Instruction: Generate impression based on findings.

Input: 42 year old male with a history of traumatic pericardial effusion, pericarditis referred for cardiac MRI for constriction. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 108 ml/m2 (normal range: 74+/-15), the LVEDV is 240 ml (normal range 142+/-34), the LV end systolic volume index is 57 ml/m2 (normal range 25+/-9), the LVESV is 128 ml (normal range 47+/-19), the LV mass index is 31 g/m2 (normal range 85+/-15), and the LV mass is 69 g (normal range 164+/-36). There is global hypokinesis There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation time is normal (~1030 ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 91 ml/m2 (normal range 82+/-16), the RVEDV is 199 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 106 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and at least mild 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 pseudo-bovine aortic arch. 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.PericardiumSmall pericardial effusion some of which does not appear to be free-flowing. There is thickening of the pericardium. There is hyperenhancement of the pericardial sac on T2-Stir imaging suggestive of inflammatory process of the pericardium. There is evidence of pericardial late gadolinium enhancement. There is evidence of mild respirophasic septal shift during free breathing which is consistent with constrictive physiology. With tagged imaging there is a suggestion of tethering of the pericardium.Extracardiac FindingsSmall left pleural effusion with left lower lobe atelectasis. 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 mildly reduced systolic function (LVEF 46%).2. The right ventricle is normal in size with mildly reduced systolic function (RVEF 47%). 3. Small pericardial effusion some of which does not appear to be free-flowing. 4. Evidence of acute pericarditis with thickening of the pericardium. There is hyperenhancement of the pericardial sac on T2-Stir imaging suggestive of an acute inflammatory process of the pericardium. There is also evidence of pericardial late gadolinium enhancement. 5. Mild respirophasic septal shift during free breathing which is consistent with constrictive physiology.Tagged imaging suggestion possible tethering of the pericardium. 6. This constellation of findings are consistent with acute pericarditis with possible early pericardial constrictive physiology. Follow-up and clinical correlation suggested.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 11 years old Reason: h/o osteomyelitis, now with fevers s/p SCT, please eval for ?progression of osteo History: fevers s/p SCT with broad spectrum Abx There is no evidence of cellulitis, osteomyelitis or abscess. Normal bone marrow and soft tissues as well as cortical bone signal.

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Significant decline in vision OD, concern for compressive/ischemic optic neuropathy OD: afferent pupillary defect and loss of color OD. Orbits: The bilateral globes, optic nerves, and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.Brain: There is high T2 signal and enhancement of the optic chiasm and prechiasmatic optic nerves, right more than left, with minimal swelling. There are a few punctate foci of non-enhancing white matter T2 hyperintensity in the bilateral frontal lobes. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, cerebellum, brainstem, 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 skull and scalp soft tissues are grossly unremarkable. There are left maxillary ans sphenoid sinus retention cysts.

Output: Enhancement of the optic chiasm and prechiasmatic optic nerves, right more than left is compatible optic neuritis and a few nonspecific punctate white matter lesion in the unilateral frontal lobes. An autoimmune demyelinating process is a possible etiology, but other considerations include a subacute ischemic event or toxic-metabolic exposure, or perhaps even a neoplastic process, such as lymphoma.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Reason: eval for acl tear; chondromalacia and medial retinaculum tear History: knee pain and instability and history of dislocations for years MENISCI: Globular signal within the medial meniscus is consistent with intrasubstance degeneration but we see no discrete meniscal tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is fraying of the articular cartilage of the weightbearing portion of the medial compartment. There is also fraying of the articular cartilage of the lateral tibial plateau along the intercondylar eminence. The femoral trochlea is shallow, indicating dysplasia. We see no bone marrow edema.LIGAMENTS: The collateral and cruciate ligaments appear intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. We see no fluid signal intensity traversing the medial retinaculum. However, there is ossification along the medial facet of the patella, presumably reflecting old injury to the retinaculum at its insertion. ADDITIONAL

Output: 1. Femoral trochlear dysplasia. Ossification along the medial facet of the patella presumably represents prior injury at this site given the history of prior patellar dislocation.2. Articular cartilage degeneration as described above.3. Normal-appearing ACL.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for multiple sclerosis. Patient has some in cervical spine and has a left foot drop. Signs and symptoms: Left foot drop. Pre and post enhanced thoracic MRI:Examination demonstrates no convincing evidence of any lesion within the cord or abnormal enhancement of the cord/leptomeninges.The signal intensity and caliber of thoracic cord remains within normal.There is also normal anatomical alignment of vertebral column and no evidence of central spinal stenosis or clinically significant neural foraminal compromise at any level.No detectable abnormal enhancement of the vertebral column.Unremarkable. Spinal soft tissues.Pre- and post enhanced lumbar MRI:Examination demonstrates normal signal intensity, morphology and caliber of the lower most visualized thoracic cord, conus and cauda equina without detectable abnormal enhancement.T11-T12 demonstrate mild degenerative changes and unremarkable otherwise.T12-L1 demonstrate mild degenerative changes and unremarkable otherwise.L1-L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy without central spinal stenosis however mild right neural foraminal compromise is noted.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate bilateral facet and ligamentum flavum hypertrophy and a small right lateral shallow disc protrusion. Constellation of findings results in moderate central spinal stenosis and mild-to-moderate right neural foraminal compromise.L4-L5 demonstrate mild to moderate disc disease and loss of disc height, moderate to severe bilateral ligamentum flavum and mild to moderate facet hypertrophic changes are noted at this level. Constellation of changes at this level results in moderate to severe central spinal stenosis and mild to moderate left neural foraminal compromise.L5-S1 demonstrate mild disc disease and moderate facet hypertrophic changes. No spinal stenosis however moderate to severe left neural foraminal compromise is present.Incidental note is made of multiple nonenhancing well-demarcated cyst like lesions in the liver. Follow-up with dedicated imaging including ultrasound is recommended.

Output: 1.Pre- and post enhanced MRI of thoracic spine demonstrate no evidence of demyelinating disease. No evidence of spinal canal or neural foraminal compromise at any level.2.Pre and post enhanced MRI of lumbar spine demonstrate no evidence of demyelinating disease or abnormal enhancement. Degenerative changes at L3-4 and L4-L5 levels results in central spinal stenosis. Degenerative changes at L5-S1 resulting in moderate to severe left neural foraminal compromise and no central spinal stenosis. Please review above the detailed report per level for additional levels of neural foraminal compromise.3.Incidental note is made of multiple nonenhancing well-demarcated cyst like lesions within the liver. Follow-up with dedicated imaging including ultrasound is recommended.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for renal angiomyolipomas History: Tuberous Sclerosis. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. No fat-containing or other renal lesion identified. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No renal lesions identified. No significant abnormality.


Instruction: Generate impression based on findings.

Input: Evaluate etiology of left arm pain and paresthesias, numbness and tingling in left forearm and thumb Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is benign. Again seen are multilevel degenerative changes in the cervical spine which are minimally progressed since 5/8/2013. There is minimal interval increase in endplate marrow signal changes at C6 and C7.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is uncovertebral hypertrophy on the right resulting in mild right neural foraminal narrowing. No significant spinal canal or left neural foraminal stenosis.C4-5: No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing related to mild uncovertebral hypertrophy.C5-6: There is disk osteophyte complex and ligamentum flavum thickening with resulting mild spinal canal stenosis at this level. There is moderate to severe bilateral neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: There is disk osteophyte complex and ligamentum flavum thickening with resulting mild spinal canal stenosis at this level. No evidence of cord compression or cord signal abnormality. There is moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Degenerative changes in the cervical spine are minimally progressed compared to 5/8/2013. Again seen are disk osteophyte complexes with uncovertebral hypertrophy at C5-C6 and C6-C7 with moderate to severe neural foramina stenosis at C5-C6 and moderate neural foramina stenosis at C6-C7 bilaterally. There may be impingement of the exiting C6 and C7 nerve roots, respectively.2. No significant change in mild spinal canal stenosis at C5-C6 and C6-C7 without evidence of cord compression or cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is blunting of the free edge of the medial meniscus suggesting radial tear. The root of the medial meniscus is also not well seen. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of both the medial and lateral compartments although no discrete full-thickness defect is appreciated. There is moderate fibrillation of the patellofemoral cartilage, particularly medially.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Radial tearing of the medial meniscus with the root is not well seen. The lateral meniscus is intact.2. Mild tricompartmental articular cartilage loss.


Instruction: Generate impression based on findings.

Input: Ms. Chandler is a 49 year old female with a personal history of left breast mastectomy in 2010 for DCIS. Recent diagnostic workup in August 2016 revealed a cluster of calcifications in the right breast for which stereotactic biopsy has been recommended. Left reconstructed breast: The patient is status post left breast mastectomy with tissue based reconstruction. There is a focal area of enhancement seen superficially in the skin of the left superior breast, likely of benign etiology. There is no abnormal enhancement seen in the left reconstructed breast or chest wall.Right breast: There is heterogeneous amount of fibroglandular tissue in the right breast. In the right upper inner breast, there is a linear distribution of clumped nonmass enhancement identified measuring approximately 3.3 cm in AP dimension. This area corresponds to the mammographically detected linear distribution of calcifications, which will undergo stereotactic biopsy later today. Seen approximately 0.8 cm inferomedial to this is an additional focal area of enhancement, measuring up to 0.4 cm. This likely corresponds to an additional small cluster of calcifications seen medial to the index calcifications on the diagnostic mammogram.Total span of abnormal enhancement measures approximately 3.3 x 2.2 x 2.2 cm (AP x ML x SI).Axilla: Expected post surgical changes are identified in the left axilla. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) 3.3 cm span of linear clumped nonmass enhancement in the right upper inner breast, corresponding to the mammographically detected calcifications. This area will undergo stereotactic biopsy later today. Of note, there is an additional focal area of enhancement seen 0.8 cm inferomedial to the index enhancement, corresponding to an additional small cluster of calcifications seen on diagnostic mammogram.(2) Focal area of enhancement seen superficially in the skin of the left superior breast, corresponding to a bug bite seen on the patient's skin upon visual inspection. No MRI evidence of malignancy of the left reconstructed breast.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: Tiny cysts are noted along the root of the posterior horn of the medial meniscus although no tear is identified.ARTICULAR CARTILAGE AND BONE: Mildly increased signal of the articular cartilage of the medial patellar facet is noted. There is no fluid-filled defect present.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Mild degeneration of the articular cartilage of the medial patellar facet without evidence of full-thickness defect. Additional findings described above.


Instruction: Generate impression based on findings.

Input: Cirrhosis with history of HCC status post resection and RFA. ABDOMEN:LIVER, BILIARY TRACT: Relatively stable segment 6 ablation cavity measures approximately 5.8 x 5.7 cm, compared to 5.8 x 4.8 cm previously, and contains T1 weighted hyperintense proteinaceous/hemorrhagic debris.Relatively stable segment 5 ablation cavity measures approximately 3.9 x 3.7 cm (series 11/124), compared to 3.6 x 2.5 cm previously and contains T1 weighted hyperintense proteinaceous/hemorrhagic debris.No evidence of residual or recurrent disease along the ablation margin.The segment 8 arterial enhancing focus in the right hepatic dome measures approximately 1.1 x 0.8 cm (series 11/19) without evidence of washout on portal venous or delayed phase imaging. This may represent a perfusional anomaly. Attention to this lesion on subsequent surveillance imaging is recommended.Cirrhotic liver morphology with mild fibrotic changes. No intrahepatic or extrahepatic biliary ductal dilatation. The vessels are patent. Cholelithiasis without evidence of cholecystitis.SPLEEN: The spleen is normal in morphology without a focal lesion. The spleen measures 12 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing renal cysts. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes at the level of the right-sided Spigelian hernia repair.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver with relatively stable postablation zones without evidence of recurrent or residual marginal lesion.2.Stable enhancing focus in segment 8 is unchanged and may represent a perfusional anomaly, attention to this on subsequent surveillance imaging is recommended.


Instruction: Generate impression based on findings.

Input: 67-year-old female with left hip pain, only temporary relief from injection x2. ACETABULAR LABRUM: The acetabular labrum cannot be well-visualized likely secondary to underlying degenerative changes as described below.ARTICULAR CARTILAGE AND BONE: There is marked bone marrow edema within the left acetabulum and femoral head with associated partial collapse of the femoral head. On the sagittal sequences there is a 'double line' sign within the femoral head which is convincing evidence of underlying avascular necrosis. There are secondary osteoarthritic changes related to the aforementioned avascular necrosis and femoral head collapse with associated joint space narrowing.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Findings compatible with avascular necrosis of the left femoral head with associated partial collapse and secondary osteoarthritic changes as described above.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with neck pain status post MVA. The cervical lordosis is straightened which may reflect positioning. Sagittal alignment is otherwise unremarkable. Vertebral body morphology and signal characteristics are within normal limits. The spinal cord is normal in caliber and signal. No epidural abnormalities are suspected. The paraspinal soft tissues and ligaments all appear intact.The spinal canal is congenitally narrow with additional level specific findings as follows.C2-3: Unremarkable. C3-4: Mild right uncovertebral hypertrophy. No significant spinal canal or foraminal stenosis. C4-5: Mild right uncovertebral hypertrophy. Mild right foraminal narrowing. No significant spinal canal stenosis. C5-6: Mild posterior disc-osteophyte complex formation. Mild to moderate spinal canal narrowing. Mild bilateral foraminal narrowing.C6-7: Mild posterior disc-osteophyte complex formation. Mild to moderate spinal canal narrowing. Mild bilateral foraminal narrowing. C7-T1: Unremarkable.

Output: 1.Relatively mild disc degeneration which, in correlation with a congenitally narrow spinal canal, results in spinal canal stenosis at C5-6 and C6-7.2.No evidence of any acute or posttraumatic spinal abnormality is seen.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: metastatic NSCLC with new brain metastases s/p radiosurgery; please evaluate for responseSigns and Symptoms: brain metastases The CSF spaces are appropriate for the patient's stated age with no midline shift. A previously measuring 5 mm nodule in the right cuneus near the parieto-occipital sulcus now measures 2 mm. A ring-enhancing lesion in the right occipital lobe previously measuring 6 mm now measures 3 mm. A right cerebellar lesion measuring 4 mm on the prior exam now measures 2 mm. A left cerebellar lesion previously measuring 2 mm is not readily identified.A 14 mm x 7 mm FLAIR signal hyperintensity along the left superior frontal gyrus subcortical white matter remains stable.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images which are not associated with contrast enhancement and are stable compared to the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam multiple enhancing nodules in the occipital lobes and cerebellum have decreased in size.


Instruction: Generate impression based on findings.

Input: Right optic neuritis, question demyelination. There is abnormal enhancement involving the prechiasmatic right optic nerve at the level of the optic canal and immediately posteriorly. Evaluation of the bilateral orbits is otherwise unremarkable without evidence of masses. Extraocular muscles appear unremarkable. Outside MRI from 2/11/2015 is limited however demonstrates some abnormal enhancement involving the right prechiasmatic optic nerve.Remainder of the brain demonstrates multiple foci of T2/FLAIR hyperintensity scattered in the supratentorial white matter. These lesions are nonspecific distribution although demyelination not excluded. Relatively largest of these focus is in the right parietal lobe and adjacent to prominent perivascular spaces.No intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement is seen within the remainder of the brain. Major flow-voids are preserved. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. T2 hyperintensity and enhancement involving the right prechiasmatic optic nerve at the level of the optic canal and immediately posteriorly. Finding is compatible with optic neuritis. Outside study from 2/11/2015 is technically degraded but also demonstrates enhancement within this location.2. Multiple scattered T2/FLAIR hyperintensity in the periventricular and subcortical white matter in the brain have a nonspecific appearance and distribution and may reflect mild chronic small vessel ischemic disease or prior inflammation/infection, with demyelinating disease not entirely excluded. No abnormal enhancement is seen within the remainder of the brain to suggest an active infectious/inflammatory or neoplastic process.


Instruction: Generate impression based on findings.

Input: 62-year-old male with and urinary incontinence. Evaluate for spinal cord compression. Exam is limited by motion. No cord compression is identified although a small posterior epidural fluid collection versus epidural thickening may be present within the lower lumbar spinal canal which is contributing to crowding of the thecal sac. Apparent cord signal abnormalities within the cervical and thoracic spine are most likely artifact. The vertebral bodies are appropriate in the overall alignment and height. There are multilevel degenerative changes involving the cervical spine especially spanning the C3-4 through C6-7 levels where there is mild to moderate spinal canal stenosis at these levels secondary to disc osteophyte complexes. The spinal canal is narrowed in this region and there may be some degree of chronic cord impingement. There is degenerative anterolisthesis of L4 on L5 and degenerative loss of disc height most prominently involving L4-5 and L5-S1 with disc bulges. Advanced facet arthropathy is seen at L4 and L5 with facet effusions and substantial edema within the facet complexes and pedicles. There is at least moderate neuroforaminal narrowing involving the right L4-5 level. The superior pole of the left kidney, which is only partially visualized, seems subjectively enlarged and abnormal in shape.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified although a small posterior epidural fluid collection versus epidural thickening may be present within the lower lumbar spinal canal which is contributing to crowding of the thecal sac. Dedicated lumbar MRI imaging is recommended for further evaluation.Additional multilevel degenerative changes visualized within the cervical and lumbar spine are as described above. Advanced facet arthropathy at L4 and L5 is seen with significant edema in the marrow and surrounding soft tissues. While this could all be inflammatory and related to severe degeneration, the possibility of superimposed infection is not excluded.The superior pole of the left kidney seems subjectively enlarged and abnormal in shape for which dedicated renal imaging can be obtained if clinically warranted.


Instruction: Generate impression based on findings.

Input: Swelling and pain over medial malleolus. Evaluate for cause of pain and swelling for several months. Question of stress fracture. Multiple normal x-rays. TENDONS: Ankle:There is enlargement of the posterior tibialis tendon with increased fluid sensitive signal surrounding the tendon compatible with tendinopathy. Additionally there is a small amount of fluid sensitive signal around the anterior tibialis tendon which is abnormal. The remaining tendons of the anterior and lateral compartments are normal in appearance. There is a thin longitudinal stripe of high T1 and faint T2 signal within the Achilles tendon which may be related to remote injury. Forefoot/midfoot:The tendons appear intact. LIGAMENTS: Ankle:The deltoid ligament is intact. The anterior and posterior talofibular ligament is intact.Forefoot/midfoot:The ligaments appear intact.ARTICULAR SURFACES AND BONE: Ankle:A T2 hyperintense lesion within the lateral aspect of the navicular bone likely represents a cyst. No fracture is evident. There is mild edema of the medial aspect of the anterior talus.Forefoot/midfoot: Bone marrow signal is within normal limits. No fracture is evident.ADDITIONAL

Output: 1. Enlarged posterior tibialis tendon with fluid in the tendon sheath is compatible with tendinopathy and tenosynovitis.2. Mild anterior tibialis tendon tenosynovitis.3. No fracture is evident.


Instruction: Generate impression based on findings.

Input: Reason: evaluate worsening lumbar degeneration History: left back/hip/thigh pain, b/l foot drop 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. There are endplate and uncal ritual osteophytes present at this level with narrowing of the neural foramina bilaterally left worse than right and encroachment of the left sided exiting nerve roots. There is loss of disk space height and disk desiccation at this level.At C4-5 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated loss of disk space height and disk desiccation. There is associated narrowing of the neural foramina bilaterally right worse than left with encroachment of exiting nerve roots bilaterallyAt C5-6 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated loss of disk space height and disk desiccation. There is associated narrowing of the neural foramina bilaterally right worse than left with encroachment of exiting nerve roots bilaterally. Overall is a mild degree of spinal stenosis at this levelAt C6-7 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with posterior ligamentous hypertrophy and mild narrowing of the spinal canal appeared there is narrowing of the neural foramina at this level with encroachment of left sided exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is some endplate and uncovertebral osteophyte is present at this level associated with a disk bulge and some mild encroachment of the exiting nerve roots.The vertebral artery flow voids appear to be intact. Incidental note is made of partial empty sella.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disk desiccation present. Patient is status post anterior fusion at L2-3 and L3-4 as well as laminectomy at L2-3 and L3-4. There is a mild right lateral translation of L3 on L4. The patient is status post facetectomies at L3-4 and L2-3.There is mild clumping of nerve roots present at the L2-3 and L3-4 levels.There is a dextrocurvature to the lumbar spine as well as a rotatory component.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height present at this level as well as some facet hypertrophy.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge and mild facet and ligamentum flavum hypertrophy at this levelAt 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.Osteophytes are present along the sacroiliac joints bilaterally.At T10-T11 there is a disk bulge associated with posterior ligamentous hypertrophy and partial effacement of spinal fluid ventral posterior the spinal cord

Output: 1.There are degenerative change is present in the cervical spine with multilevel neural foramina encroachment of exiting nerve root as detailed above. This is stable when compared to the prior exam.2.There are are multilevel degenerative changes present in the lumbar spine status post lumbar spine surgery at L2-3 and L3-4 without significant compromise to the spinal canal and nerve roots at this time. This is stable when compared to the prior exam.3.Degenerative changes present at T10- 11with findings suggestive of a mild spinal stenosis. This is stable when compared to the prior exam.


Instruction: Generate impression based on findings.

Input: 5-year-old female with hemangiomas of intracranial structures. Clinical question: Multiple cerebral cavernous malformations brain , + CCM3 gene, history left sided weakness, headaches, yearly evaluation please do on 3T with ccm protocol. Signs and Symptoms: yearly surveillance The CSF spaces are appropriate for the patient's stated age with no midline shift. Redemonstrated is a heterogeneous pontine mass currently measuring 19 x 22 mm (previously 19 x 24 mm) as measured on the axial T2 sequence, demonstrating slight interval decrease in size primarily due to a smaller intralesional cystic cavity on the right. Fluid fluid levels are less conspicuous, and there has been expected evolution of internal hemorrhagic components. The surrounding hypointense rim is unchanged in appearance and there is no new perilesional edema.Previously identified lesions within the anterior left temporal lobe, the more posterior left temporal lobe, along the medial right periatrial white matter, and involving the right occipital lobe are unchanged in appearance.Incidental note is made of a small developmental venous anomaly within the medial right frontal lobe without associated susceptibility abnormality focus. 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 and demonstrate some mucosal thickening. The visualized portions of the mastoid air cells demonstrate partial opacification of right mastoid air cells. The visualized portions of the orbits are intact.

Output: 1.The patient's pontine cavernous malformation has decreased in size compared to the prior exam, primarily due to a smaller intralesional cystic cavity on the right. Fluid fluid levels are less conspicuous, and there has been expected evolution of internal hemorrhagic components. The surrounding hypointense rim is unchanged in appearance and there is no new perilesional edema.2.Stable cavernous malformations elsewhere.


Instruction: Generate impression based on findings.

Input: Female 47 years old with right shoulder pain and limited range of motion after trauma. Evaluate for rotator cuff pathology. Evaluation is limited due to motion artifact.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon with mild retraction of the supraspinatus muscle fibers and marked muscle atrophy. There is increased T2 signal within the infraspinatus tendon as well as thickening of the subscapularis tendon compatible with tendinopathy but no evidence of discrete tear. The teres minor tendon is intact. There is mild atrophy of the subscapularis muscle. Fluid is present within the subacromial/subdeltoid bursa.There is increased T2 signal within the supraspinatus, infraspinatus, and teres minor musculature likely secondary to atrophy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a moderate glenohumeral joint effusion. There is a irregularity of the anterior superior glenoid labrum which may be a normal variant.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL

Output: 1.Full-thickness tear of the supraspinatus tendon as described above. Severe tendinopathy of the infraspinatus and subscapularis tendons without evidence of tear.2.Edema within the supraspinatus, infraspinatus and teres minor muscles is likely secondary to atrophy.3.Moderate glenohumeral joint effusion.


Instruction: Generate impression based on findings.

Input: Headache and neck pain. Evaluate for signs of infection. History of spina bifida, tethered cord and pseudomeningocele. Also history of right suboccipital shunt placement. MRI brain:There is redemonstration of an 8 mm diameter lesion centered in the left putaminal and of the basal ganglia. It has not changed in diameter compared to the prior exam, however, has enlarged since the 3/2/2009 exam. Lipid density subependymal punctate foci of T1 signal hyperintensity are redemonstrated along the lateral ventricles and within the left sylvian fissure and are not significantly changed from the previous exam. The ventricles and basal cisterns are unchanged in size and configuration. Enhancement is noted within the soft tissues of the prior right suboccipital ventriculostomy but no fluid collections are evident. This could represent phlegmon in the appropriate clinical setting but could also represent aseptic postsurgical reaction. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI cervical spine:Limited study secondary to motion. Within these limitations the 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. No significant neuroforaminal or spinal canal stenosis. Paraspinous soft tissue structures appear within normal limits.

Output: Enhancement within the soft tissues of the prior right suboccipital ventriculostomy surgical site could represent phlegmon in the appropriate clinical setting but could also represent aseptic postsurgical reaction. No loculated fluid collection is noted.


Instruction: Generate impression based on findings.

Input: 68-year-old woman with history of PBC with multiple pancreatic cysts and liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Liver is cirrhotic in morphology with reticular increased T2 signal indicating fibrosis. A TIPS stent is patent.2 focal hepatic lesions are seen on arterial phase imaging with slightly increased T2 signal and diffusion restriction. These lesions are isointense to liver parenchyma on venous and delayed phase images. The first measures 23 x 19 mm, previously 20 x 20 mm in segment 7 (9/80). The second measures 12 x 11 mm, previously 8 x 8 mm in segment 5/6 (9/69).Prominent dilation of the extrahepatic biliary system is unchanged. There is no intrahepatic biliary ductal dilatation.SPLEEN: Borderline splenomegaly.PANCREAS: The pancreatic parenchyma is near completely replaced by cysts and has not changed in appearance significantly from 2008 study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small simple cysts bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cirrhotic morphology of liver with two arterially enhancing lesions with imaging characteristics suspicious for but not entirely diagnostic of hepatocellular carcinoma. Of note, the segment 5/6 lesion has grown slightly from the prior exam.2.Near complete replacement of the pancreatic parenchyma with cysts representing unchanged main branch and side branch type IPMNs.


Instruction: Generate impression based on findings.

Input: Reason: evaluate changes to angiomyolipomas History: tuberous sclerosis on Afinitor EXAMINATION: MR renal protocol with and without contrast. ABDOMEN:LIVER, BILIARY TRACT: Large stone is again seen in the gallbladder neck, without significant interval change. There is mild dilatation of the common bile duct but no evidence of acute cholecystitis. Hepatic signal is within normal limits. No focal lesion liver lesions are identified.SPLEEN: Normal appearance of the spleen.PANCREAS: No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple lesions are again seen throughout both kidneys, many of which represent simple and mildly complex cysts, some with evidence of previous hemorrhage. The largest lesion is a partially exophytic cystic structure in the lower pole of the right kidney, which measures up to 2.8 cm in diameter, previously 2.4 cm, slightly increased from the previous study (series 6, image 10).The reference partially exophytic lesion in the midpole of the left kidney currently measures 1.4 x 1.2 cm, previously 1.8 x 1.3 cm (series 6, image 18). This lesion is heterogeneous on T2 without microscopic fat on out of phase imaging or enhancement, as seen previously.The lesion slightly more inferior to this reference lesion in the mid/lower pole of the left kidney measures 1.6 x 0.9 cm, previously 1.8 x 1.3 cm, slightly decreased in size (series 6, image 14). This lesion also demonstrates heterogeneous signal on T2 weighted imaging as well as dropout on out of phase imaging, indicating microscopic fat, the lesion does not enhance.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.Reference lesion in the left kidney is slightly decreased when compared to the prior study. The lesion does not demonstrate enhancement or microscopic fat. Continued follow-up is recommended.2.Slight interval decrease in size in the angiomyolipoma of the mid/inferior pole of the left kidney.3.Multiple additional bilateral renal cysts, some of which demonstrate evidence of previous hemorrhage, are again seen, the largest of which in the right lower pole is slightly increased in size when compared to the prior study.4.Cholelithiasis without acute cholecystitis.


Instruction: Generate impression based on findings.

Input: Pain and swelling of right knee, evaluate for ACL, MCL, and meniscal injury. MENISCI: There is a complex, bucket-handle-like tear of the medial meniscus with displacement of meniscal tissue centrally within the medial compartment. Additionally, there is a near-full-thickness radial tear through the posterior horn of the lateral meniscus near its root at the interface with the meniscofemoral ligament of Wrisberg.ARTICULAR CARTILAGE AND BONE: There is edema within the lateral tibial plateau posteriorly representing a bone contusion. There is cyst formation in the medial tibial plateau posteriorly that we suspect is chronic. There is a focal cartilage defect along the medial femoral condyle above the torn posterior horn of the medial meniscus. There is moderate degeneration of the articular cartilage of the patella, particularly along the lateral facet, which includes foci of full-thickness cartilage loss. There is relatively mild partial thickness degeneration of the articular cartilage of the femoral trochlea centrally.LIGAMENTS: There is a full-thickness tear of the ACL with slight anterior translation of the tibia relative to the long axis of the femur. Distally, the superficial band of the medial collateral ligament appears torn, along with the patellotibial fibers of the medial retinaculum. An associated fluid collection along the anteromedial aspect of the proximal tibia likely represents a hematoma. The iliotibial band and biceps femoris tendon appear intact. Increased signal intensity within the proximal fibers of the lateral collateral ligament proper likely represents a sprain or partial tear. The popliteus tendon appears intact, although there is mild edema within the popliteus muscle. Additional edema within the soft tissues posterior to the fibular head raises concern for additional posterolateral corner (e.g., arcuate/popliteofibular ligament) injury. EXTENSOR MECHANISM: There is an incomplete tear of the patellar tendon predominantly involving the medial half of the tendon. The quadriceps tendon appears intact.ADDITIONAL

Output: Extensive injury to the knee, including medial and lateral meniscal tears, anterior cruciate and medial collateral ligament tears, tearing of the patellar tendon, and other findings as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Hallucination, new. Signs and symptoms: Altered mental status. Non-enhanced CT of brain: Physiological calcification of bilateral dentate nucleus and the posterior fossa is noted. Images through the posterior fossa otherwise negative for acute findings. There is prominence of the folia of the cerebellum and vermis for age which may represent underlying parenchymal volume loss.Heavy physiological calcification of bilateral basal ganglial is also noted. There is no evidence of acute supratentorial intracranial finding. There is prominence of cortical sulci especially in the left hemisphere for patient's stated age.Correlate with history and further follow-up with an MRI is recommended. Minimal small vessel disease of indeterminate age is suspected.

Output: 1.No evidence of acute intracranial findings.2.Minimal small vessel disease of indeterminate age is suspected.3.Physiological calcification of bilateral dentate nuclei and basal ganglia as described.4.Calvarium, visualized paranasal sinuses and mastoid air cells are unremarkable


Instruction: Generate impression based on findings.

Input: 60 year-old female. Pain posterior shoulder, at times sense of popping and pain for 24 hours. ROTATOR CUFF: We see no full thickness rotator cuff tear. There is increased signal intensity within the distal fibers of the supraspinatus tendon at the 12 o'clock position, which may reflect tendinosis and perhaps partial thickness attritional thinning. There are also small cysts in the underlying humeral head. The supraspinatus muscle is within normal limits. Mild increased signal intensity within the distal subscapularis tendon is suggestive of mild tendinosis. The infraspinatus and teres minor tendons and muscles are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint appears slightly widened with fluid in the joint, the clinical significance of which is uncertain but could be from old trauma or simply normal variation for this patient. There is a osteophyte projecting from the inferior aspect of the distal clavicle resulting in mild impression on the superior fibers of the supraspinatus muscle. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. There is no joint effusion. Mild increased signal intensity within the anterior superior labrum may reflect degeneration but we see no fluid-filled tear. The articular cartilage of the shoulder appears normal.BICEPS TENDON: Given the limitation of a non-arthrogram exam, the tendon of the long head of the biceps is unremarkable.

Output: 1. Findings suggestive of mild tendinosis and possibly mild focal attritional thinning of the distal supraspinatus tendon. We see no fluid filled discrete rotator cuff tear.2. Slight widening of the acromioclavicular joint, which may reflect old trauma or simply normal anatomic variation for this patient. There is a distal clavicular osteophyte that results in mild impression of the superior fibers of the supraspinatus muscle. A small amount of fluid in the subacromial/subdeltoid bursa may reflect a mild bursitis.3. Other findings as above.


Instruction: Generate impression based on findings.

Input: Right posterior tongue lesion at circumvallate papilla/BOT junction that was previously biopsied that revealed "low grade epithelial neoplasm". There appears to be an ill-defined lesion at the junction of the right lingual tonsil and oral tongue that measures up to approximately 12 mm. The other oropharyngeal structures and oral tongue appear to be intact. There is no evidence of significant cervical lymphoadenopathy. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable.

Output: Apparent ill-defined lesion at the junction of the right lingual tonsil and oral tongue, which likely corresponds to the biopsied neoplasm.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are scattered foci of T2 hyperintensity within the periventricular and subcortical white matter without restricted diffusion or susceptibility abnormality. There is a small focus of susceptibility hypointensity involving the right caudate head consistent with a chronic microhemorrhage. Incidental note is made of a 7 mm T2 hypointense, susceptibility hypointensity lesion along the dura overlying the right parietal lobe, consistent with an incidental tiny meningioma without mass effect upon the underlying brain. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified.

Output: 1.Mild chronic small vessel ischemic disease.2.There is a small focus of susceptibility hypointensity involving the right caudate head consistent with a chronic microhemorrhage.3.Incidental note is made of a 7 mm T2 hypointense, susceptibility hypointensity lesion along the dura overlying the right parietal lobe, consistent with an incidental tiny meningioma without mass effect upon the underlying brain.4.Negative MRA of the brain.5.Negative MRA of the neck.


Instruction: Generate impression based on findings.

Input: 75-year-old female with pancreatitis. Evaluate for mass. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense lesion with peripheral nodular enhancement in segment 4A, most likely due to a hemangioma (series 501/31). No suspicious hepatic lesions. Mild intrahepatic biliary ductal dilation with dilation of the common bile duct measuring up to 10 mm with smooth distal tapering. No evidence of obstructing mass or stone. Ampulla is noted to be bulging into the duodenum with slight mucosal thickening, likely corresponding to ampullary mucosal edema seen on recent ERCP. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Mild peripancreatic edema has decreased since prior CT. No focal pancreatic lesions. Normal caliber of the pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts and other subcentimeter T2 hyperintense lesions which are too small to characterize but likely due to additional cysts.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm, as seen on prior CT. Atherosclerotic narrowings of the abdominal aorta branch vessels also noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Biliary tree dilation without evidence of obstructing mass or stone.2. Mild peripancreatic edema has decreased since prior CT. No focal pancreatic lesions.


Instruction: Generate impression based on findings.

Input: Increased confusion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is bilateral tympanomastoid fluid. There are also secretions in the nasal cavity.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Bilateral tympanomastoid fluid may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: Reason: right knee pain History: same MENISCI: There is blunting of the posterior horn of the lateral meniscus with associated linear signal abnormality that extends to the tibial articular surface indicating a horizontal tear (image 8; series 5). The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the lateral tibiofemoral compartment appears intact. There is blistering of the articular cartilage along the anterior aspect of the weightbearing surface of the medial femoral condyle. There is a linear focus of low signal intensity within the femoral trochlear articular cartilage, centrally, likely representing a full-thickness articular cartilage cleft (image 16; series 7). There is also a near full-thickness articular cartilage cleft along the medial facet of the patella with surrounding articular cartilage degeneration. There are small tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is mild increased signal abnormality within the proximal fibers of the patellar tendon which may represent a very mild patellar tendinosis.ADDITIONAL

Output: 1. Horizontal tear of the lateral meniscus.2. Articular cartilage degeneration and full-thickness articular cartilage clefts most severely affecting the patellofemoral articulation.3. Edema interposed between the lateral femoral condyle and iliotibial band is nonspecific, but can be seen in patients with iliotibial band friction syndrome, particularly in an avid runner.4. Mild tendinosis of the patellar tendon.


Instruction: Generate impression based on findings.

Input: 64 year old male. History of Gleason 3+3=6 prostate cancer on active surveillance, with growing nodule. PELVIS:PROSTATE:Prostate Size: 2.7 x 4.7 x 3.9 cmPeripheral Zone: Diffuse heterogeneity of the peripheral zone. 2 x 3 mm T2 hypointense lesion that diffusion restricts and shows early enhancement in the medial left base is suspicious for prostate carcinoma (series 1001, image 13). Central Gland: Central gland hypertrophy.Seminal Vesicles: No invasion.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent distal external iliac lymph nodes, likely reactive.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 2 x 3 mm lesion in the medial left base suspicious for prostate cancer.


Instruction: Generate impression based on findings.

Input: 81-year-old male with pain and tingling left leg. Evaluate for lumbar radiculopathy. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is disk desiccation, moderate disk bulge, ligament flavum hypertrophy and facet arthropathy causing mild narrowing of the spinal canal at this level. There is moderate right and mild left neural foraminal stenosis. At L4-5 there is disk dessication, diffuse disk bulge, ligamentum flavum hypertrophy and asymmetric facet osteoarthritic changes, right greater than left, with associated mild to moderate right neural foraminal narrowing. There is no significant compromise to the spinal canal or right neural foramen. At L3-4 there is disk dessication, mild diffuse disk bulge, ligamentum flavum hypertrophy and facet arthropathy. There is no significant narrowing of the spinal canal or neural foramina.At L2-3 there is disk dessication, minimal disc bulge with no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: Multilevel degenerative disk disease predominantly affecting the lower spine as described above related to disk bulge, ligamentum flavum hypertrophy and facet osteoarthritic changes.


Instruction: Generate impression based on findings.

Input: Asymptomatic 59 year old woman presents for routine screening mammography. Personal history of benign right breast biopsy in December 2011. Family history of breast cancer in mother, two sisters, maternal cousin, and four paternal cousins. Mild parenchymal enhancement is noted bilaterally. Scattered fibroglandular densities seen in both breasts. The multiple enhancing foci in both breasts, right greater than left, are unchanged from prior the study and without unique enhancement pattern. The lobulated mass in the right breast 9 o'clock position is stable compared to prior, though slightly smaller compared to 11/23/11 No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 68 year old man with a past medical history of HFrEF (LVEF=22%), CVA x3, DVT, HTN presenting with SOB. Referred for cardiac MRI to assess myocardial viability Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 23%. The LVEDV is 258 ml (normal range 142+/-34), the LV end diastolic volume index is 153 ml/m2 (normal range: 74+/-15), the LVESV is 198 ml (normal range 47+/-19) and the LV end systolic volume index is 117 ml/m2 (normal range 25+/-9). The LV mass is 177 g (normal range 164+/-36) and the LV mass index is 105 g/m2 (normal range 85+/-15). There is global left ventricular systolic dysfunction with regional variation. The basal septum is hypertrophied (20mm). There is akinesis of the inferior, inferolateral and lateral walls. There is a basal inferolateral aneurysm with apical dyskinesis. - There is transmural (>50%) late gadolinium enhancement in the basal to mid inferolateral and lateral walls. This area is not viable. - There is subendocardial late gadolinium enhancement in the mid-apical antero-septum. This region is of intermediate viability.- There is transmural late gadolinium enhancement at the apical cap (>50%). This area is not viable. - The remainder of the myocardium is viable.Left AtriumThe left atrium is not well visualized. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%. The RVEDV is 103 ml (normal range 142+/-31), RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVESV is 40 ml (normal range 54+/-17), and the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is moderate central aortic regurgitation (regurgitant fraction 32%).Mitral ValveThe mitral valve opens widely and there is at least mild 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 ascending aorta is mildly dilated (41x42 mm). The descending aorta makes a sharp turn from the left to the midline at the level of T6-7.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 23%2.There is global left ventricular systolic dysfunction with regional variation. There is akinesis of the inferior, inferolateral and lateral walls. There is a basal inferolateral aneurysm with apical dyskinesis. 3. There is transmural (>50%) late gadolinium enhancement in the basal to mid inferolateral and lateral walls. This area is not viable. There is subendocardial late gadolinium enhancement in the mid-apical antero-septum. This region is of intermediate viability. There is transmural late gadolinium enhancement at the apical cap (>50%). This area is not viable. The remainder of the myocardium is viable. 4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%5. Moderate central aortic insufficiency (regurgitant fraction 32%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with spinal stenosis status post C3-4 fusion with significant wound drainage. Assess for CSF leak versus epidural hematoma. Redemonstrated are findings related to recent anterior cervical discectomy and fusion. Fusion instruments are seen from C3 through C7.Prevertebral edema and/or fluid spans from C2 through C4. At the C4 and C5 prevertebral levels, there is a fluid collection which extends superficially through the surgical tract to the skin surface (see image 22 series 14). The margins of this collection and fluid filled tract show enhancement but this degree of enhancement is very likely within expected postoperative limits. Fluid from this collection seems to communicate with the C5-6 disc space. The posterior annulus bulges mildly causing slight effacement of the left ventral thecal sac. No definite evidence of any pathologic epidural collection or hemorrhage is seen. Image quality, including artifact from the orthopedic instruments, does not permit reliable localization of any potential dural defect.There is a mild reversal of the normal cervical lordosis. Only the C2 vertebral body and the upper thoracic vertebral bodies are adequately visualized to assess for marrow signal and these levels appear within normal limits.A small area of mild T2 hyperintensity is evident within the cervical spinal cord at the C3-4 level which may reflect myelomalacia from prior cord impingement. No other areas of concerning spinal cord signal abnormality are detected.C2-3: Right facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Bilateral facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. C4-5: Postoperative artifact. Minimal disc bulging. Mild spinal canal narrowing. No significant foraminal narrowing. C5-6: Postoperative artifact. Left paracentral disc bulging as above. Mild generalized spinal canal narrowing. Moderate left foraminal narrowing. C6-7: Postoperative artifact. No significant spinal canal or foraminal stenosis. C7-T1: Postoperative artifact. No significant spinal canal or foraminal stenosis.

Output: A small fluid collection is evident within the prevertebral space at the C4 and C5 levels which extends superficially through the left neck surgical tract to the skin surface. Fluid from this collection appears to communicate with the adjacent C5-6 disc space and there is mild posterior bulging of the C5-6 annulus which causes mild effacement of the left ventral thecal sac, a finding which is likely within expected postoperative limits. Given the imaging findings and timeframe after surgery, a CSF leak is felt to be likely. Image quality is not adequate to accurately identify potential dural defects. Superinfection of the above-described fluid collection and tract is not highly suspected. No evidence of any significant epidural collection or hematoma is seen.


Instruction: Generate impression based on findings.

Input: Left cranial nerve 3 palsy. There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: No evidence of cerebral aneurysm.


Instruction: Generate impression based on findings.

Input: Left hip pain; prior labral repair, gluteus medius repair, and iliotibial band resection ACETABULAR LABRUM: Cystic changes identified within the anterior superior labrum with a small paralabral cyst that is new from the prior exam (series 801 image images 8-11). This may in part relate to surgical change and degenerative tearing but there is no gross labral detachment. ARTICULAR CARTILAGE AND BONE: There is no abnormal marrow signal intensity within the pelvis. Mild osteoarthritis affects the hip.SOFT TISSUES: There is increased signal intensity of the gluteus medius tendon and its attachment upon the greater trochanter is poorly visualized concerning for partial tearing. There is a small amount of fluid overlying the greater trochanter which may reflect a mild amount of bursitis. There is increased signal intensity within the intrasubstance fibers of the iliotibial tract (series 601 image 15) which may indicate minimal tearing proximal and distal to this area, the band appears relatively intactADDITIONAL

Output: 1. Cystic changes within the anterior superior labrum with a labral cyst which may in reflect a combination of postsurgical change and degenerative tearing.2. Increased signal intensity of the gluteus medius tendon with poor visualization of its attachment on the greater trochanter concerning for partial tearing.3. Increased signal intensity within the intrasubstance fibers of the iliotibial tract but this appears grossly intact otherwise.


Instruction: Generate impression based on findings.

Input: Left lateral recess syndrome. Spinal stenosis. For the purposes of numbering, the first nonrib-bearing vertebral bodies labeled L1. As such there are 4 lumbar type vertebral bodies and a sacralized transitional segment labeled S1. Vertebral body heights are within normal limits. Alignment is within normal limits aside from minimal anterolisthesis of L3 on L4. Bone marrow signal is benign. The conus medullaris is normal in position.Mild disc bulges are present in the lower thoracic spine without significant spinal canal stenosis or neural foraminal stenosis based on sagittal images. Multilevel degenerative changes in the lumbar spine, as described below:T12-L1: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy. No significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis.L3-L4: Disc bulge, advanced facet arthropathy, and ligamentum flavum thickening contribute to moderate spinal canal stenosis including effacement of the bilateral lateral recesses. There is also mild to moderate bilateral neural foraminal stenosis. Mild distention of the facet joints. Minimal anterolisthesis.L4-S1: Disc bulge and moderate bilateral facet arthropathy. There is some loss of disc height, degenerative endplate changes and vacuum phenomena. There is partial effacement of the lateral recesses, left worse than right. There is no significant central spinal canal stenosis. There is moderate to severe left and moderate right neural foraminal stenosis. There are multiple bilateral renal cysts. There is an exophytic lesion involving the left kidney with T2 hypointensity which is partially imaged, favored to represent a cyst with hemorrhage and grossly similar to CT chest dated 3/2/2009.

Output: 1. Please note transitional lumbosacral junction anatomy as described above with the most inferior well-defined disc space labeled L4-S1.2. Multilevel degenerative changes, relatively worse at the L3-L4 and L4-S1 levels. There is moderate spinal canal stenosis at the L3-L4 level. At L4-S1 level, there is no significant central spinal canal stenosis although there is effacement of the lateral recesses, particularly on the left. There is minimal anterolisthesis of L3 on L4 which can be further assessed with dynamic radiographs as clinically indicated.3. Neural foraminal stenosis is worst at the L4-S1 level where there is moderate to severe left and moderate right neural foraminal stenosis.4. Multiple renal cysts are noted but not well evaluated. Please see comment above.


Instruction: Generate impression based on findings.

Input: 59-year-old male with prostate cancer and cystic mass. PSA 1.95 in May 2013, 4.730 in Feb 2014, 7.330 in March 2015. TRUS-guided saturation biopsy on 5/12/15 demonstrated 2 cores of Gleason 3+3=6 prostate adenocarcinoma (<5% of tissue) at the right anterior apex, 2 cores of Gleason 3+3=6 (30%) at the left anterior base, and three cores of Gleason 3+3=6 (15%) at the left posterior base. PELVIS:PROSTATE:Prostate Size: 6.1 cm TV x 4.7 cm AP x 7.0 cm CC.Peripheral Zone: There two 7 mm foci of T2 hypointensity with diffusion restriction, one in the right paramedian apex and one in the right base suspicious for carcinoma. Central Gland: Heterogeneous with small nodules.There is a 6.3 x 4.9 x 6.3 cm multilocular cystic nodule with enhancing septations and internal hemorrhage that is associated with the left aspect of the prostate gland and displacing the prostate rightward. Seminal Vesicles: No evidence of seminal vesicle invasion by the aforementioned subcentimeter foci in the right peripheral zone. Extracapsular Extension: No evidence of extracapsular extension.BLADDER: The bladder is displaced slightly rightward due the aforementioned cystic mass.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Two subcentimeter foci in the right prostatic peripheral zone at the apex and base suspicious for carcinoma. 2.6.3 cm multilocular cystic nodule with enhancing septations and internal hemorrhage at the left aspect of the prostate gland. The differential for this includes a giant multilocular prostate cystadenoma, a cystic carcinoma.


Instruction: Generate impression based on findings.

Input: Left thigh mass Arising from the posteromedial subcutaneous tissue of the left femur is a large predominantly fatty mass measuring approximately 12.8 x 9.2 x 13 cm in the greatest craniocaudal, lateral, and AP dimensions. Cystic foci of high T1 signal is noted within the lipoma which may reflect a small component of hemorrhage and/or necrosis. Thin septations are noted throughout the mass and following contrast administration, there is no thick septal or nodular enhancement identified. No additional lesions are seen. The underlying muscle and bone marrow signal of the thigh is normal.

Output: Large fatty mass arising from the subcutaneous tissues of the left femur demonstrate characteristics most consistent with lipoma. There are no aggressive features and no thick septal or nodular enhancement identified.


Instruction: Generate impression based on findings.

Input: 64-year-old female with known left breast IDC presents for MR directed ultrasound for additional lesions at posterior 3:00 position and anterior 12:00 position seen on the recent MRI (12/22/2016). Focused ultrasound is performed for the left breast at 3:00 position and 12:00 position, where abnormal enhancing lesions were detected in recent MRI. There is a complex solid and cystic mass at 3:00 position, 5 cm from nipple in the left breast, measuring 8 x 5 x 8 mm at posterior 3:00 position with increased blood flow, corresponding to the mass seen at MRI.There is also a hypoechoic mass measuring 6 x 3 mm at 12:00 position, 2 cm from the nipple in the left breast, corresponding to the enhancing focus seen at MRI.

Output: MR directed ultrasound detected two lesions correlating to MR findings; a complex solid and cystic mass at 3:00 position and a hypoechoic mass measuring at 12:00 position. Biopsy for these two masses were performed later today. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Motion artifact degrades image quality. There are enhancing lesions with associated surrounding T2 hyperintensity in the left basal ganglia measuring 7mm, left parahippocampal gyrus measuring 4mm, right temporal stem measuring 5 mm, and inferior right temporal gyrus measuring 3 mm. There is no evidence of intracranial hemorrhage or acute infarct. There are additional scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter as well as the medial temporal lobes, right greater than left, which are nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a partially empty sella. The left parotid gland appears to be atrophic. The skull and extracranial soft tissues are otherwise unremarkable.

Output: Multiple intracranial metastases with associated vasogenic edema, but no midline shift or acute hemorrhage.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 no T2/FLAIR abnormality. There is no abnormal enhancement. The myelination is normal for the patient's corrected age. No migrational abnormalities.There is no restricted diffusion. There are no susceptibility abnormalities.Ventricular size is normal. Basal cisterns are patent. No structural abnormalities.Vascular flow voids are normal.There is a nonspecific enlargement of the nodes of Rouvière bilaterally, left more than the right, up to 15 mm. This enlargement is most likely reactive for a patient of this age.There is patchy opacification of the paranasal sinuses.

Output: 1. No acute findings.2. No structural abnormalities.3. Nonspecific significant enlargement of the nodes of Rouvière, likely reactive for a patient of this age.


Instruction: Generate impression based on findings.

Input: Abscess, cellulitis The examination is limited by motion artifact and the patient's difficulty tolerating the exam.Within the subcutaneous tissues of antecubital fossa is a thick-walled, peripherally enhancing fluid collection measuring approximately 3.2 x 2.9 x 3.6 cm in the greatest transverse, AP, and craniocaudal dimensions. A second smaller collection is seen slightly lateral to the dominant mass measuring approximately 1.8 x 0.7 cm. This may represent a second smaller abscess or extension of the larger one. There is extensive surrounding subcutaneous edema and overlying skin thickening. There is mild underlying fascial edema and muscle enhancement reflecting additional inflammatory changes.The bone marrow signal is normal and there is no osseous erosion.The ulnar nerve, radial nerve, and median nerve appear grossly unremarkable.

Output: Thick-walled peripherally enhancing fluid collection within the antecubital fossa representing abscess which is further detailed above.


Instruction: Generate impression based on findings.

Input: Preoperative planning for laser ablation surgery: epilepsy. There is no significant interval change in the lesion with extensive susceptibility effect and an adjacent developmental venous anomaly within the periatrial white matter of the left temporal lobe. There is also no significant interval change in the smaller lesion with extensive susceptibility effect in the posterior left cingulate gyrus. There is no evidence of acute infarct or vasogenic edema. There are a few nonspecific foci of high T2 signal scattered within the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is an unchanged left middle cranial fossa arachnoid cyst. 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 significant change in the probable cavernous malformations in the left cerebral hemisphere.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of parietal lobe of brainClinical question: 20 yo woman with a history of GBM for followup scanSigns and Symptoms: 20 yo woman with a history of GBM for followup scan The patient is status post right parietal lobe surgery. There are signal changes with a T2 and FLAIR hyperintensity along the medial aspect of the surgical bed. This appearance is stable when compared to the previous exam. There are susceptibility changes present along the margins of the surgical site. There is no associated contrast enhancement.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 only demonstrate minor opacities in the left ethmoid air cells and left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Status post right parietal lobe surgery for removal of a mass. There is no evidence for recurrence.


Instruction: Generate impression based on findings.

Input: 4-year-old status post Chiari decompression. Evaluate Chiari and syrinx. There has been evolution of postoperative changes of Chiari decompression which included suboccipital craniectomy, C1 laminectomy, and reduction of cerebellar tonsillar tissue. There has also been evolution of the previously seen diffusion abnormality involving the inferior cerebellum. The cerebellar tonsils and cervicomedullary junction remain caudally displaced with persistent crowding at the foramen magnum at the C1-C2 level; retroflexed dens also contributes to the crowding. Cerebellar tonsils extend to the mid to lower C2 level on the right, previously at the C2-C3 level on preoperative study. There is interval decrease in T2/FLAIR signal abnormality involving the inferior cerebellum. No new parenchymal signal abnormality is seen. No suspicious intracranial mass, midline shift, or herniation. Ventricles remain normal in size. Subcentimeter pineal cyst is unchanged. Cystic arachnoid space extension superiorly along the anterior superior surface of the tentorium cerebell is also unchanged. Extradural suboccipital fluid collection is again seen and compatible with a pseudomeningocele. There is mild to moderate mucosal thickening in the right maxillary sinus which is increased in the interval. There is also mild additional scattered paranasal sinus opacification.CSF flow imaging again demonstrates focally attenuated biphasic flow through the anterior aspect of the foramen magnum, similar to prior. Flow through the posterior aspect of the foramen magnum is similar to recent prior but improved since preoperative MRI from 5/25/2016. There appears to be preserved flow into the fourth ventricle.MRI CERVICAL SPINE

Output: 1. Postoperative changes of Chiari decompression have evolved in the interval. The residual cerebellar tonsils and cervicomedullary junction remain caudally displaced with persistent crowding at the foramen magnum at the C1-C2 level, although improved compared to preoperative study. 2. There has been interval progression of cervical and partially imaged thoracic syringohydromyelia.


Instruction: Generate impression based on findings.

Input: There are foci of high T2 signal in the subcortical white matter of the left superior frontal gyrus and a focus in the mid left cerebellar hemisphere. There are a few scattered periventricular white matter foci that are nonspecific and likely represent small vessel ischemic disease. The ventricles and sulci are within normal limits in size. There is no midline shift or significant mass effect. There is no evidence of acute cerebral infarction or intracranial hemorrhage. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Subcentimeter foci of signal abnormality in the left superior frontal gyrus and left cerebellar hemisphere are incompletely characterized. Further evaluation via a brain MRI with contrast is recommended for evaluation for metastatic disease. This was discussed with Livia Szeto, who will order the brain MRI with contrast and have the patient return for the imaging.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 30-year-old female patient with wrist pain. Evaluate for radioscaphoid arthrosis. There is enlargement of the membranous portion of the scapholunate ligament with increased signal intensity that likely represents mucinous degeneration and probable partial-thickness tearing. The dorsal and volar components of the scapholunate ligament appear intact. There is also lobular abnormal signal intensity within the adjacent proximal portion of the scaphoid, likely representing mucinous extension into the bone (intraosseous ganglion). This was not present on the prior examination. There is a defect in the distal radial articular surface, measuring 5 x 7 mm an area and approximately 1 mm in depth. This defect is immediately proximal to the abnormal scapholunate ligament and was also not present on the prior MRI exam. We are uncertain if this defect is due to prior trauma or represents a shallow erosion related to the aforementioned abnormal scapholunate ligament. The remaining articular cartilage of the distal radius is intact, including that of the radioscaphoid articulation. The lunotriquetral ligament is not well visualized on this study, but this is often the case on non-arthrogram MRI examinations. The remainder of the bones appear normal. We suspect that there is a partial-thickness tear of the proximal surface fibers of the articular disc of the triangular fibrocartilage that extends into the volar radioulnar ligament. This can be further evaluated with dedicated MRI arthrogram, if clinically warranted. The tendons and visualized muscles appear normal as do the visualized nerves.

Output: 1.Enlargement of the membranous portion of the scapholunate ligament likely represents mucinous degeneration with adjacent ganglion formation in the proximal pole of the scaphoid.2.Articular surface defect in the distal radius just proximal to the abnormal portion of the scapholunate ligament may represent additional erosion or may be due to old trauma. 3.Other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 25 years old, with new back pain radiating to the leg, status post laminectomy in July 2015. Findings are again seen compatible with right sided laminectomy and facetectomy at L2-3. Since the prior examination, acute postoperative fluid and edema have resolved. No new or concerning fluid collection is seen.At the L2-3 level, evidence of disc degeneration persists with loss of disc height and disc T2 signal as well as a generalized bulge of the disc with a superimposed small central protrusion. These findings are unchanged when compared to the prior examination. However, with resolution of postoperative edema, the degree of spinal canal narrowing at this level has improved. The right foramen at this level is only mildly narrowed.At L4-5, mild loss of disc height and T2 signal is seen along with a small central disc protrusion. There is no significant generalized spinal canal or neuroforaminal stenosis.The remaining levels show normal disc morphology, with patency of the spinal canal and neural foramina. Mild facet hypertrophy at lower lumbar levels is unchanged.Spinal alignment is slightly straightened but otherwise unremarkable. Vertebral body heights are preserved. No worrisome marrow signal abnormality or marrow edema is seen.

Output: 1.Demonstration of findings related to right-sided laminectomy and facetectomy at L2-3. Since the prior examination, postoperative fluid and edema in the posterior soft tissues have resolved.2.Degenerative disc disease persists at L2-3 with a mild bulging disc with small central disc protrusion. With resolution of postoperative edema, however, the degree of spinal canal narrowing at this level is improved from the prior exam.3.A small central disc protrusion at L4-5 is unchanged without significant spinal canal or neuroforaminal narrowing.4.No additional or new findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate left shoulder for rotator cuff vs. SLAP tear History: left shoulder pain x 6 weeks after fall ROTATOR CUFF: There is a transverse full-thickness tear through the supraspinatus tendon with approximately 1 cm retraction. There is thickening and increased T2 signal within the supraspinatus tendon, consistent with tendinopathy. The infraspinatus, subscapularis, and teres minor tendons appear intact.SUPRASPINATUS OUTLET: Severe degenerative changes affect the acromioclavicular joint with a small amount of fluid in the joint space and small foci of heterotopic bone formation.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is marked globular signal with degeneration of the anterior labrum extending superiorly with more mild changes affecting the posterior labrum. There are small paralabral cysts. There is a small amount of fluid in the glenohumeral joint and subscapular recess. Degenerative changes also affect the humeral head, with multiple small subchondral cysts.BICEPS TENDON: The long and short heads of the biceps tendon are intact. There is increased intermediate signal intensity and thickening of the long head of the biceps tendon, consistent with tendinopathy and fraying.ADDITIONAL

Output: 1. Marked degeneration of the anterior and posterior glenoid labrum.2. Full-thickness tear through the supraspinatus tendon with retraction.3. Fraying of the long head of the biceps tendon.


Instruction: Generate impression based on findings.

Input: h/o spondylolysis. Examination demonstrates a spondylolysis of the left L4 pars interarticularis. The lumbar spine alignment and vertebral body height appear normal. No spinal stenosis or neuroforaminal compromise is identified.

Output: Spondylolysis of the left L4 pars interarticularis.


Instruction: Generate impression based on findings.

Input: 12-year-old male in auto accident with loss of consciousness Calvarium remains within normal limits and no evidence of posttraumatic fracture. Mastoid air cells are well pneumatized and unremarkable. Limited view of the paranasal sinuses demonstrates complete opacification of left chamber of the sphenoid sinus with no bony fracture which is believed to represent chronic sinus disease.Images through intracranial space demonstrates no evidence of post traumatic findings in particular no evidence of intra-axial or extra-axial hemorrhage is detected. No definitive evidence of edema is present. There is however multiple periventricular and subcortical area of low attenuation which appear old. These findings are suspicious for multiple foci of encephalomalacia which are nonspecific however differentials includes demyelinating disease, multiple areas of encephalomalacia from a prior infectious process or ischemic. There is no evidence of any abnormal intracranial calcification. There are no old films available for comparison. Further evaluation with a dedicated MRI is recommended.

Output: 1.No definitive evidence of any post traumatic findings intracranially or of the calvarium.2.Multiple small foci of low attenuation which appear old and needs further evaluation with a dedicated MRI of brain. Please see above comments.


Instruction: Generate impression based on findings.

Input: Diagnosis: Syncope and collapseClinical question: r/o CVA vs seizureSigns and Symptoms: loss of consciousness, hx seizure disorderComments: Please do epilepsy protocol with thin hippocampal cuts. | Patient has Synchromed 2 intrathecal pain pump. Medtronic states the pump is conditional up to 3 Tesla. | Patient has history of carotid disease s/p bilateral carotid stents. | Patient has history of cervical spine disease s/p titanium hardware to c spine. | Creatinine is elevated but at his baseline level. The CSF spaces are appropriate for the patient's stated age with no midline shift. On diffusion-weighted imaging there are several punctate foci of signal hyperintensity representing diffusion restriction by ADC maps located within the cerebellar hemispheres. Two involve the right cerebellar hemisphere and the other involves the medial aspect of the left cerebellar hemisphere.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate T2 FLAIR and T2 foci are present in the brainstem, cerebral hemispheres and thalami as well as external capsules and of the right internal capsule..Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Findings suggest that there are mild acute microinfarcts present within the cerebellar hemispheres.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.Multiple (mild degree) punctate lesions in the brainstem, cerebellar hemispheres, thalami, external capsules and right internal capsule are most likely vascular related at this age.4.Images are mildly degraded T2 motion artifact which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Female, 48 years old, with altered mental status. Assess for encephalitis. History of multiple sclerosis. No restricted diffusion is seen. No areas of parenchymal edema or mass effect are observed.Numerous foci of T2 hyperintensity are seen within the juxtacortical and periventricular white matter. These range in size from punctate up to approximately 1 cm in diameter. They have increased in size and number compared to the prior examination.No evidence of pathologic parenchymal or extra-axial enhancement is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The ventricular system is normal in size and morphology.

Output: 1.No definite acute intracranial abnormality or evidence of active encephalitis is seen.2.Numerous scattered white matter lesions have increased in size and number when compared to the prior examination. These lesions would be compatible with a diagnosis of demyelinating disease as per the patient's history.


Instruction: Generate impression based on findings.

Input: 8-year-old female with optic glioma, evaluate disease status. Orbits: Redemonstrated is fusiform enlargement, up to 6 mm in diameter, and tortuosity of the orbital segment of the left optic nerve with associated T2 hyperintensity, but no enhancement, with extension into the canalicular and cisternal segments of the left optic nerve. The optic chiasm is not involved and the right orbit is unremarkable. Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Stable left optic nerve glioma.


Instruction: Generate impression based on findings.

Input: Reason: questioning is mass in liver seen on CT-scan History: with increase alkphos ABDOMEN:LIVER, BILIARY TRACT: Noncirrhotic liver morphology.There is a mass in the right hepatic lobe measuring 6.8 x 7.5 cm which is mildly hyperintense on T2-weighted images and demonstrates diffusion restriction (1004/73). This lesion is hypointense on precontrast T1 and demonstrates mild arterial hyperenhancement and washout on delayed phases with suggestion of a capsule. There are several foci of central hypoenhancement and increased T2 signal, likely necrosisSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule with loss of signal on out of phase images is consistent with an adenoma.KIDNEYS, URETERS: Right hepatic T2 hyperintensity, likely a 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: Large lesion in the right hepatic lobe. Differential diagnosis includes a well-differentiated hepatocellular carcinoma, adenoma or metastases.


Instruction: Generate impression based on findings.

Input: Newly diagnosed prostate cancer. PELVIS:PROSTATE:Prostate Size: 2.7 x 4.3 x 5.0 cmPeripheral Zone: The dominant lesion is noted in the left mid gland measuring 1.2 x 1.0 cm demonstrating low T2 weighted signal (series 701/19) and restricted diffusion (series 904/344). This lesion demonstrates relative washout.Additional lesion in the right base with similar characteristics (series 904/384).An additional 5 mm lesion is noted in the right lateral mid gland (series 701/17).Central Gland: Changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: There is suspected extracapsular extension of both the right and left mid gland lesions. On the left there is broad-based abutment and loss of definition of the prostate margin. On the right the lesion extends beyond the margins of the prostate.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymph nodes.BONES, SOFT TISSUES: No definite enhancing osseous lesion is identified.OTHER: No significant abnormality noted.

Output: Multifocal disease including bilateral mid gland lesions with suspected extracapsular extension as described above. No evidence of seminal vesicle invasion or enlarged pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female, 19 years old. Knee pain. Evaluate for meniscus and ACL tear. MENISCI: The medial meniscus is intact. The body of the lateral meniscus is mildly extruded. The anterior horn of the lateral meniscus is small in size and displaced superiorly by underlying fluid, although a clear displaced fragment is not definitely identified.ARTICULAR CARTILAGE AND BONE: There is and approximately 1 cm full-thickness focal cartilage defect in the lateral femoral condyle with associated underlying bone marrow edema. There is also bone marrow edema in the posterior aspect of the lateral tibial plateau with mild overlying cartilage irregularity. There is slight thinning of the articular cartilage in the medial femoral condyle without focal defect. Patellofemoral cartilage is intact.LIGAMENTS: Abnormal intermediate and high signal in the region of the ACL indicates a complete tear. The PCL is intact. The collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Complete tear of the ACL with associated bone marrow edema and focal cartilage loss involving the lateral compartment.2.Abnormal position and morphology of the anterior horn of the lateral meniscus suggests a tear, although the displaced fragment is not clearly identified.


Instruction: Generate impression based on findings.

Input: 28-year-old female with tailbone pain, evaluate for ligament tear There is mild edema type signal in the subcutaneous fat immediately dorsal to the coccyx which could conceivably represent mild inflammation, but this is equivocal. Marrow signal intensity within the coccyx itself is within normal limits. There is intermediate signal intensity within the sacrum, lower lumbar spine and pelvis which presumably reflects residual red marrow. The posterior sacrococcygeal ligament appears intact.Degenerative disc disease affects L4-L5 with dorsal protrusion of the disc and central T2 hyperintensity, presumably representing an annular fissure and appearing similar to the prior exam. A trace amount of free fluid is seen within the pelvis, within normal limits for age.

Output: 1.Minimal edema-type signal in the soft tissues posterior to the coccyx could conceivably represent a mild bursitis, however the coccyx itself appears normal.2.Mild bulging/protrusion with annular fissuring at L4-L5.


Instruction: Generate impression based on findings.

Input: History of CVA as a toddler, now with dizziness and palpations. There is paucity of white matter and mild periventricular T2 hyperintensity in the bilateral posterior cerebral hemispheres, with concomitant thinning of the posterior corpus callosum and enlargement of the posterior lateral ventricles. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is left maxillary and ethmoid sinus mucosal thickening.

Output: Findings compatible with bilateral posterior cerebral hemisphere periventricular leukomalacia, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.