Instruction: Generate impression based on findings.

Input: Clinical question: Multiple sclerosis or stroke? History reported of both? Signs and symptoms: Gait disorder and incontinence. Nonenhanced brain MRI:Negative diffusion weighted images for acute ischemic stroke.Examination demonstrates a large focus of encephalomalacia along the medial aspect of right temporal lobe posteriorly and extensively in the right occipital lobe as well as right thalamus which has the appearance of a large chronic right PCA territory ischemic stroke. There is resultant ex vacuo dilatation of occipital horn and the trigone of right lateral ventricle.There are extensive bilateral (R>L) periventricular white matter FLAIR hyperintensity with several demonstrating distinct perpendicular axes to the ventricle which in combination with the patchy foci of FLAIR hyperintensity in the corpus callosum are highly suggestive of demyelinating disease. Possibility of overlapping chronic small vessel ischemic strokes cannot be ruled out and should be considered.Multiple foci of FLAIR hyperintensity are also noted in bilateral (R>L) basal ganglia and left thalamus some with associated susceptibility signal changes. This finding is favored to represent chronic lacunar infarcts. There is evidence of right-sided medullary and degeneration.Constellation of above changes results in significant parenchymal volume loss evident by ex vacuo dilatation of the ventricles and cortical sulci for stated age of 40.Images through posterior fossa also demonstrate multiple foci of FLAIR hyperintensity in bilateral paramedian pons and without detectable lesions in the cerebellar peduncles. This appearance is often represent lacunar ischemic changes. Small focus of FLAIR hyperintensity in the left paramedian cerebellum has a linear appearance and is suggestive of a chronic left PICA territory ischemic stroke.Signal voids of major intracranial arterial branches are identified.Images through the orbits demonstrate chronic hemorrhagic or calcific changes of the left globe with decreased size of globe.Calvarium and soft tissues of the scalp are unremarkable.Sphenoid sinusitis and well-pneumatized other paranasal sinuses.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Large chronic right PCA territory ischemic stroke as detailed.3.Extensive periventricular and subcortical white matter as well as corpus callosum foci of FLAIR hyperintensity some with morphology similar to demyelinating plaques as detailed above. Possibility of overlapping small vessel ischemic strokes should also be considered.4.Multiple foci of FLAIR hyperintensity some with minimal susceptibility signal changes in bilateral basal ganglia and bilateral paramedian pons are more suggestive of chronic lacunar infarcts.5.Significant supratentorial parenchymal volume loss as a result of above findings.6.Tiny linear T2 hyperintensity in the left cerebellum has the appearance of a small chronic ischemic stroke in PICA territory.


Instruction: Generate impression based on findings.

Input: Female 51 years old Reason: eval ACL, meniscus History: knee pain MENISCI: Medial and lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow edema in the lateral femoral condyle as well as the medial aspect of the lateral tibial plateau. There is thinning of the articular cartilage of the patella, with no focal defect.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Tendinopathy of the quadriceps tendon.ADDITIONAL

Output: Bone contusions involving the lateral femoral condyle and the lateral tibial plateau. Small joint effusion. Soft tissue edema.


Instruction: Generate impression based on findings.

Input: Pain, assess for rotator cuff injury ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus tendon and anterior portion of the infraspinatus tendon indicating tendinosis. The increased signal extends to the bursal and to a lesser degree the articular surface fibers suggesting fraying. No full-thickness fluid-filled rotator cuff tear is identified. Muscle bulk and signal of the infraspinatus and supraspinatus muscles are within normal limits.The teres minor and subscapularis tendons are intact with the muscles demonstrating normal bulk and signal intensity.SUPRASPINATUS OUTLET: There is minimal osteoarthritis of the acromioclavicular joint. Small amount of fluid is noted in the subacromial/subdeltoid bursa, not necessarily of any clinical significance. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is normal. No glenohumeral joint space effusion.There is increased signal intensity in the labrum suggestive of a SLAP tear. Separation of the anterior superior labrum from the glenoid could represent an extension of the SLAP tear versus a normal variant sublabral foramen.BICEPS TENDON: The intra-articular and extra articular portion of the biceps tendon are within normal limits.

Output: 1. Rotator cuff tendinosis and fraying without full thickness tear.2. Mild AC joint osteoarthritis.3. Findings suggestive of superior labral tear.


Instruction: Generate impression based on findings.

Input: 74 year-old man with history of CVA two years ago with right-sided weakness. Now alert and oriented x 0 with increased right-sided weakness. There are multiple areas of periventricular, subcortical, and cortical hypodensity. The most prominent is a region of cortical hypodensity with encephalomalacia in the left occipital lobe. This was present on the prior study dated 5/8/2006. There is a smaller left parietal hypodensity which was also present on the prior study. The subcortical hypodensities in the left parietal region appear more pronounced on the current study. MRI could better determine whether or not this represents an acute event. There are no CT findings of intracranial hemorrhage.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Increased prominence of left parietal subcortical hypodensities. MRI is recommended to evaluate for acute stroke.2. Stable findings of periventricular, subcortical, and cortical hypodensities consistent with prior stroke and small vessel ischemic disease.2. No CT evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Female 48 years old Reason: Back pain with sciatica, no response to conservative treatment History: left sided sciatica Five lumbar type vertebral bodies are presumed to be present. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. There is diffuse decreased T1 bone marrow signal. There is more discrete decreased T1 and T2 signal in L1 vertebral body extending into the pedicles. There is a small amount of free pelvic fluid, which is likely physiologic. Presumed nabothian cysts in the cervix are incidentally noted.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is no significant compromise to spinal canal or neural foramina.L5-S1: There is an ovoid lesion in the left lateral recess with mass effect on the left S1 nerve root which remains in contact with the L5-S1 disc, suspected to represent a disc extrusion with inferior migration. Central spinal canal and neural foramina at this level are otherwise patent.

Output: 1.Ovoid lesion at the left L5-S1 level suspected to represent a disc extrusion. There appears to be impingement of the left S1 nerve root. 2.Diffusely decreased bone marrow signal is nonspecific but can be seen with marrow reconversion related to chronic anemia for example as well as lymphoproliferative disorders. 3.Discrete T1 and T2 hypointense lesion involving the L1 vertebral body extending into the pedicles which is suspicious for sclerotic lesion; neoplastic involvement cannot be excluded. Further evaluation with CT is recommended. No associated compression fracture or soft tissue or epidural extension.Findings emailed to Dr. Cifu on 4/15/2016.


Instruction: Generate impression based on findings.

Input: Reason: history of L4-5 disc herniation, now with pain and urinary retention History: as above Vertebral body heights are within normal limits. Alignment is within normal limits. No abnormal marrow signal. No abnormal signal within the cord or conus which ends at T12-L1.T12-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Mild ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. Mild facet arthropathy on the left. Mild ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L4-L5: Small central extrusion extending inferiorly. Facet arthropathy bilaterally. Mild ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L5-S1: Right foraminal protrusion producing mild right neuroforaminal narrowing. Mild bilateral facet arthropathy. No significant spinal canal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1.Mild degenerative changes in the lumbar spine at the L4-L5 and L5-S1 levels. No significant spinal canal stenosis at any level to suggest compression of the cauda equina nerve roots.2.Small central extrusion at L4-L5 without significant spinal canal or neural foraminal stenosis.3.Small right foraminal protrusion at L5-S1 producing mild right neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Female 47 years old Reason: Eval for Ligament tear History: Medial elbow pain LIGAMENTS: Ligaments including the ulnar collateral and radial collateral ligaments are intact.TENDONS: The tendons, including those of the biceps, brachialis, and triceps, are normal without evidence of tearing or thickening.ARTICULAR SURFACES AND BONE: No significant abnormality noted. Bone marrow signal is normal.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Normal MRI of the elbow with intra-articular contrast.


Instruction: Generate impression based on findings.

Input: Right upper extremity weakness, hyperreflexia, and multiple falls. There are scattered foci of cortical and subcortical high T2 signal with restricted diffusion as well as punctate enhancement in the left frontal and parietal lobes in a distribution that coincides with the ACA-MCA watered territory. There is no evidence of intracranial hemorrhage, mass, or midline shift. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a diminished left internal cerebral artery cerebral flow void. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive mucosal thickening and secretions within the left maxillary and sphenoid sinuses. There is fluid and enhancement within the left mastoid air cells.

Output: 1. Subacute infracts in the left ACA-MCA watered territory, without midline shift or hemorrhagic transformation. A diminished left internal cerebral artery cerebral flow void suggests proximal steno-occlusive disease and dedicated vascular imaging of the head and neck is warranted.2. Findings suggestive of acute sinusitis and mastoiditis.


Instruction: Generate impression based on findings.

Input: History of lung cancer with solitary brain lesion; please evaluate for radiosurgery treatment planning. There is a left posterior frontal lobe heterogeneously enhancing mass that measures up to 27 mm. There is extensive surrounding vasogenic edema with effacement of the posterior left lateral ventricle and approximately 5 mm of midline shift to the right. No other intracranial tumors are apparent. The skull and orbits appear to be grossly intact.

Output: Pre-treatment planning MRI demonstrates a posterior left frontal lobe tumor that measures up to 27 mm with extensive surrounding vasogenic edema.


Instruction: Generate impression based on findings.

Input: Clinical question: Reoperative for OR on 5-20. Signs and symptoms: Right parietal brain tumor. Pre- and postenhanced brain MRI:Examination demonstrates a loculated necrotic or cystic enhancing mass in the right posterior temporal-occipital region with extensive surrounding vasogenic edema. The enhancing tumor measures approximately at 23 x 26 mm in transaxial and 27 mm in craniocaudad axis. Mass effect is regional and without deviation of midline. There is no evidence of any additional parenchymal, leptomeningeal or calvarial enhancement. Ventricular system remains within normal size and maintained midline. There is however prominence of cortical sulci and cerebellar-vermian folia for the stated age of 46 concerning for underlying parenchymal volume loss.

Output: 1.Loculated cystic enhancing tumor in the right posterior temporal-occipital measuring 23 x 26 x 27 mm with surrounding vasogenic edema resulting in regional mass effect without deviation of midline.2.Prominence of cortical sulci and cerebellar-vermian folia for the stated age of 46.3.No additional foci of parenchymal, leptomeningeal or calvarial enhancement.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke work up History: as above56 years Male (DOB:7/14/1960)Reason: stroke workup History: dysarthria, aphasia, rUE weaknessPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI Brain MRIThe left insular cortex shows restricted diffusion lesions which extends toward left side corona radiata. There is no no evidence of hemorrhagic conversion.Scattered several T1/FLAIR high signal intensity lesions on periventricular white matter and centrum semiovale are non specific but could represent small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 1.3mm sized luminal bulge on the posterior right side of the top of the basilar artery which directs posteriorly. This lesion is likely represent a small aneurysm. Regarding anterior circulation, bilateral ICAs, MCAs and ACAs are normal. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Acute ischemic infarction involving left insular cortex and corona radiata without evidence of hemorrhagic conversion.2. Possible small aneurysm (about 1.3mm) posterior aspect of the top of basilar artery. CT angiography can be considered for further imaging evaluation if clinically indicated. Otherwise unremarkable brain MRA.3. Normal neck MRA.


Instruction: Generate impression based on findings.

Input: 44 year old with breast cancer with atypical chest pain, T2* imaging performed to rule out myocardial iron overload due to family history of hemachromatosis MEDICATIONS: none First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 104 ml/m2 (normal range: 65+/-11), the LVEDV is 170 ml (normal range 109+/-23), the LV end systolic volume index is 41 ml/m2 (normal range 18+/-5), the LVESV is 75 ml (normal range 31+/-10), the LV mass index is 36 g/m2, and the LV mass is 66 g. There are no regional wall motion abnormalities present. Myocardial T2* was 43ms and liver T2* was 34 ms. There was therefore no evidence of myocardial iron.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 100 ml/m2 (normal range 69+/-14), the RVEDV is 183 ml (normal range 110+/-24), the RV end systolic volume index is 48 ml/m2 (normal range 22+/-8), and the RVESV is 87 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral breast implants are present. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 60%).4. Normal RV size and systolic function (RVEF 52%).4. No evidence of myocardial iron.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: 24 year old male with recurrent acute pancreatitis, MRCP with secretin to evaluate the pancreatic ducts, mainly dorsal duct to evaluate for dilation History: recurrent acute pancreatitis. Evaluation of the solid organs and vascular structures is somewhat limited by lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: The liver is upper normal in size but otherwise demonstrates normal morphology. There are numerous small hepatic T2 hyperintense structures which do not appear to communicate with the bile ducts and which are compatible with multiple biliary hamartomas or hepatic cysts. No suspicious hepatic lesions are identified within the limitations of a noncontrast examination. Hepatic parenchymal signal intensity is within normal limits.The gallbladder is nondilated. There is no biliary ductal dilatation or evidence of choledocholithiasis.SPLEEN: The spleen is upper normal in size without focal lesions.PANCREAS: The pancreas demonstrates normal parenchymal signal intensity without focal lesions identified within the limitations of a noncontrast examination. No evidence of peripancreatic edema. The pancreatic duct is nondilated. Post secretin images demonstrate normal compliance and exocrine function.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal cysts are identified.RETROPERITONEUM, LYMPH NODES: A duplicated IVC is incidentally noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Numerous hepatic T2 hyperintense structures compatible with multiple biliary hamartomas and/or hepatic cysts.2.No evidence of acute pancreatitis.3.Pancreatic duct normal in caliber with normal compliance and exocrine function on post-secretin images.


Instruction: Generate impression based on findings.

Input: Provided history of tuberous sclerosis and renal angiomyolipomas. ABDOMEN: Lack of intravenous contrast limits evaluation for solid organ, bowel and vascular pathology.LIVER, BILIARY TRACT: Findings suggesting iron deposition. Numerous punctate probable hepatic cysts may reflect poly-cystic liver disease versus biliary hamartomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted. No pancreatic cysts.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are markedly enlarged and the parenchyma is entirely replaced by innumerable well-defined simple and minimally complex (fluid-fluid levels and T2-weighted hypointensity) presumed cysts. Lack of intravenous contrast limits evaluation for a solid or cystic renal neoplasm. None of the lesions demonstrate significant macroscopic fat to suggest an angiomyolipoma. A lesion in the right superior pole measures 9.6 x 4.2 cm (series 4/31) and demonstrates restricted diffusion; may reflect a hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with polycystic kidney disease. No discrete fat-containing lesion is identified to suggest an angiomyolipoma. Lack of intravenous contrast limits evaluation for a solid or cystic renal neoplasm. 2.Indeterminate right superior pole measures 9.6 x 4.2 cm (series 4/31) may reflect a large hemorrhagic cyst versus solid mass.3.Multiple punctate hepatic cysts may be related to polycystic liver disease or biliary hamartomas.4.Findings of iron deposition of the liver may reflect prior blood transfusions.


Instruction: Generate impression based on findings.

Input: There is bilateral cerebellar ectopia with the right cerebellar tonsil extending 9 mm below the level of the foramen magnum, and the left 6 mm, providing MRI evidence of Chiari I malformation. Otherwise, limited brain images are unremarkable.High-resolution images of the sella demonstrate the pituitary gland to be normal in size measuring 6 mm in height. There is no discrete mass to confirm the presence of a pituitary microadenoma. There is no macroadenoma. The pituitary infundibulum inserts on the midline of the gland. There are no sellar, suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally.

Output: 1.Negative pituitary MRI including gadolinium enhancement. Specifically, there is no discrete mass to confirm the presence of a pituitary microadenoma.2.There is bilateral cerebellar ectopia with the right cerebellar tonsil extending 9 mm below the level of the foramen magnum, and the left 6 mm, providing MRI evidence of Chiari I malformation.


Instruction: Generate impression based on findings.

Input: 74-year-old female with new left shoulder pain without history of trauma, unable to raise arm ROTATOR CUFF: There is mildly increased signal intensity within the supraspinatus and infraspinatus tendons suggesting mild tendinosis with degenerative cysts in the underlying humeral head. There is mild atrophy of the supraspinatus and infraspinatus muscles compatible with patient's age. The teres minor muscle and tendon are intact. There may be mild insertional tendinosis of the subscapularis tendon, otherwise the tendon and muscle are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid in the subacromial/subdeltoid bursa. There are also globular foci of intermediate to low signal intensity within the anterolateral aspect of the bursa with edema in the adjacent humerus. We suspect this represents calcific bursitis (calcium hydroxyapatite deposition) or could conceivably represent gout. Further imaging with conventional radiographs is recommended. Lateral spurring of the acromion process is noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint with thinning of the articular cartilage. There is diffused increased signal intensity within the superior labrum, which likely reflects degeneration. Small amount of fluid within the glenohumeral joint.BICEPS TENDON: The biceps tendon is intact.

Output: 1.Small amount of fluid in the subacromial/subdeltoid bursa with foci of low signal intensity likely reflects calcific bursitis. Further evaluation with conventional radiographs is recommended.2.Mild rotator cuff tendinosis and other degenerative findings as described aboveFindings discussed with Dr. Sandra Shi at 10:00 AM on 11/4/2015


Instruction: Generate impression based on findings.

Input: GTC x 4 total since 1/14 with asthma attacks, consist of stiffening, lower extremity jerking and eyes rolling to the back of his head. Learning disability. There is no evidence of intracranial hemorrhage, mass, 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 major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is a left maxillary sinus retention cyst. There is also a subcentimeter left adenoid retention cyst.

Output: No discernible seizure foci.


Instruction: Generate impression based on findings.

Input: Female, 16 years old. Clitoromegaly, hirsutism. Evaluate ovaries and adrenals for possible masses ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys enhance symmetrically, without focal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal bowel wall thickening or evidence of obstruction. No free intra-abdominal air or abnormal free fluid.BONES, SOFT TISSUES: The body mass index is abnormally increased.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The ovaries are normal in size, with multiple small follicles. No adnexal mass is identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: As above.OTHER: No significant abnormality noted.

Output: 1.Normal adrenal glands.2.No adnexal masses. Normal ovarian size.3.Abnormally increased body mass index.


Instruction: Generate impression based on findings.

Input: Reason: eval for rotator cuff tear History: shoulder pain overhead activities for 6 months ROTATOR CUFF: Teres minor and subscapularis are intact. There is diffusely increased T2 signal within the supraspinatus tendon suggesting a tendinopathy with a 1 cm (AP dimension ) near full-thickness tear at the footprint. Rotator cuff muscles are intact.SUPRASPINATUS OUTLET: Type II acromion is present.GLENOHUMERAL JOINT AND GLENOID LABRUM: Reactive marrow edema is present within the greater tuberosity at the insertion of the supraspinatus. Glenoid labrum is intact.BICEPS TENDON: Biceps tendon is intact. ADDITIONAL

Output: Tendinopathy and near full-thickness tearing of the supraspinatus.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. There is no significant interval change in the appearance of multiple supratentorial and infratentorial T2 hyperintense white matter lesions, many of which are also T1 hypointense. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles are normal in size and configuration. There is an unchanged superior vermian cistern 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 in the extent of demyelinating disease.


Instruction: Generate impression based on findings.

Input: History of metastatic lung cancer. The images are degraded by patient motion. There are postoperative findings related to left occipital craniotomy and lesionectomy. There is persistent confluent high T2 signal surrounding the resection cavity, but no evidence of abnormal intracranial enhancement that might otherwise suggest the presence of neoplasm. There is also unchanged confluent cerebral white matter T2 hyperintensity elsewhere, particularly in the corona radiata, which may be treatment-related and/or chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small left maxillary sinus retention cyst. There is a punctate cystic focus in the skin of the left cheek. The orbits are unremarkable.

Output: Stable post-treatment findings without evidence of recurrent or new intracranial metastases.


Instruction: Generate impression based on findings.

Input: 52 year old patient with thyroid cancer. Metastatic brain lesion. History of tumor resection and radiation. Tumor recurred and current trauma patient complains of increasing headaches and probable determining things. Nonenhanced head CT:There is a new interval area of extensive vasogenic edema in the left frontal lobe near the site of previously noted metastatic lesion on prior exam from 12 -- 13 -- 2010. This finding is associated with mass effect and effacement of adjacent cortical sulci as well as mass effect on the left frontal horn of the left lateral ventricle and midline shift of approximately 8 mm at the level of septum pellucidum. The finding is highly concerning for metastatic lesion and recommend follow with a dedicated enhanced MRI of brain. There are no additional foci of abnormal density of brain parenchyma. Ventricular system are within normal range of size.Above findings were discussed with the clinical service Dr. Postma Kelly at the time of interpretation of the exam.

Output: Large new focus of vasogenic edema in the left anterior frontal lobe with associated mass effect. Recommend follow up with enhanced CT or an enhanced MRI for evaluation of metastatic disease. Rightward midline shift of approximately 8 mm.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, complaining of left arm pain and weakness radiating from the neck after chiropractic manipulation. Evaluate for cord impingement. No evidence of cord compression is seen. Within the limitations of this examination, no spinal cord signal abnormality is appreciated.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Partial sacralization of the L5 vertebral body is seen. Marrow signal characteristics are unremarkable.A small disc protrusion is evident at T4-5 without significant cord impingement or spinal canal stenosis. A disc protrusion and possible disc extrusion are seen at L4-5, again without significant spinal canal stenosis.

Output: 1.No acute abnormalities and, in particular, no evidence of acute cord compression.2.Degenerative disc findings can be assessed with nonemergent dedicated imaging if clinically warranted.


Instruction: Generate impression based on findings.

Input: History of left C6-7 disc herniation with mass effect on the left neural foramen and a small disc herniation at C5-6. There is an eccentric left disc-osteophyte complex at C6-7 that slightly impinges upon the left aspect of the spinal cord. In conjunction with mild left facet hypertrophy, there is moderate left C6-7 neural foraminal stenosis. Milder degenerative spondylosis at C3 though C6 results in mild spinal canal stenosis and perhaps mild bilateral neural foraminal stenosis at each of these levels. The spinal cord displays normal signal characteristics. The cervical vertebral column is within normal limits. The vertebral bone marrow signal is unremarkable. There is persistent prominence of the adenoids and tonsils. The imaged portions of the intracranial structures are unremarkable.

Output: 1. An eccentric disc-osteophyte complex at C6-7 that slightly impinges upon the left aspect of the spinal cord. In conjunction with mild left facet hypertrophy, there is moderate left C6-7 neural foraminal stenosis. Milder degenerative spondylosis at C3 though C6 results in mild spinal canal stenosis and perhaps mild neural foraminal stenosis bilaterally at each of these levels. 2. Persistent nonspecific prominence of the adenoids and tonsils.


Instruction: Generate impression based on findings.

Input: 21 year old female with a history of clear cell carcinoma of the kidney with pulmonary metastatic lesions noted to have a large mediastinal mass and associated mass effect on the SVC and right atrium. She is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 109 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 22 g/m2 (normal range 67+/-11), and the LV mass is 38 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 56 ml/m2 (normal range 69+/-14), the RVEDV is 95 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 35 ml (normal range 35+/-13). Right AtriumThere is a large right mediastinal mass measuring ~9.2 x 7.6 x 5.3 cm abutting the right atrium and super vena cava. The mass is causing extrinsic compression of the right atrium and superior vena cava. There is tethering of the inferior wall of the right atrium to the mass suggesting erosion of the mass into the right side of the heart however this is not very well characterized. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC is compressed by the mediastinal mass as described above. IVC grossly normal in size and drains normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 55%). 2. The right ventricle is normal in size with normal systolic function (RVEF 63%). 3. There is a large right mediastinal mass measuring ~9.2 x 7.6 x 5.3 cm abutting the right atrium and super vena cava. There is a large right mediastinal mass measuring ~9.2 x 7.6 x 5.3 cm abutting the right atrium and super vena cava. The mass is causing extrinsic compression of the right atrium and superior vena cava. There is tethering of the inferior wall of the right atrium to the mass suggesting erosion of the mass into the right side of the heart however this is not very well characterized.


Instruction: Generate impression based on findings.

Input: Male, 44 years old. Infection involving left shoulder. Sinus tract drainage There is there is an approximately 6 x 2.5 x 6 cm soft tissue mass/collection surrounding the inferior aspect of the scapula with abnormal peripheral enhancement and associated underlying abnormal bone marrow signal. This is consistent with the patient's known fungal infection. There is an approximately 4 cm tract extending from the posteriormost aspect of the mass/collection to the overlying skin, compatible with a draining sinus tract.Increased signal on T2 fat saturated images in the humeral head is compatible with red marrow. Bone marrow signal elsewhere is normal. The rotator cuff muscles and tendons are grossly intact within the limits of a nondedicated study.

Output: Peripherally enhancing soft tissue mass in the area of the inferior scapula, consistent with the patient's known fungal infection. Associated draining sinus tract to the overlying skin.


Instruction: Generate impression based on findings.

Input: DM, HTN, dementia, bipolar disorder and recent diagnosis of MSSA bacteremia, endocarditis and T11-12 osteomyelitis, currently being treated with IV Vancomycin. Patient had outpatient CT lumbar spine for persistent back pain with new finding of L4-5 disc and end plate destruction concerning for new foci of osteomyelitis. There are endplate erosions and surrounding bone marrow edema and enhancement at the T11-12 and L4-5 levels, extending into the adjacent paraspinal soft tissues. There is also disc space narrowing and fluid, as well as mild epidural enhancement at these levels, but no evidence of abscess. There is no compression of the imaged portions of the spinal cord, which displays normal signal characteristics. There is patchy bone marrow edema and enhancement in the L1 and L2 vertebral bodies with a prominent anterior disc osteophyte complex and depression of the L2 superior endplate. There is also irregularity and enhancement associated with a right L2-3 facet joint, with epidural extension. There are small disc bulges at L4-5 and L5-S1 with mild spinal canal narrowing at L4-5, mild effacement of the left lateral recess at L5-S1, as well as severe left and moderate right neural foraminal narrowing due to superimposed inflammatory tissue at L4-5 and moderate bilateral neural foraminal narrowing at L5-S1. Likewise, there is effacement of the bilateral T11-12 neural foramina due to inflamed soft tissues. There is no spondylolisthesis. There is a globular lesion between the infrarenal aorta and the inferior vena cava that measures up to 30 mm in diameter with what may be interval flow voids. There is a filter in the adjacent inferior vena cava. There are partly imaged left renal cysts.

Output: 1. Findings suggestive of discitis-osteomyelitis at L4-5 and L5-S1 with associated phlegmon, as well as septic arthritis with phlegmon involving the right L2-3 facet joint. Patchy bone marrow edema and enhancement in the L1 and L2 vertebral bodies with a prominent anterior disc osteophyte complex may represent additional osteomyelitis, although this may also be attributable to underlying degenerative disease bone marrow effects. 2. Degenerative spondylosis at L4-5 and L5-S1 with mild spinal canal narrowing at L4-5, mild effacement of the left lateral recess at L5-S1, as well as severe left and moderate right neural foraminal narrowing due to superimposed inflammatory tissue at L4-5 and moderate bilateral neural foraminal narrowing at L5-S1.3. A globular lesion between the infrarenal aorta and the inferior vena cava that measures up to 30 mm in diameter with what may be interval flow voids, suggestive of a possible pseudoaneurysm, perhaps secondary to thrombophlebitis. Doppler ultrasound of this region may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 54-year-old female with low grade fever, swelling and tenderness over lumbar spine x1 mo after a fall. Evaluate for epidural abscess. Five lumbar type vertebral bodies are presumed to be present. There is a compression fracture of the L2 vertebral body with greater than 50% loss of vertebral body height, diffuse enhancement and retropulsion of the posterior superior aspect of the vertebral body into the spinal canal. The conus medullaris terminates just above the level of injury and appears grossly intact. There is T2 signal hyperintensity and enhancement along the right facet and pedicle and to a lesser degree left pedicle. There is no evidence of edema within the cauda equina. No epidural fluid collection is identified. There is an enhancing focus which measures up to 6 mm involving the inferior endplate of the L3 vertebral body. No additional enhancing foci are identified. The bone marrow signal otherwise appears normal.There is focal hypointensity on T1-weighted sequences with enhancement and suggestion of cortical interruption of the right sacral ala consistent with a subacute fracture.Facet and ligamentum flavum hypertrophy involving L4-5 and L5-S1 is also noted.

Output: 1.There is an L2 compression fracture present which is eccentric to the left side signal abnormality extends to involve the posterior elements as well especially along the right pedicle and facet suggesting injury in those locations as well. There is approximately 50% loss of vertebral body height. The possibly this represents about the logic fracture is raised.2.There is a right sacral Alla fracture present associated with sclerosis. It is unilateral. The possibility this is pathologic cannot be excluded.3.There is an L3 vertebral body lesion present. This has an atypical appearance. Given the above worry for pathologic fracture is possible this represents a neoplasm cannot be excluded on the basis of this exam alone.4.Findings were discussed with the clinical service.5.There are mild degenerative changes present in the lower lumbar spine mainly related to some facet hypertrophy.Please refer to CT of the same date for further comments.


Instruction: Generate impression based on findings.

Input: Low back pain, occasional radicular symptoms down right lower extremity. Pain down right posterior buttock Numbering is performed similar to prior MRI report from 2004 with postoperative changes of spinal fusion from L4 to S1. As numbered, hypoplastic ribs are noted associated with the L1 vertebral body, better seen on recent CT.There is solid osseous fusion involving the posterior elements from L4 through S1 as well as fusion at the L4-L5 and L5-S1 interbody levels.There is mild retrolisthesis of L2 on L3 and L3 on L4 similar to prior. There has been progression of disc height loss at the L3-L4 level compared to 2004 compatible with adjacent segment disease. Disc height loss and endplate changes at the L2-L3 level have also progressed. There is marrow edema involving the endplates from L2 to L4. Vacuum phenomena is evident at the L1-L2, L2-L3, and L3-L4 levels. Bone marrow signal is benign without suspicious osseous lesions evident. Vertebral body heights are maintained. The conus medullaris is normal in position.Individual levels further described below:L1-L2: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy. There is minimal narrowing of the spinal canal and minimal narrowing of the neural foramina. L2-L3: There is disc bulge and prominent ligamentum flavum thickening and facet arthropathy. There is moderate spinal canal stenosis as well as severe right neural foraminal stenosis. There is mild left neural foraminal stenosis. These findings have significantly progressed since prior 2004 MRI.L3-L4: There is retrolisthesis with endplate osteophyte and advanced bilateral facet arthropathy which contributes to moderate narrowing of the lateral aspect the spinal canal grossly similar to prior. There is up to moderate narrowing of the bilateral neural foramina similar to prior.L4-L5: No spinal canal stenosis. There is mild right and minimal left neural foraminal narrowing. L5-S1: No spinal canal stenosis. There is mild to moderate right and mild left neural foraminal narrowing.

Output: 1. Postsurgical changes of spinal fusion from L4 to S1 are again seen with intact hardware and evidence of solid osseous fusion better seen on recent CT from 12/18/2015.2. Advanced degenerative changes are seen above the level of the fusion at the L2-L3 and L3-L4 levels with moderate spinal canal stenosis, particularly progressed at the L2-L3 level when compared to remote MRI study from 9/9/2004. There is severe right L2-L3 neural foraminal stenosis and to a lesser degree at additional levels, as detailed above.3. Please note comment about numbering in the findings section above.


Instruction: Generate impression based on findings.

Input: Headache, possible sinusitis and mastoiditis seen on CT scan , also possible cavernous malformation. History: headache. BRAIN: There is a mass in the central pons with complete hemosiderin rim measuring up to 12 mm. There is no evidence of associated developmental venous anomaly. There is no evidence of acute intracranial hemorrhage or acute infarct. There is mild cerebral white matter T2 hyperintensity bilaterally. 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 is fluid within the bilateral mastoid air cells. FACE: There are bilateral lens implants. There are a small amount of secretions in the right ethmoid sinuses. The rest of the paranasal sinuses appear unremarkable. There may be small periapical cysts in the mandible bilaterally. The parotid and submandibular glands are unremarkable. There is a prominent posterior disc-osteophyte complex at C5-6, which indents the spinal cord.

Output: 1. Small amount of secretions in the right ethmoid sinuses. 2. Findings compatible with a cavernous malformation in the pons.3. Fluid in the bilateral mastoid air cells may represent mastoiditis.4. Mild cerebral white matter T2 hyperintensity bilaterally may represent chronic small vessel ischemic disease. 5. A prominent posterior disc-osteophyte complex at C5-6 indents the spinal cord.


Instruction: Generate impression based on findings.

Input: 59-year-old female patient with status epilepticus, unresponsive. Evaluate for cause of seizure and possible left thalamic infarct.. There is a questionable focus of ischemia in the right anterior and lateral cerebellum given mild diffusion restriction and questionable FLAIR signal abnormality in this region. There is extensive patchy subcortical, periventricular, basal ganglia, and pontine T2 signal abnormality consistent with chronic small vessel ischemic disease. There is encephalomalacia within the right occipital lobe consistent with a chronic ischemic infarct. There are scattered foci of susceptibility artifact within the cerebral hemispheres and cerebellum which likely represents chronic blood products.There is a heterogeneously enhancing 1.1 x 1.1 cm extra-axial lesion along the right frontal convexity underlying the right frontal bone, which does not exert significant mass effect on the adjacent frontal lobe. No other abnormal parenchymal enhancement is seen . The ventricles are minimally prominent in size due to mild generalized parenchymal volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small air-fluid level in the left maxillary sinus and scattered paranasal sinus mucosal thickening. There are secretions within the posterior nasopharynx.

Output: 1. Questionable acute ischemic infarct in the right anterolateral cerebellum.2. Extensive chronic small vessel ischemic disease and chronic right occipital ischemic infarct.3. A right frontal convexity extra-axial lesion is favored to represent a meningioma.


Instruction: Generate impression based on findings.

Input: 32 year-old female with known left breast cancer whose recent MRI showed suspicious lesion in the right breast, presents for MR-directed ultrasound for right breast and possible biopsy. Focused ultrasound was performed for the right upper outer quadrant. There is a subtle hypoechoic lesion with increased blood flow at 10 o'clock position, 4 cm from nipple, measuring 15 x 8 mm. This lesion appears to correspond to the MRI detected lesion.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, two 14-gauge core needle (Achieve) specimens were obtained of the lesion. Targeting was judged very good. Both specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location at upper outer quadrant. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe.

Output: Successful ultrasound-guided core biopsy of the right breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of bone and bone marrow(198.5)Closed fracture of lumbar vertebra without mention of spinal cord injury There is a marrow replacing lesion present within the L1 vertebral body with epidural soft tissue and extension into the right pedicle and adjacent neural foramina. This is clearly progressed compared to the prior exam in January where it didn't extend the spinal canal or the neural foramina. Since the March exam that progression is more subtle but still present. There is since March there is greater compression of the right half of the L1 vertebral body. The conus medullaris is not compressed. There is crowding of the right-sided nerve roots of the cauda equina by the tumor extension into the right hemicanal. The exiting nerve roots within the neural foramina are surrounded by fat.At L5-S1 there is no significant compromise to spinal canal. There is a disc bulge present at this level. The fat surrounding the exiting nerve roots within the neural foramina is partly effaced - right worse than left.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height and a disc bulge at this level. There is some vacuum disc phenomenon present at this level. The fat at the lateral recess is not effaced. The fat surrounding the exiting nerve roots within the neural foramina is partly effaced and the neural foramina are narrowedAt 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.The left kidney is absent.

Output: 1.An L1 vertebral body lesion has progressed since previous CT exams. It extends into the spinal canal and impresses on the thecal sac and also mildly encroaches on the adjacent neural foramina at T12-L1 and L1-L2. The compression fracture at this level has progressed.2.There are degenerative changes present in the lumbar spine with mild encroachment of the exiting nerve roots on the right side at L5-S1.


Instruction: Generate impression based on findings.

Input: 58-year-old female with left posterior knee pain. MENISCI: There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. There is a horizontal tear of the posterior horn of the meniscus with a flipped meniscal fragment extending anteriorly along the medial aspect of the PCL, best seen on coronal series 6, images 8 through 12. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. No bone marrow signal abnormality is seen.LIGAMENTS: The cruciate and collateral ligaments appear intact. Thickening of the proximal fibers of the ACL may reflect prior injury or sprain. The ACL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tear of the posterior horn of the medial meniscus with a flipped meniscal fragment as described above.2. Moderate size joint effusion.


Instruction: Generate impression based on findings.

Input: Intermittent vertigo for the last 5 years. Evaluate for acoustic neuroma or other anomalies. There is a vascular loop within the right internal auditory canal, a frequent incidental finding, most likely representing the AICA. The internal auditory canals are otherwise grossly symmetrical in size and signal intensity without definite abnormal enhancement within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific. There is no pathological enhancement. 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: 1. No specific lesions are seen within the cerebellopontine angle, cisterns or internal auditory canals to suggest the presence of a schwannoma, or any other cause for the patient's symptoms.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Multiple shoulder dislocations, evaluate for labral tear ROTATOR CUFF: No significant abnormality noted. Normal-appearing tendons and muscles.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Hill-Sachs deformity consistent with history of multiple shoulder dislocations. No evidence of labral tear or rotator cuff injury.


Instruction: Generate impression based on findings.

Input: 70 year-old male with known tonsillar cancer. Evaluate CT scan for staging. HEAD CT:There is an approximately 6-mm focus of enhancement in the left frontal lobe in the region of the corona radiata suspicious for metastatic lesion. No vasogenic edema is seen. An MRI may be obtained for further evaluation if clinically indicated. No additional areas of abnormal enhancement.The remaining cerebral hemispheres, cerebellum and brainstem are normal in structure and attenuation. No abnormal extra-axial fluid collections are identified. The ventricles are normal in volume and are midline.No osseous lesions are identified in the calvarium or skull base. The visualized paranasal sinuses and mastoid air cells are normally aerated.NECK CT:There is an approximately 3.9 x 2.6 cm (image) homogeneously enhancing mass involving the right tonsillar pillar reaching the midline as well as extending posteriorly abutting the oropharynx. There is surrounding lymphadenopathy within the right jugulodigastric region the largest of which appears to be a combination of two nodes measuring 12 x 23 mm (image 41/92) at the level of the angle of the right mandible. Additional suspicious nodes are seen at the level of the hyoid on the right. Subcentimeter nonpathologic nodes are seen on the left.The visualized osseous structures are normal.The visualized lung apices are normal. Please refer to the Chest CT performed on the same day for further details.

Output: 1. Right tonsillar mass with right neck lymphadenopathy.2. Enhancing focus in the left frontal corona radiata without evidence of vasogenic edema. A metastatic focus as the diagnosis of exclusion. An MRI may be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: 60-year-old female with question of avascular necrosis of the right knee. MENISCI: The menisci appear intact without significant pathologic defect.ARTICULAR CARTILAGE AND BONE: There is severe generalized thinning of the articular surfaces of the patella, femur, and tibia. Further, there are full-thickness defects with underlying sclerosis/subchondral cysts visualized in the medial tibial plateau, medial femoral condyle, and femoral trochlea.LIGAMENTS: There is thickening and mild edema within the anterior cruciate ligament, however the fibers appear intact. This likely is representative of ligamentous strain. The PCL appears intact. The MCL and LCL complex appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Severe osteoarthritis affects the right knee.2. Findings compatible with ACL strain, but no complete tear.3. Geographic areas of signal abnormality likely representing avascular necrosis of the femoral articulation, similar to that seen on prior radiograph.


Instruction: Generate impression based on findings.

Input: Multiple sequences are degraded by extensive motion artifact. There is suggestion of increased FLAIR signal involving the mesial right temporal lobe, however the hippocampal architecture appears grossly unremarkable. A few other areas of scattered cortical FLAIR hyperintensity are questioned more posteriorly in the peripheral right temporal lobe. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is opacification of the right frontal sinus with a fluid-fluid level, a portion of which is more proteinaceous given high T1 and low T2 signal. A small mucous retention cyst is demonstrated in the nasopharynx.

Output: 1. Subtle increased FLAIR signal of the right mesial temporal lobe without architectural distortion, with additional questioned lateral right temporal lobe cortical FLAIR hyperintensity, is of uncertain significance and may be related to postictal state. Recommend correlation with seizure history and EEG.2. Right frontal sinus disease. Please correlate clinically for possible acute sinusitis.


Instruction: Generate impression based on findings.

Input: History of prostate cancer on active surveillance. PSA 1.7. History of benign biopsy 3/28/2013 PELVIS:PROSTATE:Prostate Size: 2.8 x 4.9 x 3.9 cm.Peripheral Zone: Ill-defined, diffusely decreased T2 signal demonstrated on the prior examination has improved and thus was more likely related to prostatitis than neoplasm. No convincing focal lesions are detected in the peripheral zone.Central Gland: There is once again mildly asymmetric decreased T2 signal eccentric to the left within the central zone appearing similar to prior and which can be a normal variant.Seminal Vesicles: No significant abnormalities.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: There is a small focus of decreased T2 signal posterior and lateral to the right base appearing similar to prior and which is favored to represent a vessel. No abnormal lymph nodes are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No convincing evidence of prostate tumor. Previously described signal abnormalities within the peripheral zone have improved and thus were likely related to prostatitis.


Instruction: Generate impression based on findings.

Input: Radiculopathy, site unspecified [M54.10], Reason for Study: ^Reason: eval for nerve compression History: worsening bilateral LE pain plus low back pain in setting of degen lumbar spine xr... no specific one dermatomal/myotomal weakness. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. The bone marrow signal intensity of lumbar spine shows low signal intensity on T1 with remained fatty marrow signals on the inferior endplate of L2 and L4 as well as superior endplate of L5. This finding indicate possible bone marrow replacement such as anemia, myelodysplasia, metastasis, or diffuse sclerotic changes. Clinical correlation is indicated.There is no evidence of bone marrow edema indicating acute compression fracture.The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level.Degenerative changes are specified by the intervertebral level as follows: T12-L1: disc dessication, no neuroforaminal narrowing or spinal stenosis. L1-L2: disc dessication,diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L2-L3: diffuse bulging of disc with right severe lateral recess as well as neuroforaminal stenosis. L3-L4: disc dessication, diffuse bulging of disc, minimal to moderate left neuroforaminal stenosis. L4-L5: disc dessication, diffuse bulging of disc central focal protrusion which abuts thecal sac, there is moderate degree left side neuroforaminal stenosis. L5-S1: disc dessication, diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis.

Output: 1. Diffuse bone marrow signal abnormality seen at lumbar vertebrae, sacrum, coccyx and bilateral ilium. Clinical correlation regarding possible bone marrow replacement lesions is recommended.2. Degenerative spondylosis with mild to moderate spinal canal stenosis at the level of L23, L34 and L45.3. Severe neuroforaminal stenosis at the right L23.4. Mild to moderate neuroforaminal stenosis at the left side L34 and L45 neural foramen.


Instruction: Generate impression based on findings.

Input: 4 yo with urinary retention, evaluate for tethered cord Five lumbar type vertebral bodies are presumed to be present with the most inferior well-defined disc labelled L5-S1. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is normal. The conus medullaris is borderline low in position at the L2-3 level. Prone images demonstrate appropriate anterior motion of the conus. No evidence of filar lipoma or other masses within the lumbar spinal canal.No significant disc disease. No spinal canal or neural foraminal stenosis at any level.Bilateral hydronephrosis right worse than left noted and better assessed on recent ultrasound studies.

Output: No convincing evidence of tethered cord. The conus medullaris is at the L2-3 level which is at the lower limits of normal. Prone images demonstrate appropriate anterior motion of the conus. No evidence of filar lipoma or other masses within the lumbar spinal canal.


Instruction: Generate impression based on findings.

Input: Reason: Assess for rotator cuff injury or other cause for left shoulder pain History: Left shoulder pain. ROTATOR CUFF: Perhaps minimal tendinosis of the supraspinatus tendon, but this is equivocal and we see no discrete supraspinatus tendon tear. The supraspinatus muscle appears normal. The infraspinatus tendon and muscle appear normal. The teres minor tendon appears normal. Slight atrophy of the teres minor muscle is of uncertain significance and we see no masses within the quadrilateral space. The subscapularis tendon appears slightly thickened, but we suspect this is due to internal rotation of the humerus and we see no discrete tear. Subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Edema within the distal clavicle as well as a small amount of pericapsular edema along the AC joint. We see no edema within the acromion process. We see no free fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Given the limitations of a non-arthrographic study, the glenoid labrum appears intact. We see no joint effusion. Alignment of the glenohumeral joint is within normal limits. Bandlike signal intensity along and within the anterior aspect of the glenohumeral joint likely represents redundant capsular structures.BICEPS TENDON: Given the limitations of a non-arthrographic study, the tendon of the long head of the biceps appears intact.ADDITIONAL

Output: 1.Edema within the distal clavicle and along the capsule of the AC joint with no edema within the acromial process may represent stress reaction of the distal clavicle such as osteolysis that can be seen in weightlifters, or perhaps a low grade injury to the AC joint.2.No evidence of rotator cuff tear.3.Other findings as described above.


Instruction: Generate impression based on findings.

Input: 40 year-old male with large left retroperitoneal mass per history discussed with Dr. Rogan additional or new catheter proof of current tumor is required prior to additional therapy. History of resection with this tumor representing either incomplete resectional possible recurrence. Written informed consent was obtained. Patient was prepped and draped in sterile fashion. Skin was anesthetized with lidocaine. A posterior approach was used to avoid bowel. Using coaxial technique two 18G core samples were obtained from the central portion of the mass just above iliac crest. Samples were placed in both in formalin and submitted for pathologic analysis.Procedure was complicated by shooting pain down the leg and groin during the biopsy which slowly subsided following the procedure. The patient was discharged to the floor in good condition with some mild persistent discomfort.

Output: Two 18-gauge core biopsies left retroperitoneal mass with CT guidance.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There is a full-thickness tear of the distal fibers of the supraspinatus at its insertion upon the greater tuberosity. There is minimal retraction of the tendon to the level of the distal acromion. Additionally, there is partial undersurface tearing of the distal anterior fibers of the infraspinatus but no full-thickness tear is appreciated. The teres minor tendon is intact. The supraspinatus tendon is intact.There is mild fatty atrophy of the supraspinatus and infraspinatus muscles. The teres minor and subscapularis muscles are normal in caliber.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears grossly intact. The glenohumeral alignment is normal..BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Full-thickness tear of the distal supraspinatus upon its insertion upon the greater tuberosity which appears slightly increased from the prior exam. There is also partial undersurface/interstitial tearing of the anterior fibers of the infraspinatus.


Instruction: Generate impression based on findings.

Input: Ms. Greer is a 39 year old female with known left breast cancer currently on neoadjuvant chemotherapy. She presents today for I-SPY2 protocol MRI #3. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left retroareolar region, the known malignancy now measures approximately 5.1 x 4.4 x 5.4 cm, previously 4.6 x 4.4 x 5.2 cm (AP x ML x SI), and originally measuring 4.1 x 4.5 x 4.5 cm. The malignancy continues to extend towards and involve the anterior skin and nipple. The biopsy marker clip is seen peripherally at the anterior aspect of the malignancy. The interval increase in measurement is partially due to enlargement of the lateral nodular component of the mass. There is additionally a 1.3 cm area of enhancement along the posterior lateral aspect of the mass that is more nodular and suspicious in appearance on this exam. No abnormal enhancement is seen in the right breast. At least two enlarged left axillary lymph nodes continue to be seen, the previously measured node again measures 3.0 x 1.7 cm. A biopsy marker clip is seen within this lymph node. However, an additional deeper lymph node is enlarged compared to the prior studies, now measuring up to 2.0 cm. No abnormal lymph nodes are identified in the right axillary or internal mammary region.

Output: 1. Interval increase in enhancement in the left breast, with the index mass enlarged to 5.4 cm in greatest dimension. 2. Interval increase in size of one axillary lymph node, now measuring up to 2.0 cm. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 68 year old with hypertrophic cardiomyopathy presenting for cardiac function and scar evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. There is left ventricular hypertrophy that is asymmetry. The septal wall thickness is 15-16 mm while the anterior and lateral walls are 13-14mm. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 92 ml/m2 (normal range: 65+/-11), the LVEDV is 177 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 63 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is small amount of mid myocardial late gadolinium enhancement in the basal inferior wall that suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process in a pattern that is atypical for myocardial infarction. Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 61 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 48 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is jet of eccentric mitral regurgitation that is at least mild. There is systolic anterior motion (SAM) seen with flow acceleration in the LVOT. 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 with a common origin to the right innominate and left common carotid (normal variant - "pseudo-bovine"). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. Pericardial fat was seen. Extracardiac FindingsProbable left renal cysts. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. There is left ventricular hypertrophy that is asymmetry. The septal wall thickness is 15-16 mm while the anterior and lateral walls are 13-14mm. The overall LV ejection fraction is 65%.There are no regional wall motion abnormalities present. There is a small amount of mid myocardial late gadolinium enhancement in the basal inferior wall that suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process in a pattern that is atypical for myocardial infarction. 2. Asymmetric left ventricular hypertrophy with systolic anterior motion of the mitral valve with associated flow acceleration. 3. The right ventricle is normal in size and systolic function (RVEF 59%). 4. Left atrial enlargement.


Instruction: Generate impression based on findings.

Input: Male 21 years old Reason: Rule out meniscus tear. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is edema within the posterior aspect of the lateral femoral condyle. This edema is associated with an approximately 1.5 cm curvilinear focus of low signal intensity (series 7, image 22) in the subchondral bone marrow of the posterior aspect of the lateral femoral condyle, possibly representing a nondisplaced subchondral fracture. The overlying cartilage appears intact. There is no adjacent soft tissue edema. Tiny focus of bone marrow edema is seen just subjacent to the proximal attachment of the medial collateral ligament.LIGAMENTS: No significant abnormality of the cruciate or collateral ligaments. There is edema along the proximal fibers of the medial patellar retinaculum with poor visualization of the femoral attachment of the medial patellofemoral ligament.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Edema along the medial retinacular structures posteriorly with poor visualization of the medial patellofemoral ligament at its attachment suggesting at least a partial thickness tear.2. Edema within the posterior aspect of the lateral femoral condyle with possible nondisplaced subchondral fracture. This edema is more posterior than would be expected with transient patellar dislocation.3. No evidence of meniscal tear.


Instruction: Generate impression based on findings.

Input: 71 year-old female experiencing low back pain and difficulty ambulating, left more symmetric than right, history of L5/S1 radiculopathy Limited view of the lower thoracic spine and thoracic cord is unremarkable.T12/L1: Mild bilateral facet hypertrophy without stenosis, unchanged.L1/2: There is a new midline disc extrusion which extends above the disc level superimposed upon asymmetric bulge to the left. There is also ligamentum flavum thickening and mild bilateral facet hypertrophy. There is new mild central central and mild to moderate left lateral recess with stable mild left neural foraminal stenosis.L2/3: Asymmetric bulge to the left, ligamentum flavum thickening, progression of prominent posterior epidural fat, mild left facet hypertrophy, and mild to moderate right facet hypertrophy. There is new mild stenosis and stable mild left neural foraminal stenosis.L3/4: Diffuse annular disc bulge, progression of prominent epidural fat, ligamentum flavum thickening, and moderate bilateral facet hypertrophy. There is new mild to moderate central stenosis as well as stable moderate right neural foraminal and mild left neural foraminal stenosis.L4/5: Diffuse annular disc bulge, progression of prominent epidural fat, ligament of flavum thickening, severe bilateral facet hypertrophy, and a right facet effusion. There is new mild to moderate central stenosis as well as stable mild bilateral lateral recess and moderate bilateral neural foraminal stenosis.L5/S1: Previously demonstrated T1 and T2 hyperintensity of disc material now appears predominantly hypointense on both sequences. There has been interval significant progression of epidural fat, now resulting in severe central stenosis, whereas previously there was none. There remains diffuse annular disc bulge and mild to moderate bilateral facet hypertrophy which result in stable mild to moderate bilateral neural foraminal stenosis.

Output: 1.L1/2: There is a new midline disc extrusion which extends above the disc level superimposed upon asymmetric bulge to the left. There is new mild central central and mild to moderate left lateral recess with stable mild left neural foraminal stenosis.2.L2/3: Progression of prominent posterior epidural fat. There is new mild stenosis and stable mild left neural foraminal stenosis.3.L3/4: Progression of prominent epidural fat. There is new mild to moderate central stenosis as well as stable moderate right neural foraminal and mild left neural foraminal stenosis.4.L4/5: Progression of prominent epidural fat. There is new mild to moderate central stenosis as well as stable mild bilateral lateral recess and moderate bilateral neural foraminal stenosis.5.L5/S1: There has been interval significant progression of epidural fat, now resulting in severe central stenosis, whereas previously there was none. There remains stable mild to moderate bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 76-year-old female with intermittent abdominal pain and rising white cell count ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodense lesions in the left lobe, too small to characterize but are most likely cysts.SPLEEN: No significant abnormality notedPANCREAS: 14 x 7 mm cystic lesion in the pancreatic body likely representing a benign branch type I PMN. Follow-up imaging with MRI in one year is recommended.ADRENAL GLANDS: Diffuse left adrenal thickening.KIDNEYS, URETERS: Striated nephrogram involving the left kidney consistent with acute pyelonephritis. Mild wall thickening of the right uroepithelium, most prominent in the pelvis is also suspicious for pyelonephritis. Fat stranding along both ureters also suggest pyelonephritis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral pyelonephritis. No evidence of abscess.Small pancreatic cyst likely representing a branch type I PMN. Follow-up with MRI in one year is recommended.


Instruction: Generate impression based on findings.

Input: 35-year-old male with NF1 and multiple plexiform neurofibromas. Again seen are innumerable masses which demonstrate high signal intensity on fluid sensitive sequences, some of which have a target appearance, compatible with nerve sheath tumors and the known history of neurofibromatosis type I. Plexiform lesions are again noted in the soft tissues adjacent to the right lung apex with a smaller concentration of neurofibromas noted within the soft tissues adjacent to the left lung apex. Neurofibromas are again noted along all thoracic nerve roots, bilaterally, with additional neurofibromas involving the intercostal nerves at all levels. Additional solitary neurofibromas of varying size are noted within the musculature and soft tissues of the chest wall. No new lesions are identified.The reference lesion in the right anterolateral chest wall measures 2.4 x 1.4 x 3.5 cm (TR x AP x CC), previously 2.4 x 1.3 x 3.5 cm (image 19; series 501). The reference right-sided paraspinal lesion at the level of the thoracic inlet measures approximately 2.9 x 2.1 x 3.4 cm, previously 3 x 2.1 x 3.5 cm (image 6; series 501).The additional reference right-sided paraspinal lesion at the level of the thoracic inlet measures 3.1 x 1.1 x 2.5 cm, previously 3 x 1 x 2.5 cm (image 7; series 501).There may also be a few small mediastinal nerve sheath tumors which also appear similar to the prior study. Small nerve sheath tumors are also noted within the arms bilaterally, incompletely imaged. We see no specific imaging findings to suggest malignant degeneration within the limitations of this noncontrast examination.

Output: Findings compatible with neurofibromatosis without significant interval change in the reference lesions, with measurements provided above. No new lesions are identified.


Instruction: Generate impression based on findings.

Input: 50-year-old male with deep ulcer, pain, erythema and drainage from wound as well as an elevated CRP, evaluate for osteomyelitis There is a skin defect and deformity along the mid to distal anterolateral aspect of the leg consistent with history of a chronic ulcer. There is extensive underlying edema in the subcutaneous tissues as well as dystrophic calcifications along the course of the defect and adjacent to the lateral aspect of the tibia. However, no focal fluid collection is present to suggest abscess. The underlying marrow signal is intact without findings to suggest osteomyelitis. The muscles of the leg are diffusely atrophic. Numerous varicose veins are noted.

Output: Ulceration along the lateral aspect of the leg and diffuse edema within the subcutaneous tissues. No evidence of osteomyelitis or focal fluid collection.


Instruction: Generate impression based on findings.

Input: 53 year old who is status post excision of left breast cancer with positive surgical margins presents for MRI study. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.At 2:00 position in the left breast, there is a seroma cavity from recent surgery, measuring 17 x 15 x 24 mm. The seroma contains high signal fluid on T1 weighted images, indicating bloody fluid. Entirely around this seroma, there is a thick rim-enhancement, suggesting residual disease. The rim-enhancement is especially thick at anterior and medial margins, measuring up to 10 mm.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Status post excision of left breast cancer at 2:00 position in the left breast. Suspicious thick rim-enhancement around the seroma.2. No MR evidence of malignancy in the right breast. 3. No abnormal lymph nodes in either axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 78 years old, with history of breast cancer and multiple acute intracranial hemorrhage foci. Evaluate for metastases, tumors, vascular lesions or stroke. Multiple foci of susceptibility artifact are seen correlating to areas of suspected parenchymal hemorrhage on CT including within the left paramedian frontal lobe, the right lateral frontal lobe and the left lateral temporal lobe. These lesions demonstrate mild surrounding T2 hyperintensity but no definite pathologic enhancement.No restricted diffusion is seen. No generalized edema or mass effect is detected. There is no pathologic intracranial enhancement. Mild scattered periventricular T2 hyperintensities have progressed slightly from the prior examination. Ventricular size and morphology are within normal limits. Mild scalp swelling is seen at the left zygoma.

Output: 1.Evidence of scattered small parenchymal hemorrhages is seen correlating with findings on prior CT.2.No definite underlying tumor or vascular lesion is seen. No acute ischemic stroke is detected.3.Findings compatible with mild chronic microvascular ischemia.


Instruction: Generate impression based on findings.

Input: Metastatic T8 spine lesion. Status post resection and stabilization. Evaluate for residual tumor or abnormality. The examination is limited at the operative levels by susceptibility artifact related to the metallic hardware.The vertebral bodies are preserved in height. There is desiccation and moderate height loss involving C5-C6 and C6-C7 discs. The disc-osteophyte complexes at C5-C6 and C6-C7 result in mild spinal canal narrowing. There are changes of previous partial, right-sided T8 corpectomy and costotransversectomy, complete T8 and partial T7 laminectomies. The associated hardware (interbody spacer at partial T8 corpectomy site as well as dual posterior rods and the bilateral pedicle screws at T6, T7, T9 and T10) are better depicted on the companion CT scan. The artifact related to the hardware partially obscures the fused segments. The lobulated soft tissue mass at the corpectomy level, which also involves the remaining part of T8 vertebra, does circumferentially encase and mildly narrow the thecal sac resulting in near complete obliteration of the CSF extending from the mid T7 level to the inferior T8 level. However, there is minimal, if any, deformity of the spinal cord. It is difficult to assess the spinal cord for signal abnormality. The soft tissue mass also effaces the T7-T8 and T8-T9 neural foramina bilaterally and abut the posterior wall of the adjacent aorta. The new T11 central/anterior vertebral body compression and the progressed T10 at the inferior endplate fracture are associated with mild subjacent marrow edema but no gross replacement of marrow. This is associated with intervertebral and intervertebral gas, as evident on the CT scan. There is no retropulsion at this level. There is no compression or significant marrow signal abnormality at the other thoracic levels.STIR/T2-hyperintense, contrast enhancing lesion involving the L2 vertebral body may represent a hemangioma though not completely assessed on this examination.There are postoperative findings in the overlying back soft tissues at midline but no drainable fluid collection. There is dilatation of the renal collecting systems, likely a combination of mild hydronephrosis and extrarenal pelvises. This is probably related to the known large pelvic mass.

Output: 1.The examination is limited at the operative levels by susceptibility artifact related to the metallic hardware.2.Postoperative findings related to tumor resection, spinal canal decompression, partial T8 corpectomy, and T6-T10 fusion. Hardware better depicted on the comparison CT scan from the same day.3.Destructive soft tissue mass centered at the T8 corpectomy level with epidural extension narrows the thecal sac, from mid T7 to the inferior T8 level, but does not appear to cause frank cord compression. If there is high clinical suspicion of residual cord compression, CT myelogram may be considered.4.There is a new T11 and worsened T10 vertebral body compression fracture since the CT scan from February 7, 2016 with mild associated edema. 5.L2 vertebral body lesion is not completely assessed but may represent a hemangioma.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. T2 hyperintensity in the pons is nonspecific, but likely represents age-indeterminate small vessel ischemic changes.C1-2: Unremarkable, no neuroforaminal narrowing or spinal stenosis. C2-3: Unremarkable, no neuroforaminal narrowing or spinal stenosis. C3-4: Mild facet hypertrophy, left greater than right; minimal disc osteophyte complex formation, without significant neural foraminal narrowing or central canal stenosis.C4-5: Mild facet hypertrophy, left greater than right, mild disc osteophyte complex formation with mild generalized central canal stenosis, without significant cord impingement. No neural foraminal narrowing.C5-6: Mild facet hypertrophy on the left. Mild disc osteophyte complex formation, without neuroforaminal narrowing or spinal stenosis. C6-7: Left greater than right facet hypertrophy and minimal disc is difficult complex formation, without neuroforaminal narrowing or spinal stenosis. C7-T1: Mild bilateral facet hypertrophy; no neuroforaminal narrowing or spinal stenosis. Postcontrast images are slightly degraded by motion. However, there is no evidence of abnormal enhancement.

Output: Relatively mild scattered degenerative changes as detailed above, without high-grade stenosis or significant neural foraminal narrowing. No areas of abnormal enhancement or marrow replacement.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for distal biceps tendinosis History: elbow pain LIGAMENTS: The ulnar collateral ligament, radial collateral ligament, and lateral ulnar collateral ligament appear intact within the limitations of this non arthrogram study.TENDONS: The biceps and brachialis tendons appear intact. The triceps tendon appears intact. The common flexor and extensor tendons appear intact.ARTICULAR SURFACES AND BONE: There is a small amount of fluid within the joint without evidence of a large effusion. No bone marrow signal abnormality is identified.SURROUNDING STRUCTURES: There is a small amount of increased signal abnormality within the ulnar nerve as it courses through the cubital tunnel which is of questionable significance, but may represent mild neuritis.ADDITIONAL

Output: No findings to account for the patient's elbow pain. The biceps tendon appears intact without evidence of tendinosis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: History of left lumpectomy and sentinal node biopsy in May 2014 present for screening MRI. She is also status post neoadjuvant chemotherapy and adjuvant XRT. There is scattered fibroglandular tissue in both breasts. A few small cysts are scattered in the right breast. Marked parenchymal enhancement is noted in the right breast and minimal enhancement is present in the left breast. This limits the sensitivity of this exam in the right breast.No suspicious focal enhancement is seen in either breast. A focus of enhancement in the anterior depth of the left medial breast is stable. No abnormal lymph nodes are identified in either axillary region.

Output: Significantly asymmetric breast enhancement, right breast much greater than left. The right breast enhancement is much greater than on prior MRIs. The asymmetry is most likely to due to the effect of radiation on the left breast which has in this case decreased the background enhancement on that side. Presuming this 35 year old is having normal menstrual cycles, future MRI follow up exams should be performed at the optimal time of her menstrual cycle (days 7-10) to minimize the effect of background enhancement.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Right elbow locking. Prior MRI dated 1/30/2011 demonstrated an old osteochondral defect/degenerative cyst. Prior MRI also demonstrated prominence of synovial fat versus intra-articular loose bodies. There is no significant elbow effusion.The noncontrast CT appearance of the common flexor and extensor tendons is normal. The noncontrast CT appearance of the biceps, brachialis, and triceps is normal.No fluid collections within the soft tissues.Small subchondral lucencies in the anterior aspect of the capitellum are again seen, and given differences in technique appear unchanged from the prior MRI. These may represent degenerative cysts, or old osteochondral defects. The overlying bone plate is intact, suggesting stability. A small defect more posteriorly in the capitellum may represent a normal variant "pseudodefect."No new osseous defects. No fractures.The trochlea, olecranon, and radial head appear normal.Adherent to the posterior wall of the olecranon fossa are a cluster of small 3-mm foci with central fat density, and a rim of calcification. These correspond to the finding on the prior MRI and in keeping with small intra-articular loose bodies. No additional intra-articular loose bodies are seen.

Output: 1. Cluster of small 3-mm foci with central fat density and rim calcification adherent to the posterior wall of the olecranon fossa. These correspond to the finding on prior MRI and are in keeping with small intra-articular loose bodies.2. Small unchanged subchondral cysts in the anterior aspect of the capitellum representing degenerative cysts or old osteochondral defects. The overlying bone plate is intact, suggesting stability.


Instruction: Generate impression based on findings.

Input: Ms. King is a 40 year old female with personal history of BRCA2 mutation and strong family history of breast cancer including her mother (diagnosed at the age of 44) and maternal grandmother (diagnosed at the age of 63). There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.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: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 50 year old female with non-ischemic cardiomyopathy, severe MR, COPD referred for cardiac MRI. Left VentricleThe left ventricle is severely dilated and moderately reduced systolic function. The overall LV ejection fraction is 34%, the LV end diastolic volume index is 185 ml/m2 (normal range: 65+/-11), the LVEDV is 215 ml (normal range 109+/-23), the LV end systolic volume index is 121 ml/m2 (normal range 18+/-5), the LVESV is 142 ml (normal range 31+/-10), the LV mass index is 45 g/m2 (normal range 67+/-11), and the LV mass is 53 g (normal range 114+/-24). There is global hypokinesis with regional variation. There is no definitive late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The myocardial T1 relaxation time ranges from 1020-1050 ms which is within normal limits. There is no evidence of myocardial iron overload. No evidence of left ventricular thrombus. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 25%, the RV end diastolic volume index is 115 ml/m2 (normal range 69+/-14), the RVEDV is 134 ml (normal range 110+/-24), the RV end systolic volume index is 86 ml/m2 (normal range 22+/-8), and the RVESV is 100 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is thickened. There is bileaflet tethering of the mitral valve. There is moderate to severe mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsOne 7mm mediastinal lymph node (likely calcified) is noted above right pulmonary artery. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is severely dilated and moderately reduced systolic function (LVEF 34%). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2.The right ventricle is moderately dilated with severely reduced systolic function (RVEF 25%).3.The mitral valve is thickened. There is bileaflet tethering and moderate to severe mitral regurgitation. 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, 58 years old, with Horner's syndrome, several cranial nerves, sensory, motor and ataxic abnormalities. High suspicion for posterior circulation stroke. No restricted diffusion is seen. No evidence of significant parenchymal edema or mass effect is detected. A few scattered small foci of white matter T2 hyperintensity are seen, a nonspecific finding. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology. No convincing abnormality is seen on the fat-suppressed T1-weighted images to suggest vascular dissection or intramural hematoma. Staphylomatous deformation of the globes is redemonstrated.

Output: No evidence of acute ischemia or any other specific finding which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female 32 years old Reason: evaluate right arm mass History: tingling and numbness of right hand There is a homogeneous, ovoid mass in in the subcapsular deltoid space immediately adjacent to subcutaneous fat which follows fat on all sequences with no appreciable enhancement on postcontrast images measuring 6 x 3 cm in axial dimension and approximately 6 cm in craniocaudal dimension. Osteophyte formation and T2 hyperintense edema signal at the acromioclavicular joint indicating osteoarthritis. The rotator cuff appears intact. No muscle atrophy is noted about the shoulder. No axillary lymphadenopathy.

Output: Findings consistent with subcapsular lipoma in the right deltoid.