Instruction: Generate impression based on findings.

Input: 19 year old man with history of palpitations, referred for cardiac MRI to evaluate for structural heart disease. Left VentricleThe left ventricle is mildly dilated with low normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 109 ml/m2 (normal range: 74+/-15), the LVEDV is 210 ml (normal range 142+/-34), the LV end systolic volume index is 45 ml/m2 (normal range 25+/-9), the LVESV is 87 ml (normal range 47+/-19), the LV mass index is 45 g/m2 (normal range 85+/-15), and the LV mass is 86 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Wall thickness is normal without evidence of asymmetric hypertrophy. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 1025 ms in the basal septum, which is within normal limits. There is no myocardial iron overload.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 124 ml/m2 (normal range 82+/-16), the RVEDV is 238 ml (normal range 142+/-31), the RV end systolic volume index is 62 ml/m2 (normal range 31+/-9), and the RVESV is 119 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely, and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The sinus of Valsalva measures 26 x 26mm. The ascending aorta is 22 x 23mm. There is no evidence of coarctation or aneurysmal disease of the aorta.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. Mild biventricular dilation with low normal systolic function. (LVEF 56%, RVEF 50%). 2. No evidence of late gadolinium enhancement to suggest underlying myocardial fibrosis, infiltration or inflammation. 3. Mild aortic regurgitation.4. Normal dimensions of the aortic root and ascending aorta. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is a punctate focus of diffusion restriction in the right external capsule compatible with an acute ischemic infarct. No mass effect or midline shift. There are additional foci of T2/FLAIR hyperintensity in the bilateral basal ganglia and left thalamus without diffusion restriction, likely representing old lacunar infarcts. There is T2/FLAIR hyperintensity in the pons, in addition to a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions on FLAIR and T2 images. There is a punctate focus of signal loss on susceptibility imaging in the left corona radiata, which most likely represents a punctate focus of microhemorrhage. In isolation, this is of limited clinical significance.There is no evidence of intracranial hemorrhage, extra-axial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are normal in position. Flow-voids are present within the major vessels indicating patency. Trace mucosal thickening of the ethmoid air cells and scattered opacification of the right mastoid air cells. The visualized paranasal sinuses and mastoid air cells are otherwise clear. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. Punctate focus of diffusion restriction in the right external capsule is compatible with acute ischemic infarction. No mass effect or midline shift.2. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Female 55 years old Reason: metastatic breast cancer History: forgetfulness. There is no abnormal intracranial enhancement suggest metastatic disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastatic disease, hemorrhage, or infarct.


Instruction: Generate impression based on findings.

Input: 66-year-old female with right medial knee pain and swelling for 3 months. MENISCI: Note is made of blunting and linear increased signal abnormality which extends to the femoral articular surface of the posterior horn of the medial meniscus consistent with a complex tear, which extends to the body of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the medial compartment. There is focal near full-thickness articular cartilage degeneration along the posterior aspect of the weightbearing portion of the medial femoral condyle above the posterior horn of the meniscus with underlying subchondral signal abnormality, likely degenerative in etiology. There is a partial-thickness articular cartilage fissure along the lateral facet of the patella. There is near full-thickness to full-thickness focal articular cartilage degeneration affecting the patellar cartilage, centrally, with underlying subchondral signal abnormality, likely degenerative in etiology.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial meniscus as described above.2. Small knee joint effusion.3. Articular cartilage degeneration and fissuring as described above.


Instruction: Generate impression based on findings.

Input: 79-year-old woman with history of chronic pancreatitis, questionable stone and ventral duct which could not be removed during ERCP on 9/21/2015. ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. There is no intrahepatic biliary duct dilatation. The gallbladder and common bile ducts appear normal.SPLEEN: The spleen appears normal.PANCREAS: The pancreatic parenchyma is mildly atrophic. No solid masses are identified. Segments of the pancreatic duct are irregularly dilated measuring up to 7 mm in the body. A 20 x 9mm cystic lesion in the pancreatic head (series 8, image 19) appears to communicate with the pancreatic duct. Additionally, there are additional small foci of increased T2 signal which communicated with the pancreatic duct (series 4, images 19 and 20). No pancreatic duct stone is identified.After administration of secretin, a bolus is seen filling the duodenum, however the pancreatic duct does not changed in size.ADRENAL GLANDS: The adrenal glands appear normal.KIDNEYS, URETERS: Subcentimeter T2 hyperintense foci in the kidneys bilaterally are likely cysts. The kidneys are otherwise normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon appear normal.BONES, SOFT TISSUES: Bilateral Tarlov cysts noted.OTHER: No significant abnormality noted.

Output: 1.Irregular pancreatic duct dilatation compatible with given history of chronic pancreatitis.2.Preserved exocrine function but decreased pancreatic duct compliance also compatible with chronic peritonitis.3.Probable side branch IPMN documented in the pancreatic head without suspicious features.4.No obstructing mass or stone identified.


Instruction: Generate impression based on findings.

Input: 73 years Female (DOB:4/17/1943)Reason: r/o stenosis History: back painPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is some multilevel disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is minimal facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a minor disc bulge at this level. There is mild facet hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are some mild degenerative changes present lumbar spine but no significant compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 71 year old female with breast cancer on Doxorubicin with new diagnosis of heart failure with reduced ejection fraction. Coronary angiogram demonstrated moderate coronary artery disease including a 100%, small distal LAD occlusion. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function . The overall LV ejection fraction is 20%, the LV end diastolic volume index is 123 ml/m2 (normal range: 65+/-11), the LVEDV is 228 ml (normal range 109+/-23), the LV end systolic volume index is 98 ml/m2 (normal range 18+/-5), the LVESV is 183 ml (normal range 31+/-10), the LV mass index is 31 g/m2 (normal range 67+/-11), and the LV mass is 57 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is subendocardial late gadolinium enhancement of the inferior and septal apex that is consistent myocardial infarction and less likely suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. T1 mapping, T2 stir not performed as scan was done on 3T scanner. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function . The overall RV ejection fraction is 34%, the RV end diastolic volume index is 111 ml/m2 (normal range 69+/-14), the RVEDV is 207 ml (normal range 110+/-24), the RV end systolic volume index is 74 ml/m2 (normal range 22+/-8), and the RVESV is 138 ml (normal range 35+/-13). 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 at least mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve not well visualized.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLarge bilateral pleural effusions. 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 (LVEF 20%). There is global hypokinesis with regional variation.2. The right ventricle is mildly dilated with moderately reduced systolic function (RVEF 34%). 3. There is subendocardial late gadolinium enhancement of the inferior and septal apex is consistent myocardial infarction of the distal LAD territory.4. Mildly dilated left atrium, moderately dilated right atrium. 5. At least mild-moderate mitral regurgitation.6. Large bilateral pleural effusions. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Worsening dizziness. There is no significant interval change in the enhancing mass that extends from the left cerebellopontine angle to the porus acusticus and is associated with the left vestibular nerve. The mass measures up to 19 mm. There is intact fluid signal within the inner ear structures.

Output: No significant interval change in the left vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: Renal cell carcinoma with hemorrhagic brain metastasis, status post resection. Postoperative surveillance and planning for radiation. Please note limited sequences were obtained for treatment planning protocol. Again seen are postsurgical changes of left frontal craniotomy for tumor resection and hematoma evacuation. There is evolution of postoperative blood products with T1 hyperintensity now seen in the previously seen extra-axial collection beneath the left frontal craniotomy. There is a 18 x 15 mm lesion involving the superior aspect of the resection cavity which is hyperintense on the post gadolinium 3-D T1 weighted images and demonstrates a rim of susceptibility effect and favored to represent a hematoma. Similar lesion was present on prior MRI from 1/20/2015. There is edema in the left frontal lobe which is decreased since prior. There is also decrease in associated mass-effect including rightward midline shift and decreased effacement of the left lateral ventricle.No new lesion or new mass-effect is seen on the postcontrast sequence. No hydrocephalus. Postsurgical changes related to posterior wire fixation at C1-C2 level noted.

Output: Examination limited to sequences for treatment planning demonstrates evolution of postsurgical changes including hemorrhage within the left frontal lobe. 18 x 15 mm lesion along the superior aspect of the resection cavity probably represents a hematoma. Please note however for surveillance of metastatic disease, complete brain MRI including pre-gadolinium T1-weighted sequence should be considered.


Instruction: Generate impression based on findings.

Input: Sacral pain, prostate cancer There is diffusely homogeneous appearance of the marrow signal intensity were likely relating to post radiation change. There is no evidence of osseous metastatic disease. There is a mild amount of increased signal intensity of the right vastus lateralis and adductor musculature but no abnormal enhancement following contrast administration. A mild amount of nonspecific increased signal intensity is also present in the right paraspinal musculature. There is mild fatty edema of the paraspinal musculature.Bladder diverticula are noted. There is a prominent right-sided 9 mm iliac chain lymph node. The prostate is enlarged.

Output: No evidence of osseous metastatic disease or sacral lesion.


Instruction: Generate impression based on findings.

Input: History of RCC and duodenal carcinoid tumor status post Bilroth II on September 10, 2015, now with GJ tube secondary to delayed gastric emptying with high gastric residuals ABDOMEN:LIVER, BILIARY TRACT: Small layering sludge in gallbladder. No secondary signs of acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: 1.6 cm pancreatic body cystic focus (punctate wall calcification better seen on earlier CT imaging), most likely a sidebranch intraductal papillary mucinous neoplasm. Pancreatic duct normal in size. No pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Dominant left simple renal cyst measuring up to 13 cm in longitudinal dimension, additional smaller renal cysts also seen. Mild fullness of left mid to lower renal collecting system without significant change from prior CT imaging. Absent right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous gastrojejunal tube seen entering gastric body with tip located beyond ligament of Treitz in left upper quadrant jejunum. Collapsed stomach. Gastroenteric anastomosis unremarkable.BONES, SOFT TISSUES: Ventral abdominal postsurgical sequela including adjacent scarring. Deep to this area is a 1.3 x 0.8 cm focus of enhancing nodularity, persistent to increased enhancement seen in delayed phase, may reflect postsurgical sequela such as scarring or fat necrosis but attention on follow-up recommended to exclude interval increasing size. T9 vertebral body T2 and T1 hyperintense focus most likely a vertebral body hemangioma. Partially imaged aneurysmal ascending thoracic aorta.

Output: Gastroenteric anastomosis unremarkable, no evidence of bowel obstruction. Deep to region of ventral abdominal postsurgical changes is 1.3 cm focus of enhancing nodularity as above, likely reflecting postsurgical scarring or fat necrosis but attention on follow-up suggested.1.6 cm pancreatic body cystic lesion, most likely a sidebranch IPMN.Gallbladder sludge.


Instruction: Generate impression based on findings.

Input: Female, 57 years old. Right shoulder pain, continued pain despite injections and physical therapy, evaluate for rotator cuff tear. ROTATOR CUFF: There is a full-thickness near-complete to complete tear of the supraspinatus tendon with retraction of the tendon to the level of the glenohumeral joint. There is moderate atrophy of the supraspinatus muscle. There may be mild degeneration and/or fraying of the anterior fibers of the infraspinatus tendon, but the majority of the tendon appears to extend to the greater tuberosity. Mild increased signal intensity within the tendon suggests tendinosis. The infraspinatus muscle appears normal. The teres minor muscle and tendon appear normal. There is thickening and increased signal intensity within the distal subscapularis tendon indicating moderate tendinosis with additional linear foci of high signal intensity at its insertion indicating partial thickness insertional tearing. The subscapularis muscle appears normal. Small cysts are noted in the greater and lesser tuberosities likely reflecting the aforementioned rotator cuff pathology.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint with a small amount of fluid in the joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is increased signal intensity within the superior labrum suggestive of tearing. The inferior labrum appears intact. There is a small amount of fluid in the glenohumeral joint but no large effusion.BICEPS TENDON: There is increased signal intensity within the biceps tendon particularly at its transition from the rotator interval to the intertubercular groove indicating moderate tendinosis and partial-thickness tearing.

Output: 1.Near-complete/complete tear of the supraspinatus with retraction and additional rotator cuff pathology as described above.2.Osteoarthritis of the acromioclavicular joint.3.Tendinosis and partial-thickness tearing of the tendon of the long head of the biceps and other findings as above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Syringomyelia and syringobulbia Arnold-Chiari syndrome without spina bifida or hydrocephalusClinical question: Syrinx, yearly eval for changes/sizeSigns and Symptoms: yearly eval of syrinx Cervical spine:There is redemonstration of an 8 mm x 6 mm axial dimensions syrinx extending from the C5-6 disc space level down to the upper thoracic spine and centered at C7 which previously measured approximately 7 x 5 mm axial dimensions and extended from the C5-6 disc level. On the 2013 exam it measured 4.5 x 6 mm axial dimensions.The patient is status post Chiari decompression.The cervical vertebral bodies are appropriate in overall alignment and height. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The syrinx extends down to the C6-7 disc space level on the current exam and previously extended down to approximately the same level.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: Compared to prior exams over the past 2 years the patient's syrinx is currently larger in axial dimensions at the C7 vertebral level. The superior and inferior extent of the syrinx appears approximately the same.


Instruction: Generate impression based on findings.

Input: The corpus callosum is diffusely atrophic and the lateral ventricles are symmetrically enlarged suggesting periventricular leukomalacia. There is a 14 x 11mm porencephalic cyst in the white matter deep immediately adjacent to the body of the left lateral ventricle and approximately 6 x 5 mm paraventricular porencephalic cyst near the frontal horn of the right lateral ventricle. Increased FLAIR signal seen around the CSF spaces is suggestive of gliosis. Punctate areas of susceptibility artifact are noted in the occipital horns and walls of the lateral ventricles and in the right choroid plexus. There is no mass or mass effect. There is no diffusion abnormality to suspect acute stroke. The basal cisterns remain patent. Normal flow-voids are demonstrated in the major intracranial vascular structures. The craniocervical junction is normal. The orbits are unremarkable. There is mucosal thickening in the maxillary sinuses. The adenoids are enlarged with partial effacement of the nasopharyngeal airway.

Output: Periventricular leukomalacia with associated porencephalic cysts and staining of the lateral ventricles suggestive of remote injury involving intraventricular hemorrhage.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified hearing loss, right earClinical question: assess for retrocochlear pathologySigns and Symptoms: asymmetric SNHL of right ear; h/o facial trauma one year ago The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils are low lying.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.No abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally. The acetabular aqueducts do not appear enlarged. There is no evidence for dehiscent some of the superior semicircular canal.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.

Output: MRI of the brain and IACs are within normal limits. No abnormal lesions are identified within the internal artery canals.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement appreciated. There is no diffusion restriction appreciated. No extra-axial fluid collection is identified.There is a single punctate focus of signal hyperintensity on T2 and FLAIR MRI in the right frontal lobe white matter which is unchanged from the previous study. This is nonspecific and likely of little clinical significance.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mucosal thickening of the paranasal sinuses.

Output: 1.No evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: 79-year-old female with hypertension now with progressive lower extremity weakness x 1 day. Generalized weakness x 2 weeks. No objective neuro findings on exam. Question acute ischemia. Question subdural hematoma. Patient has very poor gait. Patchy areas of deep subcortical and periventricular white matter hypodensity likely represent moderate small vessel ischemic disease, age indeterminate by CT. However, if there is concern for an acute stroke, an MRI is recommended for further evaluation. There is no evidence of intracranial hemorrhage, mass or midline shift. Prominence of the sulci and ventricles indicates mild to moderate corticomedullary volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. If there is concern for an acute stroke, an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Clinical question: Seizure activity. Signs and symptoms: Seizure activity. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is noted. Diffuse patchy areas of periventricular and subcortical low attenuation are nonspecific however in the presence of risk factors of diabetes, hypertension and hyperlipidemia he may represent advanced to small vessel disease of indeterminate age. Follow-up with an MRI is recommended. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: Findings concerning for advanced to small vessel disease.


Instruction: Generate impression based on findings.

Input: CERVICAL SPINE: Redemonstrated is a small caliber syrinx of the cervical cord without significant interval change in size or extent since prior study. The largest transaxial dimension of the syrinx measuring approximately 1.5 mm at the C6 level is unchanged. There is mild straightening of the cervical spine. The vertebral body and disc heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE: Redemonstrated is a mildly expansile syrinx of the mid to lower thoracic cord extending from T6 to L1 similar to the prior exam. The syrinx at T8 measures 3.9 x 3.9 mm (AP x TR), previously 3.5 x 3.8 mm. The syrinx at T11 measures 3.9 x 3.5 mm (AP x TR), previously 3.9 x 3.5 mm. The cord terminates at upper L2 level. The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disc heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Stable appearance of syrinx in the cervical and mid to lower thoracic cord, without significant interval change in size and extent from prior exam.2. No significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: BRAIN: There is an area of restricted diffusion in the left paramedian pons, with associated T2/FLAIR signal abnormality, compatible with acute infarct. There tiny foci of susceptibility in the right thalamus and right parietal lobe, compatible with chronic microhemorrhages. Mild to moderate scattered periventricular and subcortical T2/FLAIR signal abnormality, likely reflecting chronic microvascular ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There is no evidence of flow-limiting stenosis or aneurysm in the anterior circulation. There is at least moderate stenosis involving the left V4 segment. The right vertebral artery, bilateral PCAs, basilar artery, and cerebellar arteries are patent.MRA NECK: Exam is limited by suboptimal contrast timing. Noncontrast "Inhance" sequence demonstrates a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are slightly narrowed, with additional atherosclerotic mild narrowing of the left subclavian artery. The left vertebral artery is narrow throughout its course, likely reflecting a combination of hypoplasia and atherosclerotic disease. There is moderate stenosis involving the left V4 segment.

Output: 1.Left paramedian pontine acute infarct. No acute intracranial hemorrhage is evident.2.Moderate stenosis is suspected involving the left V4 segment, although this is not well assessed. The basilar artery is patent. The left vertebral artery is diffusely small in caliber, likely related to a comminution of hypoplasia and atherosclerotic disease. Further delineation with CT angiography can be considered if clinically indicated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67-year-old man with radial nerve pain. Evaluate for site of compression. ELBOW:LIGAMENTS: No significant abnormality noted.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Bone marrow signal intensity is within normal limits. No abnormalities of the articular cartilage are evident.SURROUNDING STRUCTURES: No abnormal soft tissue masses or abnormalities are evident.ADDITIONAL

Output: No significant findings are seen to account for the patient's radian nerve pain. Normal examination of the elbow and forearm.


Instruction: Generate impression based on findings.

Input: Diagnosis: CervicalgiaClinical question: h/o MCV, evaluate for ligamentous injury to cervical spine The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level.At C4-5 there is loss of disc space height, disc desiccation, endplate osteophytes and uncovertebral osteophytes associated with mild posterior ligamentous hypertrophy. There is effacement of the spinal fluid ventral and posterior the spinal cord at this level. There is a right paramedian disc protrusion present at this level which encroaches on the right hemicord and right-sided exiting nerve root at this level. Overall there is a mild to moderate degree of spinal stenosis at this level.At C5-6 there is loss of disc space height, disc desiccation, endplate and uncovertebral osteophytes and a disc bulge associated with some effacement of spinal fluid ventral and posterior the spinal cord and encroachment of the exiting nerve roots within the neural foramina bilaterally due to osteophytes and disc material.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C4-5 and C5-6 and encroachment of the right-sided exiting nerve roots at C4-5 and bilaterally at C5-6.


Instruction: Generate impression based on findings.

Input: 35-year-old male with a possible radial MCP collateral injury. Evaluate grade in degree. Presents with pain and swelling. LIGAMENTS: The radial collateral ligament appears intact. The ulnar collateral ligament appears intact.TENDONS: The flexor and extensor tendons appear intact. BONES: There is increased bone marrow signal abnormality within the volar aspect of the head of the first metacarpal which may reflect a combination of resolving bone contusion or degenerative change. There is no linear signal abnormality to suggest an acute fracture. No additional bone marrow signal abnormality is identified.ADDITIONAL

Output: Findings consistent with a resolving bone contusion versus degenerative change affecting the volar aspect of the first metacarpal head. The radial collateral ligament appears intact.


Instruction: Generate impression based on findings.

Input: Male 28 years old; Reason: instability ankle History: pain and swelling TENDONS: A small amount of circumferential fluid is noted around the posterior tibial tendon, which may conceivably represent mild tenosynovitis, however this is equivocal. Best seen on the axial T2 sequence, there is fluid signal around the peroneus tendons as they courses below the fibular tip. The peroneus brevis tendon appears attenuated at this level, suggestive of chronic attritional tearing. The peroneus longus tendon appears disrupted at its surface, likely representing a longitudinal split tear.LIGAMENTS: The talofibular and calcaneofibular ligaments are intact. The visible fibers of the deltoid ligament are intact.ARTICULAR SURFACES AND BONE: There appears to be a mild pes cavus deformity, as suggested on the prior radiographs. The bone marrow signal is normal. No osteochondral lesion is identified. ADDITIONAL

Output: 1. Findings suggestive of a longitudinal split tear of the peroneus longus tendon and possible chronic attritional tearing of the peroneus brevis tendon as they course below the fibular tip.2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Status post left nephroureterectomy. Evaluate for recurrent or metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes from left nephroureterectomy. No evidence of residual or recurrent disease in the nephrectomy bed.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: Abnormal thickening and enhancement of the left superolateral aspect of the bladder with mild adjacent perivesicular stranding; compatible with patient's known recurrent bladder cancer.No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: cT4N1Mx left tongue squamous cell carcinoma, status post treatment. There is no measurable residual tumor in the left tongue or surrounding structure. There is no significant lymphadenopathy in the neck. The thyroid and major salivary glands are unchanged. The osseous structures and paranasal sinuses are unremarkable. The imaged intracranial structures and orbits are unremarkable.

Output: No evidence of gross measurable tumor or significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: 20-year-old female with right knee pain. MENISCI: There is globular intermediate signal intensity within the body of the posterior horn of the medial meniscus. There is equivocal mild fraying of the undersurface posterior horn of the medial meniscus, but we see no discrete tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage and bone marrow signal intensity are normal.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Edema between the iliotibial band and lateral femoral condyle suggesting iliotibial band friction syndrome.2. Intrasubstance degeneration of the medial meniscus and equivocal minimal undersurface fraying, but no discrete meniscal tear is noted.


Instruction: Generate impression based on findings.

Input: 59-year-old male patient with newly diagnosed prostate cancer, Gleason 6 adenocarcinoma left mid medial gland. Staging examination. PELVIS:PROSTATE:Prostate Size: 4.2 x 5.5 x 4.4 cm.Peripheral Zone: Numerous linear areas of low T2 signal with low ADC values are indeterminate. The largest on the right measures 1.0 x 0.7 cm (image 95, series 301) and the largest on the left measures 1.0 x 0.5 cm (image 95, series 301). Central Gland: The central gland is hypertrophied with BPH nodules.Seminal Vesicles: No evidence of involvement.Extracapsular Extension: No specific evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Areas of signal abnormality within the bilateral peripheral zone which is indeterminate for tumor. No specific evidence of extraprostatic extension.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for change in enhancing lesion. Patient is now on high dose of steroids. History of grade 2 meningioma. New visual symptoms. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination demonstrates noticeable interval decrease in vasogenic edema in the left anterior frontal since prior exam with resultant better visualization of cortical sulci and the subarachnoid space.There is also significant interval decrease in the extent of patchy enhancement of left frontal cortex and periventricular white matter of the frontal horn of left lateral ventricle since prior exam.A previously noted uniformly enhancing masslike lesion along the floor of the left anterior cranial fossa with resultant subtle elevation of the left frontal lobe and significant bulge into the apex of the left orbit is again noted. This mass demonstrate interval decreased enhancement and with a new central focus of hypoenhancement . This lesion however demonstrate no convincing evidence of change in its size, extent or overall mass effect on the left orbital apex. On coronal T2 weighted images the mass measures at least 11.5 mm in cranial caudad axis which is nearly identical to prior exam.Extra-axial enhancing lesion along the lateral aspect of the middle cranial fossa anteriorly is again identified without evidence of change in its size and measuring approximately 20 x 12 mm in transaxial dimensions (axial post enhanced series 11 image 23). There is however subtle interval decrease in intensity of enhancement since prior study.

Output: 1.No diffusion-weighted abnormalities.2.Interval significant decreased vasogenic edema in the left frontal lobe since prior study.3.Interval significant decrease in enhancement of the left frontal cortex and left frontal periventricular white matter.4.Extra-axial mass along the floor of left anterior cranial fossa without significant change in its size or mass effect on the apex of the orbit however it demonstrate decreased enhancement as detailed/measured about. This mass similar to prior exam demonstrate extension into the left anterior aspect of the cavernous sinus.5.Decreased enhancement however without change in the size of a left lateral anterior middle cranial fossa mass since prior exam.


Instruction: Generate impression based on findings.

Input: There is significant dilatation of the bilateral lateral ventricles due to a large intra- and suprasellar mass invading and obstructing the third ventricle. Periventricular T2 hyperintensity is compatible with transependymal flow. There is a large multicystic and solid mass arising from the sella with osseous remodeling of the sphenoid body. The entire left sphenoid sinus and the majority of the right sphenoid sinus are obliterated by the mass. The mass measures 4.9 x 6.3 x 4.2 cm and the solid portions avidly enhance. The superior portion of the mass is predominantly multicystic with fluid-fluid levels, which may represent blood, and scattered intrinsic T1 signal hyperintensity. There is encasement of the left internal carotid artery and lateral displacement of the right internal carotid artery. The right internal carotid artery is asymmetrically smaller compared to the left. The additional vessels within the circle of Willis are displaced peripherally by the mass. Presumably the optic chiasm and optic tracts are stretched, but are not clearly delineated on this examination.The cavernous sinus is likely filled with tumor. The right Meckel's cave is visualized and the left Meckel's cave is not visualized. There is mild bilateral convexity dural thickening and enhancement, likely secondary to recently shunt placement. Note that diffusion-weighted images are nondiagnostic anteriorly, as there is also dental hardware resulting in artifact.There are two frontal approach shunt catheters in place. The shunt catheter on the right extends to midline immediately superior to the suprasellar mass. The left catheter tip is in the body of the left lateral ventricle. A punctate focus of susceptibility effect is noted in the dependent portion of the left occipital horn, likely blood product secondary to shunt placement. Small amount of air in the nondependent portion of the right lateral ventricle. No extra-axial fluid collection is identified.

Output: 1.Large intrasellar and suprasellar partially multicystic enhancing mass causing hydrocephalus from obstruction of the third ventricle most likely represents a craniopharyngioma, versus other etiologies such as an adenoma, or less likely a germ cell tumor or primary astrocytoma.2.Encasement of the left internal carotid artery by the mass and lateral displacement of the right internal carotid artery.


Instruction: Generate impression based on findings.

Input: 19 year-old male with right shoulder/acromioclavicular joint pain. ROTATOR CUFF: The rotator cuff is intact and unremarkable.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a cleft in the posterior labrum is consistent with a posterior labral tear. No paralabral cyst is identified.BICEPS TENDON: The biceps tendon is intact and unremarkable. ADDITIONAL

Output: Findings consistent with a posterior labral tear of the right shoulder.


Instruction: Generate impression based on findings.

Input: T8 -- T9 level mass. Possible vascular period recommended CTA for further evaluation. Examination demonstrates a dural based high density mass measuring approximately 22 mm in cranial cephalad access in 5-mm in AP access immediately anterior to the superior facet of T8 on the left. There is no evidence of increased vascularity to suggest arteriovenous malformation, dural aVF at this location. This lesion is primarily on the left side however a very small extension of the lesion across the midline to the right is noted. The finding is believed to represent a meningioma. A high density lesion on axial images is more suggestive of calcification rather than enhancement. Review of prior MRI examination demonstrates no abnormal edema of the cord. No definitive increased vascularity within the epidural dorsal fat pad is detected.

Output: Dural based intradural extra medullary high density (likely calcification and less likely enhancement) may represent an intracanalicular meningioma. No definitive evidence of increased vascularity to suggest vascular malformation and no evidence of edema of the cord on prior MRI examination from 4 -- 9 -- 2009 was noted.


Instruction: Generate impression based on findings.

Input: Alignment of the lumber spine is anatomic. The vertebral body heights are grossly preserved without evidence of fracture. There is infiltrative marrow abnormality involving all lumbar vertebral bodies and the visualized T11-12 vertebral bodies with slight increase in the right aspect of L1 and L2. At the level of L4, there is circumferential epidural enhancing soft tissue abnormality with mild to moderate central spinal stenosis, similar to the prior exam. Additionally, there is epidural tumor at the level of L3, eccentric to the left, which effaces the posterolateral aspect of the thecal sac and extends into the left lateral recess, unchanged. There is a large soft tissue mass with osseous destruction of the left iliac bone extending into the ipsilateral sacroiliac joint, unchanged.

Output: Widespread metastatic disease involving the vertebrae, epidural space, and left iliac bone; stable to minimally progressed since prior. Extent of epidural disease is not significantly changed in the interval with mild to moderate spinal canal stenosis at L3 and L4 again seen.


Instruction: Generate impression based on findings.

Input: Assessment of Chiari 1 malformation. MRI Brain:There is left tonsilar herniation extending 1 cm below the level of the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are mildly enlarged and the posterior horn of the right lateral ventricle is mildly ectatic compared to the left. The fourth ventricle is patent without evidence of obstruction. The 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. Incidental note is made of some fluid within the right mastoid air cells.MRI C-Spine:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. There is no evidence of a syrinx.Degenerative changes are seen in the cervical spine as described below:C2-3: Left greater than right disc osteophyte complex with mild left neuroforaminal stenosis. No right neuroforaminal or central spinal canal stenosis.C3-4: Disc osteophyte complex is noted with mild bilateral neuroforaminal stenosis and mild central spinal canal stenosis.C4-5: Disc osteophyte complex is seen with uncovertebral hypertrophy causing mild central spinal canal stenosis but no neuroforaminal stenosis.C5-6: A right greater than left disc osteophyte complex and uncovertebral hypertrophy with mild central canal stenosis, moderate to severe right neuroforaminal stenosis and mild left neuroforaminal stenosis.C6-7: Left greater than right disc osteophyte complex with moderate uncovertebral hypertrophy causing mild right and moderate left neuroforaminal stenosis. No central canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.MRI T-Spine:The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no evidence of a syrinx.Ligamentum flavum and facet hypertrophy involving the T6/7-T9/10 levels but no neuroforaminal narrowing or central spinal canal stenosis. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remaining thoracic spine.

Output: 1.Left tonsillar herniation 1 cm below the foramen magnum compatible with Chiari I malformation.2.No evidence of a syrinx within the cervical or thoracic cord.3.Multilevel degenerative changes of the cervical spine which causes at most mild central spinal canal stenosis at multiple levels and moderate to severe right neural foraminal stenosis at the C5-6 level.


Instruction: Generate impression based on findings.

Input: Treated squamous cell carcinoma of the left upper alveolus that grew around an implant, status post left infrastructure maxillectomy and left neck dissection with STSG. Pathology demonstrated invasion into bone and pathologic stage was T4aN0M0, - margins, but + perineural invasion, treated with XRT. The patient subsequently developed a second primary tumor in the left lateral tongue (pT1N0 squamous cell carcinoma with PNI), status post re-excision of close margins. There are postoperative findings related to infrastructure left maxillectomy, left neck dissection, and left lateral glossectomy. There is no evidence of measurable enhancing mass lesions in the treatment bed. There is a left mandibular dental implant. There is no evidence of significant lymphadenopathy in the neck. The thyroid and remaining salivary glands are unremarkable. The imaged intracranial structures and orbits are unremarkable. There is mild multilevel degenerative spondylosis in the lower cervical spine.

Output: Post-treatment findings centered in the left oral cavity region with no evidence of gross residual tumor or significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: 61-year-old male patient with history of HCV and a focal cirrhosis, status post TACE/RFA for HCC. Note the examination is limited by patient motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.RFA defect in the inferior segment six is unchanged with no new arterial enhancement.RFA defect in segment eight of the liver is again noted. There is heterogeneous signal with intrinsic T1 hyperintensity compatible with proteinaceous or blood products, decreased compared to prior exam. Surrounding the RFA defect there is an area of postcontrast enhancement that does not demonstrate washout and correlates with vague T2 hyperintensity, decreased in size compared to prior.No new arterial enhancing lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Segment eight ablation defect with interval decrease in intrinsic T1 signal compatible with proteinaceous or hemorrhagic products. Postcontrast enhancement without washout in the adjacent parenchyma appears stable to slightly smaller compared to prior examination and likely represents postinflammatory/perfusional changes as opposed to recurrent cancer.2.Stable segment six ablation defect. No evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: 73 year-old female history of pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: Subsegmental left hepatic lobe nonenhancing cyst. The common bile duct appears normal measuring 5 mm. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: There is decreased intrinsic T1 signal abnormality with distal fatty atrophy. There is pancreatic ductal dilatation measuring up to 9mm with tortuosity about the neck, body, and tail region and dilated sidebranches. There are three areas of abrupt narrowing without enhancing mass, filling defect or nodularity. The proximal duct appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter nonenhancing left interlobar cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dilated and tortuous pancreatic duct with multiple areas of abrupt narrowing as above without abnormal enhancement, filling defect or mass, likely secondary to benign strictures. Decreased intrinsic T1 signal of the pancreas with distal atrophy. Constellation of findings suggests chronic pancreatitis. Continued follow up with Secretin stimulated MRCP is recommended if clinically warranted.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma with new left posterior thigh mass Within the left gluteus maximus of the left hip is a mixed solid and cystic mass measuring 3.1 x 3.3 x 3 cm in the greatest transaxial and craniocaudal dimensions. The solid component demonstrates T1 hyperintensity when compared to surrounding skeletal musculature. There is layering intermediate signal within the mass suggesting internal hemorrhage or debris. Following contrast administration, there is enhancement of the solid component which is situated medially. There is a mild amount of subcutaneous edema surrounding the mass.No additional masses are identified. The underlying bone marrow signal is normal.

Output: Mixed solid and cystic mass within the left gluteus maximus concerning for metastatic disease. No additional masses are identified and there is no suspicious bone marrow signal.


Instruction: Generate impression based on findings.

Input: sudden onset right arm and leg weakness, dysphagia There is focal restricted diffusion on the left internal capsule posterior limb without evidence of hemorrhagic lesion. This lesion indicates acute ischemic infarction.Underlying brain shows periventricular white matter high signal intensities on FLAIR images indicating non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Acute ischemic infarction on the left internal capsule posterior limb without evidence of hemorrhagic conversion.2. Otherwise no remarkable finding.


Instruction: Generate impression based on findings.

Input: Follow up on right breast mass seen on prior imaging. Personal history of left breast lumpectomy in 2015 for DCIS followed by radiation and hormonal therapy. Family history of breast cancer in mother, diagnosed at the age of 56. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No new abnormal enhancing lesion is seen in either breast. Small enhancing mass in the right breast 3:00 position is again seen and measures up to 6 mm today. The right breast 6:00 focus is stable, as are multiple other scattered foci in the right breast. Post surgical change is noted in the left breast, unchanged. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Stable right breast masses/foci. Annual MRI and mammography are recommended given her dense breasts and young age at cancer diagnosis. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Rotator cuff tear ROTATOR CUFF: There is a tiny focus of increased signal intensity within the supraspinatus tendon at its insertion upon the greater tuberosity which likely represents a small concealed interstitial tear with a small cyst in the underlying greater tuberosity. Mild fraying of the bursal surface fibers of the anterior supraspinatus are also noted but there is no full-thickness rotator cuff tear. The infraspinatus, teres minor, and subscapularis tendons are intact. The muscles of the rotator cuff are normal in caliber and signal intensity.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint. A trace amount of fluid is noted in the subacromial bursa which is not necessarily of any clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis and cartilage degeneration affects the glenohumeral joint. There is abnormal signal intensity of the superior labrum indicating the presence of a tear with a bucket handle type fragment. There is low signal intensity extending inferiorly along the posterior labrum which may represent a labral fragment resulting from the aforementioned tear or simply a prominent posterior capsular band. Additional linear signal is present within the anterior superior labrum also likely representing extension of the above-mentioned SLAP tear. There is no joint effusion.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Tiny concealed interstitial tear of the supraspinatus tendon with possible bursal surface fraying; however there is no evidence of a full-thickness rotator cuff tear.2. Moderate osteoarthritis of the acromioclavicular joint.3. SLAP tear and other findings as above.


Instruction: Generate impression based on findings.

Input: Female 94 years old Reason: renal pathology History: rising cr, urinary frequency RIGHT KIDNEY: 10.5 cm in length. Numerous cysts. There is concern that the collecting system might also be dilated. Parenchyma mildly echogenic.LEFT KIDNEY: Several cysts, the largest measuring 6 x 5.7 cm. Heterogeneous left lower pole solid lesion with somewhat spongy cystic components. A mass cannot be excluded. The lesion measures 9.4 x 8.1 x 10.5 cm. Ultimately this could represent abnormal renal parenchyma with numerous small cysts. The kidney should be evaluated further with dedicated renal CT or MR. If patient cannot get intravenous contrast due to abnormal renal function then an MRI is recommended.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Bilateral renal cysts. Possible heterogeneous mass left lower pole kidney. Possible hydronephrosis on the right although hydroureter is not seen. Recommend further evaluation with dedicated renal MRI. Dedicated renal CT may be obtained if the patient can receive IV contrast.Discussed with Dr. David Meltzer.


Instruction: Generate impression based on findings.

Input: 62-year-old male with continued left shoulder pain despite injections. ROTATOR CUFF: There is a full-thickness near complete tear of the supraspinatus tendon with retraction of the proximal tendon by approximately 3 cm. There is mild atrophy of the supraspinatus. There is thickening and intermediate signal intensity within the infraspinatus tendon indicating moderate tendinosis. There is partial thickness tearing of the anterior fibers of the infraspinatus at the level of its insertion on the greater tuberosity. There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. There is mild fatty infiltration along the myotendinous junction of the infraspinatus. There is partial thickness undersurface tearing of the subscapularis tendon. There is mild fatty atrophy of the subscapularis muscle. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Mild to moderate degenerative changes affect the acromioclavicular joint with subchondral cyst formation. There is a small amount of fluid identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal abnormality affecting the superior and anterior glenoid labrum consistent with degenerative tearing.BICEPS TENDON: There is a longitudinal split tear affecting the intra- and extra-articular portion of the long head of the biceps tendon. ADDITIONAL

Output: 1. Full-thickness near complete tear of the rotator cuff with retraction as described above. 2. Degenerative tearing of the glenoid labrum. 3. Longitudinal split tear of the long head of the biceps tendon as described above.


Instruction: Generate impression based on findings.

Input: Prior pT2N0M0 right lateral tongue cancer, resected May 2016 now with intermittent pain evaluate for any submucosal mass in region of right glossotonsillar sulcus. There are post-treatment findings, including partial right glossectomy and neck dissection. There is an infiltrative mass in the posterior right tongue that measures up to approximately 20 mm. There is no evidence of significant lymphadenopathy in the imaged portions of the neck. The remaining salivary glands and thyroid are unremarkable. The osseous structures appear to be intact. The imaged intracranial structures are unchanged. There is a small amount of fluid in the left mastoid air cells.

Output: Post-treatment findings in the neck with an infiltrative mass in the posterior right tongue that measures up to approximately 20 mm, which likely represents recurrent tumor. Otherwise, no evidence of significant lymphadenopathy in the imaged portions of the neck.


Instruction: Generate impression based on findings.

Input: Rule out progression of metastatic brain disease: breakthrough seizures. There are new subcentimeter enhancing lesions in the superior left precentral gyrus and bilateral cerebellar hemispheres with a mild degree of vasogenic edema. In addition, two superior right cerebellar hemisphere lesions have increased in size. The other subcentimeter enhancing lesions within the inferior right cerebellar hemisphere, cerebellar vermis, and right parietal lobe have not significantly changed. There is also an unchanged subcentimeter enhancing lesion within the fundus of the right internal auditory canal. There are postoperative findings related to left parieto-occipital craniotomy without evidence of nodular enhancement to suggest tumor recurrence in this location. There is unchanged confluent white matter T2 hyperintensity at the treatment bed. There is an unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations. There is unchanged mild periventricular white matter T2 hyperintensity. There is unchanged mild encephalomalacia in the left cerebellar hemisphere. There is no evidence of acute infarct. The ventricles and basal cisterns are stable in size and configuration, with ex vacuo dilatation of the left lateral ventricle. There is minimal midline shift to the left. There is minimal fluid signal within the left mastoid air cells. There is mild mucosal thickening in the paranasal sinuses. The skull and extracranial soft tissues are unchanged.

Output: 1. New subcentimeter metastatic lesions in the superior left precentral gyrus and bilateral cerebellar hemispheres, as well as increase in size of right superior cerebellar hemisphere metastases. Other subcentimeter intracranial metastases have not significantly changed.2. Unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations.Discussed with JACOBSEN, JOHN at 10:55 AM on 11/5/15.


Instruction: Generate impression based on findings.

Input: pt with bladder cancer; possible metastatic lesion to T12 that requires a biopsy for definitive result . Benign compression fracture versus malignancy. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: T12 vertebral bone biopsy under CT guidance. A total of five samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: 62-year-old man with thyroid nodule requiring further assessment. RIGHT LOBE MEASUREMENTS: 4.7 x 1.9 x 2.0 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.7 x 2.4 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: 2 nodules are noted in the right lobe of the thyroid. Both measure 7 x 8 mm. The medial and anterior nodule which is predominantly hypoechoic and slightly nodular in contour corresponds to the abnormality documented on recent PET/CT.LEFT LOBE: 7 mm complex nodule noted in the left lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple thyroid nodules. The anterior-medial nodule in the right lobe of thyroid measuring 7 x 8 mm corresponds to the PET CT abnormality. FNA of this nodule could be attempted however given relatively small size, a nondiagnostic result is a distinct possibility.


Instruction: Generate impression based on findings.

Input: Follow-up of IPMN in pancreatic tail ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small splenule.PANCREAS: Stable tiny cystic focus in pancreatic tail, measuring 4 mm. Nondilated pancreatic duct. Nondilated main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Spinal degenerative disease and scoliosis.OTHER: No significant abnormality noted.

Output: Unchanged 4 mm cystic focus in pancreatic tail, likely a sidebranch IPMN (intraductal papillary mucinous neoplasm).


Instruction: Generate impression based on findings.

Input: Reason: 65 yo male with pancreas mass; please do scan and evaluate for changes and or abnormalities History: pancreas mass ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation. No evidence of hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: Multilobulated cystic lesion in the head of the pancreas with thin nonenhancing septations and communication with the main pancreatic duct is unchanged in size measuring 3.2 x 1.6 cm (8/19), previously 3.4 x 1.6 cm. Slight prominence of the main pancreatic duct to 3 mm is unchanged. No abnormal enhancement within the lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Lesion in the gastric body measures 3.6 x 1.8 cm, similar to prior exams in follows fat on all sequences, suggestive of an intramural lipoma.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multilobulated cystic lesion in the pancreatic head is stable and likely represents a side branch IPMN.2.Lesion in the gastric body is suggestive of an intramural lipoma.


Instruction: Generate impression based on findings.

Input: 50 year old man with heart/kidney transplant on 10/22/15, referred for serial MRI as part screening for cardiac allograft rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the end diastolic volume is 151 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 87 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Quantitatively, the myocardial to skeletal T2-enhancement ratio is 1.2, which is in the normal range. The global relative enhancement is 2.2, which is in the normal range and has normalized since the last exam. The native myocardial T1 time in the interventricular septum is 1090-1110ms, which is elevated and may indicate edema or fibrosis, but this value measures similarly to the previous study. The extra-cellular volume fraction (ECV) is 31%, which is similar to that obtained on the previous exam. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 71 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (32mm)Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is persistent evidence of fibrin sheaths versus catheter within the SVC.PericardiumNo pericardial effusion noted on this study. There is no increased signal in the pericardium on T2-STIR and late gadolinium imaging to suggest edema or inflammation of the pericardium. Extracardiac FindingsSternal wires are present. There is diffuse low signal of the liver and spleen, which was seen on the previous study. 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 normal in size with normal systolic function. The overall LV ejection fraction is 53%. This is slightly lower than the previous exam.2. The myocardial to skeletal T2 ratio and global relative enhancement are normal. There is no late gadolinium enhancement. The native T1 myocardial relaxation time is stable, and the ECV is marginally elevated from previous.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%. This is similar to the previous previous exam. 4. Mild tricuspid regurgitation. 5. See extracardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 54-year-old male with right lateral epicondylar pain and weakness. LIGAMENTS: The radial collateral ligament is intact. No other significant abnormalities are identified.TENDONS: There is a 1 cm area of increased signal intensity at the attachment of the common extensor tendon to the lateral epicondyle, suggestive of partial intrasubstance tear. Minimal adjacent soft tissue edema is present.ARTICULAR SURFACES AND BONE: The osseous structures and articular surfaces are normal in appearance. No joint effusion is identified/SURROUNDING STRUCTURES: There is minimal soft tissue edema adjacent to the lateral epicondyle.ADDITIONAL

Output: Moderate signal abnormality of the common extensor tendon at its insertion site to the lateral epicondyle, suggestive of partial intrasubstance tear.


Instruction: Generate impression based on findings.

Input: Prostate cancer status post prostatectomy with rising PSA PELVIS:PROSTATE:Prostate Size: Status post prostatectomy. No definite residual prostatic tissue seen.Seminal Vesicles: Surgically absent.BLADDER: 3 x 3 mm enhancing polypoid lesion along the posterior inferior bladder wall.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post prostatectomy without residual prostatic tissue evident.2.3 mm enhancing polypoid lesion along the posterior inferior bladder wall, suspicious for a primary bladder neoplasm. Evaluation with cystoscopy may be helpful.


Instruction: Generate impression based on findings.

Input: Male 64 years old Reason: hydronephrosis? History: CKD, aki Limited by body habitus.RIGHT KIDNEY: 10 cm in length. Normal echogenicity. No hydronephrosis or hydroureter.LEFT KIDNEY: 12.4 cm in length. No hydronephrosis or hydroureter.URINARY BLADDER:No significant abnormality noted.OTHER: Trace ascites. Perisplenic varices.

Output: No hydronephrosis. Trace ascites. Perisplenic varices which are also seen on the CT of 11/16/2015.


Instruction: Generate impression based on findings.

Input: History of partial right nephrectomy. Type II papillary renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology. There is an 8 mm focus in segment 7 of the liver (series 11/26) which is mildly T2 hyperintense and demonstrates arterial enhancement. A similar segment 5 8-mm focus is present (series 11/60). There is no rim enhancement, washout, restricted diffusion or interval growth of these lesions.There is no ductal dilatation or vascular abnormality. Normally distended gallbladder.SPLEEN: Subcentimeter perihilar splenules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes from a prior right renal inferior pole partial nephrectomy. No evidence of residual or recurrent disease in the surgical bed. No regional lymphadenopathy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel are normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Subcentimeter segment 7 and 5 arterially-enhancing lesions are difficult to characterize given their small size, but they have no suspicious imaging characteristics, such as rim enhancement, washout, restricted diffusion or interval growth of these lesions. These may reflect perfusional abnormalities. Attention to these lesions on follow-up surveillance imaging is recommended.2. Postsurgical changes from right inferior pole partial nephrectomy without evidence of recurrent disease.


Instruction: Generate impression based on findings.

Input: 34 years Female (DOB: 10/17/1981)Reason: ? Spinal cord process History: L sided hypotensionPROVIDER NAME: MICHAEL A WARD NAOUM P ISSA MRI brain: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 an air-fluid level in the left maxillary sinus. There is partial desiccation of the left frontal sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No intracranial mass lesion or other explanation for the patient's generalized weakness is appreciated.2.There is no compromise of the cervical spinal canal and no abnormal enhancing lesion within the cervical spine.3.There is an air-fluid level in the left maxillary sinus. The possibility of an acute sinusitis cannot be excluded. Please correlate with patient's clinical evaluation.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other cervical disc displacement, unspecified cervical regionClinical question: herniated disk The cervical vertebral bodies are appropriate in overall alignment and height. Since the prior exam the patient is undergone anterior fusion at C4-5. A previously noted disc extrusion at C4-5 has been removed.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a diffuse disc bulge associated with posterior ligamentum flavum hypertrophy as well as uncovertebral osteophytes. There is effacement of spinal fluid ventral and posterior the spinal cord at this level associated with mild flattening the spinal cord. Compared to the previous exam this has not progressed significantly. There is spinal stenosis of a moderate degree present at this level. There is mild encroachment of the exiting nerve roots within the neural foramina at this level.At C4-5 there is no significant compromise to the spinal canal. The patient is status post anterior fusion at this level and removal of disc protrusion. There is mild encroachment of the left-sided exiting nerve roots within the neural foramen at this level. There is subtle cord signal hyperintensity present this level which was also present on the preoperative exam.At C5-6 there is no significant compromise to the spinal canal. There is a mild disc bulge present at this level associated with some mild ligamentum flavum hypertrophy. There is mild encroachment of left-sided exiting nerve roots related to a small disc protrusion and some uncovertebral osteophytes.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level associated with some mild ligamentum flavum hypertrophy.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is moderate spinal stenosis and mild encroachment of exiting nerve roots present at C3-4 related to a degenerative changes which has not progressed since the prior exam.2.Status post anterior fusion at C4-5 with alleviation of spinal stenosis due to a large disc extrusion.3.There is encroachment of left-sided exiting nerve roots at C4-5 related to disc disease and uncovertebral osteophytes.4.There is mild encroachment of left-sided exiting nerve roots at C5-6 due to degenerative changes.


Instruction: Generate impression based on findings.

Input: Female 16 years old Reason: Chiari malformation and syrinx, yearly eval for changes, Cervical spine: Redemonstrated are findings of Chiari I with peg-like cerebellar tonsils measuring up to 17 mm below the foramen magnum and unchanged. There remains severe crowding at the foramen magnum with effacement of the anterior and posterior CSF spaces and severely diminished biphasic flow. There is unchanged retroflexed configuration of the odontoid which contributes to the foramen magnum narrowing.Overall, no significant change in syringomyelia which extends from C3 to T11. It measures 2 x 7 mm at the C6 level in the AP and transverse dimensions in the axial plane. There appears to be tiny decrease at certain levels, for example measuring 1.9 mm in the sagittal plane at C7, previously 2.6 mm .The vertebral body heights and intervertebral disk spaces are maintained. The alignment is anatomic. No bone marrow signal abnormalities. No significant disc disease, spinal canal or neural foraminal stenosis. No significant change in CSF signal structure in the posterolateral right spinal canal at the C1 level measuring 8 x 4 mm which may represent a pocket of CSF/arachnoid cyst. Thoracic spine: Syringomyelia extending to T11 as described above with areas appearing stable to minimally smaller in the interval. The vertebral body heights are maintained. Thoracic dextroscoliosis and thoracolumbar levoscoliosis again noted and better assessed on standing radiographs. No bone marrow signal abnormalities. Mild degenerative changes including disc osteophyte complex at T11-12. No significant spinal canal or neural foramen stenosis.Lumbar Spine: The vertebral body and intervertebral disk heights are maintained. The alignment is anatomic. No bone marrow signal abnormalities. The conus medullaris terminates at the L1 level and the filum terminale is within normal limits. No significant spinal canal or neural foramen narrowing.

Output: Compared to 8/7/2014, no significant change in findings of Chiari I with cervico-thoracic syrinx extending from C3 to T11. Upper thoracic dextroscoliosis and thoracolumbar junction levoscoliosis better assessed on standing radiographs.


Instruction: Generate impression based on findings.

Input: Clinical question: Headache. Signs and symptoms: Headache. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates few punctate foci of FLAIR hyperintensity primarily in the subcortical white matter of bilateral frontal lobes without evidence of hemorrhagic changes or enhancement. Findings are nonspecific however considering patient's stated age possibility of demyelinating disease or small vessel ischemic stroke to be considered.The anatomical morphology and the signal intensity of brain parenchyma is otherwise within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal enhancement of brain parenchyma or the leptomeninges.Unremarkable images through the orbits and including axial fat sat post enhanced series.Calvarium and soft tissues of the scalp demonstrate normal signal intensity and without abnormal enhancement.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Negative diffusion weighted images.2.Few punctate nonspecific foci of FLAIR hyperintensity only in the subcortical white matter of frontal lobes as detailed.3.Unremarkable pre and post enhancement brain MRI otherwise as detailed above.4.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Right cavernous sinus meningioma: surveillance. There are postoperative findings related to right pterional craniotomy with encephalomalacia and gliosis in the anterior right temporal lobe. There is a dural-based, enhancing mass in the right cavernous sinus region, measuring up to 12 mm in thickness, which is not significantly changed. A petroclival portion of the tumor abuts the pons, extension of the tumor into Meckel's cave compresses the trigeminal nerve roots, and sellar extension of tumor abuts the pituitary gland. There is persistent marked narrowing of the right integral carotid artery by the tumor. There are a few scattered nonspecific foci of cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits are grossly unremarkable.

Output: No significant interval change in the right cavernous sinus region meningioma.


Instruction: Generate impression based on findings.

Input: Female 29 years old Reason: Right shoulder pain evaluate for rotator cuff tear, biceps injury History: Right shoulder pain ROTATOR CUFF: Small degenerative cysts in the humeral head at the insertion of the supraspinatus without evidence of tearing. The rotator cuff is intact. SUPRASPINATUS OUTLET: Type I acromion. Moderate osteoarthritis affects the acromioclavicular joint with subchondral cysts.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is well seated at the glenoid. No evidence of labral tear.BICEPS TENDON: The biceps tendon is well seated within the bicipital groove and normal in appearance. ADDITIONAL

Output: Osteoarthritis without evidence of rotator cuff tear or biceps injury as clinically questioned.


Instruction: Generate impression based on findings.

Input: Female, 50 years old. R posterior arm palpable mass A palpable marker is placed over the posterior lateral aspect of the arm, near the level of the mid humeral diaphysis. The imaged soft tissues of the right arm are unremarkable, without focal areas of abnormal enhancement, solid mass lesions, or discrete fluid collections. The visualized neurovascular structures are grossly unremarkable.The underlying osseous structures are unremarkable, with normal cortical thickness and marrow signal.

Output: No focal abnormality to account for the patient's symptoms. Note: On MR images, some palpable subcutaneous lipomas cannot be readily distinguished from surrounding normal fat.


Instruction: Generate impression based on findings.

Input: Ms. Schiller submitted outside studies for review. Submitted for review are:-Right breast diagnostic mammogram: 8/1/2016-Bilateral breast ultrasound: 8/1/2016-Left breast ultrasound-guided biopsy: 8/2/2016-Bilateral breast MRI: 8/17/2016-Bilateral breast ultrasound: 8/24/2016-Left breast diagnostic mammogram: 8/24/2016The right breast diagnostic mammogram and bilateral breast ultrasound dated 8/1/2016, and left breast ultrasound-guided biopsy dated 8/2/2016 were performed at Diagnostic Imaging Specialists of Chicago. The bilateral breast MRI dated 8/17/2016, bilateral breast ultrasound dated 8/24/2016, and left breast diagnostic mammogram dated 8/24/2016 were performed at Rush University Medical Center.For comparison, bilateral screening mammograms dated 11/4/2013, 12/4/2014, and 11/19/2015 and bilateral breast ultrasound dated 5/19/2015 are available. RIGHT BREAST DIAGNOSTIC MAMMOGRAM: CC, MLO, ML, and spot compression views of the right breast are submitted.The breast parenchyma is heterogeneously dense, which may obscure small masses. There is a BB marker overlying the lower inner right breast. No suspicious masses, microcalcifications or areas of architectural distortion are seen in the right breast. BILATERAL BREAST ULTRASOUND: Static ultrasound images are submitted.In the area labeled palpable in the right breast, along the 1:00 radian, there is an 8 x 7 x 4 mm simple cyst. There are subcentimeter cysts in the right breast at the 4:00 and 9:00 positions.In the left breast, 2-3:00 position, 5 cm from the nipple, there is an irregular mass with posterior shadowing and internal vascularity. This mass measures 9 x 7 x 5 mm. There are additional subcentimeter cysts in the left breast at the 12:00, 1:00, 2:00, 7:00, 9:00, 10:00, and 11:00 positions.ULTRASOUND-GUIDED BIOPSY, LEFT BREAST: Static ultrasound images are submitted.The irregular mass in the left breast at the 2-3:00 position was targeted for biopsy. Targeting appears appropriate. Biopsy clip is seen within the target mass.Postprocedure mammogram demonstrates a lock-shaped biopsy clip in the central outer left breast at posterior depth. There are grouped calcifications in the upper inner left breast, which appear similar to prior studies dating back to 2013.BILATERAL BREAST MRI: Multiple enhanced MR sequences are submitted per outside institution protocol.There is heterogeneous fibroglandular tissue. There is mild background parenchymal enhancement. There are bilateral enhancing foci, none more suspicious than the rest.Left breast:There is susceptibility artifact from biopsy clip centered within a 9 x 9 x 9 mm enhancing mass in the central outer left breast, corresponding to biopsied malignancy. A few typically benign foci of enhancement with internal non-enhancing areas are seen. These may represent small fibroadenomas. Right breast:There is a 6 x 6 x 6 mm irregular enhancing mass in the central slightly inner right breast at mid-depth. This mass demonstrates mixed enhancement kinetics with areas of rapid wash in and washout. Elsewhere a few typically benign enhancing foci are also seen.BILATERAL BREAST ULTRASOUND: Static ultrasound images are submitted.In the left breast, 3:00 position, there is a 6 mm hypoechoic mass, corresponding to biopsied malignancy. There is a subcentimeter cyst in the left breast at the 6:00 position.There are subcentimeter cysts in the right breast at the 9:00 and 2:00 positions.LEFT BREAST DIAGNOSTIC MAMMOGRAM: CC, MLO, ML, and spot magnification views of the left breast were submitted.A lock-shaped biopsy clip is seen in the central outer left breast at posterior depth. Again seen are grouped calcifications in the upper inner left breast, which appear similar to prior studies dating back to 2013 and demonstrate benign morphology on spot magnification views.OUTSIDE PATHOLOGY (per outside report):Left breast mass, ultrasound-guided biopsy: Invasive ductal carcinoma, grade 1

Output: 1. Biopsy-proven left breast invasive ductal carcinoma. Surgical management of known malignancy is recommended.2. Indeterminate 6 mm irregular enhancing mass in the central slightly inner right breast at mid-depth. No sonographic correlate was identified on outside imaging. MR-guided biopsy is recommended based on the lack of sonographic correlation. Follow up MRI in 6 months for the typically benign enhancing foci is also recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 11-year-old girl with history of shoulder pain and palpable posterolateral chest wall mass. ROTATOR CUFF: No abnormality noted. Normal signal is seen in the rotator cuff tendons.SUPRASPINATUS OUTLET: No abnormality seen in the supraspinatus outlet.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is anatomic. Although this is not an arthrogram, no gross labral tear is identified. There is no joint effusion.BICEPS TENDON: The biceps tendon is intact and appropriately located in the bicipital groove. Minimal amount of bicipital tendon sheath fluid is normal.ADDITIONAL

Output: Normal examination. Specifically, no mass at the marked site.


Instruction: Generate impression based on findings.

Input: 80 years, Female, altered mental status. Evaluate for etiology of mental status decline. There is moderate degree of restricted diffusion involving the right frontal and anterior parietal lobes including the cortex and subcortical white matter with corresponding FLAIR hyperintensity and is new since 4/23/2015. There is extensive confluent T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which is otherwise similar to prior. Encephalomalacia involving the right parietal lobe posteriorly is unchanged. Extensive encephalomalacia involving the left basal ganglia with FLAIR hyperintensity extending into the subinsular white matter and left thalamus is also unchanged. There is FLAIR hyperintensity extending along the left corticospinal tracts which is similar to prior and consistent with Wallerian degeneration. There is extensive enhancement involving the right frontoparietal cortex corresponding to the region of restricted diffusion and extending into the subcortical and deep white matter, new since prior.There is ex vacuo dilatation, particularly of the left lateral ventricle without evidence of hydrocephalus. Multiple foci of susceptibility effect including the left frontal lobe, left temporal lobe, and left parietal lobe are unchanged and consistent with chronic microhemorrhages. No intracranial mass or mass effect. No extra-axial collections. Major arterial flow-voids are present. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: 1. Late acute to subacute infarct involving the right frontal and right parietal lobes.2. Advanced chronic small vessel ischemic disease and multiple chronic infarcts including the right posterior parietal lobe and the left basal ganglia. Evidence of Wallerian degeneration along the left corticospinal tract. Unchanged scattered chronic microhemorrhages, which may be related to amyloid angiopathy but nonspecific.Dr. Ali discussed findings with Dr. Tang at 1350 hours on 8/26/2015.


Instruction: Generate impression based on findings.

Input: Speech delay, hyperreflexia. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a normal degree of myelination. 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.Spine: 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 conus medullaris is positioned at the L1 level. There is no evidence of intraspinal mass lesions. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial anomalies.2. No evidence of spine anomalies.


Instruction: Generate impression based on findings.

Input: Male 53 years old with left shoulder pain. Evaluate degree of degenerative changes. There is mild acromioclavicular and glenohumeral joint osteoarthritis. There may be an os acromiale. There are cysts in the greater tuberosity at the expected site of insertion of the rotator cuff, and the humeral head appears high riding on the transscapular view. If there is clinical concern for rotator cuff tearing, MRI may be considered.

Output: Osteoarthritis and other findings as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate epidural fluid. Signs and symptoms: Status post AP CSF leak into epidural space causing back pain and headache. Nonenhanced brain MRI:Diffusion weighted images nondiagnostic due to fairly extensive artifact from patient's dental braces.There is evidence of prior suboccipital Chiari decompression.There is also deterioration of images on other MRI sequences secondary to metallic artifact however they remain diagnostic.Examination demonstrates no detectable intracranial abnormality beyond the artifact that obscures the lower aspect of frontal lobes and anterior bilateral temporal lobes.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and alignment into the brain are unremarkable. The signal void of major intracranial arterial branches are identified. There is intensity of intracranial venous sinuses are beginning normal. Calvarium and soft tissues of the scalp are unremarkable.Images through the paranasal sinuses, orbits are nondiagnostic due to extensive artifact.Nonenhanced total spine MRI:Examination demonstrate expected postoperative changes of Chiari decompression with expansion of subarachnoid space. On sagittal images there is pointed tenting deformity of the posterior cerebellum toward the surgical site/dura which may represent a focus of adhesion.The signal intensity and caliber of the cord remains within normal and in particular no evidence of syrinx is detected. There is no evidence of abnormal signal intensity or fluid collection in the epidural space to suggest CSF leak. There is a thin band of T2 hyperintensity under the subcutaneous fat extending from T11 to L5 (sagittal T2 series 1101 image 10 ) which could represent fluid and possibly as result of CSF leak. This finding measures maximum of 3.5-mm in thickness and overall 152-mm in length. No axial images were acquired on this exam.  There is no evidence of a spinal canal or neural foraminal compromise at any level.CSF flow study is deteriorated secondary to metallic hardware artifact from patient's braces. Within this limitation however the study demonstrate normal biphasic flow through the foramen magnum both anterior and posterior to the cord. There is also detectable flow through the fourth ventricle and the aqueduct.

Output: 1.Nonenhanced brain MRI images are degraded due to extensive metallic artifact from patient's dental braces. Beyond the artifacts examination demonstrate no evidence of intracranial pathology. Expected postoperative changes of Chiari decompression is noted.2.Total spine MRI demonstrate expected postoperative changes of Chiari decompression as detailed. No detectable CSF leak into the epidural space. A thin band of fluid signal intensity under the subcutaneous fat extending from T11 to L5 and measuring maximum of 3.5-mm in thickness which could represent fluid and CSF leak. No axial images were acquired on this study. Normal signal intensity and caliber of the cord. Normal CSF flow study at the level of foramen magnum.