Instruction: Generate impression based on findings.

Input: Clinical question: Assess for intracranial hemorrhage. Signs and symptoms: Found down. Nonenhanced head CT:There is no detectable acute intracranial process.CT is insensitive for early detection of acute ischemic strokes.Excessive premature a subcortical low attenuation white matter is nonspecific caliber considering patients age likely representing small vessel ischemic strokes of indeterminate age.Mild expansion of right temporal horn secondary to minimal right anterior temporal tip encephalomalacia.Calvarium and soft tissues of the scalp are unremarkable.Limited images through the paranasal sinuses are unremarkable.Limited images through the orbits are unremarkable.There is evidence of a C1 fracture involving both the anterior and posterior arch on the right. There is mild compromise of the spinal canal at this level. This finding is not associated with any associated surrounding soft tissue abnormality and likely to present a chronic fracture. Recommend dedicated CT of cervical spine and/or MRI for further assessment.Findings on this exam were discussed on the phone with Dr. Juan Rojas # 3577at the time of review of the study.

Output: 1.Small muscle ischemic stroke of indeterminate age. CT is insensitive for the detection of nonhemorrhagic acute strokes.2.No acute intracranial process.3.Right anterior temporal tip encephalomalacia and resultant ex vacuo dilatation of right temporal horn.4.Fracture of C1 anterior and posterior arch without any associated surrounding soft tissue abnormality. The finding is highly suspect a chronic fracture. Recommend follow-up with dedicated CT and or MRI for better assessment.


Instruction: Generate impression based on findings.

Input: 71 year old female with a history of pancreas cyst. Please evaluate for change or abnormality. ABDOMEN:LIVER, BILIARY TRACT: No evidence of intra- or extra-hepatic biliary ductal dilation. The liver morphology is within normal limits. There are no focal mass lesions identified. SPLEEN: No significant abnormality noted.PANCREAS: Note is made of multiple subcentimeter foci of fluid signal intensity in the head/uncinate process and body of the pancreas. The largest is in the uncinate process and measures approximately 8 mm in diameter. No solid mass lesions are identified. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple simple cysts are identified within the kidneys bilaterally. Subcentimeter foci of fluid signal intensity are identified in the kidneys bilaterally which are too small to characterize but may represent simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple subcentimeter foci of fluid signal intensity in the pancreas appearing similar to the prior study, when allowing for differences in technique likely representing branch type IPMN's.


Instruction: Generate impression based on findings.

Input: Daily headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is a small left maxillary sinus retention cyst.

Output: No evidence of intracranial hemorrhage, mass, or acute infarction.


Instruction: Generate impression based on findings.

Input: Eye pain, vision loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate foci of T2 hyperintensity in the cerebral white matter, which appear to be similar to the exam from 2010. There is no abnormal intracranial enhancement. There appears to be a partially empty sella. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The slight swelling of the bilateral eyelids is better depicted on the recent orbit MRI.

Output: 1. Suggestion of a partially empty sella, which may be a manifestation of pseudotumor cerebri, along with mild prominence of the optic nerve sheath cerebrospinal fluid depicted on the recent orbit MRI, versus an normal variant. 2. A few punctate foci of T2 hyperintensity in the cerebral white matter, which appear to be similar to the exam from 2010, are nonspecific, but are not particularly reminiscent of multiple sclerosis. 3. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: New hyperreflexia. Evaluate for cervical spinal stenosis. There is minimal retrolisthesis of C5 on C6. There is minimal anterior wedging of the C5 vertebra. There is multilevel disc desiccation with preserved disc heights. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: No significant disc bulge, spinal canal or foraminal stenosis.C4-C5: Minimal posterior disc osteophyte complex with minimal effacement of the right ventral thecal sac. No significant disc bulge, spinal canal or foraminal stenosis.C5-C6: No significant disc bulge, spinal canal or foraminal stenosis.C6-C7: No significant disc bulge, spinal canal or foraminal stenosis. Ligamentum flavum thickening posteriorly.C7-T1: No significant disc bulge, spinal canal or foraminal stenosis.

Output: Minimal degenerative changes of the cervical spine without significant spinal canal or neural foraminal stenosis at any level. No cord signal abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 69-year-old male with a history of severe right shoulder osteoarthritis presents with right shoulder pain, preoperative evaluation for a total shoulder arthroplasty. ROTATOR CUFF: The tendons of the rotator cuff are torn with accompanying atrophy of the musculature.SUPRASPINATUS OUTLET: Moderate to severe degenerative changes affect the acromioclavicular joint. Small amount of fluid is present in the subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Severe degenerative changes affect the glenohumeral joint with accompanying gross degeneration of the labrum.BICEPS TENDON: The tendon of the long head of the biceps is intact with a large fluid collection within the tendon sheath.ADDITIONAL

Output: Severe right shoulder osteoarthritis with a torn rotator cuff and associated muscular atrophy.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with low back pain. Findings related to posterior instrumented fusion from L2 through L5 are described on the prior noncontrast lumbar MRI. On today's postcontrast examination, enhancement is seen within the facet joints at T11-12. Disc bulging and facet hypertrophy at this level result in a moderate spinal canal stenosis with slight impingement of the cord as well as moderate foraminal narrowing. No other definite pathologic enhancement is seen.

Output: 1.Demonstration of spinal canal stenosis at T11-12 due to a combination of disc disease and posterior element hypertrophy. The facets at this level are enhancing which likely indicates an arthropathy with inflammation.2.No other enhancing lesions identified in the lumbar spine. Details of posterior instrumented spinal fusion are discussed on the recent precontrast evaluation.


Instruction: Generate impression based on findings.

Input: Elevated PSA. 3+3 disease identified on outside hospital biopsy. PELVIS:PROSTATE:Prostate Size: 3.2 x 4.5 x 4.0 cm.Peripheral Zone: In the left mid gland there is an ill-defined region of T2 hypointensity measuring up to 1.0 x 0.6 cm (series 801/15), associated with restricted diffusion (series 704/2 24). There is also associated early arterial enhancement on dynamic contrast-enhanced imaging (series 1 401/201 0). On the ADC imaging the signal abnormality appears to extend across the midline and to the base of the seminal vesicles, however there is no abnormal contrast enhancement of the seminal vesicles appreciated. This signal may be artifactual.In the left apex there is a 8 x 9 mm T2 weighted hypointense rounded focus (series 601/52) with possible associated restricted diffusion (series 704/124) but no arterial enhancement.No additional suspicious lesion is identified.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: Abnormal ADC signal extends to the base of the seminal vesicles without abnormal postcontrast enhancement appreciated. These findings are equivocal for seminal vesicle invasion.Extracapsular Extension: The left mid gland lesion has a broad base of abutment with spicular enhancement outside of the prostatic margin with a discrete enhancing nodule between the adjacent rectum and prostate suspicious for extraprostatic tumor and involvement of the neurovascular bundle.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.0 cm lesion in the left mid gland peripheral zone with suspected extraprostatic tumor extension involving the left neurovascular bundle.Moderately suspicious 9 mm left apex peripheral zone lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for possible subdural. Signs and symptoms: Poor quality initial CT need to evaluate for subdural. Nonenhanced head CT:There is no evidence of intracranial hemorrhage.There is paucity of cortical sulci, sylvian fissures and a small basal cistern. Findings although may be the normal for patient stated age of 35 possibility of mild diffuse cerebral edema cannot be entirely ruled out. Comment current follow-up with an MRI examination.There is poor differentiation of gray -- white matter however I cannot be certain whether this is due to patient's thicker than normal calvarium and also presence of board under patient's head.

Output: 1.No evidence of parenchymal or subdural hematoma as clinically questioned.2.Paucity of cortical sulci and small size of basal cistern and sylvian fissures and poor differentiation of gray -- white matter as described above. Concern for possible underlying cerebral edema and recommend further follow-up with an MRI exam. Please see above comments.


Instruction: Generate impression based on findings.

Input: Female 39 years old Reason: liver cyst and liver hamangioma on usg. Also early FH of pancreatic cancer (sister age 37) . Pt with lipase 76 and vague RUQ pain ,please evaluate pancreas with liver History: same LUNG BASES: Bilateral breast prostheses.ABDOMEN:LIVER, BILIARY TRACT: Two T2 hyperintense lesions within the liver. The largest in the left hepatic lobe measures 1.3 cm (series 4, image 13). This is most compatible with a simple cyst. The second is in the right hepatic lobe and measures 1.2 cm (series 4, image 13). This demonstrates peripheral nodular enhancement with progressive fill-in and is most compatible with a hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: Unremarkable appearance of the pancreas without focal mass lesion or duct 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.

Output: 1.No evidence of pancreatic mass or focal duct dilatation.2.Two benign appearing hepatic lesions as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: eval for abscess History: pain ROTATOR CUFF: There is an undersurface tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity with delamination and minimal retraction of the undersurface fibers involving approximately 50% of the tendon thickness. There may also be tearing or fraying of the far anterior bursal surface fibers of the supraspinatus, but this is equivocal. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. We see no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is enhancement of the glenohumeral joint with a small amount of fluid indicating a synovitis. There are multiple focal defects of the articular cartilage of the glenohumeral joint as well as tearing of the anterior and superior labrum. We see no definite bone erosions. There are small foci of bone marrow signal abnormality within the greater tuberosity likely reflecting overlying rotator cuff pathology.BICEPS TENDON: Fluid and synovitis extends into the biceps tendon sheath. There is increased signal intensity within the intra-articular portion of the tendon of the long head of the biceps likely reflecting tendinosis. ADDITIONAL

Output: 1. No evidence of abscess.2. Nonspecific glenohumeral joint synovitis with a small amount of fluid within the joint as well as tearing of the articular cartilage and glenoid labrum. We see no bone marrow edema or erosions.3. Partial thickness tear of the supraspinatus tendon and other findings as described above.


Instruction: Generate impression based on findings.

Input: 70 year-old male with syncope and fall; rule out ICH versus fracture BRAIN:There is no evidence of intracranial hemorrhage, significant mass effect or midline shift. Right basal ganglia lacunar infarcts. Patchy hypoattenuating foci are seen in the periventricular and subcortical white matter which are nonspecific but most likely represent small vessel ischemic disease of indeterminate age.There is hyperdensity overlying the left frontal operculum which corresponds to the left frontal lobe cavernoma seen on previous MRI and likely represents dystrophic calcifications. The ventricles and basal cisterns are prominent, consistent with age-related volume loss. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Left phthisis bulbi is noted.CERVICAL SPINE:The cervical spine alignment is anatomic. Vertebral body heights are maintained without evidence of fracture. Paravertebral soft tissues are unremarkable. Moderate degenerative disease affects the cervical spine with multilevel disk protrusions, most prominently affecting C3-C4 and C4-C5, as well as uncovertebral joint hypertrophy. Extensive atherosclerotic calcifications are noted in the carotid and vertebral arteries.

Output: 1. No acute intercranial hemorrhage. 2. Likely small vessel ischemic disease of indeterminate age. 3. Left frontal hyperdensity likely corresponds to the cavernous malformation seen on the prior MRI.4. No fracture or malalignment is identified. If clinical concern for ligamentous or cord injury, MRI may be obtained for further evaluation.5. Degenerative changes of the cervical spine as above.


Instruction: Generate impression based on findings.

Input: 52-year-old male with fever. Right hip and back pain with incontinence today. The bony density of the vertebral column and the alignment remains within normal limits. The bony density of posterior elements and soft tissue density of the lumber region are unremarkable. The spinal canal appears patent and no evidence of any masses is detected.Considering provided clinical data and unremarkable CT of lumber spine, MRI may be a better test for further evaluation. No spinal stenosis or neural foramina compromise is detected with certainty.

Output: 1.Essentially unremarkable CT examination of lumber spine.2.Further follow-up with an MRI examination is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: History of small cell lung cancer S/P chemotherapy, evaluate for brain Metastasis. Signs and symptoms: None. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease. Unremarkable signal intensity on calvarium and without detectable abnormal enhancement.There are moderate patchy and confluent foci of FLAIR hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres and minimally in bilateral basal ganglia and pons without evidence of hemorrhagic changes and consistent with chronic small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise for age.Unremarkable images through the orbits and including axial fat sat post enhanced surgeries.Normal pneumatization signal pattern of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.

Output: 1.No detectable metastatic lesions.2.Negative diffusion weighted images and moderate chronic nonhemorrhagic small vessel ischemic strokes.


Instruction: Generate impression based on findings.

Input: There are mild disc bulges in the lumbar spine at L3-4, L4-5, and L5-S1 encroaching upon the bilateral neural foramen, but no significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no fatty filum or dysraphism. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No definite evidence of spondylolysis, within the limits of MRI.2. Mild disc bulges at L3-4, L4-5, and L5-S1, with mild bilateral L5-S1 neural foramen stenosis, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Loss of sensation, increased weakness. Evaluate for cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no evidence of spinal cord compression. There are mild degenerative changes of the cervical spine and mild disc bulges about the lower lumbar spine but no significant central spinal canal stenosis.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.


Instruction: Generate impression based on findings.

Input: 54-year-old male with history of pancreatic cyst. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Stable 1.5 cm cystic lesion in the mid body of the pancreas with rim enhancement but no solid component. No definite connection between the cystic lesion and the pancreatic duct. Pancreatic duct is normal in caliber. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are increased inflammatory changes in the right upper quadrant with findings most suspicious for new complex fistulization. There is an enterocolic fistula seen between a loop of distal small bowel in the right upper quadrant and the proximal transverse colon stump (series 4/29-36), proximal to an ileocolic anastomosis from prior right hemicolectomy. There is also suspicion for a very small or developing enteroenteric fistula between the distal descending duodenum and the proximal transverse colon stump (series 4/28).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable nonspecific 1.5 cm cystic lesion in the mid body of the pancreas, which may be a mucinous neoplasm.2.Increased inflammatory changes in the right upper quadrant with new complex fistulization as detailed above.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: This exam is mildly degraded by motion artifact. Regions of cortical, subcortical, and deep white matter diffusion restriction within the bilateral cerebral hemisphere watershed zones, right more than left, have decreased in size as has the associated T2 hyperintensity. Patchy gyriform enhancement in these areas persists but with developing intrinsic gyriform T1 hyperintensity suggesting laminar necrosis. The dominant region of abnormality within the right occipital, inferior parietal lobule, and posterior temporal regions demonstrates mildly improved diffusion cortical and subcortical restriction and minimally worsened associated T2 hyperintensity that extends to involve the right forceps major. T2 hyperintensity within the posterior medial right thalamus is unchanged. There is increased patchy gyriform enhancement in the regions of signal abnormality compared to the prior exam. The contrast bolus was not of optimal quality, and therefore, the perfusion data may not be entirely reliable. Evidence of largely sulcal elevated rCBV is seen which may reflect vasodilatation and luxury perfusion.There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is unchanged fluid within the bilateral mastoid air cells. MR SPECTROSCOPY: The dominant right occipital lesion was interrogated with single voxel spectroscopy performed at multiple TEs. These show a marked lactate peak, significantly decreased NAA, and mildly increased choline relative to the contralateral lobe.

Output: Continued evolution of subacute, possibly watershed, infarcts involving the cerebral hemispheres, right side more than left.Evolving parenchymal abnormality within the right occipital and posterior temporal lobes which is highly likely to represent ischemic injury. This is supported by the distribution which conforms to the PCA territory (including posterior thalamic involvement), as well as MR spectroscopy showing a pronounced lactate presence indicating anaerobic respiration. No findings are seen to suggest an aggressive or highly proliferative process.The underlying etiology for these suspected ischemic lesions is not entirely clear. As above, the high cerebral lesions seem to show a watershed pattern while the right temporo-ccipital lesion appears to be territorial. These could reflect a combination of hypoperfusion and thromboembolic disease. Vasculitis or a PRES-like phenomenon can also be considered. An underlying inflammatory process is felt to be less likely.


Instruction: Generate impression based on findings.

Input: Clinical question: Memory loss. Assess for vascular/other etiology.Signs and Symptoms: As above The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.

Output: 1.There no evidence for acute ischemic cerebral infarction.2.MRI of the brain is appropriate in appearance for the patient's stated age.


Instruction: Generate impression based on findings.

Input: Reason: right C6-7 and left C7-T1 neural foraminal lesions History: weakness Serial CT images obtained during the aspiration procedure demonstrate the needle placement within the right C6-7 neural foraminal lesion. Following needle removal images obtained demonstrate no complications.

Output: Right C6-7 neural foraminal lesion lesion fine needle aspiration under CT guidance.


Instruction: Generate impression based on findings.

Input: History of renal cell carcinoma status post partial nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe subcentimeter hemangioma. No suspicious liver lesion or biliary ductal dilatation. Normally distended gallbladder. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Postsurgical changes of a partial right superior/interpolar nephrectomy. No evidence of residual tumor in the surgical bed. No hydronephrosis. No suspicious renal lesion. No regional lymphadenopathy.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia without evidence of complication.OTHER: No significant abnormality noted.

Output: Status post right partial nephrectomy without evidence of residual, recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: 72-year-old male status post right hemicolectomy for colon cancer and prostate cancer presenting abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatic cysts near the dome are unchanged. New, ill-defined, hypodense lesion in segment 8 measuring 9 by 8mm image number 34, series number 4. This lesion is suspicious for a small metastatic disease, however, it's too small to definitely characterize. Alternatively, this represent a Opitz of focal fatty infiltration. MRI of the liver may be helpful for further information. Previous described possible hemangioma in the left lobe is unchanged.SPLEEN: 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: Mild wall thickening and fat stranding around the ileocolonic anastomosis.BONES, SOFT TISSUES: Sclerotic lesions involving the thoracic and lumber spine consistent with metastatic disease, stable.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Thrombose of the right internal iliac vein. Minimal fat stranding in the pelvis of unknown significance.

Output: Right internal iliac vein thrombosis.Sclerotic bone metastases are stable.New subcentimeter lesion in the liver. This lesion is too small to characterize and may represent a small metastases versus focal fatty infiltration. MRI of the liver may provide further characterization.Mild wall thickening and fat stranding around the ileocolonic anastomosis without evidence of any abscess.These findings were discussed with Dr.Kalscheur at the time of dictation.


Instruction: Generate impression based on findings.

Input: Female, 39 years old, with low back pain. Spinal alignment is anatomic. Vertebral body morphology is normal. No concerning marrow replacement or marrow edema is detected.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable.Loss of T2 signal is seen within the L4-5 and L5-S1 disk spaces. Additional level specific findings are as follows:L1-2 through L3-4: Unremarkable.L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Central disk protrusion without evidence of nerve impingement or significant spinal canal stenosis. No significant neuroforaminal narrowing. L5-S1: Mild facet hypertrophy. Right paracentral annular fissuring and small protrusion. No evidence of nerve root impingement or significant spinal canal stenosis. No significant neuroforaminal narrowing. A perineural root sleeve cyst is present in the lower sacral spinal canal.

Output: Mild degenerative disk disease at L4-5 and L5-S1 with small disk protrusions at both levels. There is no evidence of any nerve root impingement or significant spinal canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: The skull appears heterogeneous with multiple lesions, which are otherwise incompletely characterized without contrast. There is also an incompletely imaged and characterized left mandibular lesion. There is no mass effect upon the underlying brain parenchyma. There is no evidence of intracranial hemorrhage or acute infarct. There are unchanged minimal nonspecific scattered nonspecific T2 hyperintense foci in the supratentorial white matter. There is chronic right cerebellar infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation.

Output: 1. No evidence of intracranial hemorrhage or acute infarct.2. Redemonstration of multiple skull lesions and left mandibular lesions,are incompletely characterized in the absence of contrast, but are compatible with multiple myeloma.


Instruction: Generate impression based on findings.

Input: headache, memory loss and cognitive problems. No evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 40 year old woman with history of spontaneous LAD dissection s/p PCI, LV dysfunction referred for interval imaging to evaluate ejection fraction and scar burden. Left VentricleThe left ventricle is moderate-severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 110 ml/m2 (normal range: 65+/-11), the LVEDV is 175 ml (normal range 109+/-23), the LV end systolic volume index is 60 ml/m2 (normal range 18+/-5), the LVESV is 96 ml (normal range 31+/-10), the LV mass index is 30 g/m2 (normal range 67+/-11), and the LV mass is 46 g (normal range 114+/-24). There is akinesis of the basal and apical anterior wall, and dyskinesis in the mid segment, with associated thinning. There is hypokinesis of the mid and apical septum. There is transmural late gadolinium enhancement in the entirety of the anterior wall, and mid to apical septum, which suggests previous myocardial infarction with minimal viability.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is mildly enlarged.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 126 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 57 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The thoracic aorta and proximal brachiocephalic vessels do not have evidence of aneurysm or dissection. The abdominal and infrarenal aorta do not have evidence of aneurysm or dissection. 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 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. Moderately to severely enlarged left ventricle with mildly reduced systolic function (LVEF 45%). While the ejection fraction is unchanged, the left ventricular volumes are larger than on the previous study from 12/3/2014. 2. There is akinesis of the basal and apical anterior wall, and dyskinesis in the mid segment, with associated thinning. There is hypokinesis of the mid and apical septum. There is transmural late gadolinium enhancement in the entirety of the anterior wall, and mid anteroseptum. This appears similar to the previous study. 3. Normal size right ventricle with normal systolic function (EF 54%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right knee pain, microfracture of the patella and lateral femoral condyle MENISCI: Globular signal observed in the medial meniscus extending to the posterior horn without clear linear component. Signal however does abut and extend towards the inferior articular surface. In addition, clear demonstration of the posterior anchoring of the lateral meniscus is not observed any concern for radial tear or at minimum degenerative signal is raised. Medial and lateral meniscal fraying of the inner edge. ARTICULAR CARTILAGE AND BONE: Mild cartilaginous thinning of the medial and lateral compartments with a small focal rent observed along the posterior aspect of the lateral femoral condyle (image 9 series 5). In addition, extensive degeneration and loss is observed in the undersurface of the patella most extensively underlying the lateral facet with associated underlying marrow edema and full-thickness defects. Marrow signal is otherwise unremarkableLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Scattered cartilaginous degenerative changes with focal defects involving the patella and lateral compartment2. Nonspecific and suspected subacute or degenerative changes involving largely the posterior horn of the lateral meniscus, please see detail provided


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for flow through the fourth ventricle. Signs and symptoms: Status post Chiari decompression. Nonenhanced brain MRI:Negative diffusion-weighted images.Examination demonstrates expected postoperative changes of Chiari decompression with resultant expansion of subarachnoid space and without evidence of tonsillar herniation or deformity.There is normal anatomical morphology of brain and with normal signal intensity on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.CSF flow study demonstrate presence of biphasic flow through the neo-foramen magnum both anteriorly and posteriorly as well as through the fourth ventricle and the aqueduct.Nonenhanced MRI of cervical spine:There is normal anatomical alignment of vertebral coronal however with straightening of cervical lordosis which could be positional.There is normal signal intensity and caliber of the cervical and upper most visualized thoracic cord down to T5 level. No evidence of spinal canal or neural foraminal compromise or stenosis.Revisualization of expected postoperative changes of Chiari decompression as detailed above.No detectable perispinal soft tissue abnormality.

Output: 1.Nonenhanced brain MRI demonstrate expected postoperative changes of the artery decompression and unremarkable brain MRI otherwise.2.Nonenhanced MRI of cervical spine is unremarkable and in particular no evidence of syrinx is detected.3.CSF flow study demonstrates presence of biphasic flow through the neo-foramen magnum both anteriorly and posteriorly as well as through the fourth ventricle and the adequate.


Instruction: Generate impression based on findings.

Input: Reason: Rectal cancer on observation therapy evaluate for tumor recurrence. Please comment on t2 signal intensity and fibrosis History: rectal cancer PELVIS:UTERUS, ADNEXA: Left adnexal cystic lesion with a thin septation is stable measuring 5.3 x 4.2 cm (701/58), previously 5.6 x 4.3 cm. Partially septated uterus.BLADDER: No significant abnormality noted.LYMPH NODES: Tiny mesorectal lymph nodes seen previously are no longer evident.BOWEL, MESENTERY: Asymmetric low rectal wall thickening appears similar to the prior exam. Thickening at the 1:00 position in the lower rectum as referenced on the prior exam is unchanged measuring 8 mm (1401/13). Rectal wall thickening at the 10:00 position with diffusion restriction and mildly increased T2 signal is unchanged measuring 1.6 cm (1001/27). Low T2 signal within the rectal wall posteriorly may represent fibrosis and is unchanged. No extramural extension or stricturing is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post treatment changes with asymmetric rectal wall thickening appears similar to the prior exam.2.Left adnexal cystic lesion is unchanged.


Instruction: Generate impression based on findings.

Input: 60-year-oldwith history of right mastectomy for ILC in 2009 followed by radiation delayed reconstruction. Status post right mastectomy with reconstruction.There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or in the right reconstructed breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Ms. Doss is a 46-year-old female with known right breast invasive ductal carcinoma and metastatic right axillary lymphadenopathy on neoadjuvant chemotherapy presenting for follow-up MR imaging. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.In the right lateral breast, at site of biopsy-proven malignancy, there has been an interval decrease in the heterogeneously enhancing mass, now measuring 2.1 x 1.5 x 0.9 cm (AP x ML x SI), previously measuring 3.8 x 3.9 x 3.7 cm. A biopsy marker clip is seen centrally within this lesion. Of note, previously noted linear nonmass enhancement extending anteriorly from the biopsy-proven malignancy is not appreciated on today's examination.In addition, there has been an interval decrease in biopsy-proven metastatic right axillary lymph node, now measuring 1.6 cm, previously measuring 4.4 cm. A biopsy marker clip is seen eccentrically within the cortex of this lymph node. No abnormal enhancement is seen elsewhere in the right breast or in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region.

Output: (1) Interval decrease in biopsy proven malignancy in the right breast and biopsy proven metastatic right axillary lymph node. (2) No MRI evidence of malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Scattered high signal intensities on FLAIR imaging on bilateral periventricular white matter and centrum semiovale indicating minimal nonspecific small vessel ischemic disease, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No change of nonspecific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Small cell lung cancer with previously radiated brain metastases. There is no evidence of intracranial hemorrhage or acute infarct. There are unchanged nonspecific scattered foci of cerebral white matter T2 hyperintensity without associated enhancement or restricted diffusion. There is no definite residual abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. However, there is persistent fluid within the bilateral mastoid air cells. There is also scattered paranasal sinus mucosal thickening.

Output: No discernible residual enhancing brain metastases.


Instruction: Generate impression based on findings.

Input: Pain, clicking in left knee. Evaluate for meniscal tear. MENISCI: The menisci appear normal. I see no tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage of the femoral trochlea centrally and inferiorly extending along the anterior margin of the medial femoral condyle, with cyst formation and edema-type signal in the underlying subchondral marrow. The articular cartilage of the patella appears intact. The articular cartilage of the tibiofemoral compartments likewise appears intact. There is mild edema-type signal within the medial femoral condyle posteriorly at the level of the physeal scar, perhaps simply representing mild enthesopathic changes near the origin of the medial head of the gastrocnemius.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. Mild enthesopathic changes are noted at the insertion of the distal quadriceps tendon on the patella, not necessarily of any clinical significance.ADDITIONAL

Output: Full-thickness cartilage degeneration involving the femoral trochlea and anterior margin of the medial femoral condyle. I see no meniscal tear. Other findings as above.


Instruction: Generate impression based on findings.

Input: Parotid mass status post surgery. There are interval postoperative findings related to right parotidectomy, lateral temporal bone resection, and neck dissection. There is fluid within the remaining right mastoid air cells. There is diffuse enhancement in the region of the surgical bed, but no gross tumor in the surgical bed or significant lymphadenopathy in the neck. However, there is persistent enhancement along the remaining portion of the right labyrinthine segment and canalicular segment of the right facial nerve. There are denervation changes involving the right facial muscles. There is no significant cervical lymphadenopathy. The osseous structures appear to be intact. There are bilateral lens implants.

Output: Interval postoperative findings related to right parotidectomy, lateral temporal bone resection, and neck dissection with no evidence of gross tumor in the surgical bed or significant lymphadenopathy in the neck. However, persistent enhancement along the remaining portion of the right labyrinthine segment and canalicular segment of the right facial nerve may represent residual perineural tumor.


Instruction: Generate impression based on findings.

Input: 18 months, Male, seizures. There is no intracranial mass or mass effect. No evidence of hemorrhage or ischemia. No findings to suggest cortical dysplasia, within the limitations in assessment due to incomplete myelination. No evidence of gray matter heterotopia or other lesions to suggest possible seizure focus. The hippocampi are grossly symmetric and unremarkable. The ventricles are within normal limits in size and configuration. Myelination appears appropriate for age. Midline structures including the corpus callosum and posterior fossa are within normal limits. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are within normal limits for age.

Output: Examination appears within normal limits for patient's age. If patient has persistent seizures, follow-up examination in 6-12 months when myelination is complete may be helpful.


Instruction: Generate impression based on findings.

Input: 47 year old male with a history of ulcerative colitis s/p total colectomy with IPAA, anal fissure, assess for fistula or abscess, presents with severe rectal pain. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted on this nondedicated examination.BLADDER: No significant abnormality noted.LYMPH NODES: No evidence of enlarged lymphadenopathy.BOWEL, MESENTERY: Punctate foci of increased T2 signal abnormality with faint enhancement near postsurgical anastomosis and are nonspecific. These findings may represent postoperative changes, however, correlation with recent endoscopy findings is recommended. There is no evidence of fistula formation or fluid collection to suggest abscess formation. Postoperative changes of prior colectomy with ileo-anal anastomosis. BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. No evidence of fistula formation or focal fluid collection to suggest abscess formation.2. Punctate foci of T2 signal abnormality with faint enhancement at the level of the ileal pouch-anal anastomosis are nonspecific. These findings may represent postoperative changes, however, correlation with recent endoscopy findings is recommended.


Instruction: Generate impression based on findings.

Input: Metastatic base of tongue squamous cell carcinoma, treated with pembrolizumab, palliative RT to left orbit, and started palliative carbo/paclitaxel/cetuximab. The left cerebellar tonsil lesion is now intrinsically hyperintense with associated susceptibility effect and measures up to 5 mm in diameter. There is no evidence of other infratentorial or supratentorial lesions. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is interval decrease in size of the enhancing left posterior globe lesion, measuring up to 3 mm in thickness, previously 7 mm. The left lateral retinal detachment has resolved. There is mild diffuse conjunctival and lacrimal gland enhancement, likely related to radiation therapy effects. The skull and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst. There are left mastoid air cell effusions.

Output: 1. Interval evolution of the appearance of the subcentimeter left cerebellar tonsil metastasis, likely due to treatment effects. 2. Interval decrease in size of the left ocular metastasis with improvement of the associated retinal detachment.


Instruction: Generate impression based on findings.

Input: Migraines headache, well controlled asthma, ADHD, OSA, gait instability, and some on/off jerking movements in the hands over the last over a month. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, and cerebellum appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 39 years Male (DOB:10/22/1976)Reason: hx of MS, evaluate for progression on betseron History: weakness in shoulder, fatigue, balance problemsPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ There is redemonstration of multiple periventricular and subcortical white matter lesions present which are up to a centimeter in size. Some of these are perpendicularly oriented to the lateral ventricles. There are a couple located at the colossal cingulate junction. When compared to the prior exam these appear similar in number and distribution. No new lesions are clearly appreciated. Some additional lesions are present in the cerebellum and pons which are also stable. There is no abnormal enhancement associated with these lesions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Multiple periventricular and subcortical white matter lesions are present compatible with patient's clinical history of multiple sclerosis. No new lesions are clearly appreciated


Instruction: Generate impression based on findings.

Input: 19 year old female with radial wrist pain. Evaluate for scapholunate tear. LIGAMENTS: The lunotriquetral ligament appears intact. The scapholunate ligament appears intact. No intra-articular gadolinium is identified within the radiocarpal joint.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage appears intact.TENDONS: The flexor and extensor tendons appear intact. BONES: No bone marrow signal abnormality is identified.ADDITIONAL

Output: The scapholunate and lunotriquetral ligaments appear intact.


Instruction: Generate impression based on findings.

Input: Reason: cuff tear? History: pain ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. There is a 4 mm linear focus of increased signal intensity at the insertion of the infraspinatus on the greater tuberosity, that is seen on only one image, which could represent a small undersurface tear, but this is equivocal and not necessarily of any clinical significance. The infraspinatus muscle appears intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is widening of the acromioclavicular joint, compatible with prior decompression surgery. There is a small amount of 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 glenohumeral joint, but no evidence of a large effusion. The superior labrum is blunted, but the inferior labrum appears intact.BICEPS TENDON: The patient has undergone a biceps tenodesis. ADDITIONAL

Output: 1. Surgical changes of acromioclavicular joint resection. Nonvisualization of the biceps tendon reflects a tenodesis.2. Equivocal tiny insertional tear of the infraspinatus, which may not be of any clinical significance. The rotator cuff is otherwise unremarkable.3. Blunting of the superior labrum may also be postoperative in etiology.


Instruction: Generate impression based on findings.

Input: 42-year-old male with headaches. Question of sigmoid sinus thrombosis. CTV of intracranial venous sinuses:65 cc of Omnipaque 350 is administered for this exam.3-D reformatted images were acquired utilizing in the dependent workstation.Axial source images, axial, coronal and sagittal 0.9 mm MIP images as well as 3-D reformatted images were obtained and utilized for interpretation of the exam.Examination demonstrates an intraluminal defect seen the left transverse sinus highly suspected of a thrombosed as was suspected on prior MRI examination. There is no definitive extension of this defect into the sigmoid sinus. The lumen of the sinus however remains patent. There is also no detectable abnormality of the left jugular bulb and visualized proximal left internal jugular vein.The confluence of sinuses, right transverse and sigmoid sinus as well as right jugular bulb and proximal dominant right internal jugular remains within normal limits. The superior sagittal sinus, inferior sagittal sinus, straight sinus, vein of Galen, bilateral internal cerebral veins and bilateral thalamostriate veins remain patent and unremarkable.Nonenhanced head CT:Examination demonstrates no evidence of intracranial edema, hemorrhage, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and greater white matter differentiation remains within normal.

Output: 1.Intraluminal defect in the left nondominant transverse sinus likely result of thrombus as described. The left transverse sinus lumen is compromised however remains patent and there is no definitive evidence of thrombus within the left sigmoid sinus or the jugular bulb.2.Patent all other intracranial venous sinuses as well as visualized deep venous structures.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma, syncopal episode, pacemaker/defibrillator, Cushing's disease. Evaluate change. Pre-and post-enhanced CT of pituitary:100 of Omnipaque 350 is administered for the post-infused portion of the exam.Contiguous axial 0.9-mm CT images of the entire brain before and after administration of contrast were obtained. Sagittal and coronal 2-D reformatted images were also rendered.This examination is tailored primarily for evaluation of pituitary gland.The nonfused exam demonstrates no evidence of any acute intracranial process. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is identified. Coronal and sagittal reformatted images demonstrate normal at hearing size of sella turcica and with primarily CSF density content. A very thin pituitary gland is identified. The pituitary stalk is also identified. There is no evidence of any abnormality in the basal cistern. The suprasellar visual complex is unremarkable.On post infused images there is no detectable abnormal enhancement the brain parenchyma or leptomeninges.Sagittal and coronal 0.9-mm 2-D reformatted images through the sella identifies very small thin pituitary gland with enhancement. Due to very small size of the gland precise measurement is not possible however but the best estimate the gland measures approximately 1.5 mm in cranial -- cephalad axis. On prior enhanced MRI of pituitary the heights of pituitary gland measured 3 mm.There is normal enhancement of midline pituitary stalk. There is subtle increase in the caliber of the pituitary far laterally on the left which measures approximately 3.9 x 4.9-mm in size. This may represent a pituitary microadenoma. There is no abnormality of basal cistern. The cavernous sinuses demonstrate no definitive abnormality. Sphenoid sinus is well pneumatized and unremarkable.Although not possible to precisely compare this CT exam with the prior pituitary MRI study the overall very small size of the pituitary gland is similar to prior exam. Prior MRI also demonstrates a focus of low attenuation on post infused images in the far left side of pituitary gland along its inferior aspect which measures 7.1 x 4.1-mm which is larger than current measurements of 3.9 times 4.9-mm..

Output: 1.Very small and thin (approximately 1.5 mm in thickness) and abnormal enhancement. The heights of pituitary on prior exam and measures approximately 3 mm in size. Pituitary stalk demonstrates normal enhancement and is in midline.2.Focal thickening of pituitary gland far laterally on the left measuring 4.9 x 3.9-mm in size compared to prior MRI measurements of 7.1 x 4.1-mm. This finding could represent a small pituitary microadenoma.3.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: History of questionable peritoneal carcinomatosis on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. A few small cysts are again noted in the right hepatic lobe and in segment 1.No suspicious liver lesion.Normally distended gallbladder.No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology, signal intensity and enhancement. Mild prominence of the main pancreatic duct up to 5 mm, unchanged. No obstructing lesion is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small aortocaval lymph node measuring 1.0 x 0.7 cm (series 1902/45).BOWEL, MESENTERY: Demonstrated again are small mesenteric lymph nodes as well as enhancing nodularity of the peritoneum within the left lower quadrant.BONES, SOFT TISSUES: New small pleural effusions.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is normal in size and contains a heterogeneously enhancing left posterior subserosal 4.2 x 2.6 cm fibroid. Additional right body pedunculated fibroid measuring 1.4 cm. The endometrium is normal in thickness. The inner myometrial/junctional zone is unremarkable..The adnexa are atrophic and difficult to visualize. No adnexal mass lesion is evident.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small volume pelvic ascites.BONES, SOFT TISSUES: Heterogeneous enhancement of the pelvis is compatible with known Paget's disease. Focal osseous enhancing foci are also noted. No cortical disruption is evident. OTHER: No significant abnormality noted.

Output: Enhancing peritoneal nodularity is again noted. No adnexal mass lesion is seen. Malignancy of unknown primary is still suspected. PET/CT or tissue sampling of a peritoneal soft tissue nodule should be considered. New small pleural effusions and ascites.


Instruction: Generate impression based on findings.

Input: Clinical question:? Acute intracranial pathology. Signs and symptoms: Altered mental status. Unenhanced CT of brain:The examination demonstrates multiple areas of bihemispheric and right middle cerebellar low-attenuation with subtle associated focal mass effect on the adjacent cortical sulci. These findings were noted on prior MRI exam, however there appears to be worsening of the findings in particular in the supratentorial brain parenchyma. There is no evidence of acute hemorrhage, midline shift or hydrocephalus. There is no change in the normal size of lateral ventricles.

Output: 1.In comparison to prior exam there appears to be worsening of findings in bilateral cerebral hemispheres. 2.No evidence of acute hemorrhage, midline shift or hydrocephalus.


Instruction: Generate impression based on findings.

Input: 68-year-old female with pain, evaluate for rotator cuff tear ROTATOR CUFF: There is diffuse thickening and increased signal intensity of the supraspinatus tendon, indicating moderate to severe tendinosis. We see no fluid signal intensity within the tendon to indicate a tear, although there may be mild associated undersurface fraying. The supraspinatus muscle is within normal limits. Cysts are noted within the underlying humeral head. Similar tendinosis also affects the distal infraspinatus tendon without discrete tear. The infraspinatus muscle is within normal limits. The teres minor tendon and muscle appear normal. There is mild thickening of the distal subscapularis tendon consistent with mild tendinosis. The subscapularis muscle appears normal. SUPRASPINATUS OUTLET: Mild osteoarthritis affects the AC joint. Trace fluid is present within the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is a small collection of fluid signal intensity along the anteroinferior margin of the glenoid with mild signal abnormality within the adjacent bone. There is also mild increased signal intensity within the adjacent anteroinferior labrum, which may represent a focal tear, although this is equivocal. The superior labrum and superior half of the posterior labrum are attenuated, perhaps from longstanding degenerative tearing. No joint effusion.BICEPS TENDON: There is thickening and increased signal intensity in the tendon of long head of the biceps at its transition from the rotator interval to the intertubercular sulcus indicating moderate tendinosis.

Output: 1. Moderate to severe tendinosis of the rotator cuff and biceps tendon without discrete tear.2. Additional degenerative arthritic changes as described above.


Instruction: Generate impression based on findings.

Input: Reason: possible scaphoid fracture, pain over lunate as well History: fall and pain LIGAMENTS: Although this examination was not optimized for evaluation of the intrinsic ligaments of the wrist, the scapholunate and lunotriquetral ligaments appear intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact within the limitations of this non arthrogram study.TENDONS: The flexor and extensor tendons appear intact. There is increased signal abnormality within the extensor carpi ulnaris tendon which may represent a mild strain injury or perhaps tendinosis. There is circumferential fluid within the tendon sheath which may represent a very mild tenosynovitis.BONES: There is increased signal abnormality within the distal ulna as well as decreased linear signal abnormality traversing the ulnar styloid indicating a nondisplaced fracture. There is also increased bone marrow signal abnormality within the triquetrum with associated linear decreased signal abnormality traversing the triquetrum indicating a comminuted nondisplaced fracture. No definite scaphoid fracture is identified.ADDITIONAL

Output: Nondisplaced fractures of the ulnar styloid and triquetrum. No bone marrow signal abnormality to suggest a scaphoid fracture as clinically questioned. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: s/p transphenoidal resection of pituitary tumor on 1/30 History: post-op follow up. MRI pituitary:The patient has undergone transphenoidal pituitary surgery. There is a residual mass present in the pituitary fossa and suprasellar cistern measuring 30 x 21-mm sagittal dimensions (unchanged compared to the prior exam from 1/31/15) which expands the pituitary fossa and extends laterally into the cavernous sinus regions. Superiorly it displaces the optic chiasm superiorly and impresses upon the inferior aspect of the hypothalamus - left more than right.

Output: 1.There is redemonstration of a sellar and suprasellar mass which was partially removed status post transphenoidal surgery. Its relationship to the suprasellar structures has not changed.


Instruction: Generate impression based on findings.

Input: Reason: knee instability History: rule out meniscal tear MENISCI: The medial meniscus appears normal. There is slight blunting of the free edges of the anterior and posterior horns of the lateral meniscus, which may reflect chronic attritional fraying/tearing or perhaps sequela of interval surgery, but the horizontal tear seen on the prior study is no longer evident. We see no fluid signal intensity within the lateral meniscus, to indicate an unstable tear. ARTICULAR CARTILAGE AND BONE: We see no fluid-filled cartilage defects. Bone marrow signal is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact.ADDITIONAL

Output: Slight blunting of the free edge of the lateral meniscus may reflect mild chronic attritional fraying/tearing or sequela of interval partial meniscectomy. We see no findings to suggest an unstable tear.


Instruction: Generate impression based on findings.

Input: There is minimal anterolisthesis of L3 on L4 and of L4 on L5. There is normal marrow signal in the vertebral bodies. The conus medullaris ends at the level of the upper L2. At the level of T11-T12 there is a loss of disc height with desiccation of the disc. There is also loss of normal disk signal and height in the mid to lower lumbar spine. Further details are provided below level by level.T12-L1: No evidence of disk bulge, neural foraminal narrowing or central stenosis.L1-L2: No evidence of disk bulge, neural foraminal narrowing or central stenosis.L2-L3: There is mild loss of disc height with desiccation. There is mild disc bulge with mild right and minimal left neural foraminal narrowing. No central canal stenosis.L3-L4: Mild diffuse disk bulge and ligamentum flavum thickening with facet degenerative changes causes mild to moderate bilateral neural foraminal narrowing and minimal spinal canal stenosis. L4-5: There is disc desiccation with loss of height. There is moderate degree of disc bulge, advanced facet arthropathy and ligamentum flavum thickening resulting in moderate degree of spinal stenosis similar to prior. There is bilateral moderate degree of neural foraminal stenosis, left more than the right. L5-S1: Minimal disk bulge with moderate facet degenerative changes and mild ligamentum flavum thickening without significant neural foraminal or central canal stenosis.

Output: 1. Degenerative changes as above, worst at the L4-5 level with moderate spinal canal and bilateral neural foraminal stenosis, not significantly changed since 6/17/2013. Mild L3-4 and L4-5 degenerative spondylolisthesis similar to prior.2. Advance facet arthropathy at L4-5 and to a lesser degree at L3-4 and L5-S1. These may be contributing to patient's back pain.


Instruction: Generate impression based on findings.

Input: Female, 8 years old, with tuberous sclerosis and epilepsy, evaluate SEGA and cortical tubers for change. Numerous scattered areas of cortical thickening and subcortical T2 hyperintensity are redemonstrated in the cerebral hemispheres without significant interval change. Likewise, numerous subependymal nodules are demonstrated showing variable enhancement and susceptibility effect, also without change. The largest lesions, and those with the most conspicuous enhancement, are found at the bilateral foramina of Monro and measure up to 16 mm in length.No new lesions are appreciated. No significant generalized mass effect is detected. There are no findings to suggest acute intracranial hemorrhage. The ventricular system is stable in size and morphology.

Output: Multiple stigmata of tuberous sclerosis are redemonstrated without significant interval change. This includes prominent enhancing subependymal lesions at the foramina of Monro which may represent SEGAs.


Instruction: Generate impression based on findings.

Input: New horizontal double vision and headache. There is mild scattered cerebral white matter T2 hyperintensity. There also appears to be a punctate focus of restricted diffusion in the left posterior cingulate gyrus without correlate on the other sequences. There is no evidence of intracranial hemorrhage or mass. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Mild scattered cerebral white matter T2 hyperintensity is nonspecific, but likely represents chronic small vessel ischemic disease. An apparent punctate focus of restricted diffusion in the left posterior cingulate gyrus without correlate on the other sequences is likely artifactual, although an acute infarct is a potential consideration.


Instruction: Generate impression based on findings.

Input: Clinical question: NSCLC with brain metastases status post SRS. In MRI to evaluate. Signs and symptoms: As above. Pre-and post enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates internal significant decreased size of the left posterior temporal metastatic lesion measuring at approximately 3 mm size compared to prior study measurement of 8.8-mm. There is no residual surrounding edema but this finding.The second smaller metastatic lesion in the right frontal lobe seen on prior exam is no longer identified.There is also no detectable new metastatic lesions since prior exam.Flair and T2 weighted images demonstrate extensive periventricular and to a lesser degree subcortical foci of hyperintensity which are nonhemorrhagic and nonenhancing. Similar findings are also noted in bilateral thalami. Compared to prior exam there is minute internal progression of this finding. Differentials of chronic nonhemorrhagic small vessel ischemic strokes should be considered. This finding is also believed to be at least partially secondary to overlapping post radiation change.

Output: 1.Significant decreased size of a left posterior temporal metastatic lesion measuring at 3 mm compared to prior study measurement of 8.8-mm. Previously noted right frontal metastatic lesion is no longer present. No evidence of new metastatic lesions to brain, leptomeninges or the calvarium.2.Negative diffusion weighted images.3.Minute interval progression of periventriclar and subcortical flair hyperintensity which could represent a combination of chronic nonhemorrhagic small vessel ischemic strokes as well as post radiation change.


Instruction: Generate impression based on findings.

Input: Shoulder and arm pain, evaluate for cervical radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is reversal of cervical lordosis with kyphotic angulation noted with apex at the C4-C5 level. Mild C3-C4 anterolisthesis. Bone marrow signal is benign. The cervical spinal cord demonstrates no signal abnormality.Degenerative changes are seen in the cervical spine with disc space narrowing at the C3-C4, C4-C5, C5-C6, and C6-C7 levels and multilevel facet arthropathy. Individual levels as described below:C2-3: No significant spinal canal stenosis. Effacement of the dorsal thecal sac related to ligamentum flavum laxity. Mild right and moderate left neural foraminal narrowing related to facet arthropathy and uncovertebral hypertrophy.C3-4: There is disc osteophyte complex and mild anterolisthesis. There is partial effacement of the ventral and dorsal thecal sac resulting in mild spinal canal narrowing. There is prominent uncovertebral hypertrophy with moderate right greater than left neural foraminal stenosis. C4-5: Disc osteophyte complex and ligamentum flavum laxity, and prominent uncovertebral hypertrophy result in moderate to severe bilateral neural foraminal stenosis. There is moderate spinal canal stenosis, particularly on the left.C5-6: Disc osteophyte complex including prominent right paracentral component with moderate to severe spinal canal stenosis on the right with some flattening of the cord. Ligamentum flavum laxity. There is also moderate to severe right and mild-to-moderate left neural foraminal stenosis.C6-7: Disc osteophyte complex and ligamentum flavum laxity resulting in up to moderate spinal canal stenosis. There is also moderate bilateral neural foraminal stenosis.C7-T1: Uncovertebral hypertrophy and small right foraminal disc protrusion with mild to moderate narrowing of the right neural foramen. No significant spinal canal stenosis or left neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Moderate degenerative changes throughout the cervical spine with kyphotic angulation and multilevel disc osteophyte complexes.2. There is moderate spinal canal stenosis at C4-C5, C5-C6, and C6-C7. Findings are worst at the C5-C6 level where there is flattening of the right aspect of the cord and moderate to severe right neural foraminal stenosis. Moderate foraminal narrowing at additional levels as above.


Instruction: Generate impression based on findings.

Input: Systemic lupus erythematosus [710.0] / Unspecified cause of encephalitis, myelitis, and encephalomyelitis [323.9] / Other causes of myelitis [323.82], Reason for Study: ^Reason: 22 y/o with SLE and cerebritis c/o neck/back pain evaluate changes Brain MRI:No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal signal intensity on FLAIR imaging.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-spine:There are multifocal some continuous and some are interrupted high signal intensity lesions on cervical spine from cervico medullary junction to the level of C6 vertebral body. Most prominent lesion is located on the posterior aspect of the spinal cord between C2-C3 to C3-C4 level. The MR characteristics of these lesions are consistent with demyelinating disease involvement of cervical spine with various stages. These lesions were not conspicuous on prior scan.On post enhancement scan, the lesion at the level of C23 disc space shows subtle nodular enhancement indicate possible active lesion.Minimal kyphotic angulation centered at the level of C45 with intervertebral disc degenerations are again seen, no change since prior scan.There is diffuse bulging of disc which abuts thecal sac at level of C45, no change since prior scan.There is no evidence of neural foraminal narrowing, nor spinal canal stenosis.

Output: 1. Normal brain MRI2. Interval development of multistage demyelinating disease involving cervical spine as described above. The enhancing lesion at the level of C23 disc space may indicate active lesion.


Instruction: Generate impression based on findings.

Input: Migraine, unspecified, intractable, without status migrainosus [G43.919] / Other abnormal findings on diagnostic imaging of central nervous system [R90.89], Reason for Study: ^Reason: please do dr javed MS protocol compare to prior History: severe headache. Redemonstration of multiple scattered FLAIR/T2 high signal intensity lesion on bilateral periventricular white matter including right corona radiata lesion (series 901, image 108) which shows punctate contrast enhancement, unchanged in terms of approximate number, extent and size since prior scan. Again these findings are non specific thus differential diagnosis include demyelination, inflammatory conditions, vasculitis and ischemic lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter including a punctate enhancing lesion on the right side corona radiata, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Re-do Chiari decompression. Brain: There are postoperative findings related to revision Chiari decompression with a small amount of fluid in the extradural surgical bed. There appears to be flow of cerebrospinal fluid into the fourth ventricle, which has decreased in size, although it remains dilated. The third and lateral ventricles are also less dilated. There is a small amount of pneumocephalus and trace blood products layering within the occipital horns of the lateral ventricles. There is edema and restricted diffusion along the margins of the cerebellar tonsillectomy sites. There is no evidence of acute infarct. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable.Spine: There is interval decrease in caliber of the long-segment, partially-septated, cervicothoracic syringohydromyelia, now measuring up to 10 mm in width, previously 16 mm, and extending from C2 to T8. There is unchanged mild thoracic scoliosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Interval revision Chiari decompression with decreased dilatation of the ventricular system.2. Interval decrease in caliber of the cervicothoracic syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Female, 26 years old, with a tender left parotid mass. Any elongated, T2 hyperintense lesion is evident within the superficial left masticator muscle measuring 20 x 6 mm in transaxial dimension and up to 9 mm in the craniocaudal dimension. This lesion demonstrate mild intrinsic T1 hyperintensity with avid superimposed enhancement. Within the anterior portion of the lesion, there is a suggestion of multiple small cystic spaces with fluid-fluid levels.The above lesion approaches but does not clearly involve or arise from the left parotid gland. The salivary glands are morphologically unremarkable with no evidence of any masslike lesion or pathologic enhancement. The thyroid is free of focal suspicious lesions. No pathologic adenopathy is detected in the neck. The aerodigestive mucosa is unremarkable. Bone marrow signal characteristics are within normal limits.

Output: A lesion is identified within the superficial aspect of the masseter muscle on the left with T1 imaging characteristics suggestive of the presence of intralesional fat, blood product or slow vascular flow. The anterior portion of the lesion seems to show multiple small cystic spaces with fluid-fluid levels.Given the imaging characteristics, and the apparent intramuscular location of the lesion, the possibility of a venous malformation or some other vascular anomaly is favored. A recent intralesional hemorrhage could account for new tenderness on palpation. No significant surrounding inflammation is seen to suggest an infectious etiology. A neoplastic lesion is considered less likely.


Instruction: Generate impression based on findings.

Input: Male, 29 years old, with paresthesias and a diagnosis of multiple sclerosis. Cervical:Midline T2 hyperintensity is seen within the cord at C1 extending to the dorsal cord surface. No additional focal cervical cord lesion is seen. No epidural abnormalities are suspected.The cervical spine is straightened but sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No marrow signal abnormalities are detected. The intervertebral discs are preserved with no significant compromise of the spinal canal or neural foramina.Thoracic:No convincing focal spinal cord lesions are identified. No epidural abnormalities are suspected.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality is detected. The intervertebral discs are preserved. The spinal canal and neural foramina are patent.

Output: A single lesion is identified within the cervical spinal cord at C1 which would be compatible with multiple sclerosis. No additional lesions are seen in the cervical or thoracic regions.


Instruction: Generate impression based on findings.

Input: 52-year-old male patient with metastatic thyroid cancer. Please compare to prior examination. Thoracic spine: An enhancing lesion in the left anterior aspect of the T5 vertebral body is unchanged from the prior exam measuring approximately 13 x 9 mm on axial images. The lesion is associated with mild superior endplate concavity, also unchanged.Lesions within the left transverse process and pars interarticularis of T5 and T6 also show no significant interval change.Instrumented fusion of T10 through T12 is again seen. The T11 vertebral body has been at least partly resected and replaced by an orthopedic spacer device. The residual vertebral body remains compressed demonstrating diffusely abnormal signal characteristics compatible with metastatic involvement. Findings are stable.No new lesions are seen. No epidural disease extension is identified. The spinal canal is not significantly narrowed. Mild kyphotic angulation and scoliosis centered at T11 are stable.T1 shortening in the thoracic and lumbar spine is likely related to prior radiation. Increased signal within the T9 and L1 vertebral bodies on fat-suppressed T1 post contrast images is at least in part artifactual and due to metal related failure of fat suppression.Lumbar:Lesions within the right aspect of the L2 vertebral body, the left aspect of the L3 vertebral body, and the left aspect of the L5 vertebral body are unchanged. For reference, the L5 lesion measures 18 x 16 mm. A small nonspecific lesion along the inferior endplate of L4 is also unchanged.No new lesions are detected. No epidural disease extension is identified. The spinal canal and neural foramina remain patent. The conus and cauda equina are normal.

Output: Stable exam with no evidence of new or progressive metastatic disease in the thoracic or lumbar spine.


Instruction: Generate impression based on findings.

Input: The last well-formed disk space is referred to as L5-S1. There is benign osseous marrow signal. The vertebral body and disk heights are preserved. There is normal alignment of the lumbar spine. The conus shows normal caliber and signal, terminating normally at L1. There is a 1 mm linear focus of high T1 signal intensity within the lumbar thecal sac likely representing a small vessel.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: Minimal disk bulge with no spinal stenosis.L3-4: Minimal disk bulge with no spinal stenosis.L4-5: Mild disk bulge with tiny central protrusion and facet arthropathy with no significant central spinal canal or neural foraminal stenosis.L5-S1: Small disk protrusion with no significant central spinal canal or neural foraminal stenosis.Incidentally seen is a small intraosseous pneumatocyst involving the left iliac bone and also seen on prior abdominal CT.

Output: Minimal lumbar degenerative changes without significant spinal canal or neural foraminal stenosis at any level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out spinal pathology for pain. Signs and symptoms: Severe low back pain. Nonenhanced lumbar MRI:Examination is incomplete and degraded due to patient's severe pain and inability to continue.There is normal anatomical alignment of the vertebral column.There is unremarkable signal intensity of vertebral column.Lower most visualized thoracic spine and thoracic cord is unremarkable.There is no evidence of spinal stenosis at any level.Examination at T11-T12 through L1-L2 is unremarkable.L2-L3 straight mild hypertrophic changes of posterior elements and unremarkable otherwise.L3-L4 demonstrate mild hypertrophic changes of the ligamentum flavum and the right greater than left facet hypertrophy without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild hypertrophic changes of posterior elements and unremarkable otherwise.L5-S1 demonstrate no spinal stenosis or neural foraminal compromise. Moderate disc disease and loss of disc height is noted.Incidental note is made of extensive varying size bilateral renal cysts which are partially visualized. Correlate with history and consider dedicated imaging.

Output: 1.There is no evidence of an acute finding on this suboptimal study.2.Mild bilateral facet degenerative changes in the lower lumbar spine and including mild facet effusion is present.3.There is no evidence of a spinal canal or neural foraminal compromise.4.There is no detectable acute finding in the perispinal soft tissues.5.Extensive varying sized bilateral renal cysts are noted.


Instruction: Generate impression based on findings.

Input: 32-year-old female with bilateral knee pain. Unknown cause. MENISCI: There is superficial fraying of the free edge of the body of the medial meniscus. No fluid filled tear is evident. The anterior and posterior horn appear intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a small amount of increased signal abnormality within the medial aspect of the medial tibial plateau which may represent a small bone contusion versus early degenerative change. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Small bone contusion in the medial tibial plateau versus early degenerative signal abnormality.2. Nonspecific subcutaneous edema along the anterior aspect of the knee.


Instruction: Generate impression based on findings.

Input: 37 year old with biopsy proven IDC with proven satellite lesion in the left breast and metastatic left axillary lymph node presents for staging MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.LEFT BREAST:The biopsy proven cancer is present at posterior 1 o'clock position as an irregularly shaped mass, measuring 102 x 86 x 98 mm (AP x LR x CC). There is an additional mass, which is a proven satellite lesion, measuring 30 x 44 x 32 mm, at postero-lateral-inferior from the main mass. Overall measurement on AP dimension of the main tumor and satellite tumor is 122 mm.Diffuse edema and diffuse skin thickening is noted in the left breast.LEFT AXILLA:There is an enlarged lymph node with internal marker clip in the left axilla. This is a proven metastatic lymph node. In addition, there are a few smaller, but abnormal lymph nodes in the left axilla.RIGHT BREAST:No abnormal enhancement is seen in right breast. RIGHT AXILLA:No abnormal axillary lymph nodes are identified in right axillary region.

Output: 1. Biopsy proven cancer and satellite tumor in the left breast with metastatic left axillary lymph node.2. No MR evidence of malignancy in the right breast or in the right axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Left hip pain, evaluate for femoral acetabular impingement. The examination is somewhat limited by metallic artifact from metallic pin within the femoral head and neck.ACETABULAR LABRUM: Within the limitations described above, the acetabular labrum is grossly intact.ARTICULAR CARTILAGE AND BONE: A single pin traverses the left femoral head and neck consistent with treatment for slipped femoral capital diaphysis. There is abnormal prominence of the anterior femoral head neck junction with an alpha angle measuring approximately 68 degrees compatible with a cam deformity. The visualized bone marrow signal intensity is within normal limits.SOFT TISSUES: The visualized soft tissues and musculature are grossly within normal limits. ADDITIONAL

Output: 1.Exam somewhat limited by metallic artifact from SCFE fixation. 2.Cam deformity of the left hip. No gross labral tear is evident.


Instruction: Generate impression based on findings.

Input: 64 year-old female with tongue tumor. 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. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. A partially empty sella is noted.

Output: No intracranial metastasis.


Instruction: Generate impression based on findings.

Input: 52-year-old female presents with right knee pain, evaluate for meniscal tear. MENISCI: Mild intrasubstance degeneration of the medial and lateral menisci, essentially normal for age. No discrete tear is identified.ARTICULAR CARTILAGE AND BONE: There is focal partial-thickness degeneration of the articular cartilage of the lateral surface of the medial femoral condyle just above the free edge of the posterior horn of the medial meniscus. There is a small full-thickness focus of degeneration of the articular cartilage along the medial facet of the femoral trochlea. There is perhaps mild superficial fraying of the articular cartilage of the lateral facet of the patella inferiorly, however this is equivocal. There is no significant bone marrow signal abnormality.LIGAMENTS: There is minimal edema type signal between the iliotibial band and the lateral femoral condyle which could conceivably represent a mild "friction syndrome", but this is equivocal. The cruciate and medial collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Mild degeneration of the menisci without evidence of a tear.2. Small foci of cartilage degeneration as described above, not atypical considering the patient's age.3. Tiny Baker's cyst, not necessarily of any clinical significance.4. Minimal edema type signal between the iliotibial band and the lateral femoral condyle which could conceivably represent a mild "friction syndrome" in the appropriate clinical context.


Instruction: Generate impression based on findings.

Input: 73-year-old female with intractable knee pain, evaluate for degree of osteoarthritis, meniscus tear, and Baker's cyst MENISCI: Globular intermediate signal within the lateral meniscus suggestive of intrasubstance degeneration without focal tear. There is medial extrusion of the medial meniscus with fragmentation and heterogeneous signal within the posterior horn compatible with degeneration.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the knee with joint space narrowing worst at the patellofemoral compartment followed by the medial tibiofemoral compartment. There is complete to near complete loss of articular cartilage along the medial facet of the patella and medial femoral trochlear cartilage. There is near complete to complete loss of articular cartilage along the lateral facet of the patella and lateral femoral trochlear cartilage. There is greater than 50% articular cartilage loss of the medial tibiofemoral compartment. Abnormal edema type signal is seen within the medial femoral condyle and medial tibial plateau. To a lesser degree, there is greater than 50% articular cartilage loss along the lateral tibiofemoral compartment.LIGAMENTS: The cruciate and collateral ligaments are intact. There is ossification of the MCL near its insertion on the medial femoral condyle suggestive of a prior tear.EXTENSOR MECHANISM: The extensor mechanism is intact. ADDITIONAL

Output: 1.Severe osteoarthritis as described above. 2.Degeneration and fragmentation of the posterior horn of the medial meniscus. 3.Intrasubstance degeneration of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: Reason: healed RCR? History: pain in shoulder and pec insertion area Evaluation is slightly limited secondary to susceptibility artifact related to left shoulder hardware.ROTATOR CUFF: There has been previous rotator cuff repair. There is a full-thickness and near full-width tear of the supraspinatus; the tendon is retracted approximately 2 cm, to the level of the acromion. The infraspinatus, subscapularis, and teres minor tendons are intact. The rotator cuff musculature is within normal limits.SUPRASPINATUS OUTLET: There is a small amount of fluid in the subacromial/subdeltoid bursa, compatible with a full-thickness rotator cuff tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: Within the limitations of a non-arthrographic study, there is suggestion of an anterior/inferior labral tear.BICEPS TENDON: There is evidence of previous tenodesis of the long head of the biceps tendon. ADDITIONAL

Output: 1.Full-thickness and near full-width tear of the supraspinatus tendon.2.Chronic appearing Hill-Sachs deformity of the humeral head.3.Suggestion of an anterior/inferior tear of the glenoid labrum.


Instruction: Generate impression based on findings.

Input: 61 year-old female with headache. Prominent hypodensities at the bifrontal convexities may represent prominent subarachnoid space; however, chronic subdural collections may have a similar appearance. This finding can be compared to outside studies if available or a follow-up MRI may be considered if clinically needed. No acute findings identified. There is no evidence of acute 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.

Output: Prominent hypodensities at bifrontal convexities may represent prominent subarachnoid space. However chronic subdural collections may have a similar appearance. Please correlate this finding with outside studies if available. An MRI evaluation may be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: 67-year-old male with vertebrobasilar dilatation and previous posterior circulation infarct experienced sudden left hearing loss and a hoarse voice. Brain MRI:There are no foci of restricted diffusion to suggest the presence of acute ischemia. Redemonstrated are changes from an old large left PCA hemorrhagic stroke involving the medial aspect of the left temporal lobe and extending posteriorly to partially involve the occipital lobe. A small old stroke in the distribution of left PCA in the left thalamus is also again noted. A small focus of encephalomalacia within the pons is secondary to expected evolution of a previously identified pontine infarct. Redemonstrated are foci of T2 hyperintensity within the white matter without restricted diffusion. There is no evidence of acute intracranial hemorrhage, mass effect, midline shift or hydrocephalus. Mildly dilated lateral ventricles are secondary to parenchymal volume loss and are unchanged in appearance. The paranasal sinuses and mastoid air cells are clear.Brain MRA:Dolichoectasia of vertebrobasilar system with proximal eccentric plaque and fusiform aneurysmal dilatation of the basilar artery is present, not significantly changed in appearance given differences in technique.Redemonstrated is lack of flow within the distal right vertebral artery, although flow within right PICA is maintained.There is loss of flow within left PCA. Otherwise, there is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No other arterial stenoses, occlusions, arteriovenous malformations, or aneurysms are identified.

Output: 1.No acute ischemia.2.Stable large old minimally hemorrhagic left PCA stroke along its entire distribution as described with commensurate loss of flow in the left PCA.3.Mild chronic small vessel ischemic disease.4.Occluded intracranial right vertebral artery as was noted on prior CTA.5.Dolichoectasia of vertebrobasilar system with proximal eccentric plaque and fusiform aneurysmal dilatation of the basilar artery is present, not significantly changed in appearance given differences in technique.


Instruction: Generate impression based on findings.

Input: Female, 56 years old. Chronic right knee pain. Outside MRI study suspicious for pigmented villonodular synovitis. Three weightbearing views of the right knee demonstrate a large joint effusion. There is mild joint space narrowing along the patellofemoral compartment with patellofemoral osteophyte formation.

Output: Large joint effusion with mild osteoarthritis of the right knee.


Instruction: Generate impression based on findings.

Input: 46 year old male status post aneurysm coiling. Status post suboccipital craniotomy with partially visualized fluid collection in craniotomy site not significantly changed since post recent MRI.Metallic coils are present in proximal right MCA territory, with significant metallic streak artifact obscuring adjacent structures at this level.Focal hypodensity in right parietal lobe consistent with encephalomalacia from prior hemorrhage is noted, with interval evolution since 6/2012 CT. Encephalomalacia also noted in left frontal lobe and superior left cerebellum, unchanged.There is no evidence of acute intracranial hemorrhage, mass or edema. No hydrocephalus.The ventricles and basal cisterns are normal in size and configuration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.Postsurgical changes without evidence of acute intracranial abnormality.2.No significant change in fluid collection in suboccipital region, which may represent pseudomeningocele/CSF leak.3.Several foci of encephalomalacia again noted.


Instruction: Generate impression based on findings.

Input: 36-year-old female with history of hypertension presents with headache. On Plavix. There is no evidence of intracranial hemorrhage, mass or edema. Questionable periventricular small vessel disease that may be an artifact due to volume averaging. Follow-up MRI may be considered to evaluate for small vessel disease if clinically indicated.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.Questionable small vessel disease. MRI may be considered for further evaluation if clinically indicated.2.Otherwise normal examination.