Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for interval change. Signs and symptoms: Status post removal of calvarial implant with resection of recurrent tumor. Nonenhanced head CT:Examination demonstrates a large left temporal and parietal craniectomy.The parietal bone posterior to the craniectomy site demonstrates extensive lytic changes which traverses the midline to the right paramedian. This is a new finding since prior exam and is best appreciated on axial images 27 through 30. Finding is concerning for osteomyelitis. Fluoroscopy and an enhanced MRI exam is recommended.There is a surgical drain traversing the craniectomy site.There is no evidence of intracranial hemorrhage.There is a focus of encephalomalacia in the left posterior temporal similar to prior study.There is diffuse decreased density of left posterior frontal parietal white matter similar to prior study. This is believed to represent either residual in the normal and or partial encephalomalacia considering the duration of presence of this finding. There is slight ex vacuo dilatation of the left lateral ventricle and without evidence of midline shift. Follow up with an enhanced study is limited for better overall assessment.

Output: 1.There is interval surgical removal of a large craniotomy flap in the left temporal -- parietal and frontal as described.2.Negative changes of the posterior edge of craniectomy site is a new finding since prior exam.3.Extensive residual vasogenic edema and or combination of edema and encephalomalacia in the left hemisphere.4.No evidence of intracranial hemorrhage or midline shift.


Instruction: Generate impression based on findings.

Input: MRI of the brain is within normal limits. No intracranial mass or mass effect. The ventricles and sulci are within normal limits. There is no diffusion abnormality to suspect acute stroke. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Small left maxillary sinus mucus retention cyst.

Output: No intracranial mass or mass effect. Brain parenchymal volume appears within normal limits. No findings to suggest significant vascular disease.


Instruction: Generate impression based on findings.

Input: History of questionable Crohn's disease presenting with chronic abdominal pain mainly in the left upper quadrant. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Nonspecific borderline splenomegaly without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained.The terminal ileum is well visualized and demonstrates normal wall thickness and signal intensity without abnormal enhancement, restricted diffusion, or perienteric inflammatory changes. The remainder of the small bowel is similarly unremarkable.No fixed narrowing or upstream/prestenotic dilatation to suggest a flow-limiting stricture.No evidence of sinus or fistulous tract formation.Trace free pelvic fluid is within physiologic limits.No loculated fluid collection.The colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is maintained.The terminal ileum is well visualized and demonstrates normal wall thickness and signal intensity without abnormal enhancement, restricted diffusion, or perienteric inflammatory changes. The remainder of the small bowel is similarly unremarkable.No fixed narrowing or upstream/prestenotic dilatation to suggest a flow-limiting stricture.No evidence of sinus or fistulous tract formation.Trace free pelvic fluid is within physiologic limits.No loculated fluid collection.The colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of active bowel inflammation, flow-limiting stricture or sinus/fistulous disease; normal appearing terminal ileum.Nonspecific borderline splenomegaly without a focal lesion.


Instruction: Generate impression based on findings.

Input: Female 30 years old Reason: Evaluate for disc herniation History: Right lower extremity pain, previous thoracolumbar fusion for adolescent scoliosis There is moderate levoscoliosis of the lumbar spine with a rotational component. Thoracic dextroscoliosis is better seen in prior radiograph. Five lumbar type vertebral bodies are presumed to be present. The right side of the L2-3 disc space is diminished, otherwise the vertebral body and disk heights are well-maintained. There is evidence of prior osseous fusion involving the lower thoracic spine extending to the L4 level, which can be better assessed on CT. No focal marrow signal abnormality is appreciated. The conus medullaris is normal in appearance and terminates at the L1-2 level. The cauda equina nerve roots are displaced rightward likely related to the spinal curvature.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: Mild disc bulge. There is mild right neural foraminal narrowing. There is no significant compromise to spinal canal.L5-S1: There is no significant compromise to spinal canal or neural foramina.

Output: Levoscoliosis of the lumbar spine. Mild right neural foraminal narrowing at L4-5. Spinal canal and neural foramina are otherwise patent.


Instruction: Generate impression based on findings.

Input: Perianal fistula. PELVIS:PROSTATE/SEMINAL VESICLES: Wedge-shaped T2-weighted mild hypointensity in the left medial mid-gland peripheral zone, likely prostatitis in a patient of this age. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thin fluid filled enhancing and restricting fistula tract appears to originate at the right anterolateral aspect of the lower anal canal extending caudally in the intersphincteric space to the right gluteal fold without an associated fluid collection. There is mild adjacent ischioanal phlegmonous inflammation without a liquified drainable fluid collection. OTHER: No significant abnormality noted.

Output: Right-sided intersphincteric fistula extending to the right gluteal fold without an associated fluid collection.


Instruction: Generate impression based on findings.

Input: Female 42 years old with left knee and ankle pain Knee: There are tiny osteophytes and there is a slight lateral tilt of the patella but otherwise the knee appears normal.Ankle: There is a mild Haglund deformity and small posterior and plantar calcaneal spurs appearing similar to the prior study.

Output: 1.Mild Haglund deformity and small calcaneal spurs perhaps of no clinical significance. We otherwise see no findings to explain the patient's ankle pain.2.Small osteophytes in the knee and mild lateral tilt of the patella.


Instruction: Generate impression based on findings.

Input: Reason: Right temp lobe cystic lesion. Eval for change History: none- surveillance There is been no significant interval change in the appearance of a nonenhancing oval CSF signal intensity cystic lesion involving the mesial right temporal lobe, just superior to the hippocampus. It currently measures 8 x 17 mm in greatest axial dimensions on 801/14, x 6 mm CC on 701/15, compared to previous comparable measurements of 8 x 16 x 6 mm on the baseline exam. There is again a minimal rim of T2/FLAIR hyperintensity, predominantly anteriorly.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is a stable punctate focus of nonspecific T2/FLAIR hyperintensity in the left superior frontal gyrus white matter posteriorly. There are no new areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening in the left maxillary sinus.

Output: Continued stable appearance of nonenhancing cystic lesion in the mesial right temporal lobe, just superior to the hippocampus with minimal marginal FLAIR abnormality. The differential diagnosis is unchanged.


Instruction: Generate impression based on findings.

Input: Traumatic brain injury, evaluate pituitary. Brain: There are numerous scattered foci of high T1 signal and susceptibility effect within the right inferior frontal, left basal ganglia, and left frontal, temporal, and insular lobes with associated vasogenic edema, as well as small areas of restricted diffusion in the left insular and basal ganglia. There is also edema in the left posterior corpus callosum, hypothalamus, left more than right, left thalamus, posterior limb of the right internal capsule, and midbrain. There are also scattered foci of susceptibility effect in the midbrain, pons, and right basal ganglia. There are small subdural hematomas along the bilateral cerebral convexities, measuring up to 3 mm in thickness. There is no midline shift or herniation. There is mild effacement of the left lateral ventricle. There is a mega cisterna magna. The major cerebral flow voids are intact. Mucosal thickening of the right maxillary sinus is noted. The orbits are grossly unremarkable. The multiple skull fractures are better depicted on the prior CT. There is a 10 mm thick left scalp hematoma and bilateral tympanomastoid fluid, with T1 hyperintense components suggestive of blood products.Pituitary: The pituitary gland is not enlarged and demonstrates an intact posterior bright spot and enhancement. The infundibulum also appears to be intact.

Output: 1. Interval evolution of stigmata related to supratentorial and infratentorial diffuse axonal injury and hemorrhagic contusion with mild medialization of the left uncus. 2. Interval evolution of the small bilateral cerebral convexity subdural hemorrhages.3. Multiple skull fractures are better delineated on the prior CT.4. Edema related to traumatic brain injury is present within the hypothalamus, but the pituitary and infundibulum appear to be intact.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. There is trace prominence of the cervical central spinal canal from C2/C3 to C5/C6. There is no significant scoliosis, however, the distal cervical cord is eccentrically positioned within the spinal canal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is mucosal thickening of the visualized paranasal sinuses. C2/3: No significant canal or neural foraminal stenosis.C3/4: No significant canal stenosis. There is mild left uncovertebral and facet hypertrophy with mild left neuroforaminal stenosis.C4/5: No significant canal stenosis. Minimal left uncovertebral hypertrophy without neural foraminal stenosis. C5/6: No significant canal stenosis. Minimal left uncovertebral hypertrophy without neural foraminal stenosis.C6/7: No significant canal or neuroforaminal stenosis.C7/T1: No significant canal or neuroforaminal stenosis.

Output: 1. Minimal cervical spondylosis with mild left neuroforaminal stenosis at C3/C4.2. Trace prominence of the central spinal canal from C2/C3 to C5/C6 which is non-specific.


Instruction: Generate impression based on findings.

Input: 49 year old male patient with history of renal cell carcinoma status post partial nephrectomy. Evaluate for renal recurrence or distant metastasis. ABDOMEN:LIVER, BILIARY TRACT: A subcentimeter lesion within the right hepatic lobe is too small to characterize, but unchanged. No suspicious hepatic lesion is identified.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes of partial right nephrectomy within the right upper pole. No evidence of residual tumor in the surgical bed. No suspicious renal lesion is identified bilaterally.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: Status post right partial nephrectomy without evidence of residual/recurrent disease or metastatic disease in the abdomen.


Instruction: Generate impression based on findings.

Input: Brain MRI:There is small focus of restricted diffusion with matching ADC hypointensity within the left thalamus consistent with an acute lacunar infarct.There are foci of T2 hyperintensity within periventricular and subcortical white matter as well as within the pons without restricted diffusion, mass effect, or susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Other than scattered sporadic foci of mucosal thickening, the paranasal sinuses and mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. A previously identified potential focus of hyperdensity within the left MCA on comparison CT demonstrates MRA evident flow. Incidental note is made of bilateral posterior communicating artery origin infundibuli.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified.

Output: 1.Acute left thalamic lacunar infarct.2.Chronic small vessel ischemic disease.3.Negative MRA of the brain.4.Negative MRA of the neck.


Instruction: Generate impression based on findings.

Input: There is an intramedullary abnormality within the cervical cord at the level of C6/7. It is slightly expansile, T1 hypointense, T2 hyperintense, measuring 5 mm transverse x 4 mm AP x 11 mm craniocaudal dimension.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no significant degenerative changes and there are no stenoses.

Output: There is an intramedullary abnormality within the cervical cord at the level of C6/7. It is slightly expansile, T1 hypointense, T2 hyperintense, measuring 5 mm transverse x 4 mm AP x 11 mm craniocaudal dimension. Given this constellation of features, this most likely represents a small syrinx, and other T2 hyperintense etiologies such as inflammatory or neoplastic processes are felt to be less likely. However, contrast enhancement is recommended to further characterize the lesion.


Instruction: Generate impression based on findings.

Input: Cervicalgia [723.1] / Cervical spondylosis without myelopathy [721.0] / Brachial neuritis or radiculitis NOS [723.4], Reason for Study: ^Reason: History of neck, pain failed conservative treatment History: diffuse spondylosis, neck pain, radiculopathy. C-Spine:The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. There are minimal bulging of discs at the level of C45, 56 and 67 without evidence of spinal canal stenosis or neuroforaminal stenosis.T-Spine:There is normal thoracic kyphosis.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. T45 disc shows focal central protrusion which abuts thecal sac.No neuroforaminal stenosis is seen.L-Spine:There is normal lumbar lordosis.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L1-L2: There is central to left broad-based disc protrusion which abuts thecal sac, however, no neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation. There is a broad-based disc bulging with a focal disc protrusion central to right which narrows right side lateral recess. Degenerative changes of bilateral facet joints. No evidence of spinal stenosis. L3-L4: Diffuse bulging of disc with disc desiccation. Facet joint fluid collections indicating facet arthritis with ligamentum flavum thickening. No neuroforaminal narrowing or spinal stenosis. L4-L5: Diffuse bulging of disc with bilateral ligamentum flavum thickening causing minimal spinal canal stenosis. Associated bilateral facet arthritis were seen. No neuroforaminal narrowing. L5-S1: Disc desiccation with minimal bulging of disc. No neuroforaminal narrowing or spinal stenosis.

Output: 1. No evidence of spinal cord signal abnormality.2. Minimal bulging of cervical spine discs from C45 to C67 without evidence of spinal canal stenosis or neuroforaminal stenosis.3. Focal disc protrusion at the level of T45.4. Multiple degenerative disc disease of lumbar spine as described above.


Instruction: Generate impression based on findings.

Input: History of NSCLC and brain mets status post crani and SRS to left posterior lesion in November 2014. Surveillance. Compared to 2/17/2015, there is no significant change in 6 x 8 x 10 mm peripherally enhancing lesion within the left occipital lobe which has been previously radiated. There is surrounding FLAIR hyperintensity which represent edema and/or gliosis and remains unchanged.Again seen are postoperative findings related to right frontoparietal craniectomy and cranioplasty with unchanged confluent T2/flair hyperintensity in the right frontal lobe. Small amount of chronic blood products. Multiple additional areas of T2/flair hyperintensity in the periventricular and subcortical white matter including the left basal ganglia are also unchanged. No new intracranial mass or mass-effect. No midline shift or herniation. No new enhancing lesions to suggest disease progression. No hydrocephalus. Enhancing lesion involving the right squamosal temporal bone does not appear significantly changed. No new calvarial metastases are appreciated. Interval improvement in mucosal thickening involving the left maxillary sinus.

Output: 1. No new lesions or new mass-effect to suggest disease progression. Compared to 2/17/2015, no significant change in 6x8x10 -mm peripherally enhancing left occipital lesion which has been radiated. Continued follow-up of this lesion is suggested.2. No significant change in enhancing right temporal osseous metastases.3. Postsurgical changes in the right frontal lobe without local disease recurrence.


Instruction: Generate impression based on findings.

Input: Low back pain and radiation of pain down the right lower extremity. There is disc dessication with loss of height and slight disc bulging at L5-S1, as well as ligamentum flavum thickening and facet hypertrophy with trace joint effusions, which result in mild bilateral neural foraminal narrowing. There is also facet and ligamentum flavum hypertrophy at L4-5, with mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. Otherwise, there is no significant degenerative disease at T12 through L4. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis in the lower lumbar spine with mild neural foraminal narrowing bilaterally at L4-5 and L5-S1.


Instruction: Generate impression based on findings.

Input: Reason: ? Left pectoralis major tendon tear History: pain, weakness with adduction Multiple sequences are degraded by motion and pulsation artifact limiting evaluation of the pectoralis muscle and tendon. There is marked atrophy of the sternal and clavicular heads of the left pectoralis muscle. The pectoralis tendon can be followed to the anterior edge of the proximal biceps muscle at which point it appears discontinuous from what we suspect to be a pectoralis tendon fragment that is attached to the humerus, although it is difficult to define what is tendon and what may be scar tissue on this study. These findings are suggestive of a chronic tear of the distal pectoralis tendon with the distal end perhaps scarred down to the biceps muscle. We see no edema or hematoma within the muscle or peritendinous structures to indicate an acute injury. We suspect that there is mild osteoarthritis of the acromioclavicular joint.

Output: Markedly limited study due to extensive artifact shows atrophy of the left pectoralis major muscle and what appears to be a tear of the distal tendon. The tendons can be followed to the anterior edge of the biceps at which point it appears discontinuous from a separate low signal intensity structure at the expected site of the insertion of the tendon on the humerus that may represent a tendon stump or scar tissue.


Instruction: Generate impression based on findings.

Input: Right knee pain Evaluation is suboptimal as a dedicated knee coil was unable to be used due to the size of the knee.MENISCI: There is abnormal morphology and signal intensity of the posterior horn of the medial meniscus indicating a complex tear with possible partial root avulsion. There is attenuation of the body of the medial meniscus which is also slightly extruded medially. The anterior horn of the medial meniscus is intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is partial-thickness degeneration of the articular cartilage of the medial femoral condyle just above and anterior to the torn posterior horn of the medial meniscus. There is thinning of the articular cartilage of the medial tibial plateau especially posteriorly. The lateral compartment cartilage is relatively intact. The patellofemoral compartment demonstrates near full-thickness degeneration of the articular cartilage of the femoral trochlea centrally and along the medial facet and partial degeneration of the articular cartilage of the medial patellar facet. Tricompartmental osteophytes are present and the underlying marrow signal is normal.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted. There is nonspecific subcutaneous edema anterior to the patella which may be clinically insignificant.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus.2. Osteoarthritis and cartilage loss of the knee, further described above.3. Small to moderate joint effusion with additional findings detailed above.


Instruction: Generate impression based on findings.

Input: History of esophageal cancer, status post resection and C3 to C6 anterior-posterior spinal fusion, now with severe neck pain, and likely C6-C7 instability. Again seen are postsurgical changes of partial C4 and C5 corpectomy, placement of cage, and anterior fusion from C3 to C6 with anterior plate and screws. Posterior fusion hardware also seen from from C3 to C6 including posterior rods, screws, and bone graft. Compared to 12/17/2014, there is interval development of lucencies involving the inferior aspect of the C6 vertebral body and the superior aspect of the C7 vertebral body better seen on CT from the same day. The C6 screws are no longer embedded within solid bone. There is loss of the C6-C7 intervertebral disk space with foci of air. There is mild widening of the bilateral C6-C7 facet joints. No significant hardware displacement is appreciated. Mild 4-5 retrolisthesis is similar to prior and better seen on CT.Marrow signal changes involving the residual C4 and C5 vertebral bodies again seen and correspond to sclerosis seen on prior CTs. No prior postoperative MRI is available, however there is diffuse T1 hypointensity and T2 hyperintense marrow signal abnormality involving the C7 vertebral body extending into the pedicle. There is suggestion of T2 hyperintensity in the inferior C6 vertebral body and C6-7 disc space although not well seen due to susceptibility artifact and loss of height. Susceptibly artifact slightly limits evaluation. There is mild to moderate bilateral right worse than left neural foraminal narrowing at C6-C7 and on the right at C5-6 and C4-5. There is mild spinal canal narrowing from C3 to C6 with effacement of the ventral and dorsal thecal sac related to disc material. C6-7 spinal canal narrowing is worse since MRI from 10/14/2014. No cord signal abnormality is appreciated.

Output: 1. There are postoperative changes in the cervical spine including C4-5 corpectomy, C3-6 anterior fusion and C3-6 posterior fusion. Compared to CT from 12/17/2014, interval collapse of the C6-7 disc space and lytic changes involving the inferior C6 and superior C7 vertebral bodies noted with some loss of height, worse at C6 than C7; these findings are better appreciated on CT. There are new foci of air and within the C6-7 disc space and widening of the C6-7 facet joints consistent with instability at this level. The inferior C6 screws are no longer surrounded by solid bone. These findings are also better appreciated on the CT.2. There is new, diffuse edema involving the C7 vertebral body and the suboptimally visualized inferior C6 vertebral body and C6-C7 disk space, which while may be on a mechanical basis/instability at C6-7 with associated osseous erosive changes, raises possibility of new infection at the C6-C7 level.3. Mild spinal canal stenosis from C3 to C6 with effacement of the ventral greater than dorsal thecal sac related to disc-osteophyte complexes and postoperative changes. C6-7 spinal canal narrowing is worse since preoperative MRI from 10/14/2014. Contrast sequences may be helpful to better evaluation for infection and epidural extension if there is clinical suspicion. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: 49 years, Female, metastatic lung cancer, status post SRS, assess for recurrent/progressive disease. Again seen are postsurgical changes of frontal craniotomy for resection of right superior frontal gyrus mass. There is a small focus of enhancement along the medial surface of the right frontal gyrus abutting the falx measuring approximately 6 x 7 x 7 mm and appears more nodular in the interval (best appreciated on coronal series 1201 image 136). There has been further collapse of the underlying resection cavity. There are chronic blood products in this region. Mild T2/ FLAIR hyperintensity in the right superior frontal gyrus is also not significant changed and may represent residual edema and/or gliosis.Remainder of the brain parenchyma is unremarkable for age. No new metastatic foci. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There is interval development of moderate mucosal thickening involving the bilateral maxillary sinuses with small fluid levels, which may reflect acute sinusitis. There is also mild ethmoid and sphenoid sinus opacification.There is diffuse low T1 marrow signal which is nonspecific without discrete destructive osseous lesions.

Output: 1. Continued evolution of posttreatment changes of radiation and prior resection of right superior frontal gyrus mass. There is interval increase in nodular enhancement along the medial surface of the right superior frontal gyrus which may represent posttreatment change. Recurrent metastasis seems less likely but would recommend a close follow-up exam to better exclude this possibility. 2. No new foci of metastasis elsewhere in the brain.


Instruction: Generate impression based on findings.

Input: Diagnosis: Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: lower back pain with RLE radiculopathy 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.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a moderate degree of bilateral facet hypertrophy at this level-right worse than left.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge present at this level. There is bilateral facet and ligamentum flavum hypertrophy - right worse than left. There is effacement of the fat at the lateral recess is bilaterally right worse than left which is a result of both disc bulge and facet hypertrophy. There is moderate encroachment of the nerve root at the right lateral recess and mild encroachment of the nerve root at the left lateral recess at this level. The exiting nerve roots within the neural foramina are surrounded by fat at this level. There is a Schmorl's node present which is eccentric towards the right side. There are some endplate reactive changes at this level with the minimal signal hyperintensity on the T2 STIR images. There is a right far lateral disc protrusion at this level which mildly abuts the right-sided exiting nerve root as it exits the neural foramen. Overall there is mild to moderate spinal stenosis at this level. Comparison with the prior CT of the abdomen from 1/4/2013 does not indicate any obvious change, although subtle change may be overlooked due to differences in modality.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge present at this level. There is partial effacement of the fat at the lateral recesses bilaterally at this level and some mild strangulation of the thecal sac. There is ligamentum flavum hypertrophy present. The exiting nerve roots within the neural foramina are surrounded by fat at this level. There is a left far lateral disc protrusion at this level which abuts the left-sided exiting nerve root after it exits the neural foramen at this level. Overall there is mild spinal stenosis at this level. Comparison with the prior CT of the abdomen from 1/4/2013 does not indicate any obvious change, although subtle change may be overlooked due to differences in modality.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.There is moderate encroachment of the nerve root at the right lateral recess and mild encroachment of the nerve root at the left lateral recess at L4-5 related to facet hypertrophy and disk bulge. Please correlate with patient's clinical symptoms and dermatome distribution of pain as this would affect potentially the L5 nerve roots.2.There is mild encroachment of the nerve roots at the lateral recesses at L3-4 related to combination of disc bulge and ligamentum flavum hypertrophy.3.There are far lateral disc protrusions on the right side at L4-5 and on the left side at L3-4 which abut the exiting nerve roots after they exit the neural foramina. This appears slightly worse at the L3-4 level.


Instruction: Generate impression based on findings.

Input: 68-year-old female presents with low back pain. Thoracolumbar spine: The bones appear demineralized suggestive of osteopenia/osteoporosis. There are multiple compression fractures of varying severity throughout the thoracic and lumbar spine. Multilevel degenerative disc disease throughout the thoracic and lumbar spine is also noted. There is facet joint osteoarthritis of the lumbar spine.There may be slight retropulsion of a couple of the lower thoracic vertebra. Please refer to accompanying MRI for further detailed characterization. The thoracic spine is kyphotic with otherwise no gross malalignment. No frank instability of the lumbar spine between flexion and extension views. Aortic calcifications are noted.

Output: Multilevel compression fractures involving the thoracic and lumbar spine. No findings to suggest lumbar spine instability. Please refer to accompanying MRI for further detailed characterization.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Fluid is incidentally noted in an aerated right petrous apex. The midline structures and craniocervical junction are within normal limits.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. No evidence of acute infarct.2. No evidence of flow-limiting stenosis or aneurysm.


Instruction: Generate impression based on findings.

Input: History of right-sided gaze deviation of unresponsiveness following right hemicolectomy. Previous lacunar strokes with left-sided weakness. There is extensive patchy and confluent high T2 signal in the periventricular and subcortical cortical white matter, which has progressed since 2007. Multiple chronic lacunar infarcts are redemonstrated, especially in the left basal ganglia, right external capsule, right cerebellar hemisphere, and pons. There are also numerous scattered foci of susceptibility effect. A slightly larger focus of susceptibility artifact is redemonstrated in the left thalamus. There is no evidence of mass or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens replacements. There is a right maxillary sinus probable mucocele that mildly expands the right infundibulum, similar to the CT from 1/12/2014. There is a small left maxillary sinus retention cyst. The skull and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute infarct or intracranial mass.2. Findings compatible with chronic small vessel ischemic disease and multiple lacunar infarcts, which have progressed since 2007. 3. Scattered foci of susceptibility artifact are compatible with nonspecific chronic microhemorrhages. A slightly larger focus in the left thalamus also likely relates to a remote hemorrhage, as it was apparent on the MRI from 2007.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: 64M with osteoporosis secondary to tertiary parathyroidism, evaluate for parathyroid hyperplasia, evaluate thyroid gland. History: osteoporosis. There is an 8 mm minimally enhancing nodule (7/29) posterior to the left inferior thyroid gland which may represent a parathyroid adenoma or enlarged lymph node. The thyroid gland is otherwise normal appearing. No additional mass or lymphadenopathy is seen throughout the neck. The remaining major salivary glands are unremarkable. The major cervical vessels are patent. The airways are patent. The imaged intracranial structures show prominent ventricles and sulci, suggesting mild atrophy. Periventricular and subcortical T2 hyperintensities may reflect mild small vessel ischemic disease but are partially visualized. The imaged portions of the lungs are clear. Mild degenerative changes of the visualized spine. Mild mucosal thickening of the right maxillary sinus.

Output: Nodule posterior to the left inferior thyroid gland may represent a parathyroid adenoma or lymph node.


Instruction: Generate impression based on findings.

Input: A 78 year old male hospitalized because of osteomyelitis and right below knee amputation because, recent diagnosis of congestive heart failure with left ventricular ejection fraction of 36%, moderately reduced right ventricular function, severe aortic regurgitation, moderate tricuspid regurgitation and severe aortic root dilation. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 28%, the LV end diastolic volume index is 231 ml/m2 (normal range: 74+/-15), the LVEDV is 411 ml (normal range 142+/-34), the LV end systolic volume index is 166 ml/m2 (normal range 25+/-9), the LVESV is 296 ml (normal range 47+/-19), the LV mass index is 127 g/m2 (normal range 85+/-15), and the LV mass is 226 g (normal range 164+/-36). There is global severe hypokinesis with regional variation. Left AtriumThe left atrium is moderately dilated (142ml). Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 126 ml/m2 (normal range 82+/-16), the RVEDV is 224 ml (normal range 142+/-31), the RV end systolic volume index is 79 ml/m2 (normal range 31+/-9), and the RVESV is 140 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is severe aortic regurgitation (non-dedicated sequences)Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. In non-dedicated sequences, the aortic root is severely dilated and the ascending aorta is mildly dilated. The arch and descending thoracic aorta are normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (33mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral pleural effusion were seen: moderate on the right and mild on the left. 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. The left ventricle is severely dilated with severely reduced systolic function, the LVEF is 28%. There is global severe hypokinesis with regional variation. 2. The right ventricle is mildly dilated with moderately reduced systolic function, the RVEF is 37%. 3. There is moderate biatrial dilation. 4. There is severe aortic regurgitation.5. The aortic root is severely dilated and the ascending aorta is mildly dilated. The aortic arch and thoracic descending aorta are within normal limites. 6. The main pulmonary artery is mildly dilated (33mm).7. See extra-cardiac findings.8. Only non-contrast images were acquired due to patient inability to complete contrast portions of the study (i.e. there are no late gadolinium enhancement or MRA images acquired).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for gallstone in duct History: epigastric pain, N/V Examination mildly limited by motion.ABDOMEN:LIVER, BILIARY TRACT: The liver is mildly prominent in size measuring up to 22 cm in the craniocaudal dimension with an otherwise normal morphology. There is a mildly T2 hyperintense structure within hepatic segment 5 with reference measurements below which is nonspecific but lacks suspicious enhancement characteristics and which is most likely benign. There are a few additional scattered subcentimeter structures which are too small to characterize but likely represent cysts. The hepatic vasculature appears patent.The gallbladder demonstrates normal distention. Cholelithiasis. No gallbladder wall thickening or pericholecystic fluid. No intra or extrahepatic biliary ductal dilatation. No choledocholithiasis is identified.SPLEEN: There is diffuse mildly decreased parenchymal signal suggestive of hemosiderin deposition. Scattered areas of increased T2 signal and enhancement within the spleen are nonspecific but may reflect hemangiomas.PANCREAS: The pancreas demonstrates diffusely decreased T1 signal, restricted diffusion, and mildly heterogeneous enhancement without evidence of focal necrosis. Mild fat stranding surrounds the pancreatic tail without discrete fluid collection. The pancreatic duct is not dilated. The main pancreatic duct crosses the common bile duct anteriorly and terminates in the minor papilla consistent with pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole simple cyst. No hydronephrosis.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.INDEX LESION MEASUREMENTS (Current exam date/time: 9/20/2016 04:00:00)HEPATIC SEGMENT 5 LESION: 0.9 x 0.8 cm (Image 23, Series 6).

Output: 1.Findings compatible with pancreatitis without evidence of complication.2.Pancreas divisum.3.Cholelithiasis without evidence of cholecystitis or choledocholithiasis.4.Mild hepatomegaly. Hemosiderin deposition within the spleen which may be related to sickle cell disease.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of renal cancer, concern for hepatic metastases. ABDOMEN:LIVER, BILIARY TRACT: There is no definite enhancing hepatic mass lesion identified. The large right renal mass causes extrinsic mass effect on the right hepatic lobe with adjacent heterogeneous enhancement in this region immediately adjacent to renal mass. The noncontrast coronal images suggest that the renal mass remains encapsulated and merely abutting liver but direct invasion cannot be excluded. There is a 1 cm flash filling hemangioma in segment II. There is no biliary ductal dilatation. The gallbladder appears normal.SPLEEN: No significant abnormality noted.PANCREAS: There is normal signal intensity in the pelvis. No focal pancreas lesion is identified. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a large, heterogeneous, enhancing mass extending from the right upper pole kidney which measures 6.6 x 6.4 x 7.4 cm, compatible with known renal malignancy. There is enhancing thrombus in the proximal right renal vein, concerning for direct invasion (series 803, image 194). This does not extend to the inferior vena cava. Left kidney is normal.RETROPERITONEUM, LYMPH NODES: No thrombus is identified in the IVC. There is no significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No discrete osseous lesion is identified.OTHER: No significant abnormality noted.

Output: 1.No discrete intrahepatic mass is identified.2.Heterogeneous enhancement in the right hepatic lobe adjacent to extrinsic compression from large right renal mass --- favored to be compression effect alone, but direct invasion cannot be excluded.3.Large right renal mass with tumor thrombus in the right renal vein.


Instruction: Generate impression based on findings.

Input: 72-year-old female with degenerative disc disease. There is moderate dextroscoliosis. There is compression deformity of L1 with approximately 80% loss of height, left side greater than right. There is no associated hyperintense STIR signal abnormality to suggest acute compression fracture. There is a Schmorl node in the superior L5 endplate. There appear to be remote postoperative findings in the lower lumbar spine. There is extensive multilevel degenerative spondylosis with disc space narrowing and dessication, as well as endplate signal alterations at multiple levels. In particular, there is compression of multiple nerve roots. At T12-L1, there is mild diffuse disc bulge and moderate facet hypertrophy with mild effacement of the ventral thecal sac, as well as mild right and moderate left neural foramen narrowing. At L1-2, there is a disc bulge and facet hypertrophy with mild central canal stenosis, as well as mild right and moderate to severe left neural foramen compromise. At L2-3, there is a disc bulge, moderate facet hypertrophy, and ligamentum flavum hypertrophy with moderate to severe spinal canal stenosis and moderate bilateral neural foramen compromise. At L3-4, there is minimal anterolisthesis of L3 on L4, and a disc bulge and facet hypertrophy with moderate central canal stenosis and at least moderate bilateral neural foramen compromise. Indeed, there is associated flattening of the exiting left L4 nerve root. At L4-5, there is grade 1 anterolisthesis and a diffuse disc bulge and facet hypertrophy with mild to moderate spinal canal stenosis and bilateral moderate to severe neural foramen narrowing. At L5-S1, there is a disc bulge with moderate to severe canal stenosis and moderate neural foramen compromise. The paraspinal muscles demonstrate fatty atrophy.

Output: 1.Severe compression deformity of L1 vertebral body without evidence of associated edema.2.Extensive multilevel degenerative spondylosis of the lumbar spine with compression of multiple nerve roots, as described in the findings sections.3.Moderate dextroscoliosis of the lumbar spine. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: hx of peritoneal meso, pls compare to previous and measure History: none ABDOMEN:LIVER, BILIARY TRACT: Right hepatic T2 hyperintensity is unchanged. Scattered hypoattenuating lesions within the liver are unchanged. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a septated right upper pole lesion, the cystic component of which measures 5.4 x 4.8 cm (10/26), previously 5.7 x 4.8 cm. There is increased T1 signal within the cyst, with new ill-defined extension into the retroperitoneum posteriorly, likely representing hemorrhage with rupture. There is no enhancement on subtraction images.Additional bilateral simple and hemorrhagic cysts are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Reference peritoneal nodule adjacent to the lesser curvature measures 2.2 x 1.6 cm (12/143), previously 2.5 x 1.8 cm upon remeasurement on post contrast images (10/215).Nodule adjacent to the left hepatic lobe measures 3.1 x 2.2 cm (12/145), previously 3.3 x 2.3 cm upon remeasurement on postcontrast images (10/221)BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Reference peritoneal nodules are not significantly changed.2.Mildly complex right upper pole cyst now contains hemorrhage with partial rupture posteriorly. No enhancement is evident.


Instruction: Generate impression based on findings.

Input: Again seen is mild dilatation of the lateral and third ventricles which is stable to minimally worse in the interval. For example the third ventricle measures up to 12 mm in the transverse plane, previously 11 mm. There is mild interval increase in dilatation of the infundibular recess of the third ventricle. Obstruction at the cerebral aqueduct is again suspected and better appreciated on prior sagittal FIESTA sequence on examination from 1/31/2013. Cerebellar tonsils have a pointed configuration and extend caudally up to 6 mm below the foramen magnum and to a lesser degree on the right. Retroflexed dens also contributes to fairly mild crowding at the foramen magnum.No evidence of acute infarct or intracranial hemorrhage. No extra-axial collections. There is minimal periventricular T2/FLAIR hyperintensity similar to prior with minimal if any evidence of transependymal flow of CSF. Brain parenchyma appears otherwise unremarkable. There is no intracranial mass, midline shift, or herniation. No abnormal enhancement. Pituitary gland is grossly unremarkable.Flow voids are present within the major vessels indicating patency. Paranasal sinuses are grossly clear. Minimal opacification of the left-sided mastoid air cells is present.

Output: 1. Findings compatible with mild chronic hydrocephalus with likely obstruction at the level cerebral aqueduct, which is better appreciated on prior high-resolution 3-D T2 sequence. Findings are stable to minimally worse since 1/31/2013. There is minimal if any evidence of transependymal flow of CSF.2. Findings of mild Chiari I malformation with fairly mild crowding at the foramen magnum related to low cerebellar tonsils and retroflexed dens similar to prior.


Instruction: Generate impression based on findings.

Input: Shunt, back pain, worsening. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. There is irregularity involving the contour of the thecal sac at the L2-L3 level, the dorsal epidural fat, and in the interspinous soft tissue region which is likely postsurgical. No obvious nerve root clumping to suggest arachnoiditis.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.

Output: 1. No significant disc disease or spinal canal or neural foraminal stenosis at any level.2. Mild distortion of the epidural fat, contour of the thecal sac, and soft tissues at the L2-L3 level is compatible with postsurgical change.


Instruction: Generate impression based on findings.

Input: Multiple recurrent oral cancer s/p two major resections with free flap reconstruction and XRT with dermal metastasis with good response clinically. There are postoperative findings, including right hemiglossectomy and floor of mouth dissection with soft tissue flap reconstruction, mandibular reconstruction, and bilateral neck dissection. There is marked interval decrease in size of the enhancing mass along the posterolateral margin of the flap in the right oral cavity, with erosion of the adjacent mandible. Indeed, the tumor now measures up to approximately 15 mm, previously 45 mm. There is no evidence of significant lymphadenopathy or evidence of new mass lesions in the neck. There is a small amount of fluid signal in the right mastoid air cells. The imaged intracranial structures and orbits are unremarkable. There is partially imaged thoracic scoliosis.

Output: Extensive post-treatment findings in the oral cavity region with marked interval decrease in size of the recurrent tumor along the posterior margin of the surgical flap with adjacent right mandible erosion.


Instruction: Generate impression based on findings.

Input: Evaluate right frontal lobe encephalomalacia, history of lung cancer. There is an unchanged heterogeneously enhancing, mildly expansile lesion in the occipital bone. There is an unchanged left parietal skull resection cavity without evidence of abnormal enhancement in this region. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged encephalomalacia in the right orbitofrontal gyri. There is also unchanged mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a left lens implant. The orbits are otherwise grossly unremarkable. There are mild ethmoid sinus secretions of mucosal thickening.

Output: 1. Unchanged encephalomalacia in the right orbitofrontal gyri, with no evidence of intracranial metastases or acute infarction. 2. Unchanged occipital skull metastasis and no evidence of recurrent left parietal skull metastasis.


Instruction: Generate impression based on findings.

Input: Reason: Eval for osteomyelitis History: Deep ulcer of Left foot plantar, head of 1st metatarsal, plantar aspect, present for years There is ulceration of the ball of the foot beneath the first MTP joint. There is intermediate signal intensity on T1-weighted images replacing the underlying subcutaneous fat which is heterogeneous on T2-weighted images and extends to the head of the first metatarsal as well as the base of the great toe, likely reflecting a combination of granulation tissue, scarring, and edema. There is chronic erosion of the head of the first metatarsal that likely represents sequela of prior infection, but we see no edema within the marrow of the first metatarsal to indicate acute osteomyelitis. There is linear signal abnormality within the proximal diaphysis of the first metatarsal that may represent a small focus of bone infarction. The proximal phalanx is dorsally subluxed/dislocated relative to the first metatarsal. There is a defect within the base of the proximal phalanx, again, likely representing an erosion from prior osteomyelitis. However, we suspect that this is chronic as we see no edema within the adjacent marrow. The distal phalanx appears normal. There are small subcutaneous foci of signal void beneath the first metatarsal head which may represent gas or metal artifact. A small amount of fluid tracks along the inferior aspect of the distal diaphysis of the first metatarsal, but the clinical significance of this is uncertain, and there is little if any adjacent soft tissue inflammation. The sesamoid bones are not visualized and are presumably surgically absent or destroyed from prior infection. The flexor tendons of the great toe are not well visualized. There is diffuse atrophy of the imaged musculature of the foot. Mild osteoarthritis affects the midfoot.

Output: 1. Ulceration of the ball of the foot near the first metatarsal head with signal abnormality within the underlying soft tissues likely representing a combination of scarring and edema. There is a small collection of fluid along the undersurface of the first metatarsal. While we cannot exclude the possibility of a small abscess, this may not be of any clinical significance due to the lack of inflammation within the surrounding soft tissues and underlying bone.2. Absence of the sesamoid bones is presumably related to prior surgery or long-standing infection.3. Erosive deformity of the head of the first metatarsal and base of the proximal phalanx is likely due to infection, but we suspect that this is chronic as we see no edema within the adjacent bone marrow. Other findings as described above. Conventional radiographs may provide additional information and are recommended for initial evaluation for osteomyelitis.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of cervix uteri, unspecified [C53.9], Reason for Study: ^Reason: hx of cervical cancer, new memory loss History: memory loss, insomnia No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

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


Instruction: Generate impression based on findings.

Input: Female, 62 years old, dizzy and not feeling well status post fall. Numerous punctate foci of T2 hyperintensity are present scattered through the cerebral hemispheres, a non-specific finding. No diffusion restricting lesions are seen. No evidence of edema or mass effect is detected. There are no findings to suggest acute or chronic hemorrhage. The lateral and third ventricles are normal in size and morphology.The cerebellar fissures are prominent, particularly along the vermis and upper cerebellar hemispheres, out of proportion to the cerebral sulci which are relatively normal. In addition, the pons and middle cerebellar peduncles appear subjectively small. The fourth ventricle is prominent.On DTI imaging, no gross diffusional asymmetries or obvious focal loss of anisotropy is detected.Although the temporal bone structures are not specifically evaluated on this study, the right superior semicircular canal may be dehiscent.

Output: Findings are seen suggesting atrophy of the pons, middle cerebellar peduncles, cerebellar vermis and superior cerebellar hemispheres. These features, while not entirely specific, at least raise the possibility of an early manifestation of multiple system atrophy. Other degenerative processes, such as one of the spinocerebellar ataxia conditions, could be considered as well based on clinical symptomatology.No convincing findings of posttraumatic parenchymal injury are seen. Small foci of signal abnormality scattered through the cerebral hemispheres are nonspecific. Most commonly, these lesions reflect chronic microvascular ischemia, though the differential is broad and would include sequelae of prior inflammation, infection, demyelination, or migraine headache among many others.Incidentally noted is the appearance of possible dehiscence of the right superior semicircular canal. If vestibular symptoms are suspected, this potential finding can be better assessed with dedicated temporal bone CT.


Instruction: Generate impression based on findings.

Input: Male 65 years old Reason: 64 yo male s/p whipple for IPMN in 4/14; please evaluate for abnormalities History: pancreas mass LUNG BASES: Right basal scarring/atelectasis.ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. Subcentimeter T2 hyperintensity within the posterior right hepatic lobe is consistent with a hepatic cyst. SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple. There is marked dilatation of the pancreatic duct throughout its course, measuring up to 8 mm and increased compared to most recent CT abdomen 26/04/14. No definite enhancing mass is identified within the pancreas. Given the time interval, stricture is the most likely etiology.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Nonspecific mildly prominent portacaval lymph node.BOWEL, MESENTERY: Changes related to prior Roux-en-Y.BONES, SOFT TISSUES: T2 hyperintensities within the lower thoracic vertebral bodies are suggestive of hemangiomas.

Output: 1.Increased dilatation of the pancreatic duct in this patient who is status post Whipple. Given the time interval favor stricture as most likely etiology of the dilatation. While pancreatic mass or a main branch IPMN are differential considerations, there are no specific imaging findings to suggest these diagnoses which are therefore felt much less likely. 2.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Anterior right knee pain. Rule out chondral injury MENISCI: No evidence of meniscal injury.ARTICULAR CARTILAGE AND BONE: Articular cartilage appears normal.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism appears normal.ADDITIONAL

Output: No chondral defect or other injury to account for the patient's knee pain.


Instruction: Generate impression based on findings.

Input: C5 -- C6, C6 -- C7 radiculopathy. History of C7 -- T1 herniated disk there Nonenhanced CT of the cervical spine:Routine nonenhanced CT of cervical spine the sagittal and coronal 2-D reformatted images were obtained.This is not an appropriate exam for detection of herniated disk. The CT examination of cervical spine cannot precisely evaluate the soft tissues of the cervical spine (disk material or hypertrophic changes of the ligamentum flavum).To evaluate for a herniated disk an MRI examination of cervical spine is the study of choice.Very advanced degenerative disease throughout the cervical spine is noted. There is exaggerated lordosis of cervical spine. The alignment the vertebral column is otherwise unremarkable.Foramen magnum.Examination at this level is unremarkable.C2 -- C3.Degenerative disk disease and hypertrophic changes of posterior elements. No bony central spinal stenosis or neural foramina compromise.C3 -- C4.Advanced degenerative disk disease with loss of intervertebral disk height. Moderate hypertrophic changes of posterior elements. Compromise of bilateral neural foramina secondary to bony hypertrophic changes (left greater than right). No central spinal stenosis.C4 -- C5.Moderate degenerative disk disease and extensive hypertrophic changes of posterior elements (left greater than right). Compromise of bilateral neural foramina secondary to a both changes. No central spinal stenosis.C5 -- C6.Moderate degenerative disk disease and exaggerated hypertrophic changes of posterior elements with resultant bilateral neural frontal compromise. No central spinal stenosis.C6 -- C7.Advanced degenerative disk disease and also disk height. Moderate hypertrophic changes of posterior elements. Mild to moderate compromise of the left neural foramina. Questionable minimal compromise the right neural foramina. No central spinal stenosis.C7 -- T1.Advanced degenerative disk disease and minimal hypertrophic changes of posterior elements. No central spinal stenosis. No definitive neural foramina compromise.Limited view of upper thoracic spine demonstrate no central spinal stenosis and no significant degenerative changes.

Output: 1.Extensive degenerative disk disease and hypertrophic changes of posterior element throughout the cervical spine as detailed.2.No central spinal stenosis at any level however multi-level bilateral neural foramina compromise secondary to degenerative changes is present as detailed per level above.3.This examination cannot assess for herniated disk as mentioned above. If concern for acute herniated disk exist a dedicated MRI of the cervical spine is recommended.


Instruction: Generate impression based on findings.

Input: History of pain. Evaluate for recurrent rotator cuff tear. There is a metallic susceptibility artifact within the posteromedial aspect of the humeral head as well as additional metallic susceptibility in the soft tissues of the shoulder indicating prior surgery. ROTATOR CUFF: There is perhaps mild irregularity of the bursal surface fibers of the supraspinatus tendon that may represent fraying but we see no discrete supraspinatus tear. The supraspinatus muscle appears normal. The infraspinatus tendon is normal. There is minimal fatty atrophy along the myotendinous junction of the infraspinatus. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: Minimal osteoarthritis affects the acromioclavicular joint. Trace fluid in the subacromial/subdeltoid bursa is of doubtful clinical significance. The coracoacromial and coracohumeral ligaments appear normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. We see no joint effusion. Mild intermediate signal intensity in the superior labrum is visualized and may reflect degeneration but we see no discrete fluid-filled labral tear. Small cysts are seen within the superior aspect of the humeral head. BICEPS TENDON: The tendon of the long head of the biceps is visualized within the intertubercular groove but not clearly seen within the rotator interval, perhaps due to prior tenotomy or tear.

Output: 1. Postoperative changes as described above2. Possible mild fraying of the supraspinatus tendon but no discrete tear3. Additional degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: 33 year old male with history of L frontal GBM. S/p surgery x2, RT/TMZ+TMZ. Patient off therapy since 1/2014. Again seen are postoperative findings related to left frontal craniotomy and resection. There is unchanged T2/FLAIR hyperintensity adjacent to the resection cavity extending across the genu of the corpus callosum into the right frontal white matter. There is linear enhancement along the posterior margin of the resection cavity which is unchanged from prior study. There are no new masses identified. There are no new areas of pathologic enhancement. There is no midline shift or mass effect. The imaged paranasal sinuses are clear. The imaged orbits are unremarkable. The mastoid air cells are clear.

Output: Stable examination with no evidence of tumor progression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: stroke workup in patient with history of stroke presenting with worsening dysarthria and new onset dysphagia and ataxia. Mild asymmetry of the ventricles is again noted, felt to be within normal limits of anatomic variation, and unchanged. The basal cisterns remain patent. There is no midline shift or mass effect. There is mild volume loss involving the cerebellum. There are scattered punctate foci of increased T2/FLAIR signal within the periventricular white matter which are nonspecific and appear similar to the 4/9/2015 examination. There is also curvilinear focus of increased T2 signal within the left lower pons compatible with chronic infarction corresponding to the area of restricted diffusion seen on the 4/9/2015 examination. Previously seen increased T2 signal involving the middle cerebellar peduncles has improved, consistent with evolution of prior injury. There are numerous punctate foci of susceptibility in both the supratentorial and infratentorial compartments in a nonspecific distribution. Although some of these foci appear slightly more prominent or apparently new compared to the prior examination, this may at least in part reflect increased sensitivity of the technique. In the setting of renal insufficiency, these may reflect hemolytic microangiopathy. No pathological enhancement is identified. There is no diffusion abnormality currently. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The skull and scalp soft tissues are grossly unremarkable. There is mild patchy opacification of the paranasal sinuses. There is again volume loss and abnormal signal involving the left globe compatible with phthisis bulbi. Additional abnormal signal involving the right globe as seen on the prior studies is consistent with prior intraocular detachment.

Output: 1.No evidence of acute infarct.2.Chronic infarction involving the left pons. Additional nonspecific supratentorial white matter signal abnormality appearing similar to prior and favored to reflect chronic small vessel ischemic changes.3.Again seen are numerous foci of susceptibility compatible with chronic microhemorrhages. These are nonspecific but may reflect hemolytic microangiopathy in this patient with renal insufficiency.


Instruction: Generate impression based on findings.

Input: There is a mild dextrorotoscoliosis centered at approximately L1/2.Thoracic spine:There are no fractures. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses.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 fractures or subluxations. The marrow signal is benign. 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 and disc height loss are present throughout. Small Schmorl's nodes are noted along the inferior endplate of L1, and inferior endplate of L2. Modic type II degenerative reactive endplate changes are present at L2/3, L3/4, L4/5, and L5/S1.L1/2: No significant disc bulge or stenosis.L2/3: Diffuse annular disc bulge, slight ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is no significant stenosis.L3/4: Diffuse annular disc bulge, slight ligamentum flavum thickening, and mild bilateral facet hypertrophy. There are no significant stenoses.L4/5: Diffuse annular disc bulge, ligamentum flavum, and moderate bilateral facet hypertrophy. There is a 5 x 4 mm T2 hyperintense focus adjacent to the medial aspect the right facet joint most consistent with a small synovial cyst. There is mild bilateral lateral recess, mild to moderate left neural foraminal, and mild right neural foraminal stenosis.L5/S1:Mild disc bulge and mild bilateral facet hypertrophy without stenosis.

Output: 1.Negative noncontrast thoracic spine MRI.2.L4/5:Mild bilateral lateral recess, mild to moderate left neural foraminal, and mild right neural foraminal stenosis.3.Mild degenerative changes are noted elsewhere in the lumbar spine, without significant stenosis, as described in detail above.


Instruction: Generate impression based on findings.

Input: 57-year-old male with history of prostate cancer status post prostatectomy with elevated PSA. Evaluate for recurrence. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy. No soft tissue in the surgical bed to suggest tumor recurrence.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Status post prostatectomy.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Minimally prominent nonspecific bilateral inguinal and left external iliac chain lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: 79 year old male with language disorder and mild cognitive decline No evidence of restricted diffusion to suggest acute ischemia or infarction. Redemonstrated are primarily periventricular foci of T2/FLAIR hyperintensity without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. Also redemonstrated is a punctate focus of increased T2/FLAIR hyperintensity in the right thalamus, which appears similar to the prior study and consistent with a remote lacunar infarction. The ventricles and sulci are slightly prominent, however unchanged. There is no evidence of pathologic intracranial enhancement. The visualized paranasal sinuses are aerated. Bilateral orbital contents are unremarkable. Proximal intracranial flow voids are identified apart from loss of the signal void in the distal left vertebral artery.

Output: 1.No acute ischemia or infarction. No pathologic intracranial enhancement.2.Loss of the signal void in the distal left vertebral artery is again noted.3.Stable chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of lipomatosis, new severe left lower leg pain and inability to walk TIBIA/FIBULA: No significant abnormality noted.BONE MARROW: No significant abnormality noted.MUSCULATURE: No significant abnormality noted.ADDITIONAL

Output: Normal MRI exam of the left tibia and fibula. No acute abnormality.


Instruction: Generate impression based on findings.

Input: Asymmetrical right sensorineural hearing loss with tinnitus. The bilateral labyrinthine structures, internal auditory canals, and cranial nerve 7 and 8 complexes appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: Abnormal head CT: newly diagnosed metastatic breast cancer. There is an infiltrative, enhancing mass within the left parietal calvarium that measures up to 50 mm with epidural and subgaleal extension. There is minimal associated mass effect upon the underlying left parietal lobe. There is no evidence of lesions with in the brain, brainstem, or cerebellum. There cerebellar tonsils extend up to 5 mm inferior to the foramen magnum. There is no evidence of acute intracranial hemorrhage or acute cerebral infarction. The orbits and paranasal sinuses are unremarkable.

Output: A lesion in the left parietal bone with epidural and subgaleal extension is compatible with metastatic disease.


Instruction: Generate impression based on findings.

Input: 37-year-old with known left breast cancer on neoadjuvant chemotherapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, there has been interval decrease of the index mass, which now measures 24 x 27 x 33 mm, previously 102 x 86 x 98 mm (AP x LR x CC). This is peripherally enhancing with central signal compatible with necrosis. The posterior satellite now appears only as faint residual non-mass enhancement measuring 15 mm. The AP extent of the residual mass and non-mass enhancement measures 5.1 cm. Left axillary lymph nodes, including the biopsied node are decreased in size as well. The biopsied node is only 8 mm in short axis. The previously seem smaller suspicious nodes have normalized in morphology. No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in the right axillary region.

Output: Response to therapy as above. Residual mass and non-mass enhancement measure up to 5.1 cm.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, with neck spasm and left shoulder weakness. The normal cervical lordosis is slightly reversed which is likely positional. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No concerning areas of marrow replacement, edema or pathologic marrow enhancement are observed.The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No focal lesions are seen. No pathologic parenchymal or leptomeningeal enhancement is observed. No epidural abnormalities are suspected.C2-3: Left facet arthropathy. No significant spinal canal or foraminal stenosis. C3-4: No significant spinal canal or foraminal stenosis. C4-5: Left uncovertebral hypertrophy with moderate left foraminal narrowing. No significant spinal canal stenosis. C5-6: Posterior disc-osteophyte complex formation with a small focal component centrally. No significant spinal canal stenosis or cord impingement. No significant foraminal narrowing. C6-7: No significant spinal canal stenosis or foraminal narrowing. C7-T1: No significant spinal canal stenosis or foraminal narrowing.

Output: Relatively mild degenerative findings are seen at several levels as discussed above. Most notably, there is a moderate stenosis of the left neural foramen at C4-5. Otherwise, no high-grade spinal canal or foraminal stenosis is seen. No enhancing lesions are identified.


Instruction: Generate impression based on findings.

Input: There are a few scattered punctate foci of T2 hyperintensity within subcortical white matter locations without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Other than minimal sporadic foci mucosal thickening the paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female 91 years old; Reason: 91 Y old female with two decubitus ulcers on left hip with elevated CRP/ESR; eval for osteomyelitis History: decubitus ulcer, fever Nondiagnostic exam.

Output: Nondiagnostic exam.


Instruction: Generate impression based on findings.

Input: 47 years, Male, evaluate for tumor resection, word finding difficulty. There are postsurgical changes of left-sided craniotomy for resection of left temporal mass. There is a rind of restricted diffusion surrounding the resection cavity compatible with cytotoxic edema. No large infarct is evident. There are blood products within the resection cavity. There appears to be near total resection of the enhancing tumor with small residual enhancement suspected along the superior aspect of the resection cavity abutting the left temporal horn.Extensive surrounding T2/FLAIR hyperintensity in the left temporal lobe extending medially into the left thalamus and basal ganglia region as well as superiorly into the left parietal white matter is again seen. Mass effect including effacement of the left lateral ventricle is slightly improved. Uncal herniation with deformity of the midbrain and rightward displacement of the brainstem is slightly improved. Rightward midline shift measured at the foramen of Monro measures approximately 6 mm compared to 8 mm on the preoperative study. No hydrocephalus. Major flow-voids are maintained. There is diffuse opacification of the left mastoid air cell. Remainder of the brain parenchyma demonstrates few scattered nonspecific T2/FLAIR hyperintense foci but otherwise unremarkable.

Output: Expected postsurgical changes of left temporal tumor resection. There is near total resection of the enhancing tumor with minimal residual enhancement suspected along the superior aspect of the resection cavity along the left temporal horn.


Instruction: Generate impression based on findings.

Input: 14-year-old male with neurofibromatosis type II experiencing back pain. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord and cauda equina display normal signal and morphology. The paravertebral soft tissues are unremarkable.Nerve root thickening associated with T2 hyperintensity and enhancement is present involving the:*Left L2 nerve roots, unchanged in appearance.*Left L4 nerve roots, unchanged in appearance.*Left L5 nerve roots, unchanged in appearance.*Bilateral S1 nerve roots (left greater than right), unchanged in appearance.*Left S2 nerve roots, unchanged in appearance.There are no degenerative changes or stenoses.

Output: Stable L2, L4, L5, S1, S2 nerve root thickening, T2 hyperintensity, and enhancement.


Instruction: Generate impression based on findings.

Input: 33-year-old female with cavernous angioma, six-month follow-up. There is an unchanged cavernous malformation that measures up to 9 mm, with an associated developmental venous anomaly in the left frontal lobe, but no surrounding edema. There is also an unchanged focus of increased T2 signal in the posterior left frontal lobe without enhancement or susceptibility effect. There is no evidence of acute intracranial hemorrhage or infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Unchanged left frontal lobe cavernous malformation and associated developmental venous anomaly.A persistent small lesion in the posterior left frontal lobe remains nonspecific, but may represent a manifestation of endothelial abnormalities that can be associated with cavernous malformations, although other possibilities, such as gray matter heterotopia or low grade glial tumor, may be considered as well.


Instruction: Generate impression based on findings.

Input: History of hepatitis B and family history of pancreatic cancer. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. Normal postcontrast enhancement. Punctate hepatic cysts are present. No suspicious liver lesion or vascular abnormality. Contracted gallbladder without biliary ductal dilatation.SPLEEN: Normal size spleen without focal lesion.PANCREAS: Normal variant ductal anatomy. No focal suspicious lesion. In the distal pancreatic tail there is a 1.7 x 1.7 cm lesion which matches splenic intensity on some but not all imaging sequences.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious liver. 1.7 cm distal pancreatic tail hyperenhancing lesion matches splenic intensity on some but not all imaging sequences. Although this likely represents a intrapancreatic accessory spleen this is not confirmed. A nuclear medicine damaged RBC scan is recommended to confirm that this is splenic tissue.


Instruction: Generate impression based on findings.

Input: 20 year old male with Tetralogy of Fallot s/p repair, s/p pulmonary valve replacement. Referred for research cardiovascular MRI to evaluate right ventricular volume and function Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 173 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 119 g (normal range 164+/-36). There is systolic septal flattening, suggesting increased RV systolic pressure. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely enlarged with moderately reduced systolic function. The overall RV ejection fraction is 38%, the RV end diastolic volume index is 168 ml/m2 (normal range 82+/-16), the RVEDV is 309 ml (normal range 142+/-31), the RV end systolic volume index is 104 ml/m2 (normal range 31+/-9), and the RVESV is 192 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.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 ValveThere is a bioprosthetic pulmonary valve in place. There is moderate pulmonic valve regurgitation and moderate pulmonic valve stenosis.Regurgitant fraction 25%. Peak velocity 3.5 m/sTricuspid 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 ArteriesThe main pulmonary artery is moderately dilated (35mm). Right pulmonary artery has a diameter of 34mm and receives 53% of cardiac output. Left pulmonary artery has a diameter of 27mm and recieves 47% of the cardiac output.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: This is a limited cardiac MRI without contrast performed for research purposes.1. Severe right ventricular dilation with moderately reduced systolic function (RVEF 38%, RVEDV indexed 168 mL/m2)2. A bioprosthic valve is noted in the pulmonic position. Moderate pulmonic valve insufficiency and stenosis are noted.3. Moderate dilation of pulmonary artery.4. Normal left ventricular size and systolic function (LVEF 63%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: rule out intracranial abnormality. CVA.signs and symptoms: History of cancer with brain metastases and after mental status Nonenhanced head CT:There is evidence of a right temporal craniotomy with focus of encephalomalacia under the craniotomy flap in the right anterior temporal lobe. There is no evidence of edema, hemorrhage or mass effect with this finding. The high convexity right frontal lobe there is a mass measuring approximately 11.9 x 8.4-mm on axial image 23. There is extensive surrounding vasogenic edema with resultant effacement of adjacent cortical sulci. This finding is believed to represent a metastatic focus.There are several small foci of low-attenuation in the subcortical white matter of left hemisphere which are not suggestive of metastatic disease and may represent small vessel disease ischemic stroke of indeterminate age. Follow-up with an MRI for detection of possible additional metastatic foci is recommended.There is no evidence of hemorrhage, midline shift or hydrocephalus.

Output: 1.Metastatic lesion in high convexity right frontal lobe with possible minimal hemorrhage measuring 8.4 x 11.9-mm in size.2.Ill-defined patchy areas of subcortical invagination suspected to small vessel ischemic stroke of indeterminate age.3.Evidence of a prior right-sided anterior temporal partial lobectomy as detailed above.


Instruction: Generate impression based on findings.

Input: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. There is minimal loss of intervertebral disc space height at L4-5. Intervertebral disc space heights are otherwise well-maintained. There is disc desiccation at the L1-2 and L4-5 levels. Multilevel Schmorl nodes are noted. Heterogeneous bone marrow without evidence of marrow edema. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-2 intervertebral level.L1-2: New tiny central annular fissure is noted. No significant spinal canal or neural foraminal stenosis.L2-3: Minimal left foraminal shallow disc protrusion. No significant spinal canal or neural foraminal stenosis.L3-4: Mild disc bulge with biforaminal prominence. Mild facet joint hypertrophy. Mild bilateral neural foraminal stenosis, left greater than right. No significant spinal canal stenosis.L4-5: Mild disc bulge. Mild-to-moderate facet joint hypertrophy and ligamentum flavum thickening. Mild bilateral neural foraminal stenosis. No significant spinal canal stenosis.L5-S1: Mild facet joint hypertrophy. No significant spinal canal or neural foraminal stenosis.

Output: 1. Mild disc bulge at the L3-4 and L4-5 levels, with mild bilateral neural foraminal stenoses, without significant interval change. 2. New tiny central annular fissure at the L1-2 level. 3. Other mild degenerative changes of the lumbar spine as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified diseases of inner ear, unspecified ear Other symptoms and signs involving the nervous systemClinical question: dizziness, balance difficulties, assess for acoustic neuroma, vascular abnormalities, masses/lesions The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening in the right maxillary sinus and a minor mucous retention cyst in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. No intracranial mass is appreciated. There is no evidence for cerebral infarction.


Instruction: Generate impression based on findings.

Input: Transient right-sided weakness. Rule out stroke. BRAIN MRI: There is an area of restricted diffusion along the left posterior frontal corona radiata adjacent to the left lateral ventricle. There is no significant associated FLAIR hyperintensity. There are multiple foci of T2/FLAIR hyperintensity involving the periventricular and subcortical white matter as well as the pons which are nonspecific but compatible with chronic small vessel ischemic disease. The ventricles and other CSF-containing spaces are mildly enlarged, reflecting mild underlying brain volume loss. There is no midline shift or herniation. There is trace mucosal thickening in the ethmoid sinuses. There is deformity involving the posterior aspect of the globes/staphylomas, which may be associated with axial myopia.CRANIAL MRA:The internal carotid arteries show preserved caliber and flow-related signal. There is moderate stenosis involving the distal left M1 segments with mild attenuation of the distal middle cerebral artery branches. Moderate stenoses also involves the proximal left and mid right P2 segments with attenuated distal right posterior cerebral artery branches. Other milder, scattered stenoses involve the intracranial arteries. There is no aneurysm.CERVICAL MRA: Aortic branching pattern is conventional. There is no significant stenosis involving the bilateral common or internal carotid arteries. The vertebral arteries arise conventionally from the respective subclavian arteries. No significant stenosis involving the vertebral arteries at their origins or their course in the neck.

Output: 1.Acute/hyperacute ischemia involving the left posterior frontal corona radiata. No significant associated T2/FLAIR signal which may be related to hyperacute timing.2.Mild to moderate chronic small vessel ischemic disease.3.Multifocal atherosclerotic stenoses of the intracranial arteries, with moderate focal stenoses involving the left lateral M1 segment and the bilateral posterior cerebral arteries. 4.There is no significant stenosis of the cervical arteries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 28 year old female with a history of non-ischemic cardiomyopathy who underwent heart transplant in 2007 referred for stress cardiac MRI to rule out coronary stenosis.MEDICATIONS: ASA, prednisone, Cellcept, tacrolimus. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no evidence of prior myocardial infarction. There is, however, a tiny focus of epicardial late gadolinium enhancement noted in the apical inferior wall which suggests the presence of fibrosis, inflammation, or infiltration, such as an old episode of rejection. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVEDV is 121 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 44 ml (normal range 31+/-10), the LV mass index is 51 g/m2, and the LV mass is 92 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is consistent with transplant morphology. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 73 ml/m2 (normal range 69+/-14), the RVEDV is 131 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 52 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant morphology. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 64%) with evidence of a tiny focus of late gadolinium enhancement in the apical inferior wall. The pattern is not consistent with prior myocardial infarction and most likely represents an old episode of rejection. 4. Normal RV size and systolic function (RVEF 60%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Tib post tendinitis History: pain TENDONS: Small fluid around the posterior tibialis, flexor digitorum longus and flexor hallucis longus tendons, likely physiologic. No significant abnormality noted.LIGAMENTS: There is replacement of normal fat with low T1 signal and high T2 signal in the sinus tarsi, consistent with fluid or synovitis. ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: MR findings representing sinus tarsi syndrome.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Specifically, there is no evidence of an osteochondral defect or contusion.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: There is a small focus of increased signal within the lateral portion of the patellar tendon proximally. There is no evidence of discrete tear. Minimal signal changes are also noted in the inferior pole of the patella but there is no evidence of an sleeve avulsion or fracture.There is a small amount of increased signal within the anterolateral portion of Hoffa's fat pad.ADDITIONAL

Output: 1. Mild edema within Hoffa's fat pad which may reflect small component of patellar impingement.2. Mild patellar tendinosis.