Instruction: Generate impression based on findings.

Input: Diagnosis: Muscle weakness (generalized)Clinical question: Hand weaknessSigns and Symptoms: weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are predominantly adjacent to the trigones of the lateral ventricles. They're likely of little clinical significanceNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There are small nodules present within the parotid glands bilaterally which could represent small lymph nodes.

Output: No evidence for intracranial mass lesion to explain the patient's weakness


Instruction: Generate impression based on findings.

Input: Demyelinating cervical cord lesions, left leg weakness and neuropathic pain. Evaluate for progression. Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is some loss of cervical lordosis and mild retrolisthesis of C5 on C6 similar to prior. Degenerative changes are seen in the cervical spine relatively worse at the C5-C6 level where there is a disc osteophyte complex and bilateral uncovertebral hypertrophy producing moderate right and mild left neural foraminal stenosis as well as mild spinal canal stenosis. There is also moderate right C6-C7 neural foraminal narrowing. Bone marrow signal is benign. Paraspinous soft tissues are unremarkable.Multiple T2 hyperintense lesions are again seen in the cervical cord. These include left lateral aspect of the cord at the C3-C4 level, left lateral C4-C5 level, and the right ventral C3 level. There is no appreciable change compared to 1/16/2010. No new lesions.Thoracic: Thoracic cord is normal in signal and contour. Thoracic vertebral body heights are maintained. Alignment is maintained. No significant spinal canal or neural foraminal stenosis is seen. Bone marrow signal is benign with no suspicious lesions. T1 hyperintense lesion at the T2 vertebral body is consistent with a hemangioma. Mild multilevel degenerative changes are seen including a small left paracentral disc protrusion at T6-T7 with mild indentation on the left ventral cord. Dorsal thecal sac is widely patent at this level.

Output: 1. No significant change in appearance of the multiple T2 hyperintense lesions within the cervical cord compatible with chronic demyelinating plaques. No new lesion in the cervical cord. No thoracic cord lesions.2. Degenerative changes in the cervical spine with mild spinal canal stenosis at C5-C6 and moderate right neural foraminal stenosis at C5-C6 and C6-C7.


Instruction: Generate impression based on findings.

Input: 30 year old with history of DVT and pulmonary embolism with associated right ventricular dysfunction presenting for cardiac evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 83 ml/m2 (normal range: 65+/-11), the LVEDV is 208 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 81 ml (normal range 31+/-10), the LV mass index is 42 g/m2 (normal range 67+/-11), and the LV mass is 105 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial T2-star.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 217 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 98 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall axillary lymph nodes are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 61%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 55%).3. Mild mitral and tricuspid valve regurgitation.4. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: 61-year-old male, evaluate for deltoid abscess.IMAGE ACQUISITIONS: Contrast enhanced CT of the left shoulder was performed after the administration of IV contrast (120 cc of Omnipaque 350 at two cc/sec). Axial, coronal, and sagittal images were reviewed. Low-attenuation mass within the deltoid muscle is consistent with a multi-lobulated fluid collection with slight rim enhancement compatible with an abscess. No underlying evidence of osteomyelitis. If clinically warranted, this may be better evaluated by MRI.

Output: Low-attenuation mass with slight rim enhancement within the deltoid muscle compatible with an abscess as described above. An MRI may be obtained for better evaluation if clinically warranted.


Instruction: Generate impression based on findings.

Input: Unspecified dementia with behavioral disturbance [F03.91] / Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: please evaluate for contrast enhancing lesions History: progressive dementia, metastatic History: Unspecified dementia with behavioral disturbance [F03.91] / Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: please evaluate for contrast enhancing lesions History: progressive dementia, metastatic There are multiple lesions present involving gray and white matter scattered in both hemispheres of the supratentorial brain but in asymmetric locations. Some are located along the medial aspects of the frontal lobes, the insular cortex bilaterally as well as a lesser degree the lateral aspects of the frontal and parietal lobes and temporal lobes. These are best appreciated on the FLAIR MRI images. There is no associated contrast enhancement. There is no associated susceptibility effect with these lesions. There is associated vasogenic edema on some of these lesions. Diffusion restriction is less conspicuous on the current exam versus the prior exam. There is no involvement of the thalami.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Postcontrast imaging and susceptibility weighted imaging are degraded by patient motion which may obscure more subtle abnormalities.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 in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a small cystic lesion present in the right parotid gland measuring 7 mm in diameter. It is not entirely included on this exam.

Output: 1.There are multiple lesions scattered throughout the cortex of the supratentorial brain. Differential considerations include Creutzfeldt-Jakob disease, encephalitis due to another cause, paraneoplastic encephalitis, multiple late subacute ischemic events and hypoglycemic encephalopathy. There is no progression when compared to the prior exam.2.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.3.Postcontrast imaging and susceptibility imaging are degraded by patient motion which may obscure more subtle abnormalities.4.There is a small peripherally based lesion in the right parotid gland which is not entirely included on this exam. It is nonspecific


Instruction: Generate impression based on findings.

Input: History of neuroblastoma: daily headaches. The images are partly degraded by dental artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are secretions in the right posterior ethmoid sinuses. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or ventriculomegaly, within the limitations of dental artifact.


Instruction: Generate impression based on findings.

Input: Left vertebral artery and proximal basilar artery occlusion. Right sided weakness. Acute brainstem stroke.IMAGE ACQUISITIONS: Precontrast head CT followed by dynamic bolus contrast enhanced CTA of the head 0.9-mm source images. Sagittal and coronal and 3-D reformats were also obtained. There is complete occlusion of the dominant left vertebral artery. Right vertebral artery is congenitally small and predominantly supplies PICA with minimal if any contribution to basilar flow. Right V4 segment is very small. There is questionably a very thin lumen along the right side of the proximal basilar artery, possibly supplied by the right V4 segment. Most of the flow to the mid and distal basilar artery appears to be from posterior communicating arteries from the carotid arteries.There is intraluminal thrombus of indeterminate age in the left vertebral artery to the level of the proximal basilar artery.There is no other evidence of intracranial arterial stenosis. There is no evidence of intracranial aneurysm or intracranial pseudoaneurysm. There is no acute intracranial hemorrhage. Brain stem and corpus callosum infarcts that were demonstrated on MRI are not yet demonstrable on CT.

Output: Complete occlusion and thrombosis of dominant left vertebral artery to the level of the proximal basilar artery, with minimal if any antegrade flow from the distal right vertebral artery and likely substantial retrograde collateral flow from posterior communicating arteries.Findings were discussed by telephone with Dr. Yallapragada on 06/06/2009 approximately 1930 hrs.


Instruction: Generate impression based on findings.

Input: Headache and dizziness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants and myopic deformity of the globes. There is mild mucosal thickening in the right maxillary sinus.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Scattered cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 2-year-old previously healthy male with a recent history of abdominal lymphovascular resection 4 weeks ago, who presents with new onset focal seizures (left arm stiffening, staring, drooling). Please evaluate for brain malformation or abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears within normal limits, including bilateral terminal zones of myelination in the posterior cerebral hemispheres. No findings to suggest seizure focus are appreciated. Specifically, there is no evidence of gray matter heterotopia or cortical dysplasia. The bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal mucosal thickening.

Output: No findings to suggest seizure focus are appreciated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right progressive unilateral sensorineural hearing loss. Per EPIC: Previous MRI imaging and audiogram was completed at OSH, which did not demonstrate any abnormal pathology on imaging and a very Mild Right SNHL. Along with the previous mentioned symptoms, the patient admits to intermittent symptoms of Right tragal pain. Currently patient denies any otorrhea, dizziness, imbalance, history of chronic ear infection, and current illness. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: No evidence of retrocochlear tumor, inner ear anomalies, or cochlear nerve deficiency.


Instruction: Generate impression based on findings.

Input: Reason: Assess for cause of instability and mechanical block to ROM History: Left shoulder pain, ROM deficit, mechanical block ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: We see no fluid or gadolinium within the subacromial subdeltoid bursa. The acromioclavicular joint appears normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. The glenoid labrum is normal in appearance.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Normal appearing shoulder MR arthrogram without findings to account for instability, pain, or mechanical block.


Instruction: Generate impression based on findings.

Input: 69-year-old male with right hip pain, limp. ACETABULAR LABRUM: The acetabular labrum is suboptimally visualized on this study. ARTICULAR CARTILAGE AND BONE: There is severe osteoarthritic disease of the right hip including severe joint space narrowing, subchondral sclerosis, and subchondral cyst formation in the acetabulum, as well as osteophytosis at the femoral head/neck junction.SOFT TISSUES: There is mild fatty atrophy affecting the gluteus muscles as well as the vastus lateralis. ADDITIONAL

Output: Severe osteoarthritis of the right hip.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: There is increased intermediate signal intensity and thickening of the supraspinatus and infraspinatus tendons, indicating moderate tendinosis. The increased signal intensity within the supraspinatus tendon extends to the articular surface fibers, suggesting undersurface fraying but we see no discrete tear. There is a small focus of signal abnormality in the underlying humeral head. The supraspinatus and infraspinatus muscles appear normal. The teres minor muscle and tendon appear normal. There is focal increased signal within the undersurface of the subscapularis tendon at its insertion, likely representing tendinosis with a small focus of signal abnormality of the underlying humeral head but we see no discrete tear.SUPRASPINATUS OUTLET: There is an os acromiale. The acromioclavicular joint appears otherwise normal. There is no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. There is a small amount of fluid in the joint but there is no large effusion. There is perhaps mild fraying of the superior glenoid labrum, however we see no discrete tear.BICEPS TENDON: There is a small amount of fluid within the biceps tendon sheath, raising the possibility of mild tenosynovitis. On the axial sequences there appears to be a longitudinal split in the superior fibers of the biceps tendon but the true clinical significance of this is uncertain.

Output: 1. Rotator cuff tendinosis and possible undersurface fraying of the labrum without discrete rotator cuff tear.2. Os acromiale.3. Findings suggestive of a longitudinal split tear of the biceps tendon at its transition from the bicipital groove to the rotator interval.3. Other findings as above.


Instruction: Generate impression based on findings.

Input: Evaluate for mass, obstruction. History of cancer. Now with headaches. Nonenhanced MRI of brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal for patient stated age of 73.Calvarium is intact. Visualized orbits are unremarkable. Visualized paranasal sinuses and mastoid air cells are unremarkable.Prominence of right jugular fossa is believed to represent an anatomical variation and with no evidence of any destructive bony changes. This appears was noted on prior exam from 2003 and with no change.

Output: Negative nonenhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: Back pain with radiculopathy, status post laminectomy Five lumbar type vertebral bodies are presumed to be present. Small Schmorl's nodes are noted involving the superior endplates of L1 and L2 vertebral bodies with mild anterior vertebral body wedging, without bone marrow edema to suggest a recent compression fracture. Vertebral body heights are otherwise within normal limits. There is some loss of lumbar lordosis. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Postsurgical changes are evident including posterior spinal fusion hardware extending from L3 to S1 with pedicle screws and bilateral paraspinous rods. Interbody fusion device is also noted at the L3-L4 level. Note integrity of hardware can be better assessed with CT or radiographs, but appears grossly in adequate position. Spinal canal is surgically well decompressed at L3-L4, L4-L5, and L5-S1.Individual levels, as described below:T12-L1: Small disc bulge without significant spinal canal or neural foraminal stenosis.L1-L2: Small disc bulge, with ligamentum flavum thickening, and mild facet arthropathy result in mild narrowing of the spinal canal. Neural foramina are patent.L2-L3: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy contribute to mild central spinal canal narrowing just above the level of the laminectomy. Neural foramina are patent.L3-L4: Spinal canal is well decompressed. Neural foramina also appear patent with susceptibility artifact from hardware slightly limiting examination. L4-L5: Spinal canal is well decompressed. Mild to moderate right neural foraminal stenosis is suspected related to endplate osteophytes and facet arthropathy. Minimal left neural foraminal narrowing. Small dorsal annular fissure.L5-S1: Spinal canal is well decompressed. Disc bulge with dorsal annular fissure and small protrusion. Mild to moderate right and mild left neural foraminal stenosis is suspected with susceptibility artifact from hardware limiting examination.

Output: 1. Postoperative changes as described above. Spinal canal is well decompressed at L3-L4, L4-L5, and L5-S1.2. There is mild spinal canal stenosis at L1-L2 and L2-L3. There is mild to moderate neural foraminal stenosis involving the right L4-L5 and right L5-S1 levels and to a milder degree at left L5-S1.


Instruction: Generate impression based on findings.

Input: There are numerous scattered areas of diffusion restriction with high T2 signal and swelling involving both grey and white matter of the left cerebral hemisphere, most prominent in the left occipital and parietal lobes, where there are also punctate foci of susceptibility effect. The right cerebral hemisphere and infratentorial structures are unremarkable. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is scattered mucosal thickening in the paranasal sinuses.

Output: 1. Numerous areas of acute infarction in the left cerebral hemisphere, which may be secondary to synthetic marijuana use and less likely secondary to trauma. Head and neck neurovascular imaging may be useful to evaluate for the possibility of underlying dissection. While there may be petechial hemorrhages in the affected left occipital and parietal lobes, there is no evidence of gross intracranial hemorrhage.2. Paranasal sinus disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Metastatic nasopharyngeal cancer status post treatment. There is interval decrease in size of the enhancing lesion in the anterior left temporal pole, but a subcentimeter enhancing lesion in the right anterior temporal pole is slightly larger. There are scattered foci of high T2 signal in the cerebral white matter bilaterally. 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. There is mucosal thickening and fluid within the right maxillary sinus. There are post-treatment findings in the nasopharynx, with diffuse mucosal enhancement, but no definite tumor, although the exam is not optimized for assessment of this region. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval decrease in size of the enhancing lesion in the anterior left temporal pole, but a subcentimeter enhancing lesion in the right anterior temporal pole is slightly larger. These lesions likely represent evolving radiation necrosis.2. Scattered foci of high T2 signal in the cerebral white matter bilaterally may represent chronic small vessel ischemic disease, but no evidence of acute infarct. 3. Findings suggestive of acute right maxillary sinusitis.4. Post-treatment findings in the nasopharynx, with diffuse mucosal enhancement, but no definite tumor, although the exam is not optimized for assessment of this region.


Instruction: Generate impression based on findings.

Input: Again demonstrated are numerous ill-defined regions of cortical/subcortical T2 hyperintensity in both cerebral hemispheres without interval change in size or number of lesions. The posterior fossa is spared. None of these lesions demonstrates any definite enhancement.Multiple periventricular nodules are again noted and not significantly changed in size or number. These show intrinsic T1 hyperintensity on precontrast imaging and no convincing additional signal change after contrast is administered. Some of these are associated with strong susceptibility which correlates with mineralization/calcification seen on prior CT.There is no evidence of parenchymal mass effect. No intracranial hemorrhage or abnormal extra-axial fluid is present. Ventricles are normal in size. No evidence of restricted diffusion. Subcentimeter right parotid gland T1 hypointense foci which demonstrate contrast enhancement; findings most likely represent lymph nodes.

Output: Stable multiple cortical/subcortical and subependymal lesions compatible cortical tubers and subenedymal nodules which are stigmata for tuberous sclerosis.


Instruction: Generate impression based on findings.

Input: There is mild anterolisthesis of L4 on L5, measuring approximately 5mm, which is unchanged. The vertebral body heights are preserved. There is loss of disc height and disc desiccation at L3-L4 and L4-L5. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The tip of the conus medullaris terminates at the level of L1-L2. The paravertebral soft tissues are unremarkable.T11-T12: Bilateral facet arthropathy and thickening of the ligamentum flavum. No significant disc bulge, spinal canal or foraminal stenosis. T12-L1: Bilateral facet arthropathy and thickening of the ligamentum flavum. No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Mild disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild left foraminal stenosis. No significant spinal canal or right foraminal stenosis. L2-L3: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild right and moderate left foraminal stenosis. L3-L4: Disc bulge eccentric to the left, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to moderate spinal canal stenosis and mild right and moderate left foraminal stenosis. L4-L5: Disc bulge with slightly progressed superimposed disc protrusion, bilateral facet arthropathy and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis and moderate to severe right and moderate left foraminal stenosis.L5-S1: Disc bulge, bilateral facet arthropathy and thickening of the ligamentum flavum. No significant spinal canal or foraminal stenosis.

Output: Degenerative spondylosis of the lumbar spine, most pronounced at L4-L5 with disc bulge and slightly progressed superimposed disc protrusion, contributing to severe spinal canal stenosis and moderate to severe right and moderate left foraminal stenosis. The degree of spinal canal and foraminal stenosis at the other levels of the lumbar spine appear unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Back pain. There is no significant spinal canal or neural foramen stenosis in the lumbar spine. There is straightening of the lumbar vertebral column in the sagittal plane. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is no evidence of mass lesions. The paravertebral soft tissues are unremarkable.

Output: No evidence of spinal stenosis.


Instruction: Generate impression based on findings.

Input: Diagnosis: HypopituitarismClinical question: hypogonadotropic hypogonadismSigns and Symptoms: decreased libido MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small periventricular white matter lesion present adjacent to the left lateral ventricle. It is high signal on FLAIR and T2 imaging. In isolation it is likely of little clinical significance.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The left Meckel's cave appears asymmetrically larger than the right Meckel's cave. No particular lesion is identified in the Meckel's cave.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery is very small. The right transverse sinus is larger than the left transverse sinus.The visualized portions of the paranasal sinuses demonstrate minimal mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. The cavernous sinuses are intact bilaterally. There is an ill-defined focus of T1 signal hyperintensity present within the right half of the pituitary gland measuring approximately 4 mm in size which is associated with some hyperenhancement on the postcontrast images and on the dynamic sequence.

Output: 1.There is a ill-defined lesion in the right half of the pituitary gland which is nonspecific. It does not appear to be typical of an adenoma. It is possible this represents some local hypervascularity or blood products but is unclear what it represents.2.There is a small periventricular white matter lesion present adjacent to the left lateral ventricle. In isolation it is likely of little clinical significance.


Instruction: Generate impression based on findings.

Input: Lateral and anterior knee pain after running 3 miles MENISCI: Globular degenerative signal is noted in the posterior horn of the medial meniscus, without discrete linear component extending to the articular surfaces. The lateral meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. The cartilage and bones are normal in appearance.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Mild degenerative changes of the medial meniscus, without specific abnormality otherwise to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female; 24 years old. Reason: 24 yo F with history of chronic abdominal pain, s/p cholecystectomy in 4/2013, with severe chronic RUQ pain. MRI with gadolinium to assess pancreatic parenchyma, MRCP with secretin to assess bile ducts and pancreatic ducts History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. Status post cholecystectomy. No biliary ductal dilation. SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilation. Normal physiologic response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Unremarkable examination.


Instruction: Generate impression based on findings.

Input: Reason: met renal cell ca History: c/o right hip pain Mild osteoarthritis affects the right hip. Note is made of a focus of enhancing increased signal abnormality on fluid sensitive sequences within the medial aspect of the inferior acetabulum which likely represents an enhancing subchondral cyst. A small chronic erosion is considered a less likely differential consideration. There is thin synovial enhancement on postcontrast sequences which is likely within normal limits and of no current clinical significance. Otherwise no bone marrow signal abnormality is identified. Additionally, note is made of a 1.4 cm focus of fluid signal intensity along the posterior superior aspect of the acetabulum which may reflect paralabral cyst formation indicating degeneration and probable degenerative tearing of the acetabular labrum at the 11:00 position, within the limitations of this non arthrogram study. The imaged musculature of the right hip is unremarkable.

Output: Osteoarthritis of the right hip. No evidence of osseous metastatic disease. Findings indicating degeneration and degenerative tearing of the acetabular labrum with probable small paralabral cyst formation.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there are inflammatory changes in the left maxillary and bilateral ethmoid sinuses.CERVICAL SPINE: There is lack of the usual cervical lordosis. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. There is mildly diminished T2 signal in the C3-C4, C4-C5 and C5-C6 discs. The vertebral body and disk heights are otherwise well-maintained. The vertebral bone marrow signal is unremarkable. There is no abnormal enhancement within the spine. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of cervical spinal canal stenosis or spinal cord lesions.3. Inflammatory changes in the paranasal sinuses. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: assess for disc herniation, nerve root compression or central stenosis History: back pain, le weakness Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disk dessication present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height and a mild disk bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level. There is a small central disk protrusion at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are mild degenerative changes in the lumbar spine without compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered small foci of T2 hyperintensity throughout the supratentorial white matter that are most compatible with mild chronic small vessel ischemic disease. There is mild global volume loss that is slightly more prominent in the parietal lobes. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is a left lens implant. There is mucosal thickening throughout the paranasal sinuses.

Output: 1.No evidence of mass or acute ischemia.2.Mild chronic small vessel ischemic disease.3.Mild global volume loss that is slightly more prominent in the parietal lobes.


Instruction: Generate impression based on findings.

Input: Aneurysm yearly surveillance imaging. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a left middle cranial fossa arachnoid cyst that measures up to approximately 40 mm overlying the flattened left anterior temporal pole, which is unchanged. There is also an unchanged subcentimeter cystic focus in the right frontal lobe white matter adjacent to the frontal horn of the right lateral ventricle. 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, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst that measures up to 15 mm in width. MRA: There is an unchanged outpouching along the medial aspect of the left internal carotid artery along the anterior genu that measures up to 3 mm, with a 2 mm wide neck. There is also an unchanged 2 mm wide outpouching with a 2 mm wide neck along the inferomedial aspect of the ophthalmic segment of the right internal carotid artery. There is an unchanged punctate outpouching along the left aspect of the ACOM complex. There is no evidence of significant steno-occlusive lesions.

Output: 1. Unchanged aneurysm along the medial aspect of the left internal carotid artery along the anterior genu that measures up to 3 mm.2. Unchanged 2 mm wide outpouching along the inferomedial aspect of the ophthalmic segment of the right internal carotid artery.3. Unchanged punctate outpouching along the left aspect of the ACOM complex. 4. Unchanged left middle cranial fossa arachnoid cyst. 5. Unchanged subcentimeter cystic focus in the right frontal lobe white matter adjacent to the frontal horn of the right lateral ventricle.


Instruction: Generate impression based on findings.

Input: Ms. Forpe is a 68-year-old female with a personal history of left breast lumpectomy in 2000 for IDC followed by radiation and right breast lumpectomy in 2011 for DCIS followed by radiation. Patient received Tamoxifen. History of breast cancer in maternal great aunt diagnosed at the age of 70 and paternal aunt diagnosed at the age of 60. No current breast complaints. Initial cancer was mammographically occult. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Intact bilateral retropectoral silicone implants.No suspicious enhancement is seen in either breast. Stable post-surgical distortion, T2 low density and volume loss in the left breast. There is mild motion artifact, not limiting the study overall, but creating some artifacts on the kinetic analysis. No abnormal axillary lymph nodes are identified in either axillary region.Stable high T2 signal hepatic lesion compatible with a benign cyst or hemangioma.

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


Instruction: Generate impression based on findings.

Input: 58-year-old male with left lower extremity erythema and warmth with elevated CRP, evaluate for abscess or osteomyelitis. Multiple foci of signal void within the soft tissues presumably correspond to surgical staples seen on prior radiographs. Review of previous imaging studies reveals a history of chronic lymphedema, and there is generalized subcutaneous edema within the soft tissues of the knee and ankle. There is a paucity of subcutaneous fat between the knee and ankle, which is presumably due to prior surgery. There is generalized thickening and enhancement of the skin consistent with cellulitis. There is also reticular enhancement of the subcutaneous fat of the knee and ankle consistent with cellulitis. There is diffuse enhancement musculature of the leg with relative sparing of the flexor hallucis longus likely reflecting additional inflammation. There is also fatty infiltration of much of the musculature of the leg. Although we see no discrete abscess, within and along the posterior aspect of the tibialis anterior muscle is a poorly defined thin elongated collection of nonenhancing tissue which could represent a phlegmon or developing abscess. Marrow signal intensity is within normal limits without evidence of osteomyelitis.

Output: 1.Findings consistent with lymphedema and postoperative changes as described above.2.Findings consistent with severe cellulitis as described above.3.Muscular inflammation as described above. Although there is no discrete abscess, poorly defined non-enhancing tissue along the posterior aspect of the tibialis anterior could represent a phlegmon or developing abscess. Although no soft tissue gas is evident on yesterday's CT scan, we cannot exclude the possibility of a necrotizing infection.4.No evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Status post left knee arthroscopy with microfracture. Continued pain and mechanical symptoms. MENISCI: There is abnormal signal intensity within the anterior horn and body of the lateral meniscus extending to the tibial articular surface. There is heterogenous signal intensity anterior to the anterior horn of the lateral meniscus that likely reflects parameniscal cyst formation. There is also thin linear horizontal signal within the posterior horn extending to the free edge of the lateral meniscus. These findings are compatible with degenerative tearing although could in part represent residual intrameniscal signal following partial meniscectomy. There is also thin horizontally oriented intermediate signal within the posterior horn of the medial meniscus extending to the free edge, as well as increased signal intensity within the body of the medial meniscus extending to the tibial articular surface. Again, these findings suggest degenerative tearing, although could conceivably represent residual intrameniscal signal following partial meniscectomy.ARTICULAR CARTILAGE AND BONE: There is near full thickness degeneration of the articular cartilage of the lateral femoral condyle above the posterior horn of the lateral meniscus with relatively mild degeneration of the articular cartilage of the lateral tibial plateau beneath and anterior to the posterior horn of the meniscus. There is relatively mild degeneration of the articular cartilage of the medial tibiofemoral compartment. There is full thickness fissuring/delamination of the articular cartilage of the femoral trochlea superiorly with superficial degeneration of the articular cartilage of the patella. There are small tricompartmental osteophytes but we see no bone marrow edema or cysts. LIGAMENTS: Cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: Extensor mechanism is intact. ADDITIONAL

Output: 1. Articular cartilage degeneration as described above, most prominently affecting the femoral trochlea and the lateral compartment.2. Medial and lateral meniscal abnormalities suggestive of degenerative tearing, although could conceivably reflect residual signal following partial meniscectomy.3. Moderate sized joint effusion.


Instruction: Generate impression based on findings.

Input: 16-year-old male with knee pain with joint instability. Evaluate for meniscal tear. MENISCI: There is linear increased signal in the posterior horn of the medial meniscus that extends to the inferior articular surface, consistent with a tear. Diminutive anterior horn of the medial meniscus. No abnormality of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: Again noted is fragmentation of the tibial apophysis. Mildly increased T2 signal of the fragmented portions.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact without evidence of increased signal to suggest inflammatory changes. ADDITIONAL

Output: 1.Fragmentation of the tibial apophysis with evidence of inflammation suggestive of apophysitis. 2.Tear of the posterior horn of the medial meniscus.3.Moderate knee joint effusion.


Instruction: Generate impression based on findings.

Input: Evaluate palpable soft tissue mass incompletely evaluated on ultrasound. Abnormal LFTs. Evaluate liver. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in contour and morphology. A 1.0 x 0.6 cm T2 hyperintense lesion abuts the gallbladder and additional punctate T2 hyperintense lesions are identified, probably cysts but too small to characterize. No enhancing lesion is identified. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is normal in appearance.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are a few bilateral subcentimeter T2 hyperintense lesions, most likely cysts, but too small to characterize. No hydronephrosis or enhancing renal lesion is identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No lesion is identified at the site of clinical concern. No acute abdominal MR findings.


Instruction: Generate impression based on findings.

Input: History of multiply recurrent ganglioglioma. There are stable postoperative findings with no significant interval change in the confluent T2 hyperintensity surrounding the resection cavity in the left temporo-occipital region. There is no evidence of tumoral enhancement, acute intracranial hemorrhage, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unchanged. The orbits are unremarkable.

Output: No evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Headache. There are unchanged low-lying cerebellar tonsils, right more than left, with associated pointed morphologies. There is unchanged asymmetric enlargement of the left Meckel's cave, which measures up to 10 mm in width. There is a partially-empty sella. There is prominence of the bilateral optic nerve sheaths and flattening of the optic nerve heads. There is no evidence of intracranial hemorrhage or acute infarct. There is unchanged protrusion of the right posterior cingulate gyrus across the right tentorial leaflet. There is also protrusion of a portion of the inferior right temporal gyrus into an arachnoid granulation along the right transverse sinus. In addition, the bilateral transverses sinuses appear to be constricted. There is minimal nonspecific white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift.

Output: Unchanged enlargement of the left Meckel's cave, low-lying cerebellar tonsils, partially-empty sella, as well as optic nerve sheath prominence. The constellation of findings may indicate pseudotumor cerebri perhaps superimposed upon Chiari I malformation.


Instruction: Generate impression based on findings.

Input: 57-year-old female with history of right proximal humerus lesion. Redemonstrated is a heterogeneous lesion within the right proximal humeral metaphysis extending into both the epiphysis and diaphysis. This lesion measures 6.6 cm in maximal sagittal dimensions, previously 6.6 cm (image 18 series 1001). This lesion demonstrates decreased T1 and increased T2 signal with mild irregular enhancement. There are scattered foci of signal void corresponding to calcifications appreciated on plain film. There is no evidence of cortical breakthrough or extraosseous extension. Overall this lesion appears similar to the prior exam.The rotator cuff is grossly intact without evidence of tear. There is a trace amount of fluid within the subacromial bursa as well as mild AC joint osteoarthritis. The anterior and posterior glenoid labrum are grossly intact.

Output: 1.Stable right humeral lesion as above likely corresponding to a benign enchondroma.2.Mild AC joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: There is no abnormal signal within spinal cord. There is multilevel spondylosis in cervical spine with apparent neural foraminal narrowing at several of these levels; however, this cannot be completely characterized on this limited study. There is also slight indentation upon the cervical spinal cord at the C3-4 level secondary to a disc-osteophyte complex. There are scattered small disc-osteophyte complexes in the upper thoracic spine with mild eccentric right indentation upon the spinal cord at T5-6. There are small disc bulges at multiple levels in the lumbar spine. In particular, at L5-S1, a disc bulge results in moderate bilateral neural foraminal stenosis. There are subcentimeter hemangiomas or areas of focal fat in the thoracic and lumbar vertebral bodies at T3, L1, and L3. High T2 signal within the inferior aspect of T8 and superior aspect of T9 are likely related to endplate degenerative changes. The vertebral heights and alignment are preserved. The paraspinal soft tissues are unremarkable.

Output: 1.Multilevel degenerative cervical spondylosis with slight indentation upon the spinal cord at the C3-4 level.2. Scattered small disc-osteophyte complexes in the upper thoracic spine with mild eccentric right indentation upon the spinal cord at T5-6. 3. Multilevel spondylosis with moderate bilateral neural foraminal stenosis at L5-S1, but no evidence of cauda equina compression.4. No evidence of spinal cord signal abnormality.


Instruction: Generate impression based on findings.

Input: 47 year old female patient with rectal cancer and rectal bleeding/pain. Evaluate staging. Overall image quality: ExcellentPELVIS:UTERUS, ADNEXA: There are bilateral ovarian cysts, which are likely physiologic in a premenopausal female. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Sub-centimeter nodes (at-least 6)Lymph nodes outside the mesorectal fascia: Three subcentimeter left pelvic sidewall.BOWEL, MESENTERY: Rectal Tumor:Size: 3.3 x 3.8 x 1.8 cm (image 56/series 1601)Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensityTumor location: Upper-third(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): N/ADistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 9 cmCircumference of the rectum involved: 360Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): Close but no definite invasion.MRI T-stage: T3b - Tumor invades 0.5cm to 1cm into perirectal fat or extramural.Tumor Distance to Mesorectal Fascia: 0cm (tumor abuts the fascia with areas of thickening and focal invasion (image 47/series 1101).BONES, SOFT TISSUES: Red marrow reconversion possibly due to anemia. Lower lumbar posterior spinal fixation hardware is noted. OTHER: Small amount of pelvic ascites.

Output: Rectal mass with staging information as provided above.


Instruction: Generate impression based on findings.

Input: Left ankle pain / weakness with plantar flexion, evaluate for Achilles tear TENDONS: The Achilles tendon appears normal. There is minimal fluid in the tendon sheath of the tibialis posterior, which is unlikely of clinical significance. The peroneal tendons appear normal. The extensor tendons are within normal limits.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibia-fibula syndesmotic complex is intact. The visualized components of the deltoid ligament appear normal.ARTICULAR SURFACES AND BONE: Bone marrow signal is within normal limits. There is no osteochondral defect. There is a small amount of fluid within the joint without a frank joint effusion.ADDITIONAL

Output: Normal appearing Achilles tendon without specific findings to account for the patient's pain/weakness.


Instruction: Generate impression based on findings.

Input: Patellar instability MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is mild heterogeneity and irregularity of the articular cartilage of the medial patellar facet however no full-thickness defects are appreciated. Otherwise no significant abnormality noted.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact.ADDITIONAL

Output: Edema within Hoffa's fat pad with irregularity of the of the articular cartilage of the medial patellar facet. These findings can be seen in cases of patellar impingement. The Insall Salvati ratio and TT to TG distance are elevated although there is no evidence of trochlear dysplasia.


Instruction: Generate impression based on findings.

Input: Low back pain for 2 years and urinary incontinence Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the mid L1 level. There is minimal fatty infiltration of the filum terminale at the L5-S1 level measuring 1 to 2 mm in thickness. Prone images demonstrate appropriate ventral motion of the conus.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. Paraspinous soft tissues are within normal limits. Please refer to separate report for findings in the pelvis.

Output: 1. There is no clear imaging evidence of tethered cord. Conus is in normal position at the mid L1 level, and there is appropriate ventral motion of the conus on prone images. There is however thin fatty infiltration of the filum terminale at the L5-S1 level, which is favored to be an incidental finding.2. No significant spinal canal or neural foraminal stenosis within the lumbar spine.


Instruction: Generate impression based on findings.

Input: 97-year-old male with neck pain, new onset.? Mass exam. Also with weight loss. Evaluate for mass,? Malignancy Enhanced CT of soft tissues of neck:Images through the skull base, cavernous sinuses, orbits, paranasal sinuses and petrous bones are unremarkable.There is no evidence of a mass or pathologic adenopathy in the neck. Multiple small nonenhancing, non-necrotic and nonpathologic by CT size criteria lymph nodes are noted on the right side of neck and to a lesser degree on the left. The largest of these nodes measures 12 mm x 9.8-mm in the right neck at the level of right thyroid lobe (axial image 71). The vasculature of the neck is intact. No evidence of erosive bony or cartilaginous lesions. He limited images of the apices of the lungs are unremarkable.Extensive degenerative changes of the cervical spine with slight reversal of cervical lordosis is noted. Degenerative changes are more pronounced at C5 -- C6 level. There is multi-level neural foramina compromise at C2 -- C3 on the right, C3 -- C4 bilaterally, C4 -- C5 bilaterally, C5 -- C6 bilaterally (most severe) and C6 and C7 levels. There is also highly suspected central spinal stenosis at multiple levels which can be further evaluated with a dedicated MRI of the cervical spine. CT examination is insensitive to detect central spinal stenosis due to soft tissue hypertrophic changes (disk material or hypertrophic soft tissue changes of the ligaments).80 CC of Omnipaque 350 was utilized for the above study.

Output: 1.No evidence of a mass in the soft tissues of the neck.2.Multiple small nonenhancing, non-necrotic and nonpathologic by CT size criteria lymph nodes as detailed above.3.Extensive degenerative changes of cervical spine with multilevel bilateral neural foramina compromise and highly suspected central spinal stenosis. Further evaluation with an MRI is recommended considering patient's provided clinical data of neck pain.


Instruction: Generate impression based on findings.

Input: 70 years Female (DOB:11/3/1945)Reason: stroke evaluation History: L leg weaknessPROVIDER/ATTENDING NAME: RAYMOND ROOS JAMES A. MASTRIANNI MRI of the brainThere are punctate foci of diffusion restriction present along the inferior aspect of the right cingulate gyrus adjacent to and involving the corpus callosum. Additionally couple punctate foci are present along the right paracentral lobule.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are small foci of encephalomalacia in the right centrum semiovale.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. There are mild foci of narrowing along the carotid siphon bilaterally but no significant stenosis or occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is smaller than the left A1 segment. There is fetal origin of the right posterior cerebral artery with a hypoplastic right P1 segment. The left posterior communicating artery is not readily identified. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries, however, the origins of the vertebral arteries are not adequately imaged due to artifact. The origins of the vertebral arteries are mildly tortuous. There is only mild atherosclerotic narrowing at the left common carotid artery at the bifurcation.

Output: 1.There are multiple acute to subacute microinfarcts present along the distribution of the right pericallosal artery.2.There is no intracranial cerebral vascular occlusion appreciated.3.Small foci of encephalomalacia in the right periventricular white matter suspected to be related to prior vascular events4.Multiple foci of atherosclerotic narrowing are present in the carotid artery distribution without significant stenosis5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 18-year-old male with history of left knee pain. Evaluate for ACL/PCL tear. MENISCI: The lateral meniscus is completely torn with the anterior horn avulsed from its insertion on the tibia and flipped posteriorly with the meniscal fragments located in the posterior aspect of the lateral tibiofemoral joint space. There is longitudinal and branching fluid signal abnormality within a body of the medial meniscus extending to the articular surfaces compatible with a complex tear.ARTICULAR CARTILAGE AND BONE: Artifact from intramedullary rod limits evaluation of the distal tibia. There is edema type signal about the anterolateral aspect of the tibial plateau and the medial femoral condyle. The articular cartilage is relatively intact. There is no evidence of fracture.LIGAMENTS: There is complete disruption of the PCL. The majority of the ACL fibers are not well visualized with a few intact fibers compatible with at least a partial tear. The fibular femoral ligament is not visualized and may be also torn. The IT band and biceps femoris tendon are intact. The MCL is unremarkable.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complex and extensive tearing of the lateral meniscus as above.2.Longitudinal tear of the body of the medial meniscus.3.Complete tear of the PCL with a high grade partial tear of the ACL.4.Nonvisualized fibular femoral ligament may indicate tear.5.Other findings as above.


Instruction: Generate impression based on findings.

Input: History of pancreatic necrosectomy with high drain output. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size and signal intensity without a focal lesion.There is moderate dilatation of the common duct which measures up to 1.2 cm. Mild central intrahepatic biliary ductal dilatation. The common bile duct tapers smoothly at the level of the ampulla.The gallbladder has been surgically removed with a remnant cystic duct and cholecystectomy clips better seen on recent CT.In the gallbladder fossa there is a thick-walled heterogeneous predominantly T2-hyperintense fluid collection measuring 6.7 x 4.4 cm with regions of susceptibility artifact indicating air foci suggestive of superinfection.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates heterogeneous decreased intrinsic T1 weighted signal intensity. The parenchyma demonstrates postcontrast enhancement with focal parenchymal loss of the anterior pancreatic body compatible with necrosis. No specific evidence of hemorrhage.There is a peripancreatic fluid collection adjacent to the pancreatic tail measuring 4.4 x 2.3 cm (series 1 103/63) which is relatively in T2-weighted signal intensity. This communicates with a T2-weighted hyperintense peripherally thick-walled enhancing fluid collection extends along the left retroperitoneum along the pararenal space craniocaudally and involves the abdominal wall musculature inferiorly. There is a surgical drain in the inferior aspect of this collection.Adjacent to the inferior aspect of the pancreatic body is a 7.9 x 6.0 cm heterogeneous collection (image 68). This communicates with a more inferiorly located heterogeneous mesenteric collection measuring 6.3 x 2.6 cm (image 85). This communicates with an additional homogeneous fluid collection measuring 6.7 x 2.9 cm (image 86) anterior to the right pararenal fascia. There is a drainage catheter in the right pararenal space collection.The main pancreatic duct is mildly prominent at the tail with regions of focal narrowing at the pancreatic body measuring 2.1 cm in length (series 3/26 and series 6/92) and minimal narrowing at pancreatic head measuring approximate 7 mm in length (3/28 and series 6/112).No evidence of arterial pseudoaneurysm formation. There is moderate to severe narrowing of the SMV and splenic vein proximal to the portal vein confluence. The portal vein is patent. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral extrarenal pelvis. No hydronephrosis or focal lesion. Mild right perinephric fluid.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace left pleural effusion.

Output: Multiple peripancreatic fluid collections are noted in the abdomen and retroperitoneum. The fluid collection in the gallbladder fossa is more homogeneously T2-hyperintense with gas foci more suggestive of a pseudocyst with possible super-infection. The bilateral pararenal space collections are more homogeneously T2-hyperintense suggestive of pseudocysts. The fluid collections adjacent to the pancreatic body and tail are more heterogeneous in signal intensity and are more suggestive of internal hemorrhage/proteinaceous products (i.e. walled-off-necrosis).Focal narrowing of the main pancreatic duct at the pancreatic body level. No evidence of parenchymal necrosis/hemorrhage.Moderate to severe narrowing of the SMV and splenic vein prior to the portal vein confluence. These were better opacified on the same day CT.


Instruction: Generate impression based on findings.

Input: Impingement The exam is limited by motion artifact.ROTATOR CUFF: There is full-thickness tearing of the supraspinatus tendon with approximately 2 cm of retraction and what appears to be a small stump of tissue remaining on the greater tuberosity. There is also interstitial tearing within the retracted supraspinatus tendon more posteriorly. The aforementioned full-thickness tear extends posteriorly to involve the infraspinatus tendon anteriorly. There is additional interstitial tearing of the infraspinatus tendon along the myotendinous junction more proximally. There is mild to moderate fatty atrophy of the supraspinatus muscle with little if any atrophy of the infraspinatus muscle. The teres minor tendon and muscle are intact. There is full-thickness tearing of the subscapularis tendon superiorly with approximately 1 cm of retraction. There is delamination of the subscapularis which extends more proximally into the muscle although the muscle signal intensity is maintained.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint. A small amount of fluid is noted in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild to moderate osteoarthritis of the glenohumeral joint with a slightly high riding humeral head. There is degenerative tearing of the labrum. There is a moderate joint effusion with scattered subcentimeter foci of low signal which may represent small loose bodies.BICEPS TENDON: There is increased signal and enlargement of the long head of the biceps within the rotator interval reflecting tendinosis. Irregularity of the margin of the biceps also suggests partial-thickness tearing. Fluid is present within the biceps tendon sheath reflecting extension from the glenohumeral joint.

Output: 1. Full-thickness rotator cuff tears and tendinosis further detailed above.2. Osteoarthritis of the acromioclavicular and glenohumeral joints.3. Tendinosis of the biceps tendon. Other findings are described above.


Instruction: Generate impression based on findings.

Input: Right knee pain status post knee arthroscopy and microfracture. MENISCI: Fraying of the inner edge of both menisci is observed with mild loss of the apex of the posterior horn of the lateral meniscus. As abnormalities may be partially exaggerated due to artifact from the overlying osseous cartilaginous abnormality. Both menisci are properly anchored posteriorlyARTICULAR CARTILAGE AND BONE: Diffuse scattered cartilaginous changes representing progressing diffuse and focal abnormalities. The discrete focal lesion involving thearticular cartilage of the lateral femoral condyle anteriorly now demonstrates a more discrete defect with underlying bone changes and small cysts. This lesion measures 8 mm approximately. There is less pronounced abnormal signal in the articular cartilage of the medial femoral condyle which also may represent a partial-thickness defect and progressing changes in the undersurface of the patella and trochlea, specifically involving the medial aspects. Mild to moderate osteoarthritic changes are otherwise observedLIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Progressing degenerative changes and or post operative changes. Previously observed cartilaginous lesions, most pronounced in the lateral compartment along with an underlying change of the posterior horn of the lateral meniscus, see details provided.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: r/o tendon / muscle / ligament tear History: pain, swelling TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: Degenerative changes affect the first MTP joint. Metallic susceptibility artifact is identified within the first metatarsal head indicating postsurgical change. Otherwise no bone marrow signal abnormality is identified. ADDITIONAL

Output: Nonspecific subcutaneous edema along the anterior and lateral aspect of the ankle. No evidence of ligamentous injury. Osteoarthritis and surgical changes of the first MTP joint.


Instruction: Generate impression based on findings.

Input: Painful bony prominence adjacent to tooth #16, prior history of pre-cancerous changes of left lateral tongue. There appears to be mild torus maxillaris internus bilaterally. Otherwise, assessment of the structures surrounding tooth number 16 is limited due to dental amalgam artifact. There is no discernible gross tumor in the oral cavity region, within this limitation. There is also no evidence of significant cervical lymphadenopathy and the salivary glands and thyroid are unremarkable. The imaged intracranial structures and orbits are also unremarkable.

Output: Apparent mild torus maxillaris internus bilaterally. Otherwise, assessment of the structures surrounding tooth number 16 is limited due to dental amalgam artifact.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other symptoms and signs involving the musculoskeletal systemDiagnosis Edits: Clinical question: LE weakness, incontinence, and gait instability, evaluate for myelopathySigns and Symptoms: see above Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is left-sided facet hypertrophy presentAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this levelAt C4-5 there is no significant compromise to the spinal canal. There are some endplate and uncovertebral osteophytes present at this level which narrow the neural foramina bilaterally but worse on the right side were there is some mild encroachment of the exiting nerve roots. This has not changed substantially since the prior exam.At C5-6 there is no significant compromise to the spinal canal . There is loss of disc space height at this level. There is a right lateral recess disc protrusion present at this level which encroaches on the right-sided exiting nerve roots within the neural foramina. This is associated with some uncovertebral osteophytes.At C6-7 there is a diffuse disc bulge associated with endplate and uncovertebral osteophytes and ligamentum flavum hypertrophy. There is partial effacement of spinal fluid surrounding the spinal cord at this level with mild narrowing of the spinal canal at this level. This narrowing has progressed a very little amount since the prior examAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are large cysts present along both kidneys which can also be seen on abdomen CT from 11/20/2014. The one in the left kidney appears to be more complex than the one on the right because it does not follow spinal fluid on all MRI pulse sequences. There are smaller cystic lesions scattered in the kidneys. There is another lesion present along the inferior pole of the right kidney which is complex and hemorrhagic which measures 6 cm x 5.2 cm and has calcifications along its wall as identified on the prior CT.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal. There is bilateral facet hypertrophy present at this level which is worse on the left when compared to the right side. There are some encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At L4-5 there is a diffuse disc bulge present associated with the loss of disc space height, disc desiccation and endplate reactive changes. The endplate reactive changes are bright on T1. The endplates are irregular. There is effacement of the fat at the lateral recess on both left and right side. There is narrowing of the neural foramina present at this level with some mild to moderate encroachment of the exiting nerve roots within the neural foramina. Overall there is a moderate degree to marked degree of spinal stenosis at this level.At L3-4 there is loss of disc space height, diffuse disc bulge, posterior subluxation of L3 on L4 by several millimeters and a diffuse disc bulge. There is effacement of the fat at the lateral recess on both the left and the right side. There is bilateral facet and ligamentum flavum hypertrophy at this level. Some endplate reactive changes are also present at this level. Overall there is a moderate degree to marked degree of spinal stenosis at this level. There is mild encroachment of the exiting nerve roots within the neural foramina at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disc bulge present at this level associated with loss of disc space height and some endplate reactive changes. There is partial effacement of fat at the lateral recess bilaterally at this level. Overall there is mild narrowing the spinal canal at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is encroachment of the right-sided exiting nerve roots within the right C5-6 neural foramen and to a lesser degree right-sided exiting nerve roots at C4-5. This was also present on the 4/10/2009 exam and has not progressed2.There are multilevel degenerative changes present in the cervical spine with some mild narrowing of the spinal canal at the C6-7 level.3.There are multilevel degenerative changes present in the lumbar spine with moderate to marked spinal stenosis at L3-4 and L4-5 associated with encroachment of exiting nerve roots at L4-5 and on the left side at L5-S1. There is mild osseous subluxation of L3 on L4.4.Multiple complex appearing cystic lesions in the kidneys. Please refer to CT of the abdomen from 5/3/2015 and 11/20/2015.


Instruction: Generate impression based on findings.

Input: Female 74 years old Reason: NSCLC History: headache. There are multiple foci of T2 hyperintensity in the periventricular and subcortical white matter. There is a prominent left inferior basal ganglia perivascular space. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage or mass effect. The ventricles and basal cisterns are normal in size and configuration. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right maxillary and sphenoid sinuses.

Output: 1. No evidence of enhancing intracranial metastases.2. Probable chronic small vessel white matter ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headaches of changing character and history of thyroid cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: NF3: visual field defect, diplopia, and numbness and weakness bilaterally of arms and hands. Orbits: There is slight interval increase in size of the tumor along the right optic nerve sheath that encases and compresses the optic nerve. The tumor now measures 22 mm width and 16 mm in height, previously 20 mm and 14 mm, respectively. The tumor compresses the right medial rectus muscle and results in proptosis. The right globe is otherwise intact. The left orbit is unremarkable. The left parotid and left cheek subcutaneous tumors have not significantly changed. Brain: There are postoperative findings related to right retrosigmoid craniotomy, with encephalomalacia in the right lateral cerebellum. The remaining portion of the right vestibular schwannoma in the right cerebellopontine angle cistern is perhaps minimally larger, measuring up to 9 mm, previously 8 mm. Likewise, the residual tumor within the skeletonized right internal auditory canal appears to be slightly more prominent. There is a 2 mm wide enhancing nodule within the left internal auditory canal, which is more conspicuous. The right geniculate fossa tumor is not significantly changed, measuring 9 x 7 mm in axial cross-section. Likewise, a tumor centered in the right Meckel's cave and along the bilateral oculomotor cisternal segments have not significantly changed. There are multiple supratentorial and infratentorial dural-based enhancing tumors, which do not appear to have changed significantly. For example, the largest tumor along the right frontal convexity measures 18 mm in height and 22 mm in width, previously also 18 mm and 22 mm, perspectively. There are several unchanged punctate foci of T2 hyperintensity in the cerebral white matter. There is no midline shift or herniation. There is no evidence of acute infarction. The ventricles are unchanged in size and configuration. There is a subcentimeter right ethmoid retention cyst.Cervical Spine: There is an enhancing extramedullary mass within the left aspect of the spinal canal at C4-5 with marked compression of the spinal cord. The tumor extends through the left C4-5 neural foramen and along the brachial plexus. The tumor measures up to 15 mm in width and 45 mm in length and displaced and perhaps narrows the left vertebral artery flow void. There minimal T2 hyperintensity within the spinal cord at the C4-5 level. There is also an enhancing lesion within the right C5-6 neural foramen. In addition, there is a 3 mm wide enhancing nodule within the left spinal canal at the C2-3 level. There are dural-based enhancing lesions along the posterior spinal canal at the C2 level that measure up to 3 and 5 mm in thickness and indent the spinal cord. There also appears to be a punctate posterior dural -based lesion at the C5 level, with minimal mass-effect upon the spinal cord. The cervical spine alignment is straightened in the sagittal plane, but there is no spondylolisthesis. The vertebral body hei8ghts are preserved.

Output: 1. Stigmata of neurofibromatosis type 2 with multiple intracranial meningiomas that appear to not have significantly changed, cervical spine meningiomas, a right optic nerve sheath meningioma that has slightly increased in size, multiple intracranial schwannomas, including slight increase in size of the residual right vestibular schwannoma and a punctate left vestibular schwannoma, and a large schwannoma at C4-5 that compresses the spinal cord and extends beyond the left neural foramen. The posterior spinal canal meningiomas at the C2 level also indent the spinal cord.2. Unchanged nonspecific cerebral white matter lesions, but no evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: Orbital cellulitis possible orbital abscess: left orbital pain and blurry vision. There is secretions and moderate mucosal thickening diffusely throughout the left frontal anterior ethmoid, and maxillary sinuses. There is a defect in the left lamina papyracea with mild protrusion of the orbital contents, which is more conspicuous on the recent CT. There is high T2 signal and enhancement within the medial left orbital fat, mainly confined to the extraconal space. There is no evidence of intraorbital fluid collection. The left superior opthalmic vein demonstrates normal enhancement and the left globe and optic nerve appear to be intact. The right orbit appears unremarkable. The right maxillary and ethmoid sinuses and bilateral sphenoid sinuses appear unremarkable. There are several subcentimeter retention cysts in the adenoids. The imaged intracranial contents appear unremarkable.

Output: Left osteomeatal unit pattern of sinusitis and medial left orbit cellulitis associated with a lamina papyracea defect, but no evidence of orbital abscess.


Instruction: Generate impression based on findings.

Input: There is a more prominent left frontal dural based homogeneously enhancing focus measuring approximately 6 x 11 x 11 mm in the axial plane (series 1301 image 19, series 1401 image 14) which appeared on prior exams to be smaller and more like a prominent vessel. There is no significant associated mass effect and no edema within the adjacent brain parenchyma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, and there are no areas of abnormal signal. The midline structures and craniocervical junction are within normal limits. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. No abnormal extra-axial fluid collection is identified. The major cerebral flow voids are intact. Diffuse low T1 signal involving the visualized osseous structures, compatible with known sickle cell disease is again noted . The paranasal sinuses and mastoid air cells are clear.MRA HEAD

Output: 1.There is a more prominent left frontal dural based homogeneously enhancing focus measuring approximately 6 x 11 x 11 mm in the axial plane (series 1301 image 19, series 1401 image 14) which appeared on prior exams to be smaller and more like a prominent vessel. The differential diagnosis most likely includes a meningioma, especially given its slow growth over the interval 13 months. Recommend follow-up imaging in 6 months to evaluate progression. Otherwise negative brain MRI.2.Normal MR angiography of the brain, without flow limiting stenosis or aneurysm identified.3.Normal MRV of the brain, without occlusion or stenosis.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges. Brain lesion. Preoperative planning for brain tumor resection The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of an extra-axial mass adjacent to the medial aspect of the left precentral gyrus which measures 22 x 18 mm sagittal dimensions on the current exam and is unchanged since the prior exam. Findings suggest infiltration of the lesion to the dura and possibly into the superior sagittal sinus.There is diffuse pachymeningeal enhancement presentNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Examination is performed for the purpose of stereotactic guidance. This is a limited exam.2.There is redemonstration of an extra-axial mass adjacent to the left precentral gyrus which is suspected to infiltrate into the superior sagittal sinus.


Instruction: Generate impression based on findings.

Input: On neoadjuvant therapy for known left breast cancer. I-Spy research MRI #2. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Bilateral retropectoral silicone implants are present.In the left inner breast, the index enhancing mass near 8:00 now measures 1.4 x 2.1 x 2.8 cm, previously 2.0 x 2.7 x 2.8 cm (LM x CC x AP). Previously noted adjacent small foci/areas of non-mass enhancement are not clearly visualized. Biopsy clip artifact is seen in the mass. This index mass extends posteriorly close to the thin pectoralis muscle overlying the implant. The abnormal non-mass enhancement surrounding a cyst in the lower outer left breast now measures 2.3 x 2.8 x 5.1 cm, previously 2.7 x 3.2 x 5.7 cm. This is also decreased in degree of enhancement. These areas together currently measure 4.4 x 5.2 cm, previously 5.2 x 6.5 cm in the axial plane.No abnormal enhancement is seen in the right breast. The representative node adjacent to the pectoralis minor again measures 1.1 cm in the axial plane. Other lymph nodes are slightly decreased in short axis dimensions. No abnormal axillary lymph nodes are identified in the right axillary region.A port-a-cath is present in the right upper chest wall. A high T2 signal hepatic lesion is partially visualized, likely a benign cyst.

Output: Decrease in size and degree of enhancement of proven malignant lesions as detailed above. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 45-year-old woman with history of pancreatic pseudocyst status post drainage. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder appear normal. There is no intra or extra hepatic biliary duct dilatation.SPLEEN: The spleen appears normal.PANCREAS: The cystgastrostomy tube has been removed. The pancreatic parenchyma is atrophic. The parenchyma and pancreatic tail has decreased T1 signal and enhances poorly. Additionally, there is mild pancreatic tail duct dilatation. No pseudocyst or abnormal fluid collection is identified. No focal pancreatic lesion is identified.The duodenum distends normally on the secretin augmented images suggesting normal exocrine function.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: The kidneys appear normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: Small peripancreatic lymph nodes are noted, however there is no significant lymphadenopathy.BOWEL, MESENTERY: Loops of small bowel and colon are partially visualized.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Resolved pancreatic pseudocyst and cystgastrostomy removed.2.Findings suggestive of chronic tail pancreatitis with mild ductal dilatation, likely due to stricture or chronic ductal injury.


Instruction: Generate impression based on findings.

Input: HCV cirrhosis. HCC surveillance. ABDOMEN:LIVER, BILIARY TRACT: Liver contour: The liver contour is smooth. Hypertrophic left hepatic lobe suggestive of chronic liver disease.Features of portal hypertension: None.Portal vein: Patent.Hepatic veins: Patent.Hepatic artery: Conventional.Lesions:No suspicious arterially enhancing parenchymal lesions. Stable small right hepatic cysts.Status post cholecystectomy.SPLEEN: Status post splenectomy. Nodular enhancing foci in the left upper quadrant are stable and again suggestive of splenosis. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts bilaterally. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes consistent with gastrojejunostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious focal hepatic lesions to suggest HCC.


Instruction: Generate impression based on findings.

Input: Male 19 years old Reason: Patella dislocation. Evaluate MPFL and for loose body History: Recurrent dislocations MENISCI: Medial and lateral menisci are intact. ARTICULAR CARTILAGE AND BONE: There is T2 hyperintense bone marrow edema signal in the lateral femoral condyle and the lateral tibial plateau. Lateral trochlear inclination measuring 4 degrees consistent with trochlear dysplasia.LIGAMENTS: Increased signal and attenuation of the medial patellofemoral ligament consistent with history of patellar dislocation. Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Sequelae of patellar dislocation including injury of the medial patellofemoral ligament, and lateral femoral condyle bone contusion. 2.Large joint effusion. 3.Findings consistent with trochlear dysplasia.


Instruction: Generate impression based on findings.

Input: Male, 69 years old, with history of thoracic angiosarcoma status post resection, follow-up examination. Evidence of laminectomy is again seen from T4 through T7 for resection of prior intraspinal tumor. Epidural and soft tissue scarring appears similar to prior and does result in partial effacement of the dorsal thecal sac. Areas of signal abnormality are also redemonstrated within the left aspect of the T5 and T6 vertebral bodies related to prior tumor involvement. These also show no significant interval change. Within the limitations of a noncontrast examination, there are no findings to suggest recurrent or growing tumor.The sagittal alignment of the thoracic spine is within normal limits. Vertebral body height and morphology are unremarkable. Except as above, marrow signal characteristics are benign. There is mild narrowing of the spinal canal between T5 and T7 due to epidural scarring, but no high-grade spinal canal stenosis is seen at any level. Disc protrusions are evident at multiple levels, most notably at T8-9 where there is mild cord impingement, without significant interval change.

Output: 1.Demonstration of findings related to intraspinal tumor resection.2.Dorsal epidural and soft tissue scarring is again seen extending from T4 through T7.3.There is no evidence of recurrent or growing tumor.4.A disc protrusion with mild cord impingement at T8-9 is unchanged.


Instruction: Generate impression based on findings.

Input: 23 year old man with history of heart transplant in 2011, presenting for annual evaluation.MEDICATIONS: Pravastatin, tacrolimus, prednisone, cellcept, tricor, glipizide, metformin, synthroid. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVEDV is 150 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 43 g/m2, and the LV mass is 71 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is consistent with prior transplant.. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 116 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 53 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with prior transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. The main PA is 28 mmVenous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Depth electrode for seizures. There is a left transparietal depth electrode that terminates in the left medial temporal lobe region, a left transtemporal depth electrode that also terminates in the left medial temporal lobe region, and another depth electrode that terminates in the left thalamus region. There is new diffuse T2 hyperintensity along the left hippocampal tail, adjacent to an electrode. There is also a newly apparent T2 hyperintense lesion in the splenium of the corpus callosum. The ventricles are unchanged is size.

Output: 1. Multiple left cerebral hemisphere depth electrodes in position and new edema along the left hippocampal tail, adjacent to an electrode, which may be related to seizure activity.2. Newly apparent lesion in the splenium of the corpus callosum, which may be related to seizure activity, antiepileptic medications, or viral infection, for example.


Instruction: Generate impression based on findings.

Input: Bilateral L4, L5 radiculopathy. Evaluate for nerve root impingement. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild loss of lumbar lordosis. Alignment is otherwise maintained. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Multilevel degenerative changes are seen with disc desiccation and height loss at multiple levels, relatively worst at the L4-L5 level and T12-L1 levels, where there is at least moderate degree of disc height loss with suggestion of vacuum phenomena. Fatty endplate marrow changes at L4-L5. Multilevel degenerative changes are seen, as described below:T12-L1: Mild disc bulge without significant spinal canal or neural foraminal stenosis.L1-L2: Mild disc bulge. Mild effacement of the lateral recesses. No central spinal canal or neural foraminal stenosis.L2-L3: There is disc bulge, ligamentum flavum thickening, prominence of the dorsal epidural fat, and mild facet arthropathy. There is resulting mild spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: Mild disc bulge with partial effacement of the lateral recesses. No significant central canal stenosis. Minimal narrowing of the neural foramina. Mild to moderate bilateral facet arthropathy.L4-L5: Disc bulge, ligamentum flavum thickening, and moderate bilateral facet arthropathy. There is no significant central canal stenosis. There is moderate right and moderate to severe left neural foraminal stenosis, where there may be impingement of the exiting L4 nerve roots. There is also effacement of the lateral recesses which may be affecting the descending L5 nerve roots.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild to moderate bilateral facet arthropathy.

Output: 1. Multilevel degenerative changes in the lumbar spine, relatively worse at the L4-L5 level where there is moderate right and moderate to severe left neural foraminal stenosis. There is also effacement of the lateral recesses. There may be impingement of the L4 and L5 nerve roots at this level as described above.2. No high-grade spinal canal stenosis at any level. Central spinal canal stenosis is relatively worse at L2-L3, and is mild in degree.


Instruction: Generate impression based on findings.

Input: 52-year-old female rule out CVA. Left finger-to-nose dismetrix. Unstable gait, falling to left x 1 week This examination is within normal limits for patient's stated age of 52. In particular no evidence of stroke, hemorrhage, mass-effect, hydrocephalus or midline shift is detected. The ventricular system and cortical sulci and all CSF cisterns are within normal limits. Images through posterior fossa remains essentially unremarkable. Considering the provided clinical data an MRI examination is recommended.The bony message of calvarium, pneumatization of paranasal sinuses and mastoid air cells are also unremarkable.

Output: Negative CT examination of brain without infusion.


Instruction: Generate impression based on findings.

Input: 8 year-old former 32 week premie with significant developmental delays. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is moderate left maxillary sinus mucosal thickening.

Output: No evidence of acute intracranial hemorrhage, mass, or infarction.


Instruction: Generate impression based on findings.

Input: Clinical question: 29-year-old female with sudden onset of headaches 2 weeks ago. Signs and symptoms: As above. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted images.Examination demonstrate prominence of the vermian folia for patient's stated age of 29. Correlate with history and risk factors.Slight asymmetry of the lateral ventricles (right larger left) midline is believed to represent an anatomic variation areaThe anatomical and morphology and the signal intensity of brain parenchyma is otherwise within normal on all MRI sequences.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses remain unremarkable.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Prominence of vermian folia for patient of stated age.3.Unremarkable nonenhanced brain MRI otherwise as detailed above.4.Unremarkable visualized orbits and well pneumatized all paranasal sinuses and mastoid air cells.