Instruction: Generate impression based on findings.

Input: History of acute cholecystitis secondary to biliary stricture status post biliary stent placement. History of pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: There is moderate intrahepatic biliary ductal dilatation to the level of the common hepatic duct, increased from the prior especially in the right hepatic lobe. The visualized common hepatic duct demonstrates diffuse circumferential wall thickening and a focal region of enhancement and thickening centrally (series 1203, image 428). The common bile duct stent is noted resulting in surrounding susceptibility artifact.Contracted gallbladder with percutaneous cholecystostomy tube.Small cyst near the right hepatic dome. No suspicious focal lesion. Transient hepatic intensity difference noted in the posterior segment of the right hepatic lobe. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas. There is mild prominence of the main pancreatic duct at the level of the pancreatic body with an abrupt transition point without a focal lesion, suspicious for a stricture although an underlying neoplasm cannot be excluded (series 801/57).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several round regions of decreased T2 weighted signal intensity in the kidneys bilaterally with decreased enhancement and associated striated nephrograms, similar to prior CT. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild basilar atelectasis.

Output: Long segment peripherally thickened enhancing stricture of the proximal common hepatic duct with increasing upstream biliary ductal dilatation. Given the history of negative EUS/ERCP bile duct brushings (as cholangiocarcinoma/malignancy can appear similarly) and constellation of findings in the kidneys and pancreas auto-immune sclerosing cholangiopathy should be considered.Prominence of the main pancreatic duct with abrupt transition at the pancreatic body without a focal lesion, suspicious for a stricture (similar etiology as above) although underlying neoplasm cannot be excluded.The renal findings described could also be a manifestation of IgG4 related autoimmune disease.


Instruction: Generate impression based on findings.

Input: History: pain. Rule out epicondylitis. LIGAMENTS: The ulnar collateral ligament, lateral ulnar collateral ligament, and radial collateral ligament appear intact within the limitations of a non arthrogram study.TENDONS: The common flexor and extensor tendons appear intact. The biceps and brachialis tendons appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. SURROUNDING STRUCTURES: There is increased signal abnormality within the ulnar nerve as it traverses within the cubital tunnel under the ligament of Osbourne which may represent a neuritis and clinical correlation is indicated.ADDITIONAL

Output: 1. No evidence of epicondylitis as clinically questioned.2. Increased signal abnormality within the ulnar nerve as it traverses through the cubital tunnel which may represent a neuritis and clinical correlation with the patients symptoms is recommended.


Instruction: Generate impression based on findings.

Input: Reason: RCT? History: pain Slightly suboptimal evaluation secondary to metallic susceptibility artifact related to the patient's history of prior rotator cuff repair.ROTATOR CUFF: There is linear increased signal abnormality within the distal supraspinatus tendon approximately 1 cm proximal to its insertion on the greater tuberosity measuring approximately 7 mm in AP dimension. This likely represents a near full-thickness bursal surface tear which is partially filled with granulation tissue, although focal tendinosis is also a possibility. There is also increased signal abnormality within the anterior fibers of the infraspinatus indicating a partial-thickness tear involving less than 50% of the tendon width measuring approximately 6 to 8 mm in the AP dimension. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a moderate amount of fluid within the subacromial subdeltoid bursa. There are foci of low signal intensity debris internally which may represent a bursitis. Moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Moderate osteoarthritis affects the glenohumeral joint. There is heterogeneity and increased signal intensity within the superior and anterior glenoid labrum likely representing a combination of degeneration and degenerative tearing. There is a small glenohumeral joint effusion.BICEPS TENDON: Note is made of postsurgical changes of a prior biceps tenodesis. ADDITIONAL

Output: 1. Postsurgical changes of prior rotator cuff repair with findings likely representing a high grade near full-thickness tear of the supraspinatus although focal tendinosis is a consideration. 2. Rotator cuff tendinosis and partial thickness tearing of the infraspinatus as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Status post endovascular treatment of a giant vertebrobasilar aneurysm. Evaluate residual aneurysm and mass effect. MRI of the brainThere are five or six punctate foci of diffusion restriction in the cerebellum, thalami and occipital lobes as well as left middle frontal gyrus.There is a 42x34x34 mm premedullary and prepontine mass (thrombosed aneurysm now with coils distally and proximally) with heterogenous signal on T1 and T2 associated with flow voids. Much of the signal is hyperintense on T1WI.The brainstem is displaced and compressed posteriorly by the mass and drapes over the mass. The inferior aspect of the 4th ventricle is narrowed and the foramina of Luschka are distorted. There is mixed signal along the periphery of the mass on SWI phase imaging with some bright signal and some dark signal some of which is opposite in signal on the corresponding magnitude SWI images (suggesting peripheral calcification). The vertebral arteries and basilar artery are contiguous with this mass.A similar signal characteristic well-circumscribe mass is present in the left upper carotid space measuring 16x22xmm. It is stable compared to the prior exam.The temporal horns of the lateral ventricles are dilated. Overall there is mild enlargement of the third ventricle (10 mm width) and lateral ventricles (41mm biventricular diameter at the level of foramina of Monro).There are several supratentorial periventricular and subcortical white matter T2 and FLAIR hyperintense lesions without diffusion restriction.Normal vascular flow voids are present in the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The patient is status post embolic coil occlusion of a 44x35x35mm giant vertebrobasilar aneurysm and occlusion of the LVA distal to the PICA origin. Stents are present in the RVA across the origin of the aneurysm. There is a residual 2mm aneurysm at the more proximal RVA neck of the aneurysm extending superiorly. There is a 26x26x16 mm LICA cervical segment aneurysm redemonstrated which is not adequately compared to the prior exam because it was not entirely included on the prior exam.The anterior communicating artery is identified. The posterior communicating arteries have dilated since the prior exam.

Output: 1.Status post stent assisted embolic coil occlusion of a vertebrobasilar junction giant aneurysm and embolic occlusion of the left vertebral artery (LVA) distal to the PICA. There is 2mm residual filling of the aneurysm at the neck of the RVA component of the aneurysm.2.Several punctate foci of diffusion restriction in the posterior circulation likely represent microinfarcts.3.The overall dimensions of the aneurysm and the mass effect remain stable compared to the prior exam. The ventricles are stable.4.Stable appearing LICA cervical segment dissecting aneurysm.


Instruction: Generate impression based on findings.

Input: 31 years, Male, Reason: Evaluate for HCC History: Cirrhosis with a concerning findings on MRI/Unable to biopsy. ABDOMEN: Left gastric embolization coils produces artifact in this region which obscures visualization.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mildly nodular contour. Segment 4 lesion is unchanged in size measuring 2.3 x 1.8 cm (9/225). This lesion has some signal dropout on out of phase images, indicating some steatosis. No significant enhancement identified, however there is mild hypointensity on portal venous and delayed phase images which is similar to the prior exam. There is also a minimal amount of adjacent ill-defined hypointensity on post contrast images which is unchangedSubcentimeter right hepatic lobe simple cyst. Transjugular intrahepatic portosystemic shunt is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland is not visualized. Right adrenal gland is normal.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: Segment 4 lesion is stable in size and has nonspecific MRI features. Continued follow up is recommended.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma with brain metastases following 4th cycle of immunotherapy. There has been interval decrease in size of the multiple treated supratentorial and infratentorial brain metastases, which contain T1 hyperintense components with susceptibility effect. For example, a left inferior frontal gyrus measures up to 15 mm, previously 19 mm, and a right lateral cerebellar hemisphere lesion measures up to 8 mm, previously 10 mm. There is diffuse nonspecific periventricular white matter T2 hyperintensity. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval decrease in size of the treated supratentorial and infratentorial brain metastases.


Instruction: Generate impression based on findings.

Input: 52-year-old male, evaluate lesion in cervical spine. Evaluate for tumor in cervical spine.IMAGE ACQUISITION: Contrast-enhanced CT of the cervical spine was performed after the administration of 80 mL of Omnipaque 350 at 2.5 ml/sec. Again seen is abnormal sclerosis of the left occipital condyle, left lateral mass of C1, posterior arch of C1 with associated collapse. This was previously described on the prior CT and its overall appearance of is unchanged. Associated soft tissue and marrow abnormalities are better appreciated on the recent MRI.Also seen is a subtle focus of cortical erosion along the medial aspect of the right occipital condyle which was present retrospectively on the prior CT. This lies just lateral to a fluid signal collection much better seen by prior MR technique.The vertebral arteries are patent.There is no evidence of fracture or significant degenerative disease in the cervical spine.A new air-fluid level is present in the sphenoid sinus.

Output: 1. Abnormal sclerotic change in the left occipital condyle and left C1 vertebra which has not significantly changed from the prior study. There is also subtle cortical erosion along the medial aspect of the right occipital condyle which was also present retrospectively on the prior CT. These findings in addition to the abnormalities seen on the recent MRI are suspicious for neoplastic disease versus osteoradionecrosis. Infection is considered less likely.2. New air-fluid level in the sphenoid sinus.


Instruction: Generate impression based on findings.

Input: Lower extremity wound Examination is limited by motion artifact on multiple sequences.There is a large ulceration of the anterolateral soft tissues of the leg at approximately the level of the junction between the upper and middle thirds. The ulceration extends into the tibialis anterior muscle and appears to disrupt the central tendon. There is edema and enhancement of the tibialis anterior muscle and adjacent soft tissues. The ulceration extends to within a couple of millimeters of the anterior tibial cortex where there is a small defect as seen on the recent radiographs. While this may represent an erosion related to the ulceration, there is no abnormal marrow signal intensity in the underlying bone to confirm osteomyelitis. This defect may be posttraumatic in nature.The fibula appears normal. There is subcutaneous edema extending laterally down the leg into the ankle. There are no additional fluid collections separate from the ulceration. Small foci of signal void along the margins of this ulceration may represent foci of gas or less likely tiny metallic foreign bodies. Subcutaneous edema is also noted along the medial ankle.

Output: Soft tissue ulceration with extension into the tibialis anterior muscle and a small superficial cortically-based defect of the adjacent tibia. While this defect could represent erosion due to the ulceration, there is no abnormal signal intensity to confirm osteomyelitis and it is possible this defect is posttraumatic in nature.


Instruction: Generate impression based on findings.

Input: Family history of bicuspid AV: Quality of echocardiogram limited. Cardiac MRI ordered to evaluate aortic valve morphology and aorta Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 61 ml/m2 (normal range: 74+/-15), the LVEDV is 148 ml (normal range 142+/-34), the LV end systolic volume index is 22 ml/m2 (normal range 25+/-9), the LVESV is 54 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 125 g (normal range 164+/-36). 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.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 55%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 169 ml (normal range 142+/-31), the RV end systolic volume index is 31 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 no significant aortic regurgitation. The aortic valve is trileaflet.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.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Quality of MRA poor precluding aorta measurements.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium. Prominent azygous vein which drains into the SVC. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%3. Prominent azygous vein which drains into the SVC. 4. Quality of MRA poor precluding aorta measurements.


Instruction: Generate impression based on findings.

Input: 44 years, Female, Reason: h/o Chronic pancreatitis with PRSS1 gene mutation. Pt needs secretin stimulating MRCP. History: Abdominal Pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is diffuse hepatic steatosis with regions of fatty sparing. A wedge-shaped segment 6 focus shows diffusion restriction, edema and progressive enhancement. Left hepatic subcentimeter simple cystsStatus post cholecystectomy. The common bile duct is mildly dilated to 9 mm with a small amount of stricturing in the distal common bile duct which is likely benign, no obstructing lesion delineated. Mild intrahepatic biliary ductal dilatation.SPLEEN: Multiple peri-splenic collateral vessels. The splenic vein is not visualized and likely thrombosed .PANCREAS: There are areas of narrowing involving the mid pancreatic duct with multiple dilated side branches. A blunted response to secretin is observed, compatible with element of exocrine dysfunction. There is diffusely decreased signal on T1-weighted images. Overall these findings suggest sequela of chronic pancreatitis.ADRENAL GLANDS: Two left adrenal lesions measuring 8 mm and 7 mm appear to lose signal on phase images, likely adenomas, are unchanged.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.

Output: 1.Findings of chronic pancreatitis.2.Thrombosis of the splenic vein.3.Wedge-shaped region of diffusion restriction, edema and enhancement within the liver. A vascular etiology is suspected, such as a small portal venous thrombus which is not directly visualized.4.Likely benign stricturing of the distal common bile duct with mild intrahepatic and extrahepatic biliary ductal dilatation.5.Left adrenal nodules are stable, likely adenomas.6.Contrast extravasation as above.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with history of breast cancer. Baseline exam prior to starting on clinical trial. A 22 x 14 mm region of enhancing marrow replacement is evident within the right frontal bone. This correlates with an area of increased radiotracer uptake on prior bone scan. A lobular subcentimeter enhancing focus within the left parietal bone may simply represent a vascular space.Postcontrast images are degraded by motion artifact, but within this limitation, no definite pathologic parenchymal or extra-axial enhancement is seen. No evidence of active parenchymal edema is detected.Encephalomalacia is evident involving the right insula, basal ganglia and corona radiata with surrounding parenchymal T2 hyperintensity and mild associated susceptibility. Scattered additional foci of T2 hyperintensity are evident within the periventricular and subcortical white matter.No evidence of any acute intracranial hemorrhage is seen. No abnormal collections are detected. Ex vacuo dilatation of the right lateral ventricle is demonstrated. The ventricular system is otherwise within normal limits.

Output: 1.A lesion within the right frontal bone most likely represents a metastatic deposit, particularly given the nuclear medicine evidence for osseous metastatic disease elsewhere.2.Within the limitations of a motion degraded exam, no definite evidence of any parenchymal metastatic disease is seen.3.Chronic sequelae of right MCA distribution ischemia are demonstrated along with scattered lesions which likely reflect chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: 46-year-old female patient with ileocolonic Crohn's disease status post ileocecectomy off therapy. Strictured anastomosis. Evaluate for ileal disease. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions identified. No intra or extrahepatic ductal dilatation. The gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of an ileocecectomy. There is narrowing and wall thickening of the neo-terminal ileum over a 6 cm length with mild wall enhancement near the ileocolonic anastomosis compatible with acute on chronic disease (image 733, series 16). There is upstream dilatation of small bowel. There is fibrofatty proliferation.There is multifocal narrowing of the distal descending colon and rectosigmoid colon with corresponding wall enhancement compatible with acute inflammation. Furthermore, there is a tract of signal abnormality extending from the rectosigmoid colon to a small bowel loop within the right pelvis which likely represents a fistula (image 337, series 16). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As described above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stricturing and enhancement of the neo-terminal ileum with proximal focal bowel dilation compatible with acute on chronic disease.2.Multifocal narrowing and enhancement of the descending and rectosigmoid colon compatible with acute on chronic inflammation.3.Probable fistula between the rectosigmoid colon and small bowel within the right pelvis.


Instruction: Generate impression based on findings.

Input: Other convulsions [780.39] / Secondary malignant neoplasm of brain and spinal cord [198.3], Reason for Study: ^Reason: evaluate for tumor metastases, focal motor seizures LUE History: Cont. Keppra 500 mg bid as per verbal neurology consult There are multiple enhancing lesions including ring-enhancing lesion (14.3mm x 12.7mm) on the left post-central gyrus, irregularly enhancing lesion (14.3mm x 11.3mm) on the left pre-central gyrus and nodular enhancing lesion on the left the superior temporal gyrus with surrounding edema. The post central gyrus lesion shows susceptibility effects on gradient echo images indicate possible intra lesional hemorrhage or mineralization.Comparing to prior scan, both pre and post central gyri lesions appear to be increased in size and the left temporal lobe lesion is a new lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no acute ischemic or hemorrhagic lesion and the midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Right maxillary sinus shows opacification.

Output: Interval increase in size of left pre and post central gyri lesions and a new nodular enhancing lesion on the left superior temporal gyrus which are consistent with multiple metastatic lesions.


Instruction: Generate impression based on findings.

Input: 66-year-old Male with prostate cancer now with increased PSA ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral punctate stones without evidence of hydronephrosis. Bilateral hypodense lesions like representing cyst. Some Ultima to small to accurately characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland demonstrates nodular contour. Posterior laterally on the left side with slight enhancement. Residual disease in the prostate cannot be excluded. MRI may be helpful for further evaluation.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Nodular contours in the left posterior lateral aspect of the prostate, suspicious for residual disease. MRI is recommended for further evaluation. This lesion may be amenable to MR guided prostate biopsy if clinically indicated.Bilateral punctate stones and small renal cysts.


Instruction: Generate impression based on findings.

Input: Reason: metastatic colon cancer on chemotherapy holiday since January. Evaluate for interval change. Changed to MRI per patient request History: met colon cancer ABDOMEN:LIVER, BILIARY TRACT: Hepatic metastases have increased in size compared to prior CT. Previous reference segment 4/8 metastasis measures 3.1 x 2.9 centimeters (series 903 image 583), previously 2 x 1.9 cm. No new hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small subcentimeter left renal cysts, unchanged.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: Interval increase in size of hepatic metastases. No new lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage. Signs and symptoms: Intracranial hemorrhage. CT brain without infusion:Images through posterior fossa are unremarkable.Images through the supratentorial space demonstrate massive left frontal contusion with significant amount of hemorrhage. Two lesser degree extensive areas of contusion and hemorrhage in the right frontal lobe is also noted. Compared to prior suboptimal CT of brain there is a slight interval increase in the amount of hemorrhage in the right frontal lobe.Extensive bilateral anterior temporal lobe contusions are again identified. Slight increase in the hemorrhage in the left temporal lobe is suspected, however note should be made that the quality of the exam on the prior study is very poor due to extensive motion.Vasogenic edema surrounding all areas of the above described hemorrhage. Extensive subarachnoid hemorrhage is again identified. There is evidence of bilateral subdurals along the leaves of tentorium which is better appreciated on the current exam than prior. The subdurals extend dorsal to the occipital lobes (left greater than right). The thickest measurable portion of the larger left subdural measures only 3.7 mm on axial image 17. There is mass effect on the left frontal horn secondary to hematoma in the left frontal lobe. The degree of mass-effect remains identical to prior study. Residual blood within the bilateral dependent portion of the lateral ventricles remain similar to prior study. No change in the size of normal appearing ventricle or system.Calvarium is intact, mastoid air cells and middle ear cavities are unremarkable. Opacification of bilateral ethmoid air cells and otherwise well pneumatized paranasal sinuses.Images through orbits demonstrate severely enlarged superior ophthalmic veins which are abnormal and are concerning for increased flow secondary to carotid cavernous fistula. Recommend auscultation and bilateral orbit for detection of bruit and further evaluation with a dedicated MRI, MRA, MRV examination is recommended.

Output: 1.Extensive bifrontal and temporal contusion with surrounding vasogenic edema.2.Suggestion of slight increase in the amount of hemorrhage as detailed above.3.Extensive subarachnoid hemorrhage with no appreciable interval change.4.No appreciable interval increase in the degree of mass effect or size of ventricular system.5.Better visualization of blood in the subdural space overlapping bilateral tentorial leafs as detailed.6.Calvarium remains intact.7.Significantly enlarged and bilateral superior ophthalmic veins is concerning for a carotid cavernous fistula considering patient's history of trauma and extensive intracranial hemorrhage. Above findings were discussed with neural ICU fellow pager number 6228.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with history of Parkinson's disease, planning for deep brain stimulator. Parenchymal morphology is within normal limits. There is questionable asymmetric increased T2 signal within the left upper pons. No other significant parenchymal signal abnormality is detected on the provided sequences. No pathologic enhancement is seen. There is a small incidental developmental venous anomaly within the left temporal lobe. Focal CSF widening along the high left precentral gyrus may reflect anatomic variation or a small arachnoid cyst. The ventricular system is normal in size and morphology.

Output: No acute intracranial abnormality is suspected on these selected sequences obtained for surgical planning purposes.


Instruction: Generate impression based on findings.

Input: History of right breast cancer status post partial mastectomy and sentinal node biopsy after neoadjuvant therapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Right outer breast 1.5 cm seroma has expected thin peripheral enhancement, but no suspicious nodular enhancement. Right breast skin thickening compatible with previous radiation therapy is also noted. No abnormal axillary lymph nodes are identified in either axillary region. Post surgical change noted in the right axilla.

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


Instruction: Generate impression based on findings.

Input: Ms. Sanner is a 58 year old female with a family history of breast cancer in her mother (diagnosed at the age 50). She has a history of multiple bilateral benign breast biopsies. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Stable scars are present in the upper outer quadrant of each breast. A subcentimeter benign morphology non-enhancing mass is present in the right upper outer breast, which corresponds to a benign fibroadenoma as seen on prior ultrasound examinations. A stable subcentimeter circumscribed enhancing mass at the left 3 o'clock position is compatible with a benign intramammary lymph node. There is no abnormal enhancement identified in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 36-year-old female with a strong family history of breast cancer in her mother, maternal aunt, maternal grandmother, and two maternal cousins. Known BRCA1 mutation carrier. History of left cyst aspiration in 2011. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Seemingly recurrent facial palsy originally diagnosed as Bell's palsy and treated with steroids with a partial response 1 year ago. This has been seen in the past, but it could simply mean a variant reinnervation as a cause. The imaged portions of the bilateral facial nerves appear unremarkable. Indeed, the bilateral internal auditory canals and cranial nerve 7 and 8 complexes are unremarkable. There is no abnormal enhancement along the imaged portions of the facial nerves. 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.

Output: 1. No evidence of proximal facial nerve lesions.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: History of recurrent nasopharyngeal carcinoma and oral cavity squamous cell carcinoma, status post treatment. There are post-treatment findings in the neck. There is ill-defined heterogeneity of the right tonsillar fossa region, but no evidence of discernible residual measurable mass in the oral cavity. There is mildly prominent enhancement of the upper aerodigestive track mucosa diffusely, which likely represents mucositis. There are no significantly enlarged lymph nodes in the neck. Indeed, the left level 2A lymph node measures up to 6 mm in short axis, previously 10 mm. The salivary glands and thyroid are unchanged. The imaged intracranial structures and orbits are unremarkable. The osseous structures are unchanged. There are subcentimeter retention cysts in the right maxillary sinus.

Output: Post-treatment findings in the neck without convincing evidence of measurable tumor.


Instruction: Generate impression based on findings.

Input: Reason: Right rotator cuff tear History: Right shoulder pain ROTATOR CUFF: There is partial thickness tearing of the articular surface fibers of the supraspinatus at the level of its insertion on the greater tuberosity, involving less than 50% of the tendon width, measuring approximately 8 mm in AP dimension. There is no significant retraction. There is increased signal abnormality within the infraspinatus indicating tendinosis. There is undersurface fraying of the teres minor at the level of its insertion on the greater tuberosity. There is interstitial tearing of the subscapularis at the level of its insertion on the greater tuberosity. There is mild fatty atrophy of the infraspinatus at the level of the myotendinous junction.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Moderate degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Moderate to severe degenerative changes affect the glenohumeral joint with large portions of the glenoid completely devoid of articular cartilage. There is underlying subchondral cyst formation. There is linear increased signal abnormality traversing the posterior labrum which extends to involve the articular cartilage of the glenoid, indicating a tear (glenolabral articular disruption), within the limitations of this non arthrogram study. There is heterogeneity and increased signal abnormality within the superior and inferior labrum also consistent with degeneration/degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is circumferential fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the glenohumeral joint versus a tenosynovitis.ADDITIONAL

Output: 1. Partial thickness tearing of the supraspinatus and interstitial tearing of the subscapularis without evidence of a full-thickness rotator cuff tear or retraction.2. Osteoarthritis of the right shoulder including full-thickness articular cartilage degeneration and tearing of the glenoid labrum as described above.3. Loose bodies within the joint and tendon sheath of the long head of the biceps.4. Findings suggestive of a tenosynovitis involving the long head of the biceps tendon.


Instruction: Generate impression based on findings.

Input: Headache. 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 moderate right sphenoid and posterior ethmoid sinus, as well as left maxillary and anterior ethmoid sinus mucosal thickening.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Inflammatory mucosal disease involving the right sphenoid and posterior ethmoid sinuses, as well as left maxillary and anterior ethmoid sinuses.


Instruction: Generate impression based on findings.

Input: Male 72 years old Reason: hx of bladder cancer s/p radical cystectomy with ileal conduit urinary diversion, evaluate for metastatic disease History: see above ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Native kidneys are atrophic. Hemorrhagic debris fills the right renal collecting system, unchanged.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta. There are small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post cystoprostatectomy and ileal conduit urinary diversion without evidence of lymphadenopathy or metastatic disease2.Signal and body involving the parasymphysial regions and posterior inferior pubic rami most suggestive of stress fractures.


Instruction: Generate impression based on findings.

Input: Limited sequences were obtained for surgical localization. There is presumably heterogeneously enhancing mass in the mid to inferior fourth ventricle which is dilated, extending into the upper cervical spinal canal at the upper C1-C2 level. T2-weighted images demonstrate central areas of cystic change especially along its cranial margin. There is associated and mild to moderate dilatation of the lateral and third ventricles due to this obstructive process, although flow void is identified through the cerebral aqueduct. Significant T2 hyperintensity within the periventricular white matter to suggest acute transependymal edema. The mass measures 2.4 cm transverse x 2.9cm AP x 5.5 cm CC, and appears to extend out of the foramen of Magendie. There is significant mass effect upon the brainstem, essentially effacement of the prepontine cistern.Sulci also appear somewhat prominent for patient's stated age. There is no midline shift. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. SPINE

Output: 1.Large heterogeneously enhancing mass centered in the fourth ventricle extending along the dorsal upper cervical spinal canal, with localized mass effect on the brainstem. Differential diagnosis includes primary neoplasms such as ependymoma given patient's age, as well as medulloblastoma and pilocytic astrocytoma. Rarely, glioblastoma can also have this appearance.2.Associated obstructive hydrocephalus although without MR evidence of acute transependymal edema.3.No acute cord compression. No gross spinal abnormality on this noncontrasted spine exam.


Instruction: Generate impression based on findings.

Input: Slurred speech [R47.81] / Facial myokymia [G51.4], Reason for Study: ^Reason: structural lesions, vascular abnormalities History: left sided facial twitching and slurring of words. feels disconnect Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal with the right distal vertebral artery is hypoplastic. No intracranial arterial flow restricting stenosis or arterial aneurysm is seen.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Male, 32 years old, with leg weakness, numbness and back pain. No evidence of acute cord compression is seen. A disc herniation at L5-S1 is noted which may impinge upon some of the adjacent nerve roots. Mild disc degeneration with annular fissuring is evident at L4-5. Elsewhere, the intervertebral discs are preserved and the spinal canal is not significantly compromised. Spinal alignment is anatomic. Vertebral body height, morphology and signal characteristics are within normal limits. The visualized spinal cord shows normal signal intensity and morphology throughout.

Output: 1.No acute cord compression.2.A disc herniation is evident at L5-S1 which may impinge upon some of the adjacent nerve roots. This can be further assessed with nonemergent dedicated lumbar spine MRI.


Instruction: Generate impression based on findings.

Input: Reason: right knee pain History: right knee pain MENISCI: There is blunting of the posterior horn of the lateral meniscus indicating a new longitudinal tear although some of this may in part reflect postsurgical change from prior partial meniscectomy. There is blunting and deformity of the posterior horn of the medial meniscus likely representing a combination of prior complex tearing, postsurgical change and degeneration which extends to involve the body of the meniscus. There is a ghost meniscus affecting the posterior horn of the medial meniscus near its root indicating a full-thickness radial tear.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect along the weightbearing surface of the medial femoral condyle measuring approximately 1.5 cm in the AP dimension. There is a focal full-thickness articular cartilage defect along the femoral trochlea centrally, which extends along the lateral facet, measuring approximately 13 mm in the craniocaudal dimension.LIGAMENTS: Note is made of postsurgical changes of prior ACL graft reconstruction. The graft appears intact. The PCL appears intact. The MCL and LCL appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Postsurgical change of prior ACL graft reconstruction. The graft appears intact.2. Radial tear of the posterior horn of the medial meniscus near its root, new from prior examination. There is also blunting and deformity of the posterior horn of the medial meniscus which likely represents a combination of prior complex tearing, postsurgical change and degeneration.3. Tearing of the posterior horn of the lateral meniscus which also appears new from the prior examination.4. Focal full-thickness articular cartilage defects along the femoral trochlea and medial femoral condyle which are new when compared to the prior examination.


Instruction: Generate impression based on findings.

Input: Thyroid cancer with metastatic brain lesions: three-month follow-up. There are postsurgical findings related to left parietal metastasectomy. There is adjacent dural thickening and blood products, but no evidence of enhancing tumor in the resection cavity. There is a 6 mm enhancing lesion along the left superior parietal lobule, which appears to have slightly more confluent in enhancement, but is unchanged in size. There is also a 2 mm focus of enhancement in the right middle frontal gyrus and right medial orbitofrontal gyrus, which are also unchanged in size. There is a non-enhancing subcentimeter nodular focus of susceptibility effect along the ependymal surface of the right caudate head. There is no evidence of intracranial hemorrhage or acute infarct. The pituitary gland appears unremarkable. There is no other abnormal intracranial enhancement. Multiple foci of T2 hyperintensity in the bilateral cerebral white matter are nonspecific, but compatible with chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening involving the anterior ethmoid air cells and bilateral mucous retention cysts of the maxillary sinuses, right greater than left. The remaining paranasal sinuses and mastoid air cells are otherwise clear. The orbits are grossly unremarkable.

Output: 1. Postsurgical findings of left parietal metastasectomy without evidence of recurrent tumor at this site.2. Subcentimeter left parietal lobe and right frontal lobe lesions are stable in size. Likewise, the non-enhancing subcentimeter nodular lesion along the ependymal surface of the right caudate head is unchanged.3. No evidence of acute infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 5 years old, with history severe constipation, L1-L2 vertebral anomaly, solitary kidney. A partial block vertebra anomaly is demonstrated at the L1 level. Specifically, there is partial segmentation of the right aspect of the vertebral body which is taller than the left. There are two pedicles on the right resulting in an extra facet complex and an extra neural foramen on the right but no discrete disc space. The left aspect of the L1 vertebra is of normal height and has formed only one pedicle. As a result of this anomaly, there is a relatively focal dextroscoliotic curvature of the spine centered in the upper lumbar region with some compensatory levoscoliosis of the lower lumbar spine. The sacrum is asymmetric as well with the possibility of some posterior dysraphism at the lowest sacral levels, though this is difficult to assess on MR.Counting the block vertebra at L1 is a single vertebral body level, there is a normal complement of vertebral bodies which otherwise appear to be fully formed and intact. Sagittal alignment is within normal limits. No evidence of marrow replacement or edema is seen. The spinal canal and neural foramina are patent throughout. The intervertebral discs are normal.The conus tip terminates at the upper L3 level which is below the lower limit of normal. The filum terminale is T1 hyperintense for part of its course and closely apposed to the posterior aspect of the thecal sac. The spinal cord otherwise demonstrates normal morphology. On prone images, there does not appear to be much anterior motion of the conus and cauda equina relative to supine imaging.A single right-sided kidney is demonstrated. The partially visualized colon and bladder appear to be distended.

Output: 1.Partial block vertebra anomaly at L1 which results in a scoliotic deformity of the lumbar spine. The remaining vertebral body levels appear to be fully formed and normal, with the possible exception of the lowest sacral levels where there may be some posterior dysraphism.2.Findings are seen suggestive of tethered cord including a low-lying conus, fatty infiltration of the filum terminale, and little if any anterior motion on prone imaging.3.Incidental findings include a solitary right kidney and distended bladder and colon.


Instruction: Generate impression based on findings.

Input: A 47 year old male with history of paroxysmal atrial fibrillation, normal left ventricular function with mild concentric left ventricular hypertrophy and symptoms of palpitations. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 191 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 91 ml (normal range 47+/-19), the LV mass index is 53 g/m2 (normal range 85+/-15), and the LV mass is 108 g (normal range 164+/-36). No regional or concentric hypertrophy is noted. 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. A small left ventricular diverticulum is noted in the basal inferior wall. This finding can be a normal variant but has also been described in family members of individuals with hypertrophic cardiomyopathy.No cardiac iron overload noted.No findings of cardiac amyloid.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 50%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 199 ml (normal range 142+/-31), the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9), and the RVESV is 100 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace 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 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 low normal systolic function, the LVEF is 53%. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. No regional or concentric hypertrophy noted. No cardiac iron overload noted. No findings of cardiac amyloid. 4. A small left ventricular diverticulum is noted in the basal inferior wall. This finding can be a normal variant but has also been described in family members of individuals with hypertrophic cardiomyopathy.5. The right ventricle is normal in size with normal systolic function, the RVEF is 50%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brainClinical question: s/p craniotomy used for SRS evaluationSigns and Symptoms: S/P craniotomy The patient is status post frontal craniotomy for removal of a right superior frontal gyrus mass. There are signal changes present at the right superior frontal gyrus white matter and some susceptibility effect at the tumor bed.There is redemonstration of a subgaleal fluid collection superficial to the craniotomy site which appears relatively stable compared to the 10/28/2015 exam.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.The patient is status post right frontal lobe surgery. There is no enhancing mass present along the right frontal lobe at this time. There is interval regression of associated vasogenic edema.2.There is a subgaleal fluid collection present at the craniotomy site which is stable since the prior exam.3.Exam was performed for treatment planning and is a limited exam


Instruction: Generate impression based on findings.

Input: 60 years Female (DOB:1/4/1956)Reason: r/ostroke History: right face tinglingPROVIDER/ATTENDING NAME: GREGG M HELLAND JACQUELINE T. BERNARD MRI of the brainThere is diffusion restriction present along the left posterior limb of internal capsule extending to the centrum semiovale measuring 24 x 12 mm axial dimensions. There is associated FLAIR and T2 signal abnormality.There is a punctate focus of FLAIR signal hyperintensity in the right basal ganglia.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are very small.. The vertebral arteries are similar in size. There is extracranial origin of the right posterior inferior cerebellar artery. The left A1 segment is larger than the right A1 segment.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Acute infarction involving left posterior limb of internal capsule and adjacent centrum semiovale. 2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm.4.No evidence for extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: Neck mass, likely thyroglossal duct cyst. There is a midline intrinsically T1 hyperintense cystic lesion anterior to the body of the hyoid bone that measures up to 20 mm. The thyroid gland and base of the tongue are unremarkable. There is no evidence of significant cervical lymphadenopathy. There is multilevel degenerative cervical spondylosis with indentation upon the spinal cord at CC4-5 to C6-7. The salivary glands are unremarkable. The imaged intracranial structures are also unremarkable. There are bilateral lens implants.

Output: Findings compatible with a thyroglossal duct cyst at the level of the hyoid bone, measuring up to 20 mm.


Instruction: Generate impression based on findings.

Input: Male 25 years old Reason: RLE pain, hx of NF1. Right thigh/buttock pain and twitching. Evaluate for plexiform neurofibroma or sarcoma. Right femur: Bone marrow signal is within normal limits. Visualized muscles and tendons are unremarkable. Visualized soft tissues are unremarkable. No T2 hyperintense signal in the muscles in the right thigh. Small joint fluid is noted in the right knee.Pelvis: T2 hyperintense edema signal is seen in the left gluteal musculature. There is scarring in the overlying left subcutaneous soft tissue with a loss of subcutaneous fat. There is a focal area of superficial soft tissue scarring with low signal. No plexiform neurofibromas are identified. No lesions that are suspicious for malignant peripheral nerve sheath tumors are identified.

Output: 1.Left gluteal musculature edema with overlying subcutaneous superficial scarring.2.No plexiform neurofibromas identified, and no lesions that are suspicious for malignant peripheral nerve sheath tumors within limitations of a noncontrast-enhanced examination.


Instruction: Generate impression based on findings.

Input: 59-year-old male with history of ventral hernia now with mental status changes. Possibly blood seen on CT. Rescan for concern for hemorrhage. Focus of high attenuation in the left frontal region is less conspicuous. This may represent cortical hemorrhage or possibly a dural based calcified meningioma. If clinically indicated, an MRI could be considered for follow-up.Small vessel disease and corticomedullary volume loss as described in prior exam.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: Focus of high attenuation is less conspicuous in the left frontal region. This may represent a cortical hemorrhage or a small calcified dural based meningioma. MRI is recommended for follow-up if clinically warranted.


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage? Signs and symptoms: Headaches. Non-enhanced MRI of brain:Extensive postoperative changes of large bifrontal craniotomy. Significant widening of the epidural space containing serosanguineous fluid and air. This is a postoperative findings. Epidural collection causes mass effect and posterior displacement of frontal lobes. Residual air within the subarachnoid space from patient's surgery. No evidence of parenchymal hemorrhage. Interval reduction in the low density cyst in the basal cistern. On the current exam the cyst measures approximately 19 mm in AP and 27-mm in transverse diameter. This is a smaller than prior examination which measured 25 mm x 36-mm. no evidence of hemorrhage within the cyst.

Output: 1.Reduction in the size of cyst within the basal cistern consistent with patient's past history of craniopharyngioma.2.Extensive postoperative changes all bifrontal craniotomy as detailed above.3.No evidence of acute hemorrhage within the brain parenchymal or cyst within the basal cistern.


Instruction: Generate impression based on findings.

Input: 80 year old male with hypertension, hyperlipidemia, coronary artery disease, diabetes, peripheral arterial disease, and hyperthyroidism. Prior anterior MI in 1996 treated medically. PCI of RCA and LCx in 2012. Cath in January 2015 showed ostial occlusion of RCA stent with collateralization, and 75% stenosis of LAD. DES placed in LAD.MEDICATIONS: ASA, atorvastatin, carvedilol, plavix, digoxin, fluticasone, gabapentin, levothyroxine, mefoxin, clarithromycin, moxifloxacin. First Pass PerfusionDuring hyperemia a perfusion defect was noted in (1) the basal to mid inferior and inferoseptal walls and (2) basal to mid anterolateral and inferolateral walls. Viability/ Myocardial ScarThere is a large transmural myocardial infarction involving much of the LAD territory, which is unlikely to be viable. There is no evidence of myocardial infarction in most of the LCx and RCA territories, which are likely to be viable. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is marked thinning and akinesis in most of the LAD territory. There is hypokinesis in the RCA territory. There is normal wall motion in the LCx territory. The overall LV ejection fraction is 20%, the LV end diastolic volume index is 180 ml/m2 (normal range: 74+/-15), the LVEDV is 277 ml (normal range 142+/-34), the LV end systolic volume index is 145 ml/m2 (normal range 25+/-9), the LVESV is 222 ml (normal range 47+/-19), the LV mass index is 72 g/m2, and the LV mass is 110 g. Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 52 ml/m2 (normal range 82+/-16), the RVEDV is 81 ml (normal range 142+/-31), the RV end systolic volume index is 21 ml/m2 (normal range 31+/-9), and the RVESV is 31 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet and opens widely. There is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is mild diastolic mitral regurgitation suggesting increased left ventricular end-diastolic pressure. 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 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. There is a transmural myocardial infarction in the LAD territory.2. There is mild ischemia with normal wall motion and viability in the LCx territory.3. There is severe ischemia with hibernating myocardium and viability in the RCA territory. 4. Severe left ventricular dilation with severely reduced systolic function (LVEF 20%).5. Normal RV size and systolic function (RVEF 61%).6. Mild aortic regurgitation.7. There is mild diastolic mitral regurgitation suggesting high left ventricular end-diastolic pressure.


Instruction: Generate impression based on findings.

Input: There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Fluid is present within a few right mastoid air cells. The remaining visualized paraspinal contents are unremarkable.C1/2: Ligament thickening is present without significant resulting stenosis.C2/3: Trace anterolisthesis C2 on C3, mild posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral facet hypertrophy with bilateral facet fusion. There is moderate bilateral neural foraminal stenosis, however there is no central stenosis.C3/4: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and left-sided facet hypertrophy with left facet fusion. There is mild central, severe left neural foraminal, and mild to moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and bilateral facet hypertrophy. There is mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, ligamentum flavum thickening, and facet hypertrophy. There is mild to moderate central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.C6/7: Grade 1 anterolisthesis C6 on C7, posterior osteophyte disc complex, bilateral uncinate hypertrophy, and bilateral facet hypertrophy. There is mild central, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.C7/T1: Trace anterolisthesis C7 on T1, ligamentum flavum thickening, and bilateral facet hypertrophy. There is severe left neural foraminal and mild to moderate right neural foraminal stenosis.Bilateral facet hypertrophy is present involving all visualized upper thoracic levels which encroach the neural foramina bilaterally.

Output: 1.Fluid is present within a few right mastoid air cells. 2.C2/3: Moderate bilateral neural foraminal stenosis, however there is no central stenosis.3.C3/4: Mild central, severe left neural foraminal, and mild to moderate right neural foraminal stenosis.4.C4/5: Mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.5.C5/6: Mild to moderate central, severe left neural foraminal, and moderate to severe right neural foraminal stenosis.6.C6/7: Mild central, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.7.C7/T1: Severe left neural foraminal and mild to moderate right neural foraminal stenosis.8.Bilateral facet hypertrophy is present involving all visualized upper thoracic levels which encroach the neural foramina bilaterally.


Instruction: Generate impression based on findings.

Input: Motion artifact degrades image quality.MRI BRAIN: There is no diffusion restriction to suggest acute infarct. There is encephalomalacia of the left cerebellar hemisphere, consistent with chronic left PICA territory infarct. There are associated areas of susceptibility effect in this region, consistent with hemosiderin deposition from remote hemorrhage. There is no evidence of acute intracranial hemorrhage or mass. There are very minimal punctate foci of T2 signal abnormality in the cerebral white matter, consistent with minimal small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There appears to be a small left posterior frontal developmental venous anomaly. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. MRA HEAD: The left A1 segment is hypoplastic. There appears to be mild irregularity of the left M1 segment without significant stenosis. There is focal stenosis of the right P2 segment. There is paucity of flow-related enhancement stenosis of the proximal V4 segment of the left vertebral artery. There also appears to be irregularity of the V4 segment of the right vertebral artery. There is mildly irregular flow-related enhancement in the bilateral carotid siphons, likely due to the presence of calcifications. There is no evidence of aneurysm.MRA NECK: There is paucity of enhancement in multiple locations along the course of the cervical portion of the left vertebral artery, particularly the V1 segment. The right vertebral artery flow void appears to be intact. There is mild stenosis of the left internal carotid artery near the bifurcation. The common carotid arteries and cervical internal carotid arteries are tortuous with a retropharyngeal course. There also appears to be mild stenosis of the left proximal internal carotid artery. There is a three vessel aortic arch. There is a small effusion at the left occipital-C1 articulation.

Output: 1. Chronic left PICA territory infarct, but no evidence of acute or subacute infarct.2. Multiple focal stenoses of the intracranial and extracranial vessels, particular involving the right P2 and left V1 and V4 segments.3. Mild stenosis of the proximal left internal carotid artery. Otherwise, no high-grade stenosis of the right internal carotid artery.Findings discussed with Dr. Verma on 1/5/2015 at the time of dictation.


Instruction: Generate impression based on findings.

Input: Male, 47 years old. Left knee pain, s/p left knee medial femoral condyle microfracture, evaluate healing, evaluate for new chondral injury, meniscus tear. MENISCI: There is attenuation of the body and posterior horn of the medial meniscus consistent with partial meniscectomy. There is globular high signal intensity within the remaining posterior horn of the medial meniscus near its root likely representing intrasubstance mucoid degeneration that appears to extend to the inner edge of the meniscus, likely representing a degenerative tear appearing similar to that seen on the prior study. Also again seen is branching intermediate signal intensity within the periphery of the posterior horn more medially suggesting a complex, predominantly vertical tear that appears similar to that seen on the prior study. Given its location in the periphery of the meniscus, it is possible that this represents a healed tear. We see no lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: There is new subchondral edema within the medial femoral condyle above the anterior horn of the medial meniscus. There is an overlying full-thickness cartilage defect. The articular cartilage of the lateral compartment and patella are relatively well preserved. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. There is some edema in the subcutaneous tissues anterior to the patella and patellar tendon which is nonspecific.ADDITIONAL

Output: 1.New focus of degenerative subchondral signal abnormality in the medial femoral condyle with an overlying full-thickness cartilage defect.2.Surgical changes involving the medial meniscus with degeneration and tearing as described above, appearing similar to prior.


Instruction: Generate impression based on findings.

Input: seizure and nystagmus No evidence of acute ischemic or hemorrhagic lesion.Multifocal scattered FLAIR high signal intensity lesions on bilateral periventricular white matter indicate minimal non specific small vessel disease, no change since prior exam. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No interval change of minimal non specific small vessel ischemic disease since prior exam.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: Back pain and h/o metastatic breast cancerSigns and Symptoms: Back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is diffuse heterogeneous marrow replacement throughout the visualized osseous structures of the lumbar spine as well as the sacrum and iliac bones. Compared to the prior exam from 1/14/2015 the foci of marrow replacement appear to be somewhat smaller. For example at the first sacral segment a marrow replacing focus has decreased from 19 x 14 mm sagittal dimensions to 12 x 9 mm sagittal dimension. A similar effect is also noted at other levels as well. An epidural mass with perivertebral extension at the L2, L3 and L4 vertebral body levels is redemonstrated and appears to have regressed somewhat but not resolved. It extends into the left L2-3, L3-4 and L4-5 the neural foramina and encroaches on the exiting nerve roots. It also extends into the perivertebral space as well as the left lateral aspect of the spinal canal at these levels.There is a smaller right-sided perivertebral mass adjacent to the L2 vertebral body which involves right-sided exiting nerve roots at the lateral aspect of the right L2-3 neural foramen.There is a large mass present involving the left iliac bone which is not entirely included on this exam. This measures appears larger. Incidental note is made of multiple perineural cysts in the sacrum which were also present on the prior exam and are stable.

Output: 1.There is diffuse skeletal metastases present throughout the visualized lumbar spine, sacrum and iliac bones. These have mildly regressed since the January exam.2.Epidural and left perivertebral mass involving the neural foramina at L2-3, L3-4 and L4-5 - where it involves exiting nerve roots - as well as the spinal canal at these levels has mildly regressed since the prior exam but is not resolved. This is likely metastatic.3.A large left-sided iliac bone mass is incompletely visualized on the current exam. Please refer to MRI of the pelvis of the same date for further comments. This is likely metastatic.


Instruction: Generate impression based on findings.

Input: Buttock pain with left leg radiculopathy and weakness in left leg Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of lumbar lordosis. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc desiccation and mild bulge. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation and mild bulge. No spinal canal or neural foraminal stenosis.L4-L5: There is disc bulge eccentric to the left without significant spinal canal stenosis. Previously seen left foraminal and extraforaminal disc protrusion is slightly less prominent and the previously seen annular fissure is no longer appreciated. There is mild left neural foraminal stenosis with contact of the exiting left L4 nerve root. No significant right neural foraminal narrowing. L5-S1: Disc desiccation, loss of height, and mild bulge. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Disc bulge eccentric to the left at the L4-L5 level which contacts the exiting left L4 nerve root. There is mild left-sided neural foraminal stenosis which was also present on prior study from 2004.2. Remainder of the spinal canal or neural foramina are patent.


Instruction: Generate impression based on findings.

Input: Pain. Question of rotator cuff tear or frozen shoulder. ROTATOR CUFF: The tendons and muscles of the rotator cuff are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. The coracohumeral ligament is intact, but thickened. The subcoracoid fat pad is partially obscured; these findings likely represent "frozen" shoulder. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a subchondral cyst within the humeral head.The labrum is grossly intact.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Findings likely represent "frozen" shoulder. No evidence of a rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 64 year old man with new bi-ventricular heart failure, referred for further evaluation of inducible ischemia and viability.MEDICATIONS: Aspirin, Lipitor, Lasix, Lisinopril, Toprol XL First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was a small area of late gadolinium enhancement at the RV insertion point. Otherwise there was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. LV mass is mildly increased. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 160 ml/m2 (normal range: 74+/-15), the LVEDV is 264 ml (normal range 142+/-34), the LV end systolic volume index is 129 ml/m2 (normal range 25+/-9), the LVESV is 213 ml (normal range 47+/-19), the LV mass index is 123 g/m2, and the LV mass is 209 g. LV dysfunction is global with regional variation. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 26%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 168 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 124 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size. On LGE imaging, there is a thrombus noted in the right atrial appendage. Aortic ValveThe aortic valve opens widely and there is mild to moderate aortic regurgitation.Mitral ValveThe mitral valve has bi-leaflet tethering. 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.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 (24mm).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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable. Small area of late gadolinium enhancement noted at the RV insertion point.3. Severely dilated LV with severely reduced LV ejection fraction (LVEF 19%). There is global hypokinesis with regional variation.4. Normal RV size with severely reduced systolic function (RVEF 26%).5. Thrombus in the right atrial appendage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right shoulder pain The examination is limited by motion artifact.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon with retraction to the level of the glenoid. A full-thickness tear of the infraspinatus tendon is also evident. There is moderate fatty atrophy and edema of both the supra and infraspinatus muscles. The teres minor and subscapularis tendons and muscles are intact.SUPRASPINATUS OUTLET: There is moderate arthrosis of the acromioclavicular joint with a small amount of fluid present. Fluid is also present within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding as a result of a chronic rotator cuff tear. There is absence of the portions of the superior and anterior labrum which is likely degenerative in nature.BICEPS TENDON: Evaluation of the biceps tendon is limited secondary to motion artifact. The intra-articular portion of the biceps tendon is poorly visualized which may reflect some tearing although the extra-articular portion of the biceps is intact. ADDITIONAL

Output: 1. Full-thickness tears of the supraspinatus and infraspinatus tendons with retraction of the supraspinatus to the level of the glenoid. There is atrophy and edema of the associated rotator cuff musculature.2. Moderate osteoarthritis of the acromioclavicular joint with glenohumeral joint effusion.3. Poor visualization of the intra-articular biceps tendon which may in part be secondary to motion artifact although the presence of biceps tendon tear is not excluded.


Instruction: Generate impression based on findings.

Input: History of right ovarian artery and left uterine artery embolization for fibroids. PELVIS:UTERUS, ADNEXA: Myomatous uterus.The large reference intramural posterior mid body myoma measures 4.7 x 4.8 x 4.1 cm (TR by AP by cc), compared to 6.3 x 5.6 x 5.1 cm previously. There are no regions of T2-hyperintensity, compatible with necrosis. On postcontrast imaging there is no significant postcontrast enhancement of the majority of the fibroid, significantly decreased from the prior study.The reference subserosal pedunculated fibroid arising off the anterior fundus measures 1.6 cm (series 7/24), unchanged. This fibroid demonstrates postcontrast enhancement, unchanged.The endometrium appears very thickened with multiple fluid signal intensity foci compatible with adenomyosis.The reference fluid collection in the right vaginal introitus measures 2.7 x 2.4 cm compared to 2.8 x 2.1 cm previously compatible with a Gartner's/Bartholin's duct cyst. Multiple small nabothian cysts are again noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple nonspecific bilateral inguinal and femoral lymph nodes measure less than 1 cm in short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval decrease in the size of the dominant fibroid with interval decrease in enhancement.2.Diffuse adenomyosis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other disturbances of skin sensationClinical question: Evaluate for etiology of R facial numbnessSigns and Symptoms: R facial numbness, acute onset The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. There is no intracranial mass lesion or other explanation for the facial numbness. There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: History of noncontact injury of left ankle TENDONS: The peroneal, extensor, flexor, and Achilles tendon are intact.LIGAMENTS: The medial and lateral ligament complexes are intact.ARTICULAR SURFACES AND BONE: No fractures are identified. There is a small' cylindrical focus of bone marrow signal abnormality within the distal tibia within an additional similar focus of signal abnormality within the posterior calcaneus compatible with osseous defect from prior external fixation device. Small subchondral cysts are present within the posterior aspect of the distal tibia with associated reactive bone marrow edema. There is ossification of the distal tibiofibular syndesmosis which may reflect old injury. There is mild cartilaginous thinning along the posterior aspect of the tibiotalar joint. Visualized cartilage is otherwise grossly intact.ADDITIONAL

Output: 1.Mild-moderate osteoarthritis of the tibiotalar joint.2.Sequela of prior ankle injury as described above.


Instruction: Generate impression based on findings.

Input: 18-year-old male post fall. Evaluate for fracture. Right knee: Swelling of the anterior soft tissues of the knee which limits evaluation of the extensor mechanism. No fracture line is evident. If there is clinical concern for internal derangement of the knee, MRI can be obtained. Eccentric lucent lesion with sclerotic rim in the distal femoral metadiaphysis compatible with a benign nonossifying fibroma.Right tibia/fibula: We see no fracture.Right ankle: We see no acute fracture. 5 mm cortical ossicle seen dorsal to the head of the talus may represent old trauma.

Output: No acute fracture. Other findings as above.


Instruction: Generate impression based on findings.

Input: 75 year old female with left leg weakness. There is no evidence of intracranial hemorrhage, mass or edema. Extensive, periventricular hypodensities consistent with small vessel disease common age indeterminate. If there is clinical concern for acute ischemia an MRI may be considered. Prominence of the sulci may be within normal limits for the patient's age.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: 26-year-old woman with history of pelvic pain. PELVIS:UTERUS, ADNEXA: Fibroid uterus with largest measuring a subserosal fibroid measuring 14 x 11 mm located in the posterior body of the uterus (801/16). Endometrial stripe normal in size. Junctional zone within normal limits, no evidence of adenomyosis. Ovaries appear normal with small follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Suboptimal evaluation on this nondedicated exam but located posterior to the rectum and in the presacral space is a rounded complex fluid and T1 hyperintense signal containing focus that measures 19 x 12 mm (image 206 series 1502). Appears to communicate with adjacent rectum via dominant fistulous tract located approximately 8 cm from the anal verge and measuring approximately 15 mm in length, image 16 series 1401 and image 15 series 801. These findings demonstrate associated restricted diffusion and, particularly with respect to the aforementioned rounded structure, delayed rim enhancement. Difficult to exclude postcontrast enhancement within this lesion due to inherent T1 hyperintense signal. More subtle appearing perianal fistulous linear tract arising from the 12 o'clock position on image 11 series 1401 nonspecific, may be artifactual. Visualized terminal ileum (imaged on coronal T2 imaging sequence) unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suboptimal assessment on this nondedicated exam but findings suspicious for perirectal abscess formation, please refer to discussion above. Also among differential considerations rarer entities such as tailgut cyst formation. Correlation with patient's clinical history/physical exam and laboratory values recommended.2.Visualized terminal ileum (only imaged on coronal T2 imaging sequence) unremarkable.3.Fibroid uterus as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 62 years Male (DOB:5/10/1954)Reason: History of stage IIIA NSCLC s/p induction chemo and surgery. Surveillance brain MRI given + KRAS mutation History: NonePROVIDER/ATTENDING NAME: RENUKA J. MALIK RENUKA J. MALIK 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 enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for brain metastases.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Dysphagia. Facial and uvula asymmetry. Also, exaggerated right bicep reflexes. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the paranasal sinuses. There are small retention cysts in the nasopharyngeal mucosa.Cervical spine: There is minimal retrolisthesis of C3 on C4 and C4 on C5. The vertebral bodies are preserved in height. There is mild degenerative marrow signal along the C6-C7 and to lesser extent C5-C6 endplates. There is also a subcentimeter probable hemangioma in the C3 vertebral body. At C3-C4, a disc-osteophyte complex and facet and uncovertebral arthropathy result in mild right neural foraminal narrowing. At C4-C5, there is mild spinal canal stenosis caused by a disc-osteophyte complex and mild-to-moderate left neuroforaminal stenosis caused by uncovertebral and facet arthropathy. At C5-C6, a disc-osteophyte complexes causes mild-to-moderate spinal canal stenosis and uncovertebral arthropathy results in mild-to-moderate bilateral neural foraminal stenosis. At C6-C7, there a small disc-osteophyte complex that results in mild spinal canal narrowing and mild right neural foraminal stenosis caused by uncovertebral arthropathy. The spinal cord displays normal signal. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. Uvular asymmetry without a mass may have been present since 2006.2. Multilevel cervical spondylosis, with mild-to-moderate spinal canal and bilateral neural foraminal stenosis at C5-6.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 66 year old female with history of orthotopic heart transplant in 6/2015 for non ischemic cardiomyopathy, hypertension, anxiety and GERD now presenting with chest pain, a small pericardial effusion, neck stiffness, and possible meningitis. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 75 ml/m2 (normal range: 65+/-11), the LVEDV is 150 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 60 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is dilated consistent with transplant morphology.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 91 ml/m2 (normal range 69+/-14), the RVEDV is 181 ml (normal range 110+/-24), the RV end systolic volume index is 49 ml/m2 (normal range 22+/-8), and the RVESV is 98 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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 drain normally into the right atrium. PericardiumSmall pericardial effusion. There is evidence for pericardial inflammation by T2stir images and delayed enhancement in the pericardium. No myocardial extension of inflammation was noted.Extracardiac FindingsPost heart transplant surgery findings. Small bilateral pleural effusions. Parenchymal lung process, most prominent in LLL. 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. Normal biventricular size and systolic function.2. Small pericardial effusion with evidence for pericardial inflammation.3. Abnormal lung MRI 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: Clinical question : Status post craniotomy for removal of a seizure focus. Now with seizures. Signs and symptoms: Possible. Nonenhanced head CT:Examination the most postoperative changes of a large right frontal /temporal craniotomy. Epidural fluid -- air collection under the craniotomy flap is present. This finding is within the expected postop changes. There is evidence of partial right anterior temporal lobectomy with residual air and minimal postoperative hemorrhage. There is a area of low-attenuation in the inferior aspect of right frontal lobe and to a lesser degree of the left frontal lobe consistent with areas of encephalomalacia as was noted on prior MRI examination from 3 -- 24 -- 11.Superior to the surgical site focal area of edema is noted in the right frontal lobe. Residual small amount of subarachnoid blood within the cortical sulci of bilateral cerebral hemispheres are noted. A thin CSF density right parafalcine subdural measures approximately 2 mm in thickness. Prominent bilateral basal ganglial calcification and left frontal periventricular calcification is noted.

Output: 1.Expected postoperative changes of a large right frontal and temporal craniotomy.2.Small area of edema lungs immediately superior to the surgical site which may be postop change.3.Residual subarachnoid blood from surgery both in supero-and infratentorial spaces.4.Extensive bilateral basal ganglial calcification.5.Extensive inferior bifrontal encephalomalacia unchanged since prior studies.


Instruction: Generate impression based on findings.

Input: Male 21 years old with history of fibula Ewings with pulmonary metastases status post resection and radiation. Now with c/o great toe pain and swelling over lower leg. VIEWS: Right first toe oblique and lateral (2 views) 5/26/2015 at 11:08Right foot AP, oblique, and lateral (3 views) 5/26/2015Right tibia/fibula AP and lateral (2 views) 5/26/2015 Chest PA and lateral 5/26/2015 Right tibia/fibula: Postoperative changes of proximal fibular resection are seen with a metallic density projecting posterior to the fibula at the resection site. A small remnant of fibular head is present. Minimal irregularity of the mid fibula near the surgical clips, this may be related to postsurgical change but attention to this area on subsequent follow-up is recommended. Periosteal reaction is seen on the AP view along the lateral aspect of the remaining fibula. This may be related to prior radiation but correlation with previous imaging or further evaluation with MRI is recommended to exclude recurrence or second primary in this location.Right foot and right great toe: The bones are normal. No soft tissue swelling or evidence of fracture.Chest: Postoperative changes are again seen in the right upper and lower lobes. The cardiomediastinal silhouette is normal. There is no focal pulmonary opacity, pleural effusion, or pneumothorax.

Output: 1.Periosteal reaction along the lateral aspect of the remaining fibula. This may be related to prior radiation but correlation with previous imaging or further evaluation with MRI is recommended to exclude recurrence or second primary in this location.2.Minimal irregularity of the mid fibula at the resection site may be postsurgical but attention to this area on subsequent follow-up is recommended.Findings were discussed via phone with Dr. Drum at the time of this dictation.