Instruction: Generate impression based on findings.

Input: 22 year old woman with history of possible PFO/ASD and PDA who presents with palpitations and dizziness. CMR done to further evaluate function and anatomy. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 58 ml/m2 (normal range: 65+/-11), the LVEDV is 118 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 47 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is evidence for a small closed muscular septal defect in the mid interventricular septum.There is a small region of midwall late gadolinium enhancement in the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. There is an atrial septal aneurysm present.ShuntThere is no clear evidence of an ASD. With the presence of an atrial septal aneurysm, the possibility of a small PFO cannot be ruled out. There is no evidence of a patent ductus arteriosis.The QP:QS is 1:1Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 74 ml/m2 (normal range 69+/-14), the RVEDV is 149 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 68 ml (normal range 35+/-13). 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 no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.There is no evidence of a patent ductus arteriosis.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 drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function [LVEF 60%]2. The right ventricle is normal in size and systolic function[RVEF 54%]3. There is a small region of mid wall late gadolinium enhancement in the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. Healed muscular septal defect without other evidence for residual congenital heart disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: New suprasellar mass with visual loss, try to identify where mass is originating from for possible neurosurgical intervention. There is a homogeneously enhancing, dural-based mass along the posterior planum sphenoidale with extension into the sella and underlying hyperostosis, which measures approximately 29 mm anteroposteriorly, 25 mm transversely, and 18 mm craniocaudally. The mass mildly indents the superior surface of the pituitary gland and the anterior surface of the infundibulum. There is no evidence of intrinsic pituitary lesions. In addition, the mass displaces the the prechiasmatic optic nerves laterally and abuts the optic chiasm and bilateral paraclinoid internal carotid arteries. There is a small patchy area of subcortical T2 hyperintensity in the posterior right gyrus rectus. There is mild diffuse periventricular white matter T2 hyperintensity, which is nonspecific, but may represent chronic small vessel ischemia. There are also small areas of encephalomalacia in the bilateral posterior occipital lobes, which may be the results of prior ischemia or trauma. There is no evidence of acute infarction. There is no midline shift or herniation. There is mild diffuse cerebral volume loss. Aside from hyperostosis along the sphenoid roofs, the paranasal sinuses are unremarkable. There is mild deviation of the anterior nasal septum to the left. There is prominence of the bilateral superior ophthalmic veins, which is nonspecific. There appears to be left frontal scalp scarring.

Output: A dural-based planum sphenoidal mass with extension into the sella above the pituitary gland that measures up to 29 mm likely represents a meningioma. The mass mildly indents the superior surface of the pituitary gland and the anterior surface of the infundibulum, displaces the prechiasmatic optic nerves laterally and abuts the optic chiasm, and is associated with mild vasogenic edema in the posterior right gyrus rectus.


Instruction: Generate impression based on findings.

Input: History of anorectal squamous cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense restricting lesion in the right hepatic dome demonstrating peripheral enhancement and mild internal enhancement measures 3.7 x 3.1 cm (series 1501/48), compared to 1.8 x 1.6 cm previously (series 12001/5). No new lesion. No biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: See discussion below. Right adnexal T1 weighted hyperintense and T2 weighted hypointense 2.5 x 1.9 cm lesion without macroscopic fat likely represents an endometrioma, unchanged. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Between the right superior aspect of the vaginal cuff and the rectum there is a bilobed lesion measuring 3.4 x 2.4 cm (series 2 302/58) demonstrating peripheral thick walled enhancement, restricted diffusion and mild internal enhancement, significantly decreased in size from the prior outside MRI. There is mild tethering versus communication with the lateral aspect of the rectum. The adjacent lower rectum demonstrates circumferential wall thickening and hyperenhancement. A soft tissue component extends posterolaterally towards the right into the presacral space (series 2 302/72). Dorsally there is a 1.5 x 1.0 cm enhancing nodule which appears to be centered in the distal sacrum/coccyx (series 2 302/78).BONES, SOFT TISSUES: There is feathery T2 weighted hyperintensity of the lower pelvic musculature and mild enhancement without a discrete mass lesion, favoring myositis. No focal lesion corresponding to the FDG avid foci seen on PET/CT 10/24/16. OTHER: No significant abnormality noted.

Output: 1.Increasing size of the right hepatic dome lesion. No new liver lesion or other site of metastatic disease.2.The low rectal/anorectal mass is markedly decreased in size from the 6/18/2015 MRI with a residual bilobed centrally necrotic component in the rectouterine space. The disease is grossly similar to the PET/CT findings accounting for technical differences. 3.Right adnexal 2.5 cm lesion, unchanged from 06/18/2015, favor endometrioma given stability.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Vantin 200mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Vantin 200mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Vantin 200mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaCad was used to localize left mid gland/base peripheral zone of the prostate at the site of the T2 hypointense enhancing lesions. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 4 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: 1. Successful core-biopsies of the left mid/base prostate gland peripheral zone lesion.


Instruction: Generate impression based on findings.

Input: Dorsalgia, unspecified [M54.9], Reason for Study: ^Reason: r/o mets History: back pain and radiculopathy For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal 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-L1 level.The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: disc dessication, no neuroforaminal narrowing or spinal stenosis. L1-L2: disc dessication, minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L2-L3: disc dessication, minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L3-L4: disc dessication, there is focal obliteration of epidural fat at the left lateral recess indicating possible disc extrusion (series 6, image 23/39). L4-L5: disc dessication, diffuse bulging of disc with broad based disc protrusion toward central to right direction which abuts thecal sac. No spinal stenosis. Modic type 2 changes of L45 endplates.L5-S1: disc dessication, diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. Modic type 2 changes of L45 endplates.

Output: 1. Degenerative changes of lumbar spine.2. Focal disc extrusion at the level of L34 toward left lateral recess.3. Broad based disc protrusion at the level of L45.


Instruction: Generate impression based on findings.

Input: Male, 50 years old, with pain and weakness of the right arm. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is seen. No pathologic marrow enhancement is detected.The spinal cord demonstrates normal signal intensity and morphology throughout. No pathologic cord or leptomeningeal enhancement is seen. No epidural abnormalities are detected.C2-3: Unremarkable. C3-4: Right greater than left facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the left. No significant spinal canal stenosis. Mild right foraminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Mild left uncovertebral hypertrophy. No significant spinal canal or foraminal stenosis. C6-7: Disc osteophyte formation contributes to a mild spinal canal stenosis but no frank cord impingement. Mild bilateral foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal or foraminal stenosis.

Output: 1.Relatively mild degenerative disease, most notably at C6-7 where there is a discussed osteophyte complex which causes a mild spinal canal stenosis. No high-grade spinal canal or foraminal stenosis is seen.2.No spinal cord abnormalities are detected. No evidence of any inflammatory process is seen.


Instruction: Generate impression based on findings.

Input: Lung cancer with metastasis. Status post radiation for cord compression. Presented with urinary retention. The vertebral column alignment is near-anatomic, aside from mild straightening of the cervical and lumbar lordosis. There are postoperative findings related to T4 and T5 partial corpectomy and posterior fixation hardware from T2 through T8, which created artifact that largely obscures the spinal canal from T2 through T3 and from T4 through T8. Otherwise, there are relatively small ventral and dorsal indentations of the thecal sac by degenerative disc-osteophyte complexes and ligamentum flavum thickening at C5-C6 and C6-C7. There is no abnormal spinal cord signal at these levels, as well as inferior to T8. There is interval increase in size of the T1 hypointense and T2 hyperintense sacral mass that markedly narrows the spinal canal and compresses the S1-S2 and S2-3 sacral foramina, especially on the left side. There is also increase in size of a T1 hypointense and T2 hyperintense lesion in the anterosuperior portion of the L3 vertebral body. There is an incompletely-imaged left thoracic soft tissue mass abutting the aortic arch.

Output: 1. Postoperative findings related to T4 and T5 partial corpectomy and posterior fixation hardware from T2 through T8, which produces artifact that largely obscures the spinal canal from T2 through T3 and from T4 through T8. 2. Mild indentation of the cervical spinal cord by disc-osteophyte complexes and thickened ligamentum flavum at multilevel level. Otherwise, assessment of the spinal canal in the mid thoracic region is limited by the artifact from the posterior fixation hardware. 3. Interval increase in size of the sacral metastasis with increased spinal canal and sacral foramina narrowing, especially on the left side. Please refer to the separate pelvis MRI report for additional details.4. Interval increase in size of a metastatic lesion in the anterosuperior L3 vertebral body. 5. The left thoracic soft tissue mass abutting the aortic arch is incompletely imaged.


Instruction: Generate impression based on findings.

Input: Clinical question: Sudden syncopal episodes which patient experiences and has sudden episodes in which she falls asleep, often at the wheel. Known scleroderma.? CNS etiology for these episodes. Signs and symptoms: As above. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates patchy small varying sized confluent foci of FLAIR/T2 hyperintensity in the subcortical and periventricular white matter, minimally in bilateral basal ganglia and pons. Findings are nonspecific however in proper clinical setting could represent chronic small vessel ischemic strokes. Findings demonstrate no cortical susceptibility signal changes.There are no similar lesions within the corpus callosum, cerebellar peduncles or the cerebellum. Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces otherwise for stated age.A signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits and paranasal sinuses.

Output: 1.Negative diffusion-weighted images.2.Extensive patchy confluent FLAIR and T2 hyperintensity in periventricular and subcortical white matter and to a lesser degree in bilateral basal ganglia and pons as detailed. Findings are nonspecific however they likely representing chronic nonhemorrhagic small vessel ischemic strokes. There are no prior exams for comparison. To entirely exclude other white matter lesions follow-up with enhanced imaging is recommended.3.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Diffuse large B-cell Lymphoma. Elevated transaminase and left acid dehydrogenase. Evaluate for cholestatic lesion amenable to ERCP stenting. Recent relapse with new diagnosis of metastatic lung cancer. Evaluation is limited by motion artifact on postcontrast series.ABDOMEN:LIVER, BILIARY TRACT: A numerable T2 hyperintense bilobar hepatic lesions are identified, probably secondary to lymphoma. There is abnormal enhancement within the left hepatic lobe, which may be due to a perfusion abnormality versus infiltrative disease. There is cut off of the proximal common bile duct (series 901, image 70). However the distal common bile duct is normal in caliber. No obstructing mass is identified.SPLEEN: No significant abnormality identified. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole renal cyst measures 2.2 x 2.1 cm, unchanged. The right kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate to large left pleural effusion with adjacent atelectasis.

Output: 1.Scattered bilobar T2 hyperintense lesions and abnormal enhancement within the left hepatic lobe, suspicious for infiltrative disease.2.Large left pleural effusion with adjacent atelectasis.3.Cutoff of the proximal common bile duct, with no distal ductal dilatation. No obstructing mass is identified.Findings discussed with Dr. Thoburn at 4:30PM on January 22, 2016.


Instruction: Generate impression based on findings.

Input: 11-year-old female with new onset seizures, hypodense area noted on outside hospital CT as well as abnormality University of Chicago stealth MRI performed last Friday. Redemonstrated is an ill-defined T2 hyperintense lesion primarily involving the right temporal lobe. The current diagnostic FLAIR technique better demonstrates its involvement of nearly the entire right temporal lobe as well as a portion of the immediately subjacent inferior right frontal lobe. As before abnormality is also noted in the posterior medial right thalamus. There is matching restricted diffusion with ADC hypointensity within these same regions. There is a also tiny focus of T2 hyperintensity involving the medial right frontal lobe gyrus, also with restricted diffusion and ADC hypointensity. Better defined by FLAIR technique is a very small focus of T2 hyperintensity within the anterior left temporal lobe just lateral to the temporal horn, which unfortunately lies in a region obscured on diffusion imaging secondary to skull base artifact. There is no susceptibility hypointensity to suggest the presence of hemorrhage. Also better defined by FLAIR technique is sulcal T2 hyperintensity, primarily involving right hemispheric sulci, which correlates with previously documented enhancement, with thickening of the right tentorium.

Output: The constellation of abnormal MRI imaging features, superimposed on lesional locations (now also including the left temporal lobe), are most consistent with encephalitis/meningitis. Other inflammatory or neoplastic etiologies are felt to be less likely.


Instruction: Generate impression based on findings.

Input: 47 year old woman with long QT and syncope, referred for further evaluation of underlying structural abnormalities and scar. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 79 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10), the LV mass index is 42 g/m2 (normal range 67+/-11), and the LV mass is 79 g (normal range 114+/-24). There are no regional wall motion abnormalities present. The myocardial T1 time is borderline increased (1050-1100ms). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 136 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 55 ml (normal range 35+/-13). No focal right ventricular wall motion abnormalities or aneurysms.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 trace 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 "psuedo-bovine" brachiocephalic branching pattern (normal variant). 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 FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%. There are no regional wall motion abnormalities present. The native myocardial T1 relaxation times are borderline increased. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59% without MRI evidence of arrhythmogenic right ventricular cardiomyopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out leptomeningeal enhancement. Signs and symptoms: Cauda equina enhancement, gait problem. Pre and postcontrast enhanced lumbar MRI:Examination demonstrates mild diffuse uniform enhancement of cauda equina without definitive evidence of interval change since prior exam. There is no evidence of clumping of cauda equina and no detectable focal regions of thickening which is a similar observation is prior study. There is no detectable signal abnormality of the conus.Diffuse T1 hypointensity and T2 STIR hyperintensity with mild diffuse enhancement of all visualized bony structures remain similar to prior exam.Diffuse uniform marrow signal change (T1 hypointense, T2 and T2* hyperintense) and enhancement of vertebral body of T12 similar to prior examination without evidence of fracture or malalignment and suggestive of metastatic disease.Extensive degenerative changes of lumbar spine without significant interval progression. Mild to moderate central spinal stenosis at L2-L3 and L4-L5 levels remain very similar to prior exam. Also multilevel neural foraminal compromise some significantly demonstrate no definitive change.

Output: 1.No evidence of acute or convincing evidence of new finding since prior exam.2.Uniform diffuse enhancement of cauda equina without clumping or thickening of cauda equina similar to prior exam. This finding likely representing post treatment change considering its stable status since lumbar MRI exam from 2011. Correlation with CSF analysis is recommended.3.No detectable signal abnormality of the lower most visualized thoracic cord or the conus.4.Diffuse uniform marrow signal changes of the entire visualized bony structures with uniform mild enhancement likely representing posttreatment findings and without interval change.5.Increased T2 STIR signal intensity of T12 vertebra with uniform enhancement similar to prior exam and likely representing a stable metastatic lesion without interval change since prior exam.6.Stable extensive degenerative changes of lumbar spine with a spinal stenosis and neural foraminal compromise since prior study.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There is no diffusion abnormality. No intracranial mass or mass effect. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. There is developmental variant small left and nonvisualized right posterior communicating arteries. There is a small bulge from the origin of the left posterior communicating artery which is either infundibulum or artifact.MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.

Output: 1.No evidence of acute infarct or brain parenchymal abnormalities to explain the seizures.2.No abnormalities of the vasculature of the brain or neck.


Instruction: Generate impression based on findings.

Input: MRI:2 punctate foci of mild diffusion hyperintensity with corresponding iso- to mild hypointensity on ADC within the left frontal lobe (306/200 and 306/192) suspicious for subacute infarcts. There is also minimal associated T2 abnormality.Multiple scattered punctate foci of susceptibility bilaterally, most prominent in the left temporal and occipital regions, grossly similar in appearance, however, prior exam was limited by motion. New gyriform susceptibility artifact within the left frontal lobe with intrinsic T1 signal consistent with laminar necrosis in the area of prior infarct. Additional foci of prior infarcts now demonstrate expected encephalomalacia and resolved cytotoxic edema.Confluent areas of T2/FLAIR hyperintensity within the subcortical and periventricular white matter is again noted, consistent with chronic small vessel ischemic disease. Previous left temporal and occipital sulcal FLAIR hyperintensity, which is felt to be less likely artifactual given focality, is overall no longer appreciated on this exam. However there is minimal residual FLAIR hyperintensity along a left posterior temporal lobe sulcus. There is no mass effect. 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. Post-operative changes noted within the paranasal sinuses with fluid in the right mastoid. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRA:Increased T1 signal is noted within the left caudate along the left frontal lobe area of cortical laminar necrosis, consistent with expected evolution of prior infarct.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The left vertebral artery is dominant. Mild focal narrowing of the left proximal P2 segment is noted. The basilar artery is normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. 2 foci of mild diffusion restriction in the left frontal lobe suspicious for subacute infarcts. 2. Subtle residual FLAIR abnormality in a left posterior temporal lobe sulcus, with near complete resolution of previously seen more diffuse left temporal lobe FLAIR hyperintensity. Findings could relate to proteinaceous material or blood products. Consider post-contrast imaging for further evaluation.3. Expected evolution of prior infarcts, including cortical laminar necrosis and encephalomalacia within the left frontal lobe.4. Multiple scattered foci of susceptibility bilaterally appearing grossly similar in appearance to prior exam, overall peripheral in distribution and possibly relating to amyloid angiopathy.5. No evidence of flow-limiting stenosis or aneurysm. Mild left proximal P2 segment narrowing.


Instruction: Generate impression based on findings.

Input: Male, 58 years old, new diagnosis of adenocarcinoma, assess for metastases. A 6-mm nonenhancing focus of T2 signal abnormality is seen within the left frontal white matter. A few additional scattered punctate foci of T2 signal abnormality are evident elsewhere in the brain. None of these lesions is associated with any mass effect.No pathologic parenchymal or extra-axial enhancement is detected. No abnormal extra-axial fluid collections are seen. There is no evidence to suggest intracranial hemorrhage. The ventricular system is normal in size and morphology.

Output: 1.No evidence of intracranial metastases2.Scattered nonspecific white matter lesions are seen.


Instruction: Generate impression based on findings.

Input: There is a 2 x 7 x 3 mm mildly T2 hyperintense, T1 hypointense, slightly heterogenous lesion within the posterior aspect of the pituitary gland. The posterior pituitary bright spot is absent. The infundibulum is slightly deviated to the left. The pituitary and sella are small for age with the pituitary measuring only 3 mm in height. There is no evidence for a suprasellar mass. The optic chiasm, cavernous sinuses and intracranial portions of the optic nerves are normal in appearance.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is moderate global volume loss. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is fluid and mucosal thickening throughout the paranasal sinuses and mastoid air cells.

Output: 1.Posterior pituitary lesion that may represent a congenital cyst or a microadenoma and could be further characterized with a contrast exam when able to tolerate.2.Small pituitary gland and sella as well as global cerebral volume loss.3.Absent posterior pituitary bright spot.4.Paranasal sinus opacification and non-specific mastoid air cell fluid. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: Female, 24 years old, with history of melanoma, status post left-sided craniotomy for tumor resection. Assess for residual tumor and for small posterior fossa lesion. Evidence of left calvarial craniotomy is seen encompassing portions of the frontal and parietal bone. A small amount of extradural soft tissue thickening is seen subjacent to the craniotomy, within expected postoperative limits. Minimal residual intracranial air is seen.A small resection cavity is evident within the left middle frontal gyrus at the site of the previously seen lesion. The cavity contains a small amount of fluid and blood product. The rim of the cavity demonstrates thin enhancement which is typical after surgery. No definite nodular enhancing soft tissue is seen within or around the cavity. Along the inferior margin of the cavity, there is a curvilinear area of T2 hypointensity vaguely resembling a portion of the lesional hemorrhage seen on the preoperative study (see image 22 of series 7).The degree of T2 hyperintense edema surrounding the resection cavity is similar to that seen surrounding the lesion on the preoperative study. Elsewhere no evidence of significant parenchymal edema or mass effect is evident.A 4 mm enhancing focus is seen within the far lateral right cerebellum with no significant associated edema or mass effect (see image 79 series 13).A 6 mm focus of T1 hyperintensity which suppresses on fat-suppressed images is seen along the inferior frontal lobe on the left, just above the anterior clinoid process. On review of the prior outside CT examination, this lesion is visualized as an area of fat attenuation.No additional areas of pathologic intracranial enhancement are suspected. No other abnormal extra-axial fluid collections are seen. The ventricular system is normal in size and morphology.

Output: 1. Demonstration of expected findings status post left-sided craniotomy for resection of a lesion from the left middle frontal gyrus.2. Thin rim enhancement along the margins of the resection cavity is within expected postoperative limits. No solid nodular enhancing tissue is seen to suggest residual tumor.3. Along the inferior margin of the resection cavity, there is a curvilinear region of T2 hypointensity likely representing blood product. This material vaguely resembles a portion of the lesional hemorrhage seen on the preoperative examination, though it could also reflect blood product related to surgery. Attention to this area on follow-up examinations is suggested.4. A 4 mm enhancing lesion is evident in the right far lateral cerebellum which is suspicious for a second site of intracranial disease. This lesion induces no significant edema or mass effect.5. Note is made of a small fatty lesion along the undersurface of the left inferior frontal lobe which could represent an incidental lipoma or dermoid/epidermoid cyst.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal MRI of the shoulder.


Instruction: Generate impression based on findings.

Input: Ovarian cancer screening for clinical trial: fatigue. There is no evidence of intracranial hemorrhage, enhancing mass, or acute infarct. There is an arachnoid cyst in the right middle cranial fossa with extension to the Sylvian fissure and associated mass effect upon the adjacent temporal and frontal lobes. There is mild scattered nonspecific cerebral white matter T2 hyperintensity, mainly in a periventricular distribution. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastases. 2. Right middle cranial fossa arachnoid cyst with extension to the Sylvian fissure and associated mass effect upon the adjacent temporal and frontal lobes.


Instruction: Generate impression based on findings.

Input: Male 56 years old Reason: eval for biceps tendon tear, RTC tear History: Popeye deformity ROTATOR CUFF: There is a high-grade bursal surface tear through the anterior fibers of the supraspinatus tendon at its insertion. The tear involves the majority of the tendon thickness but appears to spare the articular surface fibers. The tear is just over 1 cm in dimension and there is minimal retraction. There is additional increased signal intensity within the distal supraspinatus tendon indicating tendinosis and perhaps surface fraying and interstitial tearing. Unremarkable appearance of the supraspinatus muscle. Mild tendinosis of the infraspinatus tendon with interstitial tearing along the myotendinous junction. Mild fatty infiltration of the infraspinatus muscle. Unremarkable appearance of the teres minor muscle and tendon. There is thinning of the subscapularis tendon likely representing attritional subscapularis tendon tearing. There is mild atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: There is spurring of the anterior aspect of the acromion process as well as a small ossicle noted anterior to the acromion. There is also slight lateral downsloping of the acromion process. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Normal alignment of the glenohumeral joint. Evaluation of the labrum is limited by patient motion. The inferior labrum is grossly intact. Apparent detachment of the anterosuperior labrum from the underlying glenoid may represent normal variant sublabral foramen. Compared to the remainder of the labrum, the posterosuperior labrum is poorly defined which may reflect degeneration or a prior SLAP tear.BICEPS TENDON: Superiorly the bicipital groove appears empty. Although evaluation of the biceps tendon is limited by motion we don't clearly see the biceps tendon within the rotator interval. More distally there is a thin low signal intensity structure within the bicipital groove that we assume represents the torn and retracted tendon. MRI HUMERUS:

Output: 1. Findings compatible with a tear of the proximal long head of biceps tendon.2. Partial thickness rotator cuff tears and tendinosis as described above.3. Distal biceps tendon intact as described above.4. Other findings as described above


Instruction: Generate impression based on findings.

Input: There are no acute fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: There is a focus of intrinsic cord T2 hyperintensity without obvious adjacent anatomic/degenerative cause.C2/3: Posterior osteophyte disc complex, ligamentum flavum thickening, and moderate bilateral facet hypertrophy. There is moderate bilateral neural foraminal stenosis.C3/4: Mild anterior compression deformity of C3 and C4, extensive posterior osteophyte disc complex, ligamentum flavum thickening, bilateral uncinate hypertrophy, moderate left facet hypertrophy, severe right facet hypertrophy, and right facet fusion. The combination of these features result in circumferential cord flattening associated with intrinsic cord T2 hyperintensity abnormality (predominately on the right). There is moderate central and moderate severe bilateral neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, moderate left facet hypertrophy, and mild right facet hypertrophy. There is mild central, severe left neural foraminal, and moderate right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, ligamentum flavum thickening, bilateral uncinate hypertrophy, moderate left facet hypertrophy, and mild right facet hypertrophy. There is mild central and severe bilateral neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and uncinate hypertrophy asymmetric to left, ligamentum flavum thickening, and mild left facet hypertrophy. There is severe left neural foraminal stenosis.C7/T1: Posterior osteophyte disc complex and mild bilateral facet hypertrophy result in mild bilateral neural foraminal stenosis.

Output: 1.C1/2: There is a focus of intrinsic cord T2 hyperintensity without obvious adjacent anatomic/degenerative cause. This is nonspecific in appearance and the differential diagnosis is broad.2.C2/3: Moderate bilateral neural foraminal stenosis.3.C3/4: A combination of degenerative features result in circumferential cord flattening associated with intrinsic cord T2 hyperintensity abnormality (predominately on the right) consistent with myelopathy. There is moderate central and moderate severe bilateral neural foraminal stenosis.4.C4/5: Mild central, severe left neural foraminal, and moderate right neural foraminal stenosis.5.C5/6: Mild central and severe bilateral neural foraminal stenosis.6.C6/7: Severe left neural foraminal stenosis.7.C7/T1: Mild bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Motion artifact degrades image quality. The ventricles and sulci are prominent, consistent with mild age-related volume loss. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. There are also subcentimeter defects in the bilateral basal ganglia, which likely represent chronic lacunar infarctions. There is no evidence of acute infarction. There are multiple foci of susceptibility artifact, within the bilateral thalami, and to a lesser extent the bilateral cerebral and cerebellar hemispheres and basal ganglia, consistent with chronic microhemorrhages. There is a partially empty sella. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Chronic basal ganglia lacunar infarcts and small vessel ischemic disease, but no acute infarct, midline shift, or mass effect.


Instruction: Generate impression based on findings.

Input: Meningioma status post CyberKnife in May 2014 and orbital pseudotumor. There are postoperative findings related to left suboccipital craniotomy for resection of a meningioma with encephalomalacia in the left cerebellar hemisphere. There is perhaps slight interval decrease in size of the tumor, which now measures up to 16 mm in thickness, previously 20 mm. However, the signal characteristics of the mass have changed somewhat, with apparent increased enhancement. There is an unchanged nodular extra-axial lesion that is markedly T2 hypointense with susceptibility effect and mild peripheral enhancement along the floor of the left posterior fossa, adjacent to the craniotomy defect that measures up to 15 mm. There is unchanged mild nonspecific periventricular T2 hyperintensity. There is no evidence of acute infarct or hemorrhage. The ventricular system is stable in size and configuration. There are postoperative findings related to orbitozygomatic craniotomy with persistent diffuse enhancement of the right orbital fat and multiple extra-ocular muscles with associated impingement upon the optic nerve and proptosis, which is not significantly changed, accounting for differences in technique.

Output: 1.Perhaps slight interval decrease in size of the treated left posterior fossa meningioma, with evolution of the enhancement characteristics.2. An unchanged nodular extra-axial lesion min left posterior fossa adjacent to the craniotomy margin may represent an organizing hematoma. 3. Persistent inflammatory process in the right orbit with impingement upon the optic nerve.


Instruction: Generate impression based on findings.

Input: Newly diagnosed prostate cancer, staging exam PELVIS:PROSTATE:Prostate Size: 3.7 x 4.9 x 3.8 cm (AP x TR x CC).Peripheral Zone: T2 hypointense foci involving predominantly the left base through the apex consistent with prostate cancer. There are small foci of signal abnormality also involving the right mid gland. T1 hyperintensity involving the apex bilaterally and left base consistent with hemorrhage from prior biopsy.Central Gland: Benign prostatic hyperplasia.Seminal Vesicles: Thickening of the left seminal vesicle.Extracapsular Extension: Evidence of focal extracapsular extension in the left mid gland posterolaterally.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Prostate cancer involving the left base peripheral zone through the apex with additional findings suggestive of extracapsular extension in the left mid gland posterolaterally and possible left seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: Patient with non-small cell lung cancer history of epilepsy. Status post craniotomy for brain metastases. No needs disease evaluation prior to therapy In comparison with the prior examination residual blood from the left posterior temporal has been absorbed. Area of edema of right frontal lobe has significantly increased since prior study and is concerning for neoplasm and should be further evaluated with a dedicated MRI examination with infusion. Postsurgical changes of left parietal craniotomy is again identified. No evidence of hemorrhage, midline shift or hydrocephalus.

Output: Significant increase in the amount of vasogenic edema in the right frontal lobe concerning for recurrence of disease and should be further evaluated with an MRI examination.


Instruction: Generate impression based on findings.

Input: 32-year-old male with history of Crohn's disease. 16 years ago, now presenting with new right scrotal pain ABDOMEN:LUNG BASES: There is and 19 x 13 mm air space opacity in the right lower lobe. There are smaller, round opacities in the right lower lobe around this larger opacity. Further evaluation of these lesions with chest CT is recommended. Linear atelectasis at the left lung base.LIVER, 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: Left lower quadrant ileostomy. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Subtle, linear increased density in the left ischiorectal fossa. This may represent inflammatory changes, however, a fistula tract cannot be excluded. Further evaluation with MRI in helpful.

Output: Multiple airspace opacities in the right lower lobe, one of them measuring approximately 2 cm.. Given the young age of the patient, these may represent inflammatory/infectious changes, however, neoplasm cannot be excluded. Further evaluation with chest CT is recommended.Inflammatory changes in the pelvis, more prominent on the left side. MRI of the pelvis may be helpful for better characterization of these changes and to evaluate for a possible fistula.


Instruction: Generate impression based on findings.

Input: Further assessment of a T11 lytic lesion with possible extension into the spinal canal. Cervical spine: There is reversal of the normal lordosis. The vertebral body height is relatively preserved accounting for the due to spondylosis. The vertebral bone marrow signal is diffusely heterogeneous with loss of the normal fatty signal, but there is no osseous expansion. There is a similar appearance of the clivus and sphenoid body. There is no significant spinal canal stenosis. The spinal cord shows normal signal and morphology.Thoracic spine: The vertebral column alignment is within normal limits. There is mild loss of T2 signal and height at the T4-T5 disc. Otherwise, the disc space heights are preserved. The vertebral bone marrow signal is diffusely heterogeneous, with loss of the normal fatty signal. Similar findings are present in the imaged ribs. There is a more intensely T1-hypointense, T2 hyperintense abnormality replacing the T11 vertebral body/pedicle marrow with mild, predominantly left sided posterior expansion/retropulsion, but no significant spinal canal narrowing. This is also associated with central compression/intravertebral disc herniations along the superior and inferior endplates, but without overall vertebral body height loss. The appearance is unchanged since the CT scan. The other vertebral body heights are preserved. A T1 and T2 hyperintense lesion in T9 vertebral body is probably a hemangioma. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Lumbar spine: There is minimal anterior subluxation of L4 relative to L5 which is degenerative, without spondylolysis. The alignment is otherwise anatomic. The vertebral body heights are preserved. The marrow is heterogeneous with loss of the normal fatty signal. Similar involvement is present in the included pelvic bones. There is nonspecific mild T1-hypointense, T2 hyperintense signal just posterior to the lumbar vertebral bodies, displacing the epidural fat posteriorly. There is degenerative stenosis of the spinal canal, which is severe at L4-L5 and moderate at L5-S1, superimposed on congenitally narrow spinal canal. The conus medullaris has normal morphology and signal. The tip of the conus medullaris is at mid L1 level. The paravertebral soft tissues are unremarkable.LEVEL-BY-LEVEL

Output: 1.Diffuse marrow infiltrating process with more focal, destructive involvement of the T11 vertebral body and pedicles associated with mild retropulsion, but no spinal cord compression or significant canal narrowing. The appearance is more suggestive of multiple myeloma rather than prostate cancer metastasis, although the assessment is somewhat limited by the lack of intravenous contrast.2.Multilevel cervical and lumbar degenerative spondylosis, including severe spinal canal narrowing at L4-L5.


Instruction: Generate impression based on findings.

Input: 36 years, Female, Reason: LLQ abdominal pain; palpable nodule LLQ; BRCA2 positive History: LLQ abdominal pain; palpable nodule LLQ; BRCA2 positive. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left-sided corpus luteum and normal appearing bilateral follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 2.5 x 1.4 cm enhancing lesion in the left rectus abdominis muscle (14/91).OTHER: Small amount of free fluid in the pelvis is likely physiologic.

Output: Enhancing lesion in the left rectus abdominis muscle is nonspecific but has the typical location and appearance of a desmoid and would be amenable to percutaneous biopsy.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for worsening cerebral edema. Signs and symptoms: Mental status change. Non-enhanced CT brain:There is suggestion of possible cerebral edema in the supratentorial brain parenchyma. The paucity of cortical sulci is similar to prior examination from 4 -- 6 -- 2010. There is no evidence of hemorrhage, midline shift or hydrocephalus. Follow-up exam with an MRI is again recommended.

Output: Stable exam. Recommend MRI examination.


Instruction: Generate impression based on findings.

Input: 84-year-old male with history of Crohn's disease, status post ileocecectomy. History of recurrent bowel obstructions. History of small bowel resection. Now with severe diarrhea and weight loss. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple loops of distended small bowel, no significant dilatation seen to suggest SBO. No focal wall thickening, fistulous connection, or drainable fluid collection. No ascites. The presumed neoterminal ileum (given reported history of ileocecectomy) is unremarkable (axial series 16 image 25).BONES, SOFT TISSUES: Small T2 hyperintense focus which demonstrates loss of signal on fat saturated sequence is most compatible with a benign osseous hemangioma (coronal series 7 image 19).OTHER: No significant abnormality noted.

Output: No evidence for bowel obstruction or active inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Evaluate for cord compression, history of kyphoplasty: sudden onset tingling, numbness, poor rectal tone. There is a metastasis within the T10 vertebral body associated with a pathologic fracture previously treated with kyphoplasty, as evidenced by cement that manifests sa low T1 and T2 signal. The tumor compresses the spinal cord, which appears to contain mild high T2 signal at the T10 level. The tumor also bulges into the paraspinal soft tissues at the T10 level and there is neural foraminal narrowing at the T9-10 and T10-11 levels bilaterally. There is a metastatic lesion that occupies much of the T5 vertebral body, where there is superior endplate concavity, but no retropulsion into the spinal canal. There is a subcentimeter T1 hypointense and T2 hyperintense lesion in the posterior T1 vertebral body. There is a hemangioma in the T6 vertebral body. There is advanced degenerative spondylosis at the L4-5 level, where there is disc space narrowing, fatty endplate marrow signal alterations, and disc bulge with superimposed eccentric left extrusion that results in severe bilateral neural foraminal stenosis, and mild spinal canal stenosis. There is also a focus of high T2 signal in the posterior L4 vertebral body more superiorly.

Output: 1. A metastasis arising from the T10 vertebral body associated with a pathologic fracture previously treated with kyphoplasty compresses the spinal cord. 2. A metastatic lesion that occupies much of the T5 vertebral body, where there is superior endplate concavity. 3. Probable small metastasis within the posterior T1 vertebral body.4. Advanced degenerative spondylosis at the L4-5 level with severe bilateral neural foramen stenosis and signal abnormality in the posterior L4 vertebral body that may be related to the degenerative process, although an underlying metastasis is not excluded.


Instruction: Generate impression based on findings.

Input: Morbid obesity. Preoperative evaluation for bariatric surgery. Exam limited by patient body habitus.RIGHT LOBE MEASUREMENTS: 4.7 x 1.9 x 1.9 cmLEFT LOBE MEASUREMENTS: 5.0 x 2.0 x 2.5 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Parenchyma is diffusely heterogeneous. No dominant nodules.LEFT LOBE: Parenchyma is diffusely heterogeneous. There is a isoechoic 1.5 x 1.5 x 1.3 cm nodule located at the lower pole.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffusely heterogeneous thyroid with solitary nodule in the left lower lobe.


Instruction: Generate impression based on findings.

Input: Ms. Michaels is a 61-year-old female presenting for MRI-directed ultrasound of a right 6:30 enhancing focus on MRI study dated 8/25/2016. A targeted right breast ultrasound was performed at the MRI-directed area of concern. In the right breast 6:30 location, approximately 4 cm from the nipple, no solid or cystic mass identified.

Output: No sonographic correlate detected for the MRI finding in the right lower outer breast. A short-term (6-month) follow-up MRI is recommended to ensure stability of this finding. Of note, patient is due for a bilateral screening mammogram in December 2016. All results and recommendations were discussed with the patient. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: 61 year-old female with right shoulder pain for 15 years, evaluate rotator cuff ROTATOR CUFF: There is a partial articular sided tear of the anterior distal supraspinatus at its insertion without retraction of the tendon or muscular atrophy. There is tendinosis of the surrounding fibrous. The remaining rotator cuff muscles and tendons are intact.SUPRASPINATUS OUTLET: Marked acromioclavicular joint osteoarthritis with fluid noted within the joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is intact. The labrum is grossly intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Partial articular sided tear of the anterior distal supraspinatus.2. Progression of acromioclavicular joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: 59 year old male with a history of Crohn's disease, ileitis presents with perianal pain. Assess for perianal fistula. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BOWEL, MESENTERY: Again seen is a transsphincteric perianal fistula tract extending from the 1 o'clock position to the level of the subcutaneous tissue along the left gluteal crease, tract is less prominent when compared to the prior examination. Tract terminates in a small elongated focus of increased signal abnormality measuring 11 x 6 mm, measuring slightly smaller than on earlier exam. Again seen is a smaller tract extending from the 7 o'clock position to the midline without focal fluid collection to suggest abscess formation. The previously described perianal fistula originating from the 2 o'clock position is also less prominent when compared to the prior examination.Complex fistula formation seen in right lower quadrant on earlier exam not included on current study.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Persistent perianal fistulae, less pronounced when compared to the prior examination.


Instruction: Generate impression based on findings.

Input: Pituitary lesion surveillance. There no significant interval change in the enhancing sellar mass with extension into the right cavernous sinus and right sphenoid sinus, measuring up to 18 mm. There is no mass effect upon the optic apparatus. The infundibulum is midline. The internal carotid artery flow voids are intact.

Output: No interval change in the invasive pituitary mass, which likely represents a macroadenoma.


Instruction: Generate impression based on findings.

Input: Clinical question: Low back pain with left-sided radiation. Signs and symptoms: As above. Nonenhanced lumbar MRI:The alignment of vertebral column is anatomical.Lower most visualized thoracic spine and thoracic cord are unremarkable.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild disk desiccation and mild hypertrophy of ligamentum flavum and minute fluid signal intensity in the right facet space. No spinal stenosis or neural foraminal compromise.L3 -- 4 demonstrate mild disk desiccation and loss of disk height, moderate right and mild to moderate left facet and ligamentum flavum hypertrophy. There is a central and slightly to the right broad-based disk protrusion resulting in subtle flattening and posterior displacement of the cord and mild central spinal stenosis. Mild bilateral neural foraminal compromise secondary to degenerative changes is also present.L5 -- S1 demonstrate moderate disk disease and loss of disk height , moderate left and mild right facet and ligamentum flavum hypertrophy is also noted. There is no central scar stenosis however moderate left and mild right neural foraminal compromise is detected. Bilateral SI joints and perispinal soft tissue/musculature remains unremarkable.

Output: 1.Degenerative changes at L4 -- L5 and a central disk protrusion results in mild central spinal stenosis. Bilateral neural foraminal compromise as detailed.2.Moderate disk disease and loss of disk height without central spinal stenosis however with bilateral neural foraminal compromise at L5 -- S1 is noted.3.Minimal degenerative changes at other levels however without spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: There is a small lesion within the posteromedial left thalamus measuring 7 x 6 mm (as measured on the axial T2 technique), previously 5 x 5 mm. The hypointense rim is slightly larger. Internal signal characteristics now demonstrate less T2 hyperintensity and more T1 hypointensity. As before, there is no perilesional edema. There are no other similar appearing lesions. There are no associated developmental venous anomalies. There are a few scattered punctate foci of T2 hyperintensity in bifrontal subcortical white matter locations without mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no 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. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Small, 7 x 6 mm, cavernous malformation within the left thalamus as described in detail above. There is no associated perilesional edema or development of venous anomaly.


Instruction: Generate impression based on findings.

Input: Benign intracranial hypertension [G93.2] / Compression of brain [G93.5] / Headache [R51], Reason for Study: ^Reason: chiari malformation , pseudotumor cerebri, new and worsening headaches, please do with csf flow study History: new and worsening headache Brain MRIRedemonstration of suboccipital craniectomy and stable downward displacement of the cerebellum and the cerebellar tonsils, unchanged.There is also a tubular structure seen through the foramen Luschka to the level of distal aspect of the aqueduct, unchanged since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion on scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.CSF Flow studyThere are to and fro flow anterior to the craniocervical junction.Flow signal at the posterior aspect of the foramen magnum appears to be attenuated, unchanged since prior scan.The degree of flow signal was not calculated but the signal intensity appears to be similar to that of prior scan.Cervical spine MRIThere is normal cervical lordosis. The cranial-cervical junction demonstrates post decompression status, unchanged. Spinal cord signal intensity is normal.In particular, no evidence of syrinx.The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal.

Output: 1. Post decompression suboccipital craniectomy of Chiari malformation status, no postoperative unusual finding.2. No evidence of syrinx. Ventricle size is stable and unremarkable.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 53 year old female with episodic hypertension, evaluate for intracranial or posterior fossa tumor The ventricles, sulci and cisterns are symmetric and unremarkable. There are a few scattered periventricular and subcortical foci of T2 signal abnormality within the white matter, sparing the posterior fossa, without associated mass effect, restricted diffusion, or susceptibility abnormality. The gray-white matter differentiation is normal. There is no mass, midline shift, intra or extra-axial fluid collection/hemorrhage, or evidence of acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Small right ethmoidal sinus retention cyst or polyp. Fluid within a few right mastoid air cells. The paranasal sinuses and mastoid air cells are otherwise clear.

Output: Few There are a few scattered periventricular and subcortical foci of T2 signal abnormality within the white matter, sparing the posterior fossa, without associated mass effect, restricted diffusion, or susceptibility abnormality. These are nonspecific in appearance, and the differential diagnosis would most likely include small vessel ischemic disease, migraine sequelae, or the residua of prior head trauma. Given their morphology and location, demyelinating disease is considered unlikely.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, cervical regionClinical question: R/O cervical disc disease. EMG shows chronic L C8 radiculopathySigns and Symptoms: Weakness L hand The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal. There is disc desiccation and a right lateral recess disc protrusion which encroaches on the right-sided exiting nerve roots at this level. At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is mild posterior ligamentous hypertrophy present at this level. There is disc desiccation present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild posterior ligamentous hypertrophy present at this level. There is disc desiccation present at this level.At C5-6 there is no significant compromise to the spinal canal. There is right-sided uncovertebral osteophyte formation associated with a right lateral recess disc protrusion which extends into the neural foramen and encroaches the right-sided exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal. There is right-sided uncovertebral osteophyte formation associated with a right lateral recess disc protrusion and mild to moderate encroachment of the right-sided exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery is small relative to the left vertebral artery.

Output: 1.There are multilevel degenerative changes present in the cervical spine with encroachment of right-sided exiting nerve roots at C3-4, C5-6 and to a lesser degree C6-7.


Instruction: Generate impression based on findings.

Input: 30 years Female (DOB:8/30/1985)Reason: Please evaluate for cerebral AVMs, HHT History: HHTPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a T2 and FLAIR hyperintense lesion located in the right temporal lobe white matter behind the right sylvian fissure and just lateral to and adjacent to the right inferior longitudinal fasciculus which measures 8 x 5 mm axial dimensions. It is not associated with any susceptibility effect and it is not associated with contrast enhancement.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium sized. The right posterior communicating arteries is not readily identified. The left posterior communicating artery is small The vertebral arteries are similar in size. The left A1 segment is larger than the right A1 segment. There is triplication of the anterior cerebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm or arteriovenous malformation.3.There is a small lesion present in the right temporal lobe white matter. In isolation this is nonspecific.


Instruction: Generate impression based on findings.

Input: Seizure-like activity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a normal degree of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal diffuse paranasal sinus mucosal thickening.

Output: No evidence of seizure foci.


Instruction: Generate impression based on findings.

Input: Hemorrhage is redemonstrated in the right lateral ventricle and in the right thalamus appearing similar in quantity and distribution to prior exams. The right lateral ventricle remains widened. There are T2/FLAIR hyperintensities in the corona radiata, representing chronic ischemic small vessel disease. No parenchymal restricted diffusion is seen. There is a ventriculostomy track coursing from a left frontal approach into the left ventricle, reflecting the previously removed ventriculostomy tube. There is a volume loss affecting the right basal ganglia with hemosiderin staining, likely indicating a prior hemorrhagic insult. There is punctate susceptibility signal along the left lateral ventricle and the ventriculostomy track, representing old blood products. There is no definite abnormal enhancement.Ventricular size is stable with no midline shift. Basal cisterns are patent.

Output: 1. As on the previous CT there is redemonstration hemorrhage in the right lateral ventricle and in the right thalamus.2. No definite evidence of any mass or enhancing lesion. Please note that the presence of blood may obscure a small or subtle enhancing lesion.3. Nonspecific T2/FLAIR hyperintensities in the corona radiata, suggestive of chronic ischemic small vessel disease.4. Mild volume loss and hemosiderin staining affecting the right basal ganglia suggests a prior hemorrhagic insult in this location.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic melanoma, history of brain metastases, now with recent seizure and left-sided weakness. Evaluate for new brain metastases. Signs and symptoms: Recent seizure and left-sided weakness. Nonenhanced brain MRI:Only a single axial FLAIR sequence was obtained which at this point patient was unable to continue with the study and terminated the exam.Examination demonstrates a new focus of vasogenic edema in the right posterior frontal-parietal region containing acute blood products. Considering patient's history of malignancy this finding could represent a new focus of hemorrhagic metastatic lesion and follow-up with a complete exam is recommended.There is also a right posterior temporal hemorrhagic mass measuring approximately at 12 x 12 mm in transaxial dimensions and the sulcal surrounding vasogenic edema which is new since prior exam and consistent with a hemorrhagic metastatic lesion.A surgical cavity with CSF signal intensity in the left artery again posterior frontal and bit surrounding edema/FLAIR hyperintensity remain similar to prior exam.Focus of FLAIR hyperintensity and a cavity formation in the right frontal lobe at the site of previously known metastatic lesion is noted. Left posterior temporal-occipital vasogenic edema is at the site of a previously noted tiny metastatic lesion however lack of intravenous contrast precludes precise assessment for the size of underlying metastases.Mild prominence of lateral ventricles similar to prior exam however with interval decreased mass effect on the right frontal horn of lateral ventricle due to interval decreased vasogenic edema.

Output: 1.Incomplete exam due to patient's inability to continue and only a single axial FLAIR sequences acquired.2.New focus of hemorrhage and surrounding edema in the right posterior frontal-parietal suspicious for a new metastatic lesion.3.New focus of hemorrhagic metastases in the right posterior temporal suspected.4.Multiple additional foci of FLAIR hyperintensity consistent with patient's previously known tumors.5.Interval decreased vasogenic edema in the right frontal lobe with resultant decreased mass effect on the right frontal horn of lateral ventricle.


Instruction: Generate impression based on findings.

Input: 72 year old man with mildly reduced LV systolic function referred to rule out ischemic heart disease. His history is significant for lymphoma which is treated with chemotherapy.  MEDICATIONS: ASA, lisinopril, and simvastatin. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Of note, the native myocardial T1 relaxation time was moderately elevated in the basal inferior and inferolateral walls suggesting the presence of either subtle interstitial fibrosis or myocardial edema. Left VentricleThe left ventricle is normal size with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 175 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 81 ml (normal range 47+/-19), the LV mass index is 79 g/m2, and the LV mass is 150 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal size and systolic function. The overall RV ejection fraction is 71%, the RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVEDV is 145 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 42 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 mild 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsLarge right sided pleural effusion with adjacent atelectasis or consolidation is noted. Mediastinal lymphadenopathy is noted. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with low normal systolic function (LVEF 54%). There is no late gadolinium enhancement; however, the native myocardial T1 relaxation time was moderately elevated in the basal inferior and inferolateral walls suggesting the presence of either subtle interstitial fibrosis or myocardial edema. 4. Normal RV size and systolic function (RVEF 71%).5. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Knee pain. Due to the patient's large body habitus, a knee coil could not be used. An alternative coil was used instead, resulting in suboptimal image quality.MENISCI: Mild intrasubstance signal intensity within both menisci suggests degeneration, but I see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is mild to moderate thinning of the articular cartilage of the lateral facet of the patella, with a near-full-thickness cartilage cleft noted in the median eminence. There is mild thinning of the articular cartilage of the medial facet of the femoral trochlea as well as focal near-full-thickness to full-thickness degeneration of the articular cartilage along the lateral facet. Small patellofemoral subchondral cysts are also noted. There is focal near-full-thickness to full-thickness cartilage degeneration along the weightbearing portion of the medial femoral condyle. There is also a small full-thickness cartilage defect along the weightbearing portion of the lateral femoral condyle. There are small tricompartmental osteophytesLIGAMENTS: Anterior cruciate ligament appears slightly thickened, suggesting mucoid degeneration. The posterior cruciate ligament appears normal. The medial collateral ligament and lateral collateral ligament complex appear normal. EXTENSOR MECHANISM: The extensor mechanism is intact. There is edema of the subcutaneous fat anterior to the patellar tendon extending along the lateral retinaculum that is nonspecific. ADDITIONAL

Output: 1.Tricompartment osteoarthritis.2.Mild edema of the subcutaneous fat anterior to the patellar tendon extending along the lateral retinaculum is nonspecific.3.Findings suggestive of an intra-articular lipoma anteriorly with extension into the patellofemoral articulation.4.Mucoid degeneration of the anterior cruciate ligament.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is minimal pannus at the dens. There is moderate loss of disc height with endplate degenerative changes at C4-5 and mild loss of disc height at C5-6 and C6-7. Aside from the associated degenerative endplate signal alterations, the vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are mild right mastoid air cell effusions. There is a 5 mm wide right thyroid nodule.C2-C3: No significant disc bulge, spinal canal or neural foramen stenosis.C3-C4: No significant disc bulge, spinal canal or neural foramen stenosis.C4-C5: Disc-osteophyte complex with uncovertebral hypertrophy and thickening of the ligamentum flavum, contributing to modearte spinal canal and mild bilateral neural foramen stenosis.C5-C6: Disc-osteophyte complex with uncovertebral hypertrophy and thickening of the ligamentum flavum, contributing to mild spinal canal and mild bilateral neural foramen stenosis.C6-C7: Disc-osteophyte complex with uncovertebral hypertrophy and thickening of the ligamentum flavum, contributing to mild spinal canal and mild bilateral neural foramen stenosis.C7-T1: No significant disc bulge, spinal canal or neural foramen stenosis.

Output: 1. Degenerative cervical spondylosis, contributing to moderate spinal canal stenosis at C4-C5 and mild spinal canal stenosis at C5-C7, as well as mild bilateral neural foramen stenosis at these levels.2. Nonspecific 5 mm wide right thyroid nodule. Thyroid ultrasound may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Proximal visual disturbance, evaluate for structural abnormality. Brain parenchyma appears within normal limits for age. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain is unremarkable.


Instruction: Generate impression based on findings.

Input: History of weight loss. Ultrasound concerning for chronic liver disease. Evaluate for malignancy or cirrhosis. Significant respiratory motion limits the quality of the images and limits the study.ABDOMEN:LIVER, BILIARY TRACT: The liver morphology and size is unremarkable. There are several predominantly peripherally based wedge-shaped arterial enhancing lesions in the liver which are isointense to liver parenchyma on portal venous and delayed phase imaging. These are not associated with T1/T2 weighted signal abnormality, restricted diffusion or washout and are compatible with THIDs/perfusion anomalies. No focal suspicious liver lesion is evident.There are several T2 weighted hyperintense, T1 weighted hypointense nonenhancing subcentimeter foci compatible with simple cysts. More punctate T2 weighted hyperintense foci diffusely likely represent benign biliary hematomas.No biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal inferior pole 1.3 cm simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid diverticulosis without diverticulitis. Normal appendix. The patient is status post gastric banding with the band in stable orientation within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.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: No specific evidence of cirrhosis as clinically questioned. No significant abnormality.


Instruction: Generate impression based on findings.

Input: Reason: RULE OUT OSTEMOMYLITITS History: BACTEREMIA AND FEVER There is no bone marrow signal abnormality to suggest osteomyelitis. There is no frank osteolysis to suggest osteomyelitis. There is peritrochanteric edema bilaterally, left greater than right. Some of this edema becomes confluent along the lateral aspect of the gluteal musculature which may represent a bursitis. No organized fluid collection is identified to suggest abscess formation. There is enhancing increased signal abnormality within the gluteal musculature bilaterally which is nonspecific but appear to correspond with foci of hypermetabolic activity on recent PET/CT examination. Note is made of enhancing lymphadenopathy in the left internal iliac region measuring 2.9 x 2.7 cm suspicious for metastatic disease. There is also right iliac lymphadenopathy measuring approximately 2.5 cm in its greatest dimension. There is associated enhancement in the surrounding area which extends to the level of the anterior aspect of the L5/S1 disc space appearing similar to the prior studies.

Output: 1. Nonspecific edema and foci of enhancement within the gluteal musculature bilaterally which appear to correspond with foci of hypermetabolic activity on recent PET/CT examination. These could represent inflammatory changes related to an infectious etiology in the correct clinical context versus metastatic disease. No drainable fluid collection is identified. No evidence of osteomyelitis. 2. Pelvic lymphadenopathy consistent with the patient's known history of metastatic disease. 3. Findings suggestive of a peritrochanteric bursitis, left greater than right. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness and numbness For the purposes of numbering, the most inferior well-defined disc space is labelled L5-S1. Again seen is a severe compression fracture involving the L3 vertebral body with approximately 70% loss of height similar to prior. There is edema involving the L3 vertebral body, also similar to prior. Evidence of cement augmentation at the L3 vertebral body is again seen. No significant osseous retropulsion.Remainder of the vertebral body heights are normal. Alignment is grossly maintained in the lumbar spine. There are diminished posterior osseous elements from L3-L4 to the sacrum reflecting combination of prior laminectomies and dysplasia. Fat within the thecal sac at the right lateral S1 level is again seen. The spinal cord remains low-lying with the distal neural tissue/conus extending to the L5 level. Prone images demonstrate no appreciable ventral motion. Septations/adhesions are again again noted in the thecal sac from the L5 to S1 levels similar to prior. T2 signal likely reflecting myelomalacia at L2-L3 again seen.Degenerative changes are specified by the intervertebral level as follows and unchanged since 2/22/2016: T12-L1: No spinal canal or neural foraminal stenosis.L1-L2: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is minimal disc bulge. There is unchanged mild central canal stenosis and bilateral mild to moderate neural foraminal stenosis.L2-L3: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge with central protrusion component without significant change in moderate to severe spinal canal stenosis and moderate bilateral foraminal stenosis. L3-L4: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is also mild disc bulge with unchanged mild spinal canal stenosis and mild to moderate bilateral foraminal stenosis.L4-L5: There is bilateral facet hypertrophy. There is central disc protrusion. No significant spinal canal stenosis. There is unchanged mild bilateral foraminal narrowing, relatively worse on the left.L5-S1: There is bilateral facet hypertrophy without neuroforaminal narrowing or spinal stenosis.Fatty atrophy involving the paraspinous musculature again seen, which is predominantly on the right.

Output: 1. Compared to 3/29/2016 and 2/22/2016, there is no significant change in moderate to severe spinal canal stenosis at the L2-L3 level.2. No significant change in compression fracture with approximately 70% height loss of the L3 vertebral body with evidence of cement augmentation.3. Unchanged appearance of the low-lying conus which extends to the L5 level and adhesions within the distal thecal sac. Prone images demonstrate no appreciable ventral motion, which in the appropriate clinical setting suggests possibility of re-tethering. 4. Unchanged T2 hyperintensity within the cord at the L2-L3 level consistent with myelomalacia.5. Degenerative changes at additional levels as detailed above.


Instruction: Generate impression based on findings.

Input: Right hip pain The examination is limited by motion artifact and by the patient's body habitus.There is no evidence of fracture or dislocation of the right hip. The marrow signal of the pelvis is normal. Following contrast administration, there is no abnormal enhancement of the right hip.Abnormal marrow signal affects the L5 and S1 vertebral bodies and disc spaces. This is better evaluated on corresponding dedicated MRI of the lumbar spine.

Output: No evidence of fracture or acute right hip pathology.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for intracranial abnormalities History: pre-syncope Brain parenchyma appears within normal limits. There are no masses, mass effect or herniation. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: MRI of the brain is within normal limits. Specifically, no evidence of intracranial mass, mass effect or acute infarct..I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, with severe right lumbar radiating pain. Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. No pathologic marrow replacement or enhancement is seen.The distal spinal cord is unremarkable. The conus tip terminates at the L1 level which is normal. The nerve roots of the cauda equina dispersed evenly through the thecal sac. No pathologic intrathecal enhancement is seen. No epidural abnormalities are suspected.Incidental note is made of mild prominence of the right renal collecting system.Mild loss of disc T2 signal is seen at L2-3 and L4-5 with preservation of disc height. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild bulging disc with a shallow central/right paracentral protrusion. Mild effacement of the ventral thecal sac but no significant generalized canal stenosis. No significant foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Right foraminal and extraforaminal disc protrusion which moderately narrows the neural foramen. The exiting L3 nerve root does not appear to be significantly impinged. However, the protrusion may impinge the descending right L4 nerve root. No significant generalized spinal canal stenosis. No significant left foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. Mild generalized spinal canal stenosis with encroachment of the lateral recesses and crowding of the descending bilateral L5 nerve roots. Superimposed left foraminal/far lateral disc protrusion which moderately narrows the left neural foramen. L5-S1: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis.

Output: 1.A right foraminal/extraforaminal disc protrusion at L3-4 causes moderate narrowing of the neural foramen. The exiting L3 nerve root does not appear to be impinged. However, this protrusion does efface the right lateral recess and may impinge on the descending right L4 nerve root.2.A bulging disc at L4-5 causes encroachment of the lateral recesses and crowding of the descending bilateral L5 nerve roots. A superimposed left foraminal/far lateral disc protrusion causes moderate left neuroforaminal narrowing.


Instruction: Generate impression based on findings.

Input: Acinic cell carcinoma of the right parotid gland, metastatic to the skull base, status post treatment. There are postoperative findings related to right parotidectomy and mastoidectomy, which are partially imaged. There is no significant interval change in the extent of the ill-defined heterogeneously enhancing mass that involves the right basiocciput, petrous ridge, and condylar and squamous portions of the occipital bone. The areas of non-enhancement within the skull base likely represent necrosis and are not significantly changed. Portions of the tumor still abut the right internal carotid artery and surround the right internal jugular vein. There is also persistent enhancement within the lateral mass of the C1 vertebra. There are a few unchanged nonspecific scattered foci of T2 hyperintensity in the cerebral white matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits are unremarkable. The remaining salivary glands are unremarkable.

Output: No significant interval change in the treated acinic cell carcinoma metastasis involving the right lateral skull base and craniocervical junction, perhaps superimposed upon osteonecrosis.


Instruction: Generate impression based on findings.

Input: Newly diagnosed cholangiocarcinoma. Evaluate for metastases. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size. There is abnormal soft tissue infiltration along the porta hepatis into the central hepatic parenchyma and infiltrating segment 5 of the liver. There is severe right hepatic lobe biliary ductal dilatation. There are additional satellite lesions in the right hepatic lobe (including series 8, image 55, 56).The common bile duct is essentially obliterated by the periductal tumor with associated intrahepatic biliary ductal dilatation.Hydropic gallbladder containing numerous gallstones. Nonspecific pericholecystic fluid. No significant gallbladder wall thickening.A biliary stent is noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate volume ascites. Perihepatic soft tissue nodule suspicious for peritoneal carcinomatosis, see measurement below.BONES, SOFT TISSUES: Mild anasarca. Well-defined hypoechoic uterine masses likely represents fibroids.OTHER: No significant abnormality noted.

Output: 1. Extensive soft tissue infiltration along the porta hepatis and into the right hepatic lobe with associated suspected hepatic satellite metastases compatible with the stated history of cholangiocarcinoma. Associated marked right hepatic lobe biliary ductal dilatation.2. Hydropic gallbladder with cholelithiasis.INDEX LESION MEASUREMENTS (Current exam date/time: 1/11/2016 22:00:00)PERIHEPATIC SOFT TISSUE NODULE: 1.2 x 1.0 cm (Image 151, Series 8).INFILTRATING PORTAHEPATIS MASS: 10.8 x 5.1 cm (Image 143, Series 8).


Instruction: Generate impression based on findings.

Input: Urinary incontinence, decreased bladder capacity, thick-walled bladder. Evaluate for tethered cord. Five lumbar type vertebral bodies are presumed to be present. The conus medullaris is normal in appearance and terminates at the L1-2 level. There is no T1 hyperintensity along the filum. There is no evidence of intraspinal tumors. The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is no significant spinal canal or neural foraminal stenosis at T12-L1 through L5-S1. The vertebral body and disk heights are well-maintained. The vertebral marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: No evidence of low-lying conus medullaris, fibrofatty filum, or other developmental anomalies in the lumbar spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: History of meningioma. Status post surgery and cyber knife for recurrence. Signs and symptoms: Surveillance scan. Pre-and post-enhanced brain MRI:Examination demonstrate bone marrow signal placement (T1 isointense and T2 hypointense) and thickening of the right skull base and including the right occipital condyle with uniform enhancement similar to prior exams.Additionally there is an associated extra osseous focus of enhancement in the right inferior cerebellopontine angle cistern which abuts the right foramen of Luschka similar to prior exam. This focus of enhancement is within the surgical bed at the level of previously resected meningioma. It measures approximately 10 x 20 mm in transaxial dimensions on axial post enhanced series 11 x 23. There is no significant interval change in the size or the extent of this finding since prior study. Similar to prior exam this focus of enhancement abuts the right lateral aspect of medulla however without detectable signal abnormality to suggest presence of edema.Examination redemonstrates a single punctate focus of flair hyperintensity in the subcortical white matter of right frontal lobe which is a nonspecific finding. Unremarkable and stable pre-and post enhanced brain MRI otherwise.

Output: 1.No evidence of an acute or new finding since prior exam.2.Marrow signal replacement and uniform enhancement of right skull base including right occipital condyle similar to prior exam.3.Associated with above finding is a right inferior cerebellopontine angle extra-axial enhancement measuring approximately 11 x 23-mm without convincing evidence of change since prior study.4.Similar to prior exam the above mentioned enhancement is inseparable from the right lateral aspect of the medulla and right foramen of Luschka as detailed.


Instruction: Generate impression based on findings.

Input: Complex febrile convulsions [R56.01], Reason for Study: ^Reason: rule out brain structural abnormality History: seizure There are a couple of small (less than 2mm) T2 high and T1 low signal intensity lesions on the right hippocampal head which follow the signal intensity of CSF. There is no MR evidence of focal parenchymal signal abnormality of the hippocampus nor evidence of volume loss. Constellation of above findings suggest possible hippocampal sulcus cysts. The left side hippocampus appears to be normal.There is no evidence of acute ischemic or hemorrhagic lesion on this scan.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. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Hippocampal sulcus cysts on the right hippocampal head, otherwise no remarkable finding.