Instruction: Generate impression based on findings.

Input: 65-year-old male with pain and large effusion on radiographs. MENISCI: There is a complex tear of the medial meniscus with maceration of the posterior aspect of the body of the medial meniscus. There is branching signal abnormality which extends into the posterior horn, which is truncated, indicating additional complex tearing. There is a 1.0 cm focus of low signal intensity adjacent to the root of the posterior horn of the medial meniscus which likely represents a displaced meniscal fragment. The anterior horn of the medial meniscus appears intact. There is medial extrusion of the fragmented body of the medial meniscus. There is globular branching signal abnormality throughout the lateral meniscus, indicating intrasubstance degeneration. Within the anterior horn, the signal appears to extend to both the tibial and femoral articular surfaces, which may represent mild degenerative tearing or fraying, but we see no fluid signal intensity within the meniscus to confirm a large unstable tear.ARTICULAR CARTILAGE AND BONE: The superior aspect of the femoral trochlea appears shallow and there is prominence of the lateral facet relative to the medial facet, suggestive of femoral trochlear dysplasia. There is slight lateral translation of the patella relative to the center of the femoral trochlea. The tibial tubercle to trochlear groove distance is 1.5 cm, which is borderline normal. Moderate to severe degeneration affects the articular cartilage of the patella along its lateral facet, with small subchondral cyst formation. There is blistering of the articular cartilage of the medial facet of the patella with underlying subchondral cyst. Mild articular cartilage degeneration affects the femoral trochlea. There is moderate diffuse degeneration of the articular cartilage of the weightbearing portions of the medial femoral condyle and medial tibial plateau. The lateral compartment appears relatively preserved. There is osteophyte formation affecting the lateral compartment. Osteophytes are also noted in the medial compartment and patellofemoral compartment.LIGAMENTS: Cysts are noted in the intercondylar eminence. There is thickening and mild increased signal intensity of the ACL, suggesting mucoid degeneration with small cysts at its proximal attachment. The MCL appears intact, although intermediate signal intensity deep to the superficial band of the MCL likely represents synovitis. The PCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact. The Insall-Salvati ratio is 1.3, suggesting mild patella alta.ADDITIONAL

Output: 1. Extensive complex tearing of the medial meniscus.2. Osteoarthritis with findings suggestive of patellofemoral instability.3. Joint effusion, synovitis, and other findings as described above.


Instruction: Generate impression based on findings.

Input: 49-year-old male with PSC, cirrhosis, ascites. Evaluate biliary and vessel patency. HCC screen. Pre-OLT evaluation. ABDOMEN:LIVER, BILIARY TRACT: Heterogenous enhancement of the liver in the arterial phase. Of note, there is opacification of the right and left portal veins on the arterial phase with nonopacification of the main portal vein/confluence. This finding is concerning for a central arterial to portal venous shunt. There is nonspecific periportal edema. The portal and hepatic veins are patent, however mild attenuation of the central hepatic veins and IVC are noted.No discrete arterially hyperenhancing lesions. No suspicious lesions with washout are identified. No intra or extrahepatic biliary ductal dilatation. Mild central biliary ductal irregularity is suggested, however a dedicated MRCP exam was not performed. Hepatomegaly. Stigmata of portal hypertension including recanalization of the left umbilical vein, mild gastroesophageal varices, and mild upper abdominal ascites. A nonspecific enlarged portocaval lymph node is also noted (series 1003 image 176). Cholelithiasis without evidence for acute cholecystitis.SPLEEN: Spleen is at the upper limits of normal in size measuring 12 cm in length.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: Trace perihepatic and perisplenic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Arterial phase perfusional variant of uncertain etiology, with diffuse heterogeneous enhancement of liver noted (may be related to underlying chronic liver disease; visualized hepatic vasculature patent). There is opacification of the right and left portal veins on the arterial phase without opacification of the main portal vein confluence, and this finding is suggestive of an arterial-portal venous shunting. In mild periportal edema is also noted. On the delayed postcontrast phase, there is relative normal opacification of the hepatic parenchyma. 2.Hepatomegaly with stigmata of portal hypertension. No suspicious lesions identified.3.No intra or extrahepatic biliary ductal dilatation. Mild central biliary ductal irregularity is suggested, however a dedicated MRCP exam was not performed.


Instruction: Generate impression based on findings.

Input: 50 year-old female with left shoulder injury, decreased range of motion ROTATOR CUFF: The rotator cuff muscles and tendons are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. There is no fluid in the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage appears normal. Linear signal abnormality within the posterior labrum is suggestive of a tear, although the current clinical significance of this finding is unclear.BICEPS TENDON: The biceps tendon appears normally situated in the bicipital groove. ADDITIONAL

Output: 1. Edema within the greater tuberosity may represent a contusion, although a poorly defined band of low signal intensity within this edema raises the possibility of a small nondisplaced fracture.2. Findings suggestive of a posterior labral tear, which may not be of any current clinical significance.


Instruction: Generate impression based on findings.

Input: Reason: 46F s/p R partial Nx for TFE3+ RCC; screening eval for right nephrectomy bed recurrence ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesion. Patient is status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right partial nephrectomy. Enhancing subcentimeter nodule at the right kidney resection bed measuring 6 x 5 mm (series 11 image 413), appearing similar to prior study. Right inferior pole T2 bright lesion is again seen. There is some mild increase in the signal on subtraction image, but this may be volume averaging as the subtraction images are now completely aligned. Favor simple cyst as lesion was stable over past 2 years, but attention on follow-up imaging.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Pericaval lymph node appears stable from prior study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Partially visualized nonspecific T2 bright lesion measuring 5.1 x 3.1 cm (series 6 image 2) without enhancement. This likely reflects fluid collection, but please correlate with patient history and obtain mammogram if indicated.

Output: 1.Enhancing 6 mm nodule in the nephrectomy bed appears similar to prior study. No new findings to suggest disease recurrence.


Instruction: Generate impression based on findings.

Input: Chronic low back pain, recent falls and urinary incontinence. Evaluate for cord compression. There is multilevel degenerative spondylosis in the cervical spine with impingement upon the spinal cord from C3-4 to C6-7. There is apparent high signal on STIR in the spinal cord at these levels. There is focal ligamentum flavum thickening at T2-3 and T5-6 without indentation of the spinal cord. There is also degenerative spondylosis in the lumbar spine superimposed upon congenital narrowing of the lower lumbar spinal canal. In particular, there disc herniations at L4-5 and L5-S1 with moderate narrowing of the spinal canal and severe right L5-S1 neural foraminal narrowing, and mild to moderate left L4-5 and L5-S1 and right L4-5 neural foraminal narrowing. There is 5 mm of anterolisthesis of L5 on S1. The vertebral body heights are preserved, but there is endplate irregularity and degenerative bone marrow signal alteration at L4-5 and L5-S1. There is a low signal subcentimeter nodule in the posterior neck subcutaneous tissues, which may represent an inclusion cyst, for example. There is a partially imaged mass in the the right lung.

Output: 1. Multilevel degenerative changes particularly in the cervical spine with associated impingement upon the spinal cord from C3-4 to C6-7. Apparent high signal on STIR in the spinal cord at these levels may be artifactual or represent edema or myelomalacia. Dedicated cervical spine imaging may be useful for further evaluation.2. Focal ligamentum flavum thickening at T2-3 and T5-6 without indentation of the spinal cord. 3. Degenerative spondylosis in the lumbar spine superimposed upon congenital narrowing of the lower lumbar spinal canal with spinal canal and neural foraminal stenoses from L4 through S1. 4. A partially imaged mass in the the right lung may represent a neoplasm. Dedicated chest CT is recommended for further imaging.Findings were discussed with Dr. Colton Clay by phone on 12/22/2016 at 12:10 PM.


Instruction: Generate impression based on findings.

Input: Reason: s/p UCL reconstruction with continued pain History: right elbow pain Status post ulnar collateral ligament repair. No joint effusion. No specific findings to account for patient's pain.

Output: Status post collateral ligament repair. No specific findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: Reason: 55 yo female with hx of resected retroperitoneal liposarcoma; please evaluate for any changes and or abnormalities History: retroperitoneal liposarcoma ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cortical defect.RETROPERITONEUM, LYMPH NODES: Focal asymmetric fat/fibrous tissue (questionable delayed enhancement) anterior to the left kidney (103:63). Retroperitoneal fat anterior to the left kidney is similar to prior study with minimal mass effect. No enhancing nodularity. Stable surgical clips. No new adenopathy. Stable nodule along the pancreatic tail (9:58) may be a small splenule.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace pelvic free fluid is noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable examination. No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Stage III C melanoma status post re-do right radical axillary lymph node dissection with excision of separate subcutaneous nodule of the right proximal upper extremity on 10/26/15 for metastatic melanoma, rule out brain metastasis. There is no evidence of intracranial mass, hemorrhage or acute infarct. There is no abnormal intracranial enhancement. There is patchy and confluent and intracerebral white matter T2 hyperintensity which may be nonspecific, but most compatible with small vessel ischemic changes. There is mild global parenchymal loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in the bilateral maxillary sinuses. There is trace fluid in the bilateral mastoid air cells. The orbits, skull and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastasis.2. Chronic small vessel ischemic changes, but no evidence of acute infarction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Worsening headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the anterior left ethmoid air cells.

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


Instruction: Generate impression based on findings.

Input: 67-year-old female with history of IPMN. ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter cyst of hepatic segment 4A (coronal series 3 image 23). No intra or extra hepatic biliary ductal dilatation. Normal gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: The small cystic lesion of the pancreatic tail at the level of the splenic hilum measuring 1.2 x 1 cm (axial series 4 image 16) is stable in size when measuring from the same slice level on the prior exam. Additional subcentimeter areas of T2 hyperintensities are again seen of the pancreatic body and neck. These foci are suggestive of sidebranch IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple subcentimeter sidebranch IPMNs. The small cystic lesion of the pancreatic tail measuring 1.2 x 1 cm (axial series 4 image 16) is stable in size when measuring from the same slice level on the prior exam.


Instruction: Generate impression based on findings.

Input: 57-year-old male with a history of hemangioblastoma presents for surveillance. Redemonstrated are post-operative changes of a right suboccipital craniotomy with resolution of the right cerebellar enhancing lesion and associated right cerebellar hemorrhage/edema. There is no longer effacement of the fourth ventricle. There is residual susceptibility abnormality indicating prior blood product and some small residual encephalomalacia. There is no restricted diffusion or abnormal enhancement. The enlarged perivascular space in the right midbrain is again seen and appears unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild maxillary sinus and frontal sinus mucosal thickening bilaterally.

Output: Status post removal of a posterior fossa mass without evidence for local recurrence.


Instruction: Generate impression based on findings.

Input: There is a wedge-like area of volume loss affecting the lateral aspect of the left cerebellar hemisphere. There is poorly defined mild T2 hyperintense signal in the left superior frontal lobe extending from the roof of the frontal horn of the left lateral ventricle into the subcortical white matter of the superior and middle frontal gyri, without associated mass effect or volume loss. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.No acute abnormality is identified.2.A small defect or area of volume loss is seen in the left cerebellar hemisphere which may be congenital or related to a previous insult, possibly ischemic.3.Vague left frontal lobe white matter signal abnormality is seen as described above of uncertain significance. The differential would include sequela of prior insult, an area of relatively delayed myelination, or less likely, a subtle cortical dysplasia.


Instruction: Generate impression based on findings.

Input: 80-year-old female experiencing radicular pain and right foot drop 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. Other than simple renal cysts, the visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation and disc height loss are present throughout. Previous Modic type I discogenic reactive endplate changes at L3/4 now appear as Modic type II. Multiple small Schmorl's nodes are noted, unchanged.T12/L1 demonstrates a small right paramedian disc protrusion without central canal stenosis, unchanged.L1/2 demonstrates an eccentric bulge to the right, without significant stenosis, unchanged.L2/3 demonstrates mild to moderate disk disease and moderate hypertrophic changes of posterior elements. No evidence of central spinal stenosis or significant neural foraminal compromise. These findings are unchanged.L3/4 demonstrates advanced degenerative disk disease with significant loss of disk height. Mild to moderate hypertrophy changes of ligamentum flavum and minimally of the facets are noted containing minimal bilateral facet effusions. There is mild to moderate central spinal stenosis, mild left neuroforaminal stenosis, and moderate right neural foraminal stenosis. These findings are unchanged. A previously demonstrated small synovial cyst projecting posterior to the articulating facet on the right is no longer evident.L4/5 demonstrates mild degenerative disk disease and moderate hypertrophic changes of facets and ligamentum flavum. There is resultant moderate central spinal stenosis. There is no significant neuroforaminal stenosis. These findings are unchanged.L5/S1 demonstrates mild to moderate disk disease and hypertrophic changes of posterior elements however without central spinal stenosis or neural foraminal compromise, unchanged.Stable fibrofatty infiltrative changes of filum terminalis.

Output: 1.L3/4: Moderate central spinal stenosis, mild left neuroforaminal stenosis, and moderate right neural foraminal stenosis, unchanged.2.L4/5: Moderate central spinal stenosis, unchanged.3.Stable fibrofatty infiltrative changes of filum terminalis.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for malignancy. Patient with known primary maligancy, leg weakness and radiculopathy. Punctate nodules of enhancement are present along the correlate quinine at that L3-4, L4-5 and L5-S1 levels.Small foci of low signal are reidentified at the L3 and L4 which do not enhance following gadolinium administration.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a moderate to marked degree bilateral facet hypertrophy present at this level. There is a ringlike enhancing adjacent to the right facet joint which has high signal centrally and low signal peripherally on T2 imaging and is hypointense centrally on T1 imaging comparedAt L4-5 there is bilateral facet hypertrophy right more than left with associated hypertrophy of the right-sided ligamentum flavum more than left. There is additional disk bulge present at this level and effacement of the fat of the right lateral recess resulting in encroachment of the nerve roots of the right lateral recess. There some mild encroachment of the exiting nerve root within the right neural foramen at this level. It overall there is a mild degree of spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is diffuse disk bulge and mild to moderate facet and ligamentum flavum hypertrophyAt L2-3 there is effacement of spinal fluid surrounding the cauda equina associated with diffuse disk bulge and mild ligamentum flavum hypertrophy. Overall there is mild/moderate spinal stenosis at this level.At L1-2 there is effacement of spinal fluid surrounding the cauda equina associated with diffuse disk bulge and mild ligamentum flavum hypertrophy. Overall there is mild spinal stenosis at this level.There is a large right-sided cystic lesion at the inferior pole of the right kidney which is not entirely included on this exam and appears to measure about 8 cm in size.

Output: 1.Several punctate lesions in the lower cauda equina are present. Differential considerations include leptomeningeal metastases, drop metastases and nerve sheath tumors.2.There are degenerative changes present in the lumbar spine with encroachment of the nerve roots of the right lateral recess at L4-5 related to disk disease and facet disease.3.There are degenerative changes present in the lumbar spine with the mild to moderate spinal stenosis at L2-3. There is mild spinal stenosis at L1-2.4.There appears be a synovial cyst associated with the right L5-S1 facet joint.5.Lesions present at L3 and L4 are suspected to represent sclerotic foci. Lack of contrast enhancement would tend to suggest that these are benign. In patients with prostate cancer. Nuclear medicine exam is more sensitive in detecting spinal metastases.6.There is an 8 cm cystic lesion present along the right kidney. It is not adequately evaluated on this lumbar spine MRI exam.


Instruction: Generate impression based on findings.

Input: Left common carotid artery originates from the proximal brachiocephalic trunk. There is atherosclerotic plaque at the right carotid bifurcation with 70% stenosis of the internal carotid artery origin. There is also atherosclerotic plaque at the left internal carotid artery origin with 40-50% stenosis. There also appears to be stenosis of the right external carotid artery origin. The remainder of the common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral arteries are patent.

Output: 70% stenosis at the right internal carotid origin. 40-50% stenosis of the left internal artery origin.


Instruction: Generate impression based on findings.

Input: History of ataxia, pseudotumor effect, mild cognitive impairment; evaluate for structural abnormalities. The lateral and third ventricles and Sylvian fissures are disproportionately prominent with respect to the cerebral sulci. There is a prominent jet of cerebrospinal fluid jet in the third ventricle. There are unchanged scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter. There is no midline shift or herniation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The major cerebral flow voids are intact. There is minimal bilateral maxillary sinus mucosal thickening and retention cyst in the left maxillary sinus. The orbits, skull and scalp soft tissues are grossly unremarkable.

Output: 1. Findings suggestive of normal pressure hydrocephalus.2. Cerebral white matter hyperintensities are nonspecific, but likely represent chronic small vessel ischemic disease.3. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Female, 41 days old, ex 34 week gestation, with multiple facial and cranial dysmorphic features, history of congenital HIV infection, with multiple anomalies identified on prenatal imaging including incracranial mass or hemorrhage. Brain:The space occupying process seen on prenatal imaging which was situated posterior to the right thalamus has resolved. In its place, there is susceptibility effect compatible with hemosiderin staining which lines the right transverse cerebral and choroidal fissures and the ambient cistern. Foci of susceptibility effect are also seen within the occipital horns and along the fourth ventricular margins likely indicating additional sites of hemosiderin staining.No evidence of acute intracranial hemorrhage is seen, including in the areas of the germinal matrix. No restricted diffusion, edema, mass or mass effect is identified. No pathologic intracranial enhancement is observed. The ventricles are normal in size and morphology. The pituitary region is within normal limits. The corpus callosum is fully formed and intact. The brainstem and cerebellum are likewise within normal limits. The pattern of white matter myelination is appropriate or at most minimally delayed for the corrected gestational age. The degree of sulcation and overall cerebral morphology are within normal limits. No migrational anomalies are detected.Orbits:Right sided findings:The right orbit is smaller than the left. A rudimentary or atrophic and malformed globe is suspected inferiorly within the orbit. Some orbital adnexae are present though they are dysmorphic and not well delineated. A hypoplastic or atrophic right optic nerve is seen.Left-sided findings:The globe is slightly elongated in the AP dimension. A lens or lens-like structure does appear to be present though it is small and situated more anteriorly than typical. A small focal outpouching of the globe along the inferior surface may represent a coloboma (see image 3series 901). The optic nerve is visualized. The extraocular muscles are present but precise delineation is difficult.Neck:The neck soft tissues are within normal limits. No cystic or solid masslike lesions are seen. The airway is patent. Bone marrow signal intensity is within normal limits. Irregularity of the left aspect of the nose is seen and can be correlated with physical exam findings.

Output: 1.On comparison with fetal imaging, a space occupying process posterior to the right thalamus has resolved leaving behind an area of cisternal hemosiderin staining. This lesion likely represented an extra-axial hematoma or hemorrhagic cyst. Trace hemosiderin staining is evident in the ventricular system. No findings to suggest acute intracranial hemorrhage are observed.2.Cerebral and cerebellar morphology are otherwise within normal limits. No parenchymal defects, encephalomalacia or migrational anomalies are observed. The degree of gyral development is appropriate for age. No findings to suggest active intracranial infection are demonstrated.3.The right orbit is small and the globe is severely atrophic or hypoplastic. A small right optic nerve seems to be present. On the left, the globe is mildly dysmorphic with a probable small inferior coloboma. The optic nerve is present on the left.4.Imaging of the neck soft tissues is within normal limits. Mild deformity of the nose can be better assessed on physical exam.


Instruction: Generate impression based on findings.

Input: 67-year-old female with outside CT demonstrating 5-mm groundglass nodule left upper lobe LUNGS AND PLEURA: Mild apical pleural scarring.A 5-mm groundglass nodules identified left upper lobe (image 38 series 4). Previous outside imaging is not available for review at the time of reporting.Mild basilar scarring bilaterally.MEDIASTINUM AND HILA: No evidence of hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: Intraspinal calcification at T10 level on the left appears be extradural in location may represent a calcified small meningioma. There is mild displacement and compression of the spinal cord from left to right. MRI of the thoracic spine is recommended for further evaluation.UPPER ABDOMEN: Cholelithiasis.

Output: 1.Small 5-mm groundglass nodule within the left upper lobe. Follow up examination in one year is advised.2.Intraspinal probable extradural calcification at T10 on the left of uncertain clinical significance. MRI of the thoracic spine is advised for further evaluation.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign intracranial hypertensionClinical question: eval VP shunt positionSigns and Symptoms: HA The CSF spaces are appropriate for the patient's stated age with no midline shift. The right lateral ventricle is smaller than the left lateral ventricle.The pontomedullary junction is present. The cerebellar tonsils are low lying. There is no evidence for pachymeningeal thickening or subdural effusions.There is a ventricular catheter was coarse of the right frontal lobe into the right lateral ventricle, through the third ventricle and into the posterior fossa abutting the basilar artery with tip in the posterior fossa anterior to the vertebrobasilar junction. There is metallic artifact present adjacent to the right frontal bone which obscures visualization superior and medial aspect of the right frontal lobe.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a minor opacity in the right ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post ventriculostomy tube placement as described above abutting the basilar artery with tip anterior to the vertebrobasilar junction.


Instruction: Generate impression based on findings.

Input: 74 years Male (DOB: 11/17/1941)Reason: neck pain r/o cervical spinal stenosis History: neck pain r/o cervical spinal stenosisPROVIDER/ATTENDING NAME: JULIE L. OYLER JULIE L. OYLER The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.There is mild indentation along the posterior aspect of thecal sac at the C1 level. There are some degenerative changes present along the right articulation between C1 and C2. This results in mild indentation along the right half of the thecal sac and encroachment of the right neural foramen at this levelAt C2-3 there is no significant compromise to the spinal canal or neural foramina. There is disc desiccation and a disc bulge at this level.At C3-4 there is loss of disc space height, endplate uncovertebral osteophytes and a diffuse disc bulge associated with right-sided facet hypertrophy. There is partial effacement of CSF ventral to the spinal cord at this level. There is encroachment of the neural foramina bilaterally with encroachment of right-sided exiting nerve roots within the neural foramen more than the left at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is disc desiccation and diffuse disc bulge associated with uncovertebral osteophytes and encroachment of the neural foramina and exiting nerve roots bilaterally. There is partial effacement of spinal fluid ventral to the spinal cord at this level.At C6-7 there is disc desiccation and diffuse disc bulge associated with loss of disc space height and endplate reactive change. Endplate reactive changes are high signal on T2 and low signal on T1. There are endplate and uncovertebral osteophytes present this level associated with encroachment of the exiting nerve roots bilaterally within this level. There is ligamentum flavum hypertrophy at this level and overall a moderate degree of spinal stenosis.At C7-T1 there is no significant compromise to the spinal canal. There are small uncovertebral osteophytes and some disc material and encroachment of the left-sided exiting nerve roots within the neural foramen at this level.The vertebral artery flow voids appear to be intact. On the right side at the level of the right vertebral artery groove the right vertebral artery flow-void is not entirely seen.

Output: 1.There are multilevel degenerative changes present in the cervical spine worse at C6-7 there is moderate spinal stenosis and subacute endplate reactive change. There is encroachment of exiting nerve roots within the neural foramina bilaterally at C3-4, C5-6 and C6-7 and on the left side at C7-T1.2.There are some erosive changes along the right articulation at C1-2. This mildly indents the thecal sac and encroaches on the right-sided exiting nerve roots at C1-2 in general this has the appearance of degenerative change but is incompletely evaluated. Perhaps a CT of the upper cervical spine would help further evaluate this if clinically appropriate. It is also unclear this affects the underlying right vertebral artery based on this exam.


Instruction: Generate impression based on findings.

Input: 3 story fall with cervical spine pain on examination. Alignment is notable for mild reversal of the normal lordosis. Craniocervical articulation is normal as well as the cervicothoracic junction. The cervical vertebral bodies are preserved in height and there is no marrow edema. Marrow signal is relatively homogeneous. Prevertebral soft tissues are not thickened or edematous. There is no interspinous or paraspinal soft tissue edema. The spinal canal is preserved. The spinal cord (down to T2 level) shows normal morphology and signal. Also, the included lower brainstem and cerebellum show no abnormality. Vertebral artery flow voids are preserved. Also, the other major cervical vessels show preserved flow voids. Small lymph nodes on both sides of the neck are very nonspecific in this age group. There is a 5 mm well-circumscribed, homogeneously T2 hyperintense lesion in the right thyroid lobe. C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: There is no spinal canal or foraminal stenosis.C4-C5: There is no spinal canal or foraminal stenosis.C5-C6: There is no spinal canal or foraminal stenosis.C6-C7: There is no spinal canal or foraminal stenosis.C7-T1: There is no spinal canal or foraminal stenosis.

Output: 1.There is no cervical spine fracture or malalignment, accounting for reversal of the normal lordosis which might be related to patient positioning or immobilizatoin.2.There is no sign of soft tissue injury.3.The spinal canal and neural foramina are patent.


Instruction: Generate impression based on findings.

Input: [17-year-old male patient with open radius fracture treated with ORIF at outside hospital. Pain in distal ulna consistent with infection.] [Evaluation of the distal radius and surrounding soft tissues is limited due to metallic susceptibility artifact from orthopedic fixation of the distal radius.The distal 5 to 6 cm of the ulna is replaced with abnormal signal intensity which is isointense to skeletal muscle on T1-weighted images and hyperintense on T2-weighted images compatible with osteomyelitis, and likely intra-osseous abscess formation. There is heterogeneous enhancement of the distal ulna and surrounding soft tissues following contrast administration with a small rim-enhancing fluid collection anterior to the distal end of the ulna representing a small abscess. Additional mild edema is noted within the distal ulnar diaphysis. Portions of the cortex of the distal ulna appear completely destroyed. The soft tissue inflammatory component along the distal end of the ulna measures approximately 3 cm in greatest transverse dimension. The inflammatory process extends to the sigmoid notch of the distal radius and there is underlying edema within the marrow of the distal radial metaphysis which could represent reactive osteitis or osteomyelitis. There is mild edema within the pronator quadratus, but we see no discrete abscess within the musculature of the forearm and visualized proximal hand. We see no findings to suggest osteomyelitis of the proximal carpal row.

Output: [Osteomyelitis of the distal ulna with surrounding soft tissue inflammatory changes as described above which abuts the sigmoid notch of the distal radius. Edema within the distal radial metaphysis may reflect reactive osteitis or osteomyelitis. On the basis of accompanying outside hospital radiographs, the diagnosis of osteomyelitis of the distal radius is favored.


Instruction: Generate impression based on findings.

Input: 44-year-old male with a history of visual disturbance and 2011 followed by memory difficulty. There are few punctate foci of T2 hyperintensity within the subcortical white matter, which are nonspecific. No evidence of acute ischemia or hemorrhage. No intracranial mass or mass effect. No abnormal enhancement. Ventricular configuration is within normal limits. Normal flow voids are seen in the major intracranial vessels. Minimal paranasal sinus mucosal thickening. Mild medial herniation of the orbital fat is seen bilaterally which may related to prior trauma but can be a normal variant. The soft tissues of the scalp are normal.

Output: Minimal scattered punctate foci of T2 hyperintensity within the subcortical white matter which are nonspecific and may represent mild chronic small vessel ischemic changes. Morphology and distribution are not particularly suggestive of demyelinating disease although not entirely excluded. MRI of the brain is otherwise unremarkable. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Neck pain, status post posterior cervical spine surgery Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign. There is mild thickening and ossification along the posterior longitudinal ligament which is discontinuous are present from C4 to the C7-T1 levels. Bridging osteophytes ventrally are also noted which may be related to DISH but are relatively small. The cervical spinal cord has normal signal characteristics and overall morphology.Postsurgical changes are better assessed on recent CT including small laminotomies. Multilevel facet arthropathy including ankylosis of the left-sided facets noted on the left from C2 to C4.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: Ossification of the posterior longitudinal ligament and ligamentum flavum thickening result in mild spinal canal stenosis. There is moderate left and mild right neural foraminal stenosis.C5-6: Disc osteophyte complex is associated with mild spinal canal stenosis. There is moderate bilateral neural foraminal stenosis particularly involving the lateral aspect of the neural foramina.C6-7: Ossification of the posterior longitudinal ligament and mild ligamentum flavum thickening is associated with mild spinal canal stenosis. There is moderate to severe neural foraminal stenosis particularly involving the lateral aspect of the right neural foramen. No significant left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal. There is mild to moderate left neural foraminal stenosis. No significant right neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild spinal canal stenosis at C4-C5, C5-C6, and C6-C7 related to disc osteophyte complexes and ossification of the posterior longitudinal ligament. There is also neural foraminal stenosis from C4-C5 to C7-T1 as detailed above. No cord signal abnormality.Postsurgical changes and ossification of the posterior longitudinal ligament better seen on recent CT.


Instruction: Generate impression based on findings.

Input: Clinical question: Lung cancer with previous metastatic lesions treated with RT. Evaluate for disease. Signs and symptoms: Lung cancer. Enhanced CT of brain:There is redemonstration of the left-sided frontal extra-axial dural based enhancing tumor measuring 18.3 millimeter in AP access (sagittal reformatted image 35) and 18.9-mm in transverse axis measured on axial postinfusion image 22 these measurements are identical to prior MRI exam. These signal characteristic and pattern of enhancement as well as its location is highly suspected for a meningioma as it was noted on prior MRI. There is subtle buckling of the adjacent brain parenchyma however no vasogenic edema is detected. There is an enhancing well-demarcated mass in the right frontal lobe with extensive surrounding vasogenic edema. This tumor measures 14.1-mm in transaxial dimension (axial postinfusion image 21). On prior exam this tumor measured 5.6-mm in its transaxial dimension. There is no evidence of an additional metastatic lesions to the brain or the leptomeninges.Calvarium is intact. Visualized mastoid air cells, middle ear cavities are unremarkable. Visualized paranasal sinuses demonstrate complete opacification of right frontal sinus this finding was noted on prior MRI and CT exam.80 cc of Omnipaque 350 is administered for the study.

Output: 1.Dural based extra axial well-demarcated enhancing mass in high convexity left frontal lobe highly suspected of a meningioma. The measurement of the tumor are similar to prior MRI exam (18.3-mm in AP access and 18.9-mm in transverse axis).2.Significant interval increase in the size of a right frontal single metastatic focus which measures 14.1 x 14.1 millimeter in transaxial dimension.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is mild increased signal intensity of the supraspinatus tendon suggesting tendinosis but we see no fluid-filled tear. There is linear increased signal intensity within the muscle fibers of the supraspinatus more proximally which is favored to represent vascularity rather than interstitial tearing. The supraspinatus muscle is otherwise normal. There is mildly increased signal intensity within the distal fibers of the infraspinatus tendon suggesting mild tendinosis but again, there is no evidence of a fluid-filled tear. The infraspinatus muscle is normal. The subscapularis and teres minor tendons and muscles are normal.SUPRASPINATUS OUTLET: There is mild to moderate osteoarthritis of the acromioclavicular joint. A trace amount of fluid is present within the subacromial subdeltoid bursa which is not necessarily of any current clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Although we see no fluid signal intensity within the superior labrum, there is branching intermediate signal intensity within the substance of the superior labrum suggesting the presence of a tear. The anterior inferior labrum is attenuated with increased intrasubstance signal intensity suggesting additional tearing. Small cysts are noted within the anterior medial humeral head which are likely degenerative in etiology.BICEPS TENDON: Within the limits of a non-arthrogram study, the tendon of the long head of the biceps appears intact.

Output: 1. Mild rotator cuff tendinosis without evidence of full-thickness tear.2. Degeneration and tearing of the superior and anterior inferior labrum as described above.


Instruction: Generate impression based on findings.

Input: Severe back and leg pain. There is a small central disc protrusion without significant spinal canal or neural foraminal stenosis at L4-5 associated with mild disc dessication. There is no significant degenerative spondylosis at the other lumbar spine levels. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged portion of the spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Small central disc protrusion without significant spinal canal or neural foraminal stenosis at L4-5 associated with mild disc dessication. No significant degenerative spondylosis at the other lumbar spine levels.


Instruction: Generate impression based on findings.

Input: Reason: eval for gastroc tear vs meniscal tear History: knee pain for months with hyperflexion, clicking not better with therapy MENISCI: There is branching intermediate signal intensity within the peripheral third of the posterior horn of the medial meniscus extending into the root. Although we suspect that much of this represents normal vascularity, the signal does extend to the tibial articular surface, suggesting a small incomplete longitudinal undersurface tear of the vascularized periphery. Please note that this could represent a healed tear, and is not necessarily of any current clinical significance. The body and anterior horn of the medial meniscus appear normal. The lateral meniscus appears normal. ARTICULAR CARTILAGE AND BONE: The articular cartilage of the knee appears intact. There is no bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact.ADDITIONAL

Output: Findings suggestive of a short incomplete undersurface tear of the peripheral third of the posterior horn of the medial meniscus. Again, please note that this could represent a healed tear and is not necessarily of any current clinical significance. We otherwise see no findings to account for the patient’s pain. Specifically, we see no muscle tear.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with new left arm weakness. Assess for new ischemic lesions or masses. Assess for critical vascular stenosis requiring intervention. Also severe back pain, leg weakness and positive straight leg test. Assess for lumbar degenerative disease. Please note that most of the sequences in the brain examination are degraded by artifact such that the central portion of the images demonstrates significant loss of signal. This artifact substantially reduces sensitivity for small or subtle abnormalities. Within this limitation, the following observations are made.MRI brain:No definite restricted diffusion is seen. Scattered foci of white matter T2 hyperintensity are redemonstrated similar to prior and without significant interval change. In the cerebellum, multiple chronic strokes are redemonstrated similar to prior.No evidence of large intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Ventricular size and morphology are within normal limits. On post contrast images, no pathologic parenchymal or extra-axial enhancement is appreciated.MRA brain:The left vertebral artery flow void is not identified on the MRA of the brain which may reflect small size or reduced flow velocity. The right vertebral artery, basilar artery, and PCAs are within normal limits.The ICAs demonstrate normal flow related signal without significant stenosis. Prominent PCOM arteries are evident bilaterally. The MCA distributions are within normal limits given the limitations of technique. The right A1 segment is hypoplastic. Only a single A2 ACA segment is identified which may reflect an azygos configuration.MRA neck:Common origin of the brachiocephalic and left common carotid arteries is seen. The right ICA is somewhat narrowed at its origin but no more than than 50% by NASCET criteria. The ICAs otherwise demonstrate relatively normal opacification to the level of the skull base. Incidental note is made of an asymmetrically prominent right internal maxillary artery of uncertain but doubtful significance. The proximal right vertebral artery may be slightly narrowed but otherwise demonstrates relatively normal caliber through the neck. The left vertebral artery is not specifically visualized until the V4 segment is reached where there appears to be a small amount of contrast opacification.MRI lumbar spine:Spinal alignment is anatomic. Vertebral body heights are preserved. No worrisome marrow signal abnormality is detected.Severe, essentially complete loss of disc height is evident at L5-S1 with fatty degenerative endplate signal change. Additional level specific findings are detailed below.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable. Multiple scattered perineural root sleeve cysts are seen within the lumbar spine and sacrum.L1-2: Unremarkable. L2-3: Left facet hypertrophy. No significant spinal canal or foraminal stenosis. L3-4: Facet hypertrophy and ligamentum flavum thickening. Mildly reduced disc height and T2 signal. No disc herniations. No significant spinal canal or foraminal stenosis. L4-5: Facet hypertrophy and ligamentum flavum thickening. Mildly reduced disc height and T2 signal with a small central annular fissure and questionable shallow central protrusion. No significant spinal canal or foraminal stenosis. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Essentially complete loss of disc height with osteophytic spurring which slightly effaces the ventral thecal sac. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing presentIncidental note is made of bilateral adnexal cystic lesions, likely physiologic.

Output: 1.Brain MRI image quality is significantly reduced by artifact as discussed above. Within this limitation, no definite acute intracranial abnormality is seen. However, the sensitivity for detection of smaller subtle lesions is significantly reduced. Therefore, the patient will be invited to return for repeat imaging at no additional cost. These repeat images will be interpreted in a separate report.2.Demonstration of multiple scattered areas of white matter signal abnormality which are nonspecific and not significantly changed. Multiple chronic cerebellar strokes are also unchanged.3.The left vertebral artery is not specifically visualized in the neck which could indicate severe narrowing or occlusion, possibly also a congenitally diminutive vessel. Some reconstitution of the vessel is seen at the V4 segment. No definite high-grade intracranial stenoses are suspected, though again, image quality intracranially is significantly reduced and the MRA examination will be repeated. Possible azygos configuration of the ACA is suggested.4.Degenerative disc disease at L5-S1 with essentially complete loss of disc height and posterior endplate spurring. Despite this, however, there is no significant spinal canal stenosis and only mild foraminal narrowing.


Instruction: Generate impression based on findings.

Input: There are post-treatment findings in the nasopharyngeal region. There has been interval decrease in the enhancing lesion in the superior right parasagittal posterior nasopharynx, with mild asymmetric prominence on that side, but no discretely measurable tumor. There is no evidence of skull base invasion or intracranial extension. The pre-vertebral, parapharyngeal, and masticator spaces are intact. There is no significant lymphadenopathy in the neck. There is no significant airway narrowing. The parotid and submandibular glands are unremarkable. There is degenerative spondylosis in the cervical spine, which is most pronounced at C4/5.

Output: Interval decrease in size of the nasopharyngeal carcnoma without evidence of skull base invasion or intracranial extension.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 33 year old male with history of ventriculoperitoneal shunt placement; please evaluate. Enlarged supratentorial ventricular system with a right-sided ventricular catheter with its tip abutting the septum pellucidum. The size of the lateral ventricles remain similar to prior MRI examination from 11 -- 26 -- 2008.The cortical sulci, basal cisterns remain within normal limits. No evidence of hemorrhage, edema, mass-effect or midline shift is detected.

Output: 1.No evidence of acute intracranial findings.2.Stable size of ventricular system since prior MRI from November of 2008.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is slight reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. A tiny focus of apparent T2 hyperintensity involving the anterior left paramedian cord on axial T2 technique (series 10, image 5) is not present on sagittal T2 technique, and thus is felt to represent artifact. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Posterior osteophyte disc complex causes slight anterior cord flattening without intrinsic cord signal abnormality or significant resulting stenosis.C4/5: Posterior osteophyte disc complex causes minimal anterior cord flattening without intrinsic cord signal abnormality or resulting central stenosis. There is also bilateral uncinate hypertrophy which causes mild bilateral neural foraminal stenosis.C5/6: Minimal posterior osteophyte complex without cord abutment is noted. There is also bilateral uncinate hypertrophy causing mild-to-moderate bilateral neural foraminal stenosis.C6/7: UnremarkableC7/T1: Unremarkable

Output: 1.C4/5: Mild bilateral neural foraminal stenosis.2.C5/6: Mild-to-moderate bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 46-year-old male with sensory level, evaluate spinal known thoracic lipoma. CERVICAL SPINE: The vertebral body heights and disc are normal. Straightening of the cervical spine, otherwise no abnormal alignment. No abnormal marrow signal or enhancement. There is mild edema within the lower cervical cord as described below. At C5-C6, there is mild left foramen disc osteophyte complex effacing the left lateral recess with associated mild left neural foramen narrowing and mild effacement of the left thecal sac. At C6-C7, there is mild disc osteophyte complex without significant spinal or neuroforamen stenosis. THORACIC SPINE: There is a nonenhancing intramedullary lesion with fat signal characteristics extending from the level of the inferior aspect of T1 to the superior aspect of T3, which measures 1.6 x 1.2 x 3.3 cm. There is expansion of the cord with edema at this level extending superiorly and inferiorly from the lesion. The central canal is mildly dilated superiorly. The alignment of the thoracic spine is normal and there is no significant spinal canal or neural foramen stenosis throughout the thoracic spine.LUMBAR SPINE: The alignment is anatomic and the vertebral body heights are intact. There is minimal disc desiccation of L3-L4 and L4-L5. No abnormal marrow signal. No abnormal signal within the cord or conus, and T12-L1. There is no significant herniation, or spinal canal or neural foramen stenosis throughout the lumbar spine.

Output: 1. Intramedullary lipoma in the upper thoracic spinal cord with associated edema.2. Multilevel degenerative cervical spondylosis that is most pronounced at C5-C6 associated with mild left neural foramen and spinal canal narrowing.


Instruction: Generate impression based on findings.

Input: There are few punctate foci of mildly high signal on DWI with corresponding low signal on ADC in the right parahippocampal gyrus (series 501 image 223), left posterior frontal/parietal lobe cortex (series 501 image 227) and right medial parietal/occipital lobe cortex (series 501 image 231). A punctate focus of apparent high DWI signal in the left periventricular white matter on series 501 image 228 is likely T2 shine through artifact. There is mild/moderate nonspecific confluent T2 hyperintensity in the periventricular and subcortical white matter, likely representing chronic microvascular ischemic changes. There is left medial and inferior cerebellar hemispheric encephalomalacia. There is mild age-related sulcal prominence. There is no hydrocephalus. There is scattered bilateral mastoid air cell high T2 signal.

Output: 1.Few punctate foci of small vessel distribution acute to subacute infarcts in the left posterior frontal/parietal cortex, right medial temporal lobe and parietal/occipital lobes. 2.Moderately advanced chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Cervical spine: There is slight reversal of normal upper cervical lordosis without fracture. There is mild degenerative marrow signal heterogeneity without discrete suspicious osseous lesion. The cervical cord is normal in signal. There is mild degenerative cervical spondylosis with level specific findings as follows: C2-3: No significant central canal or neuroforaminal stenosis. C3-4: Mild posterior osteophyte disc complex without cord abutment or stenosis.C4-5: Posterior osteophyte disc complex causes anterior midline cord flattening without intrinsic cord signal abnormality. There are no significant stenoses. A focal disk protrusion seen on the prior study appears improved. C5-6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate left neural foraminal and mild right neural foraminal stenosis.C6-7: Posterior osteophyte disc complex abuts the cord without deformation or stenosis. There is moderate left and mild right neural foraminal stenosis.C7/T1: Minimal midline posterior osteophyte disc complex without stenosis.Thoracic spine: There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There is no significant central canal or neuroforaminal stenosis. There is mild dependent pleural fluid versus thickening. Lumbar spine: 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. A simple renal cyst is present on the left, otherwise the visualized intra-abdominal and paraspinal contents are unremarkable.L1-2: No significant central canal or neuroforaminal stenosis. L2-3: No significant central canal or neuroforaminal stenosis. L3-4: Mild disc bulge and slight ligamentum flavum thickening without associated stenosis.L4-5: Disk bulge and slight ligamentum flavum thickening, and moderate bilateral facet hypertrophy containing bilateral facet effusions. There is mild bilateral lateral recess and mild bilateral neural foraminal stenosis.L5/S1: Mild disc bulge without stenosis.

Output: 1. No suspicious lesions in the cervical, thoracic, or lumbar spine, and no significant interval change since the prior study from 8/11/12. 2. Mild cervical and lumbar degenerative disease as detailed above is not significantly changed. 3. Please see separately dictated MRI pelvis report for description of findings in the pelvis.


Instruction: Generate impression based on findings.

Input: 62-year-old male with history of CNS lymphoma. Pre-surgical planning study. Stealth infused head CT:Nonenhanced 1 mm head CT examination with 2-D reformatted images for surgical planning is obtained.There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains normal. Previously noted minimal small vessel disease on prior brain MRI examination is not identified on this study.Visualized paranasal sinuses, mastoid air cells are unremarkable. Calvarium is intact.New since prior exam is bilateral paramedian high convexity parietal subcutaneous scalp soft tissue thickening which is best appreciated on axial images 27 through 29. Please correlate with history.

Output: 1.No evidence of any intracranial abnormality. Stable exam since prior study.2.Subgaleal soft tissue thickening in high convexity paramedian parietal region is new since prior exam. 3.Unremarkable calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Perianal pain. 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: Within the right ischiorectal fossa there is a 2.5 x 1.6 cm collection which communicates with a fistula tract extending to the right dorsal paramedial gluteal fold (series 5 image 24 through 31). There appears to be a complex fistula originating at the 6 o'clock position of the anal canal extending inferiorly to the 12 o'clock position where it branches and proceeds dorsally to feed the fistula tract extending to the skin surface and slightly anteriorly and cranially to supply the fluid collection/abscess. OTHER: No significant abnormality noted.

Output: Complex fistula tract believed to involve the 6 o'clock position of the anal canal extending towards the 12 o'clock position where it branches to supply a 2.5 cm fluid collection/abscess and a fistula tract extending to the right paramedial gluteal fold skin surface.


Instruction: Generate impression based on findings.

Input: Reason: breast cancer with brain met; RT planning for SRS History: RT planning; no neuro symptoms The previously seen superior left cerebellar punctate enhancing nodule has decreased in size, now measuring 3 x 3 mm on 401/75, as compared to previous 5 x 6 mm. There is associated punctate susceptibility now, with mild T2 hyperintensity.There are a few areas of ill-defined enhancement within the calvarium bilaterally, slightly more conspicuous. The areas along the vertex are more rounded in configuration (401/155 and 160). One rounded lesion along the left parietal bone (403/71) is not definitely seen on the prior exam. Review of outside bone scan seems to suggest some areas of corresponding focal uptake in the calvarium.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal or pathological parenchymal enhancement. No extra-axial fluid collection is identified.

Output: 1. Interval decreased size of single left superior cerebellar enhancing nodule, now only measuring 3 mm.2. Multiple areas of ill-defined calvarial enhancement, appearing more rounded near the vertex, suspicious for osseous metastatic disease especially given recent bone scan correlation. These appear minimally progressed since prior.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. Cervical spine:Degenerative disease of cervical spine is again noted, with disk space narrowing at C6 -- C7 level. There is disk space narrowing and posterior disk-osteophyte complex at C6 -- C7 level. There are facet and uncovertebral joint arthropathic changes at multiple levels. There are no blastic or lytic metastasis identified.Thoracic spine:There is a sclerotic lesion in right posterior aspect of T10 vertebra, likely representing a metastatic focus that was also seen in prior MRI of 5/17/2011. Mild degenerative changes are also seen in thoracic spine. Lumbar spine:There are mixed lytic / blastic lesions involving L3, L4 and L5 levels, with involvement of both anterior and posterior elements. There is epidural extension, and extension into the left neural foramina at L3 -- L4 and L4 -- L5 levels, and to the left paraspinal region. These findings are better seen on prior MRI study. Findings are consistent with metastasis. There is suspicion of new lesion in S1 vertebra. Postsurgical changes in the posterior lumbar region are again present.No evidence of acute fracture is seen.Tarlov cysts are again noted at S2 level.There are multiple small nodules in bilateral lungs, consistent with lung metastasis.

Output: 1. Metastasis in T10 vertebra.2. Extensive metastatic disease at the L2 to L5 levels, with epidural extension. 3, Suspicious new lesion at S1 level. 4. Multiple metastatic pulmonary nodules. Please correlate with CT chest. Imaging findings of the thoracic and lumbar spine can be better evaluated with MRI with contrast.


Instruction: Generate impression based on findings.

Input: 72 y/o male with systemic amyloidosis, diastolic dysfunction, ESRD, multiple myeloma, HTN and HLD. Patient is referred for MRI evaluation pre-inguinal hernia repair. Left VentricleThe left ventricle is normal in size and systolic function. There is mild concentric left ventricular hypertrophy (IVSd=12 mm; previously 14mm). The overall LV ejection fraction is 64%. The LVEDV is 110 ml (normal range 142+/-34), the LV end diastolic volume index is 52 ml/m2 (normal range: 74+/-15), the LVESV is 39 ml (normal range 47+/-19) and the LV end systolic volume index is 19 ml/m2 (normal range 25+/-9). The LV mass is 95 g (normal range 164+/-36) and the LV mass index is 45 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. The native T1 myocardial relaxation times are 1100 ms in the left ventricular lateral wall and 1157 ms in the interventricular septum. These values are elevated and consistent with his diagnosis of suspected cardiac amyloidosis and have improved from his previous cardiac MRI 9/25/2015 (1215 ms).There is no myocardial iron overload. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 52%. The RVEDV is 157 ml (normal range 142+/-31), RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVESV is 76 ml (normal range 54+/-17), and the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve is trileaflet and opens widely. 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 mild-moderate regurgitation.AortaThere is a left sided aortic arch with a pseudobovine pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (30.7 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. A catheter is noted in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a large right sided pleural effusion. 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. Normal LV size and systolic function, LVEF 64%. Mild left ventricular hypertrophy. LV wall thickness and native myocardial T1 have improved when compared to the previous cardiac MRI of 2015.2. Normal RV size with mildly reduced systolic function, RVEF 52%.3. Biatrial dilatation. 4. Large right pleural effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Mental status change. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged punctate foci of T2 hyperintensity in the right frontal lobe white matter. The ventricles and extra-axial cerebrospinal fluid spaces are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Unchanged nonspecific punctate foci of T2 hyperintensity in the right frontal lobe white matter.


Instruction: Generate impression based on findings.

Input: Clinical question: Mass? Signs and symptoms: Right basal ganglia hypodensities seen on CT. Nonenhanced brain MRI:Examination demonstrates a large focus of restricted diffusion in the right basal ganglia consistent with an acute ischemic stroke. The finding measures at least 12 x 22 mm in transaxial dimensions and corresponds to the region of low-attenuation on prior head CT. There is evidence of susceptibility signal changes within the acute stroke consistent with hemorrhagic changes. This finding results in subtle mass effect on the right frontal horn of lateral ventricle.Additionally examination demonstrate mild to moderate degree of chronic nonhemorrhagic small vessel ischemic strokes primarily in the periventricular and to a lesser degree subcortical white matter of bilateral cerebral hemispheres. Unremarkable cerebral cortex, cortical sulci and CSF spaces.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.

Output: 1.Acute hemorrhagic right basal ganglia ischemic stroke.2.Chronic nonhemorrhagic small vessel ischemic strokes of mild to moderate degree.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: There is mildly increased signal intensity involving the distal fibers of the supraspinatus tendon which may reflect mild bursal surface fraying but there is no evidence of a full-thickness tear. The remaining rotator cuff tendons also appear normal. The rotator cuff musculature is normal.SUPRASPINATUS OUTLET: There is a mild amount of increased signal intensity within the acromioclavicular joint which may reflect mild degenerative change. There is no significant fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Within the limits of this nonarthrographic study, the labrum appears grossly intact. Alignment of the glenohumeral joint is normal. There is no glenohumeral joint effusion.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Mild tendinopathy and perhaps bursal surface fraying of the supraspinatus tendon with no evidence of a full-thickness rotator cuff tear.2. Increased signal intensity within the acromioclavicular joint may represent mild degenerative change.


Instruction: Generate impression based on findings.

Input: Male; 62 years old. Reason: newly diagnosed prostate cancer, evaluate extent of disease History: none PELVIS:PROSTATE:Prostate Size: 2.8 x 3.8 x 4.4 cm.Peripheral Zone: Right mid to apical peripheral zone lesion demonstrating low T2 signal and low signal on exponential ADC map, suspicious for prostate cancer and measuring up to 9 x 8 mm (series 1001/13). Scattered areas of high T1 signal greatest in the right peripheral zone, most compatible with hemorrhage from recent biopsies.Central Gland: Heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered, subcentimeter bilateral pelvic sidewall lymph nodes are not pathologically enlarged by size criteria.BONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: No significant abnormality noted.

Output: Right peripheral zone lesion suspicious for prostate cancer without evidence of local invasion or metastatic disease.


Instruction: Generate impression based on findings.

Input: 48-year-old female with sickle cell disease hip pain. Evaluate for avascular sclerosis. Suboptimal evaluation secondary to patient motion artifact.LEFT HIP:Heterogeneous bone marrow signal abnormality is nonspecific but may reflect residual islands of red marrow and can be seen in patients with anemia. There is mild diffuse fatty atrophy of the musculature of the left hip. No findings to suggest avascular necrosis. There is a small amount of fluid within the joint without evidence of large effusion.RIGHT HIP:Heterogeneous bone marrow signal abnormality is nonspecific but may reflect residual islands of red marrow and can be seen in patients with anemia. There is mild diffuse fatty atrophy of the musculature of the left hip. No findings to suggest avascular necrosis. Mild to moderate degenerative disc disease affecting the lower lumbar spine. Note is made of subcentimeter uterine fibroids. There is a small amount of free fluid within the pelvis which is likely physiologic. There is a small amount of fluid within the joint without evidence of large effusion. Note is made of a right iliac fossa transplant kidney. There is nonspecific subcutaneous edema along the lateral aspect of the thighs bilaterally.

Output: No findings to suggest avascular necrosis. Findings consistent with the patient's stated history of sickle cell disease and other findings as described above.


Instruction: Generate impression based on findings.

Input: There is straightening of the upper cervical spine which is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Mild posterior osteophyte disc complex effaces the anterior CSF without resulting central or neural foraminal stenosis.C4/5: Mild posterior osteophyte disc complex effaces the anterior CSF without resulting central or neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, slight ligamentum flavum thickening, and bilateral uncinate hypertrophy (left greater than right). There is mild left neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, slight ligamentum flavum thickening, and bilateral uncinate hypertrophy (left greater than right). There is mild left neural foraminal stenosis. C7/T1: Unremarkable

Output: 1.C5/6: Mild left neural foraminal stenosis.2.C6/7: Mild left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: History of cervicothoracic laminectomy for metastases/debulking. Evaluate for changes/recurrence. Surveillance. Again seen are postoperative findings related to multilevel laminectomies in the lower cervical and upper thoracic spine. Vertebral body heights in the cervical spine are normal. Alignment of cervical spine is maintained. Mild degenerative changes are present including small disc osteophyte complexes at the C3-C4 to C5-C6 levels with ligamentum flavum thickening contributing to mild spinal canal stenosis. No high-grade spinal canal stenosis in the cervical spine. There is also fairly mild neural foraminal narrowing without high-grade neural foraminal stenosis at any level. Cervical cord signal is unremarkable.Again seen is severe compression fracture involving the T2 vertebral body (previously described as T1) with near complete loss of height and osseous retropulsion which is grossly similar to prior. Again noted is grade 2 anterolisthesis of T1 on T2 which appears similar to prior. There is resulting effacement of the ventral thecal sac and mild flattening of the ventral cord at the T2 level which is also similar to prior. Subtle T2 signal abnormality in the thoracic cord is again seen and extends into the left aspect of the cord to the T3-T4 level likely representing Wallerian degeneration along the left corticospinal tract. Posterior paraspinous enhancement in the laminectomy bed which is at least predominantly postsurgical is similar to prior without new or enlarging lesions to suggest tumor progression.Aside from T2, remaining thoracic vertebral body heights are maintained. Alignment is maintained. Focal signal abnormality involving the right T3 posterior elements is nonspecific but not significantly changed. Right T12-L1 lesion (previously described as T11-T12) demonstrates continued decrease in size compared to 5/24/2016 and 2/20/2016. No new metastatic lesions are appreciated. No evidence of epidural tumor. No cord signal abnormality involving the mid or lower thoracic cord. Spinal canal and neural foramina below the T2 level are also patent.

Output: 1. No evidence of progression of metastatic disease in the spine. 2. No significant change in severe compression fracture of the T2 vertebral body with osseous retropulsion and grade 2 anterolisthesis of T1 on T2. Associated indentation of the ventral cord at the T2 level is also not significantly changed. Subtle associated chronic cord signal abnormality involving the left aspect of the cord is also not significantly changed and may represent sequela of prior compression.3. Continued decrease in size of right T12-L1 lesion. Nonspecific focal signal abnormality involving the right T3 posterior elements which may represent treated lesion is not significantly changed. No new osseous lesion, new pathologic fracture, or epidural tumor.


Instruction: Generate impression based on findings.

Input: 43 years, Female, lung cancer, history of brain metastases. There is mild T2 hyperintensity with susceptibility effect, which may represent mineralization or chronic blood products, involving the left posterior temporal white matter corresponding to a site of an enhancing lesion on prior study. Punctate foci of susceptibility effect in the left anterior temporal lobe as well as at the posterior medial left temporal-occipital junction are also seen and also correspond to sites of prior enhancing lesions. There is no abnormal parenchymal or meningeal enhancement on the current study to suggest active metastatic disease. No evidence of edema, intracranial mass, or mass effect. No evidence of acute ischemia. No midline shift or herniation. Ventricles are normal in size. Sella and orbits are grossly unremarkable. Paranasal sinuses and mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: Previously seen enhancing metastatic lesions are no longer present, with residual susceptibility at the sites of prior lesions consistent with mineralization or chronic blood products. No new lesions or evidence of active intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: 58-year-old with known right breast cancer status post chemotherapy with good response on conventional imaging. MRI performed in preparation for surgery. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is clip artifact at the site of known malignancy, but no significant residual enhancement is seen near the biopsy clip. A several millimeter focus of enhancement in the right medial breast is stable and benign in appearance.No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No residual enhancement near the biopsy clip of the right breast malignancy that is been undergoing chemotherapy. Mammographic localization of the biopsy clip can be performed if clinically desired.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Right wrist pain. Injection in midcarpal region to assess for lunotriquetral ligament tear. LIGAMENTS: Following midcarpal injection of contrast, contrast remained within the midcarpal joint and does not communicate with the radiocarpal joint. The intrinsic ligaments of the wrist are intact, including the scapholunate and lunotriquetral ligaments.On the T2 weighted images, there is a small amount of fluid in the radiocarpal joint and distal radioulnar joint which is within normal limits. TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is grossly intact.TENDONS: The tendons are intact. BONES: Bone marrow signal is within normal limits.ADDITIONAL

Output: No evidence of disruption of the intrinsic ligaments of the wrist.


Instruction: Generate impression based on findings.

Input: Altered mental status. Evaluate for a cerebral abscess. Status post evacuation 11/22/2016. Additional EMR indicates patient is undergoing a seizure workup. The exam is limited along the right convexity and adjacent scalp secondary to artifact from a ventriculoperitoneal shunt device. The right sided predominantly T1 hyperintense subdural collection is slightly smaller in size, measuring 16 mm in maximal thickness. The midline shift has improved from 5 mm down to 2 mm. Susceptibility and diffusion weighted images are limited in the presence of a right sided ventriculoperitoneal shunt device positioned under the scalp but there appear to be blood products within the collection. There is evidence of a right parietal burr hole and an intraparenchymal tract measuring up to 20 mm with T1 hyperintense fluid and restricted diffusion in the right parietal brain parenchyma, as well as mild surrounding enhancement. There is susceptibility abnormality in this region as well, indicating the presence blood products. There is extensive surrounding T2 hyperintensity. There is avid diffuse enhancement and thickening of the pachymeninges which also extends to the contralateral frontal region. There is a 2 mm thick subdural collection along the posterior left temporal lobe convexity. The right frontal approach ventriculostomy catheter is unchanged in position with the tip in the frontal horn of the right lateral ventricle. The right lateral ventricle has slightly less effacement compared to the prior exam. There is diffuse T2 hyperintensity in the right hippocampus. There is no evidence of territorial infarction. The major cerebral flow voids are intact. There is a left maxillary sinus mucous retention cyst.

Output: 1.Decrease in size of the subacute right cerebral convexity subdural fluid collection with improvement in the midline shift and slight improvement in the right lateral ventricular effacement. 2.Avid diffuse pachymeningeal enhancement in the right cerebral hemisphere with extension to the contralateral frontal region is nonspecific and be reactive or related to superimposed. 3.A surgical defect in the right parietal lobe with surrounding edema may represent a subacute hemorrhagic lesion perhaps with superimposed infection and associated cerebritis.4.A small left temporal convexity subdural collection may represent addition hemorrhage or perhaps an empyema.5.Edema in the right hippocampus is likely related to seizure activity.


Instruction: Generate impression based on findings.

Input: 43-year-old female, OPM shows extrinsic compression, need further evaluation. Evaluate esophagus. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed a left-sided extrinsic mass effect upon the lower cervical esophagus and thoracic inlet which corresponds to the patient's known mass seen on prior MRI (series 301, image 8). No communication was noted to the esophagus. No evidence of esophageal diverticulum, web or cricopharyngeal bar. The esophagus was intrinsically normal. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated mild proximal escape on one swallow. Barium pill passed spontaneously.TOTAL FLUOROSCOPY TIME: 5:24AIR KERMA: 54.4 mGy

Output: 1. Intrinsically normal esophagus with left-sided extrinsic mass effect upon the lower cervical esophagus and thoracic inlet which corresponds to the patient's known mass seen on prior MRI and CT. 2. Mild esophageal motor abnormality.


Instruction: Generate impression based on findings.

Input: Chronic anterior knee pain, not improved with physical therapy. Evaluate for OCD. MENISCI: The medial meniscus appears normal. The body and anterior horn of the lateral meniscus are usually prominent, suggesting a discoid morphology. Furthermore, there is branching signal abnormality within the anterior horn and body extending to the tibial articular surface indicating a complex tear. While there do appear to be popliteal meniscal fascicles, the posterior horn of the lateral meniscus does not appear to have a well-defined root, and instead extends to the medial femoral condyle via a ligament of Wrisberg. Small cysts are noted along the medial aspect of the lateral meniscus that may either arise from the meniscus itself or less likely from the adjacent anterior cruciate ligament.ARTICULAR CARTILAGE AND BONE: The lateral tibial plateau appears slightly wider than normal, presumably a developmental abnormality. I see no fluid-filled articular cartilage defects. Bone marrow signal intensity is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact EXTENSOR MECHANISM: The extensor mechanism is intact. The Insall-Salvati ratio is approximately 1.3 suggesting a mild patella alta. The superior aspect of the femoral trochlea appears shallow and there is prominence of the lateral facet relative to the medial facet suggesting femoral trochlear dysplasia. There is slight lateral translation of the patella relative to the center of the femoral trochlea. The tibial tubercle to trochlear groove distances 18mm which is borderline abnormal.ADDITIONAL

Output: 1.Discoid lateral meniscus with tear as described above.2.Slight lateral translation of the patella with respect to the center of the femoral trochlea and anatomic findings as described above that may predispose to patellofemoral instability.


Instruction: Generate impression based on findings.

Input: 6-year-old male with history of epilepsy, ADHD, behavioral issues with intense headache in afternoon and waking the patient in the middle of the night. Evaluate for abnormalities. There is no evidence of intracranial hemorrhage, mass or edema. No abnormal enhancement in the brain or leptomeninges.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: Normal brain CT.


Instruction: Generate impression based on findings.

Input: Shoulder pain, evaluate rotator cuff. ROTATOR CUFF: Moderate tendinosis affects the anterior fibers of the supraspinatus tendon distally, but we see no discrete tear. The supraspinatus muscle appears normal. The infraspinatus as well as teres minor muscles and tendons appear normal. There is perhaps mild tendinosis of the distal fibers of the subscapularis tendon, but we see no discrete tear. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: There is edema within the distal clavicle as well as small subchondral cysts/erosions. There is also edema to lesser degree within the acromial process particularly at the acromioclavicular joint. There is also edema within the capsular structures of the acromioclavicular joint. The coracoclavicular ligaments appear intact. There is perhaps a tiny amount of fluid within the acromioclavicular joint itself. Trace fluid is present within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The anterior capsular structures appear thickened which may in part be due to the arm being held in internal rotation for the study. There is mild irregularity and increased signal intensity of the anterior labrum which may reflect mild degeneration but is not necessarily of clinical significance. A small amount of fluid is present within the glenohumeral joint without frank effusion.BICEPS TENDON: There is mildly increased signal intensity within the tendon of the long head of biceps at the transition from the rotator interval to the intertubercular groove suggesting mild-moderate tendinosis.

Output: 1.Osteoarthritis of the acromioclavicular joint with edema in the distal clavicle, acromion, and joint capsule structures. These findings may reflect sequela of prior trauma or chronic instability.2.Supraspinatus and biceps tendinosis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: renal cell carcinoma s/p resection and SRS (07/2014) and whole brain radiation 12/2014 History: eval for extent of disease Redemonstration of a treated mass adjacent to the trigone of the left lateral ventricle measuring 2.1 x 1.8 cm (series 501 image 20), previously 2.0 x 2.0 cm, with susceptibility artifact. Wall thickness of this lesion measures approximately 4 mm. Previously this lesion showed intrinsic peripheral T1 hyperintensity without significant additional enhancement. On the current exam it retains intrinsic peripheral T1 hyperintensity, but on postcontrast images there appears to be increased enhancement around the margin. A right parietal lesion measures 6 mm (series 501 image 18), previously 7 mm, with susceptibility artifact. There are stable additional foci of susceptibility artifacts in the left occipital lobe and tiny focus of susceptibility artifact in the right occipital lobe at the sites of prior lesions. Stable postoperative changes of the right frontal lobe resection bed with adjacent susceptibility artifacts. Minimal curvilinear enhancement near the resection site is stable and likely postsurgical. Progressive bilateral periatrial FLAIR signal intensity is seen. No new mass effect or masslike intracranial lesions are detected.There is a new tumor deposit in the left masticator space measuring 1 cm (series 501 image 6). Right maxillary mucous retention cyst. Partial opacification of mastoid air cells bilaterally. Orbits are intact. Normal opacification of the intracranial vasculature and venous drainage.

Output: 1.Mild increase of rim enhancing component of the dominant left parietal lesion, of uncertain clinical significance. This may represent post radiation effect or slow tumor growth. In association with this, there is progressive bilateral periatrial white matter signal abnormality, which given symmetric appearance, is favored to represent postradiation effect.2.Right frontal resection bed and other treated parenchymal lesions are unchanged.3.New 1 cm left masticator muscle tumor deposit.


Instruction: Generate impression based on findings.

Input: 10-year-old male with acute lymphoblastic leukemia, cranial nerve VI palsy. Please evaluate for evidence of ischemia. Exam is limited secondary to motion artifact. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is a small linear area of enhancement just anterior to the left cerebral peduncle that is favored to represent a normal vascular structure. Otherwise, brain parenchyma is unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Mucosal thickening of the right paranasal sinus. Mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

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


Instruction: Generate impression based on findings.

Input: 65-year-old male. History of bladder cancer. Evaluate for mets. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions.SPLEEN: Status post splenectomy with multiple splenules in the left quadrant, unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral small renal cysts, unchanged. Mild left pelvocaliectasis and mild atrophy of the left kidneys.RETROPERITONEUM, LYMPH NODES: Celiac artery aneurysm, similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Broad-based ventral hernia containing unobstructed small bowel loops.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: There are multiple punctate to small foci of T2 hyperintensity within the subcortical white matter without restricted diffusion, susceptibility abnormality, or enhancement. There are no similar appearing posterior fossa foci. 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: There are multiple punctate to small foci of T2 hyperintensity within the subcortical white matter without restricted diffusion, susceptibility abnormality, or enhancement. These findings are nonspecific, and the differential diagnosis would most likely include migraine sequelae, small vessel disease, or vasculitides. Given lesional locations and morphology, demyelination is felt to be less likely.


Instruction: Generate impression based on findings.

Input: 57 year old with right bloody nipple discharge There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.T1 high signal fluid is seen within a single duct from the nipple to retroareolar region in the right breast, consistent with blood containing fluid. On contrast images, there is a thickened ductal wall with enhancement along the high signal fluid for 13 mm. There is no intraductal enhancing lesion or suspicious breast lesions in the right breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: Findings consistent with ductulitis at the right nipple - retroareolar region. No MR evidence of malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: 29-year-old female with BRCA mutation and family history of breast cancer. History of benign MR guided biopsy of left breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.A marker clip is identified in the left breast.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: Headache [R51], Reason for Study: ^Reason: eval ischemia, vascular insufficiency History: headache, concern for aneurysm on CTA head Brain MRIMultiple scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale are seen which are non specific.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. There is no evidence of abnormal enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Mucosal thickenings are seen on bilateral ethmoid sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 2.5 x 3.2 mm sized left MCA distal M1 segment aneurysm, unchanged comparing to prior CT angiogram. The left distal ICA cavernous sinus segment appears to be unremarkable on this scan.There is no evidence of other intracranial aneurysm on the scan. Right ICA, bilateral ACAs and right MCA as well as vertebrobasilar system appear to be unremarkable.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuous course without evidence of flow-limiting arterial luminal stenosis. Subtle wall irregularities of bilateral carotid bifurcation especially carotid bulb indicate atherosclerotic plaque. Normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. About 3 mm sized left MCA distal M1 segment aneurysm, even with consideration of the difference of technique, it appears to be unchanged since prior CTA scan.3. Evidence of atherosclerotic changes of extracranial craniocervical arterial system without flow limiting arterial luminal stenosis.