Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, pain and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right elbow was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using a 25-gauge needle.Under fluoroscopic guidance, a 22 gauge needle was advanced into the joint. Next, 12 mL of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 49 seconds.

Output: Successful injection of dilute gadolinium into the right elbow for subsequent MR arthrography.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Weakness, frequent falls, low back pain. Evaluate for stenosis. Thoracic: Vertebral body heights in the thoracic spine are normal. Alignment is maintained. Bone marrow signal is benign with T1 hyperintense lesion in the T11 vertebral body consistent with a hemangioma. Mild degenerative changes are seen in the thoracic spine. There is a small central disc protrusion at the T5-T6 level without significant stenosis. There is also mild disc bulge at the T11-T12 level without significant stenosis. There is facet arthropathy at the T8-T9 level with mild left greater than right neural foraminal stenosis. No significant neural foraminal stenosis at the other levels. Mild facet arthropathy is also seen in the lower lumbar spine. No abnormal signal in the thoracic cord. No significant spinal canal stenosis at any level in the thoracic spine.Lumbar: Five lumbar type vertebral bodies are presumed to be present. There is transitional anatomy with lumbarization of the S1 vertebral body with well-defined disc space at the S1-S2 level. Vertebral body heights are within normal limits. There appears to be levoscoliosis involving the lower lumbar spine which can be better evaluated with radiographs. Bone marrow signal is benign with fatty endplate signal changes at L3-L4 and L4-L5 on a degenerative basis. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge and mild facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: Moderate loss of disc height. There is a right paracentral disc extrusion. Bilateral facet arthropathy and ligamentum flavum thickening. There is moderate spinal canal stenosis at this level. There is moderate right and minimal left neural foraminal stenosis. L4-L5: Moderate loss of disc height and mild bulge. There is advanced bilateral facet arthropathy and ligamentum flavum thickening. There is mild to moderate degree of spinal canal stenosis. There is moderate to severe right and moderate left neural foraminal stenosis.L5-S1: There is mild disc bulge and bilateral facet arthropathy, severe on the left. There is partial effacement of the left lateral recess. No significant central canal stenosis. There is mild left greater than right neural foraminal stenosis.S1-S2: No significant disc disease. No spinal canal or neural foraminal stenosis.

Output: 1. Mild degenerative changes in the thoracic spine without significant spinal canal stenosis at any level. No cord signal abnormality.2. Moderate degenerative changes in the lumbar spine with moderate spinal canal stenosis at L3-L4 and to a slightly lesser degree spinal canal stenosis at L4-L5. Neural foraminal stenosis is worst at the L4-L5 level. Please see details above.3. Transitional lumbosacral anatomy as detailed above.


Instruction: Generate impression based on findings.

Input: 84-year-old female with altered mental status x 1 week and visual hallucinations. Chronic headache. Question of ischemic stroke. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of periventricular and subcortical white matter hypodensity consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Well-defined focal hypodensity adjacent to the left basal ganglia consistent with old hemorrhagic stroke. No acute cortical stroke.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: Prior strokes and small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Female, 48 years old, with cervical radiculitis. Slight reversal of the normal cervical lordosis is likely positional. Alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No abnormal marrow replacement or edema is seen. The spinal cord demonstrates normal signal intensity and morphology throughout. No epidural abnormalities are suspected.C2-3: Mild left facet arthropathy. No significant spinal canal stenosis or neuroforaminal narrowing. C3-4: Unremarkable. C4-5: Mild facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.C5-6: Mild left facet arthropathy. Mild posterior disc-osteophyte complex formation with a small central extrusion. Mild effacement of the ventral thecal sac without cord impingement. No foraminal narrowing. C6-7: Mild left facet arthropathy. No significant spinal canal or foraminal stenosis. C7-T1: Mild facet arthropathy. No significant spinal canal stenosis. Mild left foraminal narrowing.

Output: 1.Relatively mild degenerative findings without any areas of high-grade spinal canal or foraminal stenosis.2.No other specific findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 30 year-old female with history of the C1/2 abnormality. Cervalgia.IMAGE ACQUISITIONS: Non-infused CT of the cervical spine. There is deformity and abnormal rotation at the level of the atlantoaxial joint suggesting subluxation. Additionally, there is irregular lucency within the dens. However, no associated bone marrow signal abnormality was seen on the recent MRI and there is no soft tissue swelling in this region. More likely, the dens finding represents a chronic nonhealing fracture then an acute abnormality. Additional degenerative changes at this level including subchondral cyst formation.

Output: 1. Lucency in the dens without associated findings to suggest acute fracture. More likely the findings represent chronic nonhealing fracture.2. Rotational deformity at the atlantoaxial joint suggests subluxation. Flexion and extension radiographs could be considered to assess stability.


Instruction: Generate impression based on findings.

Input: 52-year-old female with a Baker's cyst and knee pain. MENISCI: There is a large complete radial tear through the posterior horn of the medial meniscus near its root. There is minimal medial extrusion of the body of the medial meniscus. There is intrasubstance degeneration within the posterior horn and body of the medial meniscus. There is mild intrasubstance degeneration of the lateral meniscus without evidence of a tear.ARTICULAR CARTILAGE AND BONE: There is moderate partial thickness degeneration of the articular cartilage of the patella predominantly involving the medial facet and median eminence. There is a near full-thickness cleft of the articular cartilage of the medial facet of the femoral trochlea superiorly, with additional degeneration of the articular cartilage of the femoral trochlea more inferiorly. Subjectively, the articular cartilage of the medial compartment appears thinned indicating mild to moderate diffuse degeneration. There is also heterogeneity of the articular cartilage of the lateral compartment indicating mild degeneration. There are small tricompartmental osteophytes. Cystlike lesions within the intercondylar eminence likely represent intraosseous ganglia related to degeneration of the ACL. LIGAMENTS: There is thickening and increased signal intensity within the ACL indicating intrasubstance degeneration and small intrasubstance ganglia. The PCL appears intact. The MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Large radial tear of the posterior horn of the medial meniscus.2. Tricompartmental osteoarthritis.3. Degeneration of the anterior cruciate ligament.4. Small Baker's cyst.


Instruction: Generate impression based on findings.

Input: 70-year-old man with history of prostate cancer status post biopsy in 7/2015 with Gleason 8 prostate cancer and PSA of 6.7 in 9/2015. PELVIS:PROSTATE:Prostate Size: 59 x 41 mm.Peripheral Zone: There is a 16 x 9 mm mass arising from the right peripheral zone of the mid prostate (series 401, image 75). This mass is hypointense on T2 images, demonstrates diffusion restriction, enhancement, and contrast washout.Central Gland: No significant abnormality noted.Seminal Vesicles: The seminal vesicles do not appear to be involved.Extracapsular Extension: The capsule appears to be evaluated and the tumor appears to invade the adjacent neurovascular bundle (series 401, image 79). The tumor abuts the right obturator musculature.BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings compatible with right mid peripheral zone prostate adenocarcinoma. Involvement of the adjacent neurovascular bundle but no lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 67-year-old male with hip pain and concern for metastatic progression in the hips. There are multiple foci of signal abnormality within the bones of the pelvis and proximal femora indicating metastatic disease. Within the left proximal femur, metastatic disease involves the femoral neck and intertrochanteric region with penetration of the lesser trochanter. There is also metastatic disease within the left acetabular dome and anterior column. There is a small hip joint effusion with edema and enhancement in the soft tissues concentrated along the lesser trochanter, likely reflecting tumor extension. The right proximal femur demonstrates metastatic disease within the head, neck, and intertrochanteric region with tumor penetrating the posterior aspect of the femoral head/neck junction as well as the posterior aspect of the proximal femur at the level of the lesser trochanter. There are additional metastatic foci noted within the right acetabular dome. There is edema and enhancement within the soft tissues along the posterior aspect of the lesser trochanter likely reflecting tumor extension into the soft tissues. In addition to multiple additional pelvic bone lesions, and there are multiple lesions within the subcutaneous fat and musculature. Metastatic disease also affects the lower lumbar spine. Degenerative disc disease and facet joint osteoarthritis affects the lower lumbar spine. There are multiple foci of signal void surrounding the patient's neobladder likely reflecting metallic susceptibility artifact from the patient's prior surgery.

Output: Multiple bone and soft tissue metastases as described above with focal areas of penetration of the proximal femora bilaterally. These findings were relayed to Dr. Fletcher at 11:00 AM on 11/4/2015 via text page.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a heterogeneously enhancing lesion involving the left parietal lobe, not significantly changed in morphology. A change in enhancing characteristics is felt to be secondary to technique. Mild regional mass effect is unchanged. The ventricles are unchanged in size or shape. The expected vascular flow voids are demonstrated.

Output: Redemonstrated is a heterogeneously enhancing lesion involving the left parietal lobe.


Instruction: Generate impression based on findings.

Input: 19-year-old male with left knee pain history of MVA. MENISCI: Undulation of the free edge of the body of the lateral meniscus likely represents meniscal flounce. The lateral meniscus appears intact. The medial meniscus appears intactARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. 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: Muscle strain of the vastus musculature as described above. 4.8 cm hematoma along the anterior aspect of the knee. The menisci appear intact. The cruciate and collateral ligaments appear intact.


Instruction: Generate impression based on findings.

Input: Reason: left MCP laxity - r/o RCL tear History: left MCP laxity - r/o RCL tear LIGAMENTS: There is disruption of the proximal fibers of the radial collateral ligament of the interphalangeal joint of the thumb (image 6; series 1101). There is disruption of the distal fibers of the ulnar collateral ligament of the IP joint of the thumb (image 5; series 1101).There is disruption of the distal fibers of the ulnar collateral ligament of the MCP joint of the thumb (image 6; series 1101 and image 11 of series 701). The radial collateral ligament of the MCP joint of the thumb appears intact.TENDONS: The flexor and extensor tendons of the thumb appear intact. The A1 pulley appears intact. The oblique pulley appears intact. There is "bowstringing" of the flexor pollicis longus tendon at the level of the midportion and head of the proximal phalanx of the thumb likely representing disruption of the A2 pulley of the thumb. There is globular decreased signal abnormality along the volar aspect of the head of the proximal phalanx of the thumb which is nonspecific and may represent a combination of scarring, old blood products, and perhaps remnants of the aforementioned A2 pulley of the thumb (image 8; series 1601).BONES: There is a minimally displaced volar plate fracture of the base of the distal phalanx of the thumb. There is bone marrow signal abnormality within the head of the proximal phalanx of the thumb which may reflect a contusion.ADDITIONAL

Output: 1. Findings consistent with the patient's known history of prior interphalangeal joint of the thumb dislocation including disruption of the radial and ulnar collateral ligaments of the interphalangeal joint of the thumb. There is a minimally displace the volar plate fracture of the base of the distal phalanx of the thumb.2. Disruption of the A2 pulley of the thumb. Globular signal abnormality along the volar aspect of the head of the proximal phalanx of the thumb may reflect a combination of scarring, old blood products and perhaps fragments of the aforementioned disrupted A2 pulley.3. Tearing of the ulnar collateral ligament of the MCP joint without convincing evidence of a Stener lesion. The radial collateral ligament of the MCP joint appears intact.4. Bone contusion of the proximal phalanx of the thumb and other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, with history of left oral tongue squamous cell carcinoma stage III (pT1Nx), status post excision in 12/2015, status post adjuvent RT on 4/16, with recurrence in a left neck level II lymph node status post modified radical neck dissection in 11/2016. The left hemitongue is atrophic and somewhat diffusely T2 hyperintense. Mild postoperative deformity of the tongue is also seen. No discrete or clearly enhancing masslike lesion is appreciated in the operative bed. The aerodigestive mucosa as visualized is otherwise unremarkable.Mild edema is seen in the submental soft tissues. Findings are also demonstrated compatible with left neck dissection including volume loss and scarring through the fascial planes. The previously demonstrated left neck adenopathy is no longer visualized, and no new pathologic lymph nodes are identified.The left submandibular gland appears to have been resected. The residual salivary glands and the thyroid are free of focal lesions. Bone marrow signal of the spine shows evidence of prior radiotherapy but is otherwise unremarkable.

Output: 1.Findings are seen compatible with prior surgery of the left hemitongue. No definite residual or recurrent tumor is seen.2.Interval left neck dissection has been performed. The previously demonstrated adenopathy is no longer present. No new pathologic nodes are identified.


Instruction: Generate impression based on findings.

Input: Worsening back pain. Check construct. Postoperative day # 2. For the purpose of labeling, 5 lumbar vertebral bodies are assumed to be present.There are postsurgical changes, with air within L2 -- L3 and L3 -- L4 intervertebral disk spaces, and within the spinal canal. There are interspinous device, extending from L2 to L4 spinous processes. The surgical hardware appears intact. There are streak artifacts in the vicinity of the hardware, which limits evaluation of these areas. Soft tissue stranding and a small amount of fluid density are seen in the posterior subcutaneous soft tissues, which are compatible with expected postsurgical changes. There is effacement of epidural fat at the level of L2 -- L3 to L3 -- L4 levels, likely related to the postsurgical change, but given this, the spinal canal cannot be assessed adequately. At L4 -- L5 intervertebral level, there is residual disk bulging, facet arthropathic change and ligamentum flavum hypertrophy, resulting in residual spinal canal narrowing. These findings may be further evaluated with MRI of the lumbar spine.No acute fracture is identified.There is air in dilated small bowel loops, suggesting ileus.

Output: 1. Post surgical changes, with interspinous device extending from L2 to L4 levels. 2. Due to effacement of the epidural fat, and presence of streak artifacts, spinal canal from L2 -- L3 to L3 -- L4, cannot be adequately evaluated.3. Residual degenerative changes.4. MRI of lumbar spine may be helpful for further correlation.5. Dilated small bowel loops suggestive of ileus.


Instruction: Generate impression based on findings.

Input: Lower extremity numbness Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. Abnormal T2 signal is noted involving the right central and dorsal cervical cord at the C1-C2 level. Abnormal T2 signal is also noted within the right lateral aspect of the cervical cord at the mid C2 level, well seen on sagittal STIR image 7/11. Abnormal T2 signal is also noted within the cervical cord at the C4-C5 level. Small focus of T2 hyperintensity is also noted within the dorsal aspect of the cord at the midline and slightly to the left of midline at the C5-C6 level and also noted on recent cord compression protocol MRI study.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: There is a disc osteophyte complex with central disc protrusion as well as ligamentum flavum thickening posteriorly. There is moderate spinal canal stenosis including mild flattening of the cervical cord. There is abnormal T2 signal centrally within the cord at this level. There is mild bilateral neural foraminal narrowing related to uncovertebral hypertrophy.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar:Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. Abnormal T2 signal is noted in the ventral cord at the upper T12 level on the sagittal T2 and STIR sequences.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is disc desiccation and diffuse bulge which along with ligamentum flavum thickening, epidural fat, and facet arthropathy result in mild to moderate spinal canal stenosis. There is bilateral facet arthropathy with distention of the facet joints. Tiny synovial cyst is noted posterior to the inferior aspect of the left L3-L4 facet joint left. There is mild right and minimal left neural foraminal narrowing.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Multiple foci of T2 signal abnormality within the cord at the right C1-C2, right lateral mid C2, dorsal C5-C6, and ventral T12 levels. These foci are of indeterminate age but suggest demyelinating or other chronic inflammatory etiologies. Brain MRI as well as postcontrast imaging may be helpful if there is suspicion for an active inflammatory process.2. Degenerative changes in the cervical spine with moderate cervical spinal canal stenosis at the C4-C5 level related to central disc protrusion with mild cord flattening. There is associated abnormal T2 signal in the cord at the C4-C5 level.3. Degenerative changes in the lumbar spine with mild to moderate spinal canal stenosis at L3-L4. Otherwise no high-grade spinal canal stenosis in the lumbar spine is appreciated.


Instruction: Generate impression based on findings.

Input: 66-year-old female with pain and restricted range of motion. Evaluate for rotator cuff tear. ROTATOR CUFF: There is a full-thickness tear of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 10 mm in the AP dimension. There is minimal retraction of the proximal tendon. The tear extends posteriorly to involve the anterior fibers of the infraspinatus. There is minimal increased signal abnormality within the supraspinatus and infraspinatus muscles on fluid sensitive sequences suggesting that this tear may be acute/subacute in etiology. There is interstitial tearing of the supraspinatus and infraspinatus at the level of the myotendinous junction. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild to moderate degenerative changes affect the acromioclavicular joint with osteophyte formation along the inferior aspect of the distal clavicle and acromion process.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of a non arthrogram study. There is a small amount of fluid within the glenohumeral joint which extends into the subscapular recess. Mild degenerative changes affect the glenohumeral joint.BICEPS TENDON: There is circumferential fluid within the tendon sheath of the long head of the biceps which likely represents fluid extension from the joint versus a very mild tenosynovitis. ADDITIONAL

Output: 1. Full-thickness tear of the rotator cuff with minimal retraction, as described.2. Osteoarthritis of the glenohumeral joint and other findings, as described.3. Small glenohumeral joint effusion.


Instruction: Generate impression based on findings.

Input: Headache. Follow-up of pituitary mass. There is a 5 mm, relatively well-circumscribed focus of no contrast enhancement within the superior aspect of the anterior pituitary gland. It is at least partly hyperintense on T2 imaging, relative to the remainder of the gland. It has no lateral parasellar extension. The cavernous sinuses are unremarkable. Overall volume of the pituitary gland is not increased and the suprasellar cistern is preserved. The optic chiasm is unaffected. The pituitary infundibulum is midline.The remainder of the pituitary gland is notable for a 2 mm focus of no contrast enhancement situated between the posterior and anterior pituitary glands, which probably represents an incidental pars intermedia cyst.Included brain is notable for serial changes of chronic microvascular ischemia and previous infarcts. Please refer to the brain MRI report from September 16, 2015 for more details. A 2 cm left upper cervical lymph node has a preserved fatty hilum and not significant change since September 2015.

Output: 1.5 mm focus of no contrast enhancement within the anterior pituitary gland would not be compatible with the typical MR characteristics of microadenoma (which typically show mild or delayed contrast enhancement). It may represent a small cyst. There is no extrasellar extension. 2.Changes of chronic microvascular ischemia and previous infarcts in the included brain are better assessed on the brain MRI from September 16, 2015.


Instruction: Generate impression based on findings.

Input: 32 year old female with gliosarcoma. Recently on chemo/RT. Now with acute 10/10 headaches. Nausea, vomiting. Evaluate for edema or bleed. Large area of vasogenic edema /encephalomalacia in the right posterior frontal, parietal extending inferiorly into the occipital lobe, basal ganglia/thalami and frontal lobe is noted. In comparison to prior MRI there is evidence of increase in the degree of edema since prior exam. There is evidence of midline shift of approximately 6 mm which has increased since prior examination. The no evidence of hemorrhage is identified. Also new since prior examination is further interval dietitian of the right temporal horn this is believed to be secondary to entrapment of right temporal horn secondary to the mass. No evidence of hemorrhage is detected.

Output: 1.Increase in the amount of vasogenic edema in the right cerebral hemisphere surrounding the patient's known tumor.2.Enlarged right temporal horn due to entrapment.3.No evidence of hemorrhage.


Instruction: Generate impression based on findings.

Input: Female, 21 years old. Pain, tenderness. Fibular Great Toe Sesamoid Fx vs BiPartite. Low signal intensity replaces the normal fatty marrow of the lateral hallux sesamoid on T1 and T2-weighted images, which also appears fragmented or at least bipartite. There is minimal if any edema associated with this sesamoid on fluid sensitive sequences. These findings are suggestive of osteonecrosis. The medial sesamoid appears normal, as does the adjacent first metatarsal head. The proximal and distal phalanges of the great toe appear normal. The flexor hallucis longus tendon appears normal. The remaining bones of the forefoot appear normal.

Output: Low signal intensity with probable fragmentation of the lateral hallux sesamoid bone likely representing osteonecrosis. If further evaluation of the degree of fragmentation is desired, CT can be considered.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is a partial radial tear of the posterior horn of the medial meniscus. There is additional intrasubstance degeneration / degenerative tearing of the body of the medial meniscus as well as the posterior horn, particularly at its root. There is perhaps slight medial extrusion of the body of the medial meniscus. There is also blunting of the free edge of the anterior horn of the medial meniscus representing radial tearing with a small focus of low signal intensity in the adjacent joint space which may represent a displaced meniscal fragment. There is intrasubstance degeneration of the lateral meniscus without discrete tear.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the medial tibiofemoral compartment with full-thickness cartilage loss along the weightbearing portions of both the medial femoral condyle and medial tibial plateau. There is associated degenerative subchondral marrow signal abnormality of the medial femoral condyle above the anterior horn of the medial meniscus. Signal heterogeneity of the articular cartilage of the lateral compartment indicates relatively mild cartilage degeneration. There is moderate osteoarthritis of the patellofemoral articulation with foci of full-thickness cartilage loss. Tricompartmental osteophytes are noted.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Medial meniscal tearing and osteoarthritis as described above.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, history of low-grade glioma, follow-up examination. Ill-defined thickening and T2 hyperintensity is again seen within the left temporal lobe showing no significant interval change. Gyriform susceptibility within the lesion likely correlates to calcification noted on prior CT. Vague smudgy enhancement is also seen within the lesion which appears less prominent than on prior studies. Sequelae of prior lesion biopsy are again demonstrated. A subcentimeter nonenhancing focus of T2 hyperintensity within the right superior cerebellum is unchanged. No new or concerning parenchymal lesions are seen. No significant generalized mass effect is observed. The ventricles remain normal in size and morphology.

Output: 1.Findings compatible with oligodendroglioma in the left temporal lobe are unchanged. No significant change in lesion size or signal characteristics is noted.2.A nonspecific subcentimeter focus of signal abnormality in the right cerebellum is unchanged as well.


Instruction: Generate impression based on findings.

Input: 40 year-old female whose recent diagnostic mammogram and ultrasound demonstrated highly suspicious mass in the left breast with suspicious left axillary lymph node, and a suspicious mass in the right breast, presents for Alan Penn research MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.LEFT BREAST:There is a highly suspicious, irregularly shaped enhancing mass, measuring 16 x 15 x 15 mm (AP x LR x CC), at 6 o'clock position. This mass is located closely to the anterior skin. There is an additional enhancing focus in the 7 o'clock position, which is lokely a satellite lesion. Distance between two enhancing lesions is 19 mm (center to center measurement).Although recent ultrasound study detected a small mass at 5 o'clock position, there is no correlating lesion on this MRI.At 3 o'clock position, there is a lobulated mass, measuring 10 x 10 x 8 mm, likely an enlarged intramammary lymoh node.In the left axilla, there is a large oval mass, measuring 24 x 20 x 20 mm, suspicious of a metastatic lymph node.Inferior to this mass, there is a smaller lymph node with asymmetric cortical thickening.RIGHT BREAST:At 3 o'clock position, there is an enhancing multilobulated mass, measuring 4 x 7 x 4 mm. This mass correlates with a mass detected at the recent ultrasound.No abnormal lymph nodes are identified in right axillary region.

Output: 1. Highly suspicious mass at 6 o'clock position with possible satellite at 7 o'clock position in the left breast. Ultrasound study performed later today detected a sonographic correlate of the possible satellite. Ultrasound guided biopsy was performed for both lesions. 2. An enlarged intramammary lymph node at 3 o'clock position in the left breast, and one highly suspicious and one borderline left axillary lymph nodes. Ultrasound guided biopsy of the largest lymph node in the left axilla was performed later today. 3. Small enhancing mass in the right breast at 3 o'clock position, correlating to the sonographically detected mass. Ultrasound guided biopsy of this mass was performed later today. 4. No abnormal lymph nodes in right axillary region.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: RUQ pain; hemangioma on CT History: RUQ pain; hemangioma on CT ABDOMEN:LIVER, BILIARY TRACT: Simple cyst in the right hepatic dome as well as in the inferior right hepatic lobe. Segment 7 lesion with peripheral nodular enhancement measures 2.9 x 2.9 cm (3/13), consistent with a hemangioma. No adjacent lesion is present to correspond to hypoattenuation as seen on prior CT.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of right hemicolectomy.BONES, SOFT TISSUES: Midline incisional and postsurgical changes.OTHER: No significant abnormality noted.

Output: 1.Right hepatic lesion is consistent with a hemangioma.2.No new findings to account for patient's right upper quadrant pain.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (5/24/16), images from ultrasound guided biopsy of right breast with specimen radiograph and postprocedural right mammographic images (5/27/2016), breast MRI (6/3/16), ultrasound images (6/9/16) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (5/24/16):The breast parenchyma is extremely dense (BiRADS Density Category D), which limits the sensitivity of the mammogram . A BB marker is placed at upper outer quadrant of right breast, denoting the area of palpable lump.There is a cluster of pleomorphic calcifications at the site of palpable lump in the right breast at upper outer quadrant. The cluster measures approximately 18 mm in AP dimension.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (5/27/2016):An irregularly-shaped, ill-defined hypoechoic mass is detected at 11:00 position in the right breast, measuring 21 x 11 mm. This lesion likely corresponds to the area of pleomorphic calcifications on the mammogram., In addition, there is an ill-defined hypoechoic mass measuring 12 x 7 mm at 10:00 position. This mass is annotated as "area of pain/area of palp." There are a few benign-appearing lymph nodes in the right axilla.Ultrasound guided biopsy for the mass at 11:00 position and 10:00 position in the right breast were performed with an appropriate needle placement. Specimen radiograph demonstrates a single calcification within one of the cores.Postprocedural mammographic images demonstrate a coil clip at 11:00 position, near the cluster of calcifications, and a ribbon clip at 10:00 position in the right breast. Distance between these 2 clips is 23 mm on CC view, and 17 mm on ML view.Per outside radiology report, the pathology results for both sites were malignant.BREAST MRI (6/3/16):MR images were submitted with non-DICOM format, and this could not be processed at our workstation. We tried to upload the images from the original DVD, but again images could not be uploaded to our workstation.Pre and post contrast MR images uploaded to PACS are not interpretable, because only axial images are available and no subtraction images are available. On T2 weighted images and non-contrast T1 weighted images, there are two metallic artifacts, at posterior upper outer quadrant, corresponding to the biopsy clips. There are a few small cysts in the right breast.ULTRASOUND IMAGES (6/9/16):This study was performed for MR directed ultrasound after abnormal findings on the MRI performed 6/3/2016. Per outside radiology report, there was a small focal area of masslike enhancement in the retroareolar region in the right breast. On the provided ultrasound images, there is a simple cyst at retroareolar region, and a complicated cyst next to it. There are no suspicious findings in the ultrasound images.

Output: Biopsy proven malignancy in the right breast at upper outer quadrant. MRI provided from outside institution is not interpretable. MR directed ultrasound for the right retroareolar region demonstrated a simple cyst with a complicated cyst.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: 63 yo male w/ gbm s/p RT/TMZ; currently on TMZ; screening for clinical trial; compare to uploaded post-resection images on 2/2/16 There has been evolution of postsurgical changes related to repeat tumor resection seen on outside MRI studies from 2/2/2016. There is evidence of left anterior temporal lobectomy with gross total resection of the enhancing mass evident in the medial temporal lobe on earlier study from 2/1/2016 as well as the nonenhancing masslike FLAIR hyperintensity in the left anterior temporal lobe. There is interval increase in enhancement along the dorsal aspect of the left anterior temporal resection cavity corresponding to the area of restricted diffusion on the immediate postoperative MRI and consistent with evolution of postsurgical change. Minimal area of somewhat nodular enhancement along the adjacent left tentorium is also increased which may also represent posttreatment change, but suggest attention on follow-up.Areas of FLAIR hyperintensity more superior to the resection cavity with minimal nonspecific enhancement along the left insular cortex is not significantly changed when compared to 1/21/2016. FLAIR hyperintensity surrounding the periventricular white matter, particularly along the left frontal horn is also nonspecific but favored to represent posttreatment change. No significant intracranial mass effect, midline shift, or herniation. No hydrocephalus.

Output: Evolution of postsurgical changes related to repeat tumor resection involving the left anterior medial temporal lobe. There has been gross total tumor resection without evidence of interval tumor progression.


Instruction: Generate impression based on findings.

Input: BRAIN: There is a region of T2 signal abnormality centered in the dorsal pons but extending inferiorly into the medulla, and superiorly into the midbrain with mild expansion. This area demonstrates patchy internal enhancement. There is no definite leptomeningeal enhancement within the brain. There is no acute infarct. There is mild persistent crowding at the foramen magnum without evidence of Chiari I malformation.CERVICAL: Although the findings are subtle, there is very likely mild bilateral scattered nerve root enhancement in the cervical spine. There is a small somewhat linear focus of T2 signal hyperintensity in the cervical cord on the right at C3, and an additional somewhat linear focus on the left at C6. No convincing pathologic enhancement is seen in the cord. There is enhancement and high T2 signal in the left superior articulating facet of C4 probably representing a hemangioma. Minimal degenerative findings in the cervical spine are unchanged from the prior recent MRI.

Output: Stable signal abnormality with ill-defined enhancement in the brainstem, and additional lesions in the cervical cord without enhancement. Additionally, there is likely subtle enhancement of some of the cervical nerve roots. These findings are nonspecific, and the differential diagnosis again includes infectious diseases including atypical or viral etiologies, granulomatous, post-infectious and autoimmune etiologies. A neoplastic etiology is felt to be unlikely.


Instruction: Generate impression based on findings.

Input: 76-year-old female with abdominal pain. Assess the pancreas or inflammation and please also do pelvis. Prior imaging showing focal pancreatitis versus diverticulitis. CHEST:LUNG BASES: Again seen is the previously described right lower lobe pulmonary nodule, unchanged in appearance. Follow-up dedicated imaging is still recommended.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: PANCREAS:Inflammatory changes primarily surrounding the tail of the pancreas are again seen. Additional periappendiceal inflammatory changes are seen posterior to the body of the pancreas. The splenic vein is thrombosed with numerous enlarged portosystemic collateral vessels noted. These findings make focal pancreatitis the favored diagnosis. The pancreatic duct is not dilated. There is no evidence of abscess or pseudocyst formation. Additionally, retroperitoneal lymph nodes with indistinct soft tissue haziness surrounding the celiac artery is seen. These may represent further additional inflammatory changes, versus lymph nodes. Follow-up imaging with MRI following resolution of this acute episode is recommended to exclude an occult pancreatic neoplasm.. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymph nodes are noted.BOWEL, MESENTERY: Hiatal hernia is again seen. Focal thickening of the colonic wall near the splenic flexure is again visualized. This is likely secondary to adjacent peripancreatic inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: Hiatal hernia is again seen. Focal thickening of the colonic wall near the splenic flexure is again visualized. This is likely secondary to adjacent peripancreatic inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No other significant abnormality noted.

Output: 1. inflammatory changes surrounding the tail of the pancreas with thrombosis of the splenic vein is suggestive of focal pancreatitis. Additionally, ill-defined perivascular soft tissue thickening around the celiac artery may represent additional inflammation versus adenopathy. Follow up MRI is recommended following resolution of the patient's acute episode of pancreatitis to exclude an underlying occult pancreatic neoplasm..2. Right pulmonary nodule unchanged from 10/26/2010. Recommend follow up dedicated imaging for further evaluation. 3. Hiatal hernia


Instruction: Generate impression based on findings.

Input: History of L2-3 laminectomy now with new onset back pain. There are postoperative findings related to left L3 laminectomy. There is a left paracentral L2-3 disc protrusion extending into the subarticular recess, which results in mild left neural foraminal stenosis. At L4-5, there is a disc bulge, facet arthropathy, and hypertrophy of the ligamentum flavum, which creates mild right and trace left neural foraminal narrowing. At L5-S1, there is a disc bulge, along with facet arthropathy and hypertrophy of the ligamentum flavum, which results in mild right and moderate left neural foraminal stenosis. The vertebral body heights are maintained. There is mild generalized straightening of the lumbar lordosis, but no spondylolisthesis. The imaged portions of the spinal cord are unremarkable.

Output: 1. Postsurgical findings related to left L3 laminectomy. There is a stable left-sided disc protrusion at L2-3 which results in mild left neural foraminal stenosis.2. Degenerative spondylosis at L4-5 and L5-S1 results in moderate left neural foraminal stenosis at L5-S1, which is not significantly changed.


Instruction: Generate impression based on findings.

Input: 12 year old female status post 5 cycles of chemotherapy, history of osteosarcoma Enhancing, T2 intense lesion of the distal femoral diaphysis measures 15.3 cm in craniocaudad dimension and 4.7 x 3.8 cm in transverse and AP dimensions. There is associated cortical thinning and periosteal reaction with an enhancing soft tissue mass extending medially through the cortex. Overall the dimensions are not significantly changed from the prior exam although there is less intense contrast enhancement and decreased periosteal reaction. Enhancement and T2 signal abnormality extending along the medial soft tissues to the skin surface presumably represents seeding of the biopsy tract and is new from the prior exam. No skip lesions are identified.

Output: Left femoral osteosarcoma with persistent enhancement and new presumed seeding of the biopsy tract.


Instruction: Generate impression based on findings.

Input: 56 year old female with a history of benign right breast biopsy in 05/2015 and bilateral breast reduction in 2011. Strong family history of breast and other cancers. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A small enhancing mass within the right nipple with a marker clip is again seen and unchanged. Posterior to this mass in the right retroareolar region, again seen is a tortuous ectatically dilated duct with increased T1 signal, consistent with proteinaceous fluid. There is no increase in signal with contrast injection in this duct. Because of the patient's motion during the dynamic study, this T1 high signal fluid is erroneously visualized in the subtraction images due to misregistration.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Right knee pain and swelling with persistent locking MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Small joint effusion with multiple foci of low signal intensity within the knee joint highly suggestive of pigmented villonodular synovitis (PVNS).


Instruction: Generate impression based on findings.

Input: 76-year-old man with left-sided weakness and probable meningioma. Brain: Multiple sequences are degraded by motion artifact. There are multiple foci of restricted diffusion and high T2 signal in the right putamen, caudate, periventricular white matter of frontal lobe, right cerebellar hemisphere, and right middle cerebellar peduncle. There is no gross evidence of intracranial hemorrhage, although dedicated susceptibility weighted imaging was not performed. There is a dural based mass just to the left of midline and superficial to the left paracentral lobule that measures up to approximately 30 mm. There is also a left cerebellopontine angle tumor that measures up to 15 mm in diameter with mass effect upon the left brainstem and cerebellar hemisphere. The ventricles and basal cisterns are normal in size and configuration for the patient's age. There is no midline shift or herniation. The skull, and scalp soft tissues are grossly unremarkable. There is a T1 hyperintense subcentimeter left maxillary sinus retention cyst. There is right posterior globe intermediate T1 hemorrhage.Cervical Spine: There is reversal of the normal cervical lordosis and mild anterolisthesis of T2 on T3. There is anterior fusion of C3 and C4 and C5, C6 and C7 vertebral bodies as well as anterior and posterior fusion of the T1 and T2 vertebral bodies. There is multilevel degenerative spondylosis with mild spinal canal stenosis and up to severe neural foraminal stenosis from C3 to T1. There is a T1 and T2 hypointense lesion in the T2 vertebral body. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1.Multiple small recent infarcts involving the right putamen, caudate, and periventricular white matter, as well as the right cerebellar hemisphere and right middle cerebellar peduncle.2.A left paramidline mass likely represents a meningioma.3.A left cerebellopontine angle mass likely represents a vestibular schwannoma, but is incompletely characterized.4.Multilevel degenerative changes in the cervical spine without spinal cord compression.5.Nonspecific sclerotic lesion in the T2 vertebral body, which is better depicted on the prior CT.6. Right retinal hemorrhage.Findings discussed by phone with Dr Aliesje Sorgeloos at 2:24 pm on 10/8/2015.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The spinal cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The conus is normal in signal and morphology, terminating at L1/2. Upon prone positioning, the conus and cauda translate anteriorly. There is no fat intensity material within the filum terminale. There are no osseous dysplasias or stenoses. The visualized paraspinal contents are unremarkable.

Output: Negative noncontrast complete spine MRI. Specifically, there are no MRI findings of tethered cord or fatty filum terminale.


Instruction: Generate impression based on findings.

Input: There is mild to moderate motion degradation with severe motion degradation of some sequences; this limits evaluation for subtle abnormalities. There are multiple new foci of restricted diffusion in the bilateral cerebral hemispheres in the bilateral frontal lobes, corona radiata, genu of the corpus callosum, and bilateral periatrial white matter. There is no definite suspicious intracranial enhancement. There is an old lacunar infarct in the genu of the left internal capsule and the medial left thalamus with ex vacuo dilatation of the left lateral margin of the third ventricle. Compared to 2011 MRI, there is moderate increased volume loss in the interval with further prominence of the ventricles.

Output: 1.Motion limited exam with multiple new punctate to small foci of acute infarction and bilateral cerebral hemispheres (right greater than left) as described above. Findings suggest embolic etiology.2.No definite gross suspicious enhancement or mass. 3.Moderate diffuse volume loss which is new from prior MRI in 2011.4.Interval but chronic lacunar infarcts in the genu of the left internal capsule and left thalamus.Findings were discussed with Dr. Laura Gardner over the telephone at 9:50 a.m. today.


Instruction: Generate impression based on findings.

Input: Hepatitis C cirrhosis with IPMN. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular with widened fissures and left and caudate lobe hypertrophy with reticular T2-weighted signal consistent with cirrhosis and fibrotic changes. No focal suspicious lesion. No vascular abnormality. No specific evidence of portal hypertension.No intrahepatic or extrahepatic biliary ductal dilatation. Partially contracted gallbladder.SPLEEN: The spleen is normal in size without a focal lesion.PANCREAS: The pancreas is normal in morphology, signal intensity and enhancement. Stable 9 mm pancreatic head cystic lesion without pancreatic ductal communication or enhancing components compatible with a sidebranch IPMN. There is a lobulated 6 mm pancreatic head and 3 mm pancreatic body cystic lesion without communication with or dilatation of the pancreatic duct compatible with side branch IPMNs, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small gastrohepatic lymph nodes are not unexpected in the setting of cirrhosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis without a suspicious hepatic lesion.2.Stable side-branch IPMNs.


Instruction: Generate impression based on findings.

Input: 70 years Male (DOB:2/20/1946)Reason: LUE weakness s/p seizure History: as abovePROVIDER/ATTENDING NAME: JAMES AHN CHRISTOPHER M GOMEZ MRI of the brainThere is a mass involving gray and white matter located in the right superior and middle frontal gyri extending to the anterior most aspect of the right precentral gyrus at the hand motor area. It measures approximately 40 x 30 mm in axial dimensions. It measures approximately 40 x 33 mm in sagittal dimensions is associated with a small amount of contrast enhancement along its inferior aspect. It involves both gray and white matter. On FLAIR imaging and has a heterogeneous appearance. Along its medial aspect is associated with the punctate focus of susceptibility effect which on CT appears to represent a small calcification.The patient status post right frontal bone burr hole placementNormal 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The A1 segments are similar in diameter. The posterior communicating arteries are intact. The left posterior communicating artery is larger than the right posterior communicating artery. The left vertebral artery is smaller than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery. Left vertebral artery originates from the aortic arch.

Output: 1.There is a mass present in the right frontal lobe involving the medial and posterior aspect of the right superior frontal gyrus, the lateral and posterior aspect of the right middle frontal gyrus as well as the anterior aspect of the right precentral gyrus at the level of the hand motor area. Most likely this represents a neoplasm such as a primary brain tumor possibly oligodendroglioma.2.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: AMS. Fever. Evaluate for mass or intracranial hemorrhage. Similar to the brain MRI from 2004, there is extensive parenchymal volume loss, leukomalacia, and stable hydrocephalus. There is no evidence acute intracranial hemorrhage, mass or edema. The calvaria and skull base are radiographically normal. Minimal mucosal thickening is noted in the left maxillary sinus and ethmoid air cells. The remainder of the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable parenchymal volume loss and hydrocephalus with no acute abnormality.


Instruction: Generate impression based on findings.

Input: Alignment of the lumbar spine is anatomic. There are 5 lumbar type vertebral bodies. The vertebral body heights are preserved. The bone marrow signal is normal. Mild degenerative spondylosis affects the lower lumbar spine L4-5 and L5-S1 where there is disc desiccation. The conus is normal in signal and morphology and terminates at L1. The visualized intra-abdominal and paraspinal contents are unremarkable.No spinal canal stenosis or neural foraminal narrowing at T11/12 or T12/L1 as seen on the sagittal images.L1/2: Mild facet arthropathy without spinal canal stenosis or neural foraminal narrowing.L2/3: Mild facet arthropathy without spinal canal stenosis or neural foraminal narrowing.L3/4: Minimal disc bulge, facet arthropathy and ligamentum flavum thickening with minimal bilateral neural foraminal narrowing. No spinal canal stenosis.L4/5: Small annular fissure. Minimal disc bulge, facet arthropathy, and ligamentum flavum thickening with minimal left and no right neural foraminal narrowing. No spinal canal stenosis.L5/S1: Small annular fissure. Disc bulge, eccentric to the right, which contacts the right L5 nerve extraforaminally without clear impingement. Mild facet arthropathy without spinal canal stenosis or neural foraminal narrowing.

Output: Mild degenerative changes in the lumbar spine without significant spinal canal stenosis or clear evidence of nerve root impingement at any level. Minimal neural foraminal narrowing as described above.


Instruction: Generate impression based on findings.

Input: Male 49 years old Reason: 3 cm dysplastic nodule in liver, followup, R flank pain History: HCV cirrhosis, 3 cm nodule. ABDOMEN:LIVER, BILIARY TRACT: The liver demonstrates cirrhotic morphology with widening of the hepatic fissures and nodularity of the hepatic contour. There is no intra or extrahepatic biliary ductal dilatation. Patent hepatic vasculature.Again seen is an intrinsically T1 hyperintense 2.9 x 2.1 cm lesion in segment 8, previously measuring 3.2 x 2.4 cm. There is no arterial enhancement or washout. There is no diffusion restriction. The appearance is not significantly changed compared to prior study and likely represents a dysplastic or regenerative nodule.SPLEEN: Splenomegaly measuring 16.4 cm. Multiple prominent vessels centrally within the spleen which may represent a vascular malformation. The appearance is not significantly changed compared to prior study.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered prominent portacaval lymph nodes which can be seen in the setting of cirrhosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with stable splenomegaly.2.Stable appearance of a segment 8 liver lesion which likely represents a dysplastic or regenerative nodule. Continued follow-up is recommended.


Instruction: Generate impression based on findings.

Input: 60-year-old female with worsening low back pain and left leg pain, history of lumbar stenosis Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation is present throughout with significant disc height loss evident at L3/4 and L4/5. Scattered discogenic reactive endplate changes are again noted. These findings are stable.T11/12: Mild disc bulge and bilateral facet hypertrophy with mild central stenosis, unchanged.T12/L1: Asymmetric bulge to the right, ligamentum flavum thickening, moderate left facet hypertrophy, and mild to moderate right facet hypertrophy. There is mild central and moderate left neural foraminal stenosis, unchanged.L1/2: A symmetric bulge to the right, ligamentum flavum thickening, moderate left facet hypertrophy, and mild right facet hypertrophy. There is mild left and mild to moderate right neural foraminal stenosis. These findings are unchanged.L2/3: Asymmetric bulge to the right, ligamentum flavum thickening, and moderate bilateral facet hypertrophy. There is mild central, mild right lateral recess, mild left foraminal, and moderate right neural foraminal stenosis. These findings are unchanged.L3/4: Diffuse annular disc bulge, ligamentum flavum thickening, and moderate to severe bilateral facet hypertrophy. There is moderate central, moderate left lateral recess, marked right lateral recess, and moderate to severe bilateral neural foraminal stenosis. These findings are unchanged.L4/5: Diffuse annular disc bulge, ligamentum flavum thickening, severe left facet hypertrophy, and very severe right facet hypertrophy. There is moderate to severe central, marked bilateral lateral recess, and severe bilateral neural foraminal stenosis. These findings are unchanged.L5/S1: Mild disc bulge, severe left facet hypertrophy, and very severe right facet hypertrophy. There is a small right facet effusion. Reactive marrow changes are noted extending to the right L5 pedicle. There is moderate to severe left neural foraminal and moderate right neural foraminal stenosis. These findings are unchanged.

Output: 1.T11/12: Mild central stenosis, unchanged.2.T12/L1: Mild central and moderate left neural foraminal stenosis, unchanged.3.L1/2: A mild left and mild to moderate right neural foraminal stenosis. These findings are unchanged.4.L2/3: Mild central, mild right lateral recess, mild left foraminal, and moderate right neural foraminal stenosis. These findings are unchanged.5.L3/4: Moderate central, moderate left lateral recess, marked right lateral recess, and moderate to severe bilateral neural foraminal stenosis. These findings are unchanged.6.L4/5: Moderate to severe central, marked bilateral lateral recess, and severe bilateral neural foraminal stenosis. These findings are unchanged.7.L5/S1: Moderate to severe left neural foraminal and moderate right neural foraminal stenosis. These findings are unchanged.


Instruction: Generate impression based on findings.

Input: 75-year-old female with history of multiple CVAs now presents with increased altered mental status and muscle twitches. Please evaluate for new bleed, mass effect or shift. Compared to previous to evaluate progression of CVA. There is no evidence of intracranial hemorrhage, mass or edema. The previously described there is low attenuation throughout the MCA vascular territory the left consistent with a subacute infarct but remains overall unchanged from the previous examination. Multiple other areas of hypodensity in the periventricular and subcortical white matter distribution is consistent with small vessel disease, age indeterminant. Multiple lacunar infarcts redemonstrated within the bilateral basal ganglia and cerebellum. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are stable 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. Stable right frontoparietal subacute infarct. 2. Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Hepatitis C cirrhosis. Evaluate for focal lesion. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver morphology with widened fissures compatible with cirrhosis. No intra or extrahepatic biliary ductal dilatation.Patent portal vein, hepatic veins and hepatic artery. No suspicious liver lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate volume abdominal ascites, decreased from the prior study.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology without a focal lesion.2.Moderate volume abdominal ascites, decreased from the prior study.


Instruction: Generate impression based on findings.

Input: 38 year old woman with BRCA mutation and family history of breast cancer in mother and sister. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Follow-up of mildly restricted diffusion lesion on prior MRI, numbness and tingling of the right upper extremity, possible demyelinating disease. There is no evidence o acute ischemic or hemorrhagic lesion on today's scan.There is no evidence of abnormal enhancement either.Previously recognized left inferior frontal area mildly restricted diffusion lesions are not demonstrated on today's scan. However, corresponding high signal intensity lesions on FLAIR images are seen and do not show any significant interval change since prior exam (series 5, image18/38).Previously seen focal high signal intensity on vermis on FLAIR imaging (series 8, image 21/30) appears to be much lessen signal intensity than prior scan.Above findings could represent evolution of small subacute ischemic lesions or could also represent evolving demyelinating lesion. Again there is no evidence that can suggest chronic demyelinating lesion on this scan.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: 1. There is no evidence of acute ischemic or hemorrhagic lesion.2. Non visualization of previously recognized restricted diffusion lesions on the left inferior frontal lobe but can still recognizable on FLAIR images. Lessen signal intensity and smaller in size of the anterior vermis lesion on FLAIR images without evidence enhancement. Again diagnostic possibilities include evolving subacute ischemic lesions and demyelinating lesions. Follow up imaging study and clinical correlation might be valuable for the differential diagnosis.


Instruction: Generate impression based on findings.

Input: H/o porencephalic cyst . S/p Ommaya shunt. Evaluate for interval change. Examination demonstrates further enlargement of the right porencephalic cyst and the supratentorial ventricular system. There have been large areas of encephalomalacia in the bilateral cerebral hemispheres since prior exams. There has been an interval placement of a right frontal catheter, and the tip appears to be approximately within the confluence of the sinus. No hemorrhage is identified. The cerebellar hemispheres remain unchanged from prior exam.

Output: 1. Diffuse cerebral encephalomalacia which has further evolved since prior exam. Findings are compatible with ischemic injury. 2. Further enlargement of the right porencephalic cyst and the supratentorial ventricular system, which is secondary to underlying brain volume loss related to diffuse encephalomalacia versus increased intraventricular pressure.


Instruction: Generate impression based on findings.

Input: Reason: dizziness, right gait deviation History: vertigo, ataxia There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered periventricular and subcortical T2 hyperintensities which are nonspecific. Small T2 hyperintensities in the pons without diffusion restriction are also noted. 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. Osteoma in the frontal sinus is better seen on recent CT.

Output: 1.No evidence of an acute infarct.2.Scattered periventricular and subcortical T2 hyperintensities as well as T2 hyperintensity in the pons may represent chronic small vessel ischemic disease, however at this age, the differential diagnosis also includes demyelinating disease, chronic migraines or other infectious/inflammatory etiologies. Please note, the pattern of disease is not classic for MS.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of pituitary gland [D35.2] / Benign neoplasm of craniopharyngeal duct [D35.3], OSH questionable lesion to Pituitary. Headaches. There is a 4 mm diameter hypoenhancing ovoid lesion in the right superior pituitary gland suspicious for pituitary microadenoma. The pituitary gland also appears slightly enlarged overall, measuring up to 10 mm. The pituitary exerts mild mass effect on the optic chiasm and pituitary stalk. The posterior pituitary T1 bright spot an perhaps slightly prominent. There is prominence of the visualized lateral and third ventricles and the partly imaged cerebellum appears to be somewhat dysmorphic.

Output: 1. A 4 mm diameter lesion in the superior right pituitary gland may represent pituitary microadenoma.2. Prominence of the visualized lateral and third ventricles and possible dysmorphic appearance of the partly imaged cerebellum may be developmental in nature. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Human bite There is diffuse soft tissue edema and enhancement of the index finger particularly surrounding the middle phalanx suggestive of cellulitis. There is a small skin defect along the radial aspect of the middle phalanx with an underlying approximately 1 cm focus of nonenhancing tissue which could represent phlegmonous change or early abscess formation that we suspect is continuous with the aforementioned skin defect. Although the enhancement and edema contacts the flexor tendon apparatus, we see no frank fluid within or enhancement of the tendon sheath itself and there is no extension of this process proximal to the MCP joint.A small amount of fluid and enhancement is seen within the PIP joint and while this could represent a reactive synovitis, we cannot exclude the possibility of early infection. There is no bone marrow edema to confirm septic arthritis or osteoarthritis. The remaining digits of the hand are unremarkable.

Output: 1. Skin defect and cellulitis of the index finger with underlying nonenhancing collection which may reflect phlegmon/early abscess that is suspected to communicate with the overlying skin defect.2. Enhancement of the PIP joint of the index finger indicating synovitis and although this could be reactive in nature, the possibility of early infection cannot be excluded.3. No evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Cellulitis Evaluation of the first and fifth digits is limited by the presence of susceptibility artifact from orthopedic pinning.First ray: There is a mild hallux valgus deformity. Orthopedic pinning of the head of the metatarsal is noted. A small cystic collection overlies the dorsal aspect of the head of the metatarsal. Following contrast, there is only mild peripheral enhancement. There is no abnormal signal to suggest osteomyelitis.Second ray: There is no abnormal signal to suggest osteomyelitis.Third ray: There is no abnormal signal to suggest osteomyelitis.Fourth ray: There is no abnormal signal to suggest osteomyelitis.Fifth ray: Orthopedic pinning of the metatarsal head/neck is noted. There is no abnormal signal to suggest osteomyelitis.There is diffuse swelling of the dorsal soft tissues. Following contrast administration, there is no abnormal enhancement or evidence of focal fluid collection.

Output: Subcutaneous edema and surgical changes the foot without evidence of osteomyelitis. Small cystic collection along the head of the first metatarsal may be postsurgical in nature but correlation recommended.


Instruction: Generate impression based on findings.

Input: Left cervical lymph node biopsy showed metastatic adenocarcinoma, most probably from a salivary gland primary. There is a heterogeneous, lobulated mass involving the deep left parotid lobe, which measures up to approximately 2 cm in diameter. The tumor contains small foci of T1 and T2 hypointensity, which may reflect calcifications. There is no gross infiltration of tumor into the parapharyngeal fat or masticator space. The retromandibular vein is mildly compressed by the mass, which also abuts the posterior cortex of the mandibular ramus without erosion. There is a mildly enlarged left level 2B lymph node, which measures up to 15 mm. There is also a left level 4 enlarged lymph node, which measures up to 18 mm. There is no right cervical lymphadenopathy. The other major salivary glands are unremarkable. The thyroid gland is unremarkable. The osseous structures are unremarkable. The airways are patent. There is mild ethmoid and left maxillary sinus mucosal thickening. The imaged intracranial structures are unremarkable.

Output: Deep left parotid mass most probably represents the known adenocarcinoma Ipsilateral cervical and supraclavicular lymphadenopathy was not particularly hypermetabolic on PET and may nevertheless represent metastatic disease versus reactive lymph nodes.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 40-year-old patient with cirrhosis, jaundice. Evaluate liver lesions, masses, biliary structure, and hepatic vasculature. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Cholelithiasis without evidence of intra- or extrahepatic biliary ductal dilatation. Arterially timing is suboptimal, however, there are no focal hepatic lesions that demonstrate washout on delayed imaging. The hepatic veins and portal veins are patent. SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anasarca.OTHER: Moderate ascites. There are splenic varices and a splenorenal shunt. There are bilateral pleural effusions and patchy bilateral airspace opacities.

Output: 1.Cirrhotic morphology of the liver with stigmata of portal hypertension. Limited study secondary to motion artifact and poor arterial timing, however, no focal hepatic lesion demonstrating washout to suggest hepatocellular carcinoma; CT should be considered for subsequent evaluation given inherent sensitivity of MRI to motion artifact.2.Bilateral pleural effusions and bibasilar airspace opacities; chest radiograph may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Patient presenting with left eye visual loss, evaluate for ischemic stroke. Multiple sequences are degraded by motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are apparent foci of diffusion hyperintensity in the left pons and the right pontomedullary junction without associated T2 signal changes, most likely artifactual in etiology. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are patchy foci of T2/FLAIR hyperintensity in the subcortical and deep periventricular white matter, which are nonspecific but compatible with mild chronic microvascular ischemic disease. Small foci of T2 hyperintensity in the cerebellum with associated volume loss are suggestive of chronic infarcts. Additional small foci of T2 hyperintensity in the right posterior subinsular region and left thalamus may represent chronic lacunar infarcts. Incidentally seen is a partially empty sella. Motion degraded SWAN sequences do not demonstrate any gross evidence of intracranial hemorrhage. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable. Small right frontal scalp fluid collection/hematoma is noted.

Output: 1.No definite evidence of acute infarct. Subtle foci of diffusion hyperintensity in the left pons and right pontomedullary junction without associated T2 signal abnormality are favored to be artifactual in etiology.2.Scattered foci of T2/FLAIR hyperintensity in the subcortical and periventricular deep white matter, which are nonspecific, but compatible with mild chronic microvascular ischemic disease.3.Evidence of chronic lacunar infarcts, as described above.


Instruction: Generate impression based on findings.

Input: Metastatic malignant melanoma status post surgery in the left scalp. Brain: There are postoperative findings related to left occipital scalp tumor resection. There is an enhancing nodular lesion with restricted diffusion in the left occipital scalp surgical bed subgaleal space that measures approximately 25 mm in length and 10 mm in thickness. The underlying calvarium appears to be grossly intact. There is also a 6 mm diameter enhancing nodule in the left occipital subcutaneous tissues more superiorly, as well as a 12 mm wide enhancing nodule in the left parietal scalp subcutaneous tissues adjacent to the incision plane. There is no evidence of intracranial tumor or acute infarction. The ventricular system is normal in size. The orbits are intact. There are bilateral mastoid effusions. There is a small retention cyst in the right maxillary sinus. There is a subcentimeter probable hemangioma in the right parietal calvarium.

Output: Nodules in the left occipital and parietal scalp surgical bed likely represent residual or recurrent melanoma.


Instruction: Generate impression based on findings.

Input: 75-year-old female with severe right hip pain status post fall from couch. History of renal, anal and lung cancer. There is a 3.8 x 3.0 x 7.3 cm focus of nonenhancing increased signal abnormality within the intertrochanteric and subtrochanteric region of the right femur with associated cortical destruction and soft tissue extension resulting in anterior displacement of the vastus musculature, consistent with osseous metastatic disease. Note is made of innumerable additional foci of increased signal abnormality within the bones of the pelvis including the acetabulum bilaterally, inferior pubic rami, superior pubic rami, sacrum, and iliac bones, bilaterally. There is also signal abnormality within the intertrochanteric region of the left femur, distal left femoral metadiaphysis, left femoral head and L5 vertebral body suspicious for osseous metastatic disease. Foley catheter in place. There is increased signal abnormality and fluid sensitive sequences within the right gluteus minimus muscle, anteriorly, as well as along the vastus musculature, which is nonspecific, but does not demonstrate enhancement on postcontrast sequences. There is mild diffuse fatty infiltration of the imaged musculature of the right hip. There is a small collection with fluid signal intensity and fluid fluid level within the soft tissues along the left perineum which may represent a Bartholin's cyst.

Output: Multiple foci of osseous metastatic disease involving the imaged bones of the pelvis and proximal appendicular skeleton as described above. The largest lesion is situated within the intertrochanteric/subtrochanteric region of the right femur and is associated with cortical destruction, soft tissue extension, and involvement of nearly the entire medullary space of the femur. Evaluation for the possibility of an impending pathologic fracture is recommended. Other findings as described above.


Instruction: Generate impression based on findings.

Input: NF1 with worsening headaches who has a tectal glioma. There is an unchanged ill-defined non-enhancing T2 hyperintense lesion in the periaquaductal region of the midbrain, which measures up to approximately 11 mm. While there appears to be narrowing of the aqueduct of Sylvius, the ventricles are unchanged in size and configuration. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. 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. There may be a partially imaged left parapharyngeal neurofibroma.

Output: Unchanged presumed glioma in the midbrain, without evidence of hydrocephalus.


Instruction: Generate impression based on findings.

Input: Reason: Rule out fracture History: pain after fall, popping noise in the right knee The bones appear demineralized, suggesting osteopenia. Mild osteoarthritis affects the right knee. We see no acute fracture. There is slight anterior tilting of the patella on the lateral view along with mineralization of the distal quadriceps tendon and a small joint effusion. If there is clinical concern for quadriceps tendon injury, MRI may be considered for further evaluation. Vascular calcifications are noted in the posterior soft tissues.

Output: No acute fracture. If there is clinical concern for quadriceps tendon injury, MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 38 year old with history of NICM s/p heart transplant in may 2015, hypertension, gout and constrictive pericarditis. Referred for cardiac MRI for follow up of constrictive pericarditis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 68 ml/m2 (normal range: 74+/-15), the LVEDV is 150 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 112 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying myocardial fibrosing, infiltrative, or inflammatory process. Native T1 times are moderately elevated at 1154 ms in the mid interventricular septum (similar to previous study).There is persistent mild diffuse hyperintensity of the interventricular septum on T2 STIR sequences, suggestive of persistent mild myocardial edema. Overall improvement in circumferential hyperintensity of the pericardium previously noted.Left AtriumThe left atrium is consistent with transplant morphology. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 165 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 76 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant morphology.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 at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. There is no stenosis at the anastomosis site.Venous AnatomyThe SVC is normal in size. There is IVC continuation of the azygous vein, which is enlarged and empties in the SVC normally. PericardiumThe pericardium is mildly thickened with evidence of increased T2-signal but no significant late gadolinium enhancement. Based on myocardial tagging, the pericardium is tethered to the myocardium. On real time cine imaging, there is no obvious interventricular discordance during respiration noted. There is a small, loculated pericardial effusion located apico-posteriorly. Extracardiac FindingsThere are no pleural effusions. Sternotomy wires are present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. New right atrial thrombus noted (15 x 13.5 mm).2. The pericardium is mildly thickened (decreased compared to previous) with evidence of cyst and mild increased T2-signal but no significant late gadolinium enhancement. Based on myocardial tagging, the pericardium is likely tethered to the myocardium anteriorly although there are no findings to suggest constrictive pericarditis. 3. There is a small, loculated pericardial effusion located apico-posteriorly, stable from prior. 2. Normal left ventricular size and systolic function (LVEF 61%). The native myocardial T1 time is moderately elevated and unchanged. 3. Normal right ventricular size and systolic function (RVEF 54%). Notification of emergent findings from impression #1 were communicated to Jodel Powers, APN (APN to Dr. G. Sayers).


Instruction: Generate impression based on findings.

Input: 55-year-old female. Evaluate for metastatic brain lesions, hydrocephalus and posterior fossa. Signs and symptoms: Recurrent falls Findings of the extensive white matter low attenuation is noted. These findings are nonspecific however was noted on prior CT examination from 6 -- 6 and 2009 and MRI examination from 5 -- 15 -- 2009. Findings may represent residual edema from patient's multiple previously noted (not present on the current exam) enhancing metastatic lesions). Post infusion images demonstrate no evidence of any abnormal enhancement of the brain parenchyma or the leptomeninges. No metastatic lesions to the brain, leptomeninges or the calvarium is detected. Cortical sulci and ventricular system are within normal size. Follow-up exam with an MRI is highly recommended to exclude other etiologies for a white matter abnormalities.90 CC of Omnipaque 350 was utilized for this a study.

Output: 1.No evidence of metastatic lesion to the brain, leptomeninges or calvarium.2.Extensive periventricular and subcortical low attenuation without enhancement as detailed above.


Instruction: Generate impression based on findings.

Input: 78 years Female (DOB:3/24/1938)Reason: Pain legs with walking History: PainPROVIDER/ATTENDING NAME: RODERICK H. BIRNIE RODERICK H. BIRNIE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present. There is bilateral facet hypertrophy affecting the left facet joint more than the right this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy at this level. There is mild anterior subluxation of L4 on L5.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes present in the lower lumbar spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 49 year old male with history of gallstone pancreatitis complicated by fluid collections which were still present on CT in October 2014. Please re-evaluate. Abdomen:LIVER, BILIARY TRACT: No significant abnormality noted. Cholecystostomy tube has been removed. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted. Previously identified fluid collection near the pancreatic head has resolved. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Rim enhancing fluid collection along the right retroperitoneum measures 3.4 x 1.6 cm, and corresponds to site of fluid attenuation seen on prior CT (series 1501, image 101). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.Pelvis:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval resolution of peripancreatic fluid collections with normal pancreatic appearance. 2.Persistent rim enhancing fluid collection along the right retroperitoneum as described above.


Instruction: Generate impression based on findings.

Input: Clinical question of CVA. Signs and symptoms: Left-sided facial numbness. Nonenhanced head CT:No detectable acute intracranial process.CT is insensitive for early detection of acute ischemic strokes.Examination demonstrates small focus of low attenuation in the left paramedian pons which is not a specific however it could represent an age indeterminate lacunar infarct. Consider MRI if concern for a stroke remains high.Unremarkable cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.Paranasal sinuses are unremarkable.There is evidence of an old blowout fracture of left floor of the orbit as well as lamina papyracea.

Output: 1.Minimal small vessel ischemic strokes of indeterminate age.2.No acute intracranial hemorrhage, mass effect or hydrocephalus.


Instruction: Generate impression based on findings.

Input: Rule out CVA. Patient with two days of left-sided weakness. Several areas of encephalomalacia, the largest in the right occipital lobe that likely represent areas of prior infarct. Multiple areas of subcortical and periventricular white matter hypodensity indicate small vessel ischemic disease of indeterminate age. An MRI is recommended if there is clinical concern for acute stroke.There is no evidence of intracranial hemorrhage, mass or midline shift. 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: Areas of encephalomalacia and evidence of small vessel ischemic disease of indeterminate age. An MRI is recommended for further evaluation if there is concern for an acute stroke.


Instruction: Generate impression based on findings.

Input: 47 years Male (DOB:8/24/1968)Reason: s/p crani for tumor resection in oct 2015 History: post-op surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI brain:The patient is status post left frontal craniotomy. There is surgical tract which extends through the left frontal lobe to the left half of the suprasellar lesion which is associated with T2 signal hyperintensity in the adjacent white matter. There is associated ex vacuo effect on the left lateral ventricle which was not present on the prior exam. There is susceptibility effect along the surface of this surgical tract and along the peripheral aspect of the frontal lobe component of the pituitary mass. There is approximately 2 mm shift of the septum pellucidum towards the right which has significantly decreased since the prior exam. Another component of the mass extends towards the posterior fossa and displaces the right cerebral peduncle. This is also stable compared to the prior exam. Since the prior exam the patient is developing contrast enhancement within the nonenhancing component of the tumor along the suprasellar cistern.There is dural thickening and enhancement along the craniotomy site.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 mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:There is a mass centered within the pituitary fossa with suprasellar and intraparenchymal extension. It measures 39 x 43 cm in axial dimensions on the current exam and previously measured similar axial dimensions. It is associated with suprasellar extension and a nodular extension into the left frontal lobe. This component extends into the left frontal lobe measures 27 x 30 mm axial dimensions and previously measured 23 x 37 mm dimensions. The mass extends into the cavernous sinuses bilaterally and into the infratemporal fossa and sphenoid sinus. The left internal carotid arteries displaced laterally at the level of the carotid siphon. The mass partially surrounds the ophthalmic segment of the right internal carotid artery. It displaces the anterior cerebral arteries superiorly and displaces the optic nerves and optic chiasm and tracks superiorly. The third ventricle is displaced superiorly and posteriorly. The mass expands the sphenoid sinus and mildly displaces the basilar artery posteriorly.

Output: 1.Since the prior exam there has not been a significant interval change in the overall size of the patient's sellar, suprasellar and left frontal intraparenchymal mass. There is, however, some apparent growth of the mass into what appears to have been resected component of the tumor at the suprasellar cistern.2.Since the prior exam there is been evolution of a postoperative changes involving left frontal lobe which now includes gliosis and encephalomalacia. There is less midline shift on the current exam relative to the prior exam.


Instruction: Generate impression based on findings.

Input: Male, 30 years old. +sulcus sign, pain with ADD one month after bike accident ROTATOR CUFF: There is a partial-thickness articular surface tear of the supraspinatus tendon near its insertion. The tear involves approximately 8 cm of the tendon width and approximately 50% of the tendon thickness, with approximately 1 cm of retraction of the torn fibers. The supraspinatus muscle appears normal. The infraspinatus, subscapularis, and teres minor tendons and muscles appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is irregular morphology and abnormal contrast within the anterior labrum, compatible with a tear. The remainder of the labrum appears intact.BICEPS TENDON: The tendon of the long biceps is normal in morphology and course. ADDITIONAL

Output: 1.Tear of the anterior labrum.2.Partial thickness tear of the supraspinatus tendon as above.


Instruction: Generate impression based on findings.

Input: 13-year-old boy with history of AML low status post transplant, now with fever and altered mental status. There has been increase of the extensive mucosal thickening and fluid in the the ethmoid air cells, left frontal, bilateral maxillary, and sphenoid sinuses, although fluid within the sphenoid sinuses have diminished. There is fluid within the bilateral middle ears and mastoid air cells. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Findings compatible with acute sinusitis, but no evidence of associated complications.2. Nonspecific bilateral otomastoid fluid.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Cirrhosis presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No suspicious liver lesion biliary ductal dilatation or vascular abnormality. Normally distended gallbladder without evidence of gallbladder inflammation.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate T2 weighted hyperintensities, probable simple cysts. Mild left perirenal fluid.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Air and fluid filled probable duodenal diverticulum. Extensive colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver without a focal lesion.


Instruction: Generate impression based on findings.

Input: New onset headache, please evaluate for Chiari etc. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or Chiari malformation.