Instruction: Generate impression based on findings.

Input: Pain. Torn cuff? ROTATOR CUFF: There is mild increased signal intensity within the anterior fibers of the supraspinatus tendon at its insertion on the greater tuberosity suggesting tendinosis, but I see no fluid-filled tear of the supraspinatus. The supraspinatus muscle is within normal limits. There is mild heterogeneity of signal of the infraspinatus tendon which may reflect minimal tendinosis, but I see no tear, and the muscle appears normal. The teres minor tendon and muscle appear normal. There is a focal near full-thickness to full-thickness tear of the subscapularis tendon just proximal to its humeral insertion medial to the tendon of the long head of the biceps. This tear is approximately 8 mm in greatest dimension. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint with anterior acromial spurring associated with mild impression upon the superior fibers of the supraspinatus muscle. I see no fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint, with cartilage loss posteriorly. There is also tearing of the superior and posterior labrum with formation of small para labral cysts. There is minimal posterior translation of the humeral head with respect to the center of the glenoid. Intermediate signal intensity within the anterior labrum likely reflects degeneration. There is no joint effusion. BICEPS TENDON: The tendon of the long head of the biceps appears slightly thickened within the rotator interval and contains mild increased signal intensity centrally, suggesting mild tendinosis.

Output: 1.Focal near-full-thickness to full-thickness tear of the insertional fibers of the subscapularis.2.Osteoarthritis and labral tearing.3.Other findings as described above.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial mass, acute infarct, mass effect or herniation. There is persistent ill-defined enhancement in the postsurgical area in the left frontal lobe, likely post-operative, without new or nodular enhancement. Previously seen tiny focus of high DWI signal in the right periatrial white matter is no longer present. There are stable postoperative findings related to left sided craniotomy with foci of encephalomalacia in left frontal lobe, and left occipital lobe with stable ex vacuo dilatation of the trigone of the left lateral ventricle.There is moderate degree of confluent periventricular and subcortical white matter T2 prolongation which is unchanged. Aside from differences in technique, there is redemonstration of numerous foci of punctate small susceptibility effect in the pons, cerebellar hemispheres, and bilateral cerebral hemispheres including the basal ganglia. There are stable small bilateral subdural effusions in the posterior fossa which may be secondary to volume loss. There is a small right maxillary sinus mucous retention cyst. There is new patchy increased T2 signal in the left mastoid air cells.

Output: 1.No evidence of intracranial metastases.2.Stable foci of encephalomalacia left frontal and occipital lobes.3.Stable nonspecific periventricular and subcortical white matter changes which may be related to posttreatment change or possible underlying chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 58 year old male patient with biopsy proven prostate cancer. Evaluate extent of prostate cancer invasion. PELVIS:PROSTATE:Prostate Size: 4.6 x 2.8 x 3.5 cm. Peripheral Zone: There is a region of T2 hypointensity and corresponding low ADC values extending from the right base to mid gland of the peripheral zone compatible with tumor. This measures approximately 1.0 x 0.5 cm in one region (image 19, series 901). The capsule overlying this lesion is indistinct compatible with extraprostatic extension and there is questioned involvement of the adjacent neurovascular bundle on the right.There is an additional smaller focus of signal abnormality within the left mid-gland measuring 0.5 x 0.4 cm which is also suspicious for tumor (image 20, series 901). Central Gland: There are BPH nodules.Seminal Vesicles: No definite involvement.Extracapsular Extension: As described above.BLADDER: There is irregularity and thickening of the inferior bladder wall. These regions of abnormality are intrinsically high on T1 which limit evaluation for enhancement.LYMPH NODES: Non-specific external iliac lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There are asymmetric dilated venous vessels anterior to the right gluteus musculature.

Output: 1.Large area of signal abnormality within the right mid-gland and right base of the peripheral zone most compatible with neoplasm and with extraprostatic extension and questioned involvement of the neurovascular bundle.2.Smaller lesion within the left mid-gland of the peripheral zone also suspicious for prostatic neoplasm.3.Significant irregularity and thickening of the bladder wall is concerning for neoplasm; direct visualization is recommended for further evaluation. 4. Asymmetric prominent posterior right lower extremity veins. While this could be normal anatomy, collateral vessel formation is another consideration in the setting of chronic deep venous thrombosis; if there is clinical concern for DVT, ultrasound may be considered.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for HCC History: HCV cirrhosis, elevated AFP ABDOMEN:LIVER, BILIARY TRACT: There is a dominant focal hepatic lesion at the junction of segments 5 and 6 with reference measurements as below. The lesion demonstrates increased T2 signal, restricted diffusion, decreased T1 signal, and predominantly peripheral enhancement. There is an additional similar smaller lesion at the hepatic dome at the junctions of segments 7 and 8 with reference measurements below. This lesion mildly attenuates the right hepatic vein which remains patent. No additional focal hepatic lesions are identified.The gallbladder appears within normal limits. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cyst. RETROPERITONEUM, LYMPH NODES: Few mildly prominent nonspecific periportal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/29/2016 10:30:00)HEPATIC SEGMENT 5/6 LESION: 3.5 x 4.1 cm (Image 270, Series 10).HEPATIC SEGMENT 7/8 LESION: 2.1 x 1.9 cm (Image 288, Series 10).

Output: Two focal hepatic lesions which are highly suspicious for neoplasm. The lesions do not meet diagnostic criteria for HCC. Top differential considerations include cholangiocarcinoma, metastatic adenocarcinoma, or undifferentiated carcinoma.Findings discussed with BOYLE, ELIZABETH at 2:15 PM on 11/29/2016.


Instruction: Generate impression based on findings.

Input: 14 years Female (DOB:4/10/2002)Reason: syrinx with new leg pain and numbness to the top of her foot. Please do with tethered cord protocol. Evaluate for changes. History: leg pain and numbness to the top of her foot.PROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM 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. Conus medullaris moves anteriorly in the prone position. The conus medullaris ends at the mid L2 vertebral level.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.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: No compromise to lumbar spinal canal or neural foramina. The patient's syrinx does not extend to the conus medullaris. There is no convincing evidence for tethered cord.


Instruction: Generate impression based on findings.

Input: Eethesioneuroblastoma; received 2 cycles of chemotherapy; assess for response to therapy. Face: There is a right sinonasal mass that extends from medial maxillary sinus, through the infundibulum into the middle meatus and anterior ethmoid air cells. The tumor measures up to approximately 30 mm in craniocaudal extent, 30 mm in the anteroposterior dimension, and 20 mm transversely, which is similar to the size of the tumor in August 2015. There are obstructed secretions and mucosal thickening in the right maxillary sinus, frontoethmoid, frontal sinuses. There is apparent dehiscence of the posterior wall of the right nasolacrimal duct, which appears narrowed, but no evidence of intracranial or intraorbital extension of the tumor. There appears to be a mildly asymmetrically prominent right level 2B lymph node. There is leftward nasal septal deviation. There is a subcentimeter probable nasopharyngeal retention cyst.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a prominent perivascular space in the right basal ganglia. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. A right sinonasal mass measuring up to 30 mm that involves the right maxillary, middle meatus, and ethmoid sinuses is compatible with residual esthesioneuroblastoma without evidence of intraorbital or intracranial extension. 2. A mildly asymmetrically prominent right level 2B lymph node is nonspecific.3. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Brain parenchyma appears within normal limits. No findings to suggest demyelinating disease. No abnormal enhancement. No intracranial mass or mass effect. No evidence of ischemia or hemorrhage. Ventricles and sulci are within normal limits. Cerebellar tonsils are borderline low with preserved rounded morphology. There is a left maxillary sinus mucus retention cyst. Calvarium and extracranial soft tissues are otherwise unremarkable.CERVICAL SPINE

Output: There is no evidence of demyelinating disease in the brain or spine or other significant abnormality to explain patient's symptoms.


Instruction: Generate impression based on findings.

Input: 41 years Male (DOB:4/12/1974)Reason: h/o L frontal anaplastic pleomorphic xanthoastrocytoma s/p resection and RT History: eval for EODPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left frontal craniotomy for left frontal lobe surgery. There is a small linear focus of enhancement present along the inferior medial aspect of the resection site which is stable compared to prior exam. There is also small focus of T1 signal hyperintensity adjacent to the frontal horn of left lateral ventricle. Perfusion imaging does not demonstrate any areas of increased microvascularity. The signal characteristics of the apparent fluid within the resection cavity are slightly different from that of spinal fluid.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The patient is status post left frontal lobe surgery. The appearance of the resection site is stable compared to the prior exam. Small focus of enhancement at the surgical site remains stable. It is quite possible that it is related to postoperative effect.


Instruction: Generate impression based on findings.

Input: Status post TACE RFA of a segment 5 lesion. Evaluate for residual or recurrent tumor. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology and contour.The hepatic dome ablation zone measures 2.1 x 1.7 cm (series 801/369), unchanged.The peripheral segment 5/8 ablation zone measures 3.0 x 1.6 cm (series 801/289), compared to 2.8 x 1.5 cm previously.The segment 3 ablation zone measures 1.8 x 1.1 cm (series 801/189), compared to 1.7 x 1.4 cm previously.The new segment 5 ablation zone measures 3.1 x 1.2 cm (series 801/174). No residual enhancing lesion.No new arterial enhancing lesion or other discrete mass lesion. Trace perihepatic ascites, unchanged.Normally distended gallbladder. No biliary ductal dilatation.SPLEEN: The spleen measures 10.4 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal inferior pole cyst.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm is partially imaged measuring 4.2 x 4.4 cm (series 601/1) in maximal cross-section with asymmetric mural thrombus. It measures 4.5 cm in transverse dimension on the coronal images. BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Fluid and peripheral enhancement without restricted diffusion in the right lower anterior chest wall soft tissues along the recent RFA tract.OTHER: No significant abnormality noted.

Output: 1.Interval TACE/RFA of the segment 5 lesion without evidence of residual or recurrent tumor. Relatively stable bilobar ablation zones without evidence of tumor recurrence.2.Cirrhosis with no new new suspicious liver lesion.3.Fluid and peripheral enhancement of new RFA tract; correlate for signs and symptoms of infection. 4.Partially evaluated infrarenal abdominal aortic aneurysm.


Instruction: Generate impression based on findings.

Input: Cervical radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Central disc protrusion similar to prior with minimal narrowing of the spinal canal at this level. No significant neural foraminal stenosis. C5-6: Disc bulge with central protrusion and ligamentum flavum thickening contribute to moderate spinal canal stenosis at this level, not appreciably changed since 9/29/2014. There is mild left worse than right neural foraminal stenosis, which is also similar to prior. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Compared to 9/29/2014, there is no significant change in degenerative changes at the C4-C5 and C5-C6 levels, with up to moderate spinal canal stenosis at the C5-C6 level. No cord signal abnormality. There is mild bilateral, left worse than right, C5-C6 neural foraminal stenosis which is also not significantly changed.


Instruction: Generate impression based on findings.

Input: Reason: Cmc joint injury History: Pain and swelling thumb CMC joint There is focal edema within the base of the first metacarpal dorsomedially. There is slight depression of the overlying articular surface, which may represent a small impaction fracture. There is perhaps mild thickening of the capsular structure of the joint which may reflect mild sprain injury, particularly the intermetacarpal ligament. No additional bone marrow abnormality is noted. There is small amount of fluid in the first CMC joint. We see no findings of TFCC, lunotriquetral, or scapholunate ligament disruption. There is small collection of fluid intensity volar to the distal radius along the proximal margin of the radiolunotriquetral ligament that may represent a small ganglion or synovial cyst. Median and ulnar nerves appear normal. Extensor and flexor tendons are within normal limits without evidence of tenosynovitis.

Output: Small focus of edema at the base of the first metacarpal with slight focal depression of the overlying the articular surface, which may represent a small impaction fracture. Other findings as above.


Instruction: Generate impression based on findings.

Input: 36 are old male with progressive left hip pain with history of car accident. There is linear increased signal abnormality traversing the anterior superior labrum at the 2 o'clock position indicating a tear. Additionally, there is heterogeneous signal abnormality traversing the posterosuperior labrum at the 10 o'clock position also suspicious for a tear. There is a small amount of fluid within the joint without evidence of a large effusion. The imaged musculature of the left hip is normal in appearance. There is peritrochanteric increased signal abnormality on fluid sensitive sequences with associated enhancement on postcontrast sequences with foci of low signal internally indicating a mild bursitis. The bone marrow signal abnormality is within normal limits.

Output: 1. Tearing of the acetabular labrum as described above.2. Findings consistent with a mild trochanteric bursitis.


Instruction: Generate impression based on findings.

Input: There multiple patchy foci of decreased diffusion throughout the right frontal, parietal, and occipital lobes predominantly in a watershed distribution. This minimal susceptibility effect associated with more confluent regions in the right precentral gyrus with adjacent prominence of the sulcal vessels throughout the right frontal lobe. There is also mild leptomeningeal enhancement with apparent nodularity at the right central sulcus (or tortuous dilated vessels). In addition, there multiple punctate foci of T2 hyperintensity within the left sided supratentorial white matter. The ventricles and basal cisterns are normal in size and configuration. There is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses and scalp soft tissues are unremarkable. The skull is mildly thickened.

Output: 1.Numerous foci of restricted diffusion throughout the right cerebral hemisphere are most compatible with acute/subacute infarcts. These appear predominantly in the watershed distribution. Small foci of susceptibility are also seen indicative of petechial hemorrhages. There is prominence of the pial collaterals with mild leptomeningeal enhancement and apparent nodular enhancement at the right central sulcus. This nodularity may be related to tortuous dilated collateral vessels; however, if there is possibility of underlying infection and infectious vasculopathy, suggest lumbar puncture and vascular imaging for further evaluation. 2.Additional nonspecific punctate foci of T2 hyperintensity throughout the left cerebral hemisphere.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Numbness in hands, recurrent stenosis? History of foraminotomy. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Kyphotic angulation again seen at C3-4 which is unchanged. Alignment is otherwise maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology. There is evidence of prior left-sided foraminotomies at C4-C5, C5-C6, and C6-C7.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild disk osteophyte complex and kyphotic attenuation with partial effacement of the ventral thecal sac. No significant compromise to the spinal canal or neural foramina. C4-5: Again seen is uncovertebral hypertrophy and facet hypertrophy greater on the left with interval postsurgical changes of left-sided foraminotomy. No significant spinal canal or right foramina stenosis.C5-6: There is small disk osteophyte complex with bilateral uncovertebral hypertrophy and facet arthropathy. Interval postsurgical changes of left-sided foraminotomy. There is moderate right-sided foraminal narrowing related to uncovertebral hypertrophy and right-sided extrusion which is minimally worsened in the interval. There is associated effacement of the right ventral thecal sac, otherwise no significant spinal canal stenosis. C6-7: Interval left-sided foraminotomy. Again seen is prominent left-sided uncovertebral spur with small disk component. Spinal canal and right neural foramen appear patent.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Degenerative changes in the cervical spine with interval left-sided foraminotomies at the left C4-C5, C5-C6, and C6-C7 levels compared to 4/8/2014. There is no new disk extrusion on the left to explain recurrent symptoms. There may some residual foraminal narrowing despite the foraminotomy which could be further assessed with CT to better define the osseous anatomy if surgery is contemplated.Minimal interval increase in disk extrusion at the right C5-C6 level with associated effacement of the right ventral thecal sac and moderate right foraminal stenosis.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to suboccipital craniectomy and C1 laminectomy for decompression of Chiari malformation. The cerebellar tonsils areunchanged in appearance, laying 7 mm below the basion. There are unchanged mildly diminished CSF spaces ventrally and dorsally at the foramen magnum. There is unchanged diminished CSF flow ventrally and dorsally at the craniocervical junction with a retro-odontoid turbulence. There is unchanged tenting of the left dorsal cerebellar surface compatible scarring. The partially imaged pituitary is prominent but within normal limits for age and better assessed on prior dedicated pituitary studies. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The paranasal sinuses are unremarkable.

Output: Unchanged postoperative findings related to Chiari decompression with diminished and turbulent flow at the craniocervical junction as well as findings suggestive of an arachnoid adhesion.


Instruction: Generate impression based on findings.

Input: 46-year-old female with a left breast cancer, status post neoadjuvant chemotherapy. The patient received a lumpectomy and complete axillary lymph node dissection in 9/2014 at outside institution, but residual left breast cancer and metastatic left interpectoral and left internal mammary lymph nodes were confirmed after surgery. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The known left breast cancer at 7 o'clock position is smaller, measuring 21 x 22 x 12 mm (AP x ML x CC: previously 32 x 29 x 36 mm). The mass attaches to the pectoralis major muscle.Skin thickening in the left breast is again seen.The enlarged left interpectoral lymph node and left internal mammary lymph node are no longer present. No abnormal left axillary lymph node.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region. One normal morphology right axillary lymph node with a marker clip, consistent with proven benign lymph node.

Output: Decrease in size of known left breast cancer.Complete imaging response of left interpectoral lymph node and left internal mammary lymph nodeBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Status post fourth ventricular choroid plexus tumor resection. There are postoperative findings related to suboccipital craniotomy with diffuse areas of scalp swelling. There is residual lobular enhancing mass in the inferior fourth ventricle that measures up to 15 mm. There are patchy areas of high T2 signal and restricted diffusion within the bilateral cerebellar hemispheres. There is a right transfrontal ventricular catheter that terminates in the left lateral ventricle. The ventricles continue to decrease in size, along with the associated periventricular T2 hyperintensity. There is mild high T2 signal in the parenchyma surrounding the catheter. There is no evidence of acute cerebral infarction or intracranial hemorrhage. There is a 6 mm wide arachnoid cyst anterior to the anterior temporal pole. There is a retention cyst in the left maxillary sinus. Scalp fiducial markers are present.

Output: Postoperative findings related to partial resection of a fourth ventricular choroid plexus tumor with patchy areas of acute infarction within the bilateral cerebellar hemispheres, but essentially resolved ventricular dilatation persistent obstructive hydrocephalus and transependymal edema, with a right transfrontal ventricular shunt catheter in position.


Instruction: Generate impression based on findings.

Input: Male, 33 years old, with essential tremor status post unilateral deep brain stimulator, now planning for implantation on the other side. Since the prior examination, a left frontal approach deep brain stimulator lead has been placed coursing posteriorly and inferiorly to terminate within or just below the left thalamus. No unexpected or acute findings are identified on this limited examination. Brain parenchymal morphology and signal characteristics are otherwise unremarkable.

Output: Findings compatible with interval placement of a left-sided deep brain stimulator.


Instruction: Generate impression based on findings.

Input: A 57 year old female with personal history of diabetes, osteoarthritis and overwight who was referred to cardiac MRI after she was diagnosed with idiopathic ventricular tachycardia. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 89 ml/m2 (normal range: 65+/-11), the LVEDV is 207 ml (normal range 109+/-23), the LV end systolic volume index is 48 ml/m2 (normal range 18+/-5), the LVESV is 112 ml (normal range 31+/-10). There is global mild hypokinesis with regional variation. Normal LV thickness. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Normal native myocardial T1-times. No findings to support active inflammation/edema of the myocardium.No intracavitary thrombus was seen.Left AtriumThe left atrium is mildly dilated (110ml).Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 205 ml (normal range 110+/-24), the RV end systolic volume index is 53 ml/m2 (normal range 22+/-8), and the RVESV is 122 ml (normal range 35+/-13). No regional wall motion abnormalities were noted.Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely, the leaflets are thickened and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with mildly reduced systolic function, the LVEF is 46%. There is global mild hypokinesis with regional variation. Normal LV thickness. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Normal native myocardial T1-times. No findings to support active inflammation/edema of the myocardium. No evidence of infiltrative disease. 3. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 40%. No regional wall motion abnormalities.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 52-year-old female with left breast multicentric breast cancer, presents for needle localization. On review of the prior studies, breast MRI dated 7/20/2016 and mammogram dated 6/21/2016. Target spiculated mass morphology is located in the left breast in the superior region located anterior 12 o’clock, with adjacent 'lock-shaped' clip. Another target focal asymmetry with few pleomorphic calcifications at the left upper inner quadrant is located at the 2:00 position, also with adjacent biopsy clip.The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 7 cm Kopans needle was placed through the lesion. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Wire placement was performed for the two sites, anterior 12:00 lesion and posterior 2:00 lesion. Repeat two view orthogonal mammograms reveal the spring wire to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Tremblay performed the procedure under direct supervision of Dr. Abe, who was present during the procedure at all times.Orthogonal digital specimen radiographs obtained from the more anterior target reveals the spiculated mass, lock shaped biopsy marker and spring wire to be within the specimen. Of note, spiculations extend to the anterior and superior margins of the specimen. Findings discussed with Dr. Jaskowiak , and additional tissue was resected along the margins (no image).Orthogonal digital specimen radiographs obtained from the more posterior target, reveals the clip and spring wire to be within the specimen. Additional tissue from lateral margin was excised (no image).

Output: Successful double needle localization of the left breast anterior upper mass and upper outer focal asymmetry.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 16 year-old male with non-Hodgkin's lymphoma and metastatic disease presents with headache. There is no evidence of intracranial hemorrhage or edema. The ventricles and basal cisterns are normal in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Reidentified is a large frontal abnormality with mixed soft tissue and calcific attenuation with spiculation and intra-cranial soft tissue component. This finding is unchanged when compared to the previous MRI examination of 2/29/08. Similar imaging findings have been seen with PNET tumors such as neuroblastoma, clinical correlation is advised. This appearance can also be seen in atypical aggressive type meningiomas.

Output: No acute abnormalities. Cranial/intracranial lesion, stable as described above. The differential again includes an atypical type of meningioma however similar findings have been seen with metastatic PNET. Correlate clinically.


Instruction: Generate impression based on findings.

Input: Patient with Li-Fraumeni syndrome, surveillance evaluation There is scattered fibroglandular tissuein both breasts.Moderate parenchymal enhancement is noted bilaterally.At least 2 benign morphology foci identified in the right breast 12:00 and 10:00 position, close to the skin with corresponding T2 signal most likely representing a benign fibroadenoma or intramammary lymph node.An oval slowly enhancing heterogeneous mass in the right breast 2:00 position measures 13 x 7 x 11 mm (AP X ML X CC), close to the skin most likely corresponds to the infected sebaceous cyst as seen on ultrasound dated 1/2/2015. It has bright T1 characteristics suggestive of proteinaceous component. Oval enhancing mass in the left breast 6:00 position measuring 8 x 7 x 6 mm (AP X ML X CC) needs further evaluation with MR directed ultrasound. Possible dark septations within the enhancing mass suggest a fibroadenomaNo abnormal enhancement is seen elsewhere in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Mild dependent right-sided pleural effusion.

Output: 1. 8 mm enhancing oval mass in the left breast 6:00 position needs further evaluation with MR directed ultrasound. Lesion shows few dark septations and could represent a benign fibroadenoma. If the lesion is not seen on ultrasound, 6 month follow up MRI is recommended. 2. Benign characteristic foci in the right breast and is slowly enhancing 13 mm mass close to the skin most likely is the patient's cyst at 2:00 position.3. No abnormality noted within the axillary region.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 49-year-old female patient with weakness and history of brain metastases. There are postsurgical changes of a left frontal craniotomy for resection of a left frontal lobe intraparenchymal tumor. The resection cavity is smaller in size and contains a small amount of fluid with a thin T2 hypointense rim compatible with hemosiderin deposition. There is new circumferential enhancement of the resection cavity without nodularity or focal asymmetric thickening. Vasogenic edema within the left frontal lobe is markedly improved.Multiple additional enhancing lesions are significantly smaller in size or no longer visualized. For example a centrally cystic tumor within the left temporal lobe now measures 15 x 10 mm, previously 31 x 24 mm (image 11, series 1101). A solid tumor within the right medial temporooccipital lobe now measures 9 x 8 mm, previously 24 x 19 mm (image 14, series 1101). No new enhancing lesion is identified.A nonenhancing T2 hypointense extra-axial mass along the left cranial vertex, just posterior to the resection cavity, compatible with a calcified meningioma is unchanged.There is no evidence of acute infarct. Mild periventricular T2 signal abnormality may related to chronic small vessel disease or post-therapy changes. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Bilateral maxillary sinus mucous retention cysts and a left sphenoid mucous retention cyst. There is partial opacification of the mastoid air cells. The orbits are grossly unremarkable.

Output: 1. Post-operative findings of the left frontal lobe with decreased size of the resection cavity but new circumferential enhancement; this is suspected to represent post-therapy change, however, the possibility of residual/recurrent tumor cannot be excluded. 2. Multiple additional metastatic lesions are smaller in size or no longer visualized.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with history of cystic lesion in the spine status post resection. Assess for recurrence. Findings are redemonstrated compatible with T3-4 hemilaminectomy. The postoperative soft tissue fluid collection seen on the prior examination has resolved.A loculated cystic lesion is seen within the spinal canal, dorsal to the spinal cord, extending from T3 through T8. The overall size and morphology of this lesion does not appear to have significantly changed from the prior examination. Again, it is noted that the lesion expands into and chronically widens the neural foramina from T4 through T8.The spinal cord is not significantly deformed and there is no evidence of pathologic cord signal abnormality. No areas of spinal canal or neuroforaminal stenosis are seen. The intervertebral discs are preserved. Spinal alignment is anatomic. Marrow signal characteristics are within normal limits.Multiple pulmonary nodules are seen along with a thin right pleural effusion. Multiple hepatic masses are also partially visualized.

Output: 1.Stable loculated cystic lesion within the spinal canal dorsal to the spinal cord.2.No evidence of spinal cord edema.3.Multiple pulmonary and hepatic masses are partially visualized.


Instruction: Generate impression based on findings.

Input: 35-year-old female with LLE cellulitis, elevated inflammatory markers. Rule out myositis, abscess, osteo There is thickening and enhancement of the skin as well as reticulation and enhancement of the subcutaneous fat compatible with marked cellulitis. There is poorly defined crescentic of nonenhancing tissue within the subcutaneous fat along the anterior peripheral deep fascia that may simply represent confluent edema, although it is impossible to exclude a phlegmon/developing abscess. Mild increased signal intensity within the soleus muscle as well as the flexor digitorum longus muscle may reflect very mild myositis. Bone marrow signal intensity is within normal limits. Small knee joint effusion with extension posteromedially into a tiny Baker's cyst. Mild osteoarthritis affects the knee. Relatively mild subcutaneous edema affects the right leg on the large field-of-view coronal images.

Output: 1. Cellulitis and possible mild myositis without evidence of osteomyelitis. Nonenhancing tissue within the subcutaneous fat along the anterior peripheral deep fascia probably simply represents confluent edema, although it is impossible to exclude a phlegmon/developing abscess.


Instruction: Generate impression based on findings.

Input: Ankle swelling and pain, changes most pronounced on the dorsum of foot Bones: Mild degenerative changes similar to the plain film without new abnormality. Specifically marrow signal and osseous structures remain well aligned and unremarkable. No abnormal intraosseous abnormalities or abnormal fluid collections. Particular attention was placed onThe patient placed marker overlying the dorsal and lateral aspectsSoft tissues: Mild diffuse soft tissue swelling and stranding is observed without specific focal abnormality. Specifically no abnormal fluid collections. Surrounding musculature otherwise unremarkable. No abnormal fluid collections.Ligaments: Visualized ligaments appear intact.Tendons: Tendons are also well visualized and normal in appearance, both in size, signal characteristics and contourOther: Of note are multiple engorged veins observed on the medial and inferior aspects of the ankle opposite to the patient described focal areas of pain. These are of uncertain clinical significance.

Output: Mild degenerative changes without discrete focal soft tissue abnormalities to account for patient's pain and surrounding mild to moderate nonspecific swelling..


Instruction: Generate impression based on findings.

Input: Reason: bilateral shoulder pain History: bilateral shoulder pain ROTATOR CUFF: There is mild increased signal intensity within the supraspinatus tendon near its in insertion on the greater trochanter, which is consistent with tendinopathy and appears unchanged from prior. There is no evidence of tearing. The infraspinatus, subscapularis and teres minor muscles and tendons are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears grossly intact and the glenohumeral joint is within normal limits.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Supraspinatus tendinopathy, not significantly changed from the prior exam.2. Acromioclavicular joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: Examination is motion degraded. There are numerous foci of decreased diffusion within the right cerebral hemisphere including the right frontal cortex, subcortical white matter, and corona radiata in a mainly deep watershed distribution, including the right hand motor area. There is also involvement of the right anterior caudate. Few right parietal lesions also seen. In addition, there are also patchy foci of T2 hyperintensity within the left supratentorial white matter without diffusion abnormality, most compatible with chronic small vessel ischemic disease. There is a focus of extra-axial soft tissue along the left parietal convexity with corresponding flair hyperintensity measuring up to 6 mm in thickness.There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The distal right internal carotid artery flow void appears diminutive. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1. Motion degraded exam which was terminated prematurely. There are mutliple foci of acute infarct involving the right frontal and to lesser extent right parietal lobes in a mainly deep watershed distribution. In addition, the distal right internal carotid artery flow void appears diminutive suggestive of stenosis and could be further characterized with MRA.2. Focus of extra-axial soft tissue along the left parietal convexity with FLAIR hyperintensity measuring up to 6 mm in thickness. Finding is favored to represent a a meningioma but not not well evaluated given motion artifact and absence of contrast. No significant mass effect.Findings of multiple infarcts discussed with Dr. Cejas at 5:10pm on 1/10/15I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Unspecified ptosis of eyelid Paralytic strabismus, third or oculomotor nerve palsy, partialClinical question: any change in 3 rd nerve lesion or other abnormalitiesSigns and Symptoms: 3rd nerve lesion, migraines, ptosisComments: Please do thin cuts FIESTA sequence, compare with previous imaging for any changes. Mom would like MRI either May 8th or 15th if possible. MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The small and subtle enhancing focus adjacent to the right midbrain at the expected location of the origin of the right oculomotor nerve is less conspicuous on the current exam. It is better seen on the coronal post gadolinium axial SPGR images (series 1701 image 48). It can also be seen on 3D FIESTA - image 47 series 1401. It is abutting the medial division of the superior cerebellar artery. It is best seen when comparing to the 7/11/13 exam when it was more conspicuous.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 scattered opacities with opacification of the maxillary sinus and mild mucosal thickening in some of the ethmoid air cells. The visualized portions of the mastoid air cells are partially opacified. MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact . There is disconjugate gaze present.The small and subtle enhancing focus adjacent to the right midbrain at the expected location of the origin of the right oculomotor nerve is less conspicuous on the current exam. It is better seen on the coronal post gadolinium axial SPGR images (series 1701 image 48). It can also be seen on 3D FIESTA - image 47 series 1401. It is abutting the medial division of the superior cerebellar artery. It is best seen when comparing to the 7/11/13 exam when it was more conspicuous.

Output: The small lesion along the proximal portion of the right oculomotor nerve is barely visible on the current exam.


Instruction: Generate impression based on findings.

Input: History of mesothelioma status post debulking surgery. Evaluate disease status. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and enhancement. No focal suspicious lesion. There is extrahepatic biliary ductal dilatation with the common bile duct measuring 1.1 cm which tapers smoothly to the level of the ampulla. This is likely related to the patient's cholecystectomy and is stable. No obstructive stone or mass lesion is evident.Stable subcentimeter hepatic cyst and benign hemangioma. SPLEEN: No significant abnormality noted.PANCREAS: 7 mm lobulated cystic lesion in the pancreatic head without communication with the pancreatic duct which is normal in caliber. There is no suspicious mural nodularity or postcontrast enhancement. This likely reflects a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral T2 hyperintense and T1 hypointense well-defined nonenhancing lesions compatible with simple renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes of a midline abdominal incision.OTHER: No significant abnormality noted.

Output: No specific evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening on bilateral maxillary sinus.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: 44-year-old male complaining of headache, to evaluate There is hyperdensity abnormal signal and fullness in the sella. MRI study is recommended for further evaluation of this region.The attenuation and morphology of the brain parenchyma is within normal limits for patient's stated age. No evidence of hemorrhage, edema, mass-effect or midline shift is detected. Cortical sulci, ventricular system and all CSF cisterns are within normal limits. Calvarium, visualized paranasal sinuses, orbits and mastoid air cells are also normal.

Output: There is hyperdensity abnormal signal and fullness in the sella. MRI study is recommended for further evaluation of this region. No acute intracranial hemorrhage or cortical ischemia is identified.


Instruction: Generate impression based on findings.

Input: Clinical question: cord compressionSigns and Symptoms: LE weakness Five lumbar type vertebral bodies are presumed to be present. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine. There is diffuse marrow replacement present associated with patchy enhancement of the lumbar vertebrae and the visualized sacrum. There is redemonstration of epidural fat accumulation within the lower lumbar spine and sacral spinal canal.There is a posterior convex bulging of epidural lesion into the spinal canal at L4 and L5 which was also present on the prior exam. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy redemonstrated at this level associated with a diffuse disc bulge and effacement of the fat surrounding the exiting nerve roots within the left neural foramen There is mild anterior subluxation of L5 on S1 which is stable compared to the prior exam. There is effacement of the CSF within the thecal sac at this level and in the sacral spinal canal. There is epidural thickening present behind the L4 and L5 vertebral bodies which has progressed and is associated with narrowing of the spinal canal. The thecal sac appears to be narrowed in the CSF appears to be effaced within the distal thecal sac from the L3-4 disc space level inferiorly. Compared to the prior exam and epidural thickening and associated infiltration of the fat planes at the epidural space appears to have progressed. There is also effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level which is related to diffuse disc bulge and facet hypertrophy and was present on the previous exam as well. There is bilateral facet hypertrophy at L4-5 and L5-S1 which was previously presentAt 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: 1.Since the prior examination the patient has developed greater epidural thickening which narrows the distal thecal sac and effaces spinal fluid substantially at the L4 and L5 vertebral body levels and sacral spinal canal. This appears to represent infiltrating lesion within epidural lipomatosis. This results effectively in spinal stenosis at the L4 and L5 vertebral body levels as well as the sacral spinal canal.2.Diffuse skeletal metastases.3.Findings were discussed with the radiation oncology service.4.Findings were discussed with Dr Ansari.5.There is facet hypertrophy present in the lower lumbar spine.


Instruction: Generate impression based on findings.

Input: Male 42 years old Reason: chronic knee pain, eval for medial meniscus tear History: right knee pain MENISCI: There is complex tearing of the posterior horn of the medial meniscus with at least two vertical components, one extending to the superior surface and a second extending to the undersurface. The lateral meniscus demonstrates normal signal intensity and morphology.ARTICULAR CARTILAGE AND BONE: There is mild diffuse thinning of the cartilage overlying the medial femoral condyle with an approximately 9 mm full thickness defect anteriorly (series 9, image 15).LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tearing of the posterior horn of the medial meniscus with at least two vertical components as described above.2. Full-thickness defect in the cartilage overlying the medial femoral condyle.


Instruction: Generate impression based on findings.

Input: The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle cisterns bilaterally or within the internal auditory canals.Limited visualization of the intracranial structures demonstrates ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. Partially empty sella is noted. There is also distention of the optic sheaths and suggestion of bulging of the optic nerve heads.

Output: 1. No lesions within the cerebellopontine angles, internal auditory canals, or inner ears are appreciated.2. Partially empty sella is noted with distension of the optic sheaths and suggestion of papilledema. These findings are highly suggestive of intracranial hypertension. Suggest correlation with ophthalmologic exam.


Instruction: Generate impression based on findings.

Input: Male; 49 years old. History: Right knee instability. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Incidental bone infarct in the tibial metadiaphysis, likely of no clinical significance.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal examination, without specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Left Bells palsy, not improving after 4 weeks. Internal Auditory Canals: There is diffuse enhancement along the left facial nerve, including cisternal, labyrinthine, tympanic, mastoid, and parotid segments. The right cranial nerve 7 and 8 complex is 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.Brain: There are unchanged areas of encephalomalacia in the right parietal and left temporal lobes, as well as in the left cerebellum. There are also multiple foci of T2 hyperintensity in the subcortical and periventricular white matter, which are also unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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: 1. Diffuse enhancement along the left facial nerve may represent an inflammatory neuritis. Otherwise, no evidence of mass lesions.2. Unchanged areas of encephalomalacia in the right parietal and left temporal lobes, as well as in the left cerebellum superimposed upon a background of probable chronic small vessel ischemic disease, but no evidence of acute infarction.


Instruction: Generate impression based on findings.

Input: 99-year-old female with a diabetic foot ulcer. Rule out osteomyelitis. There is ulceration of the soft tissues of the distal aspect of the great toe. Although on these images, it appears that the distal phalanx protrudes through the soft tissue ulceration, consultation with Dr. Raychaudhuri reveals that the bone does not protrude through the soft tissues nor can it be probed on physical examination. On the T2 weighted STIR sequences there is abnormal signal intensity throughout the majority of the distal phalanx. However, the signal intensity in the T1-weighted images is normal and there is no frank cortical destruction. There is signal abnormality within the subcutaneous fat, particularly dorsal to the distal phalanx, likely representing edema. The signal intensity of the proximal phalanx of the great toe and first metatarsal is normal. There is focal edema within the middle phalanx of the second toe seen on the STIR sequences with normal signal intensity on T1-weighted images. We see no adjacent ulceration to confirm osteomyelitis. The remaining phalanges and metatarsals appear normal. There is atrophy of the musculature of the forefoot.

Output: 1. Edema within the distal phalanx of the great toe on STIR sequences with normal-appearing marrow on T1-weighted images. This pattern of signal abnormality is typically seen with reactive osteitis rather than osteomyelitis, however, given the extent of signal abnormality, follow-up examination with dedicated radiographs is recommended in 7-14 days to exclude osteomyelitis.2. Nonspecific edema-type signal abnormality in the second toe only seen on STIR sequences. We see no ulceration in the surrounding area to confirm osteomyelitis.


Instruction: Generate impression based on findings.

Input: Reason: Assess extent of anterolateral thigh - looking for abscess, tracking areas of edema/possible pus History: Increasing WBC, pain anterolateral hip/thigh Please note that MRI pelvis was not performed due to inability of patient to tolerate exam. Service was paged at the time of the exam without response.There is a large collection of rim-enhancing fluid signal intensity within the subcutaneous fat along the lateral aspect of the right hip that appears to communicate with the skin surface. This collection penetrates the iliotibial band to enter the gluteus medius muscle as well as extending posteromedially between the greater trochanter and gluteus maximus muscle. Anteriorly, the collection extends deep to the tensor fascia lata. The cranial extent of this collection is beyond the field of view of this study. The caudal extent of the collection lies at the level of the subtrochanteric femur and overall the collection is at least 15 cm in craniocaudal dimension and approximately 11 cm in greatest transverse dimension. Foci of signal void within the collection likely represents air. Cutaneous skin staples are noted along the lateral aspect of the hip.Although the gluteus medius muscle is not included in its entirety, additional smaller rim-enhancing collections are noted within the muscle which may communicate with the larger subcutaneous collection. There is edema surrounding the collection with subcutaneous edema along the lateral aspect of the thigh down to just above the knee which appears to enhance, indicating cellulitis. There is also edema of the gluteus maximus muscle, tensor fascia lata, vastus lateralis, vastus intermedius, sartorius and tracking between the quadriceps musculature. Additional edema is present within the adductor muscles of the hip and thigh with relative sparing of the posterior musculature. Diffuse subcutaneous edema is also present. Bone marrow signal intensity is within normal normal limits. Slightly prominent right-sided inguinal lymph nodes are present. Osteoarthritis affects the knee with a small joint effusion.

Output: 1.Large rim-enhancing fluid collection with deep extension into the gluteal musculature and extension to the skin surface. We cannot exclude abscess on the basis of this study.2.Other findings as described above.


Instruction: Generate impression based on findings.

Input: The marrow is diffusely abnormal throughout both the thoracic and lumbar spines. Specifically this demonstrates a marrow infiltration pattern which is diffusely hypointense on T1, and diffusely mildly hyperintense on STIR. There are no acute compression deformities.Thoracic spine:The vertebral body heights and disc spaces are maintained. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are bilateral pleural effusions, right greater than left.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:There are no acute fractures. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation is present L4/5 and L5/S1 with mild disc height loss at L4/5 and moderate disc height loss at L5/S1. There is a small Schmorl's node involving the superior endplate of L5.L1/2: UnremarkableL2/3: Mild facet hypertrophy without stenosisL3/4: Mild facet hypertrophy without stenosisL4/5: Mild disc bulge, ligamentum flavum thickening, mild to moderate bilateral facet hypertrophy, and bilateral facet effusionsL5/S1:Grade 2 anterolisthesis of L5 on S1, diffuse annular disc bulge with disc uncovering, and severe bilateral facet hypertrophy with fusion. There is moderate bilateral neural foraminal stenosis.

Output: 1.The marrow is diffusely abnormal throughout both the thoracic and lumbar spines. Specifically this demonstrates a marrow infiltration pattern which is diffusely hypointense on T1, and diffusely mildly hyperintense on STIR. These MRI findings are compatible with a diffuse marrow infiltrative process, consistent with the patient's known history of multiple myeloma.2.There are no acute compression deformities.3.There are bilateral pleural effusions, right greater than left.4.L5/S1:Grade 2 anterolisthesis of L5 on S1, diffuse annular disc bulge with disc uncovering, and severe bilateral facet hypertrophy with fusion. There is moderate bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 20 year old female patient status post orthotopic liver transplant with developmental delay. Cholestasis, evaluate for biliary obstruction. Evaluation is limited as described above. ABDOMEN:LIVER, BILIARY TRACT: Post-surgical changes of a left hepatic lobe liver transplant. There is a bowel loop intimately associated with the porta hepatis which presumably represents a hepaticojejunostomy. There is no evidence of intrahepatic biliary ductal dilatation. No focal hepatic lesion is identified. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts and right upper pole renal atrophy. 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: Limited study as described above. Within limitations, no evidence of intrahepatic biliary ductal dilatation. If there is continued clinical concern for biliary pathology, evaluation by CT may be better tolerated in the future.


Instruction: Generate impression based on findings.

Input: Right sphenoid meningioma: headache. Brain: There is an enhancing dural based right paraclinoid mass that measures up to 27 mm, which is not significantly changed. The tumor abuts the right cisternal optic nerve and exerts mild mass effect upon the adjacent right medial temporal lobe. There is no evidence of intracranial hemorrhage or acute infarct. There are scattered cerebral white matter T2 hyperintense foci. 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 prominent arachnoid granulations in the bilateral greater wings of the sphenoid bones. There is mild scattered mucosal thickening in the paranasal sinuses.Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. No significant interval change in the right paraclinoid meningioma.2. Chronic small vessel ischemic white matter disease.


Instruction: Generate impression based on findings.

Input: There are low-lying cerebellar tonsils (left greater than right) with a pointed morphology extending up to 10 mm below the foramen magnum, to the level of posterior arch of C1. The CSF space around the brainstem and upper cervical cord by the tip of the cerebellar tonsils is effaced. There is no acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no hydrocephalus. There is no midline shift. The skull and extracranial soft tissues are unremarkable.

Output: Findings consistent with Chiari I malformation. No hydrocephalus.


Instruction: Generate impression based on findings.

Input: 30 year old woman with breast cancer s/p resection, NSVT, concern for possible LV dysfunction and effusion on technically difficult echocardiogram, referred for cardiac MR to evaluate for infiltrative disease. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 94 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 51 ml/m2 (normal range 18+/-5), the LVESV is 89 ml (normal range 31+/-10), the LV mass index is 31 g/m2 (normal range 67+/-11), and the LV mass is 55 g (normal range 114+/-24). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of myocardial edema.The native T1 myocardial relaxation time is normal (<1100ms).There is no LV thrombus. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 88 ml/m2 (normal range 69+/-14), the RVEDV is 156 ml (normal range 110+/-24), the RV end systolic volume index is 45 ml/m2 (normal range 22+/-8), and the RVESV is 79 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsBilateral breast implants are present. Remnant thymus tissue 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. Mildly dilated left ventricle with mildly reduced systolic function (EF 46%). There is global hypokinesis.2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. Normal sized right ventricle with normal systolic function (EF 50%).4. Trivial pericardial effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 16-year-old female with right knee swelling. Evaluate healing of lateral femoral condyle microfracture at 6 months postop. Some sequences are limited by patient motion artifact.MENISCI: There is increased signal abnormality within the posterior horn and body of the lateral meniscus which extends to the tibial and femoral articular surface and presumably represents prior tearing or postsurgical changes of prior partial meniscectomy. No fluid-filled tear is identified to confirm a re-tear of the meniscus. The anterior horn appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is heterogeneity of the articular cartilage along the weightbearing portion of the lateral femoral condyle above the posterior horn of the meniscus presumably representing postsurgical changes from prior microfracture. No full-thickness articular cartilage defect is identified in this area. The articular cartilage of the medial tibiofemoral compartment is relatively spared. There is focal near full-thickness articular cartilage degeneration along the lateral facet of the patella with underlying degenerative subchondral signal abnormality.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. Note is made of patella alta. The Insall Salvati ratio measures 1.6.ADDITIONAL

Output: 1. Postsurgical changes prior partial lateral meniscectomy and lateral femoral condyle microfracture/chondroplasty as described above. No fluid-filled defects are identified within the lateral meniscus to confirm re-tear.2. Patella alta which can be seen in patients with patellofemoral instability.3. Probable loose body within the joint space as described above.


Instruction: Generate impression based on findings.

Input: Right knee pain, meniscal tear versus loose body MENISCI: There is blunting of the free edge of the body of the medial meniscus which is new from the prior exam and likely represents inner edge fraying/tearing. The anterior and posterior horns of the medial meniscus are intact.There is poorly defined increased signal throughout the lateral meniscus representing extensive degeneration and degenerative tearing. Additionally, there appears to be a vertically oriented tear of the posterior horn with blunting of the free edge of the anterior horn that could reflect interval tearing or the sequela of partial meniscectomy. There is further lateral extrusion of the body of the lateral meniscus with deformity of the contour likely representing a combination of degeneration and tearing.ARTICULAR CARTILAGE AND BONE: The full-thickness defect of the articular cartilage of the medial femoral condyle previously seen on the prior exam is no longer evident. This has instead been replaced with an osseous protuberance measuring approximately 15 mm in width and 4 mm in depth and likely represents the site of interval microfracture surgery. The articular cartilage overlying the bony protuberance is thinned and there is a focal full-thickness defect of the articular cartilage immediately medial to this protuberance measuring approximately 5 mm. Additional heterogeneity of the remaining articular cartilage of the medial femoral condyle suggests mild degeneration. There is also focal degeneration of the articular cartilage of the medial tibial plateau immediately posterior to the truncated body of the medial meniscus. There is mild edema type signal within the subchondral bone of the medial femoral condyle as well. There has been progression of cartilage degeneration of the lateral compartment with portions of the weightbearing surface of the lateral tibial plateau essentially devoid of articular cartilage. There has also been progression of subchondral cystic change although the subchondral edema within the tibial plateau is not as prominent. Furthermore, there has been progression of thinning of the articular cartilage of the lateral femoral condyle posteriorly with areas of full-thickness degeneration.There is moderate degeneration of the articular cartilage of the patellofemoral joint which has also progressed from the prior exam with areas of new full-thickness clefts in the femoral trochlea.There is also progression of osteoarthritis of the proximal tibiofibular joint.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Tricompartmental progression of osteoarthritis with meniscal tears and other findings described above. No discrete loose body is identified within the joint.


Instruction: Generate impression based on findings.

Input: 58 year old with veno thromboembolic disease, HTN and aortic dilation (on CT) presenting for cardiac and aortic assessment. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 80 ml/m2 (normal range: 74+/-15), the LVEDV is 182 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). There is subendocardial late gadolinium enhancement in the base-mid inferolateral wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is consistent with myocardial infarction. There is tardo-kinesis in this area, otherwise no regional wall motion abnormalities were seen. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 100 ml (normal range 54+/-17).Right AtriumThe right atrium is not well seen.Aortic ValveThe aortic valve opens widely and there is least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a common right innominate and left common carotid ("pseudo bovine arch", a normal variant) and normal left subclavian. The aortic root is dilated. The portion of the arch just beyond the the take-off of the branch vessels is tortuous and appears narrowed. The descending thoracic aorta is also severely tortuous. Measurements as below: Sinus of Valsalva: 42 mm x 41 mm x 41 mmSinotubular junction: 40 mm x 40 mmMaximally dilated portion of the ascending aorta: 49x50 mmMid-arch 48 x 50 mmPost-branch narrowing 29 x 24 mmDescending aorta 31 x 31 mm Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%. There is subendocardial late gadolinium enhancement in the base-mid inferolateral wall which could be consistent with previous MI. 2. The right ventricle is normal in size and systolic function (RVEF 51%)3. Dilated Thoracic Aorta, measurements as above. 4. Aortic valve not well-seen on this study. Suggest transthoracic echocardiography to assess for bicuspid aortic valve and evaluate for aortic regurgitation.


Instruction: Generate impression based on findings.

Input: Presacral fluid collection. History of ulcerative colitis status post total abdominal colectomy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Probable gallbladder sludge within an otherwise unremarkable gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate cysts and too small to characterize presumed renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post total abdominal colectomy. Right lower quadrant end jejunostomy. The proximal small bowel is collapsed without gross abnormality. The stomach, duodenum and distal small bowel is well distended without wall thickening, abnormal enhancement or adjacent inflammatory changes.BONES, SOFT TISSUES: Mild anterior abdominal wall laxity without evidence of complication.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: In the presacral space there is a fluid-filled peripherally enhancing collection measuring 2.4 x 1.5 cm (series 21/37) which has been previously noted on CT to contain high attenuation debris. Along the left inferolateral aspect the collection appears to be intimately related to the ileoanal pouch (per EPIC patient has history of J-pouch with typical appearance on CT) (series 6, image 26). A collapsed portion of the blind end of the J-pouch is a consideration, however a presacral fluid collection is still favored. Along the right inferolateral aspect of the collection there is a fistulous tract extending inferiorly communicating with a tract (series 21 image 39 through 44) at the 7 o'clock position of the anus and exiting at approximately the 1:00 position of the anus and inferoanteriorly to the left labia (series 21 image 47 through 55).There are no significant adjacent soft tissue inflammatory changes. The ileoanal pouch abuts abut the posterior lower uterus and posterior vaginal wall and there are adjacent dependent small bowel loops in the pelvis. The pouch is tethered to the left lateral posterior pelvic wall. The small bowel loops appear to be opacified with high intensity oral contrast which does not appear to communicate into the ileoanal pouch. Communication with the vagina cannot be entirely excluded.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The presacral collection has slightly increased in size. It intimately abuts the superior aspect of the ileoanal pouch which raises the possibility that this is the free end of the pouch, however a loculated fluid collection is favored. There is a fistula extending from the collection into the anal canal and the left labia as described above.There is no clear fistulous communication between the ileoanal pouch and the dependent small bowel loops in the pelvis or the adjacent uterus and vaginal canal. A limited barium enema may be considered to evaluate the ileoanal pouch and assess the possibility of communication with the aforementioned presacral fluid collection.


Instruction: Generate impression based on findings.

Input: Female, 58 years old. Lateral joint line pain and locking MENISCI: There is a complex tear and degeneration of the posterior horn of the lateral meniscus as well as globular signal within the anterior horn of the lateral meniscus. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the medial and lateral compartments. There is complete loss of the articular cartilage of the undersurface of the patella. There is bone marrow edema within the lateral tibial plateau.LIGAMENTS: The cruciate and collateral ligaments are unremarkable. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Severe osteoarthritis with cartilage loss most prominently affecting the undersurface of the patella.2.Complex tear of the lateral meniscus as above.3.Joint effusion with possible synovitis.


Instruction: Generate impression based on findings.

Input: Acute left-sided numbness. Please evaluate for infarct. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate and confluent areas of abnormal T2/Flair hypertensity in the periventricular and subcortical white matter, consistent with mild small vessel ischemic changes. The ventricles and sulci are prominent, consistent with mild age-related volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Left maxillary sinus mucous retention cyst or polyp is seen.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Findings compatible with mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of trauma MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Generalized thinning of the hyaline cartilage without focal defect.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Small amount of joint effusion. Otherwise exam is within normal limits.


Instruction: Generate impression based on findings.

Input: There is slight straightening of the upper cervical spine which is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: Mild bilateral uncinate hypertrophy without stenosis.C5/6: Mild posterior osteophyte disc complex without stenosis.C6/7: UnremarkableC7/T1: Unremarkable

Output: Negative noncontrast cervical spine MRI. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Developmental delay. Possible seizure. Brain parenchyma appears within normal limits for age. No intracranial mass or mass-effect. No findings to suggest cortical dysplasia, heterotopic gray matter, or other findings to suggest seizure focus. Myelination appears within normal limits. There is an apparent focus of T1 hyperintensity in the left parietal cortex seen on the 3-D T1 sequences, axial series 1003 image 33/70 which is not seen on the spin echo T1 sequence and most likely artifactual. Midline structures including the corpus callosum as well as the posterior fossa structures appear within normal limits. No hydrocephalus. No extra-axial collections. Bone marrow signal is normal. There is mild mucosal thickening involving the bilateral maxillary sinuses and patchy opacification of the bilateral ethmoid air cells. Mastoid air cells are clear. Extracranial soft tissues are unremarkable.

Output: Brain MRI appears within normal limits. No findings to suggest a possible epileptogenic focus are appreciated.


Instruction: Generate impression based on findings.

Input: MRI Brain:A moderately sized area of somewhat patchy restricted diffusion is seen within the right occipital lobe correlating with the CT abnormality. Minimal susceptibility effect is seen in this area which could indicate petechial blood product. No frank hematoma is seen. One or two small foci of restricted diffusion are also suspected within the left occipital lobe. Mild local edema seen, but there is no significant generalized mass effect effect, midline shift or herniation. Minimal periventricular T2 hyperintensity is seen. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: The intracranial left vertebral artery is small and poorly visualized whereas on the prior MRA it was well-demonstrated. A possible mild narrowing of the mid basilar artery is seen, but this is unchanged. A moderate focal stenosis of the left distal P2 PCA is unchanged. Otherwise, no obvious anterior or posterior circulation deficits are seen. Redemonstrated is a 3 x 4 mm right MCA bifurcation aneurysm without significant change from the previous exam. A 2 mm aneurysm arising from the left A2 segment of the ACA is unchanged as well. MRA Neck: Descending aortic dissection is partially visualized on this examination. There is common origin of the brachiocephalic and left common carotid arteries. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is a smaller left and dominant right vertebral artery. There is no evidence of stenosis or occlusion.

Output: 1.Findings compatible with acute infarction involving the right greater than left posterior occipital regions.2.Moderate focal stenosis of the left P2 PCA, unchanged. Possible mild narrowing of the mid basilar artery, unchanged.3.Poor visualization of the intracranial left vertebral artery is new from the prior MRA and could represent a technical artifact or superimposed atherosclerotic disease.4.Aneurysms at the right MCA bifurcation and along the left A3 ACA are unchanged. No definite evidence of any new aneurysm is seen.5.A descending aortic dissection is partially visualized.


Instruction: Generate impression based on findings.

Input: Images are somewhat limited by patient motion. The thoracic spine is in normal alignment, with slight straightening of the normal lower thoracic kyphosis. The vertebral body heights are well-maintained. There is multilevel disc narrowing, up to moderate severe in degree at T5-T6 and T3-T4. No worrisome focal marrow signal abnormality is appreciated. Heterogeneous hyperintense T2 and isointense T1 signal is seen in a rounded configuration along the posterior L1 vertebral body extending into the right pedicle, most compatible with a hemangioma. A smaller hemangioma is seen in the posterior superior T10 vertebral body. The spinal cord is of normal caliber and signal.Mild disc bulges are seen from T2-T3 through T5-T6. There is up to moderate foraminal narrowing at these levels. There is mild to moderate central spinal canal stenosis at T5-T6.At T6-T7, there is a left foraminal disc protrusion with left facet arthropathy resulting in moderate-severe left foraminal narrowing.At T7-T8, there is a left paracentral disc extrusion which migrates cranially by approximately 6 mm. There is minimal central spinal canal stenosis.At T8-T9, there is a left paracentral/foraminal disc protrusion which indents the ventral thecal sac with moderate-severe left foraminal narrowing.At T9-T10, there is a right paracentral disc protrusion which indents the ventral thecal sac with mild central spinal canal stenosis.T10-T11, there is a mild disc bulge mild central spinal canal stenosis. There is mild bilateral facet arthropathy and ligamentum flavum thickening resulting in moderate-severe right and left and mild to moderate right foraminal narrowing.At T11-T12, there is a mild diffuse disc bulge with overall moderate central spinal canal stenosis. There is moderate bilateral facet arthropathy and ligamentum flavum thickening resulting in moderate-severe right and severe left foraminal narrowing.At T12-L1, there is a trace disc bulge with right foraminal prominence and mild bilateral facet arthropathy. There is overall moderate central spinal canal stenosis as well as moderate right greater than left foraminal narrowing.The counting image demonstrates interval progression of previously seen cervical multilevel spondylosis along the mid to lower cervical spine, with now a large posterior osteophyte disc complex at C4-C5, with at least moderate-severe central spinal canal stenosis at that level.There is a nonspecific oval T2 hyperintense lesion within the right kidney.

Output: 1. Multilevel thoracic spondylosis with up to moderate central spinal canal stenosis at T11-T12, as well as multiple levels of high-grade foraminal narrowing as detailed above.2. Significant cervical spondylosis partially imaged, now most significant at C4-C5 where there is likely moderate severe central spinal canal stenosis. Dedicated MRI of the cervical spine may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: 57 years Male (DOB:2/5/1959)Signs and Symptoms: left lateral neck pain and radiating left arm painPROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal. There is left-sided facet hypertrophy present associated with encroachment of left-sided exiting nerve roots within the neural foramen. There is disc desiccation present at this level. This has not changed significantly since the prior exam.At C3-4 there is a right paramedian disc protrusion present associated with uncovertebral osteophytes and narrowing of the right neural foramen. There is some effacement of spinal fluid ventral to the right hemicord at this. There is disc desiccation present at this level. This has not changed significantly since the prior exam.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is disc desiccation present at this level. There is a broad-based central disc protrusion at this level. This has not changed significantly since the prior exam.At C5-6 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with uncovertebral and endplate osteophytes. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level there is partial effacement of spinal fluid ventral to the spinal cord with a mild degree of spinal stenosis at this level. This has not changed significantly since the prior exam.At C6-7 there is no significant compromise to the spinal canal. There is disc desiccation and a broad-based left paramedian disc protrusion at this level associated with mild encroachment of left-sided exiting nerve roots within the neural foramen. This has not changed significantly since the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are multilevel degenerative changes present in the cervical spine associated with a mild degree of spinal stenosis at C5-6 and encroachment of exiting nerve roots within the neural foramina at C5-6 bilaterally, the left side at C2-3 and C6-7 and the left side at C3-4. These findings have not changed significantly since the prior exam.


Instruction: Generate impression based on findings.

Input: Clinical question: Newly diagnosed small cell lung cancer. Initial CNS staging. Signs and symptoms: No CNS symptoms. Pre-and post-enhanced brain MRI:Examination demonstrate multiple small nonhemorrhagic enhancing metastatic lesions in the supra-and infratentorial brain parenchyma.There is a left posterior frontal metastatic lesion measuring at approximately 11 mm sized with minimal associated surrounding edema and no mass effect (post-enhanced SPGR series 13 image 147).There is a small 7.9-mm metastatic lesion in the left anterior temporal lobe on series 13 image 66.There is a left posterior temporal -- occipital metastatic lesion measuring approximately 6 mm on series 13 image 51.There is a right cerebellar metastatic lesion measuring at 4.9-mm on series 13 image 36.There is a 7.7-mm metastatic lesion in the inferior left cerebellum on series 13 image 26.There are a few nonspecific small foci of flair hyperintensity in the subcortical and periventricular white matter which could represent mild chronic small vessel ischemic strokes.Ventricular system and the CSF spaces are within normal and with maintained midline.Unremarkable images through the orbits.Mild diffuse chronic sinusitis more severe in the right chamber of the sphenoid and bilateral maxillary sinuses (left greater than right).No convincing evidence of calvarial metastatic lesions.

Output: 1.Multiple small supra-and infratentorial parenchymal metastatic lesions as detailed/measured above. The lesions demonstrate minimal surrounding edema and no mass effect. No convincing evidence of osseous metastatic lesions.2.Negative diffusion weighted images and findings suggestive of very minimal chronic small vessel ischemic strokes.3.Mild diffuse chronic sinusitis more severe in the right chamber of the sphenoid sinus and the maxillary sinuses (left greater than right).


Instruction: Generate impression based on findings.

Input: T4N0 adenoid cystic carcinoma of minor salivary gland/maxillary sinus with intracranial extension. There has been interval partial left maxillectomy. Thre is diffuse mild left maxillary sinus mucosal thickening, with persistent patchy enhancement in the underlying left maxillary alveolus and retromaxillary region. There is also persistent perineural tumor extension involving the left infraorbital nerve, pterygopalatine fossa, Vidian canal, foramen rotundum, foramen ovale, and cavernous sinus, as well as along the cisternal segment of the left trigeminal nerve, but no evidence of intraparenchymal extension. There is also persistent enhancing tumor within the medial left extraconal orbit, which measures up to 6 mm in width. There is no discernible residual right pituitary tumor. 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. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable.

Output: 1. Interval post-treatment findings in the left sinonasal region with persistent perineural tumor involving the left trigeminal nerve branches with intracranial extension, as well as persistent patchy enhancement in the underlying left maxillary alveolus and retromaxillary region. 2. Persistent left medial orbit extraconal tumor.3. No evidence of brain parenchymal metastases.


Instruction: Generate impression based on findings.

Input: 46-year-old male with history of left hepatic lobe lesion seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with reticular T2 hyperintense pattern compatible with fibrosis. Enlarged portal vasculature compatible with portal hypertension. Quadrate lobe lesion measuring 14.0 x 13.0 cm does not demonstrate arterial enhancement. On delayed imaging there is equivocal signal loss.Focus of hyperenhancement in segment 6 is favored to be perfusional in etiology.SPLEEN: Marked splenomegaly measuring up to 27 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive upper abdominal periaortic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Gastric varices.

Output: 1.Cirrhotic liver morphology with findings of portal hypertension and variceal formation.2.Nonenhancing quadrate lobe lesion with equivocal signal loss on delayed imaging is indeterminant. Continued close followup is recommended.


Instruction: Generate impression based on findings.

Input: Patient with history of vasectomy, evaluate MRI compatibility of the testicular clips. The scrotum and the testicles are not included on the field of view of this study. However, on the inferior edge of the image, there is a metallic density that corresponds to the metallic clips seen on recent CT from 10/6/2015. As a general rule, such clips are safe in the standard MRI environment.

Output: Although the vasectomy clips are not included on the field of view of the current study, as a general rule such clips are safe for MRI.


Instruction: Generate impression based on findings.

Input: 61-year-old male with left shoulder pain. ROTATOR CUFF: There is a full-thickness tear of the posterior fibers of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring 11 mm in AP dimension. There is near full-thickness articular surface tearing of the anterior fibers of the infraspinatus at the level of its insertion on the greater tuberosity measuring approximately 15 mm in AP dimension. There is partial thickness undersurface tearing of the subscapularis tendon at the level of its insertion on the lesser tuberosity without significant retraction. Teres minor tendon appears intact. There is diffuse fatty atrophy of the teres minor muscle. No mass lesions are identified within the quadrilateral space. There is minimal fatty infiltration at the level of the myotendinous junction of the infraspinatus.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint with inferior osteophyte formation resulting in impression upon the superior fibers of the supraspinatus.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is increased signal abnormality and heterogeneity of the superior and superior posterior glenoid labrum indicating degenerative tearing with extension into the biceps anchor.BICEPS TENDON: There is a longitudinal split tearing of the intra and extra articular portion of the long head of the biceps.ADDITIONAL

Output: 1. Full-thickness tearing of the rotator cuff as described above.2. Degenerative tearing of the glenoid labrum with extension into the biceps anchor.3. Longitudinal split tear of the long head of the biceps tendon.4. Degenerative osteoarthritic changes of the glenohumeral joint and acromioclavicular joint.