Instruction: Generate impression based on findings.

Input: 57 year old male with heart failure with reduced ejection fraction (HFrEF), s/p renal transplant in 2007, COPD, HTN, DM, NSTEMI during neutropenic sepsis recently, cardiac cath deferred due to acute kidney injury, atrial fibrillation. Evaluation for viability/scar. First Pass PerfusionDuring hyperemia, no perfusion defects were presentViability/ Myocardial ScarThere is no evidence of prior myocardial infarction. There is a very small focal region of epicardial late gadolinium enhancement in the apical inferolateral wall which suggests the presence of a small amount of fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is mildly decreased 49%. The LVEDV is 187 ml (normal range 142+/-34), the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVESV is 96 ml (normal range 47+/-19) and the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9). The LV mass is 172 g (normal range 164+/-36) and the LV mass index is 90 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%. The RVEDV is 164 ml (normal range 142+/-31), RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVESV is 80 ml (normal range 54+/-17), and the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, 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 no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are small bilateral pleural effusions and a possible right lung infiltrate near the hilum, correlation with recent non-contrast chest CT or chest x-ray suggested. 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 and mildly decreased systolic function (LVEF 49%) with a very small focal region of epicardial late gadolinium enhancement in the apical inferolateral wall which suggests the presence of a small amount of fibrosis, inflammation, or infiltration. The pattern is not consistent with prior myocardial infarction.4. Normal RV size with normal systolic function (RVEF 51%). See extra cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of uterine mass and concern for uterine leiomyosarcoma. PELVIS:UTERUS, ADNEXA: Anteverted retroflexed uterus. Arcuate uterus. The endometrium is normal in thickness. The junctional zone measures up to 8 mm, within normal limits. The adnexa are unremarkable.There is a T2 hyperintense partially exophytic lesion extending from the anterior right lower uterine segment which does not demonstrate abnormal postcontrast enhancement. Additional smaller cysts are noted. Small defect in the lower uterine segment consistent prior cesarean section scar. The cervical stroma is unremarkable.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: 1.No suspicious uterine mass as clinically questioned.2.The lesion described on the CT is a simple benign-appearing cystic structure which may represent a post cesarean section benign fluid collection or possibly a large nabothian cyst.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate left knee for loose body, MPFL tear (patellar dislocation), chondromalacia patella History: Recent traumatic patellar dislocation 2 weeks ago Evaluation of the proximal tibia and the surrounding soft tissues is limited due to metallic susceptibility artifact related to the patient's prior tibial tuberosity transfer.MENISCI: The lateral meniscus appears intact. There is poorly defined increased signal intensity within the posterior horn of the medial meniscus suggesting intrasubstance degeneration, appearing similar to the prior study. We see no discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: Moderate osteoarthritis affects the patellofemoral joint with intra-articular osteophytes and foci of cartilage degeneration that appear slightly more prominent on the current study than on the prior examination. There are central patella and trochlear osteophytes which have increased in size with mild underlying bone marrow edema. However, we see no bone contusions within the patella. Subjectively, the superior aspect of the femoral trochlea appears shallow, appearing similar to the prior study. There are intra-articular osteophytes along the medial femoral condyle just above the posterior horn of the meniscus, which appear to have increased in size and there has been progression of articular cartilage degeneration anterior to this osteophyte. There is also relatively mild degeneration of the articular cartilage of the medial tibial plateau. There has been progressive thinning of the articular cartilage of the lateral femoral condyle above the posterior horn of the lateral meniscus as well as progression of articular cartilage degeneration more centrally along the weightbearing surface of the lateral femoral condyle and lateral tibial plateau. We see no bone marrow edema to suggest contusions.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The posterior fibers of the medial patellofemoral ligament are not well visualized which may represent a chronic tear, but this appears similar to the prior study. There is irregularity of the lateral retinacular structures likely reflecting prior release. The quadriceps and patellar tendons appear normal.ADDITIONAL

Output: 1. Progression of tricompartmental osteoarthritis of the knee.2. Poor visualization of the posterior fibers of the medial patellofemoral ligament which may represent a chronic tear, appearing unchanged when compared to the prior study.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: CLL, recent pericarditis, now with abnormal MRI from outside facility. There is unchanged mild scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild cerebral volume loss and the bilateral Meckel caves are patulous. 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: Nonspecific unchanged mild scattered cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease, but no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Female 75 years old with elevated liver enzymes s/p ERCP 7/21/16 with findings suggestive of PSC vs secondary PSC vs PBCs s/p bilateral stents in place . Now recently with worsening LFTs and leukocytosis, evaluate. ABDOMEN:LIVER, BILIARY TRACT: The wall of the common bile duct is thickened and the lumen is irregular with a stricture of the proximal common duct at the level of Klatskin's point. Filling defects within the common bile duct representing either stones or air due to recent sphincterotomy. Multiple intrahepatic biliary strictures are also noted and unchanged. There is mild thickening of the gallbladder wall however the gallbladder is contracted and not well evaluated.Subcentimeter T2 hyperintense lesions near the dome of the liver are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is mildly irregular and dilated up to the level of the ampulla with a maximum diameter of 7 mm. Several subcentimeter side branch IPMNs in the pancreatic body are unchanged (series 3, image 15).ADRENAL GLANDS: Small left adrenal adenoma is redemonstrated.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Again seen within the infrarenal abdominal aorta is an intraluminal linear focus raising the question of focal dissection (series 11, image 28).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Thickening, irregularity and narrowing of the common duct appears similar to the previous exam. The differential diagnosis includes PSC, autoimmune cholangitis and infectious etiologies.


Instruction: Generate impression based on findings.

Input: Clinical question: Bilateral hip pain going down to knees. Rule out spinal stenosis. Signs and symptoms: As above. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral, however lead exaggerated lumbar lordosis with resultant near horizontal positioning of the sacral spine. Lower most visualized thoracic spine and thoracic cord is unremarkable from T10 inferiorly. Examination at T12-L1 through L2-L3 levels demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild disc disease and mild ligamentum flavum and facet hypertrophy. There is mild mass effect on the thecal sac secondary to ligamentum flavum and mild central spinal stenosis without neural foraminal compromise..L4-L5 demonstrate mild disc disease and moderate ligamentum flavum and facet hypertrophic changes which includes minimal left facet effusiont. There is mild central spinal and bilateral lateral recess compromise and moderate mild bilateral neural foraminal compromise.L5-S1 demonstrate mild to moderate disc disease and moderate bilateral (left greater than right) facet and ligamentum flavum hypertrophic changes. No evidence of central spinal stenosis however significant left and moderate to significant right neural foraminal compromise as well as lateral recess compromise bilaterally. There is evidence of left-sided facet effusion and minimally on the right.

Output: 1.Examination is unremarkable from T11-T12 through L2-L3 levels without spinal stenosis or neural foramina compromise.2.Degenerative changes at L3-L4 results in mild central spinal stenosis.3.L4-L5 degenerative changes results in mild central spinal stenosis and bilateral neural foraminal and lateral recess compromise.4.L5-S1 demonstrate mild degenerative disc disease and significant hypertrophic changes of posterior elements with resultant significant bilateral (left >t right) neural foraminal compromise as well as lateral recess compromise bilaterally however without central spinal stenosis.5.There is normal anatomical alignment of vertebral column however exaggeration of lower lumbar lordosis results in near horizontal projection of sacral spine in relation to lumbar spine.


Instruction: Generate impression based on findings.

Input: 72 years, Male, Reason: neurodeg disease History: ataxia, cognetive. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is global parenchymal volume loss supra and infratentorially without a distribution to suggest a particular neural degenerative process. There is volume loss involving the hippocampi bilaterally which is not disproportional. No focal signal abnormalities involving the basal ganglia or midbrain.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as in the pons, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. 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: 1. Global parenchymal volume loss. 2. No intracranial mass or mass effect. 3. Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Male 64 years old Reason: cholestasis, evaluate for biliary obstruction History: cholestasis, history of NHL, anal cancer, panc adenoma with CIS s/p Whipple's ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Probable cyst noted in the right hepatic lobe. There is mild intrahepatic biliary ductal dilatation. There is mild narrowing at the biliary enteric anastomosis. The biliary limb is mildly dilated near the gallbladder fossa.Status post cholecystectomySPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes from a Whipple. There is some atrophy of the remainder pancreas. Pancreatic duct is mildly prominent. There is scarring near the expected location of the head/uncinate process of the pancreas in the region of prior abscess.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney. Left lower pole renal cyst.RETROPERITONEUM, LYMPH NODES: Reference mesenteric lymph node measures 2.1 x 1.6 cm on image 26/series 4 is not significantly changed from prior.BOWEL, MESENTERY: Postsurgical changes from a from a pancreaticoduodenectomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild intrahepatic biliary ductal dilatation with mild narrowing at the level of the biliary enteric anastomosis. The biliary limb is mildly dilated with narrowing near the head of the pancreas in the area of prior abscess formation with associated scarring. The area of obstruction may be at the biliary enteric anastomosis or at the level of the head of the pancreas where there is narrowing of the biliary limb.


Instruction: Generate impression based on findings.

Input: 67 year old male with drug refractory long standing atrial fibrillation s/p ablation x 3, s/p AICD. Referred for cardiac MRI to assess pulmonary vein anatomy and left ventricular function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%. The LVEDV is 134 ml (normal range 142+/-34), the LV end diastolic volume index is 62 ml/m2 (normal range: 74+/-15), the LVESV is 54 ml (normal range 47+/-19) and the LV end systolic volume index is 25 ml/m2 (normal range 25+/-9). The LV mass is 113 g (normal range 164+/-36) and the LV mass index is 52 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, considering limitations due tox magnetic susceptibility artifact from AICD/PM in the anterior chest wall.AICD/PM leads are noted in the right atrium and right ventricle. The distal segment of the right ventricular lead is obscured by artifact. 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 52%. The RVEDV is 207 ml (normal range 142+/-31), RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVESV is 99 ml (normal range 54+/-17), and the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveAssessment is limited. The aortic valve is poorly visualized. Mitral ValveThere is no significant mitral regurgitation.Tricuspid ValveThere is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsThe right superior, right inferior and left inferior pulmonary veins drain normally into the left atrium without any obvious stenosis. The left superior pulmonary veins were not well visualized due to metallic susceptibility artifact. Complete assessment of the left atrium and pulmonary venous ostia is limited by artifact. Pulmonary ArteryThe main pulmonary artery is mildly dilated (33 mm).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 with normal systolic function. LVEF 60%. 2.The right ventricle is normal in size with normal systolic function. RVEF 52%.3.Complete assessment of the left atrium and pulmonary venous ostia is limited by susceptibility artifact. The right upper, right lower and left lower pulmonary veins drain normally into the left atrium. The left upper pulmonary veins were not well visualized due to AICD/PM artifact.4.There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, considering limitations of technique. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ataxia. Rule out cord compression. The vertebral bodies are appropriate in the overall height. There is grade 1 anterolisthesis of L4 on L5. Alignment is otherwise maintained. No large metastatic lesion is appreciated within the limits of the screening study. T1 shortening involving the lumbosacral spine marrow may be related to prior radiation.Mild multilevel degenerative changes are seen in the cervical spine, relatively worse at the C5-C6 level where a disc osteophyte complex and ligamentum flavum thickening are associated with mild to moderate spinal canal stenosis. There is otherwise no high-grade stenosis in the cervical spine or obvious cord signal abnormality. No significant spinal canal stenosis is evident in the thoracic spine. Mild to mild-to-moderate degree of spinal canal stenosis is also evident at the L3-L4 and L4-L5 levels. Otherwise no high-grade stenosis. There is up to moderate degree of neural foraminal stenosis at the L4-L5 level.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.Due to the screening nature of this protocol, details are not as evident on imaging as dedicated protocols of the spine. Degenerate changes in the cervical and lumbar spine can be better assessed with dedicated cervical and lumbar spine imaging as clinically indicated.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are left breast ultrasound dated 4/4/2011, left diagnostic mammogram dated 4/4/2011, and MRI breast dated 4/13/2011 performed at Northwestern Graylake. LEFT DIAGNOSTIC MAMMOGRAM (4/4/2011): Two standard views of the left breast and 2 spot compression views were obtained. The breast parenchyma is heterogeneously dense. The breast tissue in the left upper inner quadrant appears slightly more conspicuous on recent mammogram dated 2/19/2015LEFT BREAST ULTRASOUND (4/4/2011): A cyst was seen in the 12 o'clock position of the left breast that measures 4 mm.BREAST MRI (4/13/2011): There is no significant interval change compared to mammogram dated 12/22/2014.

Output: Slightly more conspicuous breast parenchyma the left upper inner quadrant compared to examination in 2011 without interval change from breast MRI dated 4/13/2011 and 12/22/2014. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Female 45 years old Reason: Chronic pelvic pain, menorrhagia, polymenorrhea. Evaluate for adenomyosis. History: heavy menses. Pelvic pain PELVIS:UTERUS, ADNEXA: Uterus measures 9.0 x 5.3 x 5.0 cm. The junctional zone is irregular and thickened measuring in some areas up to 20 mm. There are foci of T2 hyperintensity within the thickened junctional zone.On postcontrast imaging, there is heterogeneous enhancement of the uterus. Right ovary measures 1.9 x 1.5 cm while the left ovary measures 2.7 x 1.1 cm. There are small simple appearing bilateral ovarian cysts, likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic ascites.

Output: 1.Findings most suggestive of adenomyosis of the uterus.


Instruction: Generate impression based on findings.

Input: Treatment planning MRI for SRS for acoustic neuroma. There is an ovoid enhancing lesion in the left internal auditory canal, which measures up to 10 mm in length and 5 mm in width. There is mild scattered cerebral white matter T2 hyperintensity bilaterally, mainly in a periventricular distribution. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is a 10 mm thick posterior apical scalp lipoma.

Output: 1. A left internal auditory canal vestibular schwannoma measures up to 10 mm.2. Mild scattered cerebral white matter T2 hyperintensity bilaterally may represent a demyelinating disease, perhaps related to Familial Mediterranean fever, but are nonspecific.


Instruction: Generate impression based on findings.

Input: Reason: Right shoulder pain, no improvement with NSAIDS, injection and therapy. Evaluate for rotator cuff tear History: Right shoulder pain ROTATOR CUFF: Increased signal intensity of the undersurface fibers of the supraspinatus tendon indicating partial thickness tearing involving approximately 50% of tendon thickness. The tear extends from the tendon insertion on the greater tuberosity approximately 2 cm proximally. There is degenerative cyst formation in the underlying humeral head and greater tuberosity. The tear extends 2 centimeter in AP dimension and involves to anterior fibers of the infraspinatus with underlying degenerative cyst formation. Subscapularis tendon and teres minor tendon are intact. There is no significant rotator cuff muscle atrophy. SUPRASPINATUS OUTLET: There are mild degenerative changes of the AC joint. There is trace fluid in the subacromial/subdeltoid bursa, likely physiologic.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is degenerative cyst formation of the humerus as described above. There is fluid signal undercutting the superior labrum suggestive of superior labral tear. Intermediate signal abnormality of the anterior labrum may represent extension of this tear. There is a small defect in the superior posterior glenoid cartilage.BICEPS TENDON: The long head of the biceps tendon is normal in location. There is small amount of fluid surrounding the tendon, likely related to joint effusion.ADDITIONAL

Output: 1. Partial-thickness undersurface tearing of the supraspinatus tendon.2. SLAP tear of the labrum.3. Mild AC joint osteoarthritis and other findings as above.


Instruction: Generate impression based on findings.

Input: Reason: HCC surveillance History: NASH and HCV cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Cholelithiasis without evidence of cholecystitis. No evidence of steatosis. No suspicious enhancing lesions.SPLEEN: Moderate splenomegaly. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged periportal and periaortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver morphology without evidence of hepatocellular carcinoma.


Instruction: Generate impression based on findings.

Input: Metastatic head and neck cancer. Neck CT:The visualized brain demonstrates an enhancing nodule in the right occipital lobe. Post-surgical changes in the right frontal lobe and additional metastatic lesions in the brain are better seen on prior MRI brain dated 7/19/2011.Postsurgical changes of previous laryngectomy is again noted. There is soft tissue thickening at the oropharynx and hypopharynx which is unchanged and presumably represents post treatment granulation.Degenerative changes of the cervical spine is again noted

Output: 1. Postsurgical changes of previous laryngectomy. No evidence of interval change.2. Metastatic brain lesions. Please refer to MRI brain for further details.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up resection of meningioma. Signs and symptoms: As above. Pre and post gadolinium enhanced brain MRI:Examination demonstrates chronic post operative changes of a bilateral posterior parietal (R<L) craniotomy. There is a focus of encephalomalacia in the right occipital and posterior parietal with minimal cortical mineralization at the surgical site is noted.There is abnormal signal intensity of superior sagittal sinus at this level suggestive of tumor/meningioma within the superior sagittal sinus. This finding demonstrate enhancement and measures maximum of 9 x 11 mm in transaxial dimensions (axial FLAIR and T2 image 22 and axial post enhanced series 1001 images 22 through 24. There are no prior exams for comparison. The superior sagittal sinus beyond this lesion demonstrate normal signal intensity.The overall anatomical morphology and signal intensity of brain parenchyma remains otherwise within normal limits on all MRI sequences and without detectable or abnormal enhancement.Calvarium demonstrates expected postoperative changes and unremarkable otherwise.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.Examination is status post bilateral posterior parietal-occipital craniotomy ((R<L) with underlying focus of encephalomalacia in the right occipital and posterior parietal.2.Residual signal abnormality and enhancement in the superior sagittal sinus in the occipital and posterior parietal concerning for residual tumor (9 x 11 mm transaxial dimension). No evidence of residual tumor otherwise and no prior exams for comparison.3.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Brain MRI:There is a focus of restricted diffusion within the right midbrain with associated T2 signal abnormality consistent with an acute infarct. An additional focus of subtle diffusion hyperintensity in the left posterior frontal corona radiata may also represent an additional focus of subacute ischemia. There is no associated susceptibility artifact to suggest hemorrhage. Encephalomalacia within the right occipital lobe is consistent with a prior right PCA territory infarct. T1 hyperintensity in this region is compatible with laminar necrosis. Periventricular and subcortical white matter abnormal T2 signal is consistent with mild chronic small vessel ischemic disease. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect, or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. A 1.6 x 1.4 cm intermediate signal, round lesion within the midline slightly anterior scalp may represent a sebaceous cyst or epidermal inclusion cyst; correlate with physical exam.Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries with right dominance and the left vertebral artery terminating as the left PICA. Antegrade flow is identified within the basilar artery with fetal morphology of the bilateral posterior cerebral arteries. There is tortuosity at the level of A1/A2 junction and the right A1 segment is not well seen, which is favored to be hypoplastic. Antegrade flow is noted within the middle cerebral arteries and the posterior cerebral arteries. No arterial aneurysmal dilatation is identified. No arteriovenous malformations are identified.Neck MRA:MRA of the neck is suboptimal in quality but there is no significant stenosis of the external or internal carotid arteries. The vertebral artery origins are poorly evaluated, however, the vertebral arteries distally are patent.

Output: 1. Acute infarct within the right midbrain. Possible additional acute to subacute punctate focus of infarct in the left frontal corona radiata.2. Chronic right PCA territory infarct with encephalomalacia within the right occipital lobe.3. Poor visualization of the right A1 segment, which is favored to be hypoplastic. Otherwise, patent intracranial arterial vasculature with bilateral fetal morphology of the PCA's and right vertebral dominance. 4. Suboptimal MRA of the neck with grossly patent vessels within the limitations of the study. The origins of the vertebral arteries are poorly assessed, though patent distally. If further evaluation is warranted, CTA of the neck may be considered.


Instruction: Generate impression based on findings.

Input: Reason: assess for cause of right base of second toe pain, particularly Morton Neuroma History: right base of second toe pain Overlying the dorsal aspect of the second metatarsal there is a 6mm oval-shaped moderately well defined focal signal abnormality which is felt to represent synovitis or a small cyst. The soft tissues are otherwise unremarkable. Bone marrow signal is within normal limits. There is no evidence of Morton neuroma. The muscle bodies and tendons of the forefoot appear normal.

Output: Signal abnormality overlying the dorsal aspect of the second metatarsal is felt to represent synovitis or a small cyst. No evidence of Morton neuroma, as clinically queried.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is increased signal intensity within the anterior most fibers of the distal supraspinatus tendon at its insertion on the greater tuberosity, indicating an insertional tear. The tear focally involves the majority of the thickness of the tendon but there is no significant retraction and overall, the tear measures approximately 1 cm in the AP dimension. There is no discrete tear of the infraspinatus tendon. The supraspinatus and infraspinatus muscles are normal. The teres minor tendon and muscle are intact. There is mild increased signal intensity of the distal fibers of the subscapularis tendon suggesting tendinosis but we see no discrete tear. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint. Fluid is noted within the subacromial subdeltoid bursa containing multiple foci of low signal intensity corresponding to the globular calcific densities seen on the comparison radiographs. An additional focus of low signal intensity is seen anterior to the greater tuberosity and lateral to the long head of the biceps representing additional hydroxyapatite deposition perhaps within the bursa or adjacent soft tissues. Foci of edema-type signal are noted within the greater tuberosity which are likely reactive and degenerative in etiology.GLENOHUMERAL JOINT AND GLENOID LABRUM: The superior labrum is deformed and attenuated compatible with tearing. There is also deformity of the inferior labrum best seen on the coronal oblique sequences which likely represents tearing with adjacent paralabral cysts.BICEPS TENDON: There is intermediate signal intensity within the long head of the biceps tendon as it courses through the rotator interval indicating mild tendinosis.

Output: 1. Calcific subacromial subdeltoid bursitis.2. Focal near full-thickness to full-thickness tear of the anterior insertional fibers of the supraspinatus tendon without retraction.3. Moderate osteoarthritis of the acromioclavicular joint.4. Labral tears as described above.


Instruction: Generate impression based on findings.

Input: A 73 year old male with personal history of liver transplant, hyperlipidemia, peripheral artery disease. His cardiovascular history includes coronary artery disease with a percutaneous stent implantation in 2010 and a aortic valvular replacement (robotic approach) in 11/2015 (a coronary angiography previous to the surgery showed patents LAD stent, 50% stenosis in ostial 3rd diagonal and mild disease in the LCx and RCA). Recently reported angina of effort with ST depressions in the EKG during exercise. Referred to stress cardiac MRI for further evaluationMEDICATIONS: aspirin, atorvastatin, baraclude, fluticasone, furosemide, lisinopril, metoprolol, prednisone, sildenafil, tacrolimus, tiotropium. First Pass PerfusionDuring hyperemia, no perfusion defects were present; however, stress perfusion acquisition was delayed due to IV infiltration and the diagnostic sensitivity is reduced. Viability/ Myocardial ScarThere was late gadolinium enhancement noted at the mid-myocardium at the basal segments (anteroseptum and inferolateral walls). This pattern suggests fibrosis, inflammation, or infiltration, and is not typical of myocardial infarction. The pattern is most consistent with some sort of myocarditis. The rest of the myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 148 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 54 ml (normal range 47+/-19), the LV mass index is 52 g/m2, and the LV mass is 110 g. There are no regional wall motion abnormalities present.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 82+/-16), the RVEDV is 152 ml (normal range 142+/-31), the RV end systolic volume index is 29 ml/m2 (normal range 31+/-9), and the RVESV is 62 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveA prosthetic aortic valve was seen at the aortic position. 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 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 no pericardial effusion. Significant pericardial fat was noted.Extracardiac FindingsSternal wires were 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; however, diagnostic sensitivity reduced due to delayed image acquisition.2. There was late gadolinium enhancement noted at the mid-myocardium at the basal anteroseptum and inferoseptal segments. This pattern suggests fibrosis, inflammation, or infiltration, and is not typical of myocardial infarction. The pattern is most consistent with myocarditis; however, the differential diagnosis includes other things as well3. Normal LV size and systolic function (LVEF 64%).4. Normal RV size and systolic function (RVEF 59%).5. A prosthetic aortic valve was seen at the aortic position.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate arachnoid cyst. History of acute lymphoid leukemia. There is an arachnoid cyst in the anterior right middle cranial fossa extending into the anterior cranial fossa which measures 7.8 cm x 6.0 cm axially and 7.0 cm craniocaudally. It is located just lateral to the branches of the right middle cerebral artery. It causes mild mass-effect on the adjacent brain parenchyma and splays the frontal and temporal gyri along the anterior part of the sylvian fissure. It also causes mild uncal herniation. However there is no brain parenchymal signal abnormality. It causes up to 6 mm of midline shift at the level of the septum pellucidum. There is no acute infarct or intracranial hemorrhage. Few dilated prevascular spaces are present within the right frontal white-matter. Major intracranial flow voids are preserved. Following contrast administration, there is no abnormal intracranial contrast enhancement.The arachnoid cyst thins the calvarium and expands the right middle cranial fossa. The remainder of the skull is unremarkable. There is no gross orbital abnormality. There is trace mucosal thickening in the paranasal sinuses.The CSF study performed at the mid sagittal plane shows preserved, ventral and dorsal biphasic CSF flow.

Output: Right frontotemporal arachnoid cyst with mass-effect as described above. Brain MRI is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 75 years Female (DOB:5/15/1941)Reason: r/o cva History: cognitive impairmentPROVIDER/ATTENDING NAME: SHELLIE N. WILLIAMS SHELLIE N. WILLIAMS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. One of these lesions in the left centrum semiovale adjacent left frontal lobe measures 15 x 11 mm axial dimensions. There are some punctate lesions present in the brainstem which are hyperintense on T2 and FLAIR MRI.There is a large flow void present adjacent to the ophthalmic segment of the right internal carotid artery which measures 14 x 10 mm in coronal dimensions. 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.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening at the floor of the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a signal hyperintense lesion on all pulse sequences located in the trigone of the left lateral ventricle which most likely represents calcifications.

Output: 1.There is a large aneurysm present at the distal right internal carotid artery at the proximal ophthalmic segment which is directed superiorly and abuts the right olfactory trigone and posterior olfactory sulcus. An MR angiogram may help further evaluate for this and additional aneurysms. Alternatively an CT angiogram may be useful.2.Periventricular and subcortical white matter lesions of a mild to moderate degree and some punctate lesions in the brainstem are nonspecific. A larger lesion in the left centrum semiovale may represent an old lacunar infarct. At this age they are most likely vascular related. 3.There is no evidence for acute ischemic cerebral infarction.4.Findings were discussed with Dr. Williams.


Instruction: Generate impression based on findings.

Input: Reason: mass over anterior antecubital fossa-probable lipoma History: soft tissue mass The biceps tendon appears intact. There is minimal intermediate signal intensity within the brachialis tendon at the level of its insertion on the indicating mild tendinosis. There is subchondral signal abnormality within the ulna at the site of the brachialis tendon insertion. The triceps appears intact. There is nonspecific subcutaneous edema along the posterior aspect of the olecranon. There is prominence of the subcutaneous fat along the medial aspect of the distal humerus underlying a skin marker presumably corresponding to the patient's palpable area of concern, however, this is difficult to accurately measure or differentiate from the adjacent subcutaneous fat due to lack of inherent contrast. There is no significant enhancement on postcontrast sequences. No bone marrow signal abnormality is identified.

Output: Prominence of the subcutaneous fat along the medial aspect of the distal humerus indicating lipoma formation. No enhancing mass lesions are identified.


Instruction: Generate impression based on findings.

Input: 80 year-old female urothelial cancer. Restaging. CHEST:LUNGS AND PLEURA: Bilateral scattered micronodules are predominantly peripheral and some are pleural based. Bibasilar dependent atelectatic changes. No nodule larger than 4 mm was found.MEDIASTINUM AND HILA: Diffuse calcified lymph nodes in the mediastinum. Small amount of coronary artery calcification. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: 1 x 2.6 cm inferior right hepatic lobe cystic lesion appears uniloculated and benign. Subcentimeter hypodensities are bilobar and too small to characterize. SPLEEN: No significant abnormality noted.PANCREAS: 8 x 10 mm distal pancreatic parenchymal cystic focus (coronal image 43, axial image 82 of series 3). If indicated, obtain MRI/MRCP for further evaluation, if indicated. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic calcifications in the aorta. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.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: Bilateral lung micronodules and subcentimeter liver hypodensities are too small to characterize.Pancreatic tail 1 cm cystic lesion. see above. No measurable metastatic disease.


Instruction: Generate impression based on findings.

Input: 11-year-old female with knee pain and swelling for weeks status post fall. MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is normal. Articular cartilage is intact.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:12/15/1962)Reason: s/p SRS intervention for dural AVM repair-12/12/14 History: SurveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 left jugular vein is smaller than the right jugular vein and substantially smaller when compared to pretreatment exams.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate a small opacity in the left mastoid air cells. The visualized portions of the orbits are intact.MRA brain:Compared to the previous exam the left external carotid artery vasculature remains stable compared to the prior exam but has decreased in caliber compared to immediate post treatment exams. The left mastoid artery can be identified extending into the left sigmoid sinus. The left ascending pharyngeal artery jugular branch is also identified extending to the jugular bulb.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 right posterior communicating artery is medium-sized. The left posterior communicating artery is tiny. The anterior communicating artery is small. The vertebral arteries are similar in size. There is extracranial origin of the right posterior inferior cerebellar artery.

Output: 1.Findings suggest a small residual arteriovenous fistula involving the jugular branch of the ascending pharyngeal artery. This has not changed substantially since the prior exam.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific.


Instruction: Generate impression based on findings.

Input: 20 old female with with B cell lymphoma and known brain metastasis presents with headache and neck stiffness x 7 days. Interval resolution of the vasogenic edema within the left cerebral hemisphere. No definite evidence of the previously described mass on this study. High density material within the right transverse sinus which appears new when compared to the prior study.There is no evidence of intracranial hemorrhage or midline shift. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Interval resolution of the vasogenic edema involving the left hemisphere. No definite evidence of a mass within the limitations of this noncontrast study.2. High density material within the right transverse sinus possibly represents thrombosis. An MRI is recommended for further evaluation.These findings were discussed with Dr. Powell at the time of this dictation.


Instruction: Generate impression based on findings.

Input: Reason: history of high grade renal cancer s/p nephrectomy. eval for recurrence or metastasis History: renal cancer ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensities within the liver are unchanged and likely represent cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of local recurrence.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: HCC Study is limited due to lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with caudate lobe hypertrophy and prominent fissures. The predominantly T2 hypointense lesion in segment 4 measures 4.2 x 3.6 cm, previously 4.6 x 3.8 cm. The lesion contains inherent T1 hyperintensity likely representing blood products. Evaluation for hepatocellular carcinoma is significantly limited by the absence of intravenous contrast, however there are no additional areas of T2 signal hyperintensity or diffusion restriction to suggest new lesions.Cholelithiasis. Stable position of the cholecystostomy tube.SPLEEN: Splenomegaly measuring 15 cm. Splenic varices noted. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts are again seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ascending colonic wall thickening, likely representing portal colopathy. Otherwise no significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites.

Output: Limited study due to lack of intravenous contrast. Slightly decreased size of the treated hepatic lesion. No new lesions evident.


Instruction: Generate impression based on findings.

Input: 54-year-old woman with history of oral squamous cell carcinoma and status post liver transplant 5/3/2015, now with increased LFTs. ABDOMEN:LIVER, BILIARY TRACT: The patient is status post liver transplant with cholecystectomy and scattered foci of susceptibility artifact representing surgical clips. The common duct measures 8 mm in diameter and is patent through the hepaticojejunostomy. There is no intrahepatic biliary duct dilatation. The liver is normal in signal without focal hepatic lesion. Flow-voids are present in the portal and hepatic veins.SPLEEN: The spleen appears normal and measures 12 cm in length.PANCREAS: The pancreas appears normal without pancreatic duct dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys appear normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Liver transplant without evidence of complication or biliary obstruction.


Instruction: Generate impression based on findings.

Input: There is mild straightening of the cervical spine, similar to prior examination. There is minimal retrolisthesis of C5 on C6, which are likely degenerative in etiology. The vertebral body heights are well-maintained. There is progression of loss of disc height and disc desiccation throughout the cervical spine with moderate to severe loss of disc height at C5-C6 and C6-C7 and mild to moderate loss of disc height at the remaining levels. The bone marrow signal is mildly heterogeneous. The spinal cord is of normal caliber and signal. Prominence of the thyroid gland is again noted.C2-C3: Left greater than right facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Posterior disc osteophyte complex, thickening of the ligamentum flavum, bilateral uncovertebral hypertrophy and facet arthropathy, contributing to mild spinal canal narrowing and mild bilateral neural foraminal stenosis. Mild progression of spinal canal stenosis. No change in neuroforaminal narrowing.C4-C5: Posterior disc osteophyte complex, thickening of the ligamentum flavum, bilateral uncovertebral hypertrophy and facet arthropathy, contributing to mild spinal canal narrowing and mild right and moderate left neural foraminal stenosis. No significant change in spinal canal or neuroforaminal stenosis.C5-C6: Posterior disc osteophyte complex, thickening of the ligamentum flavum, bilateral uncovertebral hypertrophy and facet arthropathy, contributing to mild spinal canal narrowing and mild to moderate bilateral neural foraminal stenosis. No significant change in spinal canal or neuroforaminal stenosis.C6-C7: Posterior disc osteophyte complex, thickening of the ligamentum flavum, bilateral uncovertebral hypertrophy and facet arthropathy, contributing to mild spinal canal narrowing and minimal bilateral neural foraminal stenosis. No significant change in spinal canal or neuroforaminal stenosis.C7-T1: Posterior disc osteophyte complex, thickening of the ligamentum flavum, bilateral uncovertebral hypertrophy and facet arthropathy. No significant spinal canal stenosis or neural foraminal stenosis.

Output: Image quality is degraded by motion artifact. Degenerative cervical spondylosis, most prominent at C5-C6, with unchanged mild to moderate bilateral neural foraminal stenosis. Progression of degenerative disc disease at with mild progression of stenosis at C3-4 as described above. Variable multilevel neural foraminal stenoses are not significantly changed.


Instruction: Generate impression based on findings.

Input: 6-year-old male with history of brain abscess related to mastoiditis, status post resection. There are unchanged postoperative findings related to prior right tympanomastoidectomy andtemporal craniotomy. There is unchanged high signal within the mastoidectomy bowl consistent with fluid. There is an unchanged T2 hypointense rim-enhancing lesion in the right inferior temporal lobe along the mastoid roof, which measures up to 14 mm. There is confluent high T2 signal in the adjacent white matter, which is also unchanged. No new lesions are identified. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are skin-based fiducial markers.

Output: Postoperative findings related to right mastoidectomy and temporal craniotomy without significant change in size right temporal lobe chronic abscess or granuloma and associated vasogenic edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 25 years old Reason: 24 yo female with left foot pain over dorsum of foot, SCD machine fell on left foot. Still with tingling in goes. History: left toes with tingling, foot pain TENDONS: The imaged portions of the flexor and extensor tendons are intact. No tenosynovitis or tendon thickening.LIGAMENTS: Lisfranc ligament is intact.ARTICULAR SURFACES AND BONE: Marrow signal is normal. There are subchondral cystic changes at the first metatarsal head at the hallux sesamoid complex with reactive changes in the sesamoids indicating osteoarthritis. No acute fracture or malalignment. There is a mild hallux valgus deformity.No joint effusion.ADDITIONAL

Output: Moderate arthritis at the first MTP joint at the level of the hallux sesamoid complex.


Instruction: Generate impression based on findings.

Input: 83-year-old woman with headache. Question intracranial hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Right frontal encephalomalacia remains. Extensive periventricular and subcortical white matter hypoattenuation is present. This most likely represents age-indeterminate small vessel ischemic disease. Large vessel calcifications are noted. If acute stroke is suspected, MRI is recommended. The ventricles and basal cisterns are unchanged in size and configuration from the CT scan dated 10/20/2009.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Calcifications of the lateral limbus of the right eye are unchanged.

Output: 1. No CT findings of acute intracranial process. If there is clinical concern for acute stroke, MRI is recommended.2. Findings of small vessel ischemic disease, prior right frontal infarct, and large vessel calcifications.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:8/2/1962)Reason: stroke? History: slurred speech and L sided weaknessPROVIDER/ATTENDING NAME: KATIE TATARIS KATIE TATARIS There is a focus of diffusion restriction present along the corpus callosum on the left side associated T2 and FLAIR signal hyperintensity. There are some other foci which are high signal on diffusion-weighted imaging but also high signal on the ADC maps suggesting these represent T2 shine through.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 demonstrate some mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is an acute lacunar infarct present in the left genu of the corpus callosum.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 76 years, Male, newly diagnosed lung cancer. Evaluate for metastases. There is a 6 mm focus of enhancement along the surface of the inferior cerebellar vermis without associated parenchymal edema or mass effect. There is susceptibility effect involving this lesion with corresponding calcification demonstrated on recent CT. There is no significant abnormal parenchymal or meningeal enhancement in the remainder of the brain. There is minimal smooth enhancement along the right frontal dura which may be related to remote subdural hemorrhage, for example. No significant extra-axial collections are present on the current study. There is global parenchymal volume loss commensurate with patient's age. No intracranial mass effect, midline shift, or herniation. No hydrocephalus.There are multiple punctate foci of susceptibility involving the left paracentral lobule, left parietal and left occipital deep white matter, as well as in the left medial temporal lobe. These are consistent with chronic microhemorrhages. There are minimal foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild senescent white matter changes.There is a small lipoma involving the left anterior frontal scalp. No destructive lesions in the calvarium. Degenerative changes in the cervical spine with partial ankylosis of the C4 and C5 vertebrae partially imaged.

Output: 1. No definite evidence of intracranial metastatic disease. There is a 6 mm enhancing nodule along the inferior cerebellar vermis which appears to demonstrate calcifications. Imaging appearance would be compatible with a subependymoma although a solitary metastasis is not excluded. 2. Scattered chronic microhemorrhages in the left cerebral hemisphere as described above which are in a nonspecific distribution. Please see additional comments above.


Instruction: Generate impression based on findings.

Input: Reason: 64yoF R rotator cuff injury for 1.5years, please assess for tear, capsulitis, etc ROTATOR CUFF: Full-thickness tear of the supraspinatus tendon (series 10 image 15) with moderate muscle atrophy. There is high-grade articular surface partial tear of the infraspinatus tendon with mild muscle atrophy. There is small fluid signal lesion noted within the infraspinatus tendon measuring approximately 1 cm in transverse dimension and approximately 3 cm from the insertion, likely representing intramuscular ganglion cyst secondary to partial tear. There is mild thickening of the subscapularis tendon suggestive of tendinosis with mild muscle atrophy. Teres minor tendon and muscle are intact.SUPRASPINATUS OUTLET: Moderate degenerative change in the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. Small degenerative subchondral cysts noted in the humeral head. Glenohumeral cartilage without focal defect. Sublabral foramen is noted in the anterior superior labrum. No discrete labral tear is identified on this non-arthrogram study. BICEPS TENDON: Biceps tendon is intact and located within the bicipital groove.ADDITIONAL

Output: 1. Full-thickness tear of the supraspinatus tendon with moderate muscle atrophy. 2. High-grade articular surface partial tear of the infraspinatus tendon with mild muscle atrophy and intramuscular ganglion cyst.


Instruction: Generate impression based on findings.

Input: Transient cerebral ischemic attack. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening and small fluid levels in the bilateral maxillary sinuses.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Parkinson's disease: preoperative planning for DBS. The images are degraded by patient motion. Nevertheless, there is no evidence of acute intracranial hemorrhage or tumor. However, there is a left middle cranial fossa arachnoid cyst that measures up to 25 mm with mass effect upon the anterior temporal lobe. There is also scattered cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: Left middle cranial fossa arachnoid cyst and probable small vessel ischemic disease of the white matter. Otherwise, unremarkable treatment-planning MRI.


Instruction: Generate impression based on findings.

Input: 18 years old male patient with a L5-S1 left lateral recess soft tissue mass please evaluated for biopsy and perform CT guided biopsy. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the mass within the left lateral recess of the spinal canal. Following needle removal images obtained that demonstrate no complications .

Output: L5-S1 level biopsy of mass within the spinal canal at the left lateral recess. Seven samples were obtained and delivered to pathology.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with multiple sclerosis. Assess for progression. Brain:Extensive nearly confluent T2 hyperintensity is present within the periventricular regions of the cerebral hemispheres with multiple additional scattered focal lesions seen elsewhere in the cerebral hemispheres, basal ganglia and cerebellum. No significant interval change in the size or number of these lesions is seen when compared to the prior exam.Ring enhancement of one of the right periventricular lesions has significantly subsided though it is still vaguely detectable. No additional clearly enhancing lesions are seen. There is a generalized pattern of microvascular enhancement in the periventricular regions.No evidence of significant parenchymal edema or mass effect is seen. Mild cerebral volume loss appears similar to prior. No abnormal extra-axial fluid collections are detected. Ventricles are stable in size and morphology. A hypoenhancing right intrasellar lesion is partially visualized on this exam.C-spine:Successful cord T2 signal abnormality is identified at several locations including the dorsal right aspect at C2, the lateral left aspect at C2-3, and the dorsal right aspect at C3. Accounting for differences in technique, no significant change in the size, number or distribution of these lesions is seen. These lesions show no definite pathologic enhancement. Spinal cord morphology and caliber are otherwise within normal limits.Straightening of the cervical lordosis is seen. Spinal alignment is otherwise unremarkable. The vertebral bodies demonstrate normal height and marrow signal characteristics. No significant disc degeneration, spinal canal or neuroforaminal stenosis is seen.

Output: 1.No significant interval change in the size, number or distribution of extensive white matter disease in the brain. Some interval subsidence of enhancement is seen pertaining to one of the right periventricular lesions when compared to the prior examination.2.Multiple scattered cervical spinal cord lesions are redemonstrated showing no significant interval change.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for posterior tibial tendon rupture right History: pain, edema, with inability to single heel raise right foot TENDONS: There is thickening and intermediate signal intensity within the posterior tibialis tendon indicating mild to moderate tendinosis. There is linear increased fluid signal intensity within the distal fibers of the posterior tibialis tendon at the level of its insertion on the navicular bone likely representing an interstitial insertional tear. There is no significant retraction. The flexor digitorum longus and flexor hallucis longus tendons are intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance. The extensor tendons appear intact.LIGAMENTS: There is thickening of the anterior talofibular ligament which may represent prior injury or sprain. The lateral collateral ligament complex otherwise appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is subchondral cyst formation within the posterior aspect of the tibial plafond with sclerosis, joint space narrowing, and osteophyte formation indicating mild osteoarthritis. Otherwise no bone marrow signal abnormality is identified. No osteochondral defect is seen ADDITIONAL

Output: 1. Tendinosis of the posterior tibialis tendon with partial thickness and interstitial insertional tearing as described above. No evidence of retraction.2. Osteoarthritis of the ankle.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cervical disc disorder with myelopathy, unspecified cervical regionClinical question: new symptoms of tingling to hands, increased HNP?Signs and Symptoms: increased/new tinging to hand The cervical vertebral bodies are appropriate in overall alignment and height. The patient status post anterior fusion at C6-7. There is a cord syrinx present measuring up to 1.5 mm in diameter which is unchanged since prior exam. Any subtle differences may be accounted for on the basis of difference in scan technique. There are some subtle T2 signal hyperintensity surrounding the central canal just above the C4-5 disc space level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are endplate and uncovertebral osteophytes present at this level associated with the mild encroachment of left-sided exiting nerve roots. This has not changed substantially when compared to the prior exam.At C4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with bilateral uncovertebral osteophytes and endplate osteophytes. There is ligamentum flavum hypertrophy present. There is effacement of spinal fluid ventral and posterior the spinal cord at this level and encroachment of the exiting nerve roots bilaterally within the neural foramina. There is moderate spinal stenosis at this level. There is also present on the prior exam and has not changed substantially. There are endplate reactive changes at this level which are high signal on T1.At C5-6 there is loss of disc space height, disc desiccation and endplate reactive changes of a moderate degree. There are endplate uncovertebral osteophytes present at this level which are worse in the left side when compared to the right. There is encroachment of the exiting nerve roots in the neural foramina. Overall there is no significant change compared to the prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is redemonstration of a small syrinx (enlarged central canal) in the lower cervical spinal cord which was also present on the prior exam and has not really changed in size. Some subtle signal hyperintensity surrounding the central canal just above the C4-5 disc space level suggests possible edema surrounding the syrinx on the current exam not readily identified on the prior. Differences in scan technique confound comparison of this edematous component.2.There are multilevel degenerative changes present in the cervical spine with moderate spinal stenosis at C4-5 which are stable compared to prior exam. There is encroachment of exiting nerve roots bilaterally at C4-5 and on the left-side at C5-6. There is milder encroachment of the right-sided exiting nerve roots at C5-6 and left-sided exiting nerve roots at C3-4.


Instruction: Generate impression based on findings.

Input: 49-year-old male with recurrent left paresthesias. Rule out thrombosis which was possibly seen on MRI/MRA.IMAGE ACQUISITIONS: Brain CTA with contrast, neck CTA with contrast. 120 cc nonionic Omnipaque 350 at 4.5 cc/sec. Left carotid artery: Mild noncalcified stenosis at the origin of the internal carotid artery. There is calcifications of the cavernous portion of the internal carotid artery.Right carotid artery: Calcifications of the cavernous portion of the internal carotid artery. No significant stenosis or septations elsewhere.Left are two artery:Left vertebral artery: Severe narrowing of the left vertebral artery from its origin to the basilar artery with only faint wisps of contrast seen. This is either due to marked hypoplasia or intrinsic disease.Right vertebral artery: No significant stenosis or calcification.BRAIN

Output: 1. Left vertebral artery is severely narrowed, either due to hypoplasia or intrinsic disease.2. P1 segments of the PCAs are not well visualized, either due to absence or hypoplasia3. Mild stenosis of the origin of the left internal carotid artery4. Noncontrast brain CT shows small vessel ischemic disease of indeterminate age and multiple bilateral lacunar infarcts


Instruction: Generate impression based on findings.

Input: Lung cancer to bone, worsening back pain, weakness. Evaluate for cord compression. There are numerous lesions throughout the spine including the anterior and posterior elements consistent with known metastatic disease. There is mild effacement of the dorsal thecal sac at the C5-C6 level related to tumor involving the posterior elements without evidence of cord compression. Evidence of multilevel decompressive laminectomies in the cervical spine with fusion are noted. There is also no evidence of cord compression in the thoracic or lumbar spine. No obvious cord signal abnormality.

Output: Diffuse osseous metastatic disease throughout the spine. No cord compression is identified.Please note this is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol, details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: 16-year-old male with history of acute on chronic pancreatitis.EXAMINATION: Pancreas MRI and MRCP without /with IV contrast and Secretin1/25/2016 ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. SPLEEN: Small splenule. The splenic vein is attenuated near the confluence, however it is patent.PANCREAS: No evidence of pancreatic divisum or annular pancreas.There is increased internal and peripancreatic T2 signal abnormality as well as diffuse parenchymal restricted diffusion compatible with acute pancreatitis.The pancreatic ductal anatomy is abnormal. There is a persistent duct of Santorini. The main pancreatic duct bifurcates at the level of the pancreatic head with one branch draining into the duct of Santorini and one branch draining into the duct of Wirsung which drain into the minor and major papillae, respectively. After secretin administration, the duct of Santorini and Wirsung dilate equally indicating similar drainage rates.At the level of the pancreatic head, there is a subcentimeter cystic lesion which communicates with the duct of Santorini (image 29 of series 401). No enhancement is appreciated on postcontrast imaging.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Acute pancreatitis.2. Abnormal pancreatic ductal anatomy as described above.3. Focal cystic lesion in the pancreatic head communicating with the accessory duct likely representing focal ductal dilatation secondary to stricture from chronic pancreatitis.4. Patent, but attenuated splenic vein near the confluence.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of unspecified part of unspecified bronchus or lung Secondary malignant neoplasm of unspecified siteClinical question: progression of lung cancerSigns and Symptoms: shortness of breath The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No intracranial lesions are appreciated to suggest metastatic disease to the brain.


Instruction: Generate impression based on findings.

Input: Patient with worsening confusion and headaches. History of metastatic renal cell cancer with brain metastases. Undergoing whole brain radiation. Rule out bleed, edema, increased intracranial pressure. Nonenhanced CT of brain:Examination demonstrate a slightly high density mass in the basal cistern measuring 13 mm x 16.6-mm in transaxial dimension. There is evidence of edema in the hypothalamic and bilateral basal ganglia. Considering patient's provided clinical history of malignancy this finding could represent a metastatic focus. Further follow-up with an MRI is recommended to exclude other lesions in this location.Shunted lateral ventricles with complete collapse of right lateral ventricle and normal appearing third ventricle and left lateral ventricle.Foci of encephalomalacia in the right frontal lobe under a right frontal craniectomy may represent site of prior surgical intervention for removal of tumor. There is no evidence of hemorrhage or midline shift.Calvarium demonstrates right high convexity frontal craniotomy and is otherwise negative.Limited view of paranasal sinuses and mastoid air cells are unremarkable. Limited view of orbits are negative.

Output: 1.High density mass in the basal cistern/hypothalamic region with surrounding edema highly concerning for metastatic lesion considering provided history of renal cell cancer.2.No evidence of any additional metastatic foci and no evidence of midline shift or hydrocephalus.3.High convexity right posterior frontal encephalomalacia under a right frontal craniectomy.4.Calvarium, paranasal sinuses and mastoid air cells are intact.


Instruction: Generate impression based on findings.

Input: 67-year-old male. Pain. Evaluate for medial meniscus pathology. MENISCI: Mild globular signal abnormality in the posterior horn of the medial meniscus suggestive of intrasubstance degeneration. No discrete tear is evident. The lateral meniscus is intact with normal signal and morphology.ARTICULAR CARTILAGE AND BONE: Tibiofemoral compartment cartilage is intact without defects. Mild diffuse thinning of the medial patellar articular cartilage without a full thickness defect. Bone marrow signal intensity is within normal limits. Mild osteoarthritis affects the knee with tiny osteophytes.LIGAMENTS: Collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Intrasubstance degeneration in the medial meniscus without a discrete tear.2. Mild medial patellar facet cartilage thinning without a full thickness defect.


Instruction: Generate impression based on findings.

Input: Female, 72 years old, with back pain and lumbar stenosis. Preoperative planning for decompression. A grade 1 anterolisthesis of L5 relative to S1 is new compared to the 2006 examination. Sagittal alignment is otherwise unremarkable.A T2 hyperintense and T1 heterogeneous lesion within the anterior aspect of the L3 vertebral body is unchanged and likely represents an atypical hemangioma. No other suspicious marrow space lesions are seen. No evidence of marrow edema is detected.Visualized distal spinal cord, conus and cauda equina are unremarkable except as discussed below. No epidural abnormalities are observed.L1-2: Mild facet arthropathy, progressed. No significant spinal canal or foraminal stenosis. L2-3: Mild facet arthropathy and ligamentum flavum thickening, progressed. Minimal bulging disc, progressed. No significant spinal canal or foraminal stenosis. L3-4: Mild facet arthropathy and ligamentum flavum thickening, progressed. Mild predominantly laterally bulging disc without change. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, unchanged. L4-5: Advanced facet arthropathy and ligamentum flavum thickening, progressed. Minimally bulging disc, slightly progressed. In combination with a congenitally slender spinal canal, there is a significant spinal canal stenosis with crowding of the cauda equina, worse from prior. Mild bilateral foraminal narrowing is unchanged. L5-S1: Advanced facet arthropathy and ligamentum flavum thickening, progressed. Disc uncovering and disc bulging, with mild loss of disc height, progressed. In combination with a congenitally slender spinal canal, there is a significant spinal canal stenosis with crowding of the cauda equina equina nerve roots which is progressed. Mild to moderate bilateral foraminal narrowing is also progressed.

Output: 1.Progressive degenerative disease is seen most notably at L4-5 and L5-S1. In combination with a congenitally slender spinal canal, disc and posterior element degeneration results in a significant spinal canal stenosis at these levels.2.Relatively mild degenerative findings are slightly progressed at other levels, most particularly involving the facet joints.


Instruction: Generate impression based on findings.

Input: Reason: history of metastatic renal cell carcinoma with new brain metastases; evaluate for radiosurgery treatment planning History: brain metastases The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an 11 x 8 mm enhancing nodule superior aspect of the right cerebellar hemisphere and the right superior semi-lunar lobule it is associated susceptibility effect. It is stable compared to the prior exam.The visualized portions of the paranasal sinuses demonstrate a mucus retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Right cerebellar lesion is suspected to represent metastatic disease. Associated blood products are identified within the lesion indicating that it is fairly vascular.2.This is a limited exam for the purpose of surgical navigation.


Instruction: Generate impression based on findings.

Input: 6-year-old girl with history of tuberous sclerosis and seizures, evaluate for SEGA. There are numerous T2 hyperintense areas of subcortical and cortical signal in the bilateral cerebrum, stable in extent and size from the prior examinations. Additionally, there are subependymal nodules with increased T2 signal and enhancement. These nodules are stable in size compared to the prior examination, the largest of which measures 9 mm in the left caudothalamic groove (701/16). There is no evidence of ventricular obstruction and the ventricles are normal in size and configuration. The orbits, paranasal sinuses, skull, and scalp soft tissues are unremarkable.

Output: Stable intracranial findings of tuberous sclerosis.


Instruction: Generate impression based on findings.

Input: Mild dementia. Severe AIDS. Susceptibility-weighted imaging is limited by patient motion but there is no gross intracranial hemorrhage. There is no evidence of intracranial mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is marked global parenchymal volume loss but no hydrocephalus. There is incidental cavum septa verge. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening, most pronounced in the maxillary and ethmoid sinuses. A small midline nasopharyngeal vault cystic lesion measures up to 7 mm and may represent Thornwaldt cyst. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1.Moderate global parenchymal volume loss, may be AIDS-related. Brain examination is otherwise unremarkable.2.Nonspecific mild maxillary and ethmoid mucosal thickening.


Instruction: Generate impression based on findings.

Input: 42-year-old male with mental status change There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: Male, 4 years old, history of Chiari malformation surgery, annual evaluation, please evaluate CSF flow. The cerebellar tonsils remain pointed and herniate approximately 13 to 14 mm below the level of the foramen magnum, unchanged in extent. As before, there is a slight retroflexion of the dens which abuts the cervicomedullary junction causing slight flattening, unchanged. These abnormalities contribute to effacement of the CSF space at the level of the foramen magnum. On CSF flow imaging, there is attenuated but detectable flow along the anterior aspect of the cord, and minimalflow along the posterior aspect of the cord and the tonsils, unchanged.The spinal cord demonstrates normal signal intensity and caliber throughout. No evidence of syrinx formation is seen. A full complement of normally formed vertebral bodies is seen. No dysraphism is detected. The intervertebral disks are normal. No spinal canal or foraminal narrowing is seen.

Output: 1.Stable Chiari I malformation and CSF flow imaging.2.No MRI evidence of spinal cord syrinx.


Instruction: Generate impression based on findings.

Input: History of HCC status post intra-operative ablation. ABDOMEN:LIVER, BILIARY TRACT: The left hepatic dome ablation cavity measures 5.4 x 4.3 cm. There is intrinsic intermediate and high T1-weighted signal intensity internally suggestive of proteinaceous/blood products. Within the ablation cavity there is a curvilinear region of intrinsic T1-hyperintensity which does not completely null on subtraction imaging, likely due to mis-registration. No evidence of internal enhancement or marginal recurrent and/or residual disease.In the right hepatic dome there is a 7-mm T2-weighted hypointense, T1-weighted hyperintense subcentimeter focus (series 501/35), without associated arterial enhancement. No suspicious arterial enhancing lesion.Numerous punctate siderotic nodules.Cholelithiasis without cholecystitis. No intrahepatic or extrahepatic biliary ductal dilatation. The vessels are patent.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.

Output: 1. Interval RFA ablation of the left hepatic dome lesion without evidence of residual or recurrent disease.2. 7-mm right hepatic dome lesion may represent a dysplastic nodule; attention to this lesion on follow-up surveillance imaging is recommended.


Instruction: Generate impression based on findings.

Input: The internal auditory canals are symmetrical and normal in size. The inner ears are normal. There is no mass or abnormal enhancement. The imaged intracranial structures are unremarkable. There is minimal fluid within the right mastoid air cells and mild ethmoid sinus mucosal thickening.

Output: 1.Normal MRI of the internal auditory canals. 2.Minimal nonspecific fluid within the right mastoid air cells.


Instruction: Generate impression based on findings.

Input: Diagnosis: Myoclonus Abnormal reflexClinical question: assess for cervical stenosis/myelopathySigns and Symptoms: gait impairment, hyperreflexia, H/O Sjogren syndrome MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disk dessication present. A 7mm T2 hyperintense focus within the C2 vertebral body which enhance following gadolinium is stable since the prior exam.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There are left sided uncovertebral osteophytes at this level associated with encroachment of the left exiting nerve roots. This is stable since the prior exam.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Mild degenerative changes in the cervical spine worse at C3-4 where there is mild to moderate encroachment of left sided exiting nerve roots. This is stable since the prior exam from 20132.C2 lesion is stable since the prior exam from 2013 and most likely benign.3.Several periventricular and subcortical white matter changes of a mild degree are nonspecific. They are likely of likely clinical significance.


Instruction: Generate impression based on findings.

Input: Diffuse large non-Hodgkin's lymphoma status post 6 cycles chemotherapy. Given the limitations of the lack of contrast material, I see no evidence of pathologic lymphadenopathy within the neck. Visceral structures are unremarkable.Bone windows reveal no osseous abnormality

Output: No definite lymphadenopathy in the study which is limited by the lack of IV contrast.


Instruction: Generate impression based on findings.

Input: Worsening headache, evaluate for brain pathology. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several punctate foci of increased T2/FLAIR signal within the periventricular and subcortical white matter which are favored to reflect normal variant perivascular spaces. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No definite abnormalities or specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of spinal cord . C1 vertebral mass. Please provide biopsy Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the C1 vertebral lesion. There is a soft tisse mass eroding and replacing the right half of the C1 vertebral body which partially involves right vertebral artery compresses the right jugular vein against the styloid process and displaces the right internal coronary inferiorly. The tumor extends to the dural surface and into the perivertebral space and measures 5.3 by 3.3 cm greatest axial dimensions and 3.3 cm greatest superior inferior dimension with a 5 cm AP dimension. The mass enhances following contrast administration. Follow-up scan indicates the biopsy was obtained from the center of the tumor. The right jugulodigastric node there measures 11 x 11 mm axial dimensions but does not meet the size criteria for lymphadenopathyIncidental note is made of numerous tonsilliths

Output: 1.C1 vertebral bone biopsy under CT guidance. samples were delivered to pathology for analysis. The cytologist preliminarily reported suspected plasmacytoma. The tumor essentially replaces the right sided bony elements of C1 and extends to displace adjacent critical vessels . It compresses RIJV against the styloid, displaces and mildly encases RVA which is the nondominant vertebral artery and displaces RICA.


Instruction: Generate impression based on findings.

Input: 70 year old man with history of multiple VT ablations, suspected cardiac sarcoidosis, referred for repeat cardiac MRI to evaluate Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 161 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 73 ml (normal range 47+/-19). There are no regional wall motion abnormalities. There is persistent late gadolinium enhancement in the basal lateral and a small focus of the basal anterior wall, which were seen on the previous study but appear more hyperintense in signal today. This could be clinically consistent with the patient's history of recent previous endocardial ablation, otherwise a prior myocardial infarction could be considered.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 52%, the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVEDV is 158 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 76 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trivial 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 no significant tricuspid regurgitation.AortaThe aortic root at the level of the SOV is 4.3 cm (stable from last exam). Ascending aorta at the level of the pulmonary bifurcation is upper normal (3.6cm). 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 mildly dilated (33mm).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. Normal LV size with normal systolic function (EF 56%). When compared to the previous study, the volumes are smaller and the function appears visually improved. 2. There is persistent late gadolinium enhancement in the basal lateral and a small focus of the basal anterior wall, which were seen on the previous study but appear more hyperintense in signal today. This could be clinically consistent with the patient's history of recent previous endocardial ablation, otherwise a prior myocardial infarction could be considered.3. Normal size RV with normal systolic function (EF 52%). 4. Stable dimensions of sinus of valsalva and upper normal ascending aorta dimensions.5. Mild main pulmonary artery dilation.


Instruction: Generate impression based on findings.

Input: Female, 76 years old. Reason: Neck and shoulder pain with fever History: neck and shoulder pain Cervical spine: The lower cervical spine is not well-seen on the lateral view due to overlying anatomy. Severe degenerative disc disease affects C4-5, C5-6, and C6-7. There is mild multilevel facet joint arthritis. Apparent narrowing of the neuroforamina on the left may in part be an artifact of patient positioning. There is loss of the normal cervical lordosis, but otherwise alignment is within normal limits. Severe osteoarthrosis affects the right shoulder. Calcifications in the neck lateral to the cervical spine likely reside in the carotid vasculature.Thoracic spine: The bones appear demineralized. There is a mild rightward curvature of the thoracic spine which may in part be an artifact of patient positioning. There is mild/moderate multilevel degenerative disc disease. The T11-12 disc space is not well seen, which we suspect is due to relatively severe degenerative disc disease. However, if there is clinical concern for discitis at this location, MRI is recommended for further evaluation.

Output: 1.Degenerative arthritic changes as described above.2.The T11-12 disc space is not well seen, which we suspect is due to relatively severe degenerative disc disease. However, if there is clinical concern for discitis, MRI is recommended for further evaluation.