Instruction: Generate impression based on findings.

Input: Lumbar radiculopathy For the purposes of numbering, the last rib-bearing vertebra is labeled T12. There are 5 lumbar type vertebral bodies and a sixth lumbarized transitional segment labeled L6 for the purposes of this study. Vertebral body heights are within normal limits. There is levoscoliosis of the lumbar spine. Bone marrow signal is benign. Small Schmorl's nodes are noted involving the endplates at multiple levels. There is multilevel disc desiccation with particular height loss at the L2-L3 and L3-L4 levels. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Loss of disc height. There is minimal bulge eccentric to the left with no significant spinal canal stenosis. There is minimal left neural foraminal narrowing. No significant right neural foraminal stenosis. L3-L4: Disc desiccation with minimal bulge. There is bilateral facet arthropathy. There is minimal right neural foraminal narrowing. No spinal canal or left neural foraminal stenosis.L4-L5: Mild disc bulge and bilateral facet arthropathy. There is minimal right neural foraminal narrowing. There is no significant spinal canal or left neural foraminal stenosis. L5-L6: There is advanced bilateral facet arthropathy with an ovoid epidural lesion involving the left lateral aspect of the spinal canal most consistent with a synovial cyst. This lesion measures 10 mm in the AP dimension and up to 14 mm in the craniocaudal dimension. Lesion is associated with effacement of the left lateral recess and possible impingement of the descending nerve root at this level. There is also mild mass effect on the left lateral aspect of the thecal sac. There is mild disc bulge. There is mild left neural foraminal stenosis. No significant right neural foraminal narrowing.L6-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.Paraspinous soft tissues are within normal limits. Small cysts in the kidneys are incidentally noted.

Output: 1. Please note transitional lumbosacral anatomy with numbering of the vertebral bodies as L1 through L6.2. Multilevel degenerative changes in the lumbar spine. There is levoscoliosis which can be further assessed with standing radiographs. 3. There is a synovial cyst in the left lateral epidural space at the L5-L6 level measuring 10 x 14 mm (APxcraniocaudal) and is associated with effacement of the left lateral recess as well as mild mass effect on the left lateral aspect of the thecal sac. This lesion may be contributing to left-sided radicular symptoms. Please see additional details above.


Instruction: Generate impression based on findings.

Input: Ms. Vondriska is a 60 year old female with a personal history of occult primary adenocarcinoma status post complete axillary lymph node dissection in 2006 treated with chemotherapy and radiation therapy. Personal history of benign left breast biopsy in 2006 for fibroadenoma. Family history of breast cancer in sister, diagnosed at the age of 39. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Stable postoperative changes are present along the left axilla. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: H/o renal cell carcinoma with known cerebellar metastasis. Examination demonstrates postoperative change of a left suboccipital craniotomy, including edema and trace amount of blood product at the surgical site. The mass in the left medial cerebellum identified on prior MRI has been resected. The one in the left lateral cerebellum is still present and appears hemorrhagic. It measures 1 x 1 cm. The cerebral hemispheres appear normal in attenuation and morphology. Supratentorially, there is no intracranial hemorrhage, or midline shift. The ventricles appear enlarged. A left frontal arachnoid cyst with remodeling of the adjacent frontal bone is noted. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Postoperative change of a left suboccipital craniotomy. 2. Left cerebellar hemorrhagic metastatic lesion. 3. Hydrocephalus. 4. Left frontal arachnoid cyst.


Instruction: Generate impression based on findings.

Input: 16-year-old female with patellar dislocation, rule out loose body/chondral injury MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is edema along the lateral aspect of the lateral femoral condyle which may suggest prior lateral patellar dislocation, however no kissing contusion of the medial facet of the patella is evident.The tibial tubercle to trochlear groove distance is normal measuring 15 mm. No evidence of trochlear dysplasia. The Insall-Salvati ratio is normal measuring 0.83LIGAMENTS: The ACL and PCL are intact. The medial and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: Extensor mechanism is intactADDITIONAL

Output: Findings of prior lateral patellar dislocation. No underlying morphologic abnormalities of the patellofemoral joint are identified.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. There is a right maxillary sinus retention cyst and scattered paranasal sinus mucosal thickening. The mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis.

Output: Negative MRI and MRA of the brain.


Instruction: Generate impression based on findings.

Input: Reason: quadricep tendon disruption History: fall, pain, tenderness at insertion site and what appears to be a deformity of quadricep muscle MENISCI: There is linear increased signal abnormality along the free edge of the posterior horn of the medial meniscus which extends to the tibial and femoral articular surface indicating a small radial tear (image 21; series 1101 and image 13; series 1201). The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a near full-thickness to full-thickness articular cartilage fissure along the lateral facet of the patella. No bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is tearing of the quadriceps tendon at the level of its insertion on the patella with approximately 2 cm of retraction of the proximal tendon fragments. More specifically, there is complete disruption of the rectus femoris. There is also near complete to complete disruption of the vastus medialis and lateralis as well. Fibers of the vastus intermedius can be traced to the level of their insertion on the patella, likely reflecting partial thickness tearing. The patellar tendon appears intact.ADDITIONAL

Output: 1. Near complete disruption of the quadriceps tendon with retraction as described above.2. Small radial tear of the posterior horn of the medial meniscus, near its root.3. Articular cartilage fissuring affecting the patellofemoral articulation as described above.4. Small-to-moderate size joint effusion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 54 year old woman with history of premature coronary artery disease with recent NSTEMI and stenting of the circumflex and diagonal branches in July 2016, and diagnosis of right coronary aneurysm. She underwent subsequent nuclear stress demonstrating anterior wall ischemia. She has persistent significant dyspnea with exertion and is referred for vasodilator stress testing as well as coronary imaging.MEDICATIONS: carvedilol, ramipril, atorvastatin, aspirin, nicotine patch First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is late gadolinium enhancement in the mid-apical anterior wall of the left ventricle, which involves the endocardium and involves >50% of the myocardial wall. This suggests low probability of viability.Coronary Arteries:The RCA has a normal origin from the right coronary cusp. There is aneurysmal dilation at the mid portion of the vessel which measures 9 x 7mm at its largest diameter. This aneurysmal segment is associated with either a large plaque or thrombus within it. It is surrounded on both the proximal and distal side by a severe stenosis (>70%). Just proximal to the aneurysmal segment, there is an acute marginal take off noted. The left coronary artery is not well seen due to the presence of stent artifacts. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 63 ml/m2 (normal range: 65+/-11), the LVEDV is 132 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10), the LV mass index is 37 g/m2, and the LV mass is 78 g. There is mild hypokinesis of the mid anterior wall. 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 58%, the RV end diastolic volume index is 58 ml/m2 (normal range 69+/-14), the RVEDV is 121 ml (normal range 110+/-24), the RV end systolic volume index is 24 ml/m2 (normal range 22+/-8), and the RVESV is 51 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 FindingsA gastric band is seen. 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. Late gadolinium enhancement in the mid-distal anterior wall which involves the endocardium and >50% of the wall thickness, with associated hypokinesis of these segments. This suggests previous myocardial infarction with low probability of viability. The remainder of the myocardium is free of myocardial infarction and viable.3. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 58%).5. There is aneurysmal dilation at the mid portion of the RCA which measures 9 x 7mm at its largest diameter. This aneurysmal segment is associated with either a large plaque or thrombus within it. It is surrounded on both the proximal and distal side by a severe stenosis (>70%). Just proximal to the aneurysmal segment, there is an acute marginal take off noted. The left coronary artery is not well seen due to the presence of stent artifacts. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 42 year-old female status post craniotomy with headache. Postsurgical changes from bilateral craniotomies are again seen with diffuse edema in the cerebral white matter appearing similar to the recent MRI. Expected pneumocephalus is seen in the right parietal region. Ring of hyperdensity in the left frontal lobe with small amount of adjacent blood products likely corresponds to left frontal lobe mass seen on prior MRI.The ventricles and basal cisterns are normal in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Postsurgical changes and diffuse edema in cerebral white matter as above


Instruction: Generate impression based on findings.

Input: Clinical question: Explanation for back pain. Signs and symptoms: L3, L4 radiculopathy. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column however with slight straightening of lordosis.T11-T12, T12-L1 and L1-L2 levels are unremarkable.L2-L3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. Minimal bilateral facet effusion is noted.L3-L4 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate moderate disease and loss of disc height, moderate bilateral ligamentum flavum and mild bilateral facet hypertrophic changes. Mild right-sided facet effusion. There is a shallow broad-based left lateral and far lateral disc protrusion with resultant moderate left neural foraminal compromise (sagittal T1 and T2 images for through 8). No spinal stenosis and patent left neural foramina.L5-S1 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis and only mild right neural foraminal compromise.

Output: 1.Shallow broad-based left lateral and far lateral disc protrusion at L4/L5 with resultant moderate left neural foraminal compromise and without spinal stenosis.2.Degenerative changes at other levels without spinal stenosis at any level. Neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: 58 year old female with a BRCA 1 mutation presents for screening MRI. Family history of breast cancer in her paternal grandmother at age 55, aunt at age 36 and cousin at age 48 There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal 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: Migraine, unspecified, intractable, without status migrainosus [G43.919], Reason for Study: ^Reason: evaluate for change in size of aneurysm ant comm 3mm seen in Aug 2013 at OSH History: consistent headaches for almost 1 week Brain MRINo evidence of acute ischemic or hemorrhagic lesion. A couple of T2/FLAIR high signal intensity lesions on the left frontal lobe which are nonspecific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA technique maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. There is no evidence of intracranial arterial aneurysm. There is no evidence of intracranial arterial luminal stenosis.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific white matter T2/FLAIR high signal intensity lesions.3. No evidence of intracranial arterial aneurysm. No intracranial arterial luminal stenosis.Comment: Although clinical history shows about 3 mm aneurysm seen in August 2013 outside images, this could be related to the sensitivity of different imaging modality for the detection of small intracranial arterial lesion. Therefore, if clinically indicated, head CTA can be considered for further imaging investigation.


Instruction: Generate impression based on findings.

Input: History of craniotomy for Chiari malformation. There are postsurgical changes of a suboccipital craniectomy and C1 laminectomy for decompression. The CSF spaces at the ventral and dorsal foramen magnum remain widely patent. Again seen is a retrocerebellar CSF intensity collection, not significant changed in size. CSF flow sequence demonstrates biphasic flow at the foramen magnum as well as some continuity of flow at the dorsal foramen magnum into the retrocerebellar CSF space. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate foci of increased T2/FLAIR signal within the periventricular white matter which are nonspecific but not significantly changed when accounting for differences in technique. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal patchy mucosal thickening within the paranasal sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Post-surgical changes of suboccipital craniectomy and C1 laminectomy for Chiari decompression .2. Biophysical CSF flow at the foramen magnum which appears to communicate with the prominent retrocerebellar CSF space, not significantly changed in appearance.


Instruction: Generate impression based on findings.

Input: Cirrhosis, evaluate for HCC and biliary obstruction ABDOMEN:LIVER, BILIARY TRACT: Cirrhosis and marked ascites. Segment 6 ablation zone measures 1.7 x 1.3 cm, previously 1.7 x 1.3 cm. No arterially enhancing lesions to suggest HCC.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Recanalized periumbilical vein.

Output: 1.Cirrhosis without arterially enhancing lesions to suggest HCC.2.Marked gastric wall thickening compatible with portal venous gastropathy.


Instruction: Generate impression based on findings.

Input: History of right lower quadrant pain with large pelvic phlegmon seen on recent CT. ABDOMEN:LUNG BASES: Subcentimeter left lower lobe pulmonary nodule better seen on recent CT.LIVER, BILIARY TRACT: There is mild dilation of the common bile duct up until the level of the ampulla, measuring up to 7 mm. There is associated mild intrahepatic ductal dilatation as well. No focal hepatic lesions are identified.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is diffusely dilated up until the ampulla, measuring up to 6 mm. No distinct pancreatic lesions are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large pelvic abscess as described below. Round areas of signal abnormality within the myometrium likely reflect uterine fibroids. There is no abnormal thickening of the endometrial stripe. To the right of and apparently distinct from the uterus and ovaries, there is a well-defined round structure measuring 4.3 x 3.7 cm which demonstrates decreased T2 signal, intermediate T1 signal, and heterogeneous enhancement which is nonspecific.BLADDER: No significant abnormality noted.LYMPH NODES: Mild retroperitoneal lymphadenopathy which is nonspecific but may be reactive. BOWEL, MESENTERY: The distal appendix is dilated with surrounding inflammatory changes compatible with ruptured appendicitis. There is a large associated pelvic abscess as described below.BONES, SOFT TISSUES: Degenerative changes affect the spine and hip joints.OTHER: There is a large, multiloculated fluid collection in the pelvis with peripheral enhancement compatible with an abscess. The largest single locule measures approximately 4.8 x 4.6 cm. In total, the abscess measures approximately 8.5 x 11.0 cm including adjacent surrounding inflammatory changes.

Output: 1.Findings compatible with ruptured appendicitis with large multiloculated pelvic abscess/phlegmon.2.Nonspecific 4.3 cm structure within the pelvis which appears distinct from the uterus and ovaries. Differential considerations include a pedunculated fibroid or a fibrous tumor, though evaluation is limited by aforementioned pelvic inflammatory process. Follow-up imaging when the acute episode has resolved is recommended for further evaluation.3.Dilation of the common bile duct and pancreatic duct to level of ampulla which may reflect ampullary stricture or lesion. ERCP is recommended for further evaluation if clinically indicated.Presence of an abscess was discussed by radiology on-call resident with the surgical service at 12:31 AM on 8/28/2016.


Instruction: Generate impression based on findings.

Input: And clinical question: Fall, on Lovenox. Signs and symptoms: Headaches No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal. No evidence of intracranial post traumatic finding.Multiple well demarcated lytic lesions of skull are noted. These lesions are well demarcated and demonstrate internal trabeculation. Findings are believed to a multiple skeletal capillary hemangiomas. MRI examination of brain from 10 -- 24 -- 2009 demonstrated several of these lesions.The less likely possibility of metastatic disease however cannot be entirely ruled out.Small hematoma in the right posterior high convexity parietal region is identified on axial image 25.Mastoid air cells, middle ear cavities and limited view of paranasal sinuses are unremarkable.

Output: 1.No evidence of intracranial post traumatic findings.2.Multiple well-demarcated and entirely intraosseous lytic skull lesions with internal trabeculation is believed to represent hemangiomas. Less likely possibility of metastatic lesion however cannot be entirely ruled out.3.Right posterior parietal scalp hematoma.


Instruction: Generate impression based on findings.

Input: Chiari malformation and tethered cord status post tethered cord release in 2005. New symptoms, including neck, back, arm pain and worsening headaches. History of Ehlers-Danlos/Postural Tachycardia Syndrome. MRI BRAIN: There is again 7-8 mm downward extension of relatively rounded cerebellar tonsils without peg-like appearance at this time. There is similar crowding at this level although with further effacement of the CSF space dorsal to the tonsils when comparing sagittal T2 cervical spine images back to 2011. CSF flow imaging again demonstrates decreased biphasic CSF flow through the dorsal foramen magnum.The ventricles, sulci and cisterns are within normal limits. There is no mass, mass effect or midline shift, extra-axial fluid collection, or restricted diffusion. There is again minimal nonspecific FLAIR hyperintensity along the right frontal horn. Normal flow voids are identified in the major intracranial vessels. There is a small right maxillary sinus mucosal retention cyst. There is scattered trace right mastoid fluid.MRI SPINE: The spine alignment is anatomic. The cord caliber and signal are normal. The conus medullaris terminates at the upper to mid L3 level. Filum terminale appears normal in caliber. There is apparent subtle linear T1 hyperintensity with respect to adjacent nerve roots and T2/STIR hypointensity within the distal thecal sac extending caudally from L5-S1, more conspicuous on the sagittal images, with a similar appearance when compared to prior images. Prone imaging again demonstrates ventral displacement of the conus and cauda equina nerve roots.The vertebral bodies, marrow, and disks demonstrate a normal MR appearance except for disk height loss and dessication at L5-S1. Mild scattered spondylotic changes are not significantly changed, although the C5-C6 posterior osteophyte disk complex is perhaps slightly more prominent along the right foraminal location, with slightly worsened foraminal narrowing, now moderate-severe right and moderate left in degree. There is also now increased prominence of a right paracentral disk protrusion with annular fissure at T9-10. Lumbar facet arthropathy is again noted.

Output: 1. Stable configuration and caudal extension of cerebellar tonsils through the crowded foramen magnum, with further decreased subarachnoid space dorsal to the tonsils compared back to 2011. Persistent reduced CSF flow through the dorsal foramen magnum. 2. No evidence of syrinx. 3. Abnormal low termination of the conus medullaris, but unchanged. Redemonstration of normal caliber filum with only mild intrinsic T1 hyperintensity with respect to adjacent nerve roots, with persistent normal ventral motion of distal cord/conus and cauda equina nerve roots on prone images.4. Mild scattered spondylotic changes, minimally progressed, with moderate-severe right foraminal narrowing at C5-C6.


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRV HEAD

Output: 1. No evidence of stenosis in the intracranial arterial vasculature or aneurysm.2. No evidence of venous sinus thrombosis.3. 2 cm extra axial mass along the left anterior temporal convexity is most consistent with sphenoid wing meningioma and demonstrates increase in size since prior MRI from 7/28/2015.


Instruction: Generate impression based on findings.

Input: 7-day-old male with seizures suspected to be related to sepsis or hypoxic ischemic encephalopathy, status post cooling protocol. The brain morphology is normal with age-appropriate myelination. The the pituitary gland and other midline structures appear unremarkable. There is no evidence of mass or acute infarct. A trace amount of susceptibility artifact and T1 shortening is present along the tentorium, likely related to trace subdural blood products. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Normal brain morphology. No evidence of hypoxic ischemic injury.2. Probable trace subdural blood products along the tentorium, which is not an unusual finding in the immediate post natal period and likely not of any clinical significance. No other significant intracranial hemorrhage or extra-axial fluid collections.


Instruction: Generate impression based on findings.

Input: 67 year old man with recent acute CVA and found to have systolic heart failure and multi-vessel disease. Cardiac MRI done to evaluate for function and viablity Left VentricleThe left ventricle is severely dilated with severe reduced systolic dysfunction. The overall LV ejection fraction is 25%, the LV end diastolic volume index is 173 ml/m2 (normal range: 74+/-15), the LVEDV is 350 ml (normal range 142+/-34), the LV end systolic volume index is 129 ml/m2 (normal range 25+/-9), the LVESV is 262 ml (normal range 47+/-19), the LV mass index is 108 g\m2 (normal range 85+/-15), and the LV mass is 219 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is epicardial late gadolinium enhancement involving the basal anterior wall and them mid inferior wall. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. There is no evidence of myocardial infarction and any ischemic segments are likely to be viable. However, because the patient has non-coronary disease related fibrosis, it is unclear whether the LVEF would be expected to improve after revascularization. No LV thrombus is noted. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is upper limits of normal size with severely reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 103 ml/m2 (normal range 82+/-16), the RVEDV is 209 ml (normal range 142+/-31), the RV end systolic volume index is 72ml/m2 (normal range 31+/-9), and the RVESV is 145 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.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. Severe left ventricular dilation and systolic dysfunction (LVEF 25%) due to non-ischemic and ischemic etiologies. There is evidence of myocardial fibrosis in a pattern atypical for myocardial infarction. Normally the absence of myocardial infarction would suggest that the myocardium is viable; however, in this patient, it is unclear whether the LV systolic function would be expected to improve following revascularization due to the presence of non-coronary artery disease related myocardial fibrosis.2. The RV is upper limits of normal size with severely reduced systolic function (RVEF 30%).3. At least moderate mitral regurgitation.4. Severe left atrial dilation.5. Small pericardial effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer: headaches. There are multiple, approximately 10, supratentorial enhancing lesions. For example, a right occipital lobe peripherally enhancing lesion with mild susceptibility effect measures 10 mm in diameter, previously 5 mm, a new right inferior frontal lobe enhancing lesion measures 5 mm in diameter, a left lateral temporal lobe enhancing lesion measures 5 mm in diameter, previously 2 mm, and a new left periventricular white matter enhancing lesion measures 3 mm in diameter. The lesions are generally associated with mild vasogenic edema. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles are normal in size and configuration, including cavum septum pellucidum and vergae. There is no midline shift or herniation. There is a 1 mm outpouching along the right aspect of the anterior communicating artery complex. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval increase in size and number of intracranial metastases.2. A 1 mm outpouching along the right aspect of the anterior communicating artery complex may represent an aneurysm or infundibulum.


Instruction: Generate impression based on findings.

Input: Female, 17 years old, with generalized tonic clonic seizure. Assess for seizure focus. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.The medial temporal lobe structures are symmetric and free of signal abnormality. No evidence of ectopia, dysplasia or other structural abnormality is seen. No evidence of parenchymal edema, mass, or mass effect is seen. There is no intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: No significant intracranial abnormality is seen, nor is there any specific finding to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma. There is an enhancing T2 hyperintense 8 mm diameter lesion in the left hippocampus. There are also nonspecific mild scattered foci of cerebral white matter T2 hyperintensity. There is no evidence of other intracranial lesions. 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. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is fluid or mucosal thickening in the bilateral ethmoid sinuses.

Output: A subcentimeter lesion in the left hippocampus likely represents metastatic disease.


Instruction: Generate impression based on findings.

Input: Hepatitis C. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Mildly cirrhotic liver morphology with fissural prominence. There is heterogeneous enhancement with multiple peripheral areas of arterial enhancement which become isointense to background liver on the portal venous and delayed phases compatible with perfusional anomalies.No suspicious liver lesion or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhosis without suspicious lesion.


Instruction: Generate impression based on findings.

Input: Right adrenal mass. "Likely a pheochromocytoma." EPIC CHART: 67yo female with seizure disorder not on meds, SLE dx'ed at age 28 not on meds, recently diagnosed with right neck paraganglioma, right adrenal mass, thyroid nodule, pheochromocytoma, elevated PTH, Ca, norepinephrine, concerning for MEN2 with recurrent admissions to OSH in Joliet since October for symptomatic pheochromocytoma s/p TIAx4. Also with incidental right carotid intracranial artery aneurysm, 4mm. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 1.2 x 0.9 cm right adrenal homogeneously T1 weighted hypointense and T2 weighted isointense nodule in the superior aspect of the medial limb of the adrenal gland demonstrates loss of signal intensity on out of phase imaging and mild isointense homogeneous enhancement.KIDNEYS, URETERS: No significant abnormality noted.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: 1.2 cm right adrenal nodule does not have any specific imaging features of a pheochromocytoma, but rather has imaging characteristics most commonly seen with a lipid-rich adrenal adenoma; however, given the clinical history a pheochromocytoma cannot be excluded. Correlate with patient's reported MIBI scan.


Instruction: Generate impression based on findings.

Input: 52 year-old woman with history of fall and shoulder injury one month ago, now with weakness and pain. ROTATOR CUFF: There is thickening of the supraspinatus tendon with mildly increased signal intensity, however there is no discrete tear. The muscle body of the supraspinatus a small, however there is no evidence of frank atrophy. The subscapularis, infraspinatus, and teres minor tendons and muscles are intact.SUPRASPINATUS OUTLET: There is moderate acromioclavicular joint osteoarthritis. A small amount of fluid is noted in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There are large subchondral cysts at the insertion of the supraspinatus tendon. The remainder of the cortical and marrow signal appears normal. Glenohumeral joint alignment is within normal limits. The glenoid labrum, within the limitations of this non-arthrogram study, appears intact.BICEPS TENDON: There is a small amount of fluid in the biceps tendon sheath, but the biceps tendon is intact.ADDITIONAL

Output: Supraspinatus tendinopathy with large subchondral cysts in the humeral head but no frank tear.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is deformity and maceration of the anterior horn of the lateral meniscus consistent with degeneration and degenerative tearing which extends to the body of the meniscus. There is superficial fraying of the posterior horn of the lateral meniscus which extends to involve the tibial articular surface. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a focal near full-thickness to full-thickness articular cartilage cleft along the lateral facet of the patella with underlying subchondral cyst formation and degenerative subchondral signal abnormality. There is a tiny focal articular cartilage defect along the weightbearing surface of the lateral femoral above the body of the meniscus. There is subjective thinning of the articular cartilage of the lateral compartment. There is focal full-thickness articular cartilage degeneration along the weightbearing surface of the lateral tibial plateau with underlying subchondral cyst formation.There are is thinning of the articular cartilage of the medial compartment without evidence of a full-thickness articular cartilage defect.There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is mild increased signal abnormality within the distal fibers of the patellar tendon at the level of its insertion on the tibial tubercle which may reflect a mild tendinosis. There is a small amount of fluid within the deep infrapatellar bursa of questionable clinical significance.ADDITIONAL

Output: 1. Degeneration and degenerative tearing of the lateral meniscus.2. Osteoarthritis of the knee with focal full-thickness articular cartilage defects/clefts affecting the patellofemoral and lateral tibiofemoral compartments.3. Small joint effusion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 54-year-old male with seizures and midline pain status post fall and loss of consciousness; rule out intracranial bleed or cervical spine fracture/dislocation HEAD:There is no evidence of acute intracranial hemorrhage, mass or edema. The gray-white matter differentiation is preserved. Bilateral basal ganglia calcifications.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal without evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CERVICAL SPINE:Mild straightening of the normal cervical lordosis is seen which may be due to patient positioning versus muscle spasm. Vertebral body heights are maintained without evidence of fracture. Extensive degenerative changes of the cervical spine with spinal canal stenosis worst at C3-4. See MRI of the cervical spine for further information. The prevertebral soft tissues are unremarkable.

Output: No acute intracranial abnormality. Severe degenerative changes of the cervical spine without evidence of acute fracture. Please refer to MRI for additional findings.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of hepatitis C cirrhosis, HCC. Evaluate for metastases. Evaluate cardiopulmonary status. Pre-liver transplant candidate. LUNGS AND PLEURA: Mild paraseptal apical predominant emphysema. Right upper lobe calcified granuloma. Scarring or atelectasis at the bases. No suspicious pulmonary nodules. No pleural effusions.MEDIASTINUM AND HILA: Residual thymic tissue. Normal cardiac size. Mild coronary artery calcifications. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant axillary lymphadenopathy. No suspicious osseous lesions.UPPER ABDOMEN: Hypertrophy of the left lobe with atrophy of the right lobe and nodular contour of the liver compatible with the given history of cirrhosis. Splenomegaly incompletely evaluated. Hypodense lesion in segment 5 most likely represents patient's known HCC (image 70/86). Additional hypodense lesions in the right lobe of the liver are too small to characterize. If further evaluation is required a dedicated liver CT/MRI may be considered.

Output: 1. No evidence of thoracic metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 25 years, Male, right-sided pain. Check size of caudate for Huntington's disease and rule out MS. Brain: Brain parenchyma appears essentially within normal limits for age. There is a tiny focus of T2/FLAIR hyperintensity in the right precentral gyrus which is nonspecific. No lesions to specifically suggest demyelinating disease are appreciated. Basal ganglia including the caudate nuclei are symmetric and grossly normal in size. No evidence of abnormal mineralization is appreciated in the basal ganglia, brainstem, or cerebellum.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is an ovoid focus of ill-defined enhancement and susceptibility in the right frontal lobe, with also a linear component, with MR features compatible with both capillary telangiectasia and development of venous anomaly. There is subtle associated T2 hyperintensity. There is otherwise no abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.Paraspinous soft tissue structures appear within normal limits.

Output: 1. Examination is essentially within normal limits for age. There is a tiny nonspecific focus of T2/FLAIR hyperintensity in the right frontal subcortical white matter. No findings to suggest demyelinating disease. No signal abnormality, volume loss, or iron deposition in the basal ganglia to suggest Huntington's disease by MRI.2. Incidentally seen is a right frontal lobe focus of ill-defined enhancement and susceptibility most compatible with a combined capillary telangiectasia and developmental venous anomaly.3. Cervical spine MRI is also within normal limits with no cord signal abnormality or evidence of spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for source of seizure activity, pt is nonverbal at this time which is significantly different from her baseline History: Nonfocal exam except nonverbal The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a ringlike signal hypointensity present along the medial aspect of the left cerebellar hemisphere measuring 5 mm in diameter. Centrally it is high he is signal and intermediate and T1There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally, there is T2 and flair signal hyperintensity along the brain stem distributed in a patchy manner.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin.Incidental note is made of partial empty sella

Output: 1.There is a small lesion present in the left cerebellar hemisphere measuring 5 mm in size which is suspected to represent a cerebral cavernous malformation . Susceptibility imaging and contrast enhancement may be helpful in evaluating for associated developmental venous anomaly .2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There are brainstem lesions present which are suspect to be vascular related but are nonspecific.4.Examination was somewhat compromised due to patient inability to cooperate. As a result not all pulse sequences were performed. The susceptibility weighted imaging was not performed. This may result in overlooking more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Clinical question: Worsening vision on the right, tingling right hand, burning sensation in both legs, weakness and legs, gaite problem. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates extensive tiny foci of flair hyperintensity in bilateral subcortical, periventricular white matter of city hemispheres and minimally in the posterior fossa. Findings consistent with patient's previously known multiple sclerosis. There is no significant interval change since prior exam on the extent of the above findings and none of the lesions demonstrate enhancement to suggest active demyelinating plaque.Ventricular system and cortical sulci remain within normal size and without evidence of any intracranial mass effect. The calvarium is unremarkable. Images through the orbits including axial fat sat series are unremarkable and without convincing evidence of abnormal enhancement.Pre-and post-enhanced MRI of orbits:Examination demonstrate normal signal intensity and caliber of the optic nerves bilaterally. There is no convincing evidence of enhancement of optic nerves. The optic chiasm demonstrate normal signal intensity and without detectable abnormal enhancement.There is normal signal intensity of the retro-orbital fat. The signal intensity, caliber and pattern of enhancement the extraocular musculature is also within normal.Lacrimal glands are within normal size and morphology and without detectable abnormal enhancement.Pre-and post-enhanced cervical MRI:Examination demonstrates fairly extensive foci of T2/T2 stir hyperintensity throughout the cervical cord and minimally in the uppermost visualized thoracic cord. Although difficult to precisely compare with prior exam due to technique difference there is suggestion of interval progression of disease. Examination however demonstrate no convincing evidence of an enhancing plaque.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild asymmetric right uncovertebral hypertrophic changes and a small central disk protrusion without spinal stenosis or neural foraminal compromise.C4 -- C5 demonstrates a prominent central and right paramedian broad-based disk protrusion which results in effacement of ventral subarachnoid space and slight flattening and posterior displacement of the cord resulting in mild central spinal stenosis. Mild bilateral neural foraminal compromise is also present.C5 -- C6 demonstrate degenerative changes resulting in moderate right neural foraminal compromise.C6 -- C7 demonstrate large asymmetric left uncovertebral hypertrophy, shallow broad-based disk protrusion and mild bilateral ligamentum flavum hypertrophic changes. Constellation of changes results in mild central spinal stenosis without convincing evidence of neural foraminal compromise.

Output: 1.Pre-and post-enhanced brain MRI demonstrate moderate supratentorial and mild infratentorial chronic findings of multiple sclerosis no abnormal enhancement or significant change since prior exam.2.Pre-and post-enhanced MRI of the orbits is unremarkable. 3.Pre-and post-enhanced MRI of cervical spine demonstrate extensive chronic findings of demyelinating disease with interval progression since prior exam. Large central disk protrusion at C4 -- C5 with resultant mild central spinal stenosis is noted. Degenerative changes and a shallow disk protrusion at C6 -- C7 with resultant mild central spinal stenosis. Neural foramina are compromised as detailed per level.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left knee was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using a 25-gauge needle.Under fluoroscopic guidance, a 22-gauge needle was advanced into the joint. Attempted aspiration yielded 25 cc's of slightly viscous translucent blood-tinged fluid. Next, 20 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 29 seconds.

Output: Successful fluoroscopic-guided left knee arthrogram. Approximately 25 cc's of fluid was aspirated from the left knee joint as described above.


Instruction: Generate impression based on findings.

Input: 39 years Male (DOB:8/21/1976)Reason: new onset seizure, subacute and chronic stroke History: new onset seizure, psychosis patent foramen ovale. hypohomocysteinemiaPROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS MRI of the brainThere is subacute focus of diffusion restriction involving the right inferior parietal lobule measuring approximately 46 x 64 mm in axial dimensions. This is associated with gyral enhancementThere is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate foci of T2 and FLAIR signal hyperintensity are present in the right thalamus and right brain stem.There is a T2 and FLAIR hyperintense lesion involving the corpus callosum and adjacent cingulate gyrus at the anterior aspect of the body of the corpus callosum with an junction to the genu. It measures 11 x 14 mm sagittal dimensions.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right angular artery appears to be occluded along the mid M2 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.Subacute infarction involving the right parietal lobe in the territory of the right angular artery.2.Findings are compatible with occlusion of the right angular artery3.Old lacunar infarcts involving the right brain stem and right thalamus and corpus callosum.4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. They are unusual for the patient's stated age but given the other findings they are most likely vascular related.5.Findings were discussed with Dr. Fintel at the time of this dictation


Instruction: Generate impression based on findings.

Input: 80-year-old male with pituitary adenoma. Assess for changes. Redemonstration of the lesion within the pituitary gland which is unchanged in size measuring 11 mm x 9 mm; the lesion is isointense on T1, mildly hyperintense on T2 and demonstrates minimal enhancement. The lesion abuts the left cavernous portion of the internal carotid artery by less than 180 degrees similar to prior study. The CSF space between the optic chiasm and the superior aspect of the pituitary gland is effaced on the left, also similar to prior study.Again seen are scattered periventricular and subcortical white matter T2 hyperintense foci which are partially imaged.

Output: Stable exam with unchanged pituitary microadenoma.


Instruction: Generate impression based on findings.

Input: 67-year-old man with history of back pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Multiple anterior superior and inferior endplates in the lumbar spine have increased T2 and T1 signal suggestive of fatty degenerative changes. Additionally, there is increased T2 signal and low T1 signal in the anterior inferior endplate of L4, also degenerative. There is disc desiccation with mild height loss at T11/T12, L3/L4, L4/L5, and L5/S1. The conus medullaris is normal in position at L1/L2. Of note, there appears to be congenital narrowing of the mid to distal lumbar spinal canal and prominent posterior epidural fat.Multilevel degenerative changes are seen, as described below:T11-T12: There is a disc bulge with flattening of the left ventral thecal sac but no significant spinal canal or neuroforaminal stenosis.T12-L1: 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. No spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge along with facet hypertrophy and ligamentum flavum thickening, right greater than left. Additionally, there is a central disc extrusion (201/8) extending cranially approximately 10 mm. This extrusion has slightly increased T2 signal (401/8) compared to the parent disc, suggesting sequestration. There is moderate spinal canal stenosis and narrowing of the lateral recesses, right greater than left. There is moderate right neural foraminal stenosis and mild left neural foraminal stenosis. Additionally, the disc bulge impinges on the exiting right L3 nerve root.L4-L5: There is a disc bulge along with facet hypertrophy and ligamentum flavum thickening, right greater than left. Additionally, there is a right distal foraminal/far lateral disc extrusion extending cranially approximately 5 mm, which may also be in early stages of sequestration. There is minimal spinal canal stenosis and narrowing of the lateral recesses. There is moderate to severe right neural foraminal stenosis and mild left neural foraminal stenosis. Additionally, there is impingement on the exiting right L4 nerve root by disc material.L5-S1: There is a disc bulge with facet hypertrophy, left greater than right. There is no significant spinal canal stenosis, however there is bilateral moderate neural foraminal stenosis.There is a presumed left renal cyst partially visualized, as well as a T2 hyperintense lesion in the right aspect of the liver, only partially seen as well. A subcentimeter right retrocrural lymph node is noted. Otherwise the paraspinous soft tissues are within normal limits.

Output: 1.Degenerative changes superimposed upon a congenitally narrow canal with prominent epidural fat.2.Small right distal foraminal/far lateral disc extrusion at L4-L5 also possibly in the early stages of sequestration, with moderate-severe right foraminal narrowing and impingement on the exiting right L4 nerve root.3.Large central disc extrusion at L3-L4 with suggestion of sequestration, resulting in moderate central spinal canal stenosis and moderate right foraminal narrowing. Disc material impinges upon the exiting right L3 nerve root.


Instruction: Generate impression based on findings.

Input: History of bladder cancer status post radical cystectomy. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and enhancement. No biliary ductal dilatation focal suspicious lesion or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of tumor recurrence in the nephrectomy bed.Stable right renal 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.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: Solidly enhancing left pelvic nodule measures 1.6 x 1.0 cm (series 18/29; series 14/30), compared to 0.9 x 0.5 cm previously.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 6-mm low T1, high T2, enhancing focus in the right sacral ala is unchanged since prior. OTHER: No significant abnormality noted.

Output: 1.Slight interval increase in size of the solidly enhancing left pelvic lesion.2.No new sites of disease.


Instruction: Generate impression based on findings.

Input: History of laryngeal cancer. Receiving chemotherapy. CT of the soft tissues of the neck:Images through the skull base and including cavernous sinuses remain within normal limits.Images through the larynx reidentifies post therapy changes and with no definitive evidence of residual tumor. It has not changed in appearance since 2/25/07. The thyroid cartilage shadow remains splayed. The glottis is not distorted. The epiglottis is not identified No evidence of pathologic adenopathy in the neck. There is a left jugular chain lymph node present at the level of the hyoid bone measuring about 8 mm short axis dimension which can be identified on previous exams dating back to 22507 when it measured 6 mm short axis dimension. Limited images through the apices of the lungs and mediastinum are negative for metastatic lesions. Large quantities of air within the esophagus may reflect reflux. This finding was noted on prior study and no change. There are atherosclerotic calcifications of the carotid bifurcations on the left side the there is concern for significant narrowing of the left internal carotid artery at its origin.There are degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes at multiple levels and associated narrowing of the spinal canal and the neural foramina in the upper cervical spine there is some right-sided facet hypertrophy.The patient is status post median sternotomy.The esophagus appears to have diverticulum at the level of the thoracic inlet which is directed anteriorlyCT of brain with infusion.There is a focus of encephalomalacia in the left cerebellar hemisphere unchanged since prior exams which likely represents a prior infarct. Periventricular and subcortical white matter hypodensities are present which are nonspecific but likely vascular related at this age.. A hypodense focus is redemonstrated at the genu of the right internal capsule probably lacunar infarct. There is associated atrophy of the right caudate nucleus.Along the left parietal lobe adjacent to the left intraparietal sulcus there is a small focus of enhancement measuring approximately 6 mm in size. This was not present on prior exams and is suspicious for metastatic disease. If clinically appropriate an MRI of the brain may help confirm this and to help identify additional foci that may be present. It is best seen on image number 22 and 21 of the axial CTs of the head

Output: 1.Stable CT of soft tissues of the neck and with no evidence of tumor or pathologic adenopathy.2.Suspicion for left parietal lobe metastasis as described above. This is new since the prior exam. An MRI of the brain may help confirm this and identify any other lesions. referring clinician was paged.3.Findings raise the question of a left carotid stenosis please correlate with clinical evaluation and at any other evaluation of the carotids.4.Findings suggest an esophageal diverticulum unchanged since prior exams.5.Findings suggest old infarctions previously demonstrated as described above.


Instruction: Generate impression based on findings.

Input: 58 years Male (DOB:3/25/1958)Reason: ? radiographic signs of dementia History: short-term memory lossPROVIDER/ATTENDING NAME: GREGORY W RUHNKE ANUBHA GANJOO The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute ischemic cerebral infarction or intracranial mass lesion to explain the patient's short-term memory loss.2.Several periventricular and subcortical white matter punctate foci are probably of little clinical significance given their small number and the high frequency of occurrence of such lesions in the general population.


Instruction: Generate impression based on findings.

Input: Reason: Patient with PMHx of RCC, prostate CA, presenting with RLE weakness, concern for cord compresison as etiology History: Acute LRE weakness, 1 wk hx of back pain There is moderate loss of height of the L1 and L3 vertebral bodies. The L3 vertebral body demonstrates increased STIR signal intensity, suggesting a more recent compression, while at the L1 level it appears chronic. There is mild vertebral body retropulsion at the L1 and L3 levels, without significant spinal canal stenosis. There is uniformly decreased T1 and T2 signal intensity without enhancement or STIR abnormality affecting the T12 and L2 vertebral bodies. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. An enhancing subcentimeter round focus with high T1 signal intensity within the mid anterior L2 vertebral body is compatible with an atypical hemangioma, and was seen on the CT scan dated 1/22/2016. There is mild multilevel degenerative disc disease. At L1-L2, there is minimal bilateral disc bulge, ligamentum flavum thickening, and mild bilateral facet joint arthropathy. There is moderate right and mild left neural foraminal narrowing. There is no narrowing of the spinal canal. At L2-L3, there is minimal disc bulge, ligamentum flavum thickening, and mild bilateral facet joint arthropathy. There is a left far lateral annular disc fissure. There is bilateral mild neural foraminal narrowing. There is mild narrowing of the spinal canal with effacement of the CSF space anteriorly. At L3-L4, there is mild ligamentum flavum thickening and mild bilateral facet joint arthropathy. There is moderate right and mild left neural foraminal narrowing. There is no narrowing of the spinal canal. At L4-L5, there is mild bilateral facet joint arthropathy. There is mild disc bulge without significant spinal canal narrowing. There is mild right and moderate left neural foraminal narrowing. At L5-S1, there is mild bilateral neural foraminal narrowing without disc bulge or narrowing of the central spinal canal.

Output: 1. Degenerative changes affect the lumbar spine, without significant spinal canal narrowing. Moderate loss of vertebral body height at the L1 and L3 levels, as detailed above.2. There is no definite evidence of metastatic disease within the lumbar spine. Areas of decreased T1 and T2 signal within several vertebral bodies are of uncertain significance. If further evaluation is desired, nuclear medicine bone scan can be considered.


Instruction: Generate impression based on findings.

Input: Exam is limited due to lack of contrast and some sequences are limited by patient motion. There is minimal grade 1 anterolisthesis is one measuring 3 mm. The spine is otherwise in normal alignment. There is multilevel disc narrowing and the cervical spine, overall moderate degree from C4-C5 through C6-C7. There is scattered mild disc narrowing and desiccation along the mid thoracic spine. Prominent disc narrowing and desiccation is noted throughout the lumbar spine, with vacuum phenomenon at multiple levels.The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L2 level. There is thickening and slight redundancy of the cauda equina nerve roots although this is unchanged, due to spinal stenosis below.There are mild scattered cervical spondylotic changes from C4-C5 to C6-C7, with up to mild-moderate central spinal canal stenosis at C5-C6 with slight indentation of the ventral cord. There is prominent right uncovertebral hypertrophy at this level resulting in moderate-severe right foraminal narrowing.There are scattered thoracic spondylotic changes with tiny central disc protrusions at T6-T7, T7-T8, T10-T11, and T11-T12.At T12-L1, there is a trace disc bulge without stenosis. Bilateral facet arthropathy and ligamentum flavum thickening is noted.At L1-L2, there is significant endplate degenerative changes. There is a moderate posterior osteophyte disk complex and severe bilateral facet arthropathy and ligamentum flavum thickening, with overall mild to moderate central spinal canal stenosis and moderate bilateral foraminal narrowing.At L2-L3, there is a mild disc bulge with slight left-sided prominence. There is moderate bilateral facet arthropathy and ligamentum flavum thickening with overall mild-moderate central spinal canal stenosis. There is mild-moderate left foraminal narrowing.At L3-L4, there is a mild disc bulge with bilateral facet arthropathy and ligamentum flavum thickening. There is narrowing of the right lateral recess with abutment of the descending right L4 nerve root. There is mild left foraminal narrowing.At L4-L5, there is a trace disc bulge with mild-moderate right foraminal narrowing. There is bilateral facet arthropathy and ligamentum flavum thickening.At L5-S1, there is a mild disc bulge with superimposed right foraminal disc protrusion there is mild bilateral foraminal narrowing with bilateral facet arthropathy and ligamentum flavum thickening noted.

Output: 1. No MR evidence of osseous involvement by myelomatous lesions within the limitations of noncontrast technique.2. Multilevel spondylotic changes throughout the spine as detailed above, with similar appearance of mild-moderate lumbar spondylotic changes compared to July 2014. Moderate-severe right foraminal narrowing at C5-C6.


Instruction: Generate impression based on findings.

Input: Medulloblastoma status post craniotomy, chemotherapy, and radiation therapy: off therapy evaluation. Brain: There are postoperative findings related to suboccipital craniotomy for resection of a cerebellar medulloblastoma. There is unchanged confluent T2 hyperintensity in the medial cerebellar hemispheres along the margins of the resection cavity, but no gross evidence of tumor. There are also unchanged scattered punctate foci of susceptibility effect in the cerebral hemispheres and along a right occipital surgical tract. There is no evidence of acute intracranial hemorrhage or infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull appears unchanged. The paranasal sinus inflammatory changes have resolved.Spine: The spinal cord and cauda equina nerve roots display normal signal characteristics. There is no evidence of abnormal enhancement within the spinal canal. The vertebral bone marrow displays diffuse T1 and T2 hyperintensity, compatible with fatty marrow conversions related to radiation effects. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The paraspinal soft tissues are unremarkable.

Output: 1. No convincing evidence of tumor recurrence in the posterior fossa. 2. No evidence of drop metastases in the spinal canal.


Instruction: Generate impression based on findings.

Input: Assess progression/response of disease to treatment: transverse myelitis now treated with IVIG and IV steroids. There is increased confluent T2 hyperintensity and swelling in the anterior and central portions of the spinal cord extending from the C6 to T6 levels. There is no associated abnormal enhancement or mass lesions. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Increased confluent T2 hyperintensity and swelling in the anterior and central portions of the spinal cord extending from the C6 to T6 levels.


Instruction: Generate impression based on findings.

Input: Motion artifact limits evaluation.Alignment is anatomic without evidence of acute acute spinal cord compression. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. Multilevel degenerative changes including disk bulges result in cervical stenosis and lumbar central spinal canal stenosis.

Output: No acute cord compression. Dedicated segment-specific MRI is recommended if symptomology localizes and/or if characterization of multilevel spondylitic changes is deemed clinically beneficial.


Instruction: Generate impression based on findings.

Input: 68-year-old male with renal cancer, abnormal lesion seen on CT scan ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense foci in the liver. There is no central enhancement. No suspicious liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal gland nodule measuring 12 x 8 mm, unchanged. Heterogeneously enhancing left adrenal gland nodule measures 1.8 x 1.3 cm, unchanged.KIDNEYS, URETERS: Status post right nephrectomy. T2 hyperintense cysts in the left kidney, unchanged from the prior exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel caliber is within normal limits without evidence of obstruction. The appendix is well visualized and within normal limits. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.New T2 hyperintense foci in the liver with cystic characteristics and without central enhancement. Provided the history of malignancy and that these lesions are new, these lesions are nonspecific and a follow-up is recommended to ensure stability at 6-12 months.2.Unchanged bilateral adrenal gland nodules. Favor benign, although can be evaluated on follow-up imaging.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal cancer, status post treatment, now with dysarthria, neck spasm, and left shoulder weakness. Brain: In addition to the previously demonstrated focus of susceptibility effect in the medulla, there are now numerous, on the order of 50, new intraparenchymal foci of infratentorial and supratentorial susceptibility effect. There is no evidence of acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. The calvarium is intact. Neck: There are secretions in the posterior nasopharynx, but no evidence of measurable nasopharyngeal mass. The skull base appears to be intact. There is no significant upper cervical lymphadenopathy. The salivary glands appear unchanged. The major cervical flow voids are grossly intact. There is a posterior small disc osteophyte complex at C5-6.

Output: 1. Post-treatment findings in the nasopharyngeal region without evidence of measurable locoregional tumor.2. In addition to the previously demonstrated focus of susceptibility effect in the medulla, there are now numerous new intraparenchymal foci of infratentorial and supratentorial susceptibility effect, which could represent microhemorrhages, perhaps related to treatment effects, versus less likely atypical metastases.


Instruction: Generate impression based on findings.

Input: 48-year-old male with pain and swelling of the left foot around the talocalcaneal navicular region following acute injury playing soccer. A vitamin E capsule overlies the dorsal aspect of the base of the first and second metatarsals presumably representing the patient's site of pain.TENDONS: The peroneal tendons appear intact. There is mild increased intermediate signal abnormality within the peroneus longus tendon indicating mild tendinosis. The flexor tendons appear intact. The extensor tendons appear intact. The Achilles tendon appears intact.LIGAMENTS: There is thickening of the anterior talofibular ligament which may reflect prior injury or sprain. The lateral collateral ligament complex otherwise appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: Note is made of increased signal abnormality within the second metatarsal with associated periosteal reaction and linear decreased signal abnormality traversing the base of the second metatarsal, indicating a stress reaction/fracture. ADDITIONAL

Output: 1. Stress reaction/fracture of the second metatarsal as described above.2. Nonspecific subcutaneous edema along the lateral aspect of the ankle and dorsal aspect of the foot as described above.3. Peroneus longus tendinosis.


Instruction: Generate impression based on findings.

Input: 87-year-old female status post fall with an elevated INR. Please evaluate for acute intracranial hemorrhage. There is no evidence of intracranial hemorrhage. As a parafalcine high attenuation mass with a broad based dural connection measuring 2.9 x 2.0 cm transaxial at the posterior superior aspect of the right lateral ventricle consistent with a meningioma.Scattered areas of periventricular and subcortical low attenuation consistent with small vessel ischemic disease of indeterminate age.There is asymmetry in the size and configuration of the lateral ventricles, larger on the left. The possibility of a arachnoid cyst at the level of the left foramen of Monroe is a consideration further evaluation with MRI is recommendedThe calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Right posterior parafalcine meningioma as detailed above.2. Possible intraventricular arachnoid cyst at the level of the left foramen of Monroe. Further evaluation with MRI is recommended.2. Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Clinical question: Please evaluate for old infarct or other cause for long-term change in memory. Signs and symptoms: Memory change. Enhanced CT of brain:Examination demonstrate a partially calcific and likely enhancing (no pre-infusion study available) left frontal lobe tumor which extends superiorly and involves the left basal ganglial/caudate nucleus. There is no evidence of edema, hemorrhage or mass-effect with this finding. There is ex vacuo dilatation of left frontal horn. This may be the result of a prior stroke. On coronal reformatted images this mass measures 23-mm in cranial cephalad access and 18.7-mm in transverse axis. On axial image 10 the tumor measures 16mm in AP access and 16-mm in transverse axis. This lesion may represent a cavernoma. Follow-up exam in an MRI is recommended. CT examination of brain is otherwise unremarkable.

Output: 1.Partially calcified and likely enhancing tumor in the left frontal lobe with extension superiorly into the basal ganglia/caudate nucleus could represent a cavernoma. Follow-up with an MR is recommended.2.Unremarkable CT examination of brain otherwise.


Instruction: Generate impression based on findings.

Input: 67-year-old female with episode of staring and confusion, stroke and seizure evaluation. Soft tissue swelling with mild enhancement is noted involving the soft tissues overlying the right forehead. There is no underlying osseous involvement. There is no restricted diffusion to suggest acute ischemia. No acute intracranial hemorrhage. No intracranial mass or mass-effect. No hydrocephalus. There is generalized global parenchymal volume loss, unchanged in extent. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. T2 hyperintensity is noted within the bilateral subinsular white matter which is favored to be related to combination of chronic ischemic change and prominent perivascular spaces. Redemonstrated are few punctate foci of susceptibility effect in the bilateral temporal and occipital lobes compatible with chronic microhemorrhages. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear.

Output: 1.Soft tissue swelling with mild enhancement is noted involving the soft tissues overlying the right forehead. There is no underlying osseous involvement. This is nonspecific and may be secondary to injury, infection, inflammation, and unlikely neoplastic.2.Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of infertility and possibly uni-cornuate uterus on hysterosalpingogram. PELVIS:UTERUS, ADNEXA: Anteverted anteflexed uterus. It demonstrates a normal bicornuate morphology.The uterus measures 9.0 x 4.3 cm in the sagittal plane.The endometrial cavity is normal in thickness measuring 8 mm and demonstrates normal homogeneously hyperintense T2-weighted signal intensity.The majority of the inner myometrium/junctional zone measures up to 9 mm in thickness, above normal within the indeterminate range. There are regions of the inner-outer myometrial junction which are indistinct. Adjacent to the right anterior fundal/body aspect of the inner myometrium/junctional zone there is a poorly marginated T2 hypointense focus with small T2-weighted hyperintense cystic components measuring 2.4 x 1.7 cm (series 901/29) which may represent focal adenomyosis. There are no definite T1-weighted hyperintense foci to confirm hemorrhage from small ectopic endometrial glands.Additional 9 mm probable fibroid at the right fundus (series 701/24).Multiple cervical nabothian cysts are noted. The cervix, vaginal canal and parametrial soft tissues are otherwise unremarkable.The right ovary measures 3.0 x 2.4 cm it contains numerous follicles. The left ovary measures 3.4 x 3.1 cm and contains numerous follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace simple appearing free pelvic fluid is within physiologic limits. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of a congenital mullerian duct abnormality.2.Suspected diffuse adenomyosis with focal adenomyomata I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 82-year-old male with pain with elevation of the left shoulder above 90 degrees. Evaluate for possible rotator cuff tear. ROTATOR CUFF: There is a full-thickness with near full width tear of the supraspinatus tendon with associated high riding humeral head. There is a full-thickness tear of the subscapularis tendon. There is small intrasubstance tearing of the infraspinatus tendon. The teres minor tendon appears normal. There is severe fatty atrophy of the supraspinatus muscle. There is mild fatty atrophy of the teres minor and infraspinatus muscles.SUPRASPINATUS OUTLET: There is marked narrowing of the supraspinatus outlet secondary to the aforementioned rotator cuff tear with high riding humeral head. Moderate osteoarthritic changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritic changes affect the glenohumeral joint. As above there is a high riding humeral head secondary to the aforementioned rotator cuff tears. There is globular tearing of the glenoid labrum. There is a small glenohumeral joint effusion.BICEPS TENDON: The long head of the biceps tendon is torn.ADDITIONAL

Output: 1. Full-thickness tear of the supraspinatus and subscapularis tendons as well as small intrasubstance tearing of the infraspinatus tendon with associated high riding humeral head. Fatty infiltration of the rotator cuff musculature, most prominent at the supraspinatus muscle.2. The long head of the biceps tendon is torn.3. Moderate osteoarthritic changes affect the acromioclavicular glenohumeral joints.


Instruction: Generate impression based on findings.

Input: Evaluate for brainstem pathology: third nerve palsy, ptosis, Chiari. There cerebellar tonsils extend approximately 12 mm inferior to the foramen magnum and have a pointed configuration. The brain parenchyma and brainstem appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with Chiari type 1 malformation.


Instruction: Generate impression based on findings.

Input: Evaluate liver masses seen on CT. ABDOMEN:LIVER, BILIARY TRACT: There are multiple hepatic lesions demonstrating increased T2 signal. These include a segment 8 lesion measuring approximately 1.5 x 1.5 cm (series 6, image 7) and a segment 7 lesion measuring approximately 0.8 x 2.7 cm (series 6, image 8), which demonstrate progressive, gradual fill-in on postcontrast images and no evidence of washout on delayed phase images, compatible with hemangiomas. No other definite lesions demonstrating enhancement or washout. The remainder of the T2 hyperintense lesions are too small to further characterize though likely represent tiny cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially imaged T2 hyperintense fluid collections in the right elbow, incompletely evaluated.OTHER: No significant abnormality noted.

Output: Findings compatible with two hemangiomas in the liver. Multiple other nonspecific T2 hyperintense hepatic lesions likely represent tiny cysts.


Instruction: Generate impression based on findings.

Input: 76-year-old woman with headache and hypertension. Unresponsive evaluate for ICH. There is a parenchymal hemorrhage in the left parieto-occipital region. The hemorrhage measures 4.8 x 4.3 cm in the axial plane and extends to the cortical surface. No underlying lesion (such as an AVM) is visible on this study. A subdural hematoma measuring approximately 7 mm in thickness is present. The hemorrhage has a surrounding rim of edema and causes mass effect with near total effacement of the left lateral ventricle and approximately 12mm of midline shift at the level of the thalamus. There is partial effacement of the left aspect of the suprasellar cistern, suggesting left uncal herniation. The quadrigeminal cistern is partially effaced. In addition, the brainstem is shifted to the right, causing effacement of the right prepontine cistern. The cortical sulci of both cerebral hemispheres are effaced. Low attenuation with loss of gray-white differentiation is present in the white matter of the right cerebral hemisphere and is most pronounced in the right frontal lobe. This may represent ischemia or edema and could be better evaluated with MRI. Gray-white differentiation is otherwise preserved. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Water density fills the posterior nasopharynx -- possibly representing vomitus or secretions.

Output: 1. Left parieto-occipital parenchymal hemorrhage causing mass effect and about 12 mm of midline shift. No underlying lesion such as an AVM is visible on this study. Further evaluation for an underlying lesion is recommended as clinically appropriate.2. Findings of elevated intracranial pressure including effacement of cortical sulci, left uncal herniation, and partial effacement of the quadrigeminal cistern.3. Low attenuation in the white matter of the right cerebral hemisphere with loss of gray-white differentiation concerning for ischemia. This finding could be better evaluated with MRI.This report was discussed by telephone with the Dr. Eric and Dr. Shakur at 4:10 PM.


Instruction: Generate impression based on findings.

Input: A 78 year old male with mitral valve posterior leaflet flail and severe regurgitation, diabetes mellitus, hypertension, coronary artery disease, s/p CABG (1994), mesothelioma s/p thoracotomy (1992), and metastatic neuroendocrine carcinoma. Now admitted to neurology because of bilateral leg weakness, CT showed large mass in liver, portocaval and retroperitoneal lymphadenopathy, PET showed increased uptake in liver, lymph nodes and at the right side of the heart. Echocardiography showed severe mitral regurgitation, no pericardial effusion and no mass. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 110 ml/m2 (normal range: 74+/-15), the LVEDV is 202 ml (normal range 142+/-34), the LV end systolic volume index is 57 ml/m2 (normal range 25+/-9), the LVESV is 105 ml (normal range 47+/-19), the LV mass index is 54 g/m2 (normal range 85+/-15), and the LV mass is 99 g (normal range 164+/-36). There is akinesis of the anterior wall and hypokinesis of the antero-lateral wall at the mid-to-apical segments. There is transmural late gadolinium enhancement in the pattern of a prior myocardial infarction located from the mid to apical anterior wall. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 147 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 81 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.MassThere is an irregular shaped mass at the RA and IVC junction, sized 18 X 16 mm, characterized to be heterogeneous but low signal on T1 weighted images, heterogeneous but high signal on T2-weighted images, the mass contrast enhances heterogeneously in a delayed manner. It does not appear to invade into the adjacent right atrium or IVC. The mass is concerning for malignancy.Aortic ValveThe aortic valve is trileaflet and has significant aortic valve stenosis and mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe eccentric mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild 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. Mild protruding atheroma in the descending thoracic aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trivial pericardial effusion without obvious pericardial thickening.Extracardiac FindingsLarge right and small left pleural effusion. The right pleural effusion has a heterogeneous signal suggesting it may be non-transudative. Sternal wires were noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is an irregular shaped mass at the RA and IVC junction, sized 18 X 16 mm, characterized to be heterogeneous but low signal on T1 weighted images, heterogeneous but high signal on T2-weighted images, the mass contrast enhances heterogeneously in a delayed manner. It does not appear to invade into the adjacent right atrium or IVC. The mass is concerning for malignancy.2. Mild LV dilation with mildly reduced systolic function (LVEF 48%) with evidence of an apical aneurysm.3. There is a transmural myocardial infarction involving the mid to apical anterior wall. 4. Normal RV size with mildly reduced systolic function (RVEF 45%). 5. Severe mitral regurgitation with an anteriorly directed eccentric jet. 6. At least moderate aortic valve stenosis with mild aortic regurgitation, correlation with echocardiography suggested to quantify severity. 7. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 53 years old Reason: prostate cancer History: see above PELVIS:PROSTATE:Prostate Size: Prostate measures 2.5 x 5.1 x 4.6 cmPeripheral Zone: In the left peripheral zone extending from the mid gland to the apex there is an area of abnormal T2 hypointensity that abuts the capsular surface. This area shows restricted diffusion, early enhancement and washout.Central Gland: Mild heterogeneous central gland.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Tumor abuts the capsular surface but no evident extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: Postsurgical changes in the right hip.OTHER: No significant abnormality noted.

Output: 1.Prostatic carcinoma extending from the left mid gland to apex.


Instruction: Generate impression based on findings.

Input: Reason: MS, f/u progression History: paresthesias The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a moderate degree of periventricular and subcortical white matter lesions which are hyperintense on T2 and flair MRI. Many of these are perpendicularly oriented to the lateral ventricles. Compared to the previous exam the patient has developed a couple new lesions. For example, there is one at the subcortical white matter of the right inferior parietal lobule which is new. There is another one in the right periventricular white matter at the posterior aspect of the body of the right lateral ventricle which is new. A lesion in the left frontal lobe subcortical white matter is smaller on the current examNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Since the previous exam the patient has accumulated a few more periventricular white matter lesions


Instruction: Generate impression based on findings.

Input: Acute lymphocytic leukemia. Progressive lower extension weakness, over 3 months duration. History of lumbar puncture 1 day prior to this MRI. Compared to the previous examination, there is suggestion of minimal/subtle increased contrast enhancement along the cauda equina roots which is nonspecific in this setting, as it may represent a reactive or inflammatory process to medications or lumbar puncture. The contrast enhancement is not nodular or masslike.Relatively more intense, linear contrast enhancement on the left side of the upper lumbar thecal sac along the left L3 nerve root was present previously and likely represents a radicular vein.There is contrast enhancement relating to the most caudal part of the thecal sac at S2 level which is unchanged and likely vascular/normal in etiology.The conus medullaris itself shows normal signal. The spinal canal is preserved.Alignment is notable for unchanged minimal retrolisthesis of L1 relative to L2 which is associated with desiccation and mild disc height loss. The other intervertebral discs are preserved in height. The vertebral bodies are preserved in height. There is no foraminal stenosis. Marrow signal is preserved. Contrast enhancement and stranding in the posterior subcutaneous tissues extending along the L2-L3 interspinous space is probably related to recent lumbar puncture. This is associated with slightly focal underlying posterior dural thickening which is probably reactive. There is no epidural collection.There are changes of presumed bone marrow biopsies in the posterior iliac bones.

Output: 1.There is minimal contrast enhancement involving the cauda equina nerve roots without thickening or nodularity. Finding is nonspecific given history of lumbar punctures and chemotherapy for CNS leukemia. Finding may be attributed to an inflammatory process such as Guillain-Barré Syndrome, but would be better correlated with clinical/CSF findings. No nodular leptomeningeal enhancement to suggest leukemia by imaging. 2.Minimal degenerative changes in the lumbar spine without significant spinal canal foraminal stenosis at any level. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.