Instruction: Generate impression based on findings.

Input: 17 year-old male with hydrocephalus, status post ventriculoperitoneal shunt Stable in size of the ventricles is observed when compared to the prior examinations on coronal view images. The slightly increased in size represent on axial view may be secondary to acquisition position difference between the studies. Right frontal ventriculostomy catheter is unchanged in position, with distal tip at the level of the third ventricle. The fourth ventricle remains dilated, with bilateral cerebellar encephalomalacia, which is stable. Suboccipital craniotomy, with adjacent dystrophic calcifications is also stable. Redemonstration of the encephalomalacia in left frontal periventricular white matter, consistent with previous instrumentation change. No evidence of acute intracranial hemorrhage, midline shift or hydrocephalus. Gray-white matter differentiation is preserved. The visualized paranasal sinuses and mastoid air cells are well-pneumatized. There is redemonstration of C1 congenital platybasia.

Output: 1. Interval stable in size of the supratentorial ventricular system, as described above. The slightly increased in size represent on axial view may be secondary to acquisition position difference between the studies. 2. Stable in position of the right ventriculostomy catheter. Postsurgical changes, and stable encephalomalacia in the posterior fossa.


Instruction: Generate impression based on findings.

Input: There are numerous T2 hyperintense lesions involving the cerebral white matter. A few lesions have increased in size, particularly in the bilateral deep anterior frontal lobe white matter and septocallosal region. Many lesions demonstrate corresponding T1 hypointensity. The ventricles and cortical sulci are mildly prominent diffusely due to cerebral volume loss. 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: Numerous supratentorial demyelinating lesions, some of which appear to have slightly increased in size.


Instruction: Generate impression based on findings.

Input: Male 37 years old with history of anaplastic astrocytoma four weeks post RT/TMZ Evolution of post-surgical changes related to a recent frontal craniotomy for tumor resection with mildly increased T2/FLAIR hyperintensity along the posterior aspect of the superior frontal gyrus, which extends to the left frontal horn. Ex-vacuo dilatation of the left frontal horn appears unchanged. Increased extra-axial enhancement beneath the craniotomy is compatible with expected evolution of post-surgical changes. Previously described nodular enhancement along the anterolateral aspect of the resection cavity has decreased in prominence (series 1302 image 85). No new or enlarging suspicious pattern of enhancement identified.The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Evolution of postsurgical changes related to recent re-resection of recurrent left frontal lobe tumor. No clear evidence of tumor progression. Mild interval increase in T2/FLAIR hyperintensity along the left superior frontal gyrus extending to the left frontal horn may represent post-treatment change given recent irradiation.2. Previously described nodular enhancement along the anterolateral aspect of the resection cavity is less conspicuous. No new or enlarging suspicious pattern of enhancement identified.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dementia, unspecified, without behavioral disturbance Memory lossClinical question: eval for structural lesionsSigns and Symptoms: dementia, incontinence The lateral ventricles the third ventricle and to a lesser fourth ventricle are fairly large relative to the sulci.There are T2 and FLAIR signal hyperintense periventricular and subcortical white matter lesions of a moderate to marked degree within the periventricular and subcortical white matter. They have a rather confluent pattern. Additionally there is a marked degree of a signal hyperintense foci scattered throughout the thalami. To a lesser degree there is a mild to moderate moderate degree of FLAIR and T2 signal hyperintense lesions in the midbrain and pons as well as the basal ganglia.No significant degree of lesions with susceptibility effect are appreciated intracranially.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.Periventricular and subcortical white matter signal changes of a marked degree are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 2.There are additional lesions scattered throughout the thalami and to a lesser degree pons, basal ganglia and midbrain which could also be related to a neurodegenerative process or vascular related. There are nonspecific as well.3.The ventricles are large. The possibility of normal pressure hydrocephalus cannot be excluded.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with neck pain and low back pain. Cervical:The cervical lordosis is mildly straightened which is likely positional. Sagittal alignment is otherwise unremarkable. Vertebral body morphology and signal characteristics are normal. No evidence of marrow replacement or marrow edema is seen.The visualized spinal cord shows normal signal intensity and morphology.Minimal disc osteophyte disease is seen at C3-4, C4-5 and C5-6 with very slight effacement of the ventral thecal sac. No significant spinal canal stenosis is detected.At C5-6, the left facet is hypertrophic which causes moderate left neuroforaminal narrowing. The remaining neural foramina are patent.Lumbar:Evidence of posterior approach surgery is seen at L3-4. Partial spinous process resection is seen and perhaps a partial laminectomy as well.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits allowing for a mild transitional morphology of the L5 vertebral body. No concerning marrow replacement or marrow edema is observed.Visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable.L1-2: Unremarkable. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L3-4: Facet hypertrophy. The ligamentum flavum appears to have been surgically thinned. Bulging disc with a left foraminal annular fissure. Mild generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Bulging disc with a shallow central protrusion. Mild to moderate generalized spinal canal narrowing. Mild to moderate bilateral foraminal narrowing. L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis.

Output: 1.Mild degenerative findings in the cervical spine with no evidence of significant spinal canal stenosis or cord impingement. Left facet hypertrophy at C5-6 does result in left-sided neuroforaminal narrowing at this level.2.Evidence of prior posterior approach surgery at L3-4. Posterior element hypertrophy and disc bulging at this level cause a mild spinal canal stenosis and moderate bilateral foraminal narrowing.3.Fairly significant posterior element hypertrophy is seen at L4-5 which, in combination with a bulging disc and central shallow disc protrusion, cause a mild to moderate canal stenosis. The neural foramina are also mildly to moderately narrowed at this level.


Instruction: Generate impression based on findings.

Input: 73-year-old woman with history of pain radiating to the shoulder. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is normal cervical lordosis. There is grade 1 anterolisthesis of C4 on C5. There is a hemangioma in the T2 vertebral body, otherwise bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a small disc osteophyte complex without significant compromise to the spinal canal or the right neural foramen. There is mild left neural foraminal stenosis.C4-5: There is a disc osteophyte complex and ligamentum flavum thickening without significant compromise to the spinal canal or neural foramina.C5-6: There is a disc osteophyte complex and ligamentum flavum thickening without significant spinal canal stenosis. Additionally, there is mild right and mild to moderate left neural foraminal stenosis.C6-7: There is a disc osteophyte complex and ligamentum flavum thickening without significant spinal canal or neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. There is a partially visualized, large multinodular thyroid gland with mass effect and deviation of the trachea.

Output: 1.Mild degenerative changes as described above, worst at the C5/C6 level.2.Large multinodular thyroid goiter with deviation and narrowing of the trachea.


Instruction: Generate impression based on findings.

Input: History of PSC cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Mild irregular narrowing and dilatation of the intrahepatic and extrahepatic biliary tree, similar to the prior. No new dominant stricture or focal lesion.No suspicious liver lesion. The vessels are patent.Cholelithiasis without cholecystitis.SPLEEN: Splenomegaly measuring 15.3 cm in craniocaudal dimension without a focal lesion.PANCREAS: Multiloculated cystic uncinate process lesion appears similar to the prior measuring approximately 1.4 x 0.9 cm (series 7/31), essentially unchanged. No suspicious post-contrast enhancement. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Upper abdominal retroperitoneal lymph node measures approximately 3.5 x 1.4 cm (series 7/25), compared to 3.9 x 1.3 cm previously.BOWEL, MESENTERY: Small volume ascites. Small bowel wall thickening is non-specific in the setting of ascites.BONES, SOFT TISSUES: Mild lower thoracic vertebral body height loss. Mild bilateral gynecomastia.OTHER: No significant abnormality noted.

Output: No significant interval change in findings of sclerosing cholangitis without a new dominant stricture or focal lesion. Stable multiseptated pancreatic uncinate process probable side-branch IPMN without suspicious enhancement.Stable retroperitoneal lymph nodes. Cirrhosis, mild splenomegaly and ascites. Cholelithiasis without cholecystitis.Mild small bowel wall thickening is non-specific in the setting of ascites.


Instruction: Generate impression based on findings.

Input: Reason: eval for rotator cuff pathology History: pain, limited ROM Several sequences are limited by patient motion artifact.ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus indicating tendinosis and perhaps mild articular surface fraying, but we see no discrete fluid-filled tear. The supraspinatus muscle appears normal. The infraspinatus muscle and tendon appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa which may reflect a mild bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. Mild osteoarthritis affects the glenohumeral joint. There is a small glenohumeral joint effusion. There is increased signal intensity within the superior labrum suggesting a tear. There is intermediate signal intensity within the anterior inferior labrum suggesting degeneration.BICEPS TENDON: There is mild increased signal intensity within the tendon of the long head of the biceps at its transition to the intertubercular groove suggesting mild tendinosis. There is fluid within the biceps tendon sheath that may represent fluid extension from the glenohumeral joint, rather than a tenosynovitis. ADDITIONAL

Output: 1. Tendinosis and possible articular surface fraying of the supraspinatus tendon.2. Small amount of fluid within the subacromial subdeltoid bursa which may reflect a mild bursitis.3. Mild osteoarthritis of the shoulder.4. Small glenohumeral joint effusion.5. Loss of the fat subjacent to the coracohumeral ligament which has been described in patients with adhesive capsulitis.


Instruction: Generate impression based on findings.

Input: 37 years Female (DOB:2/3/1979)Reason: eval for progression of bleed History: eval for progression of bleedPROVIDER/ATTENDING NAME: KRUPA G ANDALKAR CHRISTOPHER L KRAMER MRI of the brainThere is a large hematoma centered along the posterior and medial aspect of the right frontal lobe. It is stable. It is associated with vasogenic an cytotoxic edema and mild mass effect.Findings suggest a cord sign along the cortical draining vein adjacent to the hematoma with some thrombus extending into the superior sagittal sinus. This is best identified on coronal T2 imaging image 19 of series 9..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.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The MRV of the brain is degraded by patient motion which may obscure more subtle abnormalities

Output: 1.There is redemonstration of a large hematoma associated with edema centered along the posterior and medial aspect of the right frontal lobe. Differences in modality makes it difficult to compare interval change.2.Findings are suggestive of a "cord sign" which may represent an occluded cortical vein adjacent to the hematoma.3.The superior sagittal sinus appears patent as do all the dural venous sinuses although there may be some thrombus within the superior sagittal sinus adjacent to the hematoma.4.Examination is degraded due to patient motion which would obscure more subtle findings.


Instruction: Generate impression based on findings.

Input: Persistent headache for 5 days, bleed ruled out on CT, assess for other etiologies, PRES may be a concern. There is mild T2 hyperintensity in the pons and periventricular white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Mild nonspecific signal abnormality in the pons and periventricular white matter, which may represent chronic small vessel ischemia, but no evidence of intracranial hemorrhage, classic posterior reversible encephalopathy syndrome, or acute infarct.


Instruction: Generate impression based on findings.

Input: Reason: eval for meniscal tear History: recent fall, L knee effusion and inability to fully extend, medial sided pain MENISCI: The lateral meniscus appears intact. There is a complex tear with a large radial component involving the posterior horn of the medial meniscus, near its root. There is intrasubstance degeneration of the posterior horn of the medial meniscus with blunting likely representing additional degenerative tearing. There is slight medial extrusion of the body of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The lateral tibiofemoral articular cartilage appears relatively spared. There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus with large areas completely devoid of articular cartilage. There is full-thickness articular cartilage degeneration affecting the patellofemoral articulation with areas along the lateral facet of the patella completely devoid of articular cartilage. There is underlying subchondral signal abnormality. There is a full-thickness articular cartilage cleft along the far medial aspect of the medial facet of the patella. There are tricompartmental osteophytes.LIGAMENTS: There is thickening and intermediate signal intensity within the ACL indicating at least partial thickness tearing/sprain. There is disruption of the anterior fibers of the superficial and deep components of the MCL.EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a small amount of edema within the superolateral aspect of Hoffa's fat pad which is nonspecific. There is patella alta.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus with a large radial component and medial extrusion of the body of the medial meniscus.2. Partial-thickness tearing of the ACL.3. Disruption of the anterior fibers of the superficial and deep components of the MCL.4. Osteoarthritis of the left knee including full-thickness articular cartilage degeneration most pronounced along the medial tibiofemoral and patellofemoral articulations. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Memory decline. Assess for structural cause. There is mild diffuse cerebral and cerebellar volume loss. There are mild scattered foci of subcortical and periventricular white matter T2 hyperintensity. There is also a punctate focus of susceptibility in the right occipital lobe compatible with a small prior microhemorrhage. There are mildly prominent perivascular spaces in the bilateral basal ganglia. There is no evidence of acute intracranial hemorrhage, mass, or acute infarction. The expected intracranial vascular flow voids are present. There is mild scattered paranasal sinus mucosal thickening and retention cyst in the right sphenoid sinus. There are bilateral lens implants.

Output: 1. Mild scattered cerebral white matter T2 hyperintensities which are nonspecific, but likely represent chronic small vessel ischemic disease.2. Nonspecific diffuse cerebral and cerebellar volume loss.


Instruction: Generate impression based on findings.

Input: Craniopharyngioma, status post resection. Heterogeneously enhancing, cystic and solid lesion centered on the suprasellar cistern demonstrates significant increase in the cystic components and decrease in the solid components. Overall size of the mass is similar to prior, for example in the midline sagittal image, the lesion measures approximately 3.1 x 3.5 cm in the craniocaudal and AP dimensions, previously 3.1 x 3.6 cm.Mass effect involving the sella and suprasellar cistern including the optic apparatus as well as on the foramen of Monro and third ventricle are also similar to prior. No significant change in size of the ventricles with unchanged mild prominence of the lateral ventricles.

Output: Overall size of the craniopharyngioma and associated mass effect has not significantly changed since 5/27/2016, however the cystic components have become much more predominant in the interval and solid components have decreased.


Instruction: Generate impression based on findings.

Input: 44-year-old female with multiple sclerosis and paresthesias, for follow-up of disease progression. Brain: There are multiple foci of T2 hyperintensity in the periventricular and subcortical white matter, which appear similar to the prior exam, accounting for differences in technique. A few lesions also demonstrate T1 hypointensity. There is no significant brain parenchymal volume. There is no evidence of intracranial mass, recent infarct, or hemorrhage. There is a left maxillary sinus mucus retention cyst.Cervical Spine: The T2 hyperintense lesion at the right aspect of the cervical spinal cord at the C4 level is smaller in size when compared to 11/20/2014. There are no new lesions within the cervical spinal cord. There is mild straightening of the normal cervical lordosis, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are multilevel small posterior disc-osteophyte complexes, but no spinal cord compression. The paravertebral soft tissues are unremarkable.

Output: 1. Multiple supratentorial demyelinating lesions appear similar to the prior exam, accounting for differences in technique. 2. A demyelinating lesion involving the cervical spinal cord at the right C4 level has decreased in size.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 72 year old man with history of recent CABG and surgical MAZE procedure with recurrent atrial fibrillation, now referred for pre-ablation cardiac MRI. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVEDV is 218 ml (normal range 142+/-34), the LV end systolic volume index is 53 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 62 g/m2 (normal range 85+/-15), and the LV mass is 128 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a small area of late gadolinium enhancement in the mid inferolateral wall which is subendocardial and which is likely the focus of previous myocardial infarction or less likely an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated with a maximal LA volume of 117mL. The interatrial septum is thickened. There is no evidence of left atrial appendage thrombus.Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 120 ml/m2 (normal range 82+/-16), the RVEDV is 249 ml (normal range 142+/-31), the RV end systolic volume index is 63 ml/m2 (normal range 31+/-9), and the RVESV is 131 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated. The maximal RA volume is 139mL.Aortic ValveThe aortic valve opens widely and there is trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation which is eccentrically directed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.The dimensions are as follows:RUPV: 24 x 18mmRLPV: 22 x 20mmLUPV: 21 x 15mmLLPV: 14 x 15 mmPulmonary ArteryThe main pulmonary artery is upper normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall left pleural effusion with layering in the upper oblique fissure. Sternotomy wires are present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 49%2. There is a small area of late gadolinium enhancement in the mid inferolateral wall which is subendocardial and given the patient's history of previous CABG is likely the focus of a previous myocardial infarction3. The right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 47%4. There is mild biatrial enlargement.5. Pulmonary vein measurements are as given above6. 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: Craniotomy on 5/27 for resection of recently hemorrhagic left middle cerebellar cavernous malformation with associated DVA. There has been interval left suboccipital craniotomy for resection of the lesion centered in the left middle cerebellar peduncle with residual surrounding hemosiderin staining. There is no residual surrounding vasogenic edema or effacement of the fourth ventricle. There is no evidence of acute infarct. There is no midline shift or herniation. The orbits are grossly unremarkable. There is a retention cyst in the left maxillary sinus.

Output: Interval resection of the left middle cerebellar peduncle cavernous malformation with residual peripheral hemosiderin staining and associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Olfactory groove meningioma status post subtotal resection on 2/17/15. Re-evaluation after stage II resection of olfactory groove meningioma on 2/25/15. The patient also experiences diplopia. There are postoperative findings related to recent bifrontal craniotomy with areas of susceptibility along the margins of the resection cavity and diffuse scalp and face swelling. There is nodule enhancement in the posterior aspect of the resection cavity, adjacent to the anterior cerebral arteries, that measures up to 20 mm and is compatible with represent residual tumor. There also appears to be nodular enhancement along the left planum sphenoidale that measures up to 10 mm and may represent residual tumor. Otherwise, there is diffuse linear enhancement along the margins of the resection cavity, which likely represent granulation tissue, as well as diffuse regional reactive dural enhancement. The left optic nerve abuts this dural enhancement proximal to the optic strut. The optic apparatus and orbits otherwise appear intact. There is extensive residual edema in the deformed bilateral frontal lobes. The ventricles are unchanged in size and configuration. There is no evidence of territorial infarction.

Output: Postoperative findings related to olfactory groove meningioma resection with evidence of residual tumor in the posterior aspect of the resection cavity and perhaps along the left planum sphenoidale and extensive residual edema in the bilateral frontal lobes.


Instruction: Generate impression based on findings.

Input: Ms. Schacht is a 63 year old female with a strong family history of breast cancer, including her mother, sister, maternal aunt, and maternal cousin. She is a BRCA1 mutation carrier. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Scattered foci of enhancement are seen symmetrically in both breasts, all of which appear stable when compared to multiple prior exams. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.Stable cysts of the left hepatic lobe.

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


Instruction: Generate impression based on findings.

Input: Osteomyelitis The examination is markedly limited by motion artifact. The patient was unable to tolerate the exam and no contrast was administered.First ray: Normal marrow signal.Second ray: Normal marrow signal.Third ray: There is mild deformity of the head of the third metatarsal but the marrow signal of the third ray is normal.Fourth ray: Normal marrow signal. There is a focus of soft tissue gas and deep ulceration overlying the plantar aspect of the diaphysis.Fifth ray: There has been amputation of the fifth ray to the level of the fifth metatarsal base. The visualized portion of the fifth metatarsal base demonstrates normal marrow signal intensity.There is diffuse soft tissue swelling of the dorsal foot. Within the limits of this exam, there is no discrete fluid collection. Probable degenerative cysts noted in the navicular.

Output: Limited examination demonstrates deep ulceration and soft tissue gas at the level of the third and fourth metatarsal diaphyses but no definite evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Ms.Joyce Short, 59 years old, submitted outside study for review. The outside documents including the radiology report for the imaging are incomplete. The history of the patient is unclear.Images performed at Northwest Community Health Care submitted for review: MRI breast 12/17/2015Ultrasound breast 1/12/2016Ultrasound-guided biopsy of the breast 1/12/2016Postprocedure mammogram 1/12/2016Images submitted for comparison:None MRI BREAST 12/17/2015:Multisequence MRI breast with and without IV contrast was performed as per outside hospital MRI breast protocol. The breasts are composed of scattered fibroglandular tissue. There is a mild background parenchymal enhancement bilaterally. Kinetic analysis of these images was not possible. Left Breast:There is a 16 x 11 cm mass identified in the left breast, 9:00 o'clock position in the far posterior depth. Projecting anterolateral to the 9:00 mass are multiple irregular enhancing masses and foci. The total extent from the 9:00 mass to the multiple central masses are approximately 7.5 cm lateral to medial oblique. Additionally, there is a 5 mm enhancing mass near the medial aspect of the nipple, which has enhancement similar to the other enhancing masses and foci.Right breast:No suspicious enhancement is noted in the right breast. A few nonspecific enhancing foci likely representing the normal background parenchymal enhancement. There is also a normal sized lymph node in the lateral breast with a preserved fatty hilum. Visualized bilateral lymph nodes are unremarkable.TARGETED ULTRASOUND OF LEFT BREAST AND THE ULTRASOUND-GUIDED BIOPSY OF THE LEFT BREAST 1/12/2015:Static ultrasound images are submitted for interpretation. Multiple masses are noted in the left breast.1. Left Breast, 9:00 position, 8 cm from the nipple, there is a round hypoechoic mass measuring 1.3 x 1.1 x 1.5 cm. Immediately adjacent to this mass are another two hypoechoic masses, labeled as same position, measuring 0.7 x 0.4 x 0.5 cm and 0.5 x 0.4 x 0.5 cm, respectively.2. Left breast, labeled as 1 - 2:00 position, 2 cm from the nipple, there is a lobulated hypoechoic mass measuring 0.8 x 0.8 x 1 cm.3. Left breast, labeled as 1:00 position, 2 cm from the nipple, there is another hypoechoic mass measuring 0.6 x 0.3 x 0.6 cm.4. Left breast, 8:00 position, 4 cm from the nipple, there is a hypoechoic irregular mass measuring 0.7 x 0.3 x 0.5 cm.No suspicious finding identified on the images labeled as the left breast, 6:00, 7:00, 10:00, 11:00, and 12:00 positions.The 1.5 cm mass in the left breast, 9:00 position and the 1 cm mass left breast, labeled as 3:00 position (may correspond to the hypoechoic mass labeled as 1 to 2:00 position) are the targets for the biopsy. Targeting appears appropriate. Clips were placed at each biopsy site.POST PROCEDURE MAMMOGRAM 1/12/2016: A ribbon-shaped clip is placed in the the left breast 9:00 position.A dumbbell shaped clip is likely placed in the the left breast, 1 to 2:00 position (likely corresponding to the 3:00 biopsy site.) The two biopsy clips and biopsied masses are more than 8 cm apart. PER OUTSIDE PATHOLOGY:A. left breast mass, 3:00 position; ultrasound guided core needle biopsy:- DCIS, cribriform subtype with necrosis, grade 2- This result is concordant with the imaging findings.B. left breast mass, 9:00 position; ultrasound guided core needle biopsy:- Fragmented breast core with DCIS, cribriform subtype , grade 2- This result is concordant with the imaging findings.

Output: Biopsy proven multicentric disease in the left breast with numerous suspicious enhancing masses and foci throughout the left breast and extending to the left nipple.Please note that no imaging before the MRI is submitted at the time of this dictation. It is expected that a bilateral mammogram and probably other exams were performed before the MRI. An addendum can be issued if the images become available later.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: History of metastatic lung cancer with brain metastases. Surveillance scan. Signs and symptoms: None. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Compared to prior MRI exam from February 2015 there is near complete resolution of vasogenic edema surrounding a small right parietal metastatic lesion. Minute residual gliosis is identified. The enhancing metastatic focus however is again identified and measuring approximately at 5 x 6 mm in transaxial dimensions (axial post enhanced series 12 image 7). There is a slight interval decreased size of metastatic focus since prior MRI exam however when compared with postenhancement on the study from 3-10-15 lesion demonstrate interval increased size and intensity of enhancement since prior exam.A punctate focus of enhancement in the right frontal subcortical white matter consistent with metastatic lesion demonstrate interval significant decreased size since prior exam which measured approximately 5 mm in size. A small metastatic lesion noted in the right basal ganglia on prior exam cannot be identified on current study.Multiple small metastatic lesions in bilateral cerebellar hemispheres demonstrate decreased number since prior exam and remaining visualized metastatic foci are tiny and smaller than prior exam. Calvarium demonstrate no abnormal enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.

Output: 1.There is interval improvement of metastatic brain lesions since prior exam and with a few of the smaller previously seen metastatic lesions no longer identified on the current study.2.The largest remaining metastatic lesion in the right postcentral gyrus measures at 5 mm in transaxial dimensions. Compared to post enhanced only study from 3-10-15 there is subtle interval increased size of this lesion however when compared with earlier MRI exam from 2-13-15 there is interval decreased size of the lesion.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness BRAINThe CSF spaces are appropriate for the patient's stated age with no midline shift. There are calcifications present along the globus pallidiNo 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. There is an arachnoid granulation present along the junction of the right transverse sinus with the sigmoid sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.The left superior semicircular canal extends to the tegmen tympani. It is not clearly dehiscent on the basis of this exam.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.

Output: 1.The left superior semicircular canal extends to the surface of the tegmen tympani. It is not clearly enhancement, however, CT temporal bones is more accurate in evaluating for this.2.No abnormal mass lesions are appreciated intracranially.


Instruction: Generate impression based on findings.

Input: Female; 63 years old. Reason: pelvic US noted 3cm mass in cervix - need to further characterize to plan surgery PELVIS:UTERUS, ADNEXA: 2.5 x 3.3 x 3.8 cm cervical mass demonstrating intermediate T2 signal, restricted diffusion, and homogeneous contrast enhancement, compatible with cervical cancer. No evidence of parametrial, bladder, rectal, or vaginal invasion.Trace amount of endometrial fluid is seen superior to the mass.Both ovaries are not visualized, which may be due to atrophy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cervical cancer as detailed above.


Instruction: Generate impression based on findings.

Input: Right vestibular schwannoma treated to 12.5 Gy using SRS: dizziness. There has been slight interval increase in size of the right vestibular schwannoma that is extends from fundus of the internal auditory canal to the cerebellopontine angle cistern, now measuring up to 21 AP x 24 RL x 18 SI mm, previously 20 AP x 21 RL x 16 SI. There is associated increased mass effect upon the right middle cerebellar peduncle and right cerebellar hemisphere, where there appears to be mild edema. There is persistent slightly diminished fluid signal within the right labyrinthine structures. There are unchanged mild scattered foci of cerebral white matter T2 hyperintensity, which likely represent microangiopathy.

Output: Slight interval increase in size of the right vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: Headache, vertigo, positive head impulse, and nystagmus on right vision. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, cerebellum appear unremarkable. There is a flattened appearance of the pituitary gland. The ventricles, sulci, and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is a partially-imaged heterogeneous right parotid tumor measuring at last up to 20 mm.MRA: There is no evidence of significant steno-occlusive lesions in the head and neck arteries. In particular, while the vertebral arteries in the neck are tortuous, the posterior circulation nevertheless appears to be intact. There is no evidence of cerebral saccular aneurysms.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive lesions in the head and neck arteries. 3. A partially-imaged right parotid tumor measuring at last up to 20 mm may represent a pleomorphic adenoma, for example. Follow up with dedicated parotid imaging may be useful.4. A flattened appearance of the pituitary gland is nonspecific and can represent a normal variant or a sign of elevated intracranial pressure, for example.


Instruction: Generate impression based on findings.

Input: 34 year old woman with history of NICM, SLE, referred for evaluation of underlying ischemia and fibrosis.MEDICATIONS: Coreg, lisinopril, warfarin 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 severely dilated with moderate to severely reduced systolic function. There is severe thinning and akinesis of the basal to mid anterolateral and inferolateral walls. The basal inferior wall is hypokinetic. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 120 ml/m2 (normal range: 65+/-11), the LVEDV is 220 ml (normal range 109+/-23), the LV end systolic volume index is 84 ml/m2 (normal range 18+/-5), the LVESV is 155 ml (normal range 31+/-10), the LV mass index is 65 g/m2, and the LV mass is 119 g. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 23%, the RV end diastolic volume index is 107 ml/m2 (normal range 69+/-14), the RVEDV is 195 ml (normal range 110+/-24), the RV end systolic volume index is 82 ml/m2 (normal range 22+/-8), and the RVESV is 149 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. There is tethering of the posterior leaflet with moderate to severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate 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 FindingsBilateral lower lung consolidation versus infiltrates. 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; however, the diagnostic sensitivity of vasodilator stress testing is reduced in patients with significant LV dysfunction. Additionally, given the below regional wall motion abnormality, I would be concerned that the ischemic burden is being underestimated.2. No prior myocardial infarction. The entire myocardium is viable.3. Severe LV dilation with moderate to severe systolic dysfunction (LVEF 30%). There is severe thinning and dyskinesis of the basal to mid inferolateral and anterolateral walls suggesting the presence of hibernating myocardium. 4. Mild RV dilation with severely reduced systolic function (RVEF 23%).5. Tethering of the posterior mitral leaflet associated with at least moderate to severe ischemic mitral regurgitation.6. Moderate tricuspid regurgitation.7. Severe left atrial dilation.8. Bilateral lower lung consolidation versus infiltrate.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 3 years old Reason: anatomy and function . Status post CAPVR repair Left VentricleThe left ventricle is normal in size. The overall LV ejection fraction is 60.9%, the LV end diastolic volume index is 100 ml/m2 (normal range: 74+/-15), the LVEDV is 64.41 ml (normal range 142+/-34), the LV end systolic volume index is 25.17 ml/m2 (normal range 25+/-9), the LVESV is 39.32 ml (normal range 47+/-19), the LV mass index is 37.81 g/m2 (normal range 85+/-15), and the LV mass is 24.20 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. The LA volume is N/A ml.Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 56.2%, the RV end diastolic volume index is 84.95 ml/m2 (normal range 82+/-16), the RVEDV is 54.37 ml (normal range 142+/-31), the RV end systolic volume index is 37.2 ml/m2 (normal range 31+/-9), and the RVESV is 23.81 ml (normal range 54+/-17). Right AtriumThe right atrium is enlarged, but stable. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.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 pericardial thickening or effusion.Extracardiac Findings No abnormality noted.

Output: 1. Enlarged right atrium. 2. Normal Right and left ventricular wall motion and function. 3. Normal pulmonary venous return with no evidence of obstruction of the anastomosis of the pulmonary veins to the left atrium. Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: Right foot also The exam is suboptimal secondary to motion artifact on nearly every sequence.A vitamin E marker was placed in the region of interest along the plantar aspect of the lateral midfoot near the level of the fifth metatarsal head/neck. Within this area is a shallow skin ulceration does not appear to extend beyond the subcutaneous fat. There is mild edema subcutaneous tissues of the foot particularly along the lateral dorsal midfoot. Within the limits of this exam, there is no evidence of a subcutaneous fluid collection.There is no evidence of osteomyelitis. Severe osteoarthritis affects the first MTP joint.

Output: Suboptimal exam secondary to motion. Within these limits, there is no evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Images are slightly limited by patient motion. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild-moderate chronic small vessel ischemic changes. In addition, there is a chronic right paramedian occipital lobe infarct with focal encephalomalacia. There is no diffusion abnormality. No extra-axial fluid collection is identified.The intracranial right vertebral artery flow void is not visualized. Normal flow-voids are demonstrated in the remainder of the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is redemonstration of a prominent deep left-sided scalp hematoma measuring 20 mm in greatest thickness. Patient's known C1 and C2 fractures are not well visualized on this portion of the exam.MRA HEAD

Output: 1. Severely motion limited exam.2. No evidence of acute infarct. Mild-moderate chronic small vessel ischemic changes of chronic right occipital lobe infarct.3. Redemonstration of nonvisualization of the entire imaged cervical and intracranial right vertebral artery consistent with previously suspected occlusion which again may relate to traumatic dissection versus direct compression occlusion from surrounding traumatic injury. Please note that specific dissection sequences were inadvertently not performed.4. Right posterior cerebral artery distal to the P1-P2 junction appears diminutive in caliber as compared to prior CTA.5. Suboptimal evaluation of known C1 and C2 fractures. Redemonstration of prominent prevertebral soft tissue edema.


Instruction: Generate impression based on findings.

Input: Metastatic prostate cancer, neuropathy in right arm, history of disease in shoulder, evaluate for progression. Compared to spine CT, there has been enlargement of soft tissue masses involving the lower neck soft tissues including the bilateral supraclavicular fossa and upper paratracheal regions. For example round left upper paratracheal nodule previously measuring 13 x 13 now measures 15 x 16 mm in the coronal plane. Previously seen two nodules just more inferior to this one on the left have a more conglomerate appearance now and measure approximately 3.2 x 2.0 cm total in the transverse and craniocaudal dimensions in the coronal plane. On the right, upper paratracheal mass measures 2.9 x 5.9 x 3.3 cm, previously 2.9 x 5.1 x 3.2 cm. Again noted is diffuse tumor tumor involvement of the T1 vertebral body with extension into the posterior elements. There is epidural tumor involving mostly the right lateral aspect of the spinal canal extending from the right C6-C7 level to the T2-T3 level. There is flattening of the cord related to tumor in the epidural space bilaterally at the C7-T1 level, with suggestion of T2 hyperintensity (axial T2 image 29 of series 9). Tumor extends through the right-sided neural foramen from C6-C7 to T2-3 paravertebral soft tissues. Tumor also seen abutting the superior and medial pleural surface at the right lung apex. There is likely impingement of the right C7, C8, and T1 nerve roots of the brachial plexus at the level of the neural foramen and extraforaminal levels. Degenerative changes including disc osteophyte complexes C4-C5, C5-C6, and C6-C7 with associated mild spinal canal stenosis. There is also mild to moderate bilateral C4-C5 and right C5-C6 neural foraminal stenosis on a degenerative basis.

Output: 1. Bulky metastatic tumor involving the bilateral lower neck, supraclavicular fossa, paratracheal, and paravertebral soft tissues, which appears progressed compared to noncontrast CT dated 8/28/2015.2. There is epidural tumor extending from the C6-C7 level to the T2-T3 level with maximal mass effect and deformity of the cord at the C7-T1 level. There is probable T2 cord signal abnormality at the C7-T1 level (axial T2 image 29 of series 9). 3. Tumor involves the right neural foramen and extraforaminal soft tissues involving the right C7, C8, T1, and T2 nerve roots.4. Diffuse marrow infiltration involving the T1 vertebral body extending to the posterior elements. May consider total spine MRI with gadolinium to better assess the full extent of known tumor, as prior spine imaging was limited to CT.Dr. Ali discussed findings with Dr. Nabhan at 1027 hrs on 10/13/2015. Patient will be transported to the ED.


Instruction: Generate impression based on findings.

Input: Brain MRI:The previous head CT demonstrated what appeared to be foci of hypodensity. These are shown with multi planar MRI technique to due to volume averaging of sulci and not lesions.Soft tissue swelling is noted over the partially visualized aspects of the midface.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is appropriate. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Cervical spine MRI:Alignment is normal. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no osseous dysplasias or stenoses. There are no MR findings of ligamentous injury.

Output: 1.Negative MRI of the brain including gadolinium enhancement. The previous head CT demonstrated what appeared to be foci of hypodensity which are shown with multiplanar MRI technique to be due to volume averaging of sulci and not lesions.2.Soft tissue swelling is noted over the partially visualized aspects of the midface.3.Negative noncontrast cervical spine MRI without MRI evidence of ligamentous injury.


Instruction: Generate impression based on findings.

Input: Female, ex-30 week infant, now 19 days old, with seizures, apnea, CONS bacteremia. No evidence of restricted diffusion is seen. No significant parenchymal edema or mass effect is detected. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology. The degree of gyral development and pattern of white matter myelination are appropriate for the corrected gestational age. The pituitary region is within normal limits. The corpus callosum is fully formed and intact. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable.

Output: Unremarkable evaluation.


Instruction: Generate impression based on findings.

Input: Left C5-6 radiculopathy: shoulder and neck pain. There is multilevel degenerative cervical spondylosis. In particular, there is a prominent disc-osteophyte complex at C5-6 that compresses the left aspect of the spinal cord and severely narrows the left neural foramen. There may be mild high T2 signal in the spinal cord at this level. There is also a small central disc-osteophyte complex at C4-5 that abuts the spinal cord and a smaller central disc-osteophyte complex at C3-4 that partly effaces the cerebrospinal fluid anterior to the spinal cord. Furthermore, uncovertebral hypertrophy at C4-5 results in mild bilateral neural foraminal narrowing. There is also minimal disc-osteophyte formation and uncovertebral hypertrophy at C6-7. There is no significant degenerative spondylosis at C2-3 and C7-T1. Aside from degenerative bone marrow signal alteration at the C5-6 level, the bone marrow appears unremarkable. There is lack of the typical cervical lordosis, but no spondylolisthesis. The vertebral body heights are preserved. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative cervical spondylosis. In particular, there is a prominent disc-osteophyte complex at C5-6 that compresses the left aspect of the spinal cord and severely narrows the left neural foramen.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for atherosclerotic disease, ischemia. Signs and symptoms: Unresponsive, impaired speech and dysarthria. Nonenhanced brain MRA:Bilateral vertebral arteries are widely patent and unremarkable. The left pica and right aica/pica common trunk is identified. Basilar artery and its distal branches are widely patent. Bilateral posterior posterior cerebral arteries demonstrate diffuse irregularity of the lumen with multiple foci of moderate to high-grade stenosis highly suggestive of atherosclerotic disease. No distal vascular occlusion.Bilateral internal carotid arteries are widely patent across the skull base and in their supraclinoid segments.Bilateral anterior and middle cerebral arteries are well visualized. The knees complete occlusion of the anterior division of left MCA. Examination additionally demonstrate diffuse atherosclerotic irregularity of the vascular lumen bilateral anterior and middle cerebral arteries with multiple foci are mild to moderate degree of the stenosis. This finding in particular is significant in the A2 segment of right anterior cerebral artery which demonstrate high grade stenosis in its pericallosal segment.

Output: 1.Extensive intracranial atherosclerotic disease.2.Complete occlusion of left MCA proximal trunk at the bifurcation.3.Significant stenosis of the left pericallosal anterior cerebral artery.4.Patent bilateral vertebral arteries, basilar artery and internal carotid arteries.


Instruction: Generate impression based on findings.

Input: Reason: Right hip pain x 1 year, no improvement with physical therapy, evaluate for labral tear. PLEASE INJECT WITH KENALOG 40MG AT TIME OF ARTHROGRAM History: right hip pain. ACETABULAR LABRUM: No evidence of tear.ARTICULAR CARTILAGE AND BONE: Articular cartilage is within normal limits. Bone marrow signal intensity is within normal limits.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: No evidence of labral tear.


Instruction: Generate impression based on findings.

Input: 28-year-old female with multiple sclerosis on Tysabri. Evaluate for PML. Again seen are multiple T2 hyperintense foci scattered about the periventricular, subcortical and deep white matter of the cerebrum as well as the corpus callosum, where many of the lesions are oriented perpendicular to the callososeptal interface. Many of these foci demonstrate corresponding T1 hypointensity. There is no significant change in these lesions. No new lesions.No restricted diffusion or susceptibility abnormalities. No intracranial mass or mass effect. No findings to suggest progressive multifocal leukoencephalopathy. The CSF spaces are appropriate for the patient's stated age with no midline shift. Vascular flow voids are preserved. Calvarium and external cranial soft tissues unremarkable.

Output: No significant interval change in the multiple T2/FLAIR hyperintense foci throughout the subcortical and periventricular white matter consistent with known demyelinating disease. No new lesions. No findings suggest progressive multifocal leukoencephalopathy.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are numerous contrast enhancing masses throughout the supratentorial and infratentorial brain. The largest supratentorial lesion is within the right frontal lobe measuring 2.2 x 1.9 cm in transaxial dimension. The largest infratentorial lesion measures 2.3 x 2.2 cm and is located in the anteromedial right cerebellum. The larger lesions demonstrate irregular peripheral enhancement with an MRI appearance of central necrosis. Several also demonstrate susceptibility-weighted abnormality representing central hemorrhagic products. Larger lesions have associated vasogenic edema, although none have significant associated mass effect. Additionally, there is a background of diffuse T2 hyperintensity throughout the supratentorial white matter which suggests changes from prior therapy.The ventricles and sulci remain normal in size. The cerebellar tonsils are in normal position. There is no midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. A small mucous retention cyst versus polyp is noted in the left maxillary sinus. Fluid is present within bilateral mastoid air cells.Cervical MRI:There is an expansile, irregularly enhancing, necrotic appearing lesion involving the cervical cord spanning the levels from C3 through C6, measuring up to 5.3 cm in length. There is associated edematous changes extending superiorly and inferiorly, from the level of the cervicomedullary junction to T3. Increased fat signal within the adjacent vertebral bodies suggests prior radiation therapy. Enhancement within the interspinous tissues between C3 and C5 suggest there may have been prior biopsy.There is slight reversal of upper cervical curvature. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. Fluid is present within the nasal pharynx, oropharynx, and hypopharynx around the patient's intubation tube. A small T2 hyperintense focus is noted within the right thyroid lobe. Mild degenerative changes are noted throughout without significant stenosis.Lumbar MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The partially imaged gallbladder appears distended. There are mild degenerative changes without significant stenosis.

Output: 1.There are numerous contrast enhancing masses throughout the supratentorial and infratentorial brain. The largest supratentorial lesion is within the right frontal lobe measuring 2.2 x 1.9 cm in transaxial dimension. The largest infratentorial lesion measures 2.3 x 2.2 cm and is located in the anteromedial right cerebellum. The larger lesions demonstrate irregular peripheral enhancement with an MRI appearance of central necrosis. Several also demonstrate susceptibility-weighted abnormality representing central hemorrhagic products. Larger lesions have associated vasogenic edema, although none have significant associated mass effect. Additionally, there is a background of diffuse T2 hyperintensity throughout the supratentorial white matter which suggests changes from prior therapy.2.There is an expansile, irregularly enhancing, necrotic appearing lesion involving the cervical cord spanning the levels from C3 through C6, measuring up to 5.3 cm in length. There is associated edematous changes extending superiorly and inferiorly, from the level of the cervicomedullary junction to T3. Increased fat signal within the adjacent vertebral bodies suggests prior radiation therapy. Enhancement within the interspinous tissues between C3 and C5 suggest there may have been prior biopsy.3.No abnormal enhancement within the lumbar spine. The partially imaged gallbladder appears distended (please see abdominal CT dictation from 10/30/2015 for complete characterization).


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type I. Evaluate myelomeningocele status post repair, thoracic dural ectasia, yearly follow-up. Susceptibility artifact from spinal hardware limits evaluation for possible signal abnormalities in the spinal cord. There are postoperative findings related to attempted myelomeningocele obliteration and scoliosis fixation with stabilizing rods and laminar hooks with unchanged moderate levo thoracic scoliosis. There is a fluid collection enclosed by an expanded thecal sac that extends into the right thoracic cavity via expanded right T2-3 through T6-7 neural foramina. The fluid collection appears to be unchanged in size, measuring up to 13 x 5.3 x 8 cm (CC x AP x TR), previously 12.6 x 5.3 x 7.9 cm. The thoracic spinal cord is incompletely visualized; however, there is suggestion of the thoracic spinal cord extending extraspinally into the medial aspect of the fluid collection. There is stable associated mass effect on the right lung and the esophagus. There is unchanged scalloping of multiple thoracic vertebral bodies without loss of height. The portions of the spinal cord that are not obscured by artifact display normal signal characteristics. There is no evidence of mass lesions. The cerebellar tonsils appear to be mildly low-lying, which is unchanged.

Output: Susceptibility artifact somewhat limits evaluation; however, there is no gross interval change in the right thoracic myelomeningocele. Other stigmata of neurofibromatosis 1 and associated postoperative findings are unchanged.


Instruction: Generate impression based on findings.

Input: Other malformations of cerebral vessels [Q28.3], Reason for Study: ^Reason: AVM, s/p SRS, 3T Scanner History: Surveillance Brain MRIThere is tangled vascular structure with enhancement at the inferior aspect of left post-central sulcus and left inferior parietal lobule caudal portion. The lesion is measured about 7.8mm x 8.6mm. There is associated parenchymal T2/FLAIR high signal intensity at the left inferior parietal lobule indicating gliotic changes more likely than brain edema. There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate slightly prominent left MCA M2 and M3 segmental arteries as well as visualization of the right transverse-sigmoid sinuses indicating potential shunting of arterial flow. However, there is no definitive evidence of tangled vascular structure.There is no evidence of intracranial arterial aneurysm. No arterial luminal stenosis.The right ICA, MCA and bilateral ACAs appear to be normal. Vertebrobasilar system appears to be normal.

Output: 1. MRI evidence of enhancing lesion on the left post central sulcus and inferior parietal lobule caudal aspect indicating possible brain AVM (7.8mm x 8.6mm) with adjacent parenchymal gliosis. However, MRA did not show direct evidence (vascular tangling and enlarged feeding artery) of the lesion.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 54-year-old male with headache; evaluate for possible bleed There is no evidence of acute intracranial hemorrhage, mass or edema. Patchy nonspecific areas of hypoattenuation are seen in the subcortical white matter which may represent small vessel ischemic disease of indeterminate age. Please correlate with patient history and symptoms. No acute cortical infarct is identified. If high clinical concern for ischemia, MRI may be obtained. Bilateral basal ganglia calcifications.The ventricles and basal cisterns are normal in size and configuration.Sequelae of an old left orbital blowout fracture of the lamina papyracea is noted. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are normally pneumatized.

Output: 1. No acute intracranial hemorrhage or acute cortical infarct. 2. Likely small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Cirrhosis of liver without mention of alcohol [571.5], Reason for Study: ^Reason: eval for source of encephalopathy History: sp liver txp Abnormal high signal intensity lesions involving pons and bilateral thalami are again demonstrated. Those lesions are now showing low signal intensity on T1 and high signal intensity on T2, thus indicating focal tissue losses.On Gad enhancement, there is no evidence of contrast enhancement.On ADC maps, restricted diffusion areas of pons and bilateral thalami are now normalized which showed diffusion restrictions. The constellation of above findings and sequential changes of MR characteristics are highly suggestive for central pontine myelinolysis with extrapontine involvement. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Constellation of current MR findings and sequential changes of MR characteristics of pontine and bilateral thalamic lesions highly suggestive of central pontine myelinolysis with extrapontine involvement.


Instruction: Generate impression based on findings.

Input: Soft tissue loose body over anterior knee. "catching" MENISCI: Overall grossly similar bilateral medial and lateral menisci compared to 2013 with extensive changes. This includes a radial tear of the lateral meniscus with a more globular intrasubstance signal within the body and anterior aspects. The free edge of the meniscus remains irregular and frayed extensively. Suspected para meniscal cyst is observed The medial meniscus additionally demonstrates poorly defined globular signal also most pronounced within the body and posterior horn. Extension to the inferior articular surface supports degenerative tearing.ARTICULAR CARTILAGE AND BONE: Full-thickness articular cartilage degeneration is again observed throughout the lateral compartment with more moderate changes in the medial an patellofemoral compartments. Specifically the previously described full-thickness cleft of the posterior aspect of the medial femoral condyle is currently not appreciated. Underlying small subchondral cyst are observed with moderate degenerative changes essentially unchanged.LIGAMENTS: The ACL, PCL and collateral ligaments appear intact with persistent low signal intensity observed in the cruciate ligaments again suggesting possible scarring.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Essentially unchanged right knee MR with extensive meniscal and cartilaginous degenerative changes, both medially and laterally. Please see detail provided


Instruction: Generate impression based on findings.

Input: Right sciatica. Spinal anterior-posterior alignment is anatomic. Vertebral bodies are preserved in height. Fat signal focus in T12 vertebral body is probably a hemangioma. Marrow signal is otherwise homogeneous. There is mild T2 signal and height loss at L5-S1. The other intervertebral disks are preserved. The spinal canal shows no significant narrowing. Linear signal in the subcutaneous fat at the L5 level may represent a vessel or scar.L1-L2, L2-L3, and L3-L4: There is no significant degenerative disc disease. There is no foraminal or spinal canal narrowing.L4-L5: Minimal disc bulge but no significance spinal canal or foraminal narrowing.L5-S1: Broad-based right paracentral disc protrusion is associated with narrowing of the right subarticular recess. It also mildly narrows the right foramen and the central spinal canal (accentuated by ligamenta flava thickening).

Output: 1.Right paracentral L5-S1 disc protrusion causes narrowing of the right subarticular recess. Please correlate with right S1 radiculopathy. 2.There is no significant degenerative disease at the other levels.


Instruction: Generate impression based on findings.

Input: 59-year-old male unresponsive off sedation status post CABG with history of polio. Large, well circumscribed focus of CSF density fluid with adjacent bony remodeling without significant mass effect occupying most of the left hemisphere may be suggestive arachnoid cyst.Multiple, nonspecific areas of low density in the right internal capsule, right basal ganglia and right temporal cortex consistent with acute ischemia. MRI is recommended for further evaluation if clinically warranted.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Acute right hemisphere stroke as described above.


Instruction: Generate impression based on findings.

Input: Critical question: Evaluate for bleed or mass. Signs and symptoms: Hypertension and headaches. Non-enhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass, mass effect or midline shift or hydrocephalus.Questionable foci of low-attenuation in the subcortical white matter of both hemispheres are noted. These may represent small vessel ischemic disease. The common follow-up with an MRI exam. Cortical sulci, ventricular system and all CSF cisterns are otherwise unremarkable. Calvarium, visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of acute intracranial finding.2.Questionable small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 56-year-old male with tenderness to palpation along the left medial knee and a positive McMurray's test. MENISCI: There is linear, horizontally-oriented increased signal intensity within the posterior horn of the medial meniscus that extends through the posteromedial peripheral fibers of the meniscus decompressing into a 2 cm parameniscal cyst located deep to the tibial collateral ligament. This tear may extend to the tibial and femoral articular surfaces, however this is equivocal. There is also slight blunting of the free edge of the body of the medial meniscus suggestive of fraying. There is slight medial extrusion of the body of the medial meniscus. The anterior horn of the medial meniscus appears normal. The lateral meniscus is normal.ARTICULAR CARTILAGE AND BONE: Subjectively, the articular cartilage of the medial compartment appears slightly thinned with possible focal full thickness degeneration along the medial femoral condyle just above the free edge of the body of the meniscus. There is heterogeneity of the articular cartilage of the patella and femoral trochlea indicating mild to moderate degeneration, particularly along the trochlea where there are small subchondral cysts.LIGAMENTS: The anterior cruciate ligament appears intact. There is a 1 cm ovoid focus of low signal intensity along the anterior fibers of the ligament which may represent focal arthrofibrosis. The posterior cruciate ligament is intact. The MCL and LCL are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Horizontal tear of the medial meniscus extending through the peripheral fibers and decompressing into a parameniscal cyst.2. Cartilage degeneration and other findings as described above.


Instruction: Generate impression based on findings.

Input: 60 year-old male who presents with ataxia. Rule out CVA. There is mild generalized prominence of the ventricles and sulci, consistent with volume loss, which is slightly advanced for the patient's age. There is no evidence of acute intracranial hemorrhage, mass or edema. There is no evidence of extra-axial fluid collection. There is a focal area of hypoattenuation of the left lentiform nucleus in keeping with a chronic infarct (probably small vessel ischemic). Multiple age indeterminate scattered hypodensities are noted within the periventricular and deep white matter bilaterally, better seen on prior MRIs. These findings are nonspecific but most commonly represent mild small vessel ischemic disease. No CT evidence of acute territorial ischemia.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are clear. Moderate intracranial vascular calcifications are noted.

Output: 1. No acute intracranial hemorrhage, CT identifiable acute territorial ischemia or focal mass.2. Old lacunar infarct in the left lentiform nucleus.3. Multiple age indeterminate scattered hypodensities are noted within the periventricular and deep white matter bilaterally. These findings are nonspecific but most commonly represent chronic small vessel ischemic disease. We note an MRI of the brain has been subsequently performed for this patient.


Instruction: Generate impression based on findings.

Input: History of numbness in the hands and feet, headaches, intermittent blurry vision, essential tremor. There approximately 8 approximately T2/flair hyperintense lesions involving the supratentorial white matter, predominately involving the subcortical white matter of the left greater than right frontal lobes. There is one lesion involving the left frontal corona radiata. These have a nonspecific appearance and distribution which is not particularly suggestive of demyelinating disease.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Several foci of of T2/flair hyperintensity scattered within the supratentorial white matter. These have a nonspecific appearance and distribution and not particularly suggestive of demyelinating disease.


Instruction: Generate impression based on findings.

Input: NF1 and neck and thoracic mass, status post subtotal resection in June. There is a trans-spatial heterogeneously-enhancing plexiform mass centered in the left retropharynx that spans from the level of the nasopharynx into the upper mediastinum, with extension and left carotid space with associated encasement of the great vessels, and into the left visceral space with associated distortion of the thyroid gland. The mass measures approximately 4.0 AP x 4.5 RL x 13.5 SI cm, previously 3.3 AP x 3.3 RL x 12.0 SI cm. There is narrowing of the oropharyngeal airway. There appear to be secretions within the tracheal lumen. The cervical lymph nodes appear to be unchanged. There are T2 hyperintense lesions in the cerebellum.

Output: 1. Apparent increase in size of the plexiform neurofibroma centered in the left retropharynx at the level of the nasopharynx with extension into the left visceral space, upper mediastinum, and left carotid space with associated encasement of the great vessels since 2013. 2. Partially-imaged intracranial stigmata of neurofibromatosis type 1.


Instruction: Generate impression based on findings.

Input: Rheumatoid and osteoarthritis with significant neck pain and stiffness. There is 5 mm of retrolisthesis of C5 upon C6 associated with disc space narrowing, disc-osteophyte formation, and endplate irregularities and bone marrow edema. There is associated mild spinal canal narrowing and moderate bilateral neural foraminal narrowing. There is also trace retrolisthesis of C6 on C7 with mild disc-osteophyte formation that results in mild spinal canal narrowing and moderate bilateral neural foraminal narrowing. There is straightening of the alignment of C2 through C5 in the sagittal plane without associated degenerative spondylosis at these levels. There is focal prominence of the left ligamentum flavum with T3. The dens appears to be intact and there is no evidence of pannus formation. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. The cervical vascular flow voids appear to be intact and the paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis at C5-6 and C6-7 with associated mild retrolisthesis and spinal canal narrowing.


Instruction: Generate impression based on findings.

Input: 59 year old female patient with metastatic lung cancer on erlontinib. A small enhancing focus within the anterior left temporal lobe measures approximately 3 mm, previously 4.5 mm. No new enhancing intraparenchymal lesions are identified. There is no pachymeningeal or leptomeningeal enhancement. Multiple scattered foci of susceptibility artifact appear similar to the prior study may reflect prior treated metastases or chronic blood products. Scattered subcortical and periventricular abnormal T2 signal may represent chronic small vessel ischemic disease. There are no new diffusion-weighted abnormalities to suggest acute ischemia. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The left mastoid air cells are fluid-filled. A 5 mm enhancing focus within the left retro-orbital soft tissues is unchanged. Multiple heterogeneously enhancing calvarial lesions are similar in size and appearance compared to the prior study.

Output: 1. Slightly smaller to stable enhancing left temporal lobe metastatic lesion without new enhancing intraparenchymal lesion. 2. Stable left retro-orbital enhancing lesion and multiple calvarial lesions.


Instruction: Generate impression based on findings.

Input: 37-year-old female patient with Crohn's disease, complicated by vesico-intestinal fistula. Evaluate for extent of disease to aid surgical planning. 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: The left kidney is atrophic. There is patchy parenchymal enhancement of the right kidney. The ureters are prominent in diameter bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post-surgical changes of a total colectomy with an ileo-anal anastomosis. There is abnormal increased enhancement of the anus and ileoanal anastomosis compatible with active inflammation. There is a fistulous connection between the dome of the bladder with the adjacent ileal bowel loop (image 14, series 401 and image 32, series 1602). No specific evidence of bowel wall thickening or abnormal enhancement is identified of small bowel loops proximally.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: There is bilateral hydrosalpinx. BLADDER: A Foley catheter and an air/fluid level are noted within the bladder. There is a fistulous connection between the dome of the bladder with the adjacent ileal bowel loop (image 14, series 401 and image 32, series 1602). LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post-surgical changes of a total colectomy with an ileo-anal anastomosis. There is abnormal increased enhancement of the anus and ileoanal anastomosis compatible with active inflammation. There is a fistulous connection between the dome of the bladder with the adjacent ileal bowel loop (image 14, series 401 and image 32, series 1602). No specific evidence of bowel wall thickening or abnormal enhancement is identified of small bowel loops proximally.BONES, SOFT TISSUES: A 1.9 cm cystic lesion noted posterolateral to the right of the urethra may represent a Bartholin gland duct cyst.OTHER: No significant abnormality noted.

Output: 1.Abnormal enhancement of the anus and ileoanal anastomosis is compatible with active inflammation. 2.Fistulous connection between the dome of the bladder and an adjacent ileal bowel loop.3.Patchy parenchymal enhancement of the right kidney for which infection is not excluded; correlate with urinalysis.4.Bilateral hydrosalpinx.5.Probable Bartholin gland duct cyst.


Instruction: Generate impression based on findings.

Input: 11-year-old female with history of knee pain. MENISCI: There is speckling of the anterior horn of the lateral meniscus, a normal variant. The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is increased edema-type signal noted within the proximal tibia, most notably at the posteromedial aspect. In this region, there is a T1/T2 hypointense oblique band extending from the posterior metaphyseal cortex extending to the physis compatible with nondisplaced Salter-Harris II fracture. There is no evidence of tibial plateau depression.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Non-displaced Salter-Harris II fracture of the posteromedial proximal tibia without evidence of tibial plateau depression.


Instruction: Generate impression based on findings.

Input: Female 87 years old with a history of metastatic medullary thyroid cancer, compare to previous, measurements please. ABDOMEN:LIVER, BILIARY TRACT: Again seen are several enhancing liver lesions stable in size and number compared to the previous the reference right hepatic lobe lesion measures 2 5 x 2.4 cm (series 1308, image 228), unchanged.The gallbladder is normally distended without cholelithiasis. The common duct is dilated up to 1.1 cm in diameter, not significantly changed. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/30/2016 13:45:00)RIGHT HEPATIC LESION: 2.5 x 2.4 cm (Image 228, Series 1308); 2.5 x 2.4 cm on prior (10/5/2015) (Image 40, Series 10).

Output: Multiple enhancing hepatic lesions are stable in size and number. No new sites of disease.


Instruction: Generate impression based on findings.

Input: Male 61 years old Reason: Evaluate for medial meniscus tear, left knee History: Left knee pain in medial joint line x 2 months MENISCI: There is T2 hyperintense cleft in the posterior horn of the medial meniscus consistent with radial tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: T2 hyperintense edema signal is noted in the medial femoral condyle. There is thinning of the articular cartilage of the medial femoral condyle.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Radial tear of the posterior horn of the medial meniscus. Medial femoral condyle contusion. Moderate-sized joint effusion.


Instruction: Generate impression based on findings.

Input: 4-month-old with full fontanelle and head CT showed subdural hemorrhage. Concern for nonaccidental trauma. Evaluate for ligamentous injury. BRAIN: There is no significant change in the degree of bilateral supratentorial and infratentorial subdural blood products with relative dependent location. The hemorrhagic clot along the left paramedian frontal lobe is slightly smaller. There are scattered foci of susceptibility artifact, consistent with blood degradation products. There is persistent prominence of the subarachnoid space anteriorly as well as mild prominence of the ventricles, likely relating to benign enlargement of subarachnoid spaces of infancy. The underlying subdural collections appear slightly increased in size, but this may be related to differences in modality. There is no evidence of mass or acute infarct. The pattern of myelination is appropriate for age. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. Patchy opacities are noted diffusely in the paranasal sinuses. A small amount of fluid is present in the mastoid air cells bilaterally.CERVICAL SPINE: 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. Partially imaged is atelectasis of the right upper lobe and left lower lobe.

Output: 1. Apparent slight interval increase in bilateral subdural collections, may be related to differences in modality. 2. No significant change in the degree of bilateral supratentorial and infratentorial subdural blood products.3. No evidence of ligamentous injury.4. Partially imaged atelectasis of the right upper lobe and left lower lobe.


Instruction: Generate impression based on findings.

Input: There lumbar vertebral column alignment is unchanged. There is mild disc desiccation, facet degeneration, and diffuse disc bulges in the lower lumbar spine. In particular, a right posterolateral disc osteophyte complex that results in moderate right L3-4 neural foraminal narrowing. In addition, a disc bulge with annular fissure is associated with mild bilateral neural foraminal narrowing at L4-L5. There is also severe bilateral neural foraminal narrowing at L5-S1. There is no significant spinal canal stenosis. The vertebral body heights are preserved. There is subcentimeter focal fat or hemangioma formation in the L4 vertebra, which is unchanged. The spinal cord and cauda equina nerve roots display normal signal and morphology. No abnormal enhancement are present in the spine. The paravertebral soft tissues are unremarkable.

Output: No significant change in multilevel degenerative spondylosis in the lumbar spine since 2012, including moderate right L3-4 neural foraminal narrowing and severe neural foraminal narrowing bilaterally at L5-S1, but no significant spinal canal stenosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. A few scattered punctate foci of increased T2 signal within the periventricular and subcortical white matter are nonspecific. There is mild 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 unremarkable. There is trace mucosal thickening is present within the paranasal sinuses. The midline structures and craniocervical junction are within normal limits.

Output: 1.No evidence of acute ischemic infarction.2. Mild nonspecific cerebral white matter lesions likely represent chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Migraine without aura, not intractable, without status migrainosus [G43.009] / Benign neoplasm of cerebral meninges [D32.0], Reason for Study: ^Reason: Evaluate for structural lesions as etiology of Headaches, hx moya moya, hx dvt History: Headaches, hx Brain MRIAbout 8.5mm (RL) x 11mm (AP) x 12mm (CC) sized extra-axial homogeneously well enhancing mass on the left frontal operculum area with low signal intensity on T1 weighted image and low signal intensity on T2 weighted image. There is no evidence of mass effects against adjacent brain parenchyme. Most likely differential diagnosis is again meningioma.There is no evidence of another abnormal enhancing lesion. There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Brain MRV3D MRV brain non enhanced Phase Contrast with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Left frontal operculum area extra axial mass, unchanged in terms of size and MR characteristics since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. Normal brain MRA.4. Normal brain MRV.


Instruction: Generate impression based on findings.

Input: Anoxic brain injury. There is extensive restricted diffusion involving the cortex of the occipital lobes, parietal lobes, posterior temporal lobes, and posterior frontal lobes bilaterally. There is more mild restricted diffusion within the bilateral basal ganglia. The pattern of injury is consistent with a global anoxic event. The cerebellum and brainstem structures are spared. There is no significant associated edema, mass effect, or midline shift.There is encephalomalacia related to a chronic right anterior thalamic lacunar infarct.The ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.Small focus of increased T1 and T2 signal in the posterior left parietal bone may represent a small hemangioma.

Output: Acute to subacute ischemic changes involving the majority of the cerebral cortex as well as the basal ganglia. Findings are compatible with a global anoxic injury. No significant cerebral edema, midline shift, or herniation.


Instruction: Generate impression based on findings.

Input: 75-year-old male with history of Gleason 6 prostate cancer on the right PELVIS:PROSTATE:Prostate Size: 4.0 x 6.3 x 3.8 cm.Peripheral Zone: T2 hypointense lesion measuring 8 x 6 mm in the right apical/mid peripheral zone corresponding restricted diffusion. There is T1 hyperintensity corresponding to this lesion that may reflect blood product from prior biopsy. T1 hyperintense signal limits complete evaluation of this lesion.Central Gland: Moderate degree of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No extracapsular extension is evident.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.T2 hyperintense lesion in the right apical/mid peripheral zone suspicious for prostate malignancy. T1 hyperintense signal likely reflecting intralesional hemorrhage as described above limits complete evaluation of this lesion.


Instruction: Generate impression based on findings.

Input: 79-year-old female with a history of metastatic thyroid cancer, please compare to previous CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules demonstrate diffuse increase in the size.Reference left costophrenic nodule (image 240, series 6) measures 8 mm x 6 mm, previously, measuring 6 mm x 4 mm..Focal opacity with branching appearance in the superior segment of the left lower lobe (image 61, series 7) may represent inspissated mucus within a dilated bronchus.MEDIASTINUM AND HILA: Partially visualized heterogeneous thyroid mass is again noted.Prominent prevascular, precarinal, and subcarinal lymph nodes are stable.Moderate coronary artery calcifications with a stent identified in the LAD.CHEST WALL: Sclerotic focus within the manubrium is stable compared to prior exam dated 11/20/10ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The hypodense lesion in the inferior pole. The right kidney is unchanged and may represent a complex cyst however neoplasia cannot be excluded. Dedicated renal CT and/or MRI is recommended.PANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Multiple pulmonary nodules demonstrating diffuse increase in size compatible with progression of disease. No new sites of disease can be identified.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, with neck pain, signs of radiculopathy. Assess for spinal stenosis, DJD or any other structural process. Spinal alignment is grossly anatomic. Vertebral body heights are preserved. No concerning marrow replacement or marrow edema is seen.The spinal canal is congenitally slender. Superimposed upon this are central and left paracentral disc osteophyte complexes at C2-3 through C6-7 which result in spinal cord impingement and significant generalized spinal canal stenosis. At the C2 level, there is a focus of myelomalacia within the left posterior cord which may reflect chronic impingement from the adjacent thickened posterior atlantoaxial ligament. No other areas of cord signal abnormality are demonstrated.C2-3: Left facet arthropathy. Left paracentral disc osteophyte which impinges upon the spinal cord. No significant generalized spinal canal stenosis. No significant foraminal narrowing.C3-4: Left facet arthropathy. Broad posterior disc-osteophyte complex formation with central focality which impinges and deforms the spinal cord and causes a significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation with left paracentral focality which impinges on the cord and causes a significant generalized spinal canal stenosis. Severe bilateral foraminal narrowing. C5-6: Posterior disc osteophyte complex formation with left paracentral focality which impinges on the cord and causes a significant generalized spinal canal stenosis. Severe bilateral foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation which moderately narrows the spinal canal. Severe left foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Disc osteophyte disease, superimposed on a congenitally slender spinal canal, causes significant spinal canal stenosis through most of the cervical region. Focal disc osteophytes also impinge upon the spinal cord to varying degrees.A focus of myelomalacia is evident within the dorsal spinal cord at the C2 level. This likely represents sequelae of chronic impingement from the adjacent posterior ligaments which are thickened or buckled. Elsewhere, the spinal cord is free of significant signal abnormality.Foraminal narrowing is most notable bilaterally at C4-5, bilaterally at C5-6 and on the left at C6-7.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out intracranial hemorrhage, abscess, mass. Signs and symptoms going altered mental status, short-term memory loss. Non-infused head CT:The examination again demonstrates extensive subcortical and periventricular diffuse areas of low-attenuation with no appreciable interval change since prior MRI examination of 3 -- 29 -- 11. Findings likely represent post therapy changes. A shunted right lateral ventricle with no change in the size of ventricular system since prior study. Prominence of cortical sulci for patient's stated age concerning for underlying parenchymal volume loss.No evidence of hemorrhage, edema, mass effect or midline shift. No hydrocephalus.

Output: 1.Shunt in the right lateral ventricle and stable ventricular system since prior exam.2.Post therapy changes of bihemispheric white matter.3.No detectable acute intracranial findings.4.Extensive opacification of paranasal sinuses with fluid levels within bilateral maxillary sinuses.