Output: Biopsy proven DCIS in the right breast at lower outer quadrant (2 sites). Only minimal post-biopsy changes are seen at the site of proven malignancy in the right breast. No MR evidence of malignancy in the left breast or either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 29-year-old female with biopsy proven invasive ductal carcinoma at 2 sites in the left breast. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.LEFT BREAST: At the 2:00 position in the posterior left breast, there is an ovoid homogeneously enhancing mass with irregular margins, with artifact from the biopsy clip. This mass measures 18 x 16 x 17 mm (AP X ML X CC). While the lesion abuts the prepectoral fascia posteriorly, no definite enhancement is identified in the underlying pectoralis muscle.At the 3:00 position in the left breast, there is an irregular heterogeneously enhancing mass that measures 21 x 15 x 16 mm(AP X ML X CC), with biopsy clip artifact. This mass is located approximately 13 mm inferior to the mass at the 2:00 position described above.Just posterior to this mass at the 3:00 position there are 2 small enhancing satellite lesions, located medially and laterally. The largest of these satellite lesions located laterally measures 9 x 8 x 10 mm(AP X ML X CC); this lesion also abuts but does not appear to invade the underlying pectoralis muscle. Extensive non-mass enhancement is also noted surrounding the mass at the 3:00 position, extending anteriorly, laterally, and medially.Total extent of the 2 enhancing left breast masses, satellite lesions, and non-mass enhancement is 5.6 x 3.6 x 6.5 cm (AP X ML X CC).RIGHT BREAST: No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1.Two left breast masses, satellite lesions, and associated non-mass enhancement, compatible with the patient's known invasive ductal carcinoma with maximum extent of 5.6 x 3.6 x 6.5 cm. The masses/satellites abut but does not definitively invade the underlying left pectoralis muscle; see additional measurements above.2.No abnormality noted in the right breast or axillary regions. Due to some technical difficulties as patient returned on 4/13/16 for the breast MRI after a noninterpretable scan performed on 4/6/14, all images have been moved to accession # 16032912.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 45-year-old female. Status post Whipple 3/13/14 for IPMN, pancreatic divisum and chronic pancreatitis. Needs surveillance MRCP in March 2015. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic mass. No biliary ductal dilatation. Cholecystectomy clips. Fatty infiltration of the liver. Portal vein and hepatic veins are patent.SPLEEN: Subcentimeter T2 hyperintense focus in the spleen without appreciable enhancement, likely a cyst.PANCREAS: Post surgical findings of Whipple procedure. No evidence of local recurrence. Fatty atrophy of the pancreas, which has normal T1 signal intensity. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post-surgical changes in the midline abdomen.OTHER: No significant abnormality noted.

Output: Post-surgical findings of Whipple procedure without evidence of recurrence.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with bilateral upper extremity and lower extremity numbness. A mild reversal of the cervical lordosis is evident centered at C5-6. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. Mild edema is seen centered on the C5-6 endplates. Elsewhere, no pathologic marrow replacement or marrow edema is observed.The spinal cord is normal signal intensity and morphology throughout. No epidural abnormalities are suspected.Axial T2 images are degraded by motion artifact. Within this limitation, the following observations are made.C2-3: Left facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Mild posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild encroachment of the left neural foramen. C6-7: Minimal posterior disc-osteophyte complex formation. No spinal canal or foraminal stenosis. C7-T1: Left facet hypertrophy. Minimal posterior disc-osteophyte complex formation with a small left paracentral protrusion. No cord impingement or spinal canal stenosis is seen. No significant foraminal narrowing.

Output: Relatively mild degenerative findings as above without significant spinal canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 62-year-old male with left hip pain There is a lobulated, septated mass of fluid signal intensity situated lateral to the supra-acetabular left ilium as well as within the gluteus minimus muscles, which measures approximately 6 x 4 cm in transverse dimensions and 5.5 cm in craniocaudad dimension. A tail of fluid also extends along the indirect tendon of the rectus femoris. Mild peripheral and septal enhancement of the fluid collection is noted. The cyst connects with a small acetabular cyst as well. This most likely represents a ganglion or para-labral cyst. Moderate osteoarthritis affects the left hip joint. Although the exam was not protocoled for evaluation of the labrum, irregularity of the anterosuperior labrum likely represents degenerative tearing. Trace fluid is present within the joint itself. Moderate osteoarthritis affects the right hip with a small amount of fluid within the joint. Degenerative arthritis affects the SI joints, particularly on the left. Moderate osteoarthritis also affects the pubic symphysis. There is mild edema within the rectus femoris muscles bilaterally, which is nonspecific and may represent bilateral strains. There is also a collection of fat posterior to the right rectus femoris which is incompletely visualized and may represent a lipoma. Mild edema adjacent to the greater trochanters bilaterally is not necessarily of any clinical significance.

Output: 1. Cystic collection adjacent to the left hip as described above, which may represent a para-labral cyst or ganglion and does not have the appearance of an abscess or neoplasm.2. Osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Male 31 years old Reason: eval for colloid cyst resection History: eval for colloid cyst resection Motion artifact mildly degrades image quality and interpretation.Redemonstration of a right frontal ventriculostomy catheter with tip projecting midline in the anterior lateral ventricles. There is artifact from a prior left frontal surgical approach.There is persistent ventriculomegaly involving the lateral ventricles which is slightly decreased when compared to the preoperative MR, and there is slight interval decrease in periventricular T2 signal indicating a decrease in transependymal fluid shift. Foci of air within the anterior lateral ventricles seen on prior CT have decreased. Layering T2 hypointensity within the occipital horns has minimal susceptibility artifact compatible with postoperative blood products. Other scattered foci susceptibility are seen along the ventricular margins consistent with blood products.Redemonstration of a round mass in the third ventricle level of the foramen of Monro with low T1 and low T2 signal and only peripheral enhancement on the postcontrast images compatible with a colloid cyst. This measures 13 x 11 mm in the axial plane previously 17 x 16 mm on preoperative MRI.No pathologic extra-axial fluid collection.There is grossly stable cerebellar tonsils positioning, extending 5 mm below the level the foramen magnum, with associated pointing of the tonsils. Partially visualized syringohydromyelia in the cervical spinal cord at the level of C2 measures 9 x 8 mm in greatest axial dimensions and extends 2.5 cm in the craniocaudal dimension. There is crowding of structures at the level of the foramen magnum.The expected intracranial vascular flow voids are present.

Output: 1. Persistent residual colloid cyst at the foramen of Monro which measures 13 x 11 mm, decreased from the preoperative MR.2. Persistent dilatation of the lateral ventricles which is perhaps slightly decreased compared to the preoperative MR. The degree of transependymal CSF flow is also slightly decreased.3. Borderline cerebellar tonsillar ectopia with pointed configuration. Focal syringohydromyelia in the high cervical spinal cord is partially visualized. In retrospect this was present on the prior study but was largely obscured by motion artifact. Findings likely represent sequela of acquired Chiari I malformation. Additional spine imaging can be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: 12-year-old with history of Chiari malformation and syrinx. Interval follow-up exam. Cervical spine: Redemonstrated findings of a partially visualized Chiari 1 malformation with extension of the cerebellar tonsils 10 mm below the foramen magnum. There is crowding of the foramen magnum with partially diminished CSF spaces foramen magnum. CSF flow imaging shows diminished but present biphasic flow both anteriorly and posteriorly. Stable syringomyelia of the low cervical spine cord at the C6 and C7 levels which measures 16 mm in the craniocaudal dimension and 2 x 3 mm and axial dimension. There is also trace prominence of the central canal in the mid lower thoracic cord without frank syrinx formation, similar to prior. Redemonstration of decreased signal in the vertebral discs at C2-3 and C3-4 indicating desiccation which is associated with slight reversal of the cervical lordosis. Alignment is otherwise maintained. The vertebral body and intervertebral disc heights are preserved. Bone marrow signal is within normal limits. No significant spinal canal or neural foraminal stenosis.Thoracic spine:Alignment is within normal limits. The vertebral body and intervertebral disc heights are preserved. Bone marrow signal is within normal limits. No significant spinal canal or neural foraminal stenosis. Slight prominence of the central spinal canal as described above, otherwise the cord has normal signal and morphology.Lumbar spine:Alignment is within normal limits. The vertebral body and intervertebral disc heights are preserved. Bone marrow signal is within normal limits. No significant spinal canal or neural foraminal stenosis. The spinal cord has normal signal and morphology throughout. The conus medullaris terminates at the L1-2 level. The filum terminale is normal in appearance.

Output: 1. Stable findings of Chiari 1 malformation with the cerebellar tonsils extending 10 mm below the foramen magnum. There are diminished CSF spaces at the foramen magnum with preserved biphasic flow ventrally and dorsally. 2. Stable mild syringomyelia of the cervical spinal cord and trace prominence of the central canal in the thoracic cord.3. No findings to suggest tethered cord.


Instruction: Generate impression based on findings.

Input: 48 year-old woman with history of low back pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position and there is no cord signal abnormality.Mild multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Schmorl's nodes are noted in the inferior endplate of L2 and superior endplate of L3. No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is a mild disc bulge with minimal left neural foraminal stenosis. There is no spinal canal stenosis.L5-S1: There is a left paramedian disc protrusion causing significant stenosis of the left lateral recess. There is no significant spinal canal or neural foraminal stenosis. There is mild left L5/S1 facet joint arthropathy.The paraspinous soft tissues are within normal limits.

Output: 1.Disc protrusion at L5/S1 with effacement of the left lateral recess and possible impingement of the descending left S1 nerve root.2.Mild left L5/S1 facet joint arthropathy.3.Minimal left L4-L5 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: There is mild motion artifact limiting evaluation. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. Both vertebral arteries join to form the basilar artery. The anterior and posterior communicating arteries are present. There is no evidence of flow-limiting stenosis or aneurysm.Please note brain MRI was not obtained. There is soft tissue thickening along the inferior aspect of the left cavernous sinus and left anterior aspect of the petrous carotid canal which may correspond to reported history of schwannoma.

Output: Mildly motion degraded MRA exam with no flow-limiting intracranial stenosis or aneurysm. Please note brain MRI sequences were not obtained as patient did not want to continue with the study.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.