Instruction: Generate impression based on findings.

Input: Female, 58 years old, with low back and leg pain. History of lumbar fusion. Artifact related to an interspinous fusion device is evident at L4-5 and L5-S1.Trace retrolisthesis of L5 relative to S1 is seen. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. Fatty endplate degenerative changes are seen at L5-S1. Otherwise, marrow signal characteristics are unremarkable.The visualized distal spinal cord, conus and cauda equina are within normal limits except as discussed below. No epidural abnormalities are suspected. The spinal canal is congenitally slender and this becomes particularly exaggerated at lower lumbar levels.T12-L1: Progressive right facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, unchanged.L1-2: Mild facet arthropathy, unchanged . No significant spinal canal or neuroforaminal stenosis. L2-3: Mild facet arthropathy, unchanged. No significant spinal canal or foraminal stenosis. L3-4: Moderate facet arthropathy, unchanged minimal disc bulging. Prominence of the dorsal epidural fat. Mild narrowing of the thecal sac, unchanged. No significant foraminal narrowing. L4-5: Bulky facet hypertrophy and postoperative changes of the posterior elements. Disc bulging with a superimposed right paracentral/foraminal protrusion which is new. Severe spinal canal stenosis with crowding of the cauda equina nerve roots which has progressed. Moderate right foraminal narrowing, unchanged. L5-S1: Moderate facet arthropathy and postsurgical changes of the posterior elements. Bulging disc. No significant spinal canal stenosis. Severe left and moderate right foraminal narrowing, unchanged.

Output: 1.Postoperative findings compatible with interspinous fusion are seen at L4-5 and L5-S1.2.Since the prior examination, bulky facet hypertrophy has progressed at L4-5 and there is a new right paracentral/foraminal disc protrusion. These findings contribute to worsening of the severe spinal canal stenosis at this level.3.Facet arthropathy on the right at T12-L1 has progressed. Significant foraminal narrowing at L5-S1 is unchanged.


Instruction: Generate impression based on findings.

Input: Abdominal pain, fistulizing ileocolonic Crohn's disease ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening and enhancement involving approximately 20 cm of the distal ileum with focal areas of stricturing compatible with acute inflammatory bowel disease. There are chronic changes involving a long segment of the ileum with straightening of the mesenteric border and fibrofatty proliferation. The distal ileum abuts a segment of markedly angulated sigmoid colon in the right lower quadrant without discrete evidence of fistula. Status post ileocecectomy.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Intrauterine contraceptive device.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening and enhancement of the rectosigmoid.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Acute on chronic inflammatory bowel disease involving the distal ileum with focal areas of stricturing as described above.2.Wall thickening and enhancement the rectosigmoid compatible with acute inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Arachnoid cyst fenestration. There are recent postoperative findings related to left frontal convexity arachnoid cyst fenestration, with an air-fluid level and a punctate focus of blood products posteriorly within the cyst cavity. There is decreased mass effect upon the underlying brain parenchyma, where there is mild edema. However, there is no evidence of acute territorial cerebral infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild swelling of the left frontal scalp related to the craniotomy procedure.

Output: Recent postoperative findings related to left frontal convexity arachnoid cyst fenestration, with an air-fluid level in the cyst cavity and decreased mass effect upon the underlying brain parenchyma.


Instruction: Generate impression based on findings.

Input: 65 years Female (DOB:6/17/1950)Reason: 65 yof with h/o renal transplant with persistent headaches, on prograf - r/o PRES History: headachePROVIDER/ATTENDING NAME: SHANNON K MARTIN SHANNON K MARTIN 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. Additional T2 and FLAIR hyperintense punctate foci are present in the brainstem. This is minimally/mildly progressed since the prior exam.On susceptibility weighted imaging there are multiple punctate foci of signal loss in the periventricular and subcortical white matter. These were also present on the prior exam and have not changed substantially.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions as well as lesions in the brainstem of a mild degree are nonspecific. At this age they are most likely vascular related. This has only mildly progressed since the prior exam2.There is redemonstration of multiple microhemorrhages scattered throughout the periventricular and subcortical white matter. This is somewhat nonspecific given its distribution. One possibility is related to hypertensive episodes. The pattern may be representative of other cause of microhemorrhages including amyloid angiopathy.


Instruction: Generate impression based on findings.

Input: Resected right parietal grade 2 meningioma: post-operative scan for RT planning. Left sided weakness. There are postoperative findings related to right frontoparietal convexity meningioma resection with a small amount of residual extradural hemostatic agent and fluid deep to the craniotomy flap. There is residual tumor in the adjacent superior sagittal sinus that measures up to approximately 4.5 cm in length. There is intrinsically T1 hyperintense material along the margins of the resection cavity, which may likely represent blood products. The linear enhancement along the periphery of the resection cavity has diminished. There is no evidence of acute territorial infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is unchanged pronounced mineralization of the basal ganglia. 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: Postoperative findings related to right frontoparietal convexity meningioma resection with residual tumor in the adjacent superior sagittal sinus.


Instruction: Generate impression based on findings.

Input: 10-year-old female with history of hemangiomas. LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: 1. Decrease in size of infiltrative palmar mass.2. Unchanged tortuous vessels along the dorsum of the hand.


Instruction: Generate impression based on findings.

Input: Female, 39 years old, with paresthesias. Evaluate for demyelinating disease. Brain:No areas of pathologic parenchymal signal are detected. No edema or mass effect is observed. There are no abnormal extra-axial extra-axial fluid collections. Ventricular size and morphology are within normal limits. Brain volume is normal.C-spine:The spinal cord demonstrates normal signal intensity and morphology throughout. No focal lesions are seen. No epidural abnormalities are suspected.Straightening of the cervical lordosis is likely positional. Sagittal alignment is otherwise unremarkable. No pathologic marrow replacement or edema is seen.Mild disc osteophyte formation is seen from C3-4 through C6-7. No significant resulting spinal canal or foraminal stenosis is identified.

Output: 1.No lesions are seen in the brain or cervical spinal cord to suggest demyelinating disease.2.No additional specific intracranial or spinal abnormalities are identified which would account for the patient's symptoms.3.Mild degenerative findings are seen in the cervical spine.


Instruction: Generate impression based on findings.

Input: Patient submitted outside studies for review. Submitted for review are:-bilateral diagnostic mammogram (02/17/2016)-bilateral breast ultrasound (02/17/2016) -US guided biopsy of left breast with postprocedural left mammographic images (02/22/2016)-bilateral breast MRI (03/03/2016) performed at Adventist Hinsdale Hospital.-Images from ultrasound-guided biopsy of the right breast (03/29/2016)-Specimen radiograph of stereotactic biopsy of left breast (03/29/2016)-MR guided biopsy of right breast (03/29/2016)-Postprocedural mammogram of both breasts (03/29/2016)performed at Rush University Medical Center. BILATERAL DIAGNOSTIC MAMMOGRAM (02/17/2016):The breast parenchyma is heterogeneously dense (BiRADS Density Category C). A triangular marker is placed at posterior upper outer quadrant of left breast, denoting the area of palpable lump.Ill-defined focal asymmetry is seen at upper outer quadrant in the left breast, at the site of palpable marker. There is a small cluster of amorphous calcifications at upper inner quadrant in the left breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. BILATERAL BREAST ULTRASOUND (02/17/2016):There is an ill-defined hypoechoic mass measuring 13 x 10 mm at 2:00 position in the left breast, corresponding to the area of palpable lump. In the left axilla there is one normal appearing lymph node. In the right breast at 4:00 position, there is an anechoic 5 x 3 mm simple cyst.US GUIDED BIOPSY OF LEFT BREAST WITH POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (02/22/2016):Ultrasound guided biopsy of the left breast mass at 2:00 position is performed with appropriate needle placement. Postprocedural mammographic images demonstrate a marker clip at posterior aspect of the focal asymmetry in the left upper outer quadrant.Per outside report, the pathology result was malignant; invasive ductal carcinoma grade 2.BILATERAL BREAST MRI (03/03/2016):Breast MRI was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.In the left posterior 2:00 position, there is an enhancing mass, measuring 16 x 16 x 22 mm (AP x LR x CC), with susceptibility artifact from a marker clip. This is the proven IDC. There is an enhancing focus anterior to the index mass, suspicious for satellite lesion. Overall AP distance of index mass and focus is 31 mm.In the right breast at 12:00 position, there is an indeterminate enhancing mass, measuring 8 x 6 x 7 mm.No abnormal lymph nodes are identified in either axillary region.IMAGES FROM ULTRASOUND-GUIDED BIOPSY OF THE RIGHT BREAST (03/29/2016):Ultrasound guided biopsy was performed for an oval mass, measuring 5 mm, at 9:00 position, 3 cm from nipple, in the right breast. Needle placement appears appropriate. Post-procedural mammographic images show a marker clip at anterior 9:00 position in the right breast. Pathology result is not available.SPECIMEN RADIOGRAPH OF STEREOTACTIC BIOPSY OF LEFT BREAST (03/29/2016):Per outside radiology report, stereotactic biopsy was performed for a cluster of calcifications in the left upper inner quadrant. Specimen radiograph demonstrates target calcifications within one of the cores. Post-procedural mammographic images show a marker clip at anterior upper inner quadrant in the left breast. Pathology result is not available. MR GUIDED BIOPSY OF RIGHT BREAST (03/29/2016):MR guided biopsy was performed for an enhancing mass in the right breast at 12:00 position. Post-biopsy MR images show biopsy changes with hematoma at the site of the enhancing mass. Post-procedural mammographic images show a marker clip at anterior 11:30 position in the right breast. Pathology result is not available.

Output: 1. Biopsy proven IDC in the left breast at posterior 2:00 position, with possible satellite located anteriorly.2. Status post US guided biopsy of right breast mass at 9:00 position, stereotactic biopsy of calcifications at upper inner quadrant in the left breast, and MR guided biopsy of right breast mass at 12:00 position. Pathology results of these biopsies are not available at the time of this dictation.3. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal cancer. Head CT:There is no evidence of intracranial mass, hemorrhage or infarction. No enhancing abnormality is seen intracranially.Neck CT:There is a nasopharyngeal mass at the fossa of Rosenmueller on the left, measuring approximately 3.0 x 1.6-cm. extends to the left infratemporal fossa, at the region of the left foramen lacerum, causing erosion of the floor of the left carotid canal (image #19 of series 5). The soft tissue lesion is suspected to be partially encasing the left internal carotid canal, which can be better defined with MRI of the neck. There is no definite intracranial extension. There is adenopathy involving the left lateral retropharyngeal lymph nodes, and level 2 on the left.

Output: Left nasopharyngeal mass with extension to the left infratemporal fossa and skull base destruction. It is likely partially encasing the left internal carotid canal. Adenopathy involving left lateral retropharyngeal node and left level 2. No definite intracranial extension.


Instruction: Generate impression based on findings.

Input: 43-year-old male with pain. Evaluate for medial meniscus injury MENISCI: There is branching signal abnormality within the posterior horn and body of the medial meniscus indicating a complex but predominantly horizontal tear that extends to the femoral articular surface and also extends to the periphery of the posterior horn, decompressing into a small parameniscal cyst. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the patella with multiple partial and near full-thickness clefts/defects. There is also superficial degeneration of the articular cartilage of the femoral trochlea, centrally. We see no full-thickness articular cartilage defects of the tibiofemoral compartments. There is minimal subchondral bone marrow edema within the posteromedial aspect of the tibial plateau perhaps related to the overlying meniscal tear.LIGAMENTS: There is edema noted along the MCL which is nonspecific, but could represent a sprain in the correct clinical context. The ligament itself appears intact. The ACL and PCL appear intact. The LCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Medial meniscus tear as described above.2. Degeneration of the articular cartilage of the patellofemoral joint.3. Edema along the MCL is nonspecific but could represent a sprain in the correct clinical context.4. Moderate size joint effusion other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: new onset prolonged seizure History: prolonged seizure x 1 hour. This exam is limited by motion artifact.The corpus callosum appears thin, but fully formed, without evidence of structural abnormality. The septum pellucidum is present. The lateral ventricles are irregular and undulating in contour, with prominent atria and angular ventricular margins. There is generalized loss of periventricular white matter volume. There is mild patchy periventricular hyperintensity on T2-weighted and FLAIR images.Except for the periventricular regions, myelination is adequate for the patient's age. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. There is no evidence of cortical dysplasia, mass lesions, or migration abnormalities. The temporal lobe structures appear normal. 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 appear clear.

Output: 1. No evidence of acute hemorrhage, edema, or mass effect. There is no evidence of cortical dysplasia or migration abnormalities.2. Constellation of findings is suggestive of periventricular leukomalacia.


Instruction: Generate impression based on findings.

Input: 79-year-old male with recent code, hypotension, on pressors. Rule out stroke Exam limited by motion artifact.Again seen is a low-attenuation lesion in the left frontal deep white matter that extends to the basal ganglia. This is seen on previous studies dating back to an MRI from 2/05 and is consistent with chronic ischemic changes.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The mastoid air cells are normally pneumatized.

Output: Chronic ischemic changes unchanged. No CT finding suggesting acute ischemia. Recommend MRI exam once the patient is clinically stable to rule-out acute ischemia as clinically indicated.


Instruction: Generate impression based on findings.

Input: Multiple Sclerosis- Tysabri maintenance- follow up progression. There is no significant interval change in the multiple intracranial T2 hyperintense white matter lesions. Many of the lesions are also T1 hypointense. There is no evidence of intracranial mass. 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: 1. No significant change in the demyelinating lesions.2. No evidence of PML.


Instruction: Generate impression based on findings.

Input: 22 years Female (DOB:4/28/1994)Reason: MS, f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of corpus callosum FLAIR signal hyperintense lesions extending to the centrum semiovale bilaterally . These were also present on the previous exam and do not appear to have changed substantiallyNormal 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: Periventricular white matter lesions of a mild degree are stable and compared to the prior exam. There is no new lesion appreciated on the current exam.


Instruction: Generate impression based on findings.

Input: Back pain and leg pain. Acquired spondylolisthesis, evaluate for nerve impingement. Five lumbar type vertebral bodies are presumed to be present. There is multilevel degenerative changes involving the vertebral bodies including endplate sclerosis and increased T2 STIR signal at L1-L2 endplate level compatible with mild bone marrow edema. There is minimal depression of superior endplate of L2 vertebra without definite height loss. Constellation of above findings are more likely represent degenerative disc disease related changes, however, L2 vertebral body non-height loss, partial compression fracture cannot be completely excluded.There is a grade 1 spondylolisthesis of L4 on L5. There is no infiltrative marrow process or worrisome lesions. The conus medullaris is normal in position and terminates at L1 level.Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease or neural foraminal or spinal canal stenosis.L1-L2: There is mild disc bulge. There is bilateral facet arthropathy. There is no neural foraminal narrowing or significant spinal canal stenosis.L2-L3: This is diffuse disc bulging. There is facet arthropathy. There is no neural foraminal stenosis or significant stenosis.L3-L4: There is mild diffuse disc bulge. This doesn't have a particularly There is no significant neural foraminal narrowing or spinal canal stenosis.L4-L5: There is pseudo bulging of the disc due to spondylolisthesis. There is facet arthropathy and ligamentum flavum hypertrophy. This is left facet joint effusion. There is no significant neural foraminal stenosis. There is mild to moderate spinal canal stenosis.L5-S1: Mild diffuse disc bulge. Ligamentum flavum hypertrophy and facet arthropathy. There is mild bilateral neural foraminal narrowing. No significant spinal canal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative disc changes involving the lumbosacral spine including endplate marrow signal changes at L1-L2 consistent with acute to subacute degenerative changes. Non height loss partial compression fracture of L2 cannot be completely excluded but less likely.2. Mild to moderate spinal canal stenosis at L4-L5.3. Grade 1 spondylolisthesis of L4 over L5.


Instruction: Generate impression based on findings.

Input: History of Li Fraumeni syndrome. Surveillance examination. NECK AND SKULL BASE: No mass lesion is evident. The visualized intracranial contents are within normal limits. There are normally sized lymph nodes throughout the cervical chain bilaterally.CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Normally sized bilateral hilar lymph nodes. No significant abnormality noted.CHEST WALL: Normally sized axillary lymph nodes bilaterally.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No upper abdominal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.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: Normally sized sized pelvic and inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.THIGHS:No soft tissue mass lesion. Normal-sized popliteal fossa lymph nodes.

Output: Normal examination without evidence of tumor.


Instruction: Generate impression based on findings.

Input: Incontinence, weakness. Metastatic prostate cancer. There are multiple vertebral body osseous lesions related to known sclerotic metastases, particularly the L2, L3, and L4 levels with the L3 lesion demonstrating extension involving the posterior elements on the left. Additional small scattered lesions are present more superiorly including T3, T8, and T11 levels as well as inferiorly involving the left iliac bone which is partially imaged. Lesion involving the left-sided posterior elements at the T2 level is also noted. Large left femoral metastases also noted on the coronal survey sequence. There is corresponding sclerosis on recent CT. Burden of osseous metastases is better assessed on recent bone scan. Vertebral body heights are maintained. Alignment is maintained. There is mild developmental narrowing of the spinal canal without high-grade stenosis in the cervical, thoracic, or lumbar spine. No gross evidence of epidural tumor.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2. Multiple scattered osseous metastases, particularly in the lumbar spine. No gross evidence of epidural tumor or pathologic fracture.3. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: 40 year-old male status post fall. Experiencing left-sided numbness/tingling. Evaluate for ICH/C-spine fracture There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Mucosal thickening in the ethmoid sinuses representing mild sinus disease. Mastoid air cells are normally pneumatized.Cervical spine demonstrates normal alignment and no fracture. Neuroforamina are patent. No prevertebral soft tissue swelling. Questionable disc protrusion at the C5/C6 level to the left of midline. An MRI would be warranted if clinically indicated.

Output: 1. No evidence of intracranial process or cervical spine fracture.2. Questionable protruding disc to the left of midline at the level of C5/C6. MRI would provide more detail if clinically warranted.


Instruction: Generate impression based on findings.

Input: There is flattening of the skull base/platybasia and a high riding anterior arch of C1. The tip of the dens situated posterior to the anterior lip of the foramen magnum, but there is no evidence of basilar invagination. The lateral masses of the atlas appear fused with the occipital condyles, although please note that detailed evaluation of the osseous anatomy is limited by MRI. Degenerative changes are noted at the atlantoaxial joint. There is straightening of the cervical spine. The cervical vertebral bodies are appropriate height. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Uncovertebral joint hypertrophy with mild to moderate right and mild left neuroforaminal narrowing. No spinal canal stenosis.C4-5: Mild degenerative disk disease and uncovertebral joint hypertrophy with mild bilateral neuroforaminal stenosis. Mild spinal canal stenosis.C5-6: Moderate degenerative disk disease and moderate right neuroforaminal narrowing. No significant spinal canal stenosis.C6-7: Moderate degenerative disk disease with a central and left paramedian disk protrusion. Mild bilateral neuroforaminal narrowing, as well as mild anterior flattening of the spinal cord indicating moderate spinal canal stenosis.C7-T1: Mild degenerative disk disease and moderate facet and ligamentum flavum hypertrophy. Mild bilateral left greater than right uncovertebral joint hypertrophy. Moderate left greater than right neuroforaminal stenosis and mild spinal stenosis. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Atlanto-occipital fusion with associated platybasia but no basilar invagination or cord signal abnormality. Evaluation of the bony anatomy is limited by MRI and CT would be recommended for further evaluation if clinically warranted. 2. Multilevel degenerative changes with mild to moderate multilevel neuroforaminal narrowing and mild spinal canal stenosis, as described above.


Instruction: Generate impression based on findings.

Input: 2-year-old status post C7 neurofibroma resection. Compared to 4/21/2015, interval postsurgical changes of laminotomies from C5 to T1 are seen. Interval resection of previously seen enhancing tumor involving the spinal canal at the C7 level and multiple neural foramina below C5-C6 on the left. No residual intraspinal tumor is appreciated. Previously seen rightward displacement of the cord has resolved. Expected postsurgical changes include small amount of fluid in the surgical bed as well as epidural enhancement; there is partial effacement of the thecal sac without significant spinal canal stenosis. No cord signal abnormality.Postsurgical changes of left-sided thoracotomy are also noted related to debulking of previously seen extensive neurofibroma involving the thoracic cavity, supraclavicular fossa, and axilla.

Output: Interval postsurgical changes of C7 neurofibroma resection. No residual tumor within the spinal canal is demonstrated.


Instruction: Generate impression based on findings.

Input: 18-year-old female with pain. Evaluate for fifth metatarsal stress fracture. There is abnormal bone marrow signal within the fourth metatarsal shaft demonstrate hyperintense STIR signal intensity and relatively lower signal intensity on T1-weighted sequences when compared to the other metatarsals of the right foot. There is mild periosteal edema. This is most compatible with a stress reaction. There are no focal additional linear changes to suggest a fracture. The surrounding soft tissues, including the extensor and flexor compartment tendons and muscles appear normal.

Output: Findings most compatible with a stress reaction of the fourth metatarsal shaft.


Instruction: Generate impression based on findings.

Input: History of distal esophageal cancer and chronic pancreatitis. PET CT demonstrated a hypermetabolic focus in the pancreatic head/neck. Evaluate this lesion. ABDOMEN:LIVER, BILIARY TRACT: Demonstrate again is marked intrahepatic and extrahepatic biliary ductal dilatation. A biliary stent is noted.No suspicious liver lesion. The liver is normal in morphology. The hilar portal vein is patent. At the level of the pancreatic head is markedly attenuated. The hepatic veins are patent.Cholelithiasis.SPLEEN: Normal splenic size.PANCREAS: The pancreas is prominent with marked irregular pancreatic ductal dilatation/ectasia with multiple signal voids compatible with calcifications as seen on recent CT. These findings are consistent with severe chronic pancreatitis, although a main duct intrapancreatic mucinous neoplasm cannot be excluded.There is soft tissue enhancement of the pancreatic head/uncinate process which may represent residual pancreatic parenchyma although underlying neoplasm cannot be excluded given the marked parenchymal abnormality.There is a enhancing thick-walled focus along the anterior caudal aspect of the pancreatic head measuring 1.4 x 0.7 cm (series 12/179), which may represent a small pseudocyst or necrotic lymphadenopathy.A 1.8 cm lesion near the pancreatic tail may represent the mobile rim calcified pseudoaneurysm as seen on recent CT.There is no significant peripancreatic acute inflammatory changes/fluid.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal simple appearing cysts and too small to characterize hypointensities.RETROPERITONEUM, LYMPH NODES: Prominent gastrohepatic adenopathy is better characterized on recent CT.BOWEL, MESENTERY: The stomach is distended with heterogeneous debris to the level of the transverse duodenum without a discrete mass lesion seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Markedly distended main pancreatic duct may reflect stigmata of severe chronic pancreatitis although a main duct intrapancreatic mucinous neoplasm cannot be entirely excluded. Heterogeneous soft tissue enhancement of the pancreatic head may represent residual parenchyma although an underlying neoplasm cannot be excluded. ERCP/US correlation is recommended.2.Thick rim enhancing small lesion anterior and caudal to the pancreatic body may represent a pseudocyst versus necrotic lymphadenopathy.3.Probable mobile arterial pseudoaneurysm measuring 1.8 cm, better seen on the recent CT.


Instruction: Generate impression based on findings.

Input: History of rheumatoid arthritis and motor vehicle collision presenting with intermittent neck pain and bilateral cervical radiculopathy. Cervical spine:Straightening of the cervical lordosis related to spondylitic changes. There is mild loss of vertebral body height affecting multiple levels from C3 to C6 without frank compression fracture. No sequela of rheumatoid arthritis are identified. There is no significant pannus formation or erosions involving the dens. Flexion and extension sagittal images do not indicate atlantoaxial instability. The cervical spinal canal measures between 9 and 11 mm in AP dimension which is borderline for congenital canal narrowing. A superimposition of multiple disc osteophyte complexes and hypertrophy of the ligamentum flavum from C2 to C7. Diffuse mild spinal canal stenosis. While there is mild distortion of the cord at multiple levels, no abnormal cord signal is identified.Level by level findings are as follows:C2-C3: Small disc osteophyte complex and mild thickening of the ligamentum flavum. Minimal bilateral neural foraminal stenosis.C3-C4: Small disc osteophyte complex, uncovertebral joint hypertrophy, and hypertrophy of ligamentum flavum. Mild left neural foraminal stenosis.C4-C5: Moderate disc osteophyte complex, thickening of the ligamentum flavum, and uncovertebral joint hypertrophy. No significant foraminal stenosis.C5-C6: Mild disc osteophyte complex, hypertrophy of the ligamentum flavum, uncovertebral joint hypertrophy. Mild left neural foraminal stenosis.C6-C7: Mild disc osteophyte complex and hypertrophy of ligamentum flavum. Moderate spinal canal stenosis. Mild right neural foraminal stenosis.C7-T1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.

Output: 1. Multilevel spondylitic changes superimposed on a borderline congenitally narrow cervical spinal canal result in diffuse mild cervical canal stenosis2. Mild multilevel neural foraminal narrowings as described.3. No erosions, transformation, atlantoaxial instability, or other sequela of rheumatoid arthritis in the cervical spine.


Instruction: Generate impression based on findings.

Input: Thyroid eye disease versus multiple sclerosis: diplopia. Orbits: The bilateral inferior rectus muscles are enlarged, particularly on the right side, where there is hyperenhancement and edema. The right medial rectus muscle may also be slightly enlarged. In addition, there is mild crowding towards the right orbital apex without evidence of optic nerve compression. Indeed, the bilateral optics nerves appear to be intact, without evidence of signal abnormality or contour deformity. There is no evidence of orbital mass lesions or abnormal enhancement. The optic nerves display normal signal and morphology. The globes and ocular adnexa are unremarkable. The orbital walls appear to be intact. 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. There is a mildly ectatic and tortuous right vertebral artery. The skull and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. Findings suggestive of thyroid associated orbitopathy, with inflammatory changes involving the right inferior rectus muscles and mild crowding of the right orbital apex, but no discernible optic nerve impingement. 2. No evidence of demyelinating lesions.


Instruction: Generate impression based on findings.

Input: 56-year-old female with pain. Evaluate for cuff tear after fall. ROTATOR CUFF: There is mild tendinosis of the supraspinatus tendon. There is also a small 2 to 3 mm focus of relatively increased signal intensity within the supraspinatus tendon at its insertion, likely representing a concealed insertional tear. There is also mild irregularity of the bursal surface of the tendon suggesting fraying. There are small cysts in the humeral head at the insertion of the infraspinatus tendon, but the tendon and muscle itself appear normal. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. No fluid is identified within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is minimal increased signal intensity within the superior labrum which may reflect degeneration, but we see no evidence of a labral tear, given the limitations of a non arthrogram study. There is no glenohumeral joint effusion.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is a small amount of circumferential fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the joint. ADDITIONAL

Output: Mild supraspinatus tendinosis and bursal surface fraying and probable concealed insertional tear with other findings as described above.


Instruction: Generate impression based on findings.

Input: 36-year-old male presents with right knee pain, evaluate for a meniscal tear. MENISCI: There is extensive linear and globular signal abnormality within the body and posterior horn of the medial meniscus indicating mucoid degeneration with extension through the periphery of the posterior horn of the medial meniscus. There is decompression into a multilobulated parameniscal cyst posteriorly. Additional smaller parameniscal cysts are noted along the anterior margin of the medial meniscus. There is a equivocal extension of the intrameniscal signal to the femoral articular surface of the knee. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: The medial and lateral compartments are normal. There is a small full-thickness cleft of the articular cartilage of the median eminence of the patella.LIGAMENTS: The cruciate and lateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Extensive mucoid degeneration of the medial meniscus with decompression into parameniscal cysts, but with equivocal extension to the femoral articular surface. Additional findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, with hearing loss on the left. Evaluate for pathology in the left ear. The visualized brainstem is unremarkable. The seventh/eighth nerve complexes are well visualized and show normal morphology. No pathologic enhancement is seen along the cranial nerves, within the IACs or in the CP angles. No masslike lesions are detected. The fluid filled structures of the inner ears show normal morphology.

Output: Unremarkable evaluation of the IACs with no specific findings to account for the patient's left-sided hearing loss.


Instruction: Generate impression based on findings.

Input: 66 years, Male, Reason: evaluate for upcoming biopsy History: Elevated PSA, large prostate. PELVIS:PROSTATE:Prostate Size: 4.6 x 6.0 x 5.0 (AP x TR x SI)Prostate: There is an anterior apical lesion measuring 1.4 x 1.1 cm (604/164) which is low signal on ADC and T2 and enhances. On postcontrast images, there appears to be extracapsular extension from this lesion. An additional lesion in the right apex measures 1.0 x 0.6 cm (604/184) which is also low signal on ADC/T2 and enhances.Multiple heterogeneous lesions are compatible with BPH.Seminal Vesicles: No significant abnormalities.Extracapsular Extension: YesBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two apical lesions are identified, one of which is in the anterior prostate, that are suspicious for prostate adenocarcinoma. There appears to be extracapsular extension from the anterior lesion.


Instruction: Generate impression based on findings.

Input: 10-year-old female with sacral agenesis. Evaluate for female reproductive organs and vaginal patency. PELVIS:UTERUS, ADNEXA: The uterus is identified (for example series 1301, image 17 and series 1601, image 19). The vaginal vault appears patent (for example series 901, image 26). Both ovaries are identified are normal in appearance (series 1101, image 15 and 16). BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No specific evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No free fluid is identified.

Output: Normal appearance of the uterus and ovaries, within the limitations described above.


Instruction: Generate impression based on findings.

Input: incontinent bowel/bladder, decreased leg strength, prior mri from osh reviewed by neurosurgery. Evaluate for hematoma vs lymphoma. Thoracic spine:There are multilevel degenerative changes throughout the thoracic spine without evidence of high-grade central canal stenosis. The thoracic spine is in normal alignment. No worrisome focal marrow signal abnormality is appreciated. Within the limits of a motion degraded exam, there is no obvious cord signal abnormality.Mild disc bulges are noted at the T2-3, T5-6, T6-7, T7-8, T8-9, and T9-10 levels but there is no significant compromise to spinal canal or neural foramina.At the T10-11 level there is a mild disc bulge, facet arthropathy and ligamentum flavum thickening as well as minimal retrolisthesis of T10 and T11 which causes mild central canal stenosis and moderate to severe left neuroforaminal stenosis. No significant right neural foraminal stenosis.At the T11-12 level there is loss of disc height and a 14 mm of superior extrusion of disc material. There is minimal arthrosis at this level but no significant compromise to spinal canal or neural foramina. Lumbar Spine:There is mild exaggerated lordosis and grade 1 anterolisthesis of L3 on L4 and L4 on L5. There is some loss of disc height at the L3-4 and L4-5 levels. The vertebral body heights are preserved. The vertebral bone marrow signal is heterogeneous which is nonspecific. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is mild facet arthropathy but no significant compromise to spinal canal or neural foramina.L2-L3: There is mild facet arthropathy but no significant compromise to spinal canal or neural foramina.L3-L4: There is anterolisthesis of L3 on L4 which causes uncovering of the disc, a superimposed disc bulge and advanced facet arthropathy which cause moderate to severe central canal stenosis. A 9 x 7 x 15 cm low T1/high T2 ovoid structure extending from the L3-4 level to the mid L4 level within the posterior spinal canal, likely represents a synovial cyst and this along with prominent posterior epidural fat contributes to the moderate to severe stenosis at this level. This is best seen on sagittal STIR images series 23, image 11. There is also moderate to severe right and moderate left neuroforaminal stenosis.L4-5: There is anterolisthesis of L4 on L5 with advanced facet arthropathy and prominence of the posterior epidural fat which causes moderate to severe central canal stenosis. There is also moderate right and moderate to severe left neuroforaminal stenosis.L5-S1: There is no significant compromise to spinal canal or neural foramina.A large T2 hyperintense cystic structure is noted involving the left renal pelvis and most likely represents a parapelvic cyst.

Output: Thoracic spine:1.Multilevel degenerative changes without evidence of high-grade central canal stenosis.2.No evidence of an epidural hematoma or neoplasm.3.Within the limits of a motion degraded exam, there is no obvious cord signal abnormality.Lumbar spine: 1.Advanced degenerative changes with moderate to severe central canal stenosis at L3-4 and L4-5 with neural foraminal stenosis as detailed above.2.Cystic structure dorsal to the thecal sac at the L4 level likely represents a synovial cyst, which contributes to the moderate to severe central canal stenosis at this level.


Instruction: Generate impression based on findings.

Input: Reason: Post TACE/RFA, evaluate for new or recurrent HCC; Evaluate IPMN History: HCV cirrhosis, SVR; HCC s/p TACE/RFA, IPMN ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhotic liver morphology.The segment 8 ablation cavity measures approximately 1.8 x 1.3 cm, compared to 1.8 x 1.3 cm previously. There is again a punctate nodular focus of arterial enhancement along the anterior aspect of the ablation cavity without definite washout. Minimal thin enhancement around the ablation cavity is unchanged.There is plaque-like enhancing focus at the gallbladder fundus measuring 0.4 x 0.8 cm, not significantly changed back to 1/6/2015, with associated T2-weighted cystic intensity on prior exams, likely focal adenomyomatosis. Cholelithiasis without cholecystitis. Recanalized umbilical vein. The common hepatic artery originates from the aorta. The vessels are patent.Cholelithiasis without evidence of cholecystitis. No biliary ductal dilatation.SPLEEN: Stable mild splenomegaly, measuring 14 cm in length.PANCREAS: Lobular cystic focus in the pancreatic head measuring approximately 1.3 cm is unchanged, likely communicates with a normal caliber pancreatic duct. No suspicious postcontrast imaging features.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver with evidence of portal hypertension.2.Punctate nodular enhancement along the anterior aspect of the segment 8 ablation cavity not significantly changed and which may be a posttreatment change. Attention to this on follow-up imaging is recommended. No new suspicious liver lesions.3.Stable cystic lesion in pancreatic head suggestive of a side branch IPMN without suspicious imaging features.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: pre op planning - no fiducials needed History: ams The exam was performed with pre-operative stealth protocol.There are ill-defined low signal intensity lesions with significant surrounding edema on T2 images, one on the right parietal and the other is on the left parietal lobes (right side lesion is bigger than the left).The right lateral ventricle occipital horn shows effacement due to mass effect. However, there is no midline shift.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multiple various size intra-axial masses with surrounding edema (right side lesion is bigger than that of the left). Differential diagnosis include brain abscess, metastatic lesions, or primary malignant brain tumor.


Instruction: Generate impression based on findings.

Input: Reason: history of seizure and AVM History: seizure in 1980's MRI of the brainThere is a 38 x 19 mm sagittal dimension sellar and suprasellar mass which displaces the optic chiasm superiorly.There is subcortical signal hyperintensity on T2 and flair MRI along the inferior and lateral aspect of the right postcentral gyrus is also adjacent right inferior parietal lobule.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is adjacent widening of sulciNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening of the minor opacities. 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. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There is a large sellar and suprasellar mass which displaces the optic chiasm superiorly. This most likely represents pituitary adenoma. Prior studies are not available for comparison.2.There is encephalomalacia present along the right parietal lobe as detailed above3.There is no evidence for a true venous malformation this exam. Please note that conventional angiography is more sensitive in detection of residual arteriovenous malformation.4.An alphanumeric page was sent to pager 2356 (Sandra Rose) at the time of this dictation. The findings were discussed.


Instruction: Generate impression based on findings.

Input: 77 year old female with diabetes, hypertension, hyperlipidemia, and reported history coronary artery disease and angioplasty.MEDICATIONS: Metoprolol, Lisinopril, Aspirin, Metformin, Allopurinol, Glipizide First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is high signal at mid-wall noted in the basal inferior wall, which is atypical for prior myocardial infarction. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 89 ml/m2 (normal range: 65+/-11), the LVEDV is 171 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 69 ml (normal range 31+/-10), the LV mass index is 63 g/m2, and the LV mass is 122 g. There are no regional wall motion abnormalities present. No intracardiac thrombus.Left AtriumThe left atrium is moderately dilated. 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 63 ml/m2 (normal range 69+/-14), the RVEDV is 179 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 71 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is aortic regurgitation, visibly trace or mild.Mitral ValveThe mitral valve opens widely. There is mitral regurgitation which appears mild. Dedicated quantification was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation which appears mild. Dedicated quantification was not performed.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsBilateral renal cysts, cholelithiasis.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. There is apparent mid-wall high signal at the basal inferior wall, which is atypical for prior myocardial infarction and may be artifactual. The possibility of prior inflammation in this location cannot be excluded. In the absence of wall motion abnormality, active inflammation is not suspected. The entire myocardium is viable. 3. Normal LV size and systolic function (LVEF 59%).4. Normal RV size and systolic function (RVEF 61%).


Instruction: Generate impression based on findings.

Input: 53-year-old male with history of hepatitis B. HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Multiple enlarged porta hepatis lymph nodes again seen. Subcentimeter nonenhancing simple cysts are scattered about the liver. No suspicious lesions.Cholelithiasis.There is a nonocclusive thrombus within the distal SMV extending into the proximal portal vein appearing similar to prior.SPLEEN: Splenomegaly measuring up to 17 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis without evidence of suspicious hepatic lesion.2.Cholelithiasis.3.Nonocclusive distal SMV thrombus extending the main portal vein appearing similar to prior.


Instruction: Generate impression based on findings.

Input: Reason: Rotator cuff tear History: pain, decreased ROM ROTATOR CUFF: Complete tear of the supraspinatus with approximately 2.5 cm of retraction. There is extension of the tear posteriorly to involve the anterior fibers of the infraspinatus. There is also extension of the tear anteriorly to involve the posterior fibers of the subscapularis. The subscapularis tendon appears diffusely thinned likely representing chronic attritional tearing. There is marked fatty atrophy of the supraspinatus and superior subscapularis.SUPRASPINATUS OUTLET: Severe osteoarthritis affects the acromioclavicular joint with an associated large osteophyte/spur projecting from the inferior margin of the acromion process. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is degeneration/degenerative/degenerative changes affecting the glenoid labrum. There is partial thickness degeneration of the glenoid articular cartilage.BICEPS TENDON: There is complete disruption of the long head of the biceps tendon at the level of its transition from the rotator interval to the bicipital groove. The intraarticular portion of the tendon is poorly visualized likely reflecting retraction of the tendon.ADDITIONAL

Output: 1. Complete tear of the supraspinatus with retraction with extension of the tear to involve the anterior fibers of the infraspinatus and posterior fibers of the subscapularis. Marked atrophy of the supraspinatus and subscapularis muscles.2. Complete rupture of the long head of the biceps tendon with retraction.


Instruction: Generate impression based on findings.

Input: Female, 27 years old, with migraines and HIV. No restricted diffusion is seen. No evidence of parenchymal edema or mass effect is detected. There are no focal areas of parenchymal signal abnormality. No findings to suggest acute intracranial hemorrhage are demonstrated. No pathologic parenchymal or extra-axial enhancement is seen. An incidental cavum vellum interpositum is suspected. The ventricles are normal in size and morphology.

Output: No acute intracranial abnormalities and no specific findings to account for the patient's headaches.


Instruction: Generate impression based on findings.

Input: Left upper extremity weakness/triceps, finger extension. Suspect C6 -- C7 foramina stenosis. CT of the cervical spine without the infusion:3-mm axial images of the entire cervical spine were obtained. Sagittal and coronal reformatted images were obtained.Reformatted images demonstrate straightening of cervical lordosis. This finding may be positional. Mild degenerative disk disease and shallow ventral hypertrophic spurs are noted.Foramina magnum.Examination of this level is unremarkable.C2 -- C3.No central spinal stenosis or neural foramina compromise. C3 -- C4.Minimal degenerative changes which appears to be more pronounced on the left. There is minimal sclerotic changes of the left uncovertebral and articulating facet on the left (axial image 37). The left neural foramina appears slightly smaller than the right and is believed to be partially compromised.C4 -- C5.No central spinal stenosis or neural foramina compromise. Very minimal hypertrophic and sclerotic changes of the left uncovertebral on axial image 42. The left neural foramina appears minimally smaller than the right. This finding was also noted on prior MRI examination on axial T2 weighted image 15.C4 -- C5.Minimal degenerative changes. The left neural foramina appears minimally smaller than the right secondary to hypertrophic changes.C5 -- C6.Degenerative disk disease and hypertrophic changes of the posterior elements are noted. There is evidence of hypertrophic changes of bilateral uncovertebral with resultant compromise of bilateral neural foramina. This finding was also appreciated on axial T2-weighted image 23 of prior MRI of cervical spine. Large anteriorly located hypertrophic spurs at this level projects into the soft tissues of the prevertebral space. Reformatted images demonstrate a shallow ventral hypertrophic spur with minimal bulge of disk material. Review of prior MRI examination demonstrates no central spinal stenosis at this level.C6 -- C7.Mild degenerative disk disease and minimal hypertrophic changes of posterior elements. There is compromise of bilateral neural foramina secondary to above changes. This finding may be slightly more pronounced on the left. These findings were noted also on prior MRI examination cervical spine on axial T2-weighted image 27. No central spinal stenosis.C7 -- T1.Minimal asymmetrical hypertrophy changes on the left is suspected on axial image 57. This includes hypertrophied and minimally calcified ligamentum flavum on the left. Minimal compromise of the left neural foramina is suspected.

Output: 1.Degenerative changes of cervical spine with multilevel neural foramina compromise as detailed above.2.Prior MRI examination of cervical spine is also reviewed which shows similar findings as described above.


Instruction: Generate impression based on findings.

Input: Ms. Pedrido is a 50-year-old female with newly diagnosed left breast cancer (IDC, grade 2, mucinous type). She presents for MRI imaging evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.In the left medial breast, there is an irregular enhancing mass identified measuring 2.8 x 2.0 x 1.9 cm (AP x ML x SI). This mass demonstrates increased T2 signal intensity, characteristic for mucinous carcinoma. Two biopsy marker clips are seen, one of which is centrally located (ribbon clip) and one of which is located antero-medial to the mass (hydromark clip). Associated post-biopsy changes are seen, including minor skin thickening/enhancement at biopsy entry site. There is no abnormal enhancement identified in the right breast. There are numerous cysts of varying T2 signal intensity identified bilaterally.No abnormal axillary lymph nodes are identified in either axillary region.Few subcentimeter T2 hyperintense cysts are identified in the liver.

Output: (1) Unifocal malignancy of the left breast. If breast conservation therapy is desired, the ribbon clip can be used for preoperative localization. (2) No MR evidence of malignancy of the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:8/9/1944)Reason: s/p crani for tumor History: s/p crani for tumorPROVIDER/ATTENDING NAME: KRUPA G ANDALKAR PETER C. WARNKE Since the prior examination patient is undergone parietal craniotomy for removal of an extra-axial mass involving the superior sagittal sinus. The lobulated enhancing component remaining along the anterior aspect of the mass measuring 33 x 19 mm in axial dimensions the superior sagittal sinus appears to be patent adjacent to it.Within the brain parenchyma adjacent to the craniotomy site there is signal change within the subcortical white matter in a contiguous fashion which has not changed substantially since the prior preoperative exam.There are are some small foci of diffusion restriction adjacent to the surgical site within the brain parenchyma. There are some blood products which are hyperintense on T1 at the surgical site. There is soft tissue swelling present involving the scalp tissues.Incidental note is made of partial empty sella.There is mild anterior subluxation of C1 on C2.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.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacification of the right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.Since the prior examination the patient is undergone partial removal of an extra-axial mass adjacent to the falx and superior sagittal sinus. There are associated postoperative changes present.2.There is mild anterior subluxation of C1 on C2 which appears unchanged since the prior exam


Instruction: Generate impression based on findings.

Input: Male 68 years old Reason: RECURRENT RECTAL CANCER AT 10 CM AND SYNCHRONOUS BLADDER CANCER. STAGE RECTAL CANCER AND COMMENT ABOUT RELATION TO PROSTATE AND BLADDER History: RECTAL CANCER Overall image quality: Very goodPELVIS:PROSTATE/SEMINAL VESICLES: Benign prostatic hypertrophy. No lesions suspicious for prostate cancer. Right seminal vesicle and base of the prostate on the right side are indicated by the patient's known rectal cancer.BLADDER: Asymmetric early enhancement on the right side of the bladder wall compatible with patient's no history of bladder cancer.LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: NoneLymph nodes outside the mesorectal fascia: NoneBOWEL, MESENTERY: Rectal Tumor:Size: 2.8 x 2.3 cm mass arising from the right anterolateral aspect of the rectum invading the right seminal vesicle and base of the prostate, best seen on image number 34, series number 541. The mass is located at 8-cm of the rectum.Tumor appearance on T2-weighted images: HypointenseTumor location: 8-cm of the rectum): MRI T-stage: T4 there is evidence of extramural vascular invasion, best seen on image number 162, series number 1701.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large rectal cancer invading the right seminal vesicle and prostate base with extramural extravascular invasion.2.Right bladder wall thickening compatible with patient's known history of bladder cancer.


Instruction: Generate impression based on findings.

Input: Reason: cuff tear? History: pain ROTATOR CUFF: There is partial thickness tearing of the articular surface fibers of the supraspinatus just proximal to the level of its insertion on the greater tuberosity involving approximately 50% of the tendon width, measuring approximately 2 cm in AP dimension. There is no significant retraction. There is also thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. There is undersurface fraying of the subscapularis just proximal to its insertion on the lesser tuberosity.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: There is a full-thickness articular cartilage cleft along the inferior margin of the glenoid with underlying degenerative subchondral signal abnormality and cyst formation. There is degeneration/degenerative tearing of the inferior labrum within the limitations of a non arthrogram study.BICEPS TENDON: There is deformity and increased signal abnormality within the intra-articular portion of long head biceps tendon consistent with a longitudinal split tear. There is a small amount of circumferential fluid within the tendon sheath which may reflect fluid extension from the joint versus a tenosynovitis. ADDITIONAL

Output: 1. Tendinosis and partial thickness tearing of the supraspinatus without evidence of a full-thickness rotator cuff tear or retraction.2. Osteoarthritis of the shoulder and degeneration/degenerative tearing of the glenoid labrum.3. Longitudinal split tear of the intra-articular portion of the long head of the biceps tendon and probable biceps tendon tenosynovitis. Other findings as described.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: eval for vessel narrowing/pathology given evidence of ischemic CVA History: eval for vessel narrowing/pathology given evidence of ischemic CVA on head CT Brain MRI:Multifocal bihemispheric acute ischemic infarct including right frontal lobe, right caudate nucleus head, right occipital lobe and left posterior temporal lobe. On gradient echo technique, there are subtle blooming artifacts on the right frontal lobe acute ischemic infarct lesion indicating possible hemorrhage transformation.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D 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.

Output: 1. Multifocal bihemispheric acute ischemic infarcts as described above with possible focal hemorrhagic conversion especially on the right frontal lobe lesion.2. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: 60 y/o female w/ IgG kappa multiple myeloma, left lower back pain, numbness/tenderness, left lower pelvic area pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 and L5. Alignment is otherwise maintained. Bone marrow signal is benign with no areas of edema or enhancement to suggest active myeloma lesions. 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 right neural foraminal stenosis. Cystic enhancing lesion described below involves the inferior lateral aspect of the neural foramen on the left with minimal narrowingL2-L3: Disc bulge and facet arthropathy with suggestion of a small left foraminal disc protrusion. No significant spinal canal or right neural foraminal stenosis. Mild left neural foraminal narrowing. L3-L4: Disc bulge and bilateral facet arthropathy and prominence of the dorsal epidural fat. There is associated mild central spinal canal stenosis as well as mild bilateral neural foraminal stenosis.L4-L5: Disc bulge, moderate bilateral facet arthropathy, and ligamentum flavum thickening contribute to mild spinal canal stenosis. There is mild to moderate bilateral, left greater than right, neural foraminal stenosis.L5-S1: There is minimal disc bulge and mild to moderate bilateral facet arthropathy. There is no significant spinal canal or neural foraminal stenosis. Additional disc bulges are present in the partially imaged lower thoracic spine without high-grade spinal canal stenosis.There is a large cystic structure measuring greater than 7.5 cm in diameter inferior lateral to the right kidney without clear correlate on prior abdominal CT from 5/18/2012. There is a larger pelvic mass likely related to uterine fibroids which is partially imaged and demonstrates mass effect on the left psoas muscle.There is a peripherally enhancing tubular lesion along the posterior aspect of the left psoas muscle which measures approximately 7 x 10 mm in the axial plane and approximately 2.5 cm in the craniocaudal dimension. The lesion appears to course along the extraforaminal left L1 nerve root.There are 3 subcentimeter foci of enhancement involving the bilateral iliac bones and left sacrum.

Output: 1. No evidence of active multiple myeloma in the lumbar spine. There are 3 subcentimeter foci of osseous enhancement in the pelvis which are nonspecific but may be related to multiple myeloma.2. Peripherally enhancing fusiform cystic lesion involving the left psoas muscle at the L2 level (7x10 mm in axial plane) may represent an abscess. Neoplasm such as nerve sheath tumor with cystic degeneration (associated with the left extraforaminal L1 nerve root) and resolving hematoma are other considerations. Relative lack of inflammation involving the surrounding left psoas muscle or adjacent discitis-osteomyelitis argue against abscess. 3. Multilevel degenerative changes include grade 1 anterolisthesis at L4 and L5 and mild spinal canal stenosis at the L3-L4 and L4-L5 levels. There is also mild multilevel neural foraminal stenoses. No high-grade spinal canal or high-grade neural foraminal stenosis. Please see additional details above.4. Partially imaged large pelvic mass is compatible with uterine fibroids. There is also a cystic appearing mass inferior lateral to the right kidney without clear correlate on remote abdominal CT from 2012. Consider dedicated abdominal CT for better evaluation.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with new onset headache. Evaluate for metastasis, bladder cancer primary. MRI brain:No evidence of restricted diffusion, edema or mass effect is seen. No pathologic intracranial enhancement is observed. There are numerous scattered small foci of T2 hyperintensity within the cerebral hemispheres which are nonspecific. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits.MRA brain:No evidence of significant vascular stenosis or occlusion is seen. No aneurysm or vascular malformation is suspected.MRA neck:Conventional aortic branching is seen. The origins of the great vessels are patent. Moderate atherosclerotic disease is present at the carotid bifurcations and proximal ICAs but without significance by NASCET criteria. The vertebral arteries are free of significant vascular stenosis.

Output: 1.No evidence of intracranial metastatic disease is seen. Scattered small foci of signal abnormality are favored to represent chronic microvascular ischemia.2.No significant vascular abnormalities are detected intracranially.3.Atherosclerotic disease is seen at the carotid bifurcations and proximal ICAs. However, no areas of critical stenosis are suspected.


Instruction: Generate impression based on findings.

Input: History of ulcerative colitis and primary sclerosing cholangitis with worsening right upper quadrant pain. Several sequences mildly limited by patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: There is mild segmental narrowing of the right and left hepatic ducts just proximal to the confluence of the common duct appearing similar to prior. Additional mild scattered intrahepatic biliary ductal irregularity/beading overall appear slightly less prominent. Mild scattered intrahepatic biliary ductal dilatation appears not significantly changed. There is again slight tortuosity of the distal common bile duct without high-grade stenosis/stricture. No abnormal biliary duct enhancement is identified. The gallbladder is contracted.There is a subcentimeter T2 hyperintense structure within segment 4B which demonstrates discontinuous peripheral nodular enhancement and is compatible with a benign hemangioma. No additional focal hepatic lesions are identified. The hepatic vasculature appears patent. SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter cysts, significantly changed.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: Findings consistent with early primary sclerosing cholangitis appearing similar to prior examinations.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with anoxic brain injury now with increasing seizure frequency. Evaluate for new bleed or focus of seizure. Nonenhanced CT of brain:There is prominence of cortical sulci and significant dilatation of ventricular system with interval worsening since prior study. Prominence of cortical sulci may indicate underlying parenchymal volume loss. Enlarged lateral ventricles and third ventricle are highly concerning for hydrocephalus. There is significant ballooning of the frontal horns bilaterally.There is also evidence of significant interval increase in extra-axial bilateral temporal, frontal and parietal CSF density subdural collections. Further follow-up with an MRI is recommended. There is no evidence of acute hemorrhage, edema or midline shift.

Output: 1. Interval increase in bilateral large CSF density subdural collections in temporal -- frontal and parietal regions and2.significant interval increase in the size of the supratentorial ventricular system concerning for hydrocephalus.3.No evidence of acute intracranial hemorrhage, edema or midline shift.4.Prominence of cortical sulci is concerning for underlying volume loss.


Instruction: Generate impression based on findings.

Input: Gait abnormality. Evaluate for radiculitis. Alignment is notable for 3 mm of anterior subluxation of L4 relative to L5 as a result of facet degenerative disease. This is associated with mild height and T2 signal loss at L4-L5 disc. Alignment is otherwise anatomic and the other discs are preserved in height and T2 signal. Vertebral bodies are preserved in height. Foci of fat-signal are present in L2, L4 and S1 bodies. Otherwise, marrow signal heterogeneity is associated with complete suppression on the fat suppressed sequences and therefore most likely of no significance. The spinal canal is moderately to severely narrowed at L4-L5 level. It is preserved at the other levels. Only on the sagittal STIR images, there is a small focus of increased signal in the posterior aspect of the spinal cord at T11-T12 intervertebral level. This is not covered on the axial images and is not conspicuous on the other sagittal sequences and therefore may very likely be artifactual. Otherwise, the conus medullaris has normal morphology and signal. The tip of the conus medullaris is at the L1-L2 level.T12-L1: There is no central or foraminal stenosis.L1-L2, L2-L3 and L3-L4: Disc bulges are minimal. There is no central or foraminal stenosis.L4-L5: Anterior subluxation is associated with uncovering of the disc. There is also facet hypertrophic change and ligamenta flava buckling. Together, these result in moderate to severe central spinal narrowing. The subarticular recesses are also narrowed and there is mild right and left foraminal narrowing.L5-S1: There is mild facet hypertrophic change but no central or foraminal narrowing. Small renal lesions are not completely assessed though likely cysts.

Output: 1.Moderate to severe narrowing of the central and lateral spinal canal at L4-L5 is caused by spondylolisthesis/disc uncovering and posterior element hypertrophy/thickening as described above. Moderate right and mild left foraminal narrowing.2.Spondylosis at the other levels is minimal.3.A focus of apparent signal abnormality in the lower spinal cord seen only on the sagittal STIR sequence is likely artifactual.


Instruction: Generate impression based on findings.

Input: 47-year-old female patient with uterine fibroids. Three month follow-up imaging status post uterine fibroid embolization. PELVIS:UTERUS, ADNEXA: The uterus measures 14.8 x 8.5 cm. Multiple uterine fibroids are again identified, the largest of which have decreased in size and no longer enhance. The largest measures approximately 7.4 x 6.1 cm (image 21, series 501), previously 8.9 x 7.3 cm. This fibroid demonstrates decreased T2 signal compared to the prior exam. An additional relatively large fibroid on the left side of the uterus extending to the left adnexa now measures 4.9 x 3.2 cm (image 26, series 501), previously 6.2 x 5.1 image. Multiple other fibroids also no longer demonstrate enhancement. The endometrial stripe is unremarkable. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A small amount of free fluid is present in the pelvis.

Output: Interval decrease in size and enhancement of multiple uterine fibroids.


Instruction: Generate impression based on findings.

Input: 14-year-old male with soft tissue sarcoma of the left thigh status post resection. Evaluate At the medial aspect of the left vastus lateralis muscle below the greater trochanter (at the site of the skin marker), there is infiltrative/linear region of increased T2/STIR signal (series 8, images 45 through 51). This region demonstrates infiltrative/linear enhancement (series 10, images 43 through 50). Additionally, there is increased T2/STIR signal in the overlying subcutaneous tissues consistent with inflammatory changes. Areas of metallic susceptibility artifact correspond to the surgical clips present on the recent radiograph. No abnormality of the visualized left femur.

Output: Infiltrative/linear T2 hyperintensity with enhancement involving the left vastus lateralis muscle. These findings are more likely secondary to postoperative changes and granulation tissue than residual tumor.


Instruction: Generate impression based on findings.

Input: History of meningioma and breast cancer; subacute development of vertigo, imbalance, diplopia, and subjective coordination issues. There is mild high T2 signal and mildly restricted diffusion in the right caudate head and perhaps in the anterior right putamen without mass effect or enhancement. There is no evidence of intracranial hemorrhage or enhancing tumors. There are a few scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. The cerebellum appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is an arrested pneumatization variant of the sphenoid. There is mild scattered paranasal sinus mucosal thickening. There are bilateral lens implants.

Output: 1. High T2 signal and mildly restricted diffusion in the right caudate head and perhaps in the anterior right putamen may represent a recent lacunar infarct or a paraneoplastic encephalitis, for example.2. No evidence of meningioma or brain metastases. 3. The cerebellum appears unremarkable.4. A few scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter may represent chronic small vessel ischemia.


Instruction: Generate impression based on findings.

Input: Reason: eval for rotator cuff tear History: shoulder pain for months with mild adhesive capsulitis. ROTATOR CUFF: Mild intermediate signal intensity along the undersurface fibers of the supraspinatus tendon near its insertion may reflect fraying, but we see no discrete fluid signal tear. The supraspinatus muscle appears normal. The infraspinatus tendon and muscle appear normal. The teres minor muscle and tendon appear normal. Minimal increased signal intensity within the subscapularis tendon may reflect mild tendinosis but we see no discrete tear. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Minimal increased signal intensity within the anterior aspect of the subdeltoid bursa could conceivably reflect mild inflammation but we see no frank fluid.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage is within normal limits. Although we see no fluid signal intensity entering the glenoid labrum, intermediate signal intensity within the superior labrum is suggestive of a tear, which possibly extends into the biceps anchor. Mild increased signal intensity within the anterior inferior labrum may reflect degeneration, but we see no fluid-filled tear. No joint effusion.BICEPS TENDON: Other then the possible aforementioned SLAP tear, the long head of the biceps tendon is unremarkable.ADDITIONAL

Output: 1.Possible mild tendinosis/fraying of the rotator cuff as described above, but we see no discrete rotator cuff tear.2.Possible mild inflammation of the subdeltoid bursa anteriorly.3.Although no fluid enters the glenoid labrum, intermediate signal intensity within the superior labrum is suggestive of a tear with possible extension into the biceps anchor.4.Slight thickening of the coracohumeral ligament with partial replacement of the adjacent fat, which has been described in patients with adhesive capsulitis.


Instruction: Generate impression based on findings.

Input: 24-year-old male with concern for left hip labral tear. ACETABULAR LABRUM: Acetabular labrum is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1.Asymmetric sacroiliitis, right greater than left, correlation with HLA-B27 is suggested as clinically warranted.2.Intact articular cartilage and acetabular labrum.3.Mild cam deformity, please see dedicated CT FAI protocol for relevant measurements.


Instruction: Generate impression based on findings.

Input: 36-year-old female status post Chiari decompression complicated by CSF leak subsequently repaired started on high dose Bactrim IV, now with persistent nausea and vomiting. Evaluate for any bleed or reason for persistent nausea/vomiting. Postoperative changes status post suboccipital craniectomy are again evident. An ovoid fluid density structure is seen superficial to the operative site within the subcutaneous tissues, which appears more prominent compared to the prior CT, grossly unchanged from recent MRI. No definite communication with the posterior fossa is evident. No acute hemorrhage or extra-axial fluid collections are evident. A new focus of hypodensity is seen in the postero-medial aspect of the right cerebellar hemisphere, corresponding to focus of restricted diffusion on recent MRI. The remainder of the cerebral and cerebellar hemispheres demonstrate normal morphology and density. The ventricles are midline, with normal morphology and volume. No abnormal extra-axial fluid collections are evident.Apart from postoperative changes status post suboccipital craniectomy, the remaining calvaria and osseous structures are intact. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Subcutaneous fluid collection superficial to the operative site, with no clear communication with the posterior fossa to suggest a pseudomeningocele.2. Subacute infarction in the right cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: Female, 46 years old, with history of T4a N2c M0 oral tongue cancer. Mild deformity of the oral tongue is seen which may be posttreatment in nature. However, no tumor-like lesion is identified within the tongue or floor of mouth.Findings compatible with prior right rim mandibulectomy are seen. Abnormal T2 hyperintense signal and mild hyperenhancement is evident within the residual right mandible. In addition, there appears to be progressive erosion of the buccal mandibular cortex centered at approximately the level of the right mandibular foramen (see image 28 series 901).The mucosa of the pharynx and supraglottic larynx is edematous compatible with treatment change. No pathologic adenopathy is detected in the neck by size criteria. The salivary glands and the thyroid are unremarkable. Bone marrow signal characteristics are otherwise unremarkable. Mild cervical degenerative disc disease is seen.

Output: 1.Signal abnormality, mild hyperenhancement and progressive cortical erosion are seen within the residual right mandible centered at approximately the level of the mandibular foramen. The differential for this finding would include osteoradionecrosis, infection and perineural tumor spread. Further evaluation with CT may better characterize the osseous features of the abnormality.2.No evidence of primary tumor recurrence in the tongue or floor of mouth. No pathologic adenopathy is detected in the neck.


Instruction: Generate impression based on findings.

Input: Right knee pain and swelling MENISCI: There is horizontal tearing of the anterior horn of the lateral meniscus which extends into the body. There is a small associated para meniscal cyst. There is obliquely oriented tearing of the posterior horn of the medial meniscus which extends into the body. There is mild extrusion of the medial meniscus into the gutter with mild associated reactive marrow changes in the medial compartment.ARTICULAR CARTILAGE AND BONE: There is diffuse articular cartilage loss of the medial compartment with more moderate diffuse loss of the lateral compartment. The articular cartilage of the lateral femoral condyle is preserved while there is full-thickness loss of the medial compartment.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Tears of the anterior horn/body of the lateral meniscus and posterior horn/body of the medial meniscus.2. Diffuse tricompartmental articular cartilage loss, worst in the medial compartment.


Instruction: Generate impression based on findings.

Input: Bilateral hip impingement syndrome. ACETABULAR LABRUM: There is a horizontal area of increased signal involving the anterior superior labrum compatible with a labral tear. There is also some degeneration of the superior labrum but no discrete tear. There is no chondral-labral detachment or associated paralabral cyst formation. ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Tear of the anterior superior labrum. No evidence of chondral injury.


Instruction: Generate impression based on findings.

Input: Left temporal/occipital lobe metastasis from a salivary gland malignancy treated via SRS. There is minimal residual patchy T2 hyperintensity, but no residual abnormal enhancement at the site of the treated left temporo-occipital region brain metastasis. There are a few scattered nonspecific foci of T2 hyperintensity without associated enhancement. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid within the left mastoid air cells and mild mucosal thickening within the bilateral maxillary sinuses.

Output: Interval involution of the treated left temporo-occipital region metastasis.


Instruction: Generate impression based on findings.

Input: 45-year-old male with decreased appetite and abdominal pain. Evaluate extent and severity of Crohn's disease (ileocolonic). ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is marked wall thickening of the distal and terminal ileum over a length of approximately 20 cm with alternating areas of narrowing and dilation and surrounding fibrofatty proliferation, most compatible with acute on chronic inflammatory bowel disease. There is complex fistulization seen in the lower abdomen with a large fistula between the rectum and cecum (series 14/42) and a smaller fistula between the rectum and sigmoid colon (series 14/50). There are two small interloop abscesses also seen in this area anteriorly (series 14/45).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings most compatible with active on chronic inflammatory bowel disease of the distal and terminal ileum. There is also complex fistulization with colocolic fistulas and interloop abscesses, as detailed above.


Instruction: Generate impression based on findings.

Input: Attention deficit, memory loss No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.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: Normal brain MRI.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 27-year-old female with history of Hodgkin's disease. Status post auto stem cell therapy about day 30.IMAGE ACQUISITION: Contrast enhanced CT of the head and soft tissue neck was performed. 60 mL of Omnipaque 350 was injected intravenously. CT HEAD:No acute intracranial abnormality is evident. Specifically, there is no evidence for focal mass lesion, edema, midline shift, hydrocephalus, or abnormal enhancement. Gray white matter differentiation is preserved. The ventricles are normal in size and configuration. No abnormal fluid collections seen.A focal lucent lesion in the left frontal bone with sclerotic margins is noted, previously characterized by MRI and was felt to likely represent a benign process such as hemangioma.The visualized paranasal sinuses demonstrate a right maxillary retention cyst.CT NECK:There is no cervical lymphadenopathy based on CT imaging. The reference right level 2 lymph node measures 0.8 x 0.6 cm (image 35 demonstrates 4), previously measuring 1.2 x 0.8 cm. No new or enlarging lymph nodes are identified. No neck mass or fluid collection is seen. The aerodigestive tract is unremarkable without evidence for exophytic mass or effacement. The paraspinal soft tissues and musculature are within normal limits. The submandibular, parotid, and thyroid glands are within normal limits. The orbits are unremarkable.The carotid and jugular vessels are patent. Right anterior chest port.Limited views of the lung apices demonstrate no significant abnormality, however please refer to the dedicated CT of the chest report for complete details.

Output: 1. No CT evidence for lymphadenopathy in the neck. Slight interval decrease in size of reference node with measurements as above.2. No intracranial mass lesion. Sclerotic lesion in the left frontal bone, characterized on prior MRI and felt to represent a benign process such as hemangioma.


Instruction: Generate impression based on findings.

Input: 72 year old woman with history of heart failure with preserved ejection fraction, hilar lymphadenopathy admitted for heart failure exacerbation, and now referred for cardiac MRI to evaluate for possible etiologies of her cardiomyopathy. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 55 ml/m2 (normal range: 65+/-11), the LVEDV is 104 ml (normal range 109+/-23), the LV end systolic volume index is 20 ml/m2 (normal range 18+/-5), the LVESV is 37 ml (normal range 31+/-10), the LV mass index is 52 g/m2 (normal range 67+/-11), and the LV mass is 98 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There was significant motion artifact on late gadolinium imaging, but the following observations were made: there is late gadolinium enhancement in the basal inferolateral and lateral wall which is subendocardial and atypical for previous myocardial infarction. In addition there is a mid-myocardial stripe in the basal septum. The native myocardial T1 relaxation is abnormal (1142-1197ms), which could suggest underlying diffuse myocardial fibrosis or inflammation. The extracellular volume fraction is slightly elevated at 31%, which also suggests some degree of diffuse myocardial fibrosis or inflammation. There is no evidence for myocardial edema on T2-STIR imaging.Left AtriumThe left atrium is moderately dilated. The interatrial septum is bowed towards the right, suggestive of elevated left atrial pressures.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 81 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. 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 at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere no pericardial effusion. There is no evidence of pericardial edema or inflammation.Extracardiac FindingsThere is bilateral hilar lymphadenopathy. There is a small well-circumscribed lesion at the posterior pole of the liver. 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 sized left ventricle with normal systolic function (LVEF 65%)2. There was significant motion artifact on late gadolinium imaging, but the following observations were made: there is late gadolinium enhancement in the basal inferolateral and lateral wall which is subendocardial and atypical for previous myocardial infarction. In addition there is a mid-myocardial stripe in the basal septum. These findings could be consistent with an underlying inflammatory, infiltrative or fibrotic process. Sarcoid is included in the differential for this pattern of late gadolinium enhancement; however, given the quality of imaging a repeat study in 6 months could be considered. 3. Normal sized right ventricle with mildly reduced systolic function (RVEF 45%). 4. Biatrial dilation.5. See extracardiac 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: Male, 59 years old, history of smoldering multiple myeloma. Assess for myelomatous lesions. Cervical:No evidence of concerning marrow replacement or pathologic marrow enhancement is seen.The C5 and C6 vertebral bodies are small with a partially formed C5-6 intervertebral disc suggesting congenitally anomalous development. Vertebral body morphology is otherwise unremarkable. Alignment is anatomic.The visualized spinal cord demonstrates normal morphology and signal characteristics. No pathologic intraspinal enhancement is seen.Facet hypertrophy and disc osteophyte formation are evident at C4-5. Mild spinal canal stenosis is seen. Moderate bilateral foraminal narrowing is seen.The other cervical levels are free of significant degenerative disc disease.Thoracic:No evidence of concerning marrow replacement or pathologic marrow enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic intraspinal enhancement is detected.No significant disc disease, spinal canal or neuroforaminal stenosis is seen. Ligamentum flavum thickening is evident on the right at T10-11.Lumbar:The sacral marrow is mildly heterogeneous. However, no definite evidence of concerning marrow replacement or pathologic marrow enhancement is seen.The visualized conus and cauda equina are within normal limits. No pathologic intraspinal enhancement is seen.No significant spinal canal or neuroforaminal stenosis is demonstrated. Mild loss of disc height is evident at L5-S1 with very slight disc bulging.

Output: No findings to suggest active myelomatous lesions in the spine.