Instruction: Generate impression based on findings.

Input: Left knee pain and swelling. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: The superior aspect of the femoral trochlea is convex indicating dysplasia.There is lateral translation and tilting of the patella, with the lateral facet of the patella perched atop the lateral femoral condyle.There is severe degeneration of the articular cartilage along the medial facet of the patella with areas that appear to be essentially devoid of cartilage.There is a comma-shaped ossicle measuring just over 2 cm in greatest dimension along the inferomedial aspect of the patella which we suspect reflects an old fracture fragment related to prior patellar dislocation.There is also full-thickness degeneration of the articular cartilage along the median eminence extending slightly along the medial facet of the patella with mild subchondral edema type signal.There is focal full-thickness degeneration of the articular cartilage of the medial tibial plateau below the posterior horn of the medial meniscus with edema type signal in the underlying subchondral bone.The articular cartilage of the lateral compartment appears relatively well preserved.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. The medial patellofemoral ligament is slightly indistinct which may reflect prior injury.The Insall-Salvati ratio is within normal limitsThe tibial tuberosity to the trochlear groove distance is nearly 3 cm.ADDITIONAL

Output: 1. Findings indicating patellofemoral instability including marked cartilage loss along the undersurface of the patella and an ossicle along the medial aspect of the patella that may reflect an old fracture from prior patellar dislocation. Furthermore there is increased tibial tubercle-trochlear groove distance as well as trochlear dysplasia.2. Small joint effusion and 2cm loose body in the posterior aspect of the joint.3. Small focal cartilage defect along the posterior aspect of the medial tibial plateau.


Instruction: Generate impression based on findings.

Input: Proximal femur lesion. Centered within the anterior cortex of the proximal femoral diaphysis is a lucent lesion with internal septations. The lesion measures 8 mm x 12 mm in maximal axial dimensions, and approximately 2.2 cm in maximal craniocaudal dimensions. The lesion does not appear to contain internal fat, or chondroid matrix. A small portion of the lesion appears to extend beyond the cortex of the femur, and into the quadriceps musculature as demonstrated on outside MRI. This is seen for example on series 5, image 48. There are no enhancing components of this lesion. The lesion does not extend into the medullary cavity. Surrounding soft tissues are otherwise normal.The right hip joint is grossly normal.There is normal intravascular enhancement.Muscles and soft tissues are otherwise normal. No fractures.

Output: Lucent lesion with sclerotic borders and internal septation centered within the anterior cortex of the proximal right femoral diaphysis as above, with a component apparently extending beyond the cortex. Nonossifying fibroma is suspected, but this is nonspecific. Although this lesion has some imaging characteristics of a chondromyxoid fibroma, osteofibrous dysplasia or an adamantinoma, the location of this lesion within the femoral diaphysis makes these differential possibilities less likely. Additionally, chronic infection is disfavored.


Instruction: Generate impression based on findings.

Input: 55-year-old male patient with elevated lipase. ABDOMEN:LIVER, BILIARY TRACT: Scattered T2 hyperintense lesions compatible with cysts. No intra or extrahepatic bile ductal dilatation. The gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: There is no significant peripancreatic fluid. The pancreas is of normal signal without focal lesion. The main pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst is unchanged. There is a retroaortic left renal vein.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific evidence pancreatitis or other acute abnormality within the abdomen.


Instruction: Generate impression based on findings.

Input: New onset of back pain. Please evaluate for myeloma lesions. Evaluation of the upper thoracic spine is limited on the lateral view due to overlying anatomy. There is multilevel degenerative disc disease affecting the cervical, thoracic, and lumbar spine. The vertebral lesions seen on the prior MRI study are not evident on the on this spine survey. There is a slight leftward curvature of the thoracolumbar spine. There is a positive sagittal balance of approximately 4 cm. Components of a left total hip arthroplasty are incompletely imaged on this study.

Output: Degenerative disc disease of the cervical, thoracic, and lumbar spine, without focal myelomatous lesions evident.


Instruction: Generate impression based on findings.

Input: 77 year old female with right-sided weakness; evaluate for CVA There is no evidence of acute intracranial hemorrhage, significant mass effect/midline shift or edema. Areas of encephalomalacia are again seen in the right parietal lobe and left temporal pole appearing similar to the prior study. Basal ganglia hypodensities, likely representing lacunar infarcts, with associated ex vacuo dilatation of the lateral ventricles. Extensive confluent hypodensities are seen in the periventricular and subcortical white matter which are nonspecific, but likely represent small vessel ischemic disease of indeterminate age showing mild interval progression from the previous exam. An area of hypoattenuation appears to involve the left frontal white and possibly gray matter which is new from the previous exam and may represent a focus of previous infarction. If high clinical suspicion for acute nonhemorrhagic stroke, MRI may be performed for further evaluation.Prominence of the ventricles, sulci and basal cisterns likely representing age-related volume loss. Extensive atherosclerotic calcifications are seen in the distal internal carotid arteries and vertebro-basilar system.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial hemorrhage. CT is insensitive for the early diagnosis of acute nonhemorrhagic CVA. 2. New left frontal focus of hypoattenuation appears to involve the gray and white matter and may represent a previous infarct. MRI may be performed if high clinical suspicion for acute nonhemorrhagic CVA.


Instruction: Generate impression based on findings.

Input: Diplopia [H53.2] / Dizziness and giddiness [R42], Reason for Study: ^Reason: eval for structural lesion vs ischemia History: episodes of dizziness and double vision No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Scattered patchy high signal intensity lesions on bilateral white matter indicate nonspecific small vessel ischemic disease.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 mastoid air cells are clear.A retention cyst on the right maxillary sinus.

Output: No evidence of acute ischemic or hemorrhagic lesion.No abnormal enhancement.Minimal nonspecific 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: 76-year-old male status post head injury; evaluate for ICH There is no evidence of acute intracranial hemorrhage, mass or edema. Extensive areas of nonspecific patchy and confluent hypoattenuation are seen in the periventricular and subcortical white matter, likely representing small vessel ischemic disease of indeterminant age.There is an extra-axial soft tissue density in the interhemispheric fissure measuring 7 x 8 mm (image 11, series 3) and 11 mm in height on the sagittal images. The soft tissue density appears to be connected to the left internal carotid artery and may represent an anterior communicating artery aneurysm. Recommend MRI/MRA for further evaluation. The ventricles and basal cisterns are normal in size and configuration.Soft tissue swelling is seen overlying the left frontal region. The calvaria and skull base are radiographically normal without evidence of fracture. The visualized paranasal sinuses, middle ear cavities and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial hemorrhage. Extensive small vessel ischemic disease of indeterminate age. 2. Left frontal soft tissue swelling without underlying fracture. 3. Soft tissue density in the interhemispheric fissure as described above suspicious for ACOM aneurysm. Recommend MRI/MRA for further evaluation.These findings were discussed with the emergency room (#56807) at the time of dictation.


Instruction: Generate impression based on findings.

Input: Heel pain and multiple myeloma There is mild thickening of the plantar fascia at its attachment on the calcaneus with mild edema and enhancement in the adjacent soft tissues indicating plantar fasciitis. There is also marrow edema within the adjacent calcaneus which is likely reactive to the soft tissue findings with the possibility of a stress fracture thought to be less likely.Otherwise the marrow signal of the ankle is normal. The Achilles and remaining tendinous structures appear normal. The remaining muscles are also normal in signal and caliber.

Output: Plantar fasciitis.


Instruction: Generate impression based on findings.

Input: Left shoulder pain and limited mobility ROTATOR CUFF: There is mild increased signal intensity within the supraspinatus tendon indicating mild tendinosis with possible undersurface fraying but we see no discrete fluid-filled tear. The supraspinatus muscle is normal. The infraspinatus and teres minor muscles and tendons are normal. There is increased signal intensity within the distal subscapularis tendon indicating insertional tendinosis. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal. There is no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is intermediate signal intensity affecting much of the superior labrum reflecting degeneration and degenerative tearing which appears similar to the prior exam. The inferior labrum is normal. There is a trace amount of fluid within the glenohumeral joint but no joint effusion.BICEPS TENDON: There is mild increased signal intensity within the fibers of the biceps anchor which likely reflects mild degeneration but the tendon is otherwise intact. ADDITIONAL

Output: Rotator cuff tendinosis and superior labral tearing with no evidence of mass.


Instruction: Generate impression based on findings.

Input: History of suprasellar meningioma status post resection. There are post-surgical changes related to a right frontotemporal craniotomy for suprasellar meningioma resection. There is redemonstration of encephalomalacia in the right inferior frontal lobe at the site of previously resected meningioma as well as laminar necrosis along the cortex similar to prior exam. There is faint enhancement in the sella with decreased band of enhancement along the superior aspect of planum sphenoid extending along the floor of the right anterior cranial fossa laterally to the craniotomy flap in the right temporal region, likely reflecting post-operative change.There are subtle subcentimeter areas of heterogeneous enhancement at the medial aspect of the left cavernous sinus as well as the right aspect of the suprasellar cistern. There is unchanged increased T1 hyperintensity in the right inferior basal ganglia. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Evolution of postoperative changes related to a right frontotemporal craniotomy for suprasellar meningioma removal. Subcentimeter heterogeneous areas of enhancement at the medial aspect of the left cavernous sinus as well as the right aspect of the suprasellar cistern, may represent minimal residual tumor, but are not significantly changed from prior exam. No evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Male 30 years old Reason: 30M with ileocolonic CD, mostly involving ileum, last scope 102014 with mild inflammation but with stenosis. No cross-sectional imaging. History: abdominal pain, gas ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a 9 cm segment of abnormal terminal ileum with mural thickening, luminal narrowing and mucosal enhancement. Proximal to this there is 7 cm segment of similarly abnormal, bowel wall thickening and mucosal enhancement. There is submucosal fat deposition suggestive of chronic inflammation. These segments are separated by an approximately 2 cm segment of more normal appearing bowel. The abnormal segments demonstrate luminal narrowing which persists throughout the study. Findings are consistent with long segment fibrostenotic disease with mild acute on chronic inflammation. There is adjacent fibrofatty proliferation with minimal adjacent inflammatory changes. There is also some distortion of the cecal pole.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Segmental distal and terminal ileum fibrostenotic disease with mild associated acute on chronic inflammation.


Instruction: Generate impression based on findings.

Input: Female, 83 years old, with small cell lung cancer, initial staging exam. No intracranial enhancing lesions are seen. No evidence of parenchymal edema or mass effect is detected. Extensive patchy T2 hyperintensity is seen within the periventricular white matter and the pons. No intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Sulcal and ventricular prominence is seen indicating a mild degree of parenchymal volume loss.

Output: 1.No evidence of intracranial metastatic disease.2.Fairly extensive chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Biceps pain. Rule out muscle tear. Please refer to the shoulder MRI report for information regarding the rotator cuff. The tendon of the long head of the biceps is not visible within the bicipital groove. There is a small focus of intermediate signal intensity within the anterior cortex of the proximal humeral diaphysis which I suspect represents the site of biceps tendon tenodesis. The tendon of the long head of the biceps is slightly ill-defined as it approaches this defect, but I suspect it is intact, and the signal intensity of the biceps musculature appears normal, without edema or fatty atrophy. Distally, the biceps tendon inserts onto the radius in normal fashion. The signal intensity of the remaining musculature of the arm appears normal. The signal intensity of the humerus is normal. Mild osteoarthritis affects the elbow, with a small amount of fluid in the joint but no large effusion.

Output: Surgical changes of biceps tenodesis, but otherwise no specific findings to account for the patient's biceps pain.


Instruction: Generate impression based on findings.

Input: Male 40 years old Reason: SLAP Tear History: right shoulder pain ROTATOR CUFF: There is partial thickness undersurface tearing of the distal fibers of the supraspinatus involving just under 50% of the thickness of the tendon with approximately 1 cm of retraction of the undersurface fibers. The tear extends approximately 1.5 cm in the AP dimension. The bursal surface appears intact. No gadolinium in the subacromion or subdeltoid bursa to indicate a full-thickness tear. The infraspinatus and teres minor are normal in appearance. There is increased signal within the substance of the subscapularis muscle which likely represents iatrogenic injection of contrast rather than a tear.SUPRASPINATUS OUTLET: There is a tiny amount of gadolinium in the subdeltoid space which is likely iatrogenic and again there is no full-thickness tear of the supraspinous.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint is normal in alignment. There is abnormal signal intensity within the superior labrum compatible with suspected SLAP tear. The anterior superior labrum appears separated from the glenoid which may be a continuation of the tear or a normal variant. The anterior inferior glenoid labrum also appears frayed.BICEPS TENDON: The tendon of the long head of the biceps appears normal.

Output: 1.SLAP tear.2.Undersurface tearing of the supraspinatus.3.Other findings as detailed above.


Instruction: Generate impression based on findings.

Input: There is asymmetric increased signal in the left hippocampus in the FLAIR images. There is loss of the internal architecture of the left hippocampus and the left temporal horn is slightly asymmetrically prominent. The left temporal lobe cortex appears slightly greater in signal overall than the right, although this may be artifactual.No diffusion or susceptibility abnormalities. The ventricles and sulci are prominent. There is no midline shift. The gyri and the sulci are not thickened. No evidence of bleed, edema, or mass effect. There is normal gray-white matter differentiation. Myelination appears normal. There is scattered mucosal thickening in the sinuses and fluid is seen in the mastoids.Flow voids of the cerebral arteries and the visualized internal carotid arteries appears normal.

Output: Asymmetrically increased FLAIR signal in the left hippocampus with loss of the internal architecture, with mild volume loss at this time, consistent with left mesial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: 88-year-old female with partial cystic mass in the pancreatic neck. Assess for worsening en masse ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Several hypodense lesions throughout the liver largest measuring 1.3 x 0.9-cm in the left lobe on image number 24, series number 3 are unchanged. Homogeneously hyperdense lesion measuring 1 cm in diameter image number 51, series number 3 likely representing a benign lesion is also unchanged.SPLEEN: No significant abnormality notedPANCREAS: Predominantly cystic mass with heterogeneous enhancement which represent thin internal septations in the pancreatic neck is unchanged measuring 2.8 x 2.3 cm image number 42, series number 3. This mass is not associated with pancreatic ductal dilatation. Its not clear whether this lesion communicates with the pancreatic duct. MRI may be helpful for further evaluation.ADRENAL GLANDS: Mild bilateral adrenal thickening and a small nodule in the left adrenal gland are unchanged.KIDNEYS, URETERS: Right upper pole enhancing mass measures 3.2 x 2.8-cm on image number 32, series number 3, unchanged.Right lower pole enhancing mass is also unchanged and measures 16 x 16 mm on image number 54, series number 3. Similar lesion in the mid pole of the left kidney is also unchanged and measures 10 mm in diameter in image number 32.Numerous additional hypodense lesions in both kidneys are most likely cysts but some are too small to adequately characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Several foci of loculated fluid attenuation lesions are seen in the abdomen with the largest collection the right lower quadrant measuring approximately 4 x 2.5 cm image number 74, series number 3 are unchanged. No wall thickening or dilatation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No significant change from previous study. Liver lesions are most likely benign.Heterogeneous cystic mass in the pancreatic neck may represent a serous cystadenoma or a branch type intrapancreatic mucinous neoplasm. MRI may be helpful for differentiation by demonstrating the relation between the cystic mass and the pancreatic duct.Bilateral enhancing renal masses consistent with renal cell carcinoma.Fluid attenuation lesions in the time. There clinical significance is unknown but metastatic disease cannot be excluded.


Instruction: Generate impression based on findings.

Input: To evaluate bullet in pelvis prior to MRI. Changes of degenerative disk disease and facet osteoarthritis affect the imaged lower lumbar spine. Mild osteoarthritis affects the left sacroiliac joint. The right sacroiliac joint demonstrates a normal appearance.There are no fractures identified.The hip joints demonstrate a normal radiographic appearance.A vascular graft is identified in the region of the right superficial femoral artery, the patency of which cannot be assessed on this noncontrast study.Atherosclerotic calcifications are noted in the aorta and iliac arteries.No organized fluid collections in the subcutaneous fat.In the left psoas muscle, at the level of the bladder, is an ovoid density, which measures 16 mm in craniocaudal dimensions and 7 mm in diameter. This is compatible with the stated history of bullet.

Output: 1. Bullet fragment within the left psoas muscle as above.2. Vascular graft as above, the patency of which cannot be assessed on this noncontrast study.3. Osteoarthritis and degenerative disk disease as above.


Instruction: Generate impression based on findings.

Input: 54 years, Female, Parkinson's. Limited sequences of the brain were obtained for operative planning which are motion degraded. No abnormal enhancement, vascular lesions, or masses are appreciated along the expected trajectory of the DBS leads. Arachnoid cyst at the right cerebellomedullary junction is again seen and similar to prior with minimal local mass effect. There is no suspicious intracranial mass or significant mass effect. No midline shift or herniation. Ventricles and sulci are within normal limits for age. Low-lying cerebellar tonsils are again seen. No evidence of hemorrhage, abnormal mineralization, or gross signal abnormality in the basal ganglia or brainstem is evident.

Output: 1. Examination for operative planning pre-DBS placement is motion degraded.2. No focal lesions along the expected trajectory of the DBS leads. Incidental findings include a small arachnoid cyst centered at the right cerebellomedullary junction which appears similar to 5/3/2010.


Instruction: Generate impression based on findings.

Input: Female 64 years old. Reason: r/o meniscal tear. History: pain. The exam is suboptimal secondary to metallic susceptibility artifact.MENISCI: There is internal signal within the posterior horn of the medial meniscus which does not reach the articular surface. There is no definite tear of the medial meniscus. The lateral meniscus is unremarkable. ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the patellar cartilage, however, there is no focal defect.LIGAMENTS: The ACL is not visualized consistent with tearing. The PCL and MCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Findings consistent with an ACL tear.2.Internal signal within the posterior horn of the medial meniscus, but no definite tear.


Instruction: Generate impression based on findings.

Input: PSC, evaluate cholangiocarcinoma ABDOMEN:LIVER, BILIARY TRACT: Irregular stricturing of the intrahepatic biliary ducts, not significantly changed. Long segment stricture in the common bile duct is unchanged. No focal hepatic mass. The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Findings compatible with primary sclerosing cholangitis without evidence of interval change, suspicious hepatic, or biliary lesions.


Instruction: Generate impression based on findings.

Input: An enhancing, intrinsically T1 hyperintense treated metastatic lesion in the right superior frontal gyrus is stable. Marginal surrounding FLAIR hyperintensity is again noted. This lesion is also associated with susceptibility artifact. Small enhancing metastases in the right superior occipital and left posterior temporal occipital lobes are stable, also associated with susceptibility artifact. There are no new metastases.The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are stable scattered nonspecific punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which most likely represent mild chronic small vessel ischemic changes in a patient of this age. A tiny anterior right parietal developmental venous anomaly is again noted. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. Incidental nonenhancing cystic structure associated with the pineal gland is again noted, unchanged in appearance. The remainder of the midline structures and craniocervical junction are within normal limits. Opacification and air-fluid levels within the paranasal sinuses have improved, with a residual small air-fluid level in the right maxillary sinus. The mastoid air cells are clear.

Output: 1.Stable small metastases as described in detail above.2.Stable mild chronic small vessel ischemic disease.3.Opacification and air-fluid levels within the paranasal sinuses have improved, with a residual small air-fluid level in the right maxillary sinus.


Instruction: Generate impression based on findings.

Input: Male, 20 years old, with von Hippel-Lindau disease and pre-existing brain and spine hemangioblastomas. Evaluate for new or growing lesions including within the internal auditory canal. Brain:An enhancing focus within the far inferior left cerebellum has increased in size, now measuring 7 mm in diameter, previously 4 mm. Mild surrounding parenchymal edema has also increased slightly from prior. An additional faintly enhancing 3 mm lesion more superiorly within the left cerebellum has not convincingly changed.No additional pathologic intracranial enhancement is seen. There is a developmental venous anomaly within the paramedian right parietal lobe. Cerebral morphology is within normal limits. No evidence of generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.Spine:A 3 mm enhancing nodule along the dorsal surface of the cervico-medullary junction is unchanged. There is no significant edema associated with this lesion.A 6 mm enhancing nodule along the dorsal surface of the spinal cord at T5-6 may be minimally increased in size in comparison to prior examination. However, there is new mild associated cord edema spanning the T5 and T6 vertebral bodies. More superiorly, at the T5 level, a punctate focus of enhancement along the dorsal cord is unchanged.A 2 mm focus of enhancement is evident along the left lateral cauda equina at L2. No adequate prior examination exists in this area for comparison. The conus and cauda equina are otherwise unremarkable.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement, edema or pathologic enhancement is seen. A shallow left paracentral disc protrusion is seen at T11-12. No areas of high-grade spinal canal or foraminal stenosis are detected.

Output: Multiple small enhancing lesions are identified within the brain and spine compatible with hemangioblastomas. One such lesion in the left inferior cerebellum has increased slightly in size. A punctate lesion more superiorly within the left cerebellum is unchanged.A 3 mm nodule along the dorsal cervical medullary junction is unchanged. A 6 mm lesion along the dorsal spinal cord at T5-6 may be slightly larger than on the prior examination, but associated edema has more clearly progressed. A punctate enhancing lesion along the dorsal cord at T5 is unchanged.A 2 mm focus of enhancement along the left lateral cauda equina at the L2 level is demonstrated and could represent an additional small hemangioblastoma. No adequate prior examination is available for comparison.


Instruction: Generate impression based on findings.

Input: Unspecified fall, initial encounter [W19.XXXA] / Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: ^Reason: bilateral LE weakness, h/o of ependymoma in 2002 History: as above There is restricted diffusion on the right basal ganglia extends toward periventricular white matter with the focal susceptibility artifacts on the inferior aspect of the lesion indicating possible focal hemorrhagic conversion.Underlying brain shows evidence of left frontal craniotomy associated with underlying encephalomalacia of the left frontal lobe which likely represent postoperative changes.There are also patchy FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease. Scattered chronic lacunar infarctions including right caudate head and left internal capsule, unchanged.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Right basal ganglia acute ischemic infarct with possible focal hemorrhagic conversion.2. Post left frontal craniotomy with associated postoperative changes of left frontal lobe. No unusual finding, unchanged since prior scan.3. Nonspecific small vessel ischemic disease and multifocal chronic lacunar infarctions, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: 65 years, Male, recent fall, looking without CVA. Patient also has back pain and leg weakness.. Brain: MRI of the brain is within normal limits for age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size. There is mild global parenchymal volume loss which is appropriate for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is mild to moderate mucosal thickening throughout the paranasal sinuses, particularly the left frontal sinus, bilateral anterior ethmoid air cells, left maxillary sinus, and left sphenoid sinus. There is evidence of prior endoscopic sinonasal surgery including bilateral partial ethmoidectomies, uncinectomies, and middle turbinectomies.. Bone marrow signal and extracranial soft tissues are within normal limits. Lumbar spine: Numbering is performed as on prior MRI with transitional lumbosacral anatomy including 6 lumbar type nonrib-bearing vertebrae. There is a mild chronic compression fracture involving the L2 vertebral body, predominantly on the left and not appreciably changed in the interval. There a Schmorl's node involving the inferior endplate as before. Minimal superior endplate deformity involving the L3 vertebral body is also not significant changed. No edema at these levels. There is T1 shortening involving the marrow of the lumbar spine and pelvis compatible with prior radiation. No new or enlarging destructive osseous lesions are seen. Conus is in normal position.At L1-L2, there is a stable left paracentral to far lateral disk protrusion. There is minimal left foraminal narrowing. Spinal canal and right neural foramen are patent.At L2-L3, there is no significant change in left paracentral and foraminal disk protrusion with slight encroachment upon the left lateral recess. The descending left L3 nerve root may be impinged as before. There is mild bilateral facet arthropathy and ligamentum flavum thickening. There is mild to moderate left foraminal narrowing. Central spinal canal and right neural foramen are patent.At L3-L4, there is a small central annular fissure. There is bilateral facet arthropathy and ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.At L4-L5, there is a mild disk bulge with left foraminal and extraforaminal annular fissure. There is mild-moderate right foraminal narrowing. There is also mild left neural foraminal narrowing with contact of the left exiting L4 nerve root. Bilateral facet arthropathy and ligamentum flavum thickening is noted.At L5-L6, there is uncovering of the disk related to minimal retrolisthesis with a mild disk bulge with right foraminal/far lateral prominence, which abuts the exiting right L5 nerve root as well as the descending nerve root in the right lateral recess. There is bilateral facet arthropathy and ligamentum flavum thickening. Overall moderate right foraminal narrowing. No significant central spinal canal stenosis or left neural foraminal narrowing.At L6-S1, there is no significant disk pathology or stenosis.

Output: 1. Brain parenchyma is within normal limits. Specifically, no evidence of acute infarct.2. Mild to moderate scattered paranasal sinus opacification as described above.3. Mild chronic compression fracture involving the L2 vertebral body remains unchanged since 4/23/2015. Minimal chronic compression fracture of L3 vertebral body is also unchanged. No new or enlarging destructive osseous lesions.4. Multilevel degenerative changes are also not appreciably changed since 4/23/2015. There is no significant central spinal canal stenosis at any level. There is multilevel neural foraminal stenosis as detailed above but not significantly changed in the interval.


Instruction: Generate impression based on findings.

Input: Patient is a 26-year-old female with BRCA1 mutation and family history of breast cancer in her mother. No current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: SRS with progression of right superior frontal gyrus lesion status post laser treatment and untreated right occipital lesion. There are post-treatment findings related to laser ablation of a right superior frontal gyrus that measures up to approximately 15 mm, which has not significantly changed. However, there appears to be decreased enhancement within the mass. However, there is an intermediate to high T1 signal area with surrounding edema anteroinferior to the mass, measuring up to 25 mm, as well as a punctate nodular T1 hyperintensity inferior to this. There is also subarachnoid hemorrhage in the anterior parafalcine region. There is no significant interval change in size of the nodules within the bilateral occipital lobes and right precentral gyrus lesion. There is no midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The skull, orbits, and scalp soft tissues are unchanged.

Output: 1. Post-treatment findings related to laser ablation of a right superior frontal gyrus that measures up to approximately 15 mm, which has not significantly changed. However, there appears to be decreased enhancement within the mass, which may be due to necrosis from treatment effects.2. Predominantly T1 hyperintense area anteroinferior to the right superior frontal gyrus mass, measuring up to 25 mm may represent an acute to subacute hematoma with surrounding subarachnoid hemorrhage, although development of an underlying hemorrhagic tumor is potential consideration. Furthermore, a punctate nodular T1 hyperintensity inferior to this, may represent and additional focus hemorrhage, tumor, or possibly a pseudoaneurysm. Assessment is limited on this treatment planning MRI and dedicated brain MRI and MRA may be useful for further evaluation.3. Other subcentimeter intracranial metastases are unchanged.


Instruction: Generate impression based on findings.

Input: Prostate cancer. TRUS guided biopsy at Northwestern on 5/14/15 which showed Gleason 4+3=7 adenocarcinoma of the prostate in the right mid gland (2 of 2 cores, 90 and 95%, perineural invasion present) and Gleason 3+4= 7 adenocarcinoma of the prostate in the right base (2 of 2, 60% and 30%, perineural invasion present), left mid (2 of 2 cores, 15% and 5%, perineural invasion present), and the right apex (2 of 2 cores, 70% and 70%, perineural invasion present). PELVIS:PROSTATE:Prostate Size: 4.4 x 3.0 x 4.0 cmPeripheral Zone: Multifocal areas of T2 hyperintensity with associated diffusion restriction in the right and left mid gland compatible with carcinoma. The largest of these measures 2.0 x 0.6 cm in the right mid gland.Central Gland: Heterogeneous.Seminal Vesicles: Atrophic bilaterally, without definite invasion.Extracapsular Extension: Findings suggestive of extracapsular extension on the right and involvement of the right neurovascular bundle.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. No lymphadenopathy by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Sigmoid diverticulosis without diverticulitis.

Output: Multifocal prostate carcinoma, right greater than left, with probable extracapsular extension and involvement of the neurovascular bundle on the right.


Instruction: Generate impression based on findings.

Input: 16 year-old male with non-Hodgkin's lymphoma and metastatic disease presents with headache. There is no evidence of intracranial hemorrhage or edema. The ventricles and basal cisterns are normal in size and configuration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Reidentified is a large frontal abnormality with mixed soft tissue and calcific attenuation with spiculation and intra-cranial soft tissue component. This finding is unchanged when compared to the previous MRI examination of 2/29/08. Similar imaging findings have been seen with PNET tumors such as neuroblastoma, clinical correlation is advised. This appearance can also be seen in atypical aggressive type meningiomas.

Output: No acute abnormalities. Cranial/intracranial lesion, stable as described above. The differential again includes an atypical type of meningioma however similar findings have been seen with metastatic PNET. Correlate clinically.


Instruction: Generate impression based on findings.

Input: There is an expansile T1 hypointense, T2 hyperintense lesion in the left frontal sinus measuring approximately 1.6 x 1.9 x 2.5 cm in the AP, transverse, and craniocaudal dimensions extending into the left frontoethmoidal recess with no appreciable internal contrast enhancement. The lesion extends to the left superior medial aspect of the orbit with no mass effect on the globes. Lesion abuts the left superior oblique muscle. There is associated osseous remodeling including dehiscence involving the left superior medial orbital wall better seen on recent CT. There is T2 hyperintense signal with enhancement in the lateral left frontal sinus and to a lesser degree in the anterior ethmoids thought to be due to obstructed secretions/inflammation. There is also complete opacification of the left maxillary sinus with peripheral enhancement, which is likely inflammatory.The brain demonstrate patchy periventricular and subcortical white matter FLAIR signal abnormality which is nonspecific but likely due to moderate chronic small vessel ischemic disease. The ventricles and sulci are mildly prominent likely due to age-related volume loss. There are small nonspecific foci of microhemorrhage in the left superior temporal lobe. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The sagittal images show retroodontoid pannus which is incompletely imaged.

Output: 1. Expansile lesion in the left frontal sinus with bony dehiscence involving the left superior medial orbit most likely represents a mucocele. Given the absence of internal enhancement, neoplasm would be much less likely. There is mass effect on the left superior oblique muscle. No significant mass effect on the globe.2. T2 hyperintense, enhancing mucosal thickening in the left frontal sinus more laterally and anterior ethmoids likely due to obstructed secretions/inflammation. There is also diffuse opacification of the left maxillary sinus also likely due to inflammation.


Instruction: Generate impression based on findings.

Input: Headache. Status post tumor resection. There are postoperative findings related to left orbitofrontal craniotomy for resection of previously seen cystic and solid mass in the left inferior frontal lobe. Expected postsurgical changes include small amount of pneumocephalus and blood products within and surrounding the resection cavity. There is a small left sided extra-axial collection as well as small amount of subarachnoid hemorrhage. Surrounding vasogenic edema is again seen with FLAIR hyperintensity involving the left frontal corona radiata superiorly and extending inferiorly to the anterior temporal lobe. There is mild local mass effect with sulcal effacement. There is unchanged minimal rightward midline shift at the level of the inferior frontal lobes. Otherwise no large herniation. No hydrocephalus. There is restricted diffusion involving the left caudate head likely representing devitalized tissue. Restricted diffusion along the left anterior frontal lobe surface corresponds to blood products. There is no evidence of residual enhancement to suggest residual tumor.

Output: 1. Expected postsurgical changes related to resection of left frontal lobe mass. No evidence of residual enhancing tumor. There is persistent local mass effect and minimal rightward midline shift at the level of the inferior frontal lobes. 2. Diffusion restriction of the left caudate head, likely representing devitalized tissue.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Dizziness and PCA stenosis. Some of the sequences are degraded by patient motion, but retain diagnostic value. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Male 66 years old; Reason: eval liver lesions masses, S/P TACE/RFA 2 lesions History: HCC, HCV ABDOMEN:LIVER, BILIARY TRACT: Liver contour: Cirrhotic liver morphology. The liver has a nodular contour with widened fissures. No biliary ductal dilatation. Features of portal hypertension: Minimal perihepatic ascites is again seen. The spleen is upper limit normal. Small perigastric varices. Portal vein: Patent. Hepatic veins: Patent.Hepatic artery: Conventional arterial anatomy.The previously noted in arterially enhancing lesion in the hepatic dome is not visualized on today's examination. The adjacent ablation cavity has decreased in size, measuring 2.2 x 1.9 cm, previously 2.8 x 1.7 cm (series 8 image 9).The segment 3 cavity measures 2.4 x 1 .4 cm, previously 2.8 x 1.6 cm (series 9 image 44). No residual enhancing tumor is evident.The segment 8 ablation cavity is also not significantly changed measuring 2.7 x 1.3 cm (series 9 image 25), previously 2.7 x 1.3 cm. No residual enhancing tumor is evident.The reference punctate nodular focus of early arterial enhancement in segment 5 measures 6 mm in maximum dimension, previously 6 mm. It does not demonstrate restricted diffusion or washout and may represent a transient hepatic arterial perfusion defect. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant interval change in right cardiophrenic lymph node which measures 1.2 x 0 .8 cm, previously 1.2 x 0.8 cm (series 9 image 110).Partially visualized infrarenal aortic aneurysm now measuring up to 5.0 cm in the maximum axial dimension, previously 4.7 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver with ablation cavities in the hepatic dome, segment 8, and segment 3. No residual enhancing foci are evident to indicate residual tumor at the treatment sites.2.Interval increase in size of the previously described abdominal aortic aneurysm which now measures up to 5.0 cm in diameter.These findings were discussed with Dr. Te at 1:30 pm on 1/23/2015.


Instruction: Generate impression based on findings.

Input: 67-year-old male with history of HCC on radiation presenting with lower back pain. Evaluate for metastases or abscess.ANDERSON, STANLEY (DOB: 3/2/1949)PROVIDER/ATTENDING NAME: CHRAPEK, KRISTINE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is abnormal marrow signal consisting of decreased T1 and increased T2/STIR signal with enhancement completely replacing the L3 vertebral body as well as the pedicles and to a lesser extent S1 and along the inferior endplate of L2. There is infiltration of the surrounding soft tissues around L3 with thickening and enhancement of the adjacent epidural space causing compression of the thecal sac with associated spinal canal stenosis at this level. There is infiltration of the fat along the neural foramina at L3-L4. Similarly there is infiltration of the fat surrounding the left S1 exiting nerve root.There is similar abnormal bone marrow signal of the right iliac bone.On review of the prior CTs, in retrospect there was mild low attenuation of the above vertebral bodies on prior study dated 11/30/2016 however the lesions cannot be detected on the more remote CT studies from 11/18/16, August and June 2016 and April 2011 suggesting a rapidly developing process.At L5-S1 there is broad-based disc bulge, ligamentum flavum thickening and mild facet hypertrophy. No significant compromise to spinal canal or neural foramina.At L4-5 there is broad-based disc bulge, ligamentum flavum thickening and mild facet hypertrophy. There is mild spinal canal stenosis. No significant neural foraminal stenosis.At L3-4 there is moderate spinal canal stenosis. No significant neural foraminal stenosis.At L2-3 there is mild broad-based bulging of the disc, ligamentum flavum thickening and mild facet hypertrophy. There is no significant spinal canal or neural foraminal stenosis.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multiple infiltrating lesions the largest of which involves L3 which infiltrates and the surrounding musculature and into the adjacent L2 vertebral body along its left inferior aspect. There is extension into the spinal canal epidural space with associated narrowing of the spinal canal and moderate spinal canal stenosis. The lesion also infiltrates into the L3-4 neural foramina where it affects the exiting nerve roots. These appear to have rapidly progressed since the November 30 CT. These lesions could represent metastatic disease though the possibility the represent an infectious process such as tuberculosis cannot be excluded. Bone biopsy may be of further benefit if clinically indicated.2.There is an infiltrative lesion present in the left sacral alla which extends into the left S1 neural foramen. It is suspected to be of similar origin to the above described lesion.3.Another lesion is present within the right sacral alla and another one in the right iliac bone. These are also suspected to be of similar origin to the above described lesions.4.There is a lesion present within the liver which is not completely evaluated on this exam. Please refer to CT of the abdomen for further comments.5.Findings were discussed with the clinical service by phone on 12/29/2016 at 10:00 AM and the decision was made to proceed with bone biopsy which will be arranged today.Findings also discussed with the radiation oncology team Dr Haraf in person in the neuroradiology reading room.


Instruction: Generate impression based on findings.

Input: Female, 17 years old. Evaluation for cyclops lesion/mechanical impingement. Status post revision of ACL reconstruction on 12/15/15 with occasional catching. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: We see no articular cartilage defectLIGAMENTS: Since the prior study, the patient has undergone ACL reconstruction. The graft appears intact, although there is bowing of the graft along the intercondylar notch. Despite this bowing, we see no focal abnormal signal to confirm impingement. Furthermore, although there is scarring of Hoffa's fat pad, we see no focal arthrofibrosis to suggest a cyclops lesion. The posterior cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: ACL reconstruction with slight bowing of the graft but otherwise no imaging findings of mechanical impingement or cyclops lesion.


Instruction: Generate impression based on findings.

Input: Knee pain Radiographs of the knee appear unremarkable with no osseous abnormality or joint effusion. The left knee also appears unremarkable on the standing views.

Output: Normal radiographs of the right knee.


Instruction: Generate impression based on findings.

Input: Leg pain, lumbar radiculopathy Five non-rib-bearing lumbar type vertebral bodies are presumed to be present. L5 demonstrates transitional anatomy with articulation of the left L5 transverse process with the sacrum. Vertebral body heights are within normal limits. There is exaggeration of lumbar lordosis. Alignment is otherwise grossly maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. There is prominence of the dorsal epidural fat and bilateral facet arthropathy with mild spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: There is disc bulge, advanced bilateral facet arthropathy, and ligamentum flavum thickening resulting in moderate to severe spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis. L4-L5: There is a central disc extrusion, advanced bilateral facet arthropathy, and ligamentum flavum thickening resulting in severe spinal canal stenosis. There is moderate right and moderate to severe left neural foraminal stenosis. L5-S1: Minimal disc bulge. Advanced bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Advanced degenerative changes in the lumbar spine with high-grade spinal canal stenosis at the L3-L4 and L4-L5 levels. Neural foraminal stenosis is worst at the L4-L5 level where there is moderate right and moderate to severe left neural foraminal stenosis. There is also advanced facet arthropathy in the mid and lower lumbar spine. Please see details above.


Instruction: Generate impression based on findings.

Input: Male, 82 years old. Pain and marked decreased abduction after fall. Evaluate rotator cuff. ROTATOR CUFF: There is increased signal within the supraspinatus tendon indicating tendinosis. There is no full-thickness rotator cuff tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is blunting of the posterior inferior glenoid labrum which is most likely degenerative. The remainder of the glenoid labra appear intact. The glenohumeral joint alignment is within normal limits.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Coracohumeral ligament is not identified raising the possibility of adhesive capsulitis.2. No full-thickness rotator cuff tear. Tendinosis of the supraspinatus tendon.3. Slight muscle atrophy with a high riding humeral head.


Instruction: Generate impression based on findings.

Input: Clinical question: Subdural hematoma. Signs and symptoms: Headaches Non-enhanced head CT:There is revisualization of an extra-axial isodense lesion measuring 31.1-mm at the base and 10.7-mm in thickness. There is no appreciable interval change since prior exam in the size, density or the extent of this finding. The finding could represent a subdural home her prior MRI was also suggested of possible meningioma. There is no evidence of new hemorrhage. There is no evidence of edema, mass effect, midline shift or hydrocephalus. Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of new finding since prior exam. 2.Extra-axial right frontal lesion which could represent a subdural. Possibility of a meningioma cannot be entirely ruled out and follow-up exam is recommended.


Instruction: Generate impression based on findings.

Input: History of vision changes. Subdural hematoma. Evaluate for optic nerve injury, atrophy. Patient motion artifact limits the sensitivity of this examination.MRI brain:Scattered supratentorial tiny foci of restricted diffusion, which does not include the occipital lobes, with a distribution suggesting embolic etiology. Prominence of the ventricles and sulci due to age related volume loss. There is moderate to marked periventricular and subcortical white matter FLAIR signal abnormality, most prominent in the pons likely due to chronic small vessel ischemic disease. Irregularly of the flow void of the left distal vertebral artery, and chronic infarct in the left cerebellum is noted. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. Small left frontal CSF intensity hygroma. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. There is nonspecific fluid signal in the left mastoid air cells. Paranasal sinuses are unremarkable.MRI orbits: This portion the study was essentially nondiagnostic due to patient motion artifact. The orbits are grossly unremarkable based on the provided images.

Output: 1. Scattered tiny foci of restricted diffusion representing acute ischemia, not including the occipital lobes, with a distribution suggestive of embolic etiology.2. Within the limitations of marked patient motion artifact, no gross orbital abnormality.3. Extensive chronic small vessel ischemic disease.4. Irregular area of the left distal vertebral artery flow void with chronic left cerebellar infarct.Findings discussed with Dr. Bryan Campbell via phone at 2:20 PM on 4/25/2016.


Instruction: Generate impression based on findings.

Input: 14-year-old male with trisomy 16 and hypoplastic dislocated shoulder.IMAGE ACQUISITIONS: CT of both shoulders without contrast enhancement processed in transverse, sagittal, and coronal planes. Left shoulder: As seen on prior radiographs, there is a deformed, angulated scapula with a dysplastic, shallow, and retroverted glenoid. The articular surface of the glenoid is essentially parallel to the axis of the medial aspect of the scapular body. The humeral head articulates with the glenoid, but appears slightly anteriorly subluxed. The coracoid process extends directly anteriorly from the dysmorphic neck of the scapula, resulting in a coracohumeral interval of over 2cm As seen on radiographs, the acromion is elongated and courses anterosuperiorly in relation to the humeral head. There is a linear lucency that partially traverses the acromion and has adjacent sclerosis; we are uncertain if this is an additional developmental defect or a stress fracture. The distal end of the clavicle is located superior to the ossification center of the acromion process.Right shoulder: There is a similar abnormal morphology to the right shoulder with a shallow, dysplastic, and retroverted glenoid that articulates with the humeral head. There is a small bone fragment along the posterior lip of the glenoid that may be posttraumatic in etiology. As with the left shoulder, the coracoid extends directly anterior from the scapular neck. The distal clavicle lies superior to the ossification center of the acromion.The spine is incompletely visualized, however, there is levoscoliosis of the cervicothoracic spine. Please refer to spine MRI for further spine report.

Output: Bilateral shoulder abnormalities as described above.


Instruction: Generate impression based on findings.

Input: 82 years Female (DOB:8/16/1934)Reason: back pain History: back painPROVIDER/ATTENDING NAME: TARIQ MUSLIM MALIK TARIQ MUSLIM MALIK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level of a moderate degree.At L4-5 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated with moderate bilateral facet and ligamentum flavum hypertrophy as well as anterior subluxation of L4 and L5. Some disc material extends behind the inferior aspect of the L4 vertebral body There is effacement of the fat at the lateral recess bilaterally at this level and crowding of the nerve roots within the thecal sac. Overall there is moderate spinal stenosis at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. When compared to the exam from 2012 there appears to be some progression of the spinal stenosisAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is redemonstration of multiple large cysts along the kidneys which are incompletely imaged on this or the prior exam. As a result subtle relative change in size may not be readily made.

Output: 1.There are degenerative changes present in the lumbar spine which are worse at L4-5 where there is mild subluxation and a moderate degree of spinal stenosis which appears to have mildly progressed when compared to the 9/11/2012 exam.2.Multiple large renal cysts.


Instruction: Generate impression based on findings.

Input: 52-year-old female with proximal weakness of the lower extremities. Evaluate for progression of fatty atrophy or gadolinium enhancement within the muscles. Left femur:Again seen is severe fatty atrophy of the quadriceps musculature with relative sparing of the rectus femoris, appearing similar to the prior study. There is mild to moderate fatty atrophy of the semitendinosus, appearing similar to the prior study. There is severe fatty atrophy of the remaining hamstring musculature appearing similar to the prior study. There is relative sparing of the adductor musculature as well as the sartorius. There is no enhancement of the remaining musculature to indicate inflammation. The bone marrow signal intensity is within normal limits.Right femur:Again seen is severe fatty atrophy of the quadriceps musculature with relative sparing of the rectus femoris appearing similar to the prior study. There is severe fatty atrophy of the hamstring musculature appearing similar to the prior study. There is relative sparing of the adductor musculature as well as the sartorius. There is no enhancement of the remaining musculature to indicate inflammation. There is a small knee joint effusion as well as mild synovitis of the knee joint. The bone marrow signal intensity is within normal limits.

Output: Severe fatty atrophy of the anterior and posterior musculature of the thighs appearing similar to the prior study. We see no definite progression of atrophy nor do we see gadolinium enhancement to suggest active inflammation.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (6/5/15, 9/25/15), ultrasound images of right axilla (10/12/15) performed at Regenstein Breast Imaging Center. For comparison, digital mammographic images (8/26/14), ultrasound images of both breasts (8/27/14), breast MRI (8/27/14) are available. DIGITAL MAMMOGRAPHIC IMAGES (6/5/15, 9/25/15):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. Retropectoral silicone implant appear intact. An oval, focal asymmetry is unchanged at upper outer quadrant in the left breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. ULTRASOUND IMAGES OF RIGHT AXILLA (10/12/15):No abnormal findings are present in the provided images.BREAST MRI (8/27/14):Breast MRI was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right breast, an irregularly shaped enhancing mass is present at upper inner quadrant, measuring 29 x 24 x 20 mm. The lesion was known to be malignant.No abnormal enhancement is seen in left breast.The patient underwent right mastectomy after this MRI study.

Output: No mammographic evidence of malignancy in the left breast. No abnormal findings sonographic images of left axilla. Diagnostic mammogram of left breast is recommended annually. The next study is due in September 2016.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: hx of kidney cancer, evaluate for metastatic disease History: see above ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence cholecystitis.There are multiple bilateral nonenhancing cysts throughout the liver. Some of these cysts appear slightly larger on the prior exam which may be due to differences in technique.SPLEEN: No significant abnormality noted.PANCREAS: Lobule of fat insinuates within the pancreatic tailADRENAL GLANDS: There is both a 7 mm (7/29) and 9 mm (7/32) nodule in the right adrenal gland which loses signal on out of phase imaging, consistent with adenomas.KIDNEYS, URETERS: Postsurgical changes of left partial nephrectomy with scarring and a multi septated nonenhancing cystic lesion in the left midpole, similar to the prior CT.Interval right-sided partial nephrectomy with resection of 2 lesions seen on the prior CT. The right kidney is now oriented more anteriorly and is located more posteriorly with a decreased amount of posterior pararenal fat.There is an ill-defined region of low T2 signal along the medial aspect of the right nephrectomy bed without focal enhancement to suggest recurrence. There is however linear enhancement surrounding regions of fat in the posterior pararenal spaces bilaterally which likely represents areas of fat necrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative changes visualized spine without suspicious lesions evident.OTHER: Small right pleural effusion.

Output: 1.Status post right partial nephrectomy. Status post left partial nephrectomy. No evidence of recurrent or metastatic disease.2.Small right pleural effusion.


Instruction: Generate impression based on findings.

Input: Breast cancer. Left shoulder pain. No recent trauma. The rotator cuff tendons and muscles appear normal. The acromioclavicular joint appears normal. I see no frank fluid within the subacromial/subdeltoid bursa. Minimal enhancement of the bursa following gadolinium administration could conceivably represent a very mild bursitis, but this is equivocal. Glenohumeral joint alignment is within normal limits. Intermediate signal intensity traversing the anterior superior labrum may represent a tear or simply a normal variant, and may not be of any current clinical significance. The remainder of the labrum appears normal. There is trace fluid within the right glenohumeral joint extending into the subscapular recess, within normal limits. The tendon of the long head of the biceps appears normal. I see no soft tissue masses or bone lesions.

Output: Minimal enhancement of the subacromial/subdeltoid bursa is of uncertain clinical significance, but could conceivably represent a very mild bursitis. I see no frank fluid within the bursa nor do I see any other specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Chronic headaches, ringing in the ears, and dizziness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild left maxillary sinus mucosal thickening. There are degenerative changes involving the left temporomandibular joint.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Acute stroke? Signs and symptoms, acute ischemic stroke. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates mild scattered foci of FLAIR and T2 hyperintensity without associated susceptibility signal changes highly suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes. Findings are probably mainly in the subcortical and periventricular white matter and without detectable similar signal changes in the basal ganglia, thalami or pons. Unremarkable as cerebral cortex and cortical sulci as well as ventricular system and CSF spaces.Unremarkable orbits, paranasal sinuses, mastoid air cells and calvarium.Nonenhanced brain MRA:Bilateral internal carotid arteries are thickened and unremarkable through the skull base and in their supraclinoid segments.Bilateral anterior and middle cerebral arteries and their distal branches are unremarkable.Patent and unremarkable bilateral vertebral arteries, bilateral pedicle branches as well as basilar artery and distal branches.

Output: 1.No acute intracranial process.2.Mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter.3.Unremarkable nonenhanced brain MRA.


Instruction: Generate impression based on findings.

Input: Patient presenting with dysarthria, slow to follow commands, weakness, evaluate for stroke. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are multiple scattered foci of T2 hyperintensity in the subcortical and deep white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is right sphenoid and bilateral maxillary sinus mucosal thickening and fluid on the left side. There is right tympanomastoid fluid.

Output: 1. Findings suggestive of chronic microvascular ischemic disease, but no evidence of acute infarct.2. Findings suggestive of acute sinusitis. 3. Right tympanomastoid fluid may represent otomastoiditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 12-year-old male with visual changes and headaches. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns are within normal limits. Paucity of cortical sulci and small ventricular system although normal for patient's stated age it could also represent findings of pseudotumor cerebri.There is suggestion of some crowding at the level of foramen magnum which although may be due to slice positioning, possibility of slight ectopia of cerebellar tonsils cannot be ruled out. Multiple prior CT examination of this patient's back to 2004 were all reviewed. Similar findings are also noted on all prior studies. An MRI examination of brain is recommended for further and better evaluation to explain patient's repetitive visits for similar clinical symptoms.Bony density of calvarium, pneumatization of paranasal sinuses, middle ear cavities and mastoid air cells are within normal limits.

Output: Stable examination since prior studies. The common follow-up with an MRI examination. Please see above comments.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB: 11/2/1970)Reason: eval for structural lesions History: weakness right hand/armPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There is no compromise to the cervical spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 54 year-old male with history of conduction system disorder. Sent for CMR to rule out infiltrative heart disease Left VentricleThe left ventricle size is upper limits of normal with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVEDV is 233 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 85 ml (normal range 47+/-19), the LV mass index is 67 g/m2 (normal range 85+/-15), and the LV mass is 150 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Localized area of high signal intensity seen in the inferolateral wall which is also appreciated on the pre-contrast short axis cine images making it highly unlikely to represent fibrosis/ LGE. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 105 ml/m2 (normal range 82+/-16), the RVEDV is 235 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).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 and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.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 FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle size is upper limits of normal with normal systolic function. The overall LV ejection fraction is 64%. No wall motion abnormalities. Thin line of high signal intensity seen in the inferolateral wall which is also appreciated on the pre-contrast short axis cine images suggestive of an artefact. No late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. Normal right ventricular size and systolic function. The overall RV ejection fraction is 61%3. No evidence of infiltrative cardiomyopathy on this exam.


Instruction: Generate impression based on findings.

Input: 47-year-old woman with bilateral breast masses presents for further evaluation. Patient is in rolled in the Alan Penn Research Study. There is large amount of heterogeneous fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right breast:In the upper inner quadrant of the right breast, near the 2:00 position, posterior depth, there is an oval enhancing mass measuring 1.2 x 0.8 x 0.6 cm. This mass demonstrates progressive enhancement with washout on dynamic evaluation, correlates with the finding on mammogram and ultrasound and is suspicious for malignancy. There is no additional suspicious enhancing mass or focus of enhancement elsewhere within the right breast.Left breast:In the lower central left breast near the 6:00 location, posterior depth, there is an oval enhancing mass measuring 1.5 x 1.2 x 1.2 cm. This mass demonstrates rather than enhancement with washout on dynamic evaluation, correlates with finding on mammogram and ultrasound and is suspicious for malignancy. There is no additional suspicious enhancing mass or focus of enhancement elsewhere in the left breast.No abnormal lymph nodes are identified in either axillary region.

Output: (1) Oval enhancing mass at the right 2:00 position measuring up to 1.2 cm is suspicious for malignancy. The patient underwent an ultrasound guided biopsy of this mass after the MRI. Pathology results are pending.(2) Oval enhancing mass at the left 6:00 position measuring up to 1.5 cm is suspicious for malignancy. The patient underwent an ultrasound guided biopsy of this mass after the MRI. Pathology results are pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 27-year-old female experiencing paresthesias with previous abnormal MRI, evaluate for progression. A previously demonstrated subcentimeter enhancing lesion in the left occipital lobe with associated high T2 signal in the white matter deep to the visual cortex has resolved. Previous possible punctate focus of enhancement in the region of area postrema is not evident. There are no new lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and paranasal sinuses are unremarkable. Redemonstrated is a subcentimeter low intensity focus in the right frontal scalp, of indeterminate significance. There are several subcentimeter probable nasopharyngeal retention cysts, unchanged.

Output: 1.A previously demonstrated subcentimeter enhancing lesion in the left occipital lobe with associated high T2 signal in the white matter deep to the visual cortex has resolved. 2.Previous possible punctate focus of enhancement in the region of area postrema is not evident. 3.There are no new lesions.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with multiple sclerosis presenting with imbalance, cramping and poor coordination. Numerous white matter T2 hyperintense lesions are again seen with nearly confluent periventricular disease and scattered lesions in the juxtacortical white matter. Accounting for differences in technique, no significant interval change in the size or extent of lesions is noted. No enhancing lesions are seen. On T1-weighted images, these lesions are either undetectable or correlate with only mild T1 hypointensity.Brain parenchymal morphology is otherwise unremarkable. No evidence of edema or mass effect is seen. No abnormal extra axial fluid collections are identified. The ventricular system is stable in size and morphology.

Output: Extensive white matter lesions are seen compatible with multiple sclerosis showing no convincing change when compared to the prior exam. No enhancing lesions are evident.


Instruction: Generate impression based on findings.

Input: 22 year-old female with left lower quadrant abdominal pain. Four days postpartum. Evaluate for TOA, diverticulitis with septic thrombophlebitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: The uterus is enlarged and contains numerous air bubbles within the uterine cavity compatible with history of recent postpartum status. There is a uniloculated left ovarian cyst which measured 5.4 x 7.5 cm. Inferior to the cyst there is a smaller fluid collection in the left adnexa which may represent a fluid filled dilated fallopian tube. This may be evaluated further with transvaginal ultrasound and/or MRI. The findings are nonspecific, but can be seen with tubo-ovarian abscess or hydrosalpinx. There may be fluid in the right fallopian tube as well. Multiple small cervical cysts. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Postpartum uterus. Large left ovarian cyst. Questionable fluid filled left fallopian tube may be further evaluated with transvaginal ultrasound and/or MRI, if indicated.


Instruction: Generate impression based on findings.

Input: 44-year-old male is status post 6-foot fall from ladder with L4 compression fracture and retrolisthesis of L4 on L5 on x-ray Advanced degenerative disk disease with significant vacuum phenomenon and sclerotic changes of the adjacent endplates at L5 -- S1 level is noted. There is grade 1 anterolisthesis at this level secondary to bilateral pars defects (spondylolysis).Less than 50% compression fracture of the superior endplate of L4 and a small loose fragment anterior to the vertebral body is noted. The alignment of the spine at this level remains normal. No evidence of any fracture of the posterior elements is noted. The facets remain aligned at this level however demonstrate degenerative changes and minimal widening of the facet space which may be secondary to degenerative changes or possibly soft tissue injury secondary to patient's fall.For better evaluation of the soft tissues and MRI would be helpful. No definitive evidence of any compromise of the spinal canal at this level is detected.

Output: 1.Compression fracture of superior endplate of L4 with no malalignment.2.Grade 1 antral listhesis at L5 -- S1 secondary to bilateral spondylolysis.


Instruction: Generate impression based on findings.

Input: Reason: eval for rotator cuff pathology History: pain, limited ROM despite NSAIDs and PT course ROTATOR CUFF: There is near complete rupture of the supraspinatus tendon with approximately 4.5 cm of retraction of the proximal tendon fragment. There is thickening and intermediate signal intensity within the proximal tendon fragment indicating moderate tendinosis. There is fatty atrophy of the supraspinatus muscle. There is increased signal abnormality within the muscle belly of the supraspinatus on fluid sensitive sequences which may reflect an acute component/strain injury. There is extension of this tear to involve the anterior fibers of the infraspinatus. The infraspinatus muscle demonstrates minimal fatty atrophy at the level of the myotendinous junction. The teres minor muscle and tendon appear intact. There is near complete rupture of the subscapularis with approximately 2 cm of retraction of the proximal tendon fragmentSUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Note is made of a high right humeral head. Moderate osteoarthritic changes affect the glenohumeral joint. There is blunting and deformity of the anterior labrum which may reflect degeneration and degenerative tearing.BICEPS TENDON: There is thickening and intermediate signal intensity within the tendon of the long head of the biceps indicating tendinosis. There is linear fluid signal abnormality within the tendon just proximal to its transition into the rotator interval indicating a longitudinal split tear. The intra-articular portion of the tendon of the long head of the biceps is not visualized likely representing complete rupture with retraction. ADDITIONAL

Output: 1. Complete rupture of the supraspinatus, near complete rupture of the subscapularis, and tearing of the infraspinatus with retraction as well as rotator cuff tendinosis as described above.2. Rupture of the long head of biceps tendon with retraction.3. Osteoarthritis of the shoulder.4. Glenohumeral joint effusion with probable synovitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Episode of acute loss of consciousness followed by generalized shaking and foaming through his mouth. The episode lasted for a minute and was followed by unresponsiveness and slow recovery. At ED patient complained of HA and nausea but otherwise neurological intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, brainstem, and cerebellum appear unremarkable. There is no evidence of heterotopia or hamartoma. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration, including cavum septum pellucidum and vergae. There is no midline shift. The posterior fossa appears to be slightly small and the cerebellar tonsils appear to be mildly indented by the occipital bone, but are not particularly low lying. The major cerebral flow voids are intact. The orbits, mastoid air cells, and scalp soft tissues are grossly unremarkable. There are secretions in the right maxillary sinus.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. The posterior fossa appears to be slightly small and the cerebellar tonsils appear to be mildly indented by the occipital bone, but are not particularly low lying. This may represent a developmental variant, perhaps in the spectrum of a Chiari-type malformation.3. Findings suggestive of acute maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: 52-year-old female status post laparoscopic cholecystectomy in 2013 with congenital biliary malrotation. With persistent abdominal pain, and intermittent fevers and chills. ABDOMEN:LIVER, BILIARY TRACT: Left hepatic cyst. Again seen are postsurgical changes of a Roux-en-Y hepaticojejunostomy, similar to prior. Likely preduodenal portal vein.SPLEEN: Polysplenia.PANCREAS: Again seen are postsurgical changes of a Roux-en-Y hepaticojejunostomy, with the pancreas deviated into right abdomen. The pancreatic duct is normal in caliber, with drainage into the medial aspect of the duodenum visualized. There is normal excretion witnessed after secretin injection. The head of the pancreas has an abnormal position anteriorly, with separate drainage into the duodenum. The tail of the pancreas is not seen, which may be congenital.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal sinus cyst. Azygos continuation of the IVC, better visualized on the prior CT.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Postsurgical changes of a Roux-en-Y gastrojejunostomy and biliary hepatojejunostomy, without acute abnormality.2. Normal pancreatic response to secretin.


Instruction: Generate impression based on findings.

Input: 50-year-old male with left shoulder pain and possible rotator cuff tear. ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no fluid within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a multilobulated collection of near fluid signal intensity along the posterior aspect of the glenoid and glenoid labrum compatible with a paralabral cyst, most likely arising from a degenerated posterior labrum which contains small foci of increased signal intensity. The remainder of the labrum is normal for age. The glenohumeral joint alignment is within normal limits. No effusion.BICEPS TENDON: The tendon of the long head of the biceps is normal in appearance.

Output: 1. Mild degeneration/degenerative tearing of the posterior labrum with adjacent paralabral cyst formation.2. Normal-appearing rotator cuff.3. Minimal osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: Spinal stenosis, pain For the purposes of numbering, there are 5 lumbar type vertebrae with hypoplastic ribs at T12 and partially sacralized L5 segment. Note this numbering scheme is different from prior MRI from 2011 but same as radiographs dated 6/9/2016.Vertebral body heights are within normal limits. There is exaggeration of the lumbar lordosis. Minimal L4-L5 anterolisthesis evident on prior radiographs and not appreciable on supine MRI. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is mild multilevel disc desiccation throughout the lumbar spine without significant disc height loss. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. There is moderate bilateral facet arthropathy, left worse than right, but similar to prior.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. No significant disc disease or evidence of spinal canal or neural foraminal stenosis at any level2. Prominent facet arthropathy at the L4-L5 level which may be contributing to patient's back pain.3. Please note comment regarding numbering scheme above.


Instruction: Generate impression based on findings.

Input: Reason: please eval for meniscus tear. History: L knee pain MENISCI: The medial meniscus appears intact. There is a focus of fluid signal intensity along the root of the anterior horn of the lateral meniscus which may represent parameniscal cyst formation. The posterior horn appears intact.ARTICULAR CARTILAGE AND BONE: Lobulated focus of signal abnormality in the distal femoral metaphysis consistent with an enchondroma. There is increased signal intensity within the articular cartilage of the lateral tibial plateau beneath the posterior horn of the meniscus representing a focal full-thickness articular cartilage defect. The medial tibiofemoral and patellofemoral compartments appear relatively spared.LIGAMENTS: There is streaky increased signal within the ACL as well as a small cyst within the intercondylar eminence indicating mucoid degeneration. The PCL appears intact. The LCL appears intact. There is edema about the superficial band of the MCL indicating a sprain.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Findings indicating a sprain of the MCL.2. Parameniscal cyst arising from the root of the anterior horn of the lateral meniscus may indicate a partial-thickness tear, but is of questionable clinical significance.3. Focal full-thickness articular cartilage defect along the lateral tibial plateau. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female 40 years old; Reason: Right iliac crest/external oblique muscle strain/tear The visualized abdominal and pelvic musculature appears normal, without evidence of strain or tear.Mild signal abnormality in the sacrum adjacent to the left sacroiliac joint is likely degenerative in etiology. Severe degenerative disk disease affects the L4/L5 level with grade 1 anterolisthesis of L4 on L5. There is protrusion of disk material posteriorly at this level, without frank canal stenosis. The neural foramina are narrowed bilaterally at this level. If further imaging evaluation is clinically warranted, dedicated lumbar spine MRI is recommended.

Output: 1. No findings to suggest an external oblique strain or tear.2. Severe degenerative disk disease at L4/L5 with bilateral neural foraminal narrowing. If further imaging evaluation is clinically warranted, dedicated lumbar spine MRI is recommended.


Instruction: Generate impression based on findings.

Input: Metastatic urothelial cancer, evaluate pelvic lymphadenopathy / lymphocele PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Right-sided pelvic collection measures 3.4 x 3.1 cm with nodular enhancement involving its superior aspect (series 1003, image 603). An internal fluid fluid level likely represents hemorrhage. There is an nonenhancing left-sided pelvic fluid collection, which measures 2.9 x 1.4 cm. Mildly prominent inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Right-sided pelvic collection with nodular enhancement along its superior aspect suspicious for tumor recurrence.2.Left-sided pelvic collection with signal characteristics most consistent with a lymphocele.


Instruction: Generate impression based on findings.

Input: 80 year old female patient with history of rectal cancer. Surveillance imaging. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: The reference lymph node in the mesorectal fat adjacent to the left aspect of the upper rectum measures 4 x 3 mm (image 7, series 3), previously 4 x 4 mm. BOWEL, MESENTERY: There is minimal linear T2 signal abnormality within the region of previously seen tumor which is compatible with scarring. No abnormal enhancement or measurable tumor is identified. Sigmoid diverticulosis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small amount of presacral fluid.

Output: 1.Small scarring in the region of prior rectal tumor without current measurable disease.2.Stable reference pelvic lymph node.


Instruction: Generate impression based on findings.

Input: Left-sided numbness and tingling in face, arm, and leg. Evaluate for brain lesion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unqualified visual loss, right eye, normal vision left eyeClinical question: Evaluate for ischemiaSigns and Symptoms: Sudden loss of vision in R eye MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate focus of signal hypointensity identified in the left frontal lobe subcortical white matter at the left superior frontal gyrus near the superior frontal sulcus. Most likely this represents a microhemorrhage which in isolation is of unknown clinical significance.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eye lens is thin MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The right ophthalmic artery is attenuated and not readily identified relative to the left ophthalmic artery is readily identified.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.The right ophthalmic artery appears to be attenuated relative to the left ophthalmic artery. This is nonspecific finding and could relate to variant supply to the right orbit though it could also relate to vascular occlusive disease. Please correlate with ophthalmoscopic examination.2.No evidence for intracranial cerebrovascular occlusive disease.3.There is no evidence for acute cerebral ischemic infarction4.No evidence for intracranial aneurysm.5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: pain, instability History: pain MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema within the posterior aspect of the lateral tibial plateau indicating a bone contusion. There is linear decreased signal abnormality within the posterior aspect of the tibial plateau indicating a nondisplaced subchondral fracture (image 24; series 5). No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: There is disruption of the ACL through its proximal fibers. The PCL appears intact. There is a lobulated foci of fluid signal intensity along the posterior and anterior aspect of the PCL which may reflect mucoid degeneration. The MCL and LCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is minimal increased signal abnormality and thickening of the patellar tendon indicating mild tendinosis.ADDITIONAL

Output: 1. Disruption of the ACL through its proximal fibers.2. Nondisplaced subchondral fracture of the posterior aspect of the lateral tibial plateau with associated bone contusion. Other findings as described above.