Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch) Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch)Clinical question: assess size of pituitarySigns and Symptoms: assess size of prolactinoma There is no indication on the scans that contrast entered the patient's vascular system.There is opacification of the sphenoid sinus with mixed high signal T1 material and intermediate signal material. Anteriorly there is some high signal material on T1-weighted imaging which does not suppress on the fat suppressed images that measures approximately 12 x 16 mm axial dimensions and is suspected represent inspissated secretions. Just behind that within the sphenoid sinus there is soft tissue signal intensity which is heterogeneous on T1 and intermediate signal on T1 this measures approximately 13 x 10 mm axial dimensions and is eccentric towards the right side and appears to be contiguous with the pituitary gland. Measures 19 x 12 mm on sagittal imaging. There is a lesion present in the right half of the pituitary fossa and gland measures approximately 9 x 10 mm coronal dimensions. It is contiguous with a lesion in the sphenoid sinus and involves the clivus. Overall the lesion measures 23x17mm coronal dimensions and 19mmx19mm sagittal dimensions. The lesion bulges into the right cavernous sinus and abuts the right ICA. It enhances heterogenously. It has heterogeneous but predominantly low signal on T2-weighted imaging. It does not appear to have changed substantially since the March exam. The infundibulum of the pituitary gland is slightly tilted towards the left.The infundibulum of the pituitary gland is tilted to the left. No suprasellar mass is identified. There are opacities present within the maxillary sinuses bilaterally most likely representing mucous retention cysts.

Output: 1.There is a mass present which involves the pituitary fossa and the clivus and bulges into the right cavernous sinus. Most likely this is a pituitary adenoma with some inspissated secretions in the sphenoid sinus. However, given its involvement of the clivus and the unusual signal characteristics and involvement of the sphenoid sinus other considerations such as intrasellar chordoma mimicking a pituitary adenoma are also possible. Please correlate with the patient's endocrinological exam.2.Please note that contrast did not reach the tissues. The patient will be asked to return to complete the exam.


Instruction: Generate impression based on findings.

Input: History of left breast excisional biopsy in October 2013 with final pathology report indicating focal atypia with a fragment of pseudo-angiomatous stromal hyperplasia (originally read as ADH on MR biopsy of 7/9/2013). Known BRCA2 mutation carrier. Biopsy proven left breast fibroadenoma in 2004. History of mother with breast cancer at age 39, and maternal grandmother at age 43. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable appearance of round slowly enhancing benign morphology mass in the left breast 2:00 position corresponds to biopsy-proven fibroadenoma.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Assess for AVM spinal: LE claudication, multifocal fasciculation. There are postoperative findings related to anterior fusion of C6 and C7. There is degenerative spondylosis at C5-6 with an eccentric right disc-osteophyte complex that results in mild spinal canal and moderate right neural foraminal narrowing. There is a small perineural cyst in the right C7-T1 neural foramen. There are also posterior disc-osteophyte complexes at T2-3, T6-7, and T7-8 without spinal cord impingement. In addition, there are small disc bulges and facet hypertrophy bilaterally at L3 through S1, without significant spinal canal or neural foraminal stenosis. The spinal cord signal and morphology is unremarkable. There is no evidence of abnormal enhancement within the spinal canal. The vertebral column alignment is anatomic. The vertebral body heights are preserved. There is a small hemangioma or area of focal fat in the T8 vertebral body. The paravertebral soft tissues and imaged intracranial structures appear to be unremarkable.

Output: 1. Degenerative spondylosis in the cervical, thoracic, and lumbar spine without spinal cord compression.2. No evidence of spinal arteriovenous malformation, although MRI has limited sensitivity for the detection of such lesions. If clinical suspicion persists, a catheter angiogram may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Chronic ETOH. History of radiosurgery for menegioma Since the prior exam there has been change in the imaging characteristics related to patient's extra-axial parafalcine mass. The mass currently measures 24 x 22 mm coronal dimensions and the 24 x 22 mm axial dimensions and previously measured approximately the same dimensions. The enhancement pattern has changed dramatically in that it is no longer homogeneously enhancing but the rather ring enhancing. Additionally there is enhancement along the adjacent brain parenchyma associated with T2 and flair signal change along the adjacent left parietal lobe and cingulate gyrus and corpus callosum. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a cystic lesion in the left posterior fossa measuring 62 x 20 mm and axial dimensions which previously measured approximately same and that likely represents an arachnoid cyst.There is redemonstration of an extra-axial lesion adjacent to the right temporal lobe which insinuates itself into the surface of the right temporal bone which remains stable and compared to prior exam. This enhances following contrast administration and is somewhat heterogeneous but predominantly dark on T2 imagingThere is redemonstration of a left to inferior temporal gyrus lesion measuring 6 mm in diameter. This is associated with susceptibility effect. It enhances homogeneously and is dark on T2 imaging.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since prior exam the patient has developed a thin abnormal enhancement pattern associated with signal changes in the brain parenchyma adjacent to the patient's extra-axial mass suspected to represent meningioma. The findings are suggestive of radiation necrosis. Overall the patient's meningioma remains stable in cross-sectional dimensions, but appears at least in part to have necrosed.2.There is a small left temporal lobe mass present along the left inferior temporal gyrus which is unchanged compared to prior exams. It is nonspecific continued follow-up suggested. Signal characteristics just immediate partially calcified. A CT exam may be helpful.3.A small extra-axial mass adjacent to the right temporal lobe embeds itself and to the right temporal bone and is stable since the prior exam.4.There is redemonstration and no change in an arachnoid cyst located in the posterior fossa.


Instruction: Generate impression based on findings.

Input: Memory issues; cardiac event in 1991. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal scattered cerebral white matter T2 hyperintensity. 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. There is a midline subcentimeter nasopharyngeal Thornwaldt cyst.

Output: Minimal scattered cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Clinical question:? New metastases. Signs and symptoms: History of pituitary carcinoma now with new onset of right hand tremor No evidence of new hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Changes at the level of the sella consistent with patient's past history of pituitary carcinoma remains is stable. Focal area of enhancing tissue along the medial aspect of right middle cranial fossa also remains a stable. Review of prior MRI examination from 7 -- 22 -- 2009 and CT of brain dated 7 -- 31 -- 2009 demonstrates this lesion and in comparison to the current exam no appreciable change is detected.

Output: No definitive evidence of new findings since prior study of 7 -- 31 -- 2009.


Instruction: Generate impression based on findings.

Input: Midbrain breast cancer metastasis status post laser ablation with clinical deterioration. There are postoperative findings related to right transfrontal laser ablation of a tumor centered within the right midbrain. The tumor displays central non-enhancement and scattered areas of susceptibility effect and has enlarged, measuring up to 32 mm, previously 21 mm. There is also markedly increased associated vasogenic edema, with effacement of the third ventricle and enlargement of the lateral ventricles. There is a partially empty sella. There is no evidence of acute infarction or intracranial hemorrhage. Thre appears to be flattening of the optic nerve discs.

Output: Interval increase in size of the metastasis centered in the right midbrain treated via laser ablation, with extensive vasogenic edema and obstructive hydrocephalus.


Instruction: Generate impression based on findings.

Input: 30-year-old male with knee pain and mechanical symptoms. Evaluate for medial meniscus tear. MENISCI: There is blunting and deformity of the posterior horn of the lateral meniscus consistent with complex tearing which extends to involve the body of the meniscus. The anterior horn appears intact. There is blunting of the posterior horn of the medial meniscus which presumably represents postsurgical changes from prior partial meniscectomy. No fluid-filled defect is identified to suggest a re-tear.ARTICULAR CARTILAGE AND BONE: There is a near full-thickness articular cartilage cleft along the lateral facet of the patella. There are near full-thickness to full-thickness articular cartilage class along the lateral facet of the femoral trochlea, central femoral trochlea and medial facet of the femoral trochlea. There is a full-thickness articular cartilage cleft along the medial facet of the patella.There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus and the lateral aspect of the lateral tibial plateau with underlying degenerative subchondral signal abnormality. The articular cartilage of the medial compartment appears relatively spared. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is slight thickening of the proximal patellar tendon which may reflect mild tendinosis. The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the lateral meniscus as described above. Postsurgical changes of the medial meniscus as described above.2. Moderate size joint effusion with findings suggestive of a synovitis. 3. Full-thickness articular cartilage degeneration as described above. Mild osteoarthritic changes of the knee as described above.4. Mild patellar tendinosis.


Instruction: Generate impression based on findings.

Input: Finger injury Note that the examination is limited by motion artifact.LIGAMENTS: No significant abnormality noted.TENDONS: There is rupture of the FDP tendon overlying the fifth digit with retraction to the level of the proximal third of the proximal phalanx. The distal fibers of the tendon overlie the mid diaphysis of the middle phalanx. There is soft tissue edema within the volar portion of the digit. There is an associated hyperextension deformity of the finger as a result.BONES: The underlying marrow signal of the fifth digit is normal without evidence of fracture.ADDITIONAL

Output: Rupture of the FDP tendon overlying the fifth digit with associated hyperextension deformity. Evaluation of the associated nerve fibers is limited given inherent limitations of MRI and by motion artifact.


Instruction: Generate impression based on findings.

Input: 65-year-old female with history of endometrial carcinoma who presents for evaluation of disease progression.Per additional history obtained by Dr. Mathews from the clinical service: Patient with history of hysterectomy, bilateral oophorectomy, and nodal dissection. 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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: There is a persistent circumferential rim enhancement of residual vaginal cuff which measures 3.6 x 1.3 cm (series 16, image 29), previously measuring 4.6 x 2.3 cm; this measurement includes the vaginal cuff thickening.Postoperative changes of hysterectomy and bilateral nephrectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a 5.0 x 4.0 cm (series 17, image 30) T2 hyperintense, T1 hypointense, nonenhancing focus in the left pelvic sidewall compatible with a lymphocele.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Evidence of enhancing disease within the vaginal cuff which is improved compared to previous examination.2.Postsurgical changes of hysterectomy and bilateral oophorectomy.3.Persistent left pelvic sidewall probable lymphocele.


Instruction: Generate impression based on findings.

Input: Foot and ankle swelling There is diffuse subcutaneous edema of the foot particularly along the dorsal aspect of the metatarsals. Overlying the base of the third through fifth metatarsals is lobulated, ill-defined collection of fluid signal intensity. Following contrast administration, there is irregular peripheral enhancement of this collection. There are small areas of low signal intensity within the collection which could represent foci of gas. Additional small collections are noted between bases of the second and third metatarsals (ankle MRI series 10 image 33/42) as well as in the region of the sinus tarsi (ankle MRI series 10 image 28/42). There are erosions of the midfoot and tarsometatarsal articulation particularly involving the base of the first, third, and fourth metatarsals. Additionally, there is erosion of the head of the first metatarsal with a large associated soft tissue component. There are scattered areas of increased T2 marrow signal particularly in the bases of the metatarsalshowever there is no corresponding low signal on T1 to suggest osteomyelitis. There is no abnormal joint fluid within the foot.The visualized extensor tendons are intact. The visualized flexor tendons are intact. The peroneal tendons are intact. There is no subluxation or dislocation in the tarsometatarsal articulationsThere is normal alignment of the metatarsals.

Output: 1. Findings concerning for early abscess within the dorsal and lateral soft tissues of the foot. Additional small collections and phlegmonous changes are noted in the plantar soft tissues of the midfoot and near the sinus tarsi detailed above. There is no evidence of osteomyelitis.2. Changes of gouty arthropathy similar to the prior exam.


Instruction: Generate impression based on findings.

Input: 15-year-old female with persistent swelling and pain of left knee. Evaluate extent of synovial inflammation-synovectomy is a consideration. MENISCI: The medial and lateral meniscus are normal.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. The articular cartilage of the patellofemoral and tibiofemoral compartments is intact without of focal thinning or fissure.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. The popliteus muscle and tendon are intact.EXTENSOR MECHANISM: The extensor mechanism is normal. The patella appears normal.ADDITIONAL

Output: Synovitis with large joint effusion.


Instruction: Generate impression based on findings.

Input: Reason: Optic disc swelling - rule out intracranial process History: central visual blurrying MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. 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 and demonstrate small mucus retention cysts. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .

Output: MRI of the brain and orbits is within normal limits.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The hippocampal formations are symmetric; normal in size and signal intensity. There are no areas of abnormal parenchymal signal. 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 scalp soft tissues are unremarkable. There is mild right ethmoid sinus mucosal thickening. The cerebellar tonsils are mildly low lying. There is a subcentimeter presumed Tornwaldt cyst.

Output: No evidence for intracranial lesion or structural abnormality


Instruction: Generate impression based on findings.

Input: 59-year-old female status post cervical and thoracic decompression and fusion, tumor resection. Evaluate surgical site, tumor burden. Preoperative planning for treatment of a left frontal lesion. MRI Stealth Brain:Limited stealth sequences of the brain demonstrate a well delineated mass measuring 18 x 20 mm in the posterior aspect of the superior left frontal gyrus, which for the most part enhances centrally more than peripherally. There is surrounding vasogenic edema which causes mild localized mass effect, resulting in mild sulcal effacement. However, there is no midline shift or herniation. There is also no significant change in size or configuration of the mass and surrounding edema compared to the recent prior OSH Brain MRI from 10/24/2016. There are right cerebellar and right occipital lobe developmental venous anomalies. 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. There is mild left greater than right maxillary sinus mucosal thickening and right maxillary sinus mucus retention cyst. There is right greater than left mastoid air cell fluid. MRI C-Spine:There are postsurgical changes of a C7 corpectomy with vertical strut placement, which is fixed with an anterior plate and bilateral screws into the anterior inferior aspect of C6 and T1 vertebral bodies. There has also been partial resection of the posterior aspects of C6 and the whole of C7, with bilateral pedical screw placement at C5, T1 and T2, right pedicle screw placement at C6, and bilateral vertical rod placement extending from C5 through T2. Extensive motion degradation and artifact from hardware limits postcontrast evaluation for residual tumor. Although artifact limits full evaluation of the spinal canal, There appears to be no high grade spinal canal stenosis. The remainder of the vertebral body heights are maintained. There is interval disc height loss most prominently affecting the C5-6 and C7-T1 levels. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: 1.Enhancing 18 x 20 mm mass in the left superior frontal gyrus with surrounding vasogenic edema which causes mild mass effect on the adjacent brain parenchyma but no midline shift or herniation. 2.Post-surgical changes of a C7 corpectomy with vertical strut placement, posterior spinal resection involving C6 and C7, and posterior spinal fusion elements extending from C5 through T2.3.Motion degradation and hardware susceptibility artifact limit full evaluation for residual tumor.4.Within the above limitations, there is no evident spinal canal stenosis or spinal cord compression.


Instruction: Generate impression based on findings.

Input: Male, 7 years old, history of DNET, yearly follow-up for tumor recurrence. Postoperative findings are again seen related to prior right anterior temporal tumor resection. The surgical cavity cavity is unchanged in size and morphology. Residual T2 hyperintense thickening is again seen posterior to the resection cavity occupying the superior and middle temporal gyri with extension through the temporal stem towards the insula. This tissue shows no significant interval change. No pathologic enhancement is seen within this thickened tissue or anywhere in the vicinity of the resection cavity.Brain parenchymal morphology is otherwise unremarkable. No evidence of new parenchymal signal abnormality, edema or mass effect is seen. No new abnormal fluid collections are detected. The ventricular system is normal in size and morphology.

Output: 1.Demonstration of postoperative findings without significant interval change.2.Residual thickened tissue posterior to the resection cavity is stable in size and morphology and free of pathologic enhancement.


Instruction: Generate impression based on findings.

Input: Evaluation is limited by patient motion as well as metallic hardware in the lower lumbar spine. No acute spinal cord compression is identified. The visualized spinal cord is grossly normal in caliber. There is abnormally increased STIR signal within the lower cervical and upper thoracic spinal cord which is nonspecific but may reflect myelomalacia or less likely artifact. Several disc bulges are noted within the cervical and thoracic spine. Cervical and thoracic vertebral body heights are grossly preserved. Several foci of increased T1 and STIR signal within the vertebral bodies are nonspecific but may reflect hemangiomas. Postsurgical changes are present within the lumbar spine including posterior fusion from L3-S1 with additional metallic susceptibility artifact at the posterior elements of L1-L2. Metallic susceptibility artifact limits evaluation of the spinal canal. However, there appears to be a process centered at L2-L3 which involves the anterior epidural space and extends into the neuroforamina which may cause cause central canal and foraminal stenosis. There is also increased T2 signal within the adjacent L2-L3 disc. There is age indeterminant moderate anterior wedging of the L3 vertebral body.

Output: 1.Limited examination due to motion and hardware-induced artifact.2.No acute spinal cord compression.3.Abnormal increased STIR signal within the lower cervical and upper thoracic cord which is nonspecific but may reflect myelomalacia. Dedicated MRI without and with intravenous contrast may be obtained as clinically warranted.4.Postsurgical changes in the lumbosacral spine.5.There appears to be a process centered at L2-L3 which involves the anterior epidural space and extends into the neuroforamina which may cause cause central canal and foraminal stenosis. There is also increased T2 signal within the adjacent L2-L3 disc. Infection is a differential consideration. Recommend dedicated lumbar spine MRI without and with intravenous contrast for further characterization.Findings discussed with HAVLIN, DOROTA at 9:00 a.m on 8/31/2015.


Instruction: Generate impression based on findings.

Input: 57-year-old woman with history of cervical cancer and hypoattenuating lesion in the liver on CT. ABDOMEN:LIVER, BILIARY TRACT: The background liver is normal in signal and morphology. There are scattered, well-defined T2 hyperintense lesions, the largest of which measures 13 mm in segment 7 (11/42). These lesions do not enhance on postcontrast imaging. Additionally, there are innumerable, subcentimeter T2 hyperintensities throughout the liver which could represent biliary hamartomas.The gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is bilateral hydronephrosis, left greater than right, with proximal hydroureter and thickening of the ureteral wall. Nephroureteral stents noted. The right kidney is atrophic.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Abdominal wall collaterals are noted. Soft tissue anasarca noted.OTHER: There are bilateral pleural effusions.

Output: 1.Multiple simple cysts and biliary hamartomas in the liver without evidence of metastasis.2.Hydronephrosis, pleural effusions, chest wall collaterals, and other findings as described on recent CT.


Instruction: Generate impression based on findings.

Input: [26-year-old female patient with left pectoral swelling and pain.] [There is near fluid signal intensity between the left aspect of the manubrium and the superior fibers of the left pectoralis muscle extending over a 2.7 cm distance in the craniocaudal dimension (image 17, series 23) and 2.2 cm in the transverse dimension (image 17, series 5) consistent with tearing of superior left pectoralis muscle origin. There is approximately 1 cm of retraction of the muscle fibers in this region. Furthermore, there is asymmetric thickening, increased signal on T2-weighted images, and enhancement of the left pectoralis muscle in this region and extending laterally consistent with inflammation. There is underlying low T1 signal, increased T2 signal, and enhancement of the manubrium which likely represents reactive osteitis.

Output: [Tearing of the superior left pectoralis muscle at its origin from the manubrium with surrounding inflammation within the muscle and bone. CT can be considered to further evaluate the bony anatomy.Findings communicated via telephone to M. Sandoval at 1131 hrs on 1/6/2016.


Instruction: Generate impression based on findings.

Input: Female 37 days old (former 41 weeks), now day of life 36 with perinatal depression, MAS, PPHN, silent aspiration on OPM. Motion moderately degrades sensitivity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The myelination is normal for stated age. There is asymmetric prominence of the subarachnoid space along the lateral aspect of the left frontal lobe without definite focal parenchymal volume loss detected. Although the head is asymmetrically positioned, this does not appear to account for the focal prominence of CSF space. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Age-appropriate myelination without evidence of acute intracranial abnormality.2. Subtle asymmetric prominence of the subarachnoid space along the lateral aspect left frontal lobe without definite focal abnormality, although this raises the question of subtle possible underlying parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The conus terminates at the inferior L1 endplate. There is evidence of prior surgery at the left L4-L5 and L5-S1 levels.L1-L2: No significant disc disease, spinal canal, or neural foraminal narrowing.L2-L3: There is disc desiccation and a mild disc bulge as well as mild facet arthropathy and ligamentum flavum thickening. No significant spinal canal or neural foramina stenosis.L3-L4: No significant disc disease, spinal canal, or neural foraminal narrowing. There is prominence of the epidural fat.L4-L5: There is disc desiccation, end plate degenerative change, and a disc bulge asymmetric to the left as well as mild facet arthropathy and ligamentum flavum thickening. These findings result in mild spinal canal stenosis including partial effacement of the left lateral recess. There is mild left foramina stenosis. The disc also likely contacts the exiting left L4 and possibly traversing left L5 nerve root. There is evidence of prior surgery at this level on the left.L5-S1: There are apparent postoperative findings related to left L5 hemilaminectomy. There is disc desiccation, mild loss of height, endplate degenerative change, and a disc bulge asymmetric to left with a superimposed left foraminal herniation. There is also prominent osteophyte component. There is also left facet arthropathy. These findings result in severe left neural foramen stenosis without significant spinal canal or right foramina stenosis.

Output: 1.Postoperative changes of prior surgery/laminotomies at the left L4-L5 and L5-S1 levels.2.L5-S1 herniation resulting in severe left neural foraminal narrowing at this level. There are disk and osteophyte components.3.Mild L4-L5 spinal canal stenosis. Remainder of the levels as detailed above.4.No evidence of traumatic compression fractures or epidural hematomas.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for lesions in the cervical, thoracic and lumbar spine. Signs and symptoms: Two year progressive gait difficulty, EMG with thoracic and lumbar radiculopathies. Family history of multiple sclerosis and limb girdle dystrophic. Pre-and post-enhanced cervical MRI:The signal intensity of vertebral column demonstrate minimal changes secondary to degenerative disease and unremarkable otherwise.The alignment of vertebral column is anatomical.There is no detectable morphological or signal intensity abnormality of the cervical cord.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild degenerative changes with resultant mild to moderate left neural foramina compromise and unremarkable otherwise.C4 -- C5 demonstrate mild degenerative changes of disk and posterior elements (left greater than right). There is moderate to significant left and mild to moderate right neural foraminal compromise and mild central spinal stenosis.C5 -- C6 demonstrate moderate disk disease, loss of disk height and mild bilateral facet and ligamentum flavum hypertrophy. There is bilateral uncovertebral hypertrophy and disk -- osteophyte along the ventral aspect of the canal with resultant effacement of subarachnoid space, flattening and posterior displacement of the cord and moderate central spinal stenosis as well as significant bilateral neural foraminal compromise. C6 -- C7 demonstrate moderate disk disease and loss of disk height and mild bilateral facet and ligamentum flavum degenerative changes. There is no central spinal stenosis however moderate to significant bilateral neural foraminal compromise is present.C7 -- T1 is unremarkable.Post enhanced images demonstrate no abnormal enhancement of the cord or the meninges.Pre-and post enhanced thoracic MRI:There is normal signal intensity and anatomical alignment the vertebral column however mild exaggeration of process of the thoracic spine is noted.There is normal signal intensity and caliber of thoracic cord and without findings to suggest demyelinating disease.At T2 -- T3 there is mild degenerative disk disease and loss of disk height and moderate bilateral ligamentum flavum hypertrophy and facet disease. There is resultant minimal grade 1 anterolisthesis and mild central spinal stenosis without neural foraminal compromise.Mild to moderate degenerative disk disease and multiple Schmorl's nodes of the endplates are identified in mid to lower thoracic spine however with out evidence of central spinal stenoses at any level and no significant neural foraminal compromise present.Post enhanced images demonstrate enhancement of multiple Schmorl's nodes and unremarkable the spine. There is no detectable abnormal enhancement of the cord or the leptomeninges.Pre-and post enhanced lumbar MRI:There is normal anatomical alignment the vertebral column.There is normal signal intensity and caliber of conus and the cauda equina. T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild degenerative disk disease and mild to moderate ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis or neural foraminal compromise. A Schmorl's node along the inferior endplate of L3 is noted.L3 -- L4 demonstrate mild disk disease and loss of disk height, shallow broad-based bulging disk, moderate bilateral ligamentum flavum hypertrophy and mild facet degenerative changes. There is mild mass effect on the thecal sac by a bulging disk and ligamentum flavum hypertrophy however no convincing evidence of central spinal stenosis and the AP diameter of the thecal sac measures at 10 mm. Moderate left neural foraminal compromise is present.L4 -- L5 demonstrate moderate disk disease and loss of disk height, moderate bilateral ligamentum flavum and right facet hypertrophy changes and mild left facet degenerative changes. No central spinal stenosis and moderate to severe right neural foraminal compromise which is secondary to asymmetric right facet hypertrophy.L5 -- S1 demonstrate moderate disk disease and loss of disk height moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophy changes. No spinal stenosis is noted. Mild to moderate right neural foraminal compromise is however present.Post enhanced images demonstrate no abnormal enhancement of the lower most visualized cord, conus or cauda equina. There is however subtle expected enhancement of hypertrophic changes of posterior elements present.

Output: 1.Pre-and post enhanced MRI of cervical spine demonstrate no detectable signal abnormality or enhancement cord. Degenerative changes of cervical spine with resultant mild central spinal stenosis at C4 -- C5 and moderate central spinal stenosis at C6 -- C7. There is significant bilateral neural foraminal compromise at C5 -- C6, moderate to significant bilateral neural foraminal compromise at C6 -- C7 levels. Please see detailed report level above. 2.Pre-and post enhanced MRI of thoracic spine demonstrate normal signal intensity of the cord and without abnormal enhancement. At T2 -- T3 there is minimal retrolisthesis secondary to degenerative disease with resultant mild central spinal stenosis without neural foraminal compromise. No spinal stenosis or neuroforaminal compromise at any other level. Multiple levels of mid to lower thoracic spine degenerative disk disease and multiple Schmorl's nodes along the endplates with expected enhancement are noted.3.Pre-and post enhanced MRI of lumbar spine demonstrate no abnormal signal intensity or enhancement of the conus or cauda equina. There is no significant spinal stenosis at any level. Multilevel neural foraminal compromise (some significantly) are present as mentioned above. Please review detailed report per level above.4.


Instruction: Generate impression based on findings.

Input: Reason: New daily HA. Intractable migraine without mention of status migranosus. The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 35 year old man with coarctation repair referred for evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 90 ml/m2 (normal range: 74+/-15), the LVEDV is 192 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 83 ml (normal range 47+/-19), the LV mass index is 29 g/m2 (normal range 85+/-15), and the LV mass is 61 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 206 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 87 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is bicuspid with fusion of the right and left coronary cusps. It opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe ascending aorta is normal in size. There is dilation of the descending aorta before and after the coarctation-repair site. At the repair site turbulent flow is appreciated on cine imaging. There is a left sided aortic arch with a normal brachiocephalic branching pattern. Sinus of Valsalva: 32 x 34 x 39 mm (previously 35x41mm)ST Junction: 28x28 mm (previously 29x29mm)Ascending Aorta: 33x30 mm (previously 33x34mm)Aortic arch (prox): 25x25 mm (previously 26x25mm)Proximal to coarctation repair site: 32x32 mm (previously 33x34mm)Coarctation repair site: 22 x 21 mm (previously 25x25mm)Distal to coarctation repair site: 30x28 mm (previously 33x32mm)Distal thoracic aorta: 25x24mm (previously 25x23mm)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. Normal LV size and systolic function (LVEF 57%). Normal wall motion and no evidence of underlying myocardial fibrosis, inflammation, or infiltration2. Normal RV size and systolic function RVEF 58%. 3. Bicuspid aortic valve without evidence of stenosis or regurgitation. 4. Narrowing at the site of previous coarctation repair which is appears smaller in cross-sectional area than compared to previous study performed 9/2012.


Instruction: Generate impression based on findings.

Input: Questionable penile fracture. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a focal defect in the tunica albuginea involving the right lateral aspect of the proximal right corpus cavernosum measuring approximately 6 mm in the craniocaudal dimension by 7 mm in the transverse dimension. Superficial to the defect, there is a mixed signal intensity collection measuring 1.3 x 1.2 x 2.4 cm compatible with a hematoma. There is also subcutaneous edema involving the penis.OTHER: No significant abnormality noted.

Output: 7 mm defect of the proximal tunica albuginea involving the right lateral aspect of the corpus cavernosum with associated small hematoma. Findings were discussed by attending radiologist Dr. Thomas with clinical service at time of examination.


Instruction: Generate impression based on findings.

Input: 29 years, Female, multiple sclerosis. Paresthesias. Follow-up progression.. There are greater than 10 T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter with distribution and morphology compatible with known demyelinating disease. Comparison with prior study which is motion degraded limits comparison of small lesions. Within this limitation however, no definite new lesion is appreciated to suggest progression. Few lesions with T1 hypointensity are also evident. No infratentorial lesions. Brain parenchymal volume is grossly preserved.No intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: No definite evidence of new lesions to suggest progression of demyelinating disease, with motion degradation on the prior study limiting comparison of small lesions.


Instruction: Generate impression based on findings.

Input: Male 68 years old Reason: with doppler - r/o portal vein clot History: incr LFTs, h/o cirrhosis. Limited by bowel gas.LIVER: Cirrhotic morphology liver with marked increased echogenicity and heterogeneous texture. Very small left lobe difficult to visualize by ultrasound and also partly obscured by bowel gas. The mildly hypointense lesion in the left lobe described on the MRI is not visible by ultrasound.Portal vein is patent with hepatopedal flow. Peak velocity 0.1 m/s.GALLBLADDER, BILIARY TRACT: Gallbladder is surgically absent. No intrahepatic biliary dilatation. Common hepatic duct 0.7 cm diameter.PANCREAS: Limited visualization.RIGHT KIDNEY: Morphologically normal 11.2 cm in length.OTHER: Left kidney morphologically normal 11.1 cm in length.Spleen mildly enlarged 15 cm in length.Moderate generalized ascites

Output: Cirrhotic morphology liver with limited visualization but no definite focal lesion. Patent portal vein with slow hepatopedal flow.Splenomegaly. Ascites.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, with multiple sclerosis. Assess for progression. Again seen are numerous periventricular and subcortical T2 hyperintense white matter lesions. Some of the periventricular lesions are relatively focal and oriented perpendicularly with respect to the ventricles while in other areas the abnormality is ill-defined and confluent. Disease is also seen within the corpus callosum and to a lesser degree in the middle cerebellar peduncles and brainstem. Accounting for differences in technique with the prior examination, there has been no significant interval change in size or number of these lesions.No evidence of parenchymal edema or mass effect is seen. The corpus callosum is thinned and the lateral ventricles are slightly prominent compatible with white matter loss. No abnormal extra-axial fluid collections are detected.

Output: Stable white matter disease compatible with the history of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 24 years Female (DOB:2/16/1992)Reason: Eval tumor progression vs ischemia History: R sided numbness, changes in CT scan, ho anaplastic astrocytomaPROVIDER/ATTENDING NAME: MICHAEL ANDREW WARD SERVICES ANCILLARY There is redemonstration of a cystic appearing lesion centered in the left parietal lobe and measuring 31 x 32 mm axial dimensions and 45 x 27 mm sagittal dimensions. It is associated with diffusion restriction present in the adjacent periventricular white matter as well as the corpus callosum. There is vasogenic edema present within the left occipital lobe, parietal lobe and temporal lobe as well as external capsule and internal capsule and the posterior aspect of the frontal lobe. There is associated mass effect with compression of the left lateral ventricle. Since the prior exam the area of diffusion restriction appears to have enlarged. It now measures 36 x 14 mm axial dimensions were as it previously measured 26 x 12 mm axial dimensions. The vasogenic edema has also increased and extended compared to the prior exam.On susceptibility imaging there is redemonstration of numerous punctate foci of signal loss within the area of diffusion restriction but also in the thalami and white matter surrounding the lesion. Another focus of diffusion restriction is centered in the pons which on T2 and T1 imaging has a popcorn-like appearance. This measures approximately 8 mm axial dimensions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam the area of diffusion restriction and the associated vasogenic edema located in the posterior aspect of the corpus callosum and in the deep white matter deep to the cystic cavity in the left parietal lobe has expanded. One possibility is that this is related to treatment effect. While another possibility in the context of antiangiogenic therapy may reflect tumor growth despite lack of contrast enhancement.2.There is redemonstration of a cerebral cavernous malformation located in the pons


Instruction: Generate impression based on findings.

Input: 46-year-old female with shoulder instability. Evaluate shoulder instability/labrum. ROTATOR CUFF: The subscapularis, supraspinatus, infraspinatus and teres minor tendons and muscles appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment is anatomic. The articular cartilage appears normal. The anterior labrum is torn; the underlying periosteum is intact without avulsion. The posterior labrum is grossly normal. There is cortical depression along the posterolateral humeral head compatible with a Hill-Sach's deformity.There is small amount of fluid in the subacromial bursa. There is no evidence of communication of the intra-articular contrast material in the glenohumeral joint with the subacromial bursa.BICEPS TENDON: The long head biceps tendon appears normal. ADDITIONAL

Output: Anterior glenoid labral tear and Hill-Sach's deformity as described above.


Instruction: Generate impression based on findings.

Input: TIA vs Seizure. Transient episode of unresponsiveness No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. No foci of diffusion restriction are appreciated intracranially.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally there are small foci of high signal on T2 MRI located in the basal ganglia and thalami many of which represent perivascular spaces in the couple of which do not.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 eyeball lenses are thin.

Output: 1.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. Smaller lesions in the basal ganglia and thalami are present some of which may be related to microvascular events.2.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to right-sided L4-L5 microdiscectomy. There is persistent enhancement and effusion with a subcentimeter synovial cyst associated with the left L4-L5 facet joint. There is also enhancement along the right aspect of the L4-L5 intervertebral disc. There is a diffuse disc bulge at L4-5, with superimposed right foraminal component and associated facet arthropathy resulting in moderate bilateral neural foraminal stenosis at L4-L5 level and posterior epidural lipomatosis with mild-to-moderate spinal canal stenosis. There is a disc bulge at L5-S1, resulting in bilateral moderate neural foraminal stenosis. The vertebral body heights are preserved. There is endplate degenerative changes and Schmorl's node in the inferior endplate of L5 vertebra. The vertebral bone marrow signal is otherwise unremarkable. There is loss of disc height at L5-S1 and mild loss of disc height at L1-L2 and L4-L5 level. There is no abnormal signal within the imaged portion of the spinal cord. There is an unchanged perineural cyst in the sacral spinal canal.

Output: 1. Postoperative findings related to right L4-L5 microdiscectomy with residual eccentric right disc protrusion and what appears to be associated scar versus granulation tissue.2. Persistent enhancement and effusion associated with a subcentimeter synovial cyst involving the left L4-L5 facet joint may represent synovitis.3. Degenerative spondylosis at L5-S1 with bilateral moderate neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Female, 60 years old. Trauma 3 days ago, limping, ttp. We see no fracture. There is deformity of the left distal gluteus minimus tendon which appears at least partially separated from the greater trochanter. Edema and a small amount of fluid surrounds the distal gluteus minimus tendon. There is also increased signal intensity within the vastus lateralis muscle at its origin indicating a strain, with edema adjacent to its anterior fibers. The gluteus medius tendon appears intact.There is a small amount of fluid in the left hip joint, but there is no large effusion. Mild osteoarthritis affects both hips. Moderate osteoarthritis affects the pubic symphysis. Mild to moderate osteoarthritis affects both sacroiliac joints. There is a small amount of fluid within the right sacroiliac joint which is nonspecific, and we see no edema in the adjacent bone to indicate an inflammatory process. Facet joint osteoarthritis affects the lower lumbar spine.

Output: 1.No fracture evident.2.At least high-grade partial tear of the distal gluteus minimus tendon at its insertion on the greater trochanter, and strain of the origin of the vastus lateralis muscle.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, history of poorly differentiated adenocarcinoma, likely salivary, status post CRT, with new brain metastasis on CT. Assess disease with attention to the skull base. Brain:A 13 x 10 mm ring-enhancing lesion is seen at the junction of the left occipital and temporal lobes. There is very mild local edema without significant mass effect.No additional intracranial enhancing lesions are seen. In particular, the cranial nerves and skull base foramina as visualized on this examination are within normal limits. No additional areas of parenchymal edema are demonstrated.There are numerous scattered small foci of white matter T2 hyperintensity, a nonspecific finding which has not significant changed from the prior examination. No intracranial hemorrhage or any abnormal extra axial fluid is detected. The ventricular system is normal in size and morphology.Cervical spine:Sagittal alignment of the cervical spine is within normal limits. Diffuse fatty marrow signal likely reflects prior radiation therapy.A region of T1 hypointense, T2 hyperintense enhancement within the right lateral aspect of the T2 vertebral body is seen. On comparison with recent prior CT, no destructive or lytic lesion is seen at this location, but rather, there are vertical striations which is a feature seen in benign hemangioma.Elsewhere, marrow signal characteristics are benign with no evidence of pathologic marrow enhancement.The visualized spinal cord demonstrates normal signal intensity throughout. No pathologic intraspinal enhancement is seen.C2-3: Facet hypertrophy. No significant spinal canal stenosis or neuroforaminal narrowing. C3-4: Facet hypertrophy. Posterior disc-osteophyte complex formation. Mild spinal canal stenosis. Moderate foraminal narrowing. C4-5: Facet hypertrophy. Posterior disc-osteophyte complex formation. Moderate spinal canal stenosis. Moderate foraminal narrowing. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the left. Moderate spinal canal stenosis. Severe left and moderate right foraminal narrowing. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation. Severe left and moderate right foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1. A single metastatic lesion is seen at the junction of the left temporal and occipital lobes. This lesion causes very mild local edema and no significant mass effect.2. No definite evidence of metastatic disease to the cervical spine is seen. A region of signal abnormality and enhancement within the right lateral aspect of the T2 vertebral body is nonspecific but shows CT features compatible with a benign hemangioma. Continued follow-up is advised.


Instruction: Generate impression based on findings.

Input: 18-year-old female with medial anterior knee pain MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Diffuse abnormal signal of the patellar articular cartilage with minor fissuring. No large articular cartilage defects. Small focus of abnormal signal within the subcortical marrow likely represents reactive marrow edema.LIGAMENTS: Anterior cruciate ligament is intact. The posterior cruciate ligament is intact. The lateral collateral ligament complex is intact. The medial collateral ligament is intact. EXTENSOR MECHANISM: The extensor mechanism is intact. Small amount of edema in the infrapatellar fat pad.ADDITIONAL

Output: Abnormal signal within the patellar articular cartilage with minor fissuring and reactive bone marrow edema compatible with chondromalacia patella.


Instruction: Generate impression based on findings.

Input: 60-year-old female with foot pain for years getting worse with burning. Evaluate for tear in the plantar fascia. TENDONS: There is fluid within the peroneal tendons as they course distal to the fibular tip suggesting tenosynovitis. There is flattening of the peroneus brevis tendon beneath the fibular tip which may represent a partial-thickness longitudinal split tear, but this is equivocal. The remaining ankle tendons appear normal.LIGAMENTS: The lateral collateral ligament complex is grossly intact. The distal tibiofibular syndesmotic complex appears intact. Visualized components of the deltoid ligament appear intact. ARTICULAR SURFACES AND BONE: The tibiotalar joint appears normal for age. There is an os trigonum posterior to the talus. The os trigonum is surrounded by fluid but we see no edema within this accessory ossicle or the posterior talus. There is a small plantar calcaneal heel spur. Moderate osteoarthritic changes affect the talonavicular joint with a defect along the articular surface of the navicular and underlying edema which may reflect old trauma.ADDITIONAL

Output: 1. Findings compatible with mild plantar fasciitis as described above, without evidence of a tear of the plantar fascia.2. Peroneal tenosynovitis with possible partial-thickness longitudinal split tear of the peroneus brevis.3. Findings suggestive of sinus tarsus inflammation as described above.4. Osteoarthritis of the talonavicular joint which may be secondary to prior trauma.5. Os trigonum as described above.


Instruction: Generate impression based on findings.

Input: Ataxia and nausea. Lesion in the left middle cerebellar peduncle on outside MRI. BRAIN: There is interval evolution of the left middle cerebellar hemisphere lesion, with what now appears to be encephalomalacia. There are also small foci encephalomalacia involving the periphery of the bilateral cerebellar hemispheres, left larger than right, which have appear to be new. In addition, there is also mild cerebellar volume, mainly involving the vermis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The cerebral 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.CERVICAL SPINE: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is a minimal C5-C6 disc-osteophyte complex. There is no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is no abnormal contrast enhancement.

Output: 1.Several small foci of encephalomalacia in the cerebellum likely represent chronic infarcts superimposed upon mild vermian atrophy, which may be related to alcohol use. MRA of the head and neck may be useful for further evaluation.2.The cervical spinal cord is unremarkable.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Intermediate risk prostate cancer bilaterally. Biopsy dated 12/22/2015 demonstrated multifocal 3+3, 3+4 and 4+3 disease. PELVIS:PROSTATE:Prostate Size: 3.1 x 4.6 x 4.2 cmPeripheral Zone: Patchy areas of T1 weighted hyperintensity predominantly in the lateral peripheral zone, likely reflecting blood product, severely limits evaluation.In the medial aspect of the peripheral zone there is a 2.9 x 1.1 cm region of low T2-weighted signal intensity and restricted diffusion (series 801/12). Additional multiple smaller foci of T2-weighted hypointensity.Central Gland: Mild changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The dominant posterior paramedial peripheral zone lesion obscures and bulges the prostatic margin suspicious for extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The study is significantly limited by patchy hemorrhage in the peripheral zone. Multifocal disease with suspected dominant posterior paramedial lesion with suspected extraprostatic extension.


Instruction: Generate impression based on findings.

Input: Preterm infant. Perinatal depression. Acidosis and status epilepticus with abnormal background EEG. Status post cooling. Evaluate for hypoxic ischemic encephalopathy. There is abnormal diffusion restriction in a patchy pattern involving the frontal and parietal white matter, which is lightly worse on the left, with relative perirolandic sparing. Similar abnormality is present along the splenium of the corpus callosum and ventrolateral thalami. These areas are associated with mildly increased T1 signal. There is also low ADC/restricted diffusion involving the dorsal pons as well. There is no parenchymal susceptibility effect to indicate intraparenchymal hemorrhage. However, there is T1 hyperintensity on the dorsal surface of the parietal lobes and in the posterior fossa which may represent minimal, extra-axial hemorrhage. There is no midline shift or herniation.There is diffuse scalp soft tissue swelling (caput succedaneum). In addition, there is focal T2 hypointensity (hematoma) in the vertex on the right side which probably represents an associated cephalohematoma. This is 8 mm deep and 29 mm in transverse. There is no underlying displaced skull fracture evident.

Output: Diffusion restriction involving the subcortical white matter of the frontal and parietal lobes, splenium of the corpus callosum, thalami, and dorsal pons. Findings are consistent with extensive hypoxic-ischemic injury.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate edema, stroke, include sinuses. Signs and symptoms: Meningitis, CVAs Nonenhanced CT of brain:Multiple previously noted left hemispheric subacute cortical and left basal ganglial nonhemorrhagic strokes are again identified. There is no appreciable interval change. Mass-effect and effacement of cortical sulci is again identified. No change in the degree of mass effect.There is a very subtle area of low attenuation in the cingulate gyrus of the right posterior frontal which was not appreciated on prior CT study however it was present on prior MRI examination. There is also better visualization of a single small foci of low-attenuation in the right anterior limb of internal capsule which was also present on prior MRI however not on head CT.There is no evidence of interval hemorrhage or new ischemic stroke.CT of paranasal sinuses:There is fluid level within the dependent portion of bilateral maxillary sinuses. The ostiomeatal units of maxillary sinuses are patent. There is very extensive opacification of sphenoid sinus with mucosal thickening as well as fluid no. Extensive opacification of left posterior ethmoid air cells and to a lesser degree all the other ethmoid air cells. Frontal sinuses are pneumatized and no images of pathology. Presence of NG tube could explain presence of fluid within the sinuses.Images through nasal cavity demonstrate NG tube and some mucosal thickening. There is also partial opacification of bilateral mastoid air cells however with no opacification of the cavities.

Output: 1.Revisualization of multiple left hemispheric and few small right hemispheric ischemic strokes with no areas of hemorrhagic conversion and no evidence of new stroke. The mass-effect remains identical to prior study.2.Extensive because of thickening and fluid levels within paranasal sinuses could be result of patient's NG tube placement or sinusitis.3.The ostiomeatal units of maxillary sinuses are patent bilaterally.


Instruction: Generate impression based on findings.

Input: Soft tissue infection Evaluation is limited by motion artifact and by the patient prematurely terminating the exam resulting in a lack of contrast administration. Also note that the small toe is not entirely included on sagittal sequences.There is subcutaneous edema particularly along the dorsum of the foot. Additional signal intensity along the dorsum of the foot and base of the second toe may represent overlying bandage material. Although the subcutaneous edema becomes confluent, there is no focal fluid collection to suggest abscess.There is abnormal signal intensity within the proximal phalanx of the fifth toe with relative sparing of its base but there is no definite adjacent soft tissue ulceration. This is nonspecific in nature but it is possible this could represent a nondisplaced fracture. The signal intensity of the remaining phalanges and metatarsals is normal. There is replacement of the subcutaneous fat along the inferolateral margin of the calcaneus posteriorly with signal intensity extending to the bone; however there is no convincing evidence of underlying osteomyelitis at this time.There appears to be a pes planovalgus deformity with osteoarthritis affecting the midfoot.

Output: Significantly limited exam demonstrates soft tissue swelling and ulceration. There is abnormal signal intensity within the proximal phalanx of the fifth toe which is nonspecific and not well characterized on this exam. It is possible this represents a nondisplaced fracture as we see no adjacent ulceration to confirm osteomyelitis. Dedicated 3 view radiographs of the left fifth toe are recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Left neck glomus tumor. Neck: There is a well-defined enhancing mass containing flow voids in the left post-styloid parapharyngeal space with slight extension into the left posterior fossa through a widened foramen ovale, as well as into the middle ear cavity. Overall, the mass measures up to approximately 4.5 cm. There appears to be associated compression of the left sigmoid sinus and upper internal jugular vein. The left internal carotid artery is deviated anteromedially. There is no significant lymphadenopathy in the neck. The salivary glands are unremarkable. There are bilateral thyroid nodules. There is anterior wedge deformity of the T3 vertebral body without evidence of edema. There are secretions in the left posterior ethmoid sinus.Brain: There is no evidence of intracranial hemorrhage or acute infarct. There is diffuse patchy cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a persistent left trigeminal artery. The orbits are grossly unremarkable.

Output: 1. Left glomus jugulotympanicum tumor measuring up to approximately 4.5 cm.2. Persistent left trigeminal artery. 3. Chronic compression deformity of the T3 vertebral body. 4. Bilateral thyroid nodules. Thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 20-year-old with history of von Hippel-Lindau and prior brain/spinal hemangioblastomas. Evaluate for interval change. Motion artifact moderately limits the image interpretation, particularly within the spine Brain:Surgical changes from prior midline suboccipital surgery.Redemonstration of a nodule of enhancement along the midline dorsal medulla at the level of the foramen magnum is not significantly changed from prior measuring 5 mm, previously 5 mm.Redemonstration of 5 small enhancing nodules in the bilateral cerebellar hemispheres which are not significantly changed from prior. There is mild associated edema.Mild edema associated with the lesions is not significantly changed.Dedicated imaging of the temporal bones and internal auditory canal does not show any enhancing or destructive mass to suggest endolymphatic sac tumor. No lesions within the supratentorial brain are appreciated. No evidence of acute ischemia or hemorrhage. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. Calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine:The vertebral body and intervertebral disc heights are maintained. Straightening of the cervical lordosis is seen, alignment is otherwise maintained. No suspicious bone marrow signal abnormalities. Redemonstration of an intramedullary lesion in the posterior cervical cord at the C4 level which measures 10 mm in maximum dimension. This is previously reported as measuring 6 mm, however repeat measurement on the exam from 1/3/2015 using similar slice as on current measurement yielded a similar measurement of 10 mm. There is stable edema within the cord adjacent to this lesion. No new cervical cord lesion.No disc bulges, neural foraminal stenosis, or spinal canal stenoses in the cervical spine. Thoracic spine:There is stable mild straightening of the thoracic spine. Mild endplate irregularity which was also previously present from T9 through L1 with mild wedging deformities of the T10 and 11 vertebral bodies are unchanged. No evidence of acute fracture.Redemonstrated enhancing lesion in the right posterior cord at the T4 level measures 7 mm, previously 6 mm. Additional lesion in the right posterior cord at the T6 level measures 4 mm, previously 5 mm. These lesions are associated with mild cord edema appearing similar to prior.No significant disc bulge, spinal canal stenosis, or neuroforaminal narrowing. Lumbar Spine:The vertebral body and intravertebral disc heights are maintained. The alignment is anatomic. No bone marrow signal abnormalities.No enhancing masses are noted in the conus or cauda equina.No significant disc bulge, spinal canal stenosis, or neuroforaminal narrowing.

Output: Accounting for differences in technique and motion degradation on some sequences, there is no appreciable interval change in multiple enhancing lesions in the bilateral cerebellar hemispheres, dorsal medulla, cervical spinal cord, and thoracic spinal cord which are compatible with hemangioblastomas. Associated edema is also not significantly changed. No new lesions or new edema is identified. There are also no findings to suggest endolymphatic sac tumor


Instruction: Generate impression based on findings.

Input: Clinical question: Brain lesion; preoperative planning for tumor biopsy/ resection. Signs and symptoms: Dizziness Pre and post enhanced stealth MRI:Examination is performed utilizing surgical planning protocols and is not a complete diagnostic exam.There is a well-demarcated uniformly enhancing solid mass in the inferior left cerebellum measuring maximum of 22 x 32 mm in transaxial dimensions with extensive surrounding vasogenic edema and resultant mass effect on the fourth ventricle with subtle herniation across the midline. There are serpiginous signal voids within the inferior and surrounding the mass consistent with vascularity of the tumor. There are no prior exams for comparison.Additionally examination demonstrate a single well-demarcated focus of CSF signal intensity in the right paramedian pons which could represent a chronic lacunar infarct. Postcontrast enhanced images also demonstrate a tiny high convexity left frontal developmental venous anomaly.

Output: Solid uniformly enhancing right cerebellar mass with surrounding vasogenic edema and mass effect as detailed.


Instruction: Generate impression based on findings.

Input: 64 year old male with extensive CAD (3v CABG 2015, VF arrest/STEMI with PCI to SVG-RCA 11/2015), HTN, hyperlipidemia presenting for evaluation of viability and ischemia prior to possible revascularization. MEDICATIONS: atorvastatin, aspirin, carvedilol, amiodarone, lisinopril, ticagrelolor First Pass PerfusionDuring hyperemia, perfusion defects were present in the mid inferolateral and basal infero-septal, inferior, inferolateral and lateral walls. Viability/ Myocardial ScarThere was late gadolinium enhancement noted in the apical-mid inferior wall (<50%), and mid to basal lateral and inferolateral walls (approximately 50%) subendocardial late gadolinium enhancement in a pattern typical for myocardial infarction; there is a focal area of delayed hyperenhancement within the mid inferolateral wall which is transmural, best seen on 3 chamber images. The areas with 50% wall thickness LGE are unlikely to be viable and the area of <50% is of intermediate likelihood of being viable. The remaining myocardium is likely to be viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 110 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 38 ml (normal range 47+/-19), the LV mass index is 57 g/m2, and the LV mass is 109 g. There is hypokinesis present in the basal inferior and inferolateral walls. . Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 69%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 106 ml (normal range 142+/-31), the RV end systolic volume index is 17 ml/m2 (normal range 31+/-9), and the RVESV is 32 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsNonacute right anterior rib fractures, likely from previous CPR. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Perfusion defects were present in the mid inferolateral and basal infero-septal, inferior, inferolateral and lateral walls.2. Late gadolinium enhancement noted in the apical-mid inferior wall (<50%), and mid to basal lateral and inferolateral walls (approximately 50%) subendocardial late gadolinium enhancement in a pattern typical for myocardial infarction; there is a focal area of delayed hyperenhancement within the mid inferolateral wall which is transmural, best seen on 3 chamber images. The areas with 50% wall thickness LGE are unlikely to be viable and the area of <50% is of intermediate likelihood of being viable. The remaining myocardium is likely to be viable. 3. Normal LV size and systolic function (LVEF 65%). There is hypokinesis present in the basal inferior and inferolateral walls. 4. Normal RV size and systolic function (RVEF 69%).


Instruction: Generate impression based on findings.

Input: Prodromal psychotic episodes. The exam is markedly limited by dental brace artifact. In the portions of the exam not obscured by artifact, there is no definite evidence of mass lesions or midline shift. There appear to be terminal zones of myelination as manifested by bilateral T2 hyperintense areas in the periventricular regions of the parietal lobes. The pituitary gland and corpus callosum appear to be intact. There is no evidence of cerebellar tonsillar herniation. The ventricles appear to be normal in size.

Output: The exam is markedly limited by dental brace artifact. In the portions of the exam not obscured by artifact, there is no definite evidence of mass lesions.


Instruction: Generate impression based on findings.

Input: 65 years Male (DOB:7/27/1950)Reason: eval for disc herniation History: c/o neck pain and left arm painPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There are some uncovertebral osteophytes present this level with some mild narrowing of the left neural foramen.At C3-4 there is no significant compromise to the spinal canal . There is a disc bulge present this level. There are uncovertebral osteophytes present at this level associated with encroachment of exiting nerve roots bilaterally.At C4-5 there is no significant compromise to the spinal canal. There is a disc bulge present this level. There are uncovertebral osteophytes present at this level associated with encroachment of exiting nerve roots bilaterally. There is left-sided facet hypertrophy present at this level contributing to further narrowing of the left neural foramen.At C5-6 there is no significant compromise to the spinal canal . There is a disc bulge present this level. There are uncovertebral osteophytes present at this level associated with encroachment of exiting nerve roots bilaterally.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is mild disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level associated with mild facet hypertrophy. There is narrowing of the neural foramina at this level with mild encroachment of the exiting nerve roots within the neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge associated with mild ligamentum flavum hypertrophy. There are some effacement of the fat at the lateral recess bilaterally at this level. There is narrowing of the neural foramina bilaterally. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level associated with mild ligamentum flavum hypertrophy. The fat at the lateral recess is not effaced bilaterally. There is a left far lateral disc protrusion at this level.At L2-3 the patient is status post left hemilaminectomy. There is diffuse disc bulge present at this level. There is thickening of the posterior ligamentous tissues at this level with narrowing of the thecal sac and partial effacement of fluid surrounding the cauda equina. There are acute endplate reactive changes at this level. There is some fluid present along the posterior aspect of the epidural space especially in the right side.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a disc bulge at this level.

Output: 1.There are multilevel degenerative changes present in the cervical spine was sedated with some encroachment of exiting nerve roots bilaterally at C3-4, C4-5 and C5-6 but worse at C5-6 and on the left-sided C4-5.2.Findings are compatible with mild to moderate spinal stenosis at L2-3 where there is prior surgery. There is soft tissue thickening and fluid along the posterior aspect of the spinal canal at this level. This may be postoperative in nature. It is nonspecific and could potentially represent blood products or infection or soft tissue swelling and edema.3.There is mild to moderate encroachment of the nerve roots at the right lateral recess more than the left at L4-5 due to a disc bulge.


Instruction: Generate impression based on findings.

Input: Male, 81 years old, with dizziness and nausea and emesis. Assess for posterior circulation stroke or stenosis. Patchy, nearly confluent periventricular T2 hyperintensity is again seen, similar to the prior examination. New from the prior study is T2 hyperintensity and volume loss affecting the left cerebellar hemisphere and left middle cerebellar peduncle. Scattered focal T2 hyperintense lesions are also evident within the bilateral basal ganglia, the pons, and elsewhere throughout the cerebellum.No evidence of restricted diffusion is seen. No frank parenchymal edema or mass-effect is detected. No evidence of intracranial hemorrhage is seen. The ventricles are prominent, similar to prior, and compatible with volume loss.MRA images reveal mild to moderate vascular narrowing of the cavernous ICAs. More distally, there are scattered mild to moderate focal and segmental stenoses throughout the ACA, MCA and PCA distributions. The vertebral arteries and basilar artery do, however, remain patent. The smaller vertebro-basilar branches are not well visualized beyond their origins which can be related to technique. No aneurysms are detected within the limitations of technique.

Output: 1.No evidence of acute ischemia or any other acute intracranial abnormality.2.Extensive chronic small vessel and lacunar ischemic disease, largely unchanged from the prior examination.3.Encephalomalacia involving the left cerebellar hemisphere is new from the prior MRI and most likely represents chronic ischemic injury.4.MRA images reveal numerous scattered focal and segmental stenoses throughout all vascular distributions. The vertebral arteries and the basilar artery do, however, remain patent. Small vertebro-basilar branches are not well visualized, likely due to technique, which prevents accurate assessment for steno-occlusive disease.


Instruction: Generate impression based on findings.

Input: Male 65 years old Reason: US--lesion in dome of liver History: HBV carrier ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. There are multiple punctate T2 hyperintense foci compatible with small cysts. T2 hyperintense focus in segment 8 of the liver without central enhancement is also likely a cyst. No solid focal lesion is identified to correspond to the abnormality on ultrasound. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Scattered hepatic cysts without suspicious lesion to correspond to the abnormality on ultrasound.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified malignant neoplasm of skin of scalp and neckClinical question: abnormalities on head CT; evaluate for metastasis vs other etiology such as radiation effect.Signs and Symptoms: angiosarcoma. The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple punctate foci of susceptibility effect present in the subcortical white matter and gray matter of both hemispheres of the brain as well as the cerebellum and brainstem. To some degree these were present on the prior exam but now they are more numerous and the lungs were previously present are somewhat larger. Some of these are associated with contrast enhancement. There are several small foci of contrast enhancement present in the cerebellar hemispheres as well as one in the right occipital lobe and one in the left precentral gyrus. Some of these are associated with adjacent FLAIR signal hyperintensity.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Incidental note is made of partial empty sella.There is a focus of marrow replacement present in the left frontal bone associated with some thinning of the left frontal calvarium and thinning of the adjacent scalp.

Output: 1.There are multiple hemorrhagic lesions present throughout the brain compatible with metastases. These have progressed since the prior exam.2.Left frontal calvarial lesion associated with thinning of the adjacent scalp. Please refer to the patient's head CTs for further comments this was also present on the prior exam and does not appear to have changed


Instruction: Generate impression based on findings.

Input: 93 year-old female with left-sided facial droop and left-sided weakness. Evaluate for CVA. There is no acute intracranial hemorrhage, mass effect or basal cistern effacement. There is no CT evidence of acute territorial ischemia. However, there are multiple ill-defined areas of hypoattenuation in the periventricular and deep white matter bilaterally. In a patient of this age, these findings may represent chronic small vessel ischemic disease, however, an acute infarct cannot be completely excluded. MRI can definitively exclude ischemic insult if there is high clinical suspicion for infarct.The ventricles and basal cisterns are normal in size and configuration. . There is no extra-axial fluid collection. Expected moderate volume loss for age.The calvaria and skull base are radiographically normal. There is mild mucosal thickening of the left sphenoid sinus. There are mild atherosclerotic changes of the intradural vertebral arteries. Incidental note is made of bilateral lens prosthesis.

Output: No CT evidence of acute territorial ischemia or acute intracranial hemorrhage.Mild ill-defined periventricular and deep white matter hypoattenuation. In a patient of this age, these findings may represent chronic small vessel ischemic disease. MRI can more definitively exclude acute or small infarcts.


Instruction: Generate impression based on findings.

Input: MRI brain:There is mild general volume loss. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Bilateral sinus mucosal thickening and fluid as well as fluid in the mastoid air cells may be secondary to intubation. Sinusitis is not excluded.MRI C-spine:There is slight straightening of the cervical spine which is nonspecific. The vertebral body heights are well-maintained. There is a likely hemangioma of the T3 vertebral body. There is no abnormal pathologic enhancement. There is variable mild disc height loss and cervical spine as prominent at the C5-6 level where there is also mild endplate degenerative changes. There is a minimal retrolisthesis of C5 on C6 and a very small disc osteophyte complex at the C6-7 level. There is mild to moderate right and mild left neuroforaminal narrowing at the C5-6 level and most mild bilateral neuroforaminal narrowing at the C6-7 level. However there is no spinal canal stenosis. There is some fluid in the dependent pharynx which may be from intubation.

Output: 1.No evidence of acute intracranial hemorrhage or abnormal brain parenchymal enhancement/lesion.2.Bilateral sinus mucosal thickening and fluid as well as fluid in the mastoid air cells may be secondary to intubation. Sinusitis is not excluded.3.Mild degenerative changes of the cervical spine most prominent at the C5-6 level and C6-7 level, without cord signal abnormality or enhancing lesion.


Instruction: Generate impression based on findings.

Input: Reason: please assess for vascular disease and possible prior infarction History: transient loss of vision on R eye There is a small focus of signal loss identified only on susceptibility weighted images along the anterior aspect of the right cingulate gyrus associated with a developmental venous anomaly draining into the anterior septal vein.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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. A 7mm well circumscribed focus of T2 and FLAIR signal hyperintensity and intermediate signal on T1 and without diffusion restriction between the right mastoid and the jugular vein is present adjacent to the skull base. It could represent an arachnoid granulation but is non-specific.

Output: 1.A small vascular lesion along the right cingulate gyrus is present. Differential considerations include vascular malformation including cerebral cavernous malformation or a small arteriovenous malformation. High resolution imaging and/or an angiographic study may be helpful.2.An email was sent to Dr Cotts regarding the above finding.


Instruction: Generate impression based on findings.

Input: Patient with persistent pain in right shoulder, status post dog attack 3 months ago. Dog pulled on distal arm and shook patient. No direct attack at the shoulder joint. ROTATOR CUFF: Supraspinatus, infraspinatus, and teres minor tendons appear normal. The muscles likewise appear normal. There is a 3 to 4 mm tiny focus of signal intensity within the superior fibers of the subscapularis tendon, which may represent a small interstitial tear but this is of questionable clinical significance. The subscapularis muscle otherwise appears normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. We see no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. We see no joint effusion. Given the limitations of a nonarthrogram study, the glenoid labrum and articular cartilage appear normal. Small cysts within the anteromedial and posterolateral humeral head may be degenerative in etiology.BICEPS TENDON: Given the limitations of nonarthrogram study, the tendon of the long head of the biceps appear normal. There is small amount of fluid in the tendon sheath which is not necessarily of any clinical significance.

Output: 1.Tiny focus of signal intensity in the superior fibers of the subscapularis tendon may represent small interstitial tear, but this is of questionable clinical significance and the remainder of the rotator cuff is unremarkable.2.Mild osteoarthritis of the acromioclavicular joint and other findings as described above.


Instruction: Generate impression based on findings.

Input: Please evaluate empty sella turcica on CT head: patient presenting with nausea and vomiting. There is no evidence of intracranial hemorrhage or acute infarct. There is a flattened appearance of the pituitary gland, which measures up to 4 mm in craniocaudal dimension. The ventricles and basal cisterns are normal in size and configuration. There is a subcentimeter pineal cyst, with no significant mass effect. 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: Nonspecific flattened appearance of the pituitary gland.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 84-year-old male with critical limb ischemia. Possible TAVR. Please evaluate from arch to toes. History failed transplant kidney.Patient is on hemodialysis per clinical service. VESSELS:SINUS OF VALSALVA: 3.8 X 3.7 X 3.6 cmSINOTUBULAR JUNCTION: 3.3 X 3.3 cmASCENDING THORACIC AORTA AT LEVEL OF MAIN PULMONARY ARTERY: 3.6 X 4.0 cmPROXIMAL ARCH: 3.7 X 3.4 cmDISTAL ARCH: 2.7 X 2.6 cmSUPRARENAL ABDOMINAL AORTA: 1.9 X 1.9 cmINFRARENAL ABDOMINAL AORTA: 1.6 X 1.5 cmRIGHT COMMON ILIAC ARTERY: 10 X 9 mmRIGHT EXTERNAL ILIAC ARTERY: 8 X 7 mmRIGHT COMMON FEMORAL ARTERY: 8 X 7 mmLEFT COMMON ILIAC ARTERY: 11 X 9 mmLEFT EXTERNAL ILIAC ARTERY: 8 X 7 mmLEFT COMMON FEMORAL ARTERY: 7 X 7 mmCHEST:LUNGS AND PLEURA: Lower lobe bronchiectasis bilaterally adjacent groundglass opacities (left greater than right), suggesting chronic aspiration and/or infection. No pleural effusions or thickening.Right upper lobe granuloma.MEDIASTINUM AND HILA: Scattered calcified mediastinal lymph nodes reflect previous granulomatous disease.Coronary artery calcifications involving all 3 vessels.Aortic valve calcifications. This exam was not tailored to evaluate aortic valve morphology.Left jugular central venous catheter with tip in distal SVC.CHEST WALL: Gynecomastia. Subacute left sided rib fractures. Presumed bursal fluid about the right shoulder is incompletely evaluated.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: Atrophic end stage kidneys. Failed LLQ renal transplant.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:Bladder: Wall thickening.Pelvic kidney: Note is made of a significantly dilated collecting system of the known failed transplant kidney.Extraperitoneal space and lymph nodes: No significant abnormalities.Prostate: No significant abnormalities noted.BONES, SOFT TISSUES: Right hip prosthesis. Lumbar fixation rods and screws. L1 chronic appearing compression fracture.LOWER EXTREMITY RUN-OFF:RIGHT LEG: Mild disease of the common femoral artery with multifocal mild-to-moderate disease of the SFA.Profunda femoris patent but diffusely calcified.Popliteal artery: Multifocal disease with areas of severe narrowing at the level of the knee.Diffuse calcific disease limits evaluation of the runoff vessels. Given this limitation, probable two-vessel runoff to the right foot via anterior tibial and peroneal arteries.Anterior tibial: Multifocal moderate disease.Posterior tibial: Occluded proximally.Peroneal: Occluded proximally with reconstitution via collaterals at the level of the mid-calf.Dorsalis pedis: Patent.LEFT LEG: Severe stenosis of the proximal common femoral artery with multifocal moderate-to-severe disease of the SFA.Profunda femoris patent but diffusely calcified.Popliteal artery: moderate-to-severe disease.Diffuse calcific disease limits evaluation of the runoff vessels. Given this limitation, probable single-vessel runoff to the left foot via a severely diseased anterior tibial artery.Anterior tibial: Multifocal severe disease.Posterior tibial: Occluded.Peroneal: Probable occlusion of the peroneal artery at the midcalf level.Dorsalis pedis: Patent via collateral filling.

Output: 1. Calcified aortic valve. Ascending aorta measures 3.9 cm (nonorthogonal) at the level of the main pulmonary. Please note that this examination was not tailored for evaluation of aortic valve morphology.2. Diffuse atherosclerotic calcifications of the descending abdominal aorta and iliac vessels, which are otherwise patent.3. Left pelvic kidney with significant dilatation of the collecting system corresponds to known failed renal transplant. Bladder wall thickening is also noted.4. Bibasilar bronchiectasis with adjacent groundglass opacities (left greater than right), suggesting chronic aspiration and/or infection. Given the patient's age this should be followed to resolution to exclude underlying neoplasm, especially if there are no signs or symptoms of infection/aspiration.5. RIGHT LOWER EXTREMITY RUN-OFF: Mild inflow disease with multifocal mild-to-moderate outflow disease involving the superficial femoral artery. There is severe narrowing of the popliteal artery at the level of the knee with probable two-vessel runoff to the right foot via diseased anterior tibial and peroneal arteries.6. LEFT LOWER EXTREMITY RUN-OFF: Focal severe disease of the proximal common femoral artery with multifocal moderate-to-severe disease of the superficial femoral artery. Moderate-to-severe disease of the popliteal artery with probable single-vessel runoff to the left foot via a severely diseased anterior tibial artery.


Instruction: Generate impression based on findings.

Input: 79-year-old female with syncope and fall. Rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. Extensive periventricular and subcortical white matter areas of hypoattenuation appear unchanged and are consistent with chronic small vessel ischemic disease. Prominent sulci are consistent with parenchymal volume loss, appropriate for age.The ventricles and basal cisterns are normal in size and configuration.Mild irregularity of right orbital roof appears unchanged, and is possibly result of prior trauma. Otherwise, calvaria and skull base are radiographically normal. Right mastoid air cells are opacified, unchanged. Otherwise, the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.No acute intracranial abnormality or interval change.2.Stable chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 16-year-old male with a history of a scaphoid fracture presents with persistent wrist pain. LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: Low T1, high T2 signal through the distal pole and waist of the left scaphoid. The remaining bones are normal in appearance.ADDITIONAL

Output: Abnormal signal through the distal pole and waist of the left scaphoid is suggestive of avascular necrosis.