Instruction: Generate impression based on findings.

Input: 53-year-old female with knee mechanical symptoms and pain, evaluate for medial meniscal tear MENISCI: There is small focus of abnormal signal within the posterior horn of the medial meniscus which is seen on only one slice. No definite medial or lateral meniscal tear. ARTICULAR CARTILAGE AND BONE: No abnormal marrow signal. There is diffuse thinning within the medial and lateral compartments with a small foci of partial-thickness cartilage loss along the medial femoral condyle. No full-thickness defects in the articular cartilage. Tiny osteophytes are identified.LIGAMENTS: The MCL and lateral collateral ligament complex is intact ACL and PCL are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. A small amount of pretibial edema is seen.ADDITIONAL

Output: 1.Small focus of abnormal signal within the medial meniscus is seen on only one slice, equivocal for a tear. No definite tears of the medial or lateral meniscus.2.Minimal osteoarthritic changes.


Instruction: Generate impression based on findings.

Input: Possible hydrocephalus status post left temporal tumor excision. 1-year-old female. The patient is status post left sided craniotomy. There is a large extra-axial fluid collection present also identified on 4/29 but not on 4/28. It measures 25 mm in width comparedThere is midline shift present with the shift of the third ventricle approximately 12 mm to the right of midline appeared there is a 90 x 20 mm cystic fluid collection in the left temporal lobe. There is associated intracranial air in the subdural and subarachnoid spaces.The right lateral ventricle is larger than the left lateral ventricle and the temporal horn is dilated but not substantially different than the prior exam. the right lateral ventricle measures 24 mm in width on the current exam as well as on the recent MRI exam.There is a right sided subdural collection measuring 7 mm in thickness.

Output: 1.Bilateral subdural effusions left larger than right associated with intracranial air.2.There is a cystic cavity in the left temporal lobe extending to the frontal lobe better demonstrated on the recent MRI3.There is midline shift present as described above4.Recent left frontal and temporal surgery.5.Enlargement of the right lateral ventricle and compression of the left lateral ventricle. The size of the ventricles has not changed since exam of 4/29.


Instruction: Generate impression based on findings.

Input: Newly diagnosed lung cancer for staging. Evaluation for metastases is limited by lack of intravenous contrast. There is no evidence of intracranial hemorrhage or acute infarct. There are scattered punctate foci of abnormal T2 hyperintensity within the periventricular and subcortical white matter and pons, which are non-specific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a 5 mm prominent flow void at the right middle cerebral artery bifurcation. The skull and extracranial soft tissues are unremarkable.

Output: 1. Evaluation for metastases is limited by lack of intravenous contrast. No intracranial mass or mass effect is seen to suggest intracranial metastatic disease.2. Scattered foci of abnormal signal within the periventricular and subcortical white matter and pons, which are non-specific, but most likely represent chronic small vessel ischemic disease.3. Approximately 5 mm prominent flow void at the right middle cerebral artery bifurcation, which may represent a small aneurysm. Consider MRA for further evaluation as clinically warranted.


Instruction: Generate impression based on findings.

Input: Male, 88 years old, with left facial droop. No restricted diffusion is seen. Fairly extensive patchy periventricular FLAIR hyperintensity is again seen similar to that noted on prior MRI. No evidence of significant parenchymal edema or mass effect is detected. A small chronic infarct of the right cerebellum is unchanged. Prominence of the ventricles and sulci is unchanged and compatible with underlying volume loss. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Foci of susceptibility in the pons and adjacent to the left restiform body may represent chronic microhemorrhage.

Output: 1.No evidence of acute ischemia.2.Moderately advanced chronic microvascular ischemic disease without significant interval change.


Instruction: Generate impression based on findings.

Input: 82-year-old male with history of Whipple surgery and recurrent pancreatitis. Evaluate for complications of pancreatitis or stricture. LIVER, BILIARY TRACT: No suspicious hepatic lesions. Gallbladder is surgically absent. No biliary ductal dilation. Portal vein is patent. SPLEEN: No significant abnormality noted.PANCREAS:Postoperative changes from Whipple surgery, similar to prior MRI in 2011. Main pancreatic ductal dilation measuring up to 5 mm with side branch duct dilation, similar to prior MRI in 2011. Again the main pancreatic ductal dilation extends to the pancreaticojejunostomy. Stable mild, diffuse pancreatic atrophy. No focal pancreatic lesions or ductal filling defects are seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent peripancreatic lymph nodes are noted, but there are no pathologically enlarged lymph nodes by size criteria.BOWEL, MESENTERY:Post Whipple changes reidentified.BONES, SOFT TISSUES: Midline incisional hernia without evidence of bowel obstruction.OTHER: No significant abnormality noted.

Output: Stable postoperative appearance of the pancreas since prior MRI of 2011. Mild stricture at the pancreaticojejunostomy cannot be excluded, but there has been no progressive pancreatic ductal dilation.


Instruction: Generate impression based on findings.

Input: Questionable seizures and headaches. There is a punctate focus of high T2 signal in the left anteromedial putamen. There is no evidence of heterotopia, gross cortical malformation, or hippocampal sclerosis. There is also no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A punctate focus of high T2 signal in the left anteromedial putamen is nonspecific, but may represent a prominent perivascular space, for example. Follow up via a brain MRI with contrast may be useful. Otherwise, no other potential seizure foci are identified.


Instruction: Generate impression based on findings.

Input: Right breast invasive ductal carcinoma grade 2, post mastectomy. Left breast excision 12/28/2015 (DCIS), with possible insufficient calcifications on specimen radiograph. Patient is status post right mastectomy. There is heterogeneous amount of fibroglandular tissue in the left breast.Moderate parenchymal enhancement is noted.A left retroglandular saline implant is intact. Within the left outer breast, posterior to the implant, there is a T1/T2 hypointense lesion with rim enhancement, compatible with fat necrosis.No suspicious enhancement is seen in the left breast or right chest wall. No abnormal lymph nodes are identified in either axillary region.Within segment 4A of the liver, there is a T2 hyperintense subcentimeter lesion, not well visualized on postcontrast imaging, possible cyst versus hemangioma.

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


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: seizure like activity History: as above There are symmetrically increased signal intensity on bilateral mesial hippocampus on FLAIR and T2 images. However, estimated volume of bilateral hippocampus appear to be within normal limits.These findings may suggest possible bilateral hippocampal sclerosisNo evidence of acute ischemic or hemorrhagic lesion.There are multiple scattered high signal intensity on FLAIR/T2 weighted image on bilateral periventricular white matter right frontal operculum right subluxation of the cortex white matter indicating nonspecific chronic ischemic lesions.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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Increased signal intensity of bilateral hippocampus on FLAIR/T2 images without volume loss, may suggest possible bilateral hippocampal sclerosis.2. No evidence of acute ischemic or hemorrhagic lesion.3. Nonspecific chronic ischemic lesions as described above


Instruction: Generate impression based on findings.

Input: 59-year-old female with concern for plantar fasciitis/calcaneal tuberosity stress fracture. Examination is limited secondary to orthopedic hardware.Postsurgical findings from Lapidus procedure with 2 screws affixing the first tarsal metatarsal joint and flattening of the first metatarsal head. There is perhaps minimal edema about the plantar surface posteriorly along the calcaneus. However, no cortical disruption is visualized. There is minimal soft tissue edema about the plantar fascia, however no significant signal abnormalities are visualized within the tendons themselves. Further, there is fluid around the plantar aponeurosis, which may be compatible with tenosynovitis.There is a remote appearing partial tear of the anterior tibiofemoral ligament.

Output: Findings compatible with mild synovitis of the plantar fascia, however the plantar fascia appears intact without significant tearing. Other findings as outlined above.


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB:6/11/1947)Reason: LLE weakness etiology History: LLE weaknessPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild 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 also present in the brainstem and cerebellum which are also unchanged.The sagittal T1 images demonstrate degenerative changes in the cervical spine at C4-5 associated with the findings which raise the question of spinal stenosis.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Examination is somewhat compromised due to patient motion which may obscure more subtle abnormalities.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions as well as lesions in the brainstem and cerebellum of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Findings raise the question of spinal stenosis at C4-5 which is not adequately included on this exam for evaluation.


Instruction: Generate impression based on findings.

Input: Left shoulder pain The examination is limited by motion artifact.ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: There is mild increased signal intensity within the acromioclavicular joint there is no evidence of fracture or malalignment. There is no significant fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral alignment is normal and there is slight flattening of the superior and anterior aspect of the humeral head suggesting prior posterior dislocation. There is a rounded and blunted appearance of the posterior glenoid indicating mild glenoid dysplasia although the articular surface remains intact. Additionally, there is loss of the articular cartilage of the posterior glenoid particularly inferiorly and there is absence of the posterior inferior capsule. The anterior labrum is intact. There is a linear focus of high signal intensity seen along the posterior labrum best appreciated (series 12 image 9) which may reflect a tear.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Sequela prior posterior dislocation including a slight flattening of the anterior humeral head, articular cartilage loss of the glenoid posteriorly, and absence of the posterior inferior capsule.2. Blunting of the posterior glenoid which may reflect a combination of posttraumatic injury and congenital dysplasia. There is articular cartilage loss along the posterior glenoid and an abnormal appearance of the posterior labrum suggesting the presence of a GLAD lesion.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute ischemic infarct. No susceptibility weighted abnormalities to indicate hemorrhage. There is a right frontoparietal convexity arachnoid cyst measuring 3.3 cm in width with mass effect upon the underlying brain parenchyma. There is no midline shift. There are mild scattered foci of increased T2 hyperintensity in the periventricular and subcortical white matter. The ventricles and sulci are normal in size. There is no midline shift or herniation. The status of the cerebral flow voids are better depicted on the prior CTA. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1. No evidence of acute cerebral infarction or intracranial hemorrhage.2. Mild scattered foci of increased T2 hyperintensity in the periventricular and subcortical white matter. 3. Right frontoparietal convexity arachnoid cyst measuring 3.3 cm in width.4. The status of the cerebral flow voids are better depicted on the prior CTA.


Instruction: Generate impression based on findings.

Input: Headache, new H/A and N/V, aneurysm on prior scan. There is normal gray-white matter differentiation.There is a suprasellar peripherally calcified lesion which has been characterized on prior CT and MRI examination and consistent with a right para-opthalmic aneurysm. It is most probably stable, allowing for the difference in the imaging techniques between the examinations. It measures 13.9 x 9.9 mm in the coronal plane using series 80244, image 25/59 on the current examination and 14.9 x 8.9 mm using series 80228 image 26/64. There is a 5.7 x 6.5 mm isodense lesion paramedian to the right of the foramen of Monroe (please see series 3 image 11/29) and is separate from the suprasellar lesion. This was not apparent on the prior CT examination and may have been obscured on the prior MR examination due to motion artifact as it was not demonstrated then. It is of uncertain significance and one possibility is that it may represent a tiny colloid cyst.There is no evidence of new intracranial hemorrhage, midline shift, hydrocephalus or edema. The ventricles and basal cisterns are normal in size and configuration.The calvarium and skull base appears normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized and clear.

Output: *There is no intra-axial or extra-axial hemorrhage, edema, midline shift or hydrocephalus.*Stable appearance of the known right para-opthalmic aneurysm. *There is an apparent small isodense lesion paramedian to the right of the foramen of Monroe (please see series 3 image 11/29) which was not apparent on the prior CT or MR examination and may have been obscured by motion artefact. The lesion is separate from the suprasellar lesion and is of uncertain significance. One possibility is that it may represent a tiny colloid cyst.


Instruction: Generate impression based on findings.

Input: Female, 55 years old. Medial knee pain MENISCI: The body of the medial meniscus is extruded with abnormal signal and morphology, compatible with degeneration and complex tearing. The posterior horn of the medial meniscus appears blunted. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a large area of full-thickness cartilage loss involving the medial femoral condyle measuring up to approximately 1 cm in mediolateral dimension and 2 cm in AP dimension, with underlying bone marrow edema. There is also full-thickness cartilage loss involving the medial tibial plateau with underlying bone marrow edema. There is mild diffuse thinning of the lateral compartment articular cartilage without focal defect identified. The patellar cartilage is grossly intact. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.High-grade cartilage loss involving the medial femoral condyle and medial tibial plateau as above.2.Complex tearing of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Shoulder pain There is widening of the acromioclavicular joint with deformity of the distal clavicle, likely result of prior surgery. The shoulder otherwise is unremarkable. There is mild leftward curvature the upper thoracic spine.

Output: Widening of the acromioclavicular joint likely related to prior surgery. Otherwise no specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Reason: Cystic mass in HOP. Last Imaging in 2012. Evaluate for change History: none. ABDOMEN:LIVER, BILIARY TRACT: Bilobar hepatic cysts, some which are slightly complex and some of which have slightly increased in size compared to prior MRI.SPLEEN: No significant abnormality noted.PANCREAS: Nonenhancing cystic mass in the head of the pancreas measures 2.4 x 1.5 cm (series 15 image 48), previously measuring 2.0 x 1.4 cm. This lesion appears to communicate with the main pancreatic duct. Two additional subcentimeter cystic lesions in the uncinate and body of the pancreas are also stable. No new lesions. No pancreatic ductal dilatation. 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: No significant abnormality noted.

Output: Stable pancreatic cystic lesions likely side branch IPMN's allowing for differences in measuring technique. No new lesions.


Instruction: Generate impression based on findings.

Input: Prior Achilles repair now with overlying ulceration Ankle/foot: There are surgical changes within the posterior ankle with a cannulated screw present within the posterior calcaneus where the flexor pollicis longus tendon appears to insert. The Achilles demonstrates increased signal intensity and appears thickened and disorganized suggesting tendinosis and/or chronic tearing although the insertion upon the calcaneus appears normal.Within the distal third of the lower extremity posteriorly and within the soleus musculature are multiple high signal intensity tubular structures (series 8 image 9/36, series 15 images 17 and 41 of 60) several of which contain a dot of low signal intensity centrally (series 15 image 33/60). This reaches approximately 13 cm superior to the ankle joint and several of these tubular structures extending to the skin surface. Following gadolinium administration, there is diffuse enhancement of the posterior soft tissues and somewhat rim enhancement of these tubular structures.The forefoot appears normal.Although not tailored for the evaluation of the tendons and ligaments, the extensor tendons appear normal as do the peroneal tendons and the tibialis posterior and flexor digitorum tendons.Tibia/fibula: The proximal/mid tibia and fibula demonstrate normal marrow signal intensity and no evidence of focal fluid collection. There is a mild amount of fatty atrophy of the posterior musculature of the right leg.

Output: 1. Multiple tubular structures central dots of low signal intensity centrally within the soleus musculature as detailed above. These findings are suspicious for mycetoma.2. Disorganized appearance of the Achilles tendon suggestive of chronic tearing and tendinosis although the insertion upon the calcaneus is normal.3. Surgical changes of the ankle which appears to involve the flexor pollicis longus tendon or accessory soleus entering an orthopedic screw within the posterior calcaneus.


Instruction: Generate impression based on findings.

Input: Examination of the thoracic and lumbar spine is limited to sagittal T2 sequences as requested. There is no evidence of spinal canal stenosis at any level in the thoracic or lumbar spine. No obvious cord signal abnormality is evident. Vertebral body heights appear normal. Alignment is maintained aside from some loss of normal lumbar lordosis. Minimal degenerative changes are seen in the thoracic spine. Mild to moderate degenerative changes are seen in the lumbar spine including disc desiccation at L3-L4, L4-L5, and L5-S1 with small associated disc bulges, and endplate marrow changes at L4-L5 and L5-S1. Facet arthropathy is also evident at L4-L5 and L5-S1. There appears to be mild to moderate narrowing of the neural foramina at L4-L5 and L5-S1.

Output: 1. Examination of the thoracic and lumbar spine limited to sagittal T2 sequences demonstrates no evidence of cord compression or spinal canal stenosis at any level in the thoracic or lumbar spine.2. Degenerative changes are seen in the lower lumbar spine with mild to moderate neural foraminal narrowing suspected bilaterally at L4-L5 and L5-S1, which can be further evaluated with additional axial sequences if clinically indicated.


Instruction: Generate impression based on findings.

Input: Left pontine cavernoma for 6 month follow-up. There is redemonstration of a cavernoma in the left paramedian posterior pons, measuring approximately 16 x 13 x 12 mm (AP x TR x CC), previously 14 x 13 x 12 mm on 7/30/2014 and more remotely 10 x 11 x 10 mm on 7/26/2010. It produces mild mass effect on the left anterior aspect of the fourth ventricle, similar to prior exam. There is no evidence of surrounding T2/FLAIR signal abnormality. Post-contrast images demonstrate very subtle internal enhancement along the superomedial aspect of the cavernoma. Again seen is a very small vascular branch, likely representing a vein extending from the medial and superior aspect of the cavernoma posteriorly into the quadrigeminal plate cistern. There is no definite evidence of an associated developmental venous anomaly. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Incidentally noted are mucus retention cysts in the bilateral maxillary sinuses. The skull and extracranial soft tissues are unremarkable.

Output: A nonhemorrhagic cavernoma in the left paramedian posterior pons measuring 16 x 13 x 12 mm, with gradual increase in size compared to prior studies. There is unchanged minimal bulge into the 4th ventricle with subtle internal enhancement along the superomedial aspect of the cavernoma. No surrounding edema or definite evidence of an associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: This is a motion degraded exam which along with absence of contrast limit sensitivity for infection. No areas of susceptibility effect to suggest abnormal calcifications by MRI. No evidence of abscess or empyema. There is no diffusion abnormality. There is no acute intracranial hemorrhage. The myelination is age-appropriate. The ventricles and sulci are within normal limits. There is no hydrocephalus. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a small right parietal scalp hematoma near the vertex.

Output: No areas of susceptibility effect to suggest abnormal calcifications by MRI. No evidence of intracranial abscess, edema, or empyema.


Instruction: Generate impression based on findings.

Input: Headache. Further assessment of pituitary enlargement noted on CT scan. Pituitary: There is a heterogeneous mass within the sella turcica. The mass has a maximum height of 15 mm, compared to 11 mm in August 2011. There is no mass-effect on the optic apparatus. There is suggestion of tumor extension into the left cavernous sinus, but the cavernous internal carotid arteries are not narrowed.Brain: The study was performed without intravenous contrast given the impaired kidney function (GFR of 27 mL/m). Patchy areas of T2 hyperintensity in the parietal white-matter have very minimally increased since August 2011. Generalized mild brain volume loss results in expansion of the ventricles and sulci has not significant changed since the previous examination. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1.A sellar mass likely represents a pituitary macroadenoma and has increased in size since August 2011, with suggestion of left cavernous sinus invasion, but no mass-effect upon the optic apparatus.2.Mild cerebral white matter lesions likely represents chronic microvascular ischemia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity numbness, tingling, genital numbness. Evaluate for cord compression. The vertebral bodies are appropriate in the overall alignment and height. Degenerative changes are noted in the cervical spine with disc osteophyte complex at the C4-C5 level resulting in moderate spinal canal stenosis. There is possible associated cord signal abnormality. Abnormal cord signal is also suspected in the upper cervical cord at the C1-C2 level. Questionable patchy cord signal abnormality involving the thoracic cord is also suspected although examination is suboptimal for the evaluation of cord signal. No high-grade stenosis in the thoracic spine is seen. In the lumbar spine, there are degenerative changes including disc bulge at L3-L4 which results in mild to moderate spinal canal stenosis. No appreciable high-grade stenosis within the lumbar spine is demonstrated. Facet arthropathy is noted in the lumbar spine with distention of the L3-L4 facet joints.

Output: This is a limited exam specific for the exclusion of cord compression only and does not adequately assess more subtle lesions such as intrinsic cord abnormalities. Patchy cord signal abnormality is suspected, specifically at C1-C2 and questionably at additional levels in the thoracic spine. There is moderate spinal canal stenosis at the C4-C5 level related to prominent disc osteophyte complex. Mild to moderate lumbar spinal canal stenosis at the L3-L4 level also noted. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine. Suggest dedicated cervical and lumbar spine MRI and possibly brain and thoracic MRI to better assess the etiology of the multiple areas of cord signal abnormality (such as demyelinating/inflammatory disease).


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with altered mental status and fever. Evaluate for abscess or malignancy. Within the limitations of a motion degraded examination, no definite pathologic parenchymal or extra-axial enhancement is seen.

Output: No enhancing lesions are seen to suggest the presence of abscess or malignancy.


Instruction: Generate impression based on findings.

Input: History of recurrent ovarian cancer treated with chemotherapy, now with acute change in mental status. The images are markedly degraded by patient motion. There is no gross evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral and pontine white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No gross evidence of intracranial hemorrhage, mass, or acute infarct, within the limits of motion artifact. Mild scattered cerebral and pontine white matter T2 hyperintensity is nonspecific, but likely represents chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 21-year-old male with foot pain. Chronic plantar medial arch pain. Evaluation of the medial aspect of the midfoot and first metatarsal is limited by metallic susceptibility artifact related to orthopedic screws across the first tarsometatarsal joint from prior Lapidus procedure. Based on prior radiographs, the patient has also undergone resection of an accessory navicular bone. Multiple low signal intensity foci within the medial soft tissues extending from the tip of the medial malleolus to the medial cuneiform represent metallic susceptibility artifact related to prior surgery. This same tissue enhances following contrast administration, perhaps representing scarring/granulation tissue. There is a surgical tunnel within the navicular tuberosity. On the axial images, the posterior tibialis and flexor hallucis longus tendons can be followed to just beneath the medial malleolus, distal to which they become indistinct amidst the aforementioned scarring/scar tissue. The tendons are slightly better visualized on the STIR sagittal sequence. The fibers of the posterior tibialis appear to extend to the navicular and presumably enter the aforementioned tunnel. The flexor digitorum longus also appears to extend to the navicular and presumably enters the tunnel, although the tendon just proximal to the navicular contains increased signal intensity which could represent degeneration, inflammation, or tearing. The visualized portions of the flexor hallucis longus tendon appear normal. The Achilles tendon appears intact. The lateral tendons appear intact. The anterior tendons appear intact. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact. The signal intensity of the remaining bones is within normal limits. There is no joint effusion. The musculature of the foot is unremarkable.

Output: 1. Limited evaluation of the medial aspect of the midfoot and forefoot related to orthopedic screws from prior Lapidus procedure.2. Postoperative changes of accessory navicular resection and tendon transfer as described above. Enhancement of the medial soft tissues of the hindfoot and midfoot presumably represents scar tissue. Evaluation of the transposed posterior tibialis and flexor digitorum longus tendons is limited due to this scar tissue. Please see above for further details.


Instruction: Generate impression based on findings.

Input: 64-year-old male with elevated PSA. Evaluate prostate gland. PELVIS:PROSTATE:Prostate Size: 6.4 x 4.6 cmPeripheral Zone: There is a focus of abnormal T2 hypointensity with corresponding ADC low signal in the right lateral mid gland.Central Gland: Heterogeneous central gland consistent with benign prostatic hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Abnormal subcentimeter focus in right lateral mid gland.2.No evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Episodic vertigo, left ear fullness, left tinnitus. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. However, the cerebellar tonsils extend up to 6 mm inferior to the foramen magnum and the posterior fossa appears to be relatively small. 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.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Findings suggestive of mild Chiari I malformation.3. No evidence of head and neck arterial lesions.


Instruction: Generate impression based on findings.

Input: Image quality is significantly degraded by motion artifact. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. The pattern of myelination is within normal limits for age. There is faint diffusion hyperintensity, but isointense ADC signal, along the lateral aspect of the genu of the corpus callosum. This appears similar to atlases and is therefore not felt to be pathologic. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The known mandibular hypoplasia is not well assessed on MRI.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: lesion that might produce seizures? History: seizure, h/o developmental delay during childhood There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: Headache There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Left globe is atrophic and calcified with prosthesis. Single image of the sella turcica demonstrates calcification. There is no CSF density seen in the sella. Correlation with clinical history is recommended. Further evaluation with MRI can be performed. The optic chiasm is normal.

Output: 1. No acute abnormality seen to account for the patient's symptoms of headaches. 2. Calcification noted in the sella turcica. Correlation with clinical history is recommended and further evaluation with MRI can be performed if indicated.


Instruction: Generate impression based on findings.

Input: Reason: evaluate rotator cuff History: lateral shoulder pain with short term relief with subacromial steroid injections. ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is a full-thickness tear of the supraspinatus at the level of the insertion of the greater tuberosity measuring approximately 16 mm in AP dimension. There is minimal retraction. There is also full-thickness tearing of the anterior fibers of the infraspinatus measuring approximately 7 mm in the AP dimension. There is a tiny interstitial tear of the infraspinatus at the level of the myotendinous junction. The supraspinatus and infraspinatus muscle appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Moderate to severe osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the joint without evidence of a large effusion. The glenohumeral joint alignment is anatomic. There is linear branching signal abnormality within the superior labrum at the 1 o'clock position likely indicating a labral tear, which also appears to extend through the articular cartilage.BICEPS TENDON: The tendon of the long head of the biceps appears intact.ADDITIONAL

Output: 1. Rotator cuff tendinosis with full-thickness tears of the rotator cuff and minimal retraction as described above. 2. Osteoarthritis of the shoulder.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: STROKE History: L NUMBNESS, pt unable to tolerate exam only pre brain and mra head done pt will retry again in the amBrain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral P-comm arteries are patent. A common artery is also patent.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No mass lesion.2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with left-sided asymmetrical sensorineural hearing loss. The IACs are patent and free of mass lesions. The cranial nerve VII and VIII complexes are well seen and morphologically unremarkable. No pathologic enhancement is observed. The fluid-filled structures of the inner ear including the cochlea, vestibule and semicircular canals are within normal limits. The vestibular aqueducts are not enlarged.

Output: No specific findings to account for the patient's hearing loss.


Instruction: Generate impression based on findings.

Input: 69-year-old male with pain in right elbow. Evaluate for triceps tear. LIGAMENTS: No significant abnormality noted.TENDONS: Foci of calcification in the distal triceps tendon, which are better evaluated on the recent elbow radiograph, are present near its insertion on the olecranon process of the ulna. There is intermediate signal intensity in the fibers of the triceps tendon distally indicating tendinosis, which given the presence of calcifications distally is compatible with calcific tendinopathy. There is no tendon retraction or other findings to suggest a full-thickness tear. ARTICULAR SURFACES AND BONE: The elbow joint is in anatomic alignment. The articular cartilage appear normal. There is edema type signal in the bone marrow of the right olecranon process of the ulna likely reactive secondary to the aforementioned vallecular bursitis. Otherwise the bone marrow signal elsewhere is normal.SURROUNDING STRUCTURES: There is fluid in the olecranon bursa consistent with olecranon bursitis. There is adjacent edema and induration in the soft tissues posterior to the elbow.ADDITIONAL

Output: 1. Calcific tendinopathy of the triceps tendon near its insertion on the olecranon process of the ulna.2. Olecranon bursitis with likely reactive marrow edema in the adjacent olecranon process of the ulna.


Instruction: Generate impression based on findings.

Input: Reason: eval compression fractures and spinal cord History: urinary and fecal retention Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There are compression fractures at L5 (10% loss of vertebral body height with superior endplate compression), L4(50% loss of vertebral body height with superior endplate compression and mild retropulsion), L2(20% loss of vertebral body height with superior endplate compression), L1(20% loss of vertebral body height with superior endplate compression), T12,(40% loss of vertebral body height with superior endplate compression and mild retropulsion) and T10(20% loss of vertebral body height with inferior endplate compression). There is no significant bone edema identified to suggest acute compression. Compared to 7/3/14 there is no significant progression of the degree of compression, however, the bone edema at L4 and T10 has resolved.The conus medullaris on sagittal imaging is grossly intact. There is multilevel loss of disk space height and disk dessication present.At L5-S1 there is no significant compromise to spinal canal. There is a disk bulge and facet hypertrophy at this level with bilateral encroachment of exiting nerve roots.At L4-5 there is no significant compromise to spinal canal. There is mild facet hypertrophy and a mild disk bulge at this level. There is narrowing of the neural foramina at this level with mild encroachment of right sided exiting nerve roots. This is stable compared to the prior exam. At L3-4 there is a disk bulge and moderate facet hypertrophy at this level as well as some L4 retropulsion resulting in moderate spinal stenosis. There is narrowing of the neural foramina at this level with mild encroachment of right sided exiting nerve roots. This is stable compared to the prior exam. At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy and a mild disk bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy and a mild disk bulge at this level.

Output: 1.There are multiple compression fractures in the lumbar spine and lower thoracic spine with mild retropulsion at L4 and T12. This is stable since the prior exam. Prior bone edema has resolved.2.Moderate spinal stenosis at L4-5 and encroachment of exiting nerve roots at L5-S1 as well as L4-5 and L3-4 is stable as detailed above.


Instruction: Generate impression based on findings.

Input: New seizure workup. Many of the images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, and cerebellum appear to be grossly unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and mastoid air cells are grossly unremarkable. There are small left maxillary sinus retention cysts.

Output: No evidence of potential seizure foci, although many of the images are degraded by patient motion.


Instruction: Generate impression based on findings.

Input: 73-year-old female with right axillary mass and concern for a right infraspinatus mass. Axillary masses seen on this MRI of the shoulder are comparable to those seen on the recent CT scan, when accounting for positional and technical differences. We have no prior MRI for direct comparison. There is extensive reticulation of the adjacent subcutaneous fat which may reflect prior surgery or radiation therapy. Although the masses and reticular signal abnormality abut the chest wall, we see no signal abnormality within the ribs. Signal abnormality also abuts the anterior margin of the subscapularis and deep margin of the pectoralis, but we see no muscular invasion. The axillary vessels are contained within this signal reticulation, again appearing comparable to that seen on the prior CT examination. This process extends superiorly to the level of the coracoid process and behind the clavicular diaphysis.There is fusiform increased signal intensity along the length of the infraspinatus muscle on the fat-suppressed T2-weighted imaging, with associated enhancement following contrast administration. The muscle fibers, however, remain visible, and we see no space occupying mass within the muscles. These findings most likely reflect isolated infraspinatus myositis. We see no signal abnormality in the adjacent scapula, or other bones or muscles. Increased signal intensity and enhancement in the dependent portions of the imaged right lung likely reflect dependent atelectasis.

Output: Imaging findings of isolated myositis of the infraspinatus muscle without discrete mass within the muscle. Axillary masses and abnormality appearing similar to those seen on the prior CT scan.


Instruction: Generate impression based on findings.

Input: Diagnosis: Non-Hodgkin lymphoma, unspecified, unspecified siteDiagnosis Edits: Clinical question: PCNSL s/p ASCT, re-evalSigns and Symptoms: NHL The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially.The patient is status post suboccipital craniotomy.A small focus of encephalomalacia is present in the right middle frontal gyrus. This is unchanged since the prior exam.There is encephalomalacia present along the right cerebellar hemisphere which is unchanged since prior 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 demonstrate some mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Small foci of encephalomalacia in the right middle frontal gyrus and right cerebellar hemisphere are redemonstrated and unchanged.2.There is no evidence for recurrent lymphoma.


Instruction: Generate impression based on findings.

Input: Ms. Gabel is a 51 year old female with a personal history of benign right breast biopsy in 2011. She is a BRCA1 mutation carrier. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Susceptibility artifact from biopsy marker clip is identified in the right upper breast, compatible with prior history of benign breast biopsy. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 79-year-old female with right proximal anterolateral thigh pain and history of neurofibromatosis, assess known proximal femur mass for progression in size and character and concern for hematoma per outside hospital report Please note that exam is limited due to patient motion artifact and contrast-enhanced portions were not completed due to patient pain.Again seen is a mass within the anterior compartment of the thigh extending from the anterior aspect of the hip joint along the anterior femur over a length of approximately 16 cm. The mass is associated with chronic erosions along the anterior aspect of the femoral neck as well as the anterior femoral diaphysis at the level of the lesser trochanter. Although the erosion is similar in size, the lesion has increased in size measuring approximately 9.5 x 7 cm in cross section. On T1 weighted images, the lesion is largely isointense to skeletal muscle but contains poorly defined hyperintense signal. On T2 weighted images, the lesion is heterogeneous with foci of high signal intensity as well as signal voids. This pattern of signal intensity is compatible with the clinical suspicion of hematoma. Edema is present within the musculature and fascial planes surrounding the mass extending down the thigh to the level of an old fracture of the distal femoral diaphysis. Additional edema is noted within the subcutaneous fat along the lateral aspect of the hip. The rectus femoris muscle and tendon is displaced anteriorly by the mass and contains a smaller neurofibroma, similar to the prior exam. The remainder of the quadriceps musculature is not well-defined. The femoral artery and vein is displaced medially. Additional smaller neurofibromas are noted within the thigh. On large field of view images, additional neurofibromas are seen involving the right thigh. A scar traversing the subcutaneous fat along the right buttock presumably reflects the site of resection of known malignant peripheral nerve sheath tumor. Heterogeneous marrow is seen bilaterally, which presumably represents reconverted red marrow.

Output: Enlargement of mass along the anterior aspect of the femur with a signal intensity pattern in keeping with hematoma. Please note that we cannot exclude malignancy.


Instruction: Generate impression based on findings.

Input: 31 year old male patient with ileal Crohn's diease with phlegmon on OSH CT. Evaluate for resolution of phlegmon since starting Humira treatment. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Subcentimeter T2 hyperintense lesions within this spleen are compatible cysts.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A right ureteral stent is in place without hydronephrosis. There is circumferential thickening and enhancement of the mid to distal right ureter in the region of the terminal ileum likely representing secondary inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is wall thickening and narrowing of approximately 14 cm of the terminal ileum which demonstrates progressive enhancement compatible with active inflammation. The appendix demonstrates wall enhancement as well. There is a fistulous connection between the terminal ileum to an adjacent small bowel loop within the right lower quadrant (image 62, series 15). Furthermore, there are inflammatory changes within the right lower quadrant with several sinus tracts (image 59, series 15). No drainable fluid collection is identified. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Enhancement, wall thickening, and narrowing of the terminal ileum compatible with active inflammation.2.Right lower quadrant enteroenteric fistula, inflammatory changes, and sinus tracts. No drainable fluid collection.3.Enhancement and thickening of the right ureter likely represent secondary inflammation from the adjacent terminal ileum. Right ureteral stent in place without hydronephrosis.


Instruction: Generate impression based on findings.

Input: 46 year old man admitted with chest pain and troponin elevation, found to have no significant coronary artery disease, referred for further evaluation of possible myocarditis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 148 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 61 ml (normal range 47+/-19), the LV mass index is 65 g/m2 (normal range 85+/-15), and the LV mass is 125 g (normal range 164+/-36). There is regional thickening of the basal inferolateral and mid lateral walls (12mm). There are no regional wall motion abnormalities present. There is increased signal intensity on T2 STIR imaging in the basal inferolateral and lateral walls that is indicative of myocardial edema. T1 BB imaging shows evidence of early gadolinium enhancement in the basal lateral wall, which is indicative of an inflammatory process. There is a large area of patchy, transmural late gadolinium enhancement in the basal to mid inferolateral and lateral walls. This pattern is not well demarcated, which is atypical for myocardial infarction, however the possibility of a left circumflex infarct cannot be excluded. Overall, the findings of increased myocardial edema, early gadolinium enhancement (inflammation) and late gadolinium enhancement in the basal to mid inferolateral and lateral walls is highly suggestive of inflammatory stage of myocarditis. 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 54%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 144 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 67 ml (normal range 54+/-17).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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a "psuedo-bovine" brachiocephalic branching pattern (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%. 2. There is evidence of myocardial thickening, edema, early gadolinium enhancement and late gadolinium enhancement in the basal to mid inferolateral and lateral walls. These findings are highly suggestive of inflammatory stage of myocarditis, although the possibility of an acute left circumflex infarction cannot be excluded.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%.


Instruction: Generate impression based on findings.

Input: Diffuse pain and weakness, evaluate for cervical or segmental cord compression. Examination is obtained per screening adult cord compression MRI protocol. There is 6 mm anterolisthesis of C7 on T1 with severe loss of intervertebral disk space and T2 hyperintensity within the disc space. There is low T1 and T2 signal involving the adjacent endplates compatible with sclerosis. There is moderate loss of height involving the anterior aspect of the T1 vertebral body and minimal loss of height involving the C7 vertebral body.There are degenerative changes throughout the cervical spine with disk osteophyte complexes and moderate spinal canal stenosis at C3-C4, C4-C5, C5-C6, and moderate to severe spinal canal stenosis at C7-T1. There is T2 hyperintensity within the cervical cord at the C7-T1 level. Advanced facet arthropathy is also seen at the C7-T1 level bilaterally. There is bone marrow edema which extends into the posterior elements at C7 and T1. There is severe neural foramina stenosis at C7-T1, worse on the right than the left.Remainder of the cervical, thoracic, and lumbar vertebral body heights appear preserved. There is straightening of the lumbar spine curvature. Advanced degenerative changes are noted at the L3-L4 and L4-L5 levels and to a lesser degree at L2-L3 and L5-S1. Axial images were not obtained, however, there may be up to moderate spinal canal stenosis. There is up to severe neural foraminal narrowing at the L3-L4, L4-L5, and L5-S1 levels.

Output: Limited exam for cord compression protocol demonstrating degenerative changes throughout the cervical spine, worst at the C7-T1 level, where there is 6 mm of anterolisthesis, severe loss of intravertebral disk space, endplate sclerosis, and mild anterior wedging of the T1 vertebral body. These findings are most likely related to advanced degenerative changes. Given the advanced degenerative/destructive changes at the C7-T1 level described above including the anterior and posterior elements, Charcot/neuropathic joint can also be considered, although uncommon, in the appropriate clinical setting.Moderate to severe spinal canal stenosis at C7-T1 with T2 hyperintensity within the cord compatible with edema.Degenerative changes also noted in the lumbar spine, worst at the L3-L4 and L4-L5 levels. There is T2 hyperintensity within the disk space and adjacent endplates which may be on a degenerative basis. There may be up to moderate spinal canal stenosis which is difficult to evaluate without axial images. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: 12-year-old male with history of epilepsy. No previous imaging. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears unremarkable. There is no evidence of heterotopia or radial migration bands. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No potential seizure foci are identified.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A 71 year old with significant mitral regurgitation diagnosed after recurrent strokes. Referred to cardiac MRI to further quantify left ventricular and regurgitant volumes. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 146 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 65 g/m2 (normal range 85+/-15), and the LV mass is 132 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No thrombus was noted. There is no iron overload noted. Left AtriumThe left atrium is normal in size (84ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 152 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 63 ml (normal range 54+/-17).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 qualitatively and quantitatively mild to moderate mitral regurgitation. The quantified regurgitant volume is 16ml and the regurgitant fraction is 18%.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 60%). 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size and systolic function (RVEF 59%). 4. The left atrium is normal in size. 5. There is mild to moderate mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 53-year-old male, evaluate for acute ischemia, history of complex partial seizure with left weakness and neglect. There has been marked progression of encephalomalacia and gliosis centered in the right inferior parietal lobule extending into the superior parietal lobule and posterior superior temporal lobe as well as involving the right centrum semiovale and right corona radiata corresponding to the regions of previously identified infarction. Associated susceptibility artifact likely represents chronic blood product. There is mild ex vacuo dilatation of the posterior horn of the right lateral ventricle. Note is made of T2 signal abnormality compatible with Wallerian degeneration in the right brain stem. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Major flow-voids are preservedSella 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.

Output: 1. No evidence of acute infarction, acute hemorrhage or mass effect.2. Encephalomalacia and gliosis with chronic blood product is centered in the right inferior parietal lobule extending into adjacent superior temporal gyrus and superior parietal lobule. The territory involved has progressed significantly since the prior MRI at the time of acute cerebral ischemia in this territory. There is associated wallerian degeneration.


Instruction: Generate impression based on findings.

Input: B-cell lymphoma, leg weakness/numbness There are small subcentimeter amorphous foci of increased signal within the left sacral wing on the fat suppressed T2 sequence. These are less conspicuous on T1 sequences and demonstrate minimal enhancement following contrast administration. While we cannot entirely exclude the possibility of small lymphomatous deposits, these may simply represent components of small intraosseous vascular malformation, given their clustering in the sacral wing. Similar but smaller foci are present in the right sacral wing. There are no additional bony lesions within the pelvis. Symmetric intermediate signal intensity within the proximal femora bilaterally are thought to represent areas of red marrow.A small Tarlov cyst is seen posterior to the right S2 nerve root and is not necessarily of any current clinical significance. The muscles of the pelvis are normal in signal intensity and caliber. The hip and sacroiliac joints are normal with no evidence of synovitis or effusion.A fat-containing lesion is noted within the left adnexa perhaps representing a dermoid cyst / mature teratoma.

Output: 1. Small amorphous foci of signal abnormality with minimal enhancement noted within the sacral wings, left greater than right. These may represent small vascular malformations although we cannot entirely exclude the possibility of small lymphomatous deposits. Follow-up with serial imaging may be considered.2. Fat-containing left adnexal lesion which may represent a mature teratoma / dermoid cyst. Referral to gynecology may be considered.


Instruction: Generate impression based on findings.

Input: 47-year-old male with worsening weakness, gait instability and diplopia, evaluate for MS. THORACIC SPINE: There are multifocal patchy areas of T2 hyperintensity within the distal cervical and thoracic spinal cord. The largest lesion extends from T6 through T7 within the posterior aspect of the cord. There is no associated enhancement within these 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. The paravertebral soft tissues are unremarkable. There is a right renal cyst that measures up to 12 mm.LUMBAR SPINE: There are foci of highT2 signal in the distal spinal cord without associated abnormal enhancement. 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 a mild diffuse disc bulge at L5-S1 with a small annular fissure, but no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Multiple T2 hyperintense lesions throughout the imaged spinal cord are compatible with a demyelinating process, but no enhancing lesions are identified to suggest active inflammation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 68 year-old female. MDS and right leg skin rash concerning for leukemia cutis. She now has blistering, swelling, and exquisite tenderness to palpation concerning for superimposed NSTI or abscess. There is thickening of the skin along the dorsum of the foot. There is also extensive edema-type signal in the subcutaneous fat of the dorsum of the foot extending into the toes. This edema becomes confluent dorsal to the metatarsals and the visualized bones of the midfoot. While this confluent edema does not enhance following contrast administration and although we see no discrete rim enhancement, the possibility of a phlegmon or a developing abscess is a consideration. This collection appears to extend to the skin surface dorsal to the middle cuneiform. Overall, this collection measures approximately 1.5 cm in depth, 9 cm in length (extending off the field of view proximally), and 7 cm in the mediolateral dimension. There is enhancement of the subcutaneous fat surrounding this collection indicating inflammation. The extensor tendons lie deep to this collection and we see no specific findings to suggest extensor tenosynovitis. There is edema of the plantar musculature of the foot that does not appear to enhance following gadolinium administration. There is slight tenosynovial enhancement of the flexor hallucis longus tendon at the knot of Henry, which is of questionable current clinical significance. The bone marrow signal intensity is within normal limits.

Output: Inflammatory changes of the forefoot, as described above, particularly affecting the dorsum of the forefoot where there is a nonenhancing collection that may either represent extensive confluent edema or a phlegmon/developing abscess; however we see no well-defined rim enhancing abscess at this time. We also cannot exclude the possibility of a superficial necrotizing infection on the basis of this exam.Findings were communicated to clinical service Dr. Parker, over the phone at time of dictation.


Instruction: Generate impression based on findings.

Input: 48-year-old female with shoulder pain and weakness. Evaluation of the shoulder is slightly limited due to inability to optimally position the patient.ROTATOR CUFF: There is increased signal intensity within the anterior fibers of the supraspinatus tendon suggestive of mild tendinosis. Additionally, there is a small focus of high signal intensity within the anterior fibers of the tendon at their insertion on the greater tuberosity. This involves the articular surface fibers and approximately 50% of the tendon thickness, but only measures 3 to 4 mm in both the longitudinal and AP dimensions. The supraspinatus muscle appears normal. There is thin linear increased signal intensity within the infraspinatus tendon, best seen on the sagittal oblique images, which may represent an interstitial tear, but we see no evidence of an surface tear. The infraspinatus muscle appears intact. There is thickening and mild increased signal intensity of the distal subscapularis tendon which may represent mild tendinosis, possibly exaggerated by redundancy of the tendon related to internal rotation of the humeral head. The subscapularis muscle appears intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Note is made of an os acromiale. Mild to moderate osteoarthritis affects the acromioclavicular joint. We see no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint, but no large joint effusion. Although we see no fluid signal intensity entering the labral substance, there is intermediate signal intensity within the superior labrum extending into the anterior labrum suggestive of a tear with small adjacent focus of fluid signal intensity indicating a paralabral cyst. The inferior glenoid labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears mildly thickened at its transition from the rotator cuff interval to the intertubercular groove suggesting tendinosis.ADDITIONAL

Output: 1. Mild rotator cuff tendinosis with a small insertional tear of the anterior fibers of the supraspinatus tendon as described above.2. Osteoarthritis of the acromioclavicular joint and os acromiale.3. Findings suggestive of a superior labral tear and small paralabral cyst.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 63 year old female with pyomyositis with abscess of the left shoulder status post surgical incision and drainage with persistent MRSA bacteremia. Evaluate for recurrence or osteomyelitis. Suboptimal examination secondary to patient motion artifact.There is a small collection of fluid signal intensity between the deltoid muscle and the lesser tuberosity of the humerus that measures approximately 20 x 8 mm in the transverse dimension and 20 mm in the craniocaudal dimension in the approximate location of the suspected abscess seen on the prior study. There is edema within the soft tissues adjacent to this collection as well as foci of gas intensity. We cannot determine if this represents recurrence of abscess or simply postoperative changes. There is heterogeneous material within the remainder of the subdeltoid bursa similar in distribution to that seen on the prior examination that may represent a combination of synovitis, postoperative gas and blood products as well as a small amount of fluid. However, we cannot exclude the possibility of residual infection. There is a new collection of lobulated heterogeneous but predominantly fluid signal intensity within the subcutaneous fat of the shoulder anterior to the deltoid and pectoralis musculature that measures approximately 40 x 17 mm in the transverse dimension and 40 mm in the craniocaudal dimension which contains a large focus of signal void that presumably represents air. We presume this represents early postoperative seroma formation, although we cannot exclude the possibility of residual infection. Additional foci of signal void within the anterior soft tissues of the shoulder presumably represent gas related to the patient's recent surgical history. There is a small amount of fluid within the posterior aspect of the glenohumeral joint, but the volume of the fluid appears smaller than that seen on the prior study. There are small foci of signal abnormality within the greater tuberosity and the posterior aspect of the humeral head which are likely degenerative in etiology. We see no findings to suggest osteomyelitis. Again seen is edema within the rotator cuff musculature, particularly the infraspinatus, indicating inflammation, appearing similar to the prior study. There is mild edema within the anterior fibers of the deltoid muscle which may be postsurgical in etiology. We see no findings to suggest intramuscular abscess formation. The supraspinatus and infraspinatus tears appear similar to the prior study. Osteoarthritic changes affect the acromioclavicular joint, appearing similar to the prior study. Glenohumeral joint alignment is within normal limits. Evaluation of the labrum is limited due to patient motion artifact. The tendon of the long head of the biceps is within normal limits.

Output: Inflammatory changes of the shoulder as described above with a small fluid collection between the deltoid muscle and lesser tuberosity of the humerus as well as heterogeneous material within the subdeltoid bursa, which could be postoperative in etiology, although we cannot exclude the possibility of residual infection. There is a new fluid collection in the anterior soft tissues of the shoulder which is presumably postoperative in etiology, although we again cannot exclude the possibility of residual infection.


Instruction: Generate impression based on findings.

Input: 20 years, Female, Reason: 20 y.o. with h/o of small and large bowel Crohn's admitted with RLQ abdominal pain, please evaluate for etiology. History: RLQ abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening, abnormal enhancement or diffusion restriction. No abscess or fistula. No evidence of obstruction. No findings suggesting chronic inflammation. There no pericecal inflammatory changes or other secondary findings to suggest appendicitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: No significant abnormality notedBLADDER: Distended bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis is likely physiologic.

Output: 1.Normal MRI enterography.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:8/18/1960)Reason: Ph + ALL with intracranial relapse - possible seizure and noted to have increased ventricle size History: AMSPROVIDER/ATTENDING NAME: EHTASHAM G KHATTAK WENDY STOCK The lateral and third ventricles are mildly dilated.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.Motion artifact degrades the exam.

Output: 1.The ventricles are mildly dilated. In isolation this is non-specific. An underlying cause is not identified on this exam.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 3.Exam is degraded due to patient motion artifact which may obscure more subtle abnormalities. For example it is unclear if there is underlying mild ependymal or leptomeningeal disease or this appearance is a product of artifact.


Instruction: Generate impression based on findings.

Input: Female 31 years old Reason: reported history of pancreatitis, h/o ERCP induced pancreatitis; pls perform with secretin History: epigastric pain, n/v ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Mild increased diffusion and T2 hyperintense signal throughout the pancreas suggestive of interstitial edema. A portion of the pancreatic duct drains via the minor papilla suggestive of at least partial pancreas divisum. There is no pancreatic duct dilatation. The pancreatic duct demonstrates normal physiologic response to secretin.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.

Output: Pancreas divisum without duct dilatation. Mild interstitial edema within the pancreas consistent with pancreatitis. No peripancreatic fluid.


Instruction: Generate impression based on findings.

Input: Reason: eval for patellofemoral pathology History: L knee pos patellar apprehension test MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears normal without fluid filled defects. There is mild edema within the superolateral corner of Hoffa's fat pad which can be associated with patellar tracking disorders and/or patellar instability. The Insall-Salvati ratio is 1.2, indicating borderline patella alta. The superior aspect of the femoral trochlea appears slightly shallow, which is suggestive of mild dysplasia. There is slight lateral tilt of the patella. The TTTG distance is approximately 1.6 cm, which is borderline. LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear normal. ADDITIONAL

Output: Slight lateral tilt of the patella with borderline Insall-Salvati ratio and TTTG distance and perhaps mild femoral trochlear dysplasia.


Instruction: Generate impression based on findings.

Input: Family history of breast cancer, BRCA mutation carrier. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild 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: Reason: back pain, sp fall, evaluate for disc problem History: pain. 31 year old patient with lower back pain. She does have a left breast marker. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is a left perimedian disk extrusion present with the disk material extending slightly behind the adjacent endplates. There is a some encroachment of the nerve roots of the left lateral recess resulting. There is mild loss of disk space height and disk desiccation at this level. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge and disk desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a left paramedian disk protrusion present at L4-5 which encroaches the nerve roots of the left lateral recess increta mild degree of spinal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for chronic lumbar spine pain. Signs and symptoms: Chronic back pain. Nonenhanced lumbar MRI:Lower most visualized thoracic spine the thoracic cord is unremarkable.T2 of ventricle and one demonstrate mild degenerative disk disease and unremarkable otherwise. Incidental note is made of a small skeletal capillary hemangioma of T12 vertebrae.L1 -- L2 demonstrate minimal degenerative changes and unremarkable otherwise.L2 -- L3 demonstrate mild degenerative changes of the disk and mild ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise. Incidental note is made of a skeletal capillary hemangiomas of L3 vertebrae.L3 -- L4 demonstrate mild disk desiccation and moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate moderate disk disease and loss of disk height, significant (left greater than right) facet and ligamentum flavum hypertrophy, right facet space widening and effusion and mild grade 1 anterolisthesis. Constellation of above findings result since the thickened central spinal stenosis and bilateral neural foraminal compromise (right greater than left).L5 -- S demonstrate moderate disk desiccation and loss of disk height, shallow broad-based bulging disk and mild bilateral ligamentum flavum hypertrophy and mild facet disease. There is no spinal stenosis however significant(bilateral left > right ) neural foraminal compromise is noted. There is disk osteophyte complex on the right with resultant significant right lateral recess compromise.

Output: 1.Extensive degenerative changes at L4 -- 5 and including grade 1 anterolisthesis results in significant central spinal stenosis and bilateral neural foraminal compromise as detailed above.2.Extensive degenerative disk disease at L5 -- S1 without central spinal stenosis however significant left and to lesser degree right neural foraminal compromise. Right-sided disk osteophyte complex also results in right lateral recess compromise.3.The right kidney is not identified on this exam and the left kidney is grossly unremarkable. Recommend correlation with dedicated images.


Instruction: Generate impression based on findings.

Input: Left knee pain. Question of meniscal tear or pathology. MENISCI: There is abnormal signal and ghosting of the posterior horn of the medial meniscus which may represent a radial tear. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is near complete loss of the articular cartilage of the anterior lateral femoral condyle. There is significant chondral thinning and fraying of the weight-bearing portion of the medial femoral condyle. There is near complete loss of cartilage of the femoral trochlea with minimal cartilage remaining along the superior aspect. There is complete cartilage loss of the lateral patellar facet with bone on bone apposition and subchondral cyst formation inferiorly. There is tricompartmental osteophyte formation. LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Tricompartmental articular cartilage loss, most predominately affecting the lateral patellar facet and anterior lateral femoral condyle.2. Probable radial tear of the posterior horn of the medial meniscus.3. Severe osteoarthritis of the patellofemoral joint. 4. Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Female 69 years old; Reason: patient with history of urothelial cancer, status post 2 cycles of chemotherapy. please assess for disease progression History: urothelial cancer ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. 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 retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Urethral mass has decreased in size. It currently measures 2.2 x 1.7 cm.LYMPH NODES: Pelvic lymphadenopathy is decreased in size. Reference lymph node measures 1.2 x 0.8 cm (image 648/series 1703) previously, 1.4 x 1.1 cm.The other pelvic lymph nodes are subcentimeter in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Decrease in the size of the urethral mass and pelvic lymph nodes.2.No new sites of disease


Instruction: Generate impression based on findings.

Input: Juvenile arthritis There is abnormal marrow signal intensity involving the third metatarsal however abnormal marrow signal in this area was also partially visualized on an MRI dated 5/12/2016 of the hindfoot. Additional marrow abnormality within the fifth metatarsal seen on the prior exam is no longer visualized. The remaining marrow signal of the metatarsals is normal. There is also faint increased marrow signal intensity of the medial aspect of the head of the proximal phalanx of the fifth toe. No bony erosions are identified. There is severe osteoarthritis of the midfoot with large talonavicular osteophytes.There is soft tissue and muscle edema/enhancement between the second and third toes at the level of the metatarsals which is likely inflammatory in nature. Similar edema and enhancement is seen is within the plantar soft tissues of the great toe particularly at the level of the interphalangeal joint. There is a mild amount of fluid surrounding the flexor tendon of the first digit which is otherwise intact.

Output: 1. Mild marrow edema of the third metatarsal and distal phalanx of the great toe without discrete fracture lines. Overall the marrow edema of the foot is decreased when compared to a prior examination.2. Mild inflammation of the plantar soft tissues, particularly between the first and second interspace.3. Osteoarthritis of the midfoot.


Instruction: Generate impression based on findings.

Input: Signs and Symptoms: High probability of cardiac sarcoid and undergoing cardiac transplant eval. Has had blurry vision and HA's, want to evaluate for neuro sarcoid as well There are several nonspecific scattered foci of subcortical white matter T2/FLAIR signal hyperintensity. Brain parenchyma is otherwise unremarkable. There is no evidence of acute ischemia, intracranial hemorrhage, mass or mass effect. There is no abnormal enhancement of the parenchyma or meninges. 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. There is no specific evidence of neurosarcoidosis or other active inflammatory process.2. There are scattered foci of subcortical white matter T2/FLAIR signal hyperintensity which are nonspecific and may represent mild chronic small vessel ischemic changes or prior inflammation or infection.


Instruction: Generate impression based on findings.

Input: 69-year-old female with a history of glioblastoma multiforme presents with generalized weakness. There is redemonstration of a large right frontotemporal lobe mass involving the insula consistent with patient's biopsy proven glioblastoma multiforme. There is hypodensity surrounding this mass consistent with a combination of tumor infiltration and vasogenic edema. Periventricular white matter hypoattenuation also noted. These findings appear similar to the prior studies though MRI would be more accurate for evaluation of tumor progression.There is no evidence of a new intracranial mass or focal lesion. There is no evidence of acute territorial ischemia. There is no acute intracranial hemorrhage or extra-axial fluid collection. While there remains 4mm of right to left midline shift, the sulci and ventricles appear slightly more prominent than in November 2011, probably on the basis of treatment related change (e.g. steroids). There is no basal cistern effacement or herniation.Right frontal bone burr hole. The remainder of the calvaria and skull base are radiographically normal. The visualized mastoid air cells are clear. Partial opacification of the ethmoid sinuses bilaterally. Bilateral lens prosthesis.

Output: 1. No acute intracranial abnormality.2. Right frontotemporal mass with surrounding edema, similar to the previous examination when allowing for differences in modalities. No significant interval change in associated leftward midline shift. MRI examination would be more sensitive for evaluation of tumor progression.


Instruction: Generate impression based on findings.

Input: 59 year old woman with history of known heart failure, mild coronary disease, diabetes and previous breast cancer referred for cardiac MRI to evaluate for possible etiologies of her LV dysfunction. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 159 ml/m2 (normal range: 65+/-11), the LVEDV is 302 ml (normal range 109+/-23), the LV end systolic volume index is 118 ml/m2 (normal range 18+/-5), the LVESV is 225 ml (normal range 31+/-10), the LV mass index is 53 g/m2 (normal range 67+/-11), and the LV mass is 102 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is are two patterns of late gadolinium enhancement. The first is a mid-wall stripe pattern involving much of the septum. This pattern is most consistent with fibrosis due to non-ischemic cardiomyopathy. The second is a small focal area of transmural late gadolinium enhancement involving the mid inferior wall. This pattern could represent either an embolic myocardial infarction, vasculitis, or fibrosis. The native T1 myocardial relaxation time is 1180-1240ms. The extracellular volume fraction is 36%. These values are elevated, suggestive of the presence of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is severely dilated. The interatrial septum bows to the right, consistent with elevated left atrial filling pressures. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 120 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 61 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. There is 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 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. There is a trivial 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 LV dilation with severely reduced systolic function (LVEF 26%) with two patterns of late gadolinium enhancement. The first is a mid-wall stripe pattern involving much of the septum. This pattern is most consistent with fibrosis due to non-ischemic cardiomyopathy. The second is a small focal area of transmural late gadolinium enhancement involving the mid inferior wall. This pattern could represent either an embolic myocardial infarction, vasculitis, or fibrosis. 2. Normal RV size with mildly reduced systolic function (RVEF 49%).3. Moderate mitral regurgitation.4. Severe left atrial dilation .I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 39-year-old female with left sided weakness and numbness Brain MRI:Redemonstrated is a stable 8 mm pineal cyst. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Cervical spine MRI:Redemonstrated is slight reversal of the cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position.C2/3: Unremarkable and unchanged.C3/4: Mild degenerative changes without stenosis.C4/5: Mild degenerative changes without stenosis.C5/6: New bilateral uncinate hypertrophy (right greater left) causes new mild proximal right neural foraminal stenosis.C6/7: Unremarkable and unchanged.C7/T1: Unremarkable and unchanged.

Output: 1.Stable 8 mm pineal cyst, otherwise negative non contrast brain MR. Specifically, there are no MRI findings to explain the patient's symptoms.2.C5/6: New bilateral uncinate hypertrophy (right greater left) causes new mild proximal right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Headaches, fainting episodes, evaluate for Chiari malformation There is crowding of the foramen magnum. The cerebellar tonsils demonstrate predominantly round morphology, slightly more peg-like on the left, and protrude up to 7 mm below the foramen magnum. CSF flow is limited along the dorsal aspect of the upper cervical cord at the level of the foramen magnum. There is no evidence of brainstem compression or evidence of syringomyelia. The sagittal images include the inferior endplate of the T3 vertebral body. There is straightening of the normal cervical lordosis. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is mild degenerative spondylosis of the cervical spine worst at C5-6 where there is intervertebral disc height loss. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The prevertebral soft tissues are unremarkable.C2-3: No significant spinal canal stenosis or neural foraminal narrowing. C3-4: No significant spinal canal stenosis or neural foraminal narrowing.C4-5: No significant spinal canal stenosis or neural foraminal narrowing. C5-6: Disc osteophyte complex with indentation of the ventral thecal sac, but no significant spinal canal stenosis or neural foraminal narrowing. C6-7: No significant spinal canal stenosis or neural foraminal narrowing.C7-T1: No significant spinal canal stenosis or neural foraminal narrowing.Cystic lesions in several neural foramina of the lower cervical spine are most consistent with nerve root sleeve cysts.

Output: 1. Crowding of the foramen magnum with cerebellar ectopia and compromised dorsal CSF flow at this level, as described above, suggestive of Chiari I malformation.2. No evidence of syringomyelia or brainstem compression.3. Mild degenerative spondylosis of the cervical spine as described above.


Instruction: Generate impression based on findings.

Input: Reason: Arthrofibrosis S/P patellar tendon repair History: stiff knee MENISCI: There is slight truncation of the free edge of the body of the lateral meniscus which may reflect prior partial meniscectomy or chronic attritional tearing. Otherwise the lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Moderate to severe osteoarthritis affects the patellofemoral joint with focal full-thickness articular cartilage loss along the femoral trochlea, centrally, and additional full-thickness cartilage loss along the lateral facet. There is additional degeneration of the articular cartilage of the patella. The medial and lateral compartment articular cartilage appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is linear signal abnormality extending vertically through the patella presumably related to prior patellar tendon repair. There is deformity of the patellar tendon, the distal half of which appears thickened with the proximal half appearing thinned. Although the thinned proximal fibers can be followed to the patella on the sagittal sequences, they are less well-defined on the axial series and we are uncertain if these low signal fibers reflect residual patellar tendon or simply scar tissue related to chronic rupture. Furthermore, there is a 2 cm ossicle replacing the lateral fibers of the proximal patellar tendon. The quadriceps tendon appears slightly thickened but appears intact.ADDITIONAL

Output: 1. Surgical changes compatible with prior patellar tendon repair with deformity of the patellar tendon as described above that may in part represent scar tissue from chronic rupture.2. Osteoarthritis of the patellofemoral joint and other findings as described above.