Instruction: Generate impression based on findings.

Input: Diagnosis: alteration of consciousnessClinical question: ischemia, brain mets, seizure focusSigns and Symptoms: seizures MRI of the brainNo diffusion weighted abnormalities are appreciated.There are subtle patchy FLAIR and T2 signal hyperintensities in the occipital lobe subcortical white matter.A punctate focus of signal loss is identified in the left superior frontal gyrus subcortical white matter.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Exam is mildly compromised due to patient motion.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The LVA is smaller than the RVA.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:The MRA of the neck was compromised due to improper triggering of the imaging relative to the bolus injection. In addition, there is suspicion that some of the contrast extravasated.There is opacification of the aortic arch, the great vessels from the aortic arch and carotid arteries and vertebral arteries. The origins of the great vessels from the aortic arch are not adequately imaged. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the right vertebral artery. The left vertebral artery appears small but not well imaged. There appears to be antegrade flow in the LVA.

Output: 1.There is subtle signal abnormality in the subcortical white matter of the occipital lobes which is non-specific. It is possible that this is related to PRES but the pattern is not classic for it. 2.Left frontal lobe microhemorrhage in isolation is of unknown clinical significance.3.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.4.There is no evidence for acute ischemic cerebral infarction.5.The left vertebral artery is not adequately imaged. It is therefore possible that it is stenotic .The LVA is the non-dominant vertebral artery in this patient. The neck MRA imaging was compromised due to technical reasons.6.The origins of the great vessels from the aortic arch are not adequately imaged due to technical reasons.7.Exam is mildly compromised due to patient motion. This may obscure more subtle abnormalities.8.9.Contrast extravasation. Please see note above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Syncope and collapse Dizziness and giddinessClinical question: 48 yo with vertigo, previous MI and stroke, concern for basilar strokeSigns and Symptoms: vertigo The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated on the current exam. No abnormal enhancing foci are identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a focus of volume loss and T2 and FLAIR signal hyperintensity present along the anterior aspect of the left inferior parietal lobule compatible with encephalomalacia. There are satellite punctate foci of T2 and FLAIR signal hyperintensity associated with this. On susceptibility imaging there are small foci of the signal loss within this area of encephalomalacia.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 basilar artery appears small and findings suggest bilateral fetal origins of the posterior cerebral arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A focus of encephalomalacia in the left inferior parietal lobule associated with small foci of chronic hemorrhage most likely is a due to a prior vascular event.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific, however given the above findings vascular event is favored. 3.There is no evidence for acute cerebral infarction.


Instruction: Generate impression based on findings.

Input: 67-year-old female with cyst over the lateral malleolus, movable, compressible with increase in size over the past 2 weeks. Now with lesion/cyst over lateral malleolus of left ankle. Markers were placed along the lateral aspect of the ankle denoting the site of the mass. There is an elongated multilobulated and septated collection of fluid signal intensity within the subcutaneous fat along the anterior aspect of the distal fibula extending inferiorly beneath the fibular tip to the opening of the sinus tarsus. It shows thin peripheral and septal enhancement and measures approximately 1 cm in diameter and overall approximately 4 cm in length. Its characteristics are typical of a ganglion. Bone marrow signal intensity is normal. We see no joint effusion or synovitis. Although this study was not protocoled specifically for evaluation of the tendons and ligaments, we see no gross abnormalities. Note is made of a small accessory navicular bone.

Output: Ganglion within the lateral soft tissues of the ankle.


Instruction: Generate impression based on findings.

Input: Reason: left long finger DIP chronic infection, assess osteomyelitis History: left long finger infection, pain There is narrowing of the third distal interphalangeal joint with chronic appearing erosions of the distal middle phalanx as well as the proximal distal phalanx, as well as mild bone marrow edema at the joint line. However, there is no definite evidence of osteomyelitis.

Output: Joint space narrowing, juxta-articular erosions, and bone marrow edema at the third DIP joint joint which may represent a low-grade infection or erosive degenerative disease. However, there is no definite evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Ms. Vondriska is a 59-year-old female with a personal history of occult primary adenocarcinoma status post complete axillary lymph node dissection in 2006, neoadjuvant chemotherapy and radiation therapy. Family history of breast cancer in sister, diagnosed at the age of 39. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.Scattered foci of enhancement are seen in the right breast, appearing stable when compared to multiple prior examinations. Stable enhancing circumscribed mass in the right breast, likely representing a fibroadenoma. No abnormal enhancement is seen in either breast. Stable postoperative changes are present along the left axilla. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Brain tumor 3 yr follow up for change. There is no significant interval change in size of the enhancing sellar tumor, which measures up to 15 mm and abuts the left aspect of the optic apparatus. There is no evidence of intracranial hemorrhage or acute infarct. There are multiple nonspecific scattered foci of high T2 signal in the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are postoperative findings in the right calvarium. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in size of the sellar tumor.


Instruction: Generate impression based on findings.

Input: 35 years Female (DOB:10/18/1980)Reason: r/o leptomeningeal disease - CVA History: confusion , hx of metastatic urothelial cancerPROVIDER/ATTENDING NAME: EHTASHAM G KHATTAK EHTASHAM G KHATTAK There is a punctate focus of diffusion restriction present in the right centrum semiovale near its junction with the internal capsule.The CSF spaces are appropriate for the patient's stated age with no midline shift. Much of the imaging is degraded by motion artifact.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Acute microinfarct in the right centrum semiovale.2.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.3.Examinations markedly degraded by patient motion which will obscure more subtle abnormalities including leptomeningeal enhancement.


Instruction: Generate impression based on findings.

Input: 62 years Male (DOB: 7/29/1953)Reason: rule out new lesion in patient with ms History: increased weakness of L handPROVIDER NAME: RAYMOND F ROOS RAYMOND F ROOS MRI brain:There is redemonstration of several subcortical and periventricular white matter lesions which are bright signal on FLAIR and T2 imaging. They have not changed since the prior exam. Additionally there is a T2 and FLAIR hyperintense punctate lesion at the left posterior lateral aspect of the pons near the middle cerebellar peduncle. This is also stable. No abnormal enhancing lesions are appreciated within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There are multiple foci of T2 hyperintensity within the cervical spinal cord at the C1 level, C2 level at the C4 level, the C3 5 level and the C6 level which were also present on the prior exam. There is some atrophy of the cervical spinal cord present. No abnormal enhancing lesions are present in the cervical spinal cord. There is multilevel disc desiccation present. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is redemonstration of a central disc extrusion as well as some ligamentum flavum hypertrophy. There is bilateral narrowing of the neural foramina due to disc material. This is not changed since the prior exam.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small right paramedian disc protrusion at this level. This is not changed since the prior exam.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level associated with narrowing of the neural foramina bilaterally and some encroachment of the exiting nerve roots. This is not changed since the prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level. This is not changed since the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple lesions within the cervical spinal cord associated with some atrophy of the cervical spinal cord which were also present on the prior exam. There is not appear to be any new lesions in the cervical spinal cord when compared to the prior exam. These are compatible with patient's clinical diagnosis of multiple sclerosis.2.There are multilevel degenerative changes present in the cervical spine which are stable compared to the prior exam with encroachment of exiting nerve roots at C3-4 and to a lesser degree at other levels.3.There are several small lesions within the brain parenchyma present which are stable compared to the prior exam. Their number is too small to establish a pattern. It is quite possible they are related to demyelinating disorder but they are nonspecific.


Instruction: Generate impression based on findings.

Input: Recurrent pleomorphic adenoma right parotid gland status post multiple re-excisions. There are postoperative findings related to right parotidectomy. There are numerous nodular, high T2, enhancing lesions within the right parotid space and adjacent parapharyngeal space. Collectively, the bulk of the lesions measure up to approximately 3.5 cm. There is minimal narrowing of the oropharyngeal airway and associated displacement of the right carotid and internal jugular flow voids. The left parotid gland and submandibular gland are intact. There is no significant cervical lymphadenopathy. The thyroid gland appears unremarkable. The imaged intracranial structures are unremarkable. The osseous structures and partially imaged intracranial structures are unremarkable.

Output: Findings compatible with clusters of recurrent salivary gland neoplasm in the right parotidectomy bed and parapharyngeal space.


Instruction: Generate impression based on findings.

Input: 60 years Female (DOB:10/24/1955)Reason: new diagnosis lung cancer, evaluate for brain mets History: n/aPROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate T2 and FLAIR hyperintense focus in the left pons without any associated contrast enhancement.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eye is small and has a thin lens.

Output: 1.No evidence for brain metastasis on the basis of this exam.2.There is a punctate lesion in the left pons is suspected to be vascular related.3.Left ocular deformity. Please correlate with patient's clinical evaluation.


Instruction: Generate impression based on findings.

Input: Brain metastasis: left sided weakness. Many of the images are degraded by patient motion. There is interval development of extensive vasogenic edema in the right basal ganglia, insula, and frontal lobe surrounding a mass in the right basal ganglia that measures up to 25 mm. The mass displays susceptibility effect and high T1 signal as well as peripheral enhancement. There is partial effacement of the right lateral and third ventricle, while the left lateral ventricle may be slightly dilated. There is also an unchanged subcentimeter focus of susceptibility effect more posteriorly in the right basal ganglia. There is an unchanged area of susceptibility effect without enhancement in the right cerebellar hemisphere that measures up to approximately 15 mm. There is no evidence of acute infarct. There is 10 mm of midline shift to the left. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval development of extensive vasogenic edema in the right basal ganglia, insula, and frontal lobe surrounding a metastasis with subacute hemorrhage in the right basal ganglia and resultant 10 mm of midline shift.2. Unchanged hemorraghic lesions in the posterior right basal ganglia and right cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: History of breast cancer and metastases to the brain, status post radiotherapy. As compared to the prior exam, there is interval increase in the size of the enhancing lesions along the periphery of the cerebellar hemispheres, which are associated with vasogenic edema. The lesion along the left inferior paramedian cerebellum demonstrates increased enhancement and measures approximately 8 mm, whereas it measured 4 mm on 1/28/2016. Another lesion along the right lateral cerebellum has also increased in size, measuring 17 mm in its greatest dimension, as compared to 13 mm on the prior exam. Additionally, enhancing lesions are newly apparent in the right paramedian cerebellum and superior left cerebellum vermis. The cerebral hemispheres and brainstem are otherwise unremarkable and there is no evidence of acute infarction or herniation. The ventricles are unchanged, including a punctate cyst in the region of the foramina of Monro. The orbits and skull appear to be intact.

Output: Interval increase in size and number of the cerebellar metastatic lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Multiple tonsil cancer recurrences with a new recurrence in the nasopharynx, compare to previous with measurements, post induction scans. There are postoperative findings related to resection of the posterior right hemimandible with hardware fixation and flap reconstruction of the right-sided pharyngeal soft tissues. There are also postoperative findings related to right neck dissection. There is interval decrease in size of the infiltrative tumor centered within the right nasopharynx, at the flap margin, with extension into the pterygoid plate and parapharyngeal space, now measuring up to approximately 24 mm, previously 39 mm. There is unchanged nonspecific subcentimeter nodular soft tissue in the right retromolar trigone. There is no evidence of significant cervical lymphadenopathy. The thyroid and remaining salivary glands appear unchanged. There is scattered fluid within the right mastoid air cells. The right internal jugular vein is absent. The imaged intracranial structures are unremarkable.

Output: Interval decrease in size of the treated tumor recurrence in the right nasopharyngeal region.


Instruction: Generate impression based on findings.

Input: Calf edema and pain There is increased signal throughout the medial head of the gastrocnemius and indistinctness of the proximal tendon. Scattered areas of low signal intensity may represent tendinous fragments. The lateral head of the gastrocnemius and remaining muscles and tendons of the lower extremity are intact. There is extensive subcutaneous edema and fluid within the lower leg with areas of hemorrhage within the proximal portion of the gastrocnemius.A small focus of marrow edema is noted within the lateral tibial plateau. Otherwise the marrow signal of the tibia and fibula are normal.

Output: Ruptured tendon of the medial head of gastrocnemius with associated muscle tear and hemorrhage.


Instruction: Generate impression based on findings.

Input: Patient with parotid mass. FNA yielded low grade salivary gland neoplasm with oncocytic features. There is a heterogeneous, but fairly well-defined mass in the right parotid tail that measures up to 20 mm. The other major salivary glands are unremarkable. There is no evidence of significant lymphadenopathy in the imaged portions of the neck. The orbits are unremarkable. There are punctate T2 hyperintense foci in the right pons and left cerebellum, which may represent chronic lacunar infarcts. There is a retention cyst in the right maxillary sinus.

Output: A right parotid tail mass measuring up to 20 mm is compatible with a salivary neoplasm. No evidence of significant regional lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 31 year old woman with history of osteosarcoma, AML s/p chemotherapy with anthracycline based regimen, iron overload of the liver, diabetes who presents for vasodilator stress cardiac MRI to evaluate for complaints of chest pain and palpitations. MEDICATIONS: atorvastatin, metformin First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 110 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 46 ml (normal range 31+/-10), the LV mass index is 42 g/m2, and the LV mass is 69 g. There are no regional wall motion abnormalities present. Native T1 myocardial relaxation time is 976ms, which is normal. There is no evidence for myocardial iron overload.Left AtriumThe left atrium is upper normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 49 ml/m2 (normal range 69+/-14), the RVEDV is 81 ml (normal range 110+/-24), the RV end systolic volume index is 17 ml/m2 (normal range 22+/-8), and the RVESV is 28 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLow signal intensity of the spleen consistent with the patient's clinical history of iron overload (T2-star ~8ms). No evidence of hepatic iron overload noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable. No evidence of myocardial iron overload.3. Normal LV size and systolic function (LVEF 58%).4. Normal RV size and systolic function (RVEF 65%).5. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left submandibular lymphadenopathy: tender left lymphadenopathy. MDS progressed to AML, admitted for initiation of chemotherapy. There is an enlarged and hyperenhancing left level 1B lymph node that measures up to 20 mm, with inflammatory changes in the surrounding fat planes. There is no evidence of abscess or hematoma. There is no significant lymphadenopathy in the rest of the neck. The salivary glands and thyroid are unremarkable. The bone marrow appears to be diffusely heterogeneous. The imaged intracranial structures and orbits are unremarkable. There is a retention cyst in the left maxillary sinus.

Output: 1. Findings suggestive of left submandibular lymphadenitis and associated cellulitis, but no evidence of abscess or hematoma.2. The diffusely heterogenous bone marrow appearance may be related to the hematological malignancy.


Instruction: Generate impression based on findings.

Input: Planning for deep brain stimulator placement. Enhanced head CT:80 cc of Omnipaque 350 is administered for this exam.Stealth Enhanced head CT for surgical planning protocol is utilized.Minimal periventricular low attenuation of white matter is nonspecific and unchanged since prior head CT.There is evidence of a deep brain stimulator on the left side entering the calvarium from left paramedian frontal bone, traversing the left frontal lobe, entering the left lateral ventricle and with the tip of the stimulator at the level left cerebral peduncle. The appropriateness of this positioning should be decided by referring clinical physician.There is mild I. location of cortical sulci and ventricular system for patient's stated age of 34 similar to prior study. There is no evidence of any abnormal enhancement.A very small thin isodense subdural measuring approximately 2 mm in the frontal -- parietal region is again noted. Compared to prior MRI exam from 9 -- 8 -- 2011 there is interval decrease in the size of the subdural.

Output: 1.No evidence of acute intracranial findings.2.No evidence of abnormal enhancement.3.Left-sided deep brain stimulator with no change in position since prior study.4.A smaller residual left-sided frontal -- parietal subdural since prior MRI exam.


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine without aura, without mention of intractable migraine without mention of status migrainosusClinical question: Evaluate for structural abnormality The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. No structural abnormality is appreciated that could explain the patient's migraine.


Instruction: Generate impression based on findings.

Input: Benign intracranial hypertension: Evaluate for etiology of headaches, change in frequency. There is a partially-empty sella. There are mildly low lying cerebellar tonsils. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered cerebral white matter T2 hyperintense foci. There is also a punctate focus of susceptibility effect in the right superior frontal gyrus. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A partially-empty sella and mildly low lying cerebellar tonsils are nonspecific, but may be manifestations of pseudotumor cerebri. Mild scattered cerebral white matter T2 hyperintense foci and a punctate focus of susceptibility effect in the right superior frontal gyrus are nonspecific, but may represent chronic small vessel ischemic disease and chronic microhemorrhage, respectively. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: History of primary sclerosing cholangitis. Evaluate for stricturing or suspicious lesions. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter foci of increased T2 signal in the right hepatic lobe without appreciable enhancement likely reflecting small cysts. The bowel ducts are normal in caliber and morphology. No biliary strictures identified. No suspicious enhancing lesion within the liver. The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No biliary ductal dilatation, significant stricture, or suspicious mass lesion.


Instruction: Generate impression based on findings.

Input: Clinical question: History of melanoma with complaints of headaches. Signs and symptoms: As above. Pre-and post's brain MRI:Negative diffusion weighted series.There is normal anatomical morphology as well as signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease.Calvarium and soft tissues of the scalp demonstrate normal signal intensity and without abnormal enhancement.Minimal bilateral (right greater than left) anterior ethmoid air cell opacification is noted and unremarkable paranasal sinuses otherwise.Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: Negative pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: HIV and new onset of headaches. Brain parenchyma is unremarkable for age. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is minimal mucosal thickening the paranasal sinuses and a left maxillary sinus mucus retention cyst. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No significant intracranial abnormality. Specifically, no intracranial mass, mass effect, or abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Evaluate for any intracranial lesions, mets, stroke, demyelinating lesions, also please particularly comment on any abnormalities in the pituitary gland: mesothelioma on pembrolizumab, presenting with altered mental status, word finding difficulty, hyperreflexia, possible central adrenal insufficiency. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia in the left basal ganglia with susceptibility effect and ex vacuo dilatation of the frontal horn of the left lateral ventricle. There are also a few scattered foci of high T2 signal in the cerebral white matter bilaterally. There is no abnormal intracranial enhancement. The pituitary gland is grossly unremarkable. 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 intracranial hemorrhage, mass, or acute infarct. 2. Chronic left basal ganglia hemorrhagic infarct.3. A few scattered foci of high T2 signal in the cerebral white matter bilaterally are nonspecific. 4. The pituitary gland is grossly unremarkable.


Instruction: Generate impression based on findings.

Input: Female 42 years old with Cowden Syndrome and/or SDHB mutation, attenuated FAP. Assess for RCC recurrence and liver lesion. ABDOMEN:LIVER, BILIARY TRACT: Numerous bilobar liver lesions are not significantly changed in size or imaging characteristics.The right hepatic dome lesion measures 5.7 x 4.3 cm (series 1501/417), unchanged with allowing for differences in technique and positioning and with features compatible with focal nodular hyperplasia. Reference segment 4 lesion measures 2.3 x 2.2 cm (series 1501/390) and again has imaging features of adenoma.Stable segment 6 subcapsular hemangioma.The additional bilobar lesions are unchanged in number and appearance and are compatible with numerous FNHs. SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously. The pancreatic duct is not dilated. Punctate cystic foci are unchanged and may represent small IPMNs.ADRENAL GLANDS: No significant change in size or appearance of the right adrenal lesion with loss of signal on out of phase imaging compatible with lipid rich adrenal adenoma.KIDNEYS, URETERS: Postsurgical changes of the left kidney are again seen. There is no evidence of tumor recurrence. No new suspicious renal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small follicles are seen in both ovaries. There is no dominant follicle or suspicious adnexal mass.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of recurrent or metastatic renal cell carcinoma.2.Stable bilobar hepatic lesions compatible with hemangioma, adenoma and numerous focal nodular hyperplasia.3.Unchanged lipid rich right adrenal adenoma.


Instruction: Generate impression based on findings.

Input: 69 year-old male with history of prostate cancer in the right mid peripheral zone. Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500 mg bid starting the night before the procedure. He took 2 tablets of Ciprofloxacin 500 mg before the procedure and will take two tablets after the procedure. Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained for the research study. The procedure was performed under moderate conscious sedation.MRI focus in the left mid peripheral zone suspicious for patient's known cancer was localized with T2 weighted MR images. Following preparation, Medtronic laser ablation template was placed in the perineum on the patient and localized on MR images and registered to the MR images where prostate lesion could be visualized.Following local anesthesia with lidocaine, 14-gauge MR- compatible needles were inserted into the left side of the prostate to stabilize the prostate. Upon confirmation of the tip of the needle on the left side close to the known lesion, three laser ablations with 15-W, 92 % power was performed within the left mid lateral peripheral zone of the prostate. The needles are then placed into more medial aspect of the lesion, however, due to the malfunction of the pacer generator, the procedure was aborted. The patient tolerated the procedure well without any immediate complications.Pre-and postcontrast axial MR images are obtained before and after administration of 14 cc MultiHance, upon completion of the procedure. On MR images of ablation defect was noted within and around the posterior apical peripheral zone.

Output: MR guided laser ablation of the part of the left mid peripheral zone lesion. The patient will be brought back to complete the ablation.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for avascular necrosis History: hip pain; difficulty with ambulation There is curvilinear bandlike signal abnormality traversing the femoral head near its junction with the femoral neck with smaller foci of subchondral curvilinear signal abnormality indicating avascular necrosis. There is edema within the femoral neck extending into the intertrochanteric region which is also likely due to avascular necrosis. The majority of the proximal femoral epiphysis maintains fat signal intensity and we see no subchondral fracture or articular surface collapse. There is also moderate osteoarthritis of the right hip joint with subchondral cysts within the acetabular dome. There is edema type signal within the acetabular dome and supra-acetabular ilium which may be degenerative in etiology or represent additional osteonecrosis. There is a mild synovitis of the right hip and a small amount of fluid within the right hip joint which is not uncommon in patients with avascular necrosis. Although the study was not protocoled for detailed evaluation of the labrum, there appears to be degenerative tearing of the acetabular labrum. There is also mild inflammation of the obturator externus bursa where it communicates with the hip joint. There is atrophy of the gluteus minimus muscle and enthesopathic changes at its insertion on the greater trochanter. There is also mild inflammation of the peritrochanteric soft tissues of questionable clinical significance.Avascular necrosis and osteoarthritis also affect the left hip as seen on the large field-of-view images, although to a slightly lesser degree than that seen on the right. There is a small joint effusion on the left. There are multiple presumed uterine fibroids.

Output: Avascular necrosis of the right and left femoral heads with osteoarthritis of the hips and other findings as described above.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer, brain mets, ALK+, on Ceritinib now. There are severe scattered supratentorial and infratentorial enhancing lesions. Some of these have not significantly changed in size, while others have increased in size. For example, a right medial temporal lobe lesion measures up to 11 mm, previously 8 mm, and a left occipital lobe lesion measures 7 mm in diameter, previously 4 mm, while a left superior cerebellar hemisphere lesion measures up to 6 mm, previously also 6 mm. There is negligible vasogenic edema associated with the lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus retention cyst.

Output: Some of the metastases have not significantly changed in size, while others have increased in size.


Instruction: Generate impression based on findings.

Input: Reason: L hip FAI and labral tear History: L hip pain Note that given the patient's inability to tolerate the exam, only a coronal T2 fat sat sequence obtained in the prone position and axial T1 sequence obtained in the decubitus position was obtained. The sequences are also limited by motion artifact.There is abnormal T2 and T1 marrow signal within the left femoral head and neck. Further characterization of this abnormal signal intensity is limited.Gadolinium is noted within the left hip joint. Evaluation of small labral tears is markedly limited however within the limits of exam, there is no obvious labral detachment.

Output: Abnormal marrow signal within the left femoral head and neck which is nonspecific and cannot be further characterize given the limitations of the exam. Repeat examination of the left hip or alternatively CT may be beneficial to further characterize these findings. Evaluation of the labrum is essentially nondiagnostic.


Instruction: Generate impression based on findings.

Input: 14 year old female with congenital pulmonic valve stenosis s/p valvuloplasty and atrial septal defect s/p percutaneous closure. Patient referred to assess for severity of pulmonic regurgitation and RV size and function. Left VentricleThe left ventricle is normal in size and sytolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 109 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 41 g/m2 (normal range 67+/-11), and the LV mass is 71 g (normal range 114+/-24). There is diastolic flattening of the interventricular septum suggesting RV volume overload.Left AtriumThe left atrium is normal in size. The LA volume is 51 ml. There is evidence of an helix ASD closure.Right VentricleThe right ventricle is normal in size (but significantly larger than the LV) with mildly reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 147 ml (normal range 110+/-24), the RV end systolic volume index is 50 ml/m2 (normal range 22+/-8), and the RVESV is 85 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size (67ml). Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve has thickened leaflets but opens widely. There is moderate to severe pulmonic regurgitation. The regurgitant fraction is 39% and the regurgitant volume is 32ml.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. The RPA is normal in size (15mm) and the LPA is mildly narrowed (10mm) without evidence of flow acceleration.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 55%).2. The RV volume is normal in absolute terms; however, it is significantly larger than the LV. The systolic function is mildly reduced (RVEF 42%). 3. Normal biatrial size with evidence of an ASD closure device.4. Pulmonic valve leaflets thickened but with normal leaflet excursion. Moderate to severe pulmonic regurgitation.5. Moderate tricuspid regurgitation. 6. Mild left pulmonary artery stenosis without evidence of flow acceleration suggesting that the stenosis is not hemodynamically significant.


Instruction: Generate impression based on findings.

Input: Right venous vascular malformation, imaging post sclerotherapy. There is a well-defined, lobular, right parotid lesion with phleboliths, adjacent to the retromandibular vein, which measures up to approximately 25 mm. Although not significantly changed in size, the lesion demonstrates less enhancement. The other salivary glands are unremarkable. There is no significant lymphadenopathy in the neck. The orbits are unremarkable. The osseous structures are intact, aside from multilevel degenerative cervical spondylosis. There is a small right maxillary sinus retention cyst. There is apparent restricted diffusion in the left midbrain and pons.

Output: 1. Although the right parotid vascular malformation has not significantly changed in size, the lesion demonstrates less enhancement, which may be attributable to treatment effects.2. Apparent restricted diffusion in the left midbrain and pons may represent a recent infarct, versus artifact. Dedicated brain imaging may be useful for further clarification.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with chronic low back pain and recent exacerbation of back pain with radiation down lateral thigh and leg. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow edema or replacement is seen. The distal spinal cord, conus and cauda equina are within normal limits. No epidural lesions are seen. T11-12: Mild disc bulging. No spinal canal or foraminal stenosis.T12-L1: Unremarkable.L1-2: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L2-3: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L3-4: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L4-5: Severe facet hypertrophy with effusions. Ligamentum flavum thickening. Small right paracentral disc extrusion. Mild spinal canal stenosis. Mild right foraminal stenosis. L5-S1: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal stenosis. Mild foraminal stenosis.

Output: 1.Facet arthropathy is present at most levels, severe at L4-5.2.A small right paracentral disc protrusion is seen at L4-5 resulting in mild spinal canal stenosis. 3.No other high grade canal stenosis is seen.


Instruction: Generate impression based on findings.

Input: Male 21 years old Reason: Left knee pain laterally Motion artifact limits evaluation.MENISCI: Medial and lateral menisci are intact. Small suspected parameniscal cyst lateral to the lateral meniscus with no discrete underlying meniscal abnormality.ARTICULAR CARTILAGE AND BONE: Articular cartilage is intact. Bone marrow signal is within normal limits.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Lateral parameniscal cyst with no discrete underlying meniscal abnormality. Otherwise no findings to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal. There are thyroid nodules bilaterally.C2-C3: There is no significant disc disease, spinal canal, or neural foramen narrowing.C3-C4: There is minimal uncovertebral joint arthropathy without significant spinal canal or neural foramen narrowing.C4-C5: There is mild uncovertebral arthropathy and central disc osteophyte complex which indents the ventral thecal sac and results in mild spinal canal stenosis. There is no significant neural foramen narrowing.C5-C6: There is mild bilateral uncovertebral joint arthropathy as well as a left paracentral disc osteophyte complex which indents the thecal sac and results in mild spinal canal stenosis. There is no significant neural foramen stenosis. C6-C7: There is minimal bilateral uncovertebral arthropathy without significant spinal canal or neural foraminal narrowing.C7-T1: There is no significant disc disease, spinal canal, or neural foraminal narrowing.

Output: 1.Mild cervical spine degenerative changes are relatively worst at the C4-C5 and C5-C6 levels where there is mild spinal canal stenosis.2.Multiple bilateral thyroid nodules which can be further characterized with thyroid ultrasound as clinically indicated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 60-year-old male with prostate cancer. History of single Gleason 8 prostate cancer that was ablated with cryosurgery PELVIS:PROSTATE:Prostate Size: 3.2 x 2.5 x 3.0 cm.Peripheral Zone: Redemonstrated is a contour abnormality of the left peripheral zone is presumed to reflect changes of prior cryoablation. There are no new suspicious T2 hyperintense foci.Central Gland: Mild grade benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: Nonenhancing T1 hyperintense focus in the left acetabulum is unchanged since the prior exam, incompletely evaluated. Unchanged right pelvic sidewall lymph node measuring 5 mm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Redemonstrated are posttreatment changes in the left mid peripheral zone without interval development of any suspicious focus.2.Nonspecific 5 mm right pelvic wall lymph node.


Instruction: Generate impression based on findings.

Input: 30 year-old female status post MPC. MPC, as provided by the clinical history, is most likely an error as other reports indicate history of MVC which is understood to mean motor vehicle collision. BRAIN: There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Minimal opacification is present in few sided ethmoid air cells.CERVICAL SPINE: There is minimal straightening of the visualized cervical spine secondary to positioning for the examination. Cervical spine alignment is within normal limits without evidence of spondylolysis or spondylolisthesis. Vertebral body heights and intervertebral disk spaces are within normal limits. The pre-and paravertebral soft tissues are within normal limits. The airway is patent.Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no evidence of spinal canal stenosis. If there is clinical concern for spinal cord or ligamentous injury, an MRI may be considered.The lung apices are clear bilaterally.

Output: 1. Normal brain CT.2. Normal cervical spine without evidence of fracture or malalignment.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for enhancing lesions. History: Suspected MS flare. Worsening blurry vision, ataxia, and left-sided numbness with mild weakness. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular white matter lesions many of which are oriented perpendicular to the lateral ventricles which are bright on flair and T2 imaging. Additional lesions with high signal on T2 and flair are present in the posterior limb of the right internal capsule throughout the brainstem and in the cerebellar hemispheres. There is no comparison study available. The lesion in the medulla measures 12.5 x 10 mm axial dimensions compared there are several periventricular white matter lesions which display a little bit of contrast enhancement. Additionally there is a left medial temporal lesion which displays contrast enhancement.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Multiple periventricular, subcortical, cerebellar and brainstem lesions are present. These are suspicious for demyelinating disorder. There are several of these lesions are display contrast enhancement which is suggestive of more acute plaque formation


Instruction: Generate impression based on findings.

Input: Male, 72 years old, status post craniotomy for tumor resection. Postoperative findings are seen compatible with suboccipital craniotomy. A small amount of extra-axial fluid and trace blood product deep to the craniotomy flap are within expected limits. Scattered intracranial air is also an expected finding.A majority of the left aspect of the tumor and the tumor core has been resected. There is evidence of T1 hyperintense blood product within the central resection cavity. A rim of enhancement does, however, remain along the right margin of the resection bed.T2 hyperintensity remains evident surrounding the resection cavity with minimal involvement of the right midbrain. In addition, there is a small amount of rim restricted diffusion compatible with surgical change. The fourth ventricle remains partially effaced.No new enhancing lesions are seen. A nonspecific focus of T2 hyperintensity within the white matter adjacent to the left frontal horn is unchanged. No new parenchymal lesions are detected. Trace subdural blood product is suspected along the right tentorium. The lateral ventricles and the cerebral sulci are stable in size and morphology.

Output: Expected findings are seen status post cerebellar tumor resection. A majority of the left and central aspects of the tumor has been included in the resection. There may be a rim of residual enhancing tumor along the right margin of the resection cavity. Edema in the surrounding parenchyma is relatively unchanged.


Instruction: Generate impression based on findings.

Input: 25-year-old male with history of neurofibromatosis type I status post excision of right upper arm lesion. A vitamin E marker was placed on the medial skin surface of the arm approximately 10 cm above the elbow joint. There is band-like low signal intensity and foci of signal void in the underlying soft tissues indicating scarring and metallic susceptibility artifact from prior surgery at this site. An enhancing nerve sheath tumor along the ulnar nerve just above the medial epicondyle seen on the prior study has been intervally resected.There is enlargement of the ulnar nerve along its course associated with multiple nerve sheath tumors. The enlarged ulnar nerve is perched upon the posterior margin of the medial epicondyle, which may reflect interval release. In the area of the surgical resection, there is now an elongated subcutaneous mass that is inseparable from the ulnar nerve. This particular mass measures approximately 2.5 x 1.5 cm in transverse dimension and 4.5 cm in craniocaudal dimension. The mass is mostly isointense to skeletal muscle on T1-weighted images, but heterogeneous on T2-weighted images with areas of both low and high signal intensity. There is minimal enhancement of this mass after gadolinium administration. Nerve sheath tumors are also noted along the courses of the medial and radial nerves with additional innumerable cutaneous, subcutaneous, and intramuscular nerve sheath tumors.Bone marrow signal intensity is normal.

Output: 1. Innumerable nerve sheath tumors compatible with stated diagnosis of neurofibromatosis type I.2. Postsurgical changes of a nerve sheath tumor resection along the course of the ulnar nerve above the medial epicondyle of the distal humerus.3. New mass in the area of the resection that is inseparable from the enlarged ulnar nerve. Its signal characteristics are atypical for a nerve sheath tumor with relatively low signal intensity on T2-weighted images suggesting the possibility of a postsurgical neuroma.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right wrist radiocarpal joint was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge needle.Under fluoroscopic guidance, a 22-gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 8 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. Multiple spot radiographs were obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 3 minutes, 6 seconds

Output: Successful arthrogram injection of the right radiocarpal joint. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on findings.

Input: 43-year-old woman with right breast cancer recently completed chemotherapy presents for follow-up for treatment response and planning for surgery. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. An additional right MLO view was obtained. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. The regional asymmetry in the right breast upper outer quadrant spanning approximately 5 cm is unchanged. Associated pleomorphic calcifications at the site of this focal asymmetry extending posteriorly and inferiorly are also unchanged. A hydromark biopsy clip and three X shaped biopsy clips are seen in the right upper outer quadrant. A hydromark clip is also seen in the right axillary node.

Output: No change in mammographic appearance of right upper outer quadrant breast mass with extensive pleomorphic calcifications. Results and recommendation were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: The study was performed without contrast and is limited for evaluation of metastatic disease. The hemorrhagic metastatic lesion in the right cerebellum is again visualized and measures approximately 18 x 13 mm, not significantly changed since previous study. The associated vasogenic edema is unchanged with resultant regional mass effect. There is mild decrease in the edema associated with the previously seen hemorrhagic lesion in the right lateral basal ganglia/subinsular white matter. No new focus of edema or mass effect to suggest progression of metastatic disease, within the limitations of noncontrast study. No evidence of infarct or new hemorrhage. No hydrocephalus. No extra-axial collections.There are small bilateral maxillary mucosal retention cysts.

Output: Please note examination is obtained without contrast limiting assessment of metastatic disease. Hemorrhagic metastatic lesion in the right cerebellum with surrounding edema is not significantly changed. There is decrease in edema associated with hemorrhagic right subinsular/lateral basal ganglia lesion. No new focus of edema or new mass effect.


Instruction: Generate impression based on findings.

Input: Dizziness and ataxia. The cerebellar tonsils extend up to 7 mm inferior to the foramen magnum and display pointed morphologies. The posterior fossa has a relatively small capacity and there is crowding of the foramen magnum. 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 are grossly unremarkable. There are findings suggestive of arrested pneumatization of the sphenoid sinuses.

Output: Findings compatible with Chiari I malformation. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Given dedicated pituitary MRI acquisition technique, previously demonstrated scattered T2 hyperintensities in the subcortical and periventricular white matter are not well characterized.Redemonstrated is a hypo-enhancing lesion within the posterior pituitary gland which is T1 hyperintense and T2 hypointense measuring 7 mm, unchanged. As before, it encroaches the optic apparatus without discrete abutment or displacement.

Output: Stable pituitary lesion. As before, the differential diagnosis includes a microadenoma, perhaps with proteinaceous/hemorrhagic degeneration, or a proteinaceous/hemorrhagic Rathke's cleft cyst.


Instruction: Generate impression based on findings.

Input: Female, 78 years old, with muscle weakness, assess for stroke. Patchy foci of diffusion restriction are demonstrated within the left MCA territory, specifically involving the corona radiata and the posterior insula. Extensive patchy periventricular T2 hyperintensities are noted bilaterally as well as more vague signal abnormality in the pons. No evidence of significant generalized mass effect is seen. No intracranial hemorrhage or any abnormal extra axial fluid collections are detected. No pathologic intracranial enhancement is seen. Ventricular size and morphology are within normal limits.

Output: 1.Patchy acute ischemic lesions in the left MCA territory involving the corona radiata and the posterior insula.2.Evidence of extensive chronic small vessel ischemic disease is seen.3.No evidence of significant generalized mass effect is seen. No enhancing lesions are detected.


Instruction: Generate impression based on findings.

Input: There are postoperative changes of partial tumor resection involving the sacrum. There is a fluid density in the surgical bed. Tumor again seen approximating S2 and S3 nerve roots; however, it is better assessed on the pelvic studies. Surgical epidural drain is seen in place. There is heterogenous signal involving the spinal canal at S2-S4 levels related to the postoperative fluid. The lesions involving the bilateral iliac bones are partially visualized. There is normal alignment of the vertebral bodies. Vertebral body heights are maintained. The conus medullaris is seen in normal position at the level of L1. There is no evidence of spinal stenosis or neural foraminal compromise at any level in the lumbar spine.Expansile lytic lesion is noted involving the left 12th rib as seen on outside CT. Lesions involving the bilateral iliac bones also again seen.

Output: Interval postsurgical changes of partial sacral tumor resection are seen. Tumor is again noted to abut the left S2 and S3 nerve roots and more completely assessed on the MRI pelvis study. Postoperative blood products are noted within the spinal canal at the S2 and S3 levels. Visualized lumbar spine is unremarkable.


Instruction: Generate impression based on findings.

Input: Female 50 years old Reason: 50 F with rectal cancer s/p therapy, please eval for residual disease. Overall image quality: GoodPELVIS:UTERUS, ADNEXA: No significant abnormality noted. BLADDER: No significant abnormality noted. LYMPH NODES: No significant abnormality noted. No suspicious lymph nodes in the mesorectal fat.BOWEL, MESENTERY: There is mild circumferential proximal colonic wall thickening likely related to the patient's treatment.At the site of the previously seen mid/distal rectal tumor there is minimal enhancement without measurable disease evident. There has been interval resolution of the previously seen restricted diffusion in this region compatible with treatment response.Small amount of ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No measurable residual disease or restricted diffusion compatible with treatment response.


Instruction: Generate impression based on findings.

Input: Reason: Right shoulder pain x 6months,no improvement with physical therapy, NSAIDS, evaluate for rotator cuff tear History: Right shoulder pain ROTATOR CUFF: Increased T2 signal within the anterior supraspinatus likely reflects tendinopathy. Subscapularis, infraspinatus and teres minor are intact.SUPRASPINATUS OUTLET: Mild edema and effusion at the acromioclavicular joints indicates mild osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenoid labrum is grossly intact.BICEPS TENDON: Biceps tendon is intact ADDITIONAL

Output: 1.Supraspinatus tendinopathy.2.Mild acromioclavicular joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: 69-year-old male with abdominal pain and loss, evaluate. History of thyroid cancer. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is nondilated. There is a cystic lesion in the uncinate measuring 3.1 x 2.0 cm (8/32) which likely communicates with an accessory duct. There are multiple additional subcentimeter cysts in the pancreatic head which appear to communicate with the main pancreatic duct. There is a cystic lesion of the pancreatic neck measuring 2.2 x 1.9 cm (8/25) with apparent ductal communication. A large cystic lesion involving the pancreatic tail measures 2.5 x 3.1 cm (8/21) sheath to hypointense walls, possibly reflecting prior hemorrhage. No enhancement is present within any of these lesions.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 cystic lesions throughout the pancreas measuring up to 3.1 cm likely represent side branch IPMN's. No enhancement or main pancreatic ductal dilatation.


Instruction: Generate impression based on findings.

Input: Chronic headaches and visual changes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst.

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


Instruction: Generate impression based on findings.

Input: 42-year-old male. Knee pain and swelling and mass left inner thigh. Evaluate for osteochondroma; injury to VMO quad. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is an osteochondroma arising from the superomedial aspect of the medial femoral condyle with a thin 3 mm cartilaginous cap. The overall dimensions of the osteochondroma is 1.7 x 1 x 1.2 cm. It causes mild impression upon the medial retinaculum and the distal fibers of the vastus medialis muscle. The tibiofemoral and patellofemoral compartment articular cartilage is intact. Bone marrow signal intensity is normal.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor ligament is intact.ADDITIONAL

Output: Small osteochondroma arising from the superomedial aspect of the medial femoral condyle, as described above.


Instruction: Generate impression based on findings.

Input: 23 years, Female, headache, status post epidural on 5/14, having significant headaches. Status post blood patch x2, no resolution in pain.. Brain: There is diffusely increased dural enhancement without nodularity. There is no abnormal intraparenchymal signal abnormality or enhancement. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No restricted diffusion to suggest acute ischemia. Major flow-voids are preserved. Pituitary gland is prominent in size measuring up to 12 mm in the craniocaudal dimension, but likely within normal limits for age and peripartum state. No focal lesions or hemorrhage. There is a mucus retention cyst in the right maxillary sinus as well as minimal mucosal thickening involving the left maxillary sinus. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and remainder of the extracranial soft tissues are within normal limits. MRV head: No evidence of venous sinus stenosis. Major superficial and deep venous structures are patent.

Output: 1. There is diffusely increased dural enhancement which can be seen with intracranial hypotension and compatible with history of recent intrathecal puncture. Brain MRI is otherwise unremarkable. No subdural hematoma or extra-axial collections. 2. No evidence of venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: Elevated PSA. No pathology is available. PELVIS:PROSTATE:Prostate Size: 3.3 x 5.6 x 6.4 cmPeripheral Zone: In the left peripheral zone base, there is a 3 x 5 mm focus of decreased T2 and ADC signal (series 503, image 04) suspicious for neoplasm. In the left peripheral zone mid gland, there is a 9 x 9 mm focus of decreased T2 and ADC signal suspicious for neoplasm.Central Gland: No significant abnormality.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No significant abnormality.BLADDER: Small bladder diverticula are present.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fat-containing inguinal hernias are present.

Output: Two foci of abnormal signal within the left peripheral zone suspicious for neoplasm without evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are left breast ultrasound dated 4/4/2011, left diagnostic mammogram dated 4/4/2011, and MRI breast dated 4/13/2011 performed at Northwestern Graylake. LEFT DIAGNOSTIC MAMMOGRAM (4/4/2011): Two standard views of the left breast and 2 spot compression views were obtained. The breast parenchyma is heterogeneously dense. The breast tissue in the left upper inner quadrant appears slightly more conspicuous on recent mammogram dated 2/19/2015LEFT BREAST ULTRASOUND (4/4/2011): A cyst was seen in the 12 o'clock position of the left breast that measures 4 mm.BREAST MRI (4/13/2011): There is no significant interval change compared to mammogram dated 12/22/2014.

Output: Slightly more conspicuous breast parenchyma in the left upper inner quadrant compared to examination in 2011 without interval change from breast MRI dated 4/13/2011 and 12/22/2014. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Clinical question: Seizure, history of CVA. Signs and symptoms: Seizures. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift or hydrocephalus.The cortical sulci, ventricular system and all CSF cisterns remain within normal.Subtle small foci of nonspecific low attenuation in the periventricular white matter as was noted on prior exam. Comparison is not possible due to the sensitivity of CT for detection of findings on prior MRI. There is however a single focus of low-attenuation in the right sub-insular cortex which was not present on prior MR exam. This finding could represent a corner infarct. The appearance of this lesion is suggestive of an old stroke.

Output: 1.No evidence of acute intracranial findings.2.Partial visualization of nonspecific periventricular low-attenuation asthma noted on prior MRI.3.A single focus of low-attenuation in the right basal ganglia which was not identified on prior study.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with history of anaplastic astrocytoma status post biopsy, RT/TMZ and TMZ. Sequelae of the previously biopsied, treated tumor in the left thalamus are unchanged including intrinsic T1 hyperintensity and mild T2 hyperintensity. No enhancement is seen in this location.A faintly rim enhancing, centrally necrotic lesion within the right posterior paramedian frontal lobe is no larger than on the prior examination and perhaps 2 or 3 mm smaller. Surrounding T2 hyperintensity has also mildly decreased. Faint areas of patchy and ribbonlike enhancement within the left temporal lobe are also stable to slightly reduced in conspicuity and size.No new intracranial lesions are appreciated. Ill-defined T2 hyperintensity within the left periventricular white matter has not significantly changed from prior. No evidence of generalized mass effect is seen. The ventricles are stable in size and morphology.

Output: Areas of multifocal tumor are redemonstrated with no evidence of disease progression and perhaps some mild improvement from the prior exam.


Instruction: Generate impression based on findings.

Input: Unexplained left optic nerve atrophy History: 76 year old female with unexplained left optic nerve atrophy. Orbits: There is diffuse atrophy of the left optic nerve. There appear to be There is a defect in the lower right lamina papyracea with mild herniation of orbital far. There is also deformity of the right medial rectus muscle, with a linear projection directed. There are bilateral lens implants. There is no evidence of intraorbital mass lesions.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a focus of encephalomalacia in the left thalamocapsular junction region with associated susceptibility effect. There is diffuse patchy cerebral white matter T2 hyperintensity bilaterally. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the left maxillary sinus.

Output: 1. Diffuse left optic nerve atrophy without evidence of compressive lesions. This may be related to chronic ischemic disease, for example.2. Chronic right lamina papyracea fracture.3. Chronic hemorrhagic lacunar infarct in the left thalamocapsular junction superimposed upon a background of probable chronic small vessel ischemic disease, but no evidence of acute infarction.


Instruction: Generate impression based on findings.

Input: Mild cognitive impairment, so stated [G31.84], Reason for Study: ^Reason: Eval for MS History: fatigue, nonspecific symptoms Scattered somewhat patchy FLAIR/T2 high signal intensity lesions at bilateral subcortical and deep white matter lesions involving bilateral hemispheres and lower pons. Comparing to prior scan, these lesions are more conspicuous on today's scan, however, considering the difference in imaging technique (today's one has higher resolution and higher signal to noise ratio), there is no significant interval change in terms of number, distribution and size of above described lesions.There is no evidence of abnormal enhancement.Constellation of above findings are nonspecific white matter disease. Differential diagnosis including nonspecific small vessel ischemic disease and other demyelinating disease such as multiple sclerosis.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Minimal downward displacement of cerebellar tonsils through foramen magnum (about 4mm).Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There is interval development of sphenoid sinus mucosal thickening indicating sinusitis.

Output: 1. Multifocal scattered somewhat patch high FLAIR high signal intensity lesions at subcortical white matter and the tip white matter. These are nonspecific findings and differential diagnosis including nonspecific small vessel ischemic disease and demyelinating disease such as multiple sclerosis. Unchanged since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion on the scan.


Instruction: Generate impression based on findings.

Input: Planning for brain lesion treatment. There are bilateral frontal heterogeneous masses in the frontal lobes with extensive surrounding vasogenic edema. The largest of the lesions measures up to approximately 45 mm in the left frontal lobe. There is partial effacement of the left lateral ventricle and minimal midline shift to the right. Skin-based fiducial markers are present.

Output: Treatment planning MRI demonstrates bilateral frontal lobe lesions with extensive vasogenic edema, compatible with metastases.


Instruction: Generate impression based on findings.

Input: Differential diagnosis of the cystic lesion includes a pituitary or Rathke's cyst or a cystic pituitary adenoma; recently had growth after severe headache; 3-4 month follow up please compare to prior scan for changes, but no endocrine no visual symptoms.. There is interval decrease in size of a T1 hyperintense cystic lesion within the sella that now measures up to 2 mm in height. There is no mass effect upon the optic apparatus or cavernous sinuses and the infundibulum is intact. There is an enlarged retrocerebellar cerebrospinal fluid signal space.

Output: 1. Interval decrease in size of the pituitary lesion.2. An enlarged retrocerebellar cerebrospinal fluid signal space may represent an arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Reason: T3N2b right BOT HPV+ SCC on OPTIMA trial, finished induction chemotherapy with carboplatin/abraxane on 8/26/16. Evaluate for response. Need measurements Again seen is infiltrative enhancing lesion centered on the right base of tongue and extending into the oral tongue and floor of mouth anteriorly and posteriorly involving the glossotonsillar sulcus and right tonsillar fossa. Enhancing lesion measures 41 x 19 mm (axial postgad series 1601 image 39) previously 44 x 22 mm measured in a similar plane. A right level 2A lymph node measures 9 x 13 mm, axial T1 series 1201 image 38, which was previously 12 x 15 mm. There are additional scattered small cervical lymph nodes which are not significant by size criteria. There is motion degradation on multiple sequences however no new masses or new cervical lymphadenopathy is appreciated. Airway remains patent. There is suggestion of increased T2 hyperintensity in the right hemitongue which may represent early denervation changes.Visualized intracranial structures are unremarkable. No MRI evidence of perineural tumor spread. Visualized brain and orbits are gross the unremarkable. Paranasal sinuses are also clear aside from small bilateral maxillary mucus retention cyst.

Output: Compared to MRI dated 6/25/2016 there is mild decrease in size of the right base of tongue mass as well as decrease in size of a right level 2 cervical lymph node.


Instruction: Generate impression based on findings.

Input: 17-year-old female with laxity of the MCL. Right knee pain. MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is edema within the lateral aspect of the lateral femoral condyle and to a lesser degree within the medial patella, likely reflecting recent transient patellar dislocation. There is increased signal intensity within the articular cartilage along the median eminence of the patella indicating a full-thickness defect which measures approximately 14 mm in diameter. There are multiple cartilage fragments within the anterior knee joint, the largest measuring up to 14 mm located within the suprapatellar pouch. There may also be a smaller defect of the articular cartilage along the far lateral aspect of the weightbearing portion of the lateral femoral condyle, overlying the aforementioned bone contusion. The articular cartilage of the medial compartment appears intact.LIGAMENTS: The ACL and PCL appear intact. The MCL and LCL appear intact. There is edema along the medial retinaculum. The femoral attachment of the medial patellofemoral ligament is not well visualized and is likely torn. There is also edema along the lateral retinaculum.EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: Findings indicating recent transient dislocation of the patella with bone contusions, chondral defects, loose chondral fragments within the joint, and likely tear of the medial patellofemoral ligament.


Instruction: Generate impression based on findings.

Input: 21-year-old male with pain in the right knee. MENISCI: There is a complete longitudinal tear of the posterior horn of the lateral meniscus originating at the attachment of the ligament of Wrisberg ("Wrisberg rip") which is seen on multiple consecutive sagittal images. The anterior horn of the lateral meniscus appears intact. The medial meniscus appears intact. ARTICULAR CARTILAGE AND BONE: There are bone contusions along the posterolateral aspect of the tibial plateau and lateral femoral condyle above the anterior horn of the lateral meniscus. There is slight depression of the articular surface of the lateral femoral condyle above the anterior horn of the lateral meniscus, indicating an impaction fracture. There is also bone marrow edema within the posterior aspect of the medial tibial plateau and along the medial aspect of the medial femoral condyle representing additional contusions.LIGAMENTS: There is rupture of the ACL through its proximal fibers. There is low to intermediate signal intensity along the anterior margin of the torn ligament presumably representing displaced fibers. The PCL appears intact. The superficial band of the MCL appears intact. There is amorphous immediate signal intensity between the superficial fibers and the underlying medial femoral condyle, and we cannot exclude the possibility of a tear of the deep meniscofemoral component of the MCL.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: ACL tear, lateral meniscus tear, and other findings as described above.


Instruction: Generate impression based on findings.

Input: There is redemonstration of a blush of enhancement in the ventral cervicomedullary junction with a small venous structure draining this lesion to the sigmoid sinus, which is unchanged since prior. Ventricles remain unchanged in size with mild prominence of the temporal horns again seen. There is a hypoplastic inferior vermis, which is stable.Brain parenchyma is otherwise unremarkable for age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Mucous retention cysts involving the bilateral maxillary and right sphenoid sinus are again seen. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: There is redemonstration of a blush of enhancement in the ventral cervicomedullary junction with a small associated venous structure draining into the sigmoid sinus, which is unchanged since prior and may represent an AV malformation.


Instruction: Generate impression based on findings.

Input: Thoracic back pain with radiation to the legs. Alignment of the thoracic and lumbar spine is unremarkable. No acute fracture or dislocation is seen. At L5 -- S1 intervertebral level, there is suggestion of an epidural lesion at the central and left central location, causing effacement of the thecal sac and impingement of the left S1 nerve root. This can be seen on series 11, image number 153. It is uncertain whether this represents image artifact, disk extrusion, or other epidural lesions. Further imaging can be obtained with CT myelogram or MRI.The spinal canal and neural foramina at the other levels appear patent.A 12-mm gallstone is noted.

Output: 1. Possible epidural lesion at L5 -- S1 level, effacing the thecal sac and impinging the left S1 nerve root. Further imaging can be obtained with CT myelogram or MRI.2. 12-mm gallstone.Dr. Eileen Wang (page # 2992) was paged at time of reporting of the study, but she was not available. A note to alert the physician of the availability of the final report was left on the paging.


Instruction: Generate impression based on findings.

Input: Reason: s/p surgery and repair of fracture 10 years ago History: pain increased in past few month. ARTICULAR CARTILAGE AND BONE: Again seen is metallic susceptibility artifact within the proximal tibia reflecting removal of orthopedic hardware. Mild depression and deformity of the lateral tibial plateau compatible with healed fracture. Degenerative arthritic changes along the lateral tibial plateau have slightly progressed when compared to prior study with new subchondral cyst formation. We suspect increased loss of articular cartilage particularly along the anterior aspect of the lateral tibial plateau. There is also thinning of the articular cartilage along the lateral femoral condyle with several small intra-articular osteophytes that we suspect has also progressed when compared with prior study.Articular cartilage along the medial tibial femoral compartment appears relatively well preserved.Moderate degenerative changes of the articular cartilage of the patella, particularly centrally, where there is near full-thickness to full-thickness degeneration and subchondral cyst formation that has slightly progressed when compared to the prior study. Thinning of articular cartilage along the inferior aspect of the medial facet of the femoral trochlea appears similar to prior.MENISCI: There is mild deformity of the lateral meniscus associated with the healed tibial plateau fracture, but we see no discrete tear. We see no discrete tear of the medial meniscus.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.

Output: Posttraumatic deformity of the lateral tibial plateau with slight progression of osteoarthritic changes as described above.


Instruction: Generate impression based on findings.

Input: Reason: eval for meniscal pathology History: knee locking, lateral joint pain, hx of discoid meniscus and sx on R MENISCI: The medial meniscus appears intact. The lateral meniscus appears enlarged overall, which may represent a discoid meniscus. There is a bucket-handle tear of the lateral meniscus with a displaced fragment within the intercondylar notch (image 15; series 8). There is also increased signal abnormality within the posterior horn and body of the lateral meniscus which may reflect intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: There is focal full-thickness articular cartilage degeneration along the anterior aspect of the weightbearing surface of the medial femoral condyle above the anterior horn of the medial meniscus. There is decreased subchondral signal abnormality in the surrounding area which may represent sclerosis from prior impaction injury. There is relative sparing of the patellofemoral articular cartilage. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intactADDITIONAL

Output: 1. Bucket-handle tear of a probable discoid lateral meniscus. 2. Focal full-thickness articular cartilage degeneration along the medial femoral condyle as described above.3. Small to moderate size joint effusion.


Instruction: Generate impression based on findings.

Input: 65 year old female with Crohn's disease status post ileocecectomy. Presents with abdominal pain. 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is periaortic lymphadenopathy the the signal which measures 1.3 x 1.0 cm (27; series 5).BOWEL, MESENTERY: Note is made of diffuse wall thickening of a long segment of multiple distal ileal loops in the right lower quadrant measuring approximately 13 cm in length, with associated enhancement on postcontrast sequences, consistent with active fibro-stenotic disease. No evidence of fistula formation or abscess formation.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: Note is made of diffuse wall thickening of a long segment of multiple distal ileal loops in the right lower quadrant measuring approximately 13 cm in length, with associated enhancement on postcontrast sequences, consistent with active fibro-stenotic disease. No evidence of fistula formation or abscess formation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Long segment of bowel wall thickening and enhancement involving distal ileal loops, consistent with active fibro-stenotic disease. No evidence of fistula formation or abscess formation.


Instruction: Generate impression based on findings.

Input: Hand, foot, and tongue sensorimotor activation maps to its expected locations along on the pre- and post-central gyri. The most reliable language-related cortical activation was achieved with the verb generation and sentence completion paradigms. Language is strongly left dominant. Foci of activity compatible with Broca's area map as expected to the left pars triangularis and to a lesser degree pars opercularis. Two foci of activity, either or both of which would be compatible with Wernicke's area, map along the posterior aspect of the left superior temporal sulcus. The patient's hemosiderin stained lesion within the left temporal lobe is located inferior to, and well removed from, the visualized areas of primary or secondary language activation.

Output: Language is strongly left dominant. Activation corresponding to Broca's and Wernicke's areas maps as expected to the inferior left frontal and superior left temporal gyri respectively. The hemosiderin stained lesion in the left temporal lobe is inferior to and well removed from the visualized areas of primary and secondary language activity.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: 1. Findings most consistent with a thin subacute epidural hematoma extending throughout the thoracic spine without significant mass effect on the thecal sac. Some of the signal abnormality in the dorsal epidural space in the thoracic spine likely corresponds to the epidural venous plexus which can be better assessed with postcontrast images, although end-stage renal disease contraindicates gadolinium administration. No cord compression or cord signal abnormality. Small layering subarachnoid hemorrhage is also questioned in the upper thoracic spine, possibly related to redistribution from the intracranial subarachnoid hemorrhage. 2. Small bilateral pleural effusions.3. Diffuse low T1 marrow signal which is nonspecific but can be seen in conditions such as chronic anemia.4. Small bilateral pleural effusions.Dr. Ali discussed findings with Dr. Kak at 1450 hrs on 1/20/2015.


Instruction: Generate impression based on findings.

Input: Headache. There is no evidence of acute intracranial hemorrhage, mass-effect, or shift. No abnormal extra-axial fluid collections are identified. The ventricles and cortical sulci are within normal limits. There is an abnormal soft tissue lesion identified intraconally with the left orbit measuring approximately 1.5 cm. This examination was not tailored for evaluation of the orbits. If further imaging is warranted dedicated orbital CT or MRI may be helpful.

Output: No evidence of acute hemorrhage or shift. Intraconal mass lesion involving left orbit. This was also identified on prior MR imaging from March 16, 2009.


Instruction: Generate impression based on findings.

Input: 26-year-old female with medial joint line tenderness status post ACL reconstruction and lateral meniscectomy. MENISCI: A small remnant of the posterior horn of the lateral meniscus is seen, most compatible with stated history of prior lateral meniscectomy. The anterior horn of the lateral meniscus and the medial meniscus are within normal limits.ARTICULAR CARTILAGE AND BONE: Marked thinning of the articular cartilage of the lateral tibiofemoral compartment with mild underlying bone edema in the lateral femoral condyle. There is also marked thinning of the articular cartilage of the medial patellar facet. Otherwise, the remainder of the articular cartilage is within normal limits.LIGAMENTS: Status post ACL reconstruction without evidence of complication. PCL is intact. Collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1. Postsurgical changes from lateral meniscectomy and ACL reconstruction. 2. Articular cartilage thinning in the lateral tibiofemoral compartment and of the medial patellar facet, as described above.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Targeted ultrasound examination demonstrates a heterogeneous but predominantly hypoechoic irregular mass with internal septation and peripheral vascularity on Doppler interrogation within the left groin/thigh, corresponding to the findings of a soft tissue mass seen on recent MRI examination. Using ultrasound guidance a 16-gauge achieve core biopsy needle was advanced into the lesion. 4 16-gauge core biopsy specimens were obtained. 2 specimens were placed in formalin. One specimen was placed on a saline soaked Telfa pad. One specimen was placed in an anaerobic culture tube.The core biopsy specimens in formalin were hand carried to the Surgical Pathology lab. The remaining specimens were hand delivered to the clinical service.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: Ultrasound guided biopsy of left groin/thigh mass.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils are unchanged in appearance and terminate 5 mm below the craniocervical junction, but maintain a rounded configuration. There is biphasic CSF flow at the craniocervical junction and normal CSF space at this level. There is no syringohydromyelia. There is straightening of the cervical spine alignment in the sagittal plane and mild apex leftward thoracolumbar curvature that appears centered at L3; these findings were not apparent previously. There is an unchanged 5 mm pineal cyst. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus medullaris terminating at L1. The paravertebral soft tissues are unremarkable.

Output: 1. The cerebellar tonsils extend 5 mm inferior to the foramen magnum, but display rounded morphologies and the CSF flow across the foramen magnum appears to be intact. 2. Straightening of the cervical spine alignment in the sagittal plane and mild apex leftward thoracolumbar curvature that appears centered at L3.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.