Instruction: Generate impression based on findings.

Input: MRI:There is metallic artifact along the right petrous apex, which may be related to embolization material. There is a left transfrontal ventriculostomy shunt catheter which terminates adjacent to the right frontal horn.There is a relatively round lesion involving the pons, medulla and right middle cerebellar peduncle causing leftward displacement of the fourth ventricle. This lesion has a complex mixed signal appearance on T2-weighted and FLAIR imaging and susceptibility hypointensity, suggestive of a collection of blood products. There is associated edema within the brainstem. The cerebellar tonsils are at or slightly below the foramen magnum. On the prior examinations, the involved parenchyma was distorted and hemosiderin stained presumably due to prior hemorrhage. In addition, the fourth ventricle was somewhat cystically expanded.No evidence of midline shift or acute infarction. The ventricles are small in caliber. Flow-voids are present within the major vessels indicating patency. There is scattered opacification of ethmoid air cells and complete opacification of the sphenoid sinuses. There is mild mucosal thickening of the bilateral maxillary sinuses. Prior right parietal mastoidectomy is noted. Calvarium and extracranial soft tissues are grossly unremarkable.MRA:Immediately above the hemorrhagic collection, there is a network of small faintly flow enhancing structures which could reflect residual AVM based on the history and which appears similar to that seen on the prior exam. The right AICA is prominent and courses along this lesion potentially representing part of its vascular supply. No obvious large draining vein is seen. Outside of this lesion, no additional aneurysm or vascular malformation is suspected. The vessels otherwise demonstrate normal caliber and morphology.

Output: Findings compatible with hemorrhage involving the brainstem, primarily the pons and medulla. Immediately above this hemorrhage is a network of faintly flow enhancing structures which could reflect residual AVM based on the history, although other vascular lesions could potentially have this appearance as well. The round and well contained margins of the hematoma suggest that this could represent hemorrhage into a pre-existing cystic cavity, or potentially a large thrombosed pseudoaneurysm. No definite evidence of additional aneurysms is seen on this study.Findings were discussed with Dr. Braverman at 4:00 PM on 12/19/2016.


Instruction: Generate impression based on findings.

Input: 40-year-old male with a right knee medial mass. Assess right knee medial mass as well as for intra-articular pathology. MENISCI: The medial lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is osteophyte formation along the femoral trochlea, centrally, with near full-thickness to full-thickness degeneration of the overlying articular cartilage. The bone marrow signal intensity is normal. The lateral and medial compartment cartilage appears relatively spared. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: Extensor mechanism appears intact.ADDITIONAL

Output: 1. Large lobulated and septated medial soft tissue mass of predominantly fluid signal intensity on T2WI likely representing a ganglion or perhaps a peculiar accumulation of bursal fluid.2. Osteoarthritis of the patellofemoral joint with cartilage degeneration along the femoral trochlea. We otherwise see no intra-articular pathology.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with right-sided weakness. Scattered small foci of white matter T2 hyperintensity are seen, a nonspecific finding. No evidence of restricted diffusion is seen. No significant parenchymal edema or mass effect is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. Ventricles are normal in size and morphology.

Output: 1.No acute intracranial abnormality.2.Nonspecific white matter lesions may represent chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: History of Germinoma status post chemotherapy and radiation therapy, now off therapy for 9 months. Brain: The pineal gland region appears unchanged. There are unchanged right transfrontal surgical tracks. There is no evidence of intracranial hemorrhage or acute infarct. The sella and suprasellar regions are unremarkable. The ventricles are not significantly changed in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits are grossly unremarkable.Spine: There is no evidence of mass lesions or abnormal enhancement within the spinal canal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Unchanged treated pineal germinoma.2. No evidence of spinal drop metastases.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for change to previously demonstrated left cerebellar lesion after 2 weeks of antibiotics treatment. Signs and symptoms: Left cerebellar lesion; normal neurological exam. Pre and post enhanced brain MRI:A ring-enhancing lesion in the left cerebellar measuring at 6 x 8 mm in transaxial dimensions compared to prior study measurement of 11 x 7 mm. Trace residual FLAIR hyperintensity surrounding this lesion demonstrate significant decrease since prior exam. This patient similar to prior study demonstrate restricted diffusion which due to its small size it is difficult to assess for change in size.Stable punctate focus of ependymal enhancement of the left occipital horn since prior exam.There is revisualization of uniform thin linear enhancement of the ependymal lining of the right trigone and occipital horn of lateral ventricle without definitive interval change since prior exam. There is also significant decreased associated FLAIR hyperintensity surrounding the trigone and occipital horn of right lateral ventricle since prior study suggestive of improvement. This finding also demonstrate linear restricted diffusion which may be slightly less conspicuous compared to prior study.Mild leptomeningeal enhancement along the superior aspect of bilateral cerebellar hemispheres (L>R) is again noted and also demonstrate interval improvement since prior exam. There is no evidence of any additional new foci of restricted diffusion, FLAIR/T2 hyperintensity or abnormal parenchymal, meningeal or ependymal enhancement.Ventricular system remains within normal size and without radiation of midline. All CSF cisterns remain patent. The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses is within normal with normal pattern of enhancement.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells and calvarium.

Output: 1.Interval improvement evident by decreased size, associated edema and decreased conspicuity of restricted diffusion of multiple foci of enhancement consistent with small abscess in left cerebellum, cerebellar leptomeningeal infection and bilateral ventriculitis since prior study as detailed/measured above.2.Unremarkable pre and postcontrast enhanced brain MRI otherwise and without evidence of any new foci of restricted diffusion, abnormal FLAIR hyperintensity or abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Reason: eval for fx History: left long finger deformity. Left wrist pain. Finger:No acute fracture or malalignment is evident. There is mild soft tissue swelling about the digit.Wrist:There is subtle sclerosis of the lunate, suggestive of sequelae of ulnar impaction. This can be further evaluated with dedicated wrist MRI if clinically indicated. No acute fracture or malalignment is evident.

Output: 1.There is subtle sclerosis of the lunate, suggestive of sequelae of ulnar impaction. This can be further evaluated with dedicated wrist MRI if clinically indicated. 2.No acute fracture or malalignment of the left middle finger or left wrist.


Instruction: Generate impression based on findings.

Input: A 78 year old female with hypertension, atrial fibrillation and suspected hypertrophic cardiomyopathy. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 58 ml/m2 (normal range: 65+/-11), the LVEDV is 96 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 43 ml (normal range 31+/-10), the LV mass index is 45 g/m2 (normal range 67+/-11), and the LV mass is 74 g (normal range 114+/-24). There is focal hypertrophy of the basal antero-septum (dimension 13mm) and the remainder of the myocardium has normal wall thickness (~9mm). Based on myocardial tagging, the basal septum has somewhat reduced myocardial deformation. The deformation is normal in the remainder of the myocardium. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracavitary thrombus was seen.No myocardial iron overload was seen.Left AtriumThe left atrium is severely dilated. The LA volume is 220 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 56 ml/m2 (normal range 69+/-14), the RVEDV is 92 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 42 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate to severe mitral regurgitation. The anterior mitral leaflet is thickened and somewhat calcified. No systolic anterior motion of the mitral leaflets is noted. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate to severe tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (31 x 32mm). 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 left ventricular size and systolic function (LVEF 55%). The basal septum is mildly hypertrophied and has a mild reduction in intramyocardial deformation. The remainder of the myocardium has normal wall thickness and normal deformation. There is no evidence of underlying myocardial fibrosis, inflammation, or infiltration. Strictly speaking, the diagnostic criteria for hypertrophic cardiomyopathy are not met on this study suggesting that the hypertrophy involving the basal septum may be secondary to a sigmoid septum rather than hypertrophic cardiomyopathy. Repeat imaging to assess for change in septal wall thickness may be helpful to differentiate hypertrophic cardiomyopathy from a sigmoid septum. If the diagnosis of hypertrophic cardiomyopathy has been confirmed by other means, then from a cardiac MRI perspective, the absence of late gadolinium enhancement is considered a low risk marker for significant arrhythmia.2. Normal RV size and systolic function (RVEF 54%). 3. Severe biatrial dilation.4. At least moderate to severe mitral and tricuspid valve regurgitation .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: 79-year-old female with multiple myeloma, ESRD on HD. Transferred for septic shock. With exposed sacro- bones, evaluate for osteomyelitis. Signs and symptoms: Central decubitus stage IV ulcer. Fever Nonenhanced CT lumbar spine:Axial 3 mm CT images of the entire lumbosacral spine with zero degree angulation of the gantry were obtained.Sagittal and coronal 2-D reformatted images were also obtained for interpretation.Examination demonstrates multiple poorly defined lytic bony changes involving the vertebral bodies and posterior elements of lumbar spine consistent with patient's diagnosis of multiple myeloma. There is no significant interval change when compared with prior MRI examination from 3 -- 14 -- 11. The alignment the vertebral column is within normal limits. There is no detectable extraosseous spread of tumor into the spinal canal. Degenerative changes of SI joints bilaterally with vacuum phenomenon are noted.This examination demonstrates no evidence of findings to suggest osteomyelitis. The very tip of coccyx is not visualized on this exam.Note is made of very heavy calcification of abdominal aorta and bilateral iliac arteries.A large calcific mass in the midline in the pelvis is due to represent fibroid mass of the uterus.

Output: 1.No evidence of osteomyelitis on this exam as clinically is questioned. Recommend MRI if concern for osteomyelitis persists.2.Findings consistent with multiple myeloma with no appreciable change since prior exam from prior months.3.Mild degenerative disk disease and hypertrophic changes of posterior elements.4.Degenerative changes of the SI joints bilaterally with vacuum phenomenon.


Instruction: Generate impression based on findings.

Input: Reason: pain eval for Avn History: pain TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The distal tibiofibular syndesmotic complex appears intact. The lateral collateral ligament complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is minimal heterogeneous bone marrow signal abnormality along the anterior aspect of the distal tibia which may represent stress reaction in the correct clinical context. There is linear decreased signal abnormality within the medullary cavity along the anterior aspect of the distal tibial metaphysis in the surrounding area, however, no definite cortical disruption/extension is identified. No additional bone marrow signal abnormality is identified. No findings to suggest avascular necrosis. No osteochondral defects are identified. ADDITIONAL

Output: 1. Bone marrow signal abnormality/edema along the anterior aspect of the distal tibial metaphysis may reflect stress reaction in the correct clinical context. If further imaging evaluation is clinically warranted, follow-up radiographs could be considered.2. Small subtalar joint effusion of uncertain current clinical significance.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with epidural abscess status post debridement. There is been interval removal of the interbody cage at L4-5, posterior left iliac crest bone graft, and interbody fusion at L4-5. Revision hemi-laminotomies at L1-2, L4-5 and L5-S1 have also been performed. There is a small fluid collection within the posterior left iliac crest defect, with surrounding likely surgical packing material (T2 hypointense signal) and enhancement, which is nonspecific.Previously demonstrated ventral epidural fluid collection from L1 through L3 appears to be resolved. A persistent fluid collection involving the left laminotomy defect at L4-L5 is slightly increased in size since 8/12/2016 with encroachment on the dorsolateral left aspect of the thecal sac. A smaller fluid collection with surrounding enhancement is also again demonstrated in the paraspinal soft tissues at the level of the L2-3 left hemilaminotomy. Heterogeneous signal representing likely a combination of postoperative fluid and blood products within the ventral epidural space at L4 and L5 is slightly increased in size since prior examination. There is also enhancing granulation tissue on the left at this level. The combination causes mild to moderate effacement of the thecal sac and severe effacement of the left lateral recess with extension into the left L4-5 neural foramen. Bone graft placement may be better assessed with CT of the lumbar spine.Spinal alignment is anatomic. Lumbar vertebral body heights are preserved. There is prominent Schmorl's node and mild loss of anterior vertebral body height at T12. Signal changes at L4-5 are seen which may be postoperative in nature. No significant disc degeneration is detected.Within the posterior subcutaneous soft tissues in the midline, there is again a fluid collection, which is smaller than on prior exam, with surrounding enhancement and edema.

Output: 1. Postoperative findings are seen compatible with removal of interbody cage and interbody fusion at L4-5 and multilevel laminectomy for debridement of a large epidural abscess involving a majority of the spine. Resolved epidural fluid in the upper and mid lumbar spine.2. Likely postoperative fluid blood products and granulation tissue at the L4 and L5 levels causes severe effacement of the left lateral recess and extending into the left L4-5 neural foramina. Residual abscess cannot be completely excluded. 3. Fluid collections in the region of left iliac bone graft, left L2-3 and L4-5 paraspinal soft tissues, and posterior superficial subcutaneous soft tissues are most likely postoperative in nature. However, infection cannot be excluded.


Instruction: Generate impression based on findings.

Input: Back pain, history of kidney cancer Lack of contrast limits evaluation for small metastatic lesions. Five lumbar type vertebral bodies are presumed to be present. There is a large mass involving the right aspect of the sacrum measuring approximately 4.6 x 5.2 x 4.9 cm and is centered at the right S2 level. The tumor surrounds the right S2 nerve root and to a lesser degree S3 and S1 roots. There is evidence of epidural extension with effacement of the right aspect of the spinal canal. The left aspect of the spinal canal is patent. Elsewhere in the lumbar spine, no large lesions are evident. Scattered foci of T1 hyperintensity such as at the T12 vertebral body are compatible with hemangiomas. Small focus of T1 hypointensity and T2 hyperintensity involving the superior endplate of L2 is nonspecific. Vertebral body heights are within normal limits. There is trace anterolisthesis of L5 on S1. Alignment is otherwise within normal limits. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: There is mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is no significant spinal canal stenosis. No significant neural foraminal stenosis.L2-L3: There is mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is no significant spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: There is mild disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is minimal bilateral neural foraminal narrowing.L4-L5: There is loss of disc height, disc bulge, ligamentum flavum thickening, and advanced bilateral facet arthropathy. There is resulting moderate spinal canal stenosis. There is mild to moderate bilateral neural foraminal narrowing.L5-S1: Grade 1 anterolisthesis with disc uncovering. There is advanced bilateral facet arthropathy. There is partial effacement of the lateral recesses. No significant central canal stenosis. There is minimal right and mild to moderate left neural foraminal stenosis.

Output: 1. Large right sacral mass most compatible with metastatic disease. There is evidence of epidural extension with effacement of the right lateral aspect of the sacral spinal canal. Postcontrast imaging may be helpful to further assess extent of epidural tumor and smaller additional lesions.2. Multilevel degenerative changes in the lumbar spine with moderate spinal canal stenosis at the L4-L5 level. Additional details as above.Dr. Ali discussed findings with Dr. Renz at 940 hrs on 2/23/2016


Instruction: Generate impression based on findings.

Input: Pain and abnormal bleeding. Consideration for UFE. PELVIS:UTERUS, ADNEXA: Uterus demonstrates partial septate morphology and is retroflexed. It measures approximately 7.3 x 8.2 x 10.0 cm (AP by ML by sagittal dimensions). There are multiple T2 hypointense subserosal, intramural and pedunculated fibroids. The largest subserosal fibroid measures 1.5 x 2.3 x 1.9 cm and is located near the right isthmus. The largest intramural fibroid is located in the left fundal wall measuring 3.7 x 2.9 x 2.9 cm. The largest pedunculated fibroid located in the mid right uterine body measures 2.5 x 2.2 x 2.2 cm. These demonstrate heterogeneous enhancement on postcontrast sequences.T2 hyperintense punctate cystic changes in the myometrium and thickening of the junctional zone, compatible with adenomyosis.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple subserosal, intramural, and pedunculated fibroids, as above.2.Findings compatible with adenomyosis.


Instruction: Generate impression based on findings.

Input: Low back pain with right-sided radicular pain, status post motor vehicle collision. There is degenerative mild grade 1 anterolisthesis of L4 on L5. The vertebral column alignment is otherwise within normal limits. There is a prominent Schmorl's node in the superior endplate of L3 without significant edema, suggesting that this is chronic lesion. The vertebral body heights are otherwise preserved. The vertebral bone marrow signal is unremarkable. There is prominent epidural fat distally, especially at the L5-S1 level. There is a perineural cyst that measures up to 15 mm to the right of the midline at the level of S2. The imaged portion of the spinal cord displays normal signal and morphology. There is multilevel facet arthropathy most prominent at L4-L5. There is a mild disc bulge at L2-3, without significant spinal canal or neural foraminal stenosis. There is mild spinal canal stenosis at L4-5 and neural foraminal narrowing related to the retrolisthesis, pseudobulge, and marked facet arthropathy. There is a lobulated contour of the uterus with multiple low T1 and T2 signal tumors, measuring up to 2.6 cm.

Output: 1. Degenerative lumbar spondylosis predominantly at the L4-5 level with grade 1 degenerative anterolisthesis, mild spinal canal stenosis, and mild bilateral neural foraminal narrowing.2. Multiple probable uterine fibroids. Correlation with dedicated ultrasound examination may be useful.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 60 years, Female, sensory disturbances in the extremities, evaluate for white matter disease and demyelination.. Brain: Brain parenchyma appears within normal limits for age. No significant parenchymal T2/FLAIR signal abnormalities are seen to suggest demyelinating or other white matter disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchymal volume is within normal limits. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Partially empty sella incidentally noted, which can be normal variant. Minimal mucosal thickening in the paranasal sinuses. Heterogeneous low T1 marrow signal is noted which is nonspecific and can be seen in conditions such as chronic anemias; no destructive osseous lesions. Cervical Spine: The cervical spinal cord has normal signal characteristics and overall morphology without evidence of demounting disease. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Small disc protrusion. No significant spinal canal or neural foraminal stenosis.C5-6: Small disc osteophyte complex which partially effaces the ventral thecal sac. Minimal spinal canal stenosis. There is mild left neural foraminal narrowing. No significant right neural foraminal narrowing.C6-7: Disc osteophyte complex and uncovertebral hypertrophy on the left. There is partial effacement of the ventral thecal sac. Minimal spinal canal stenosis. There is moderate left neural foraminal stenosis and minimal right neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.No abnormal enhancement. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. MRI of the brain is within normal limits for patient's age. Specifically, no findings to suggest demyelinating disease.2. No cervical cord signal abnormality to suggest demyelinating disease.3. Mild degenerative changes in the cervical spine as detailed above with small disc osteophyte complexes at C5-C6 and C6-C7 resulting in minimal spinal canal narrowing. There is moderate left-sided neural foraminal stenosis at the C6-C7 level which may which may be impinging on the left C7 nerve root.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke? Signs and symptoms: Facial droop. Unenhanced CT of brain:No evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus. The gray -- white matter differentiation is well preserved. Questionable minute subcortical foci of low attenuation is noted. This finding may represent minimal small vessel disease. Patient has risk factors for stroke an MRI examination is recommended.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: With the exception of possible minimal small vessel disease of indeterminate age this study is unremarkable.


Instruction: Generate impression based on findings.

Input: Ms. Massarsky is a 61-year-old female with a family history of breast cancer in her sister (diagnosed at the age of 26) and BRCA2 positive. Personal history of benign left breast MR-biopsy in 2009 and benign right breast MR biopsy in 2016 both with pathology of fat necrosis. She has no current breast related complaints. Breast parenchyma is almost entirely fat in both breasts. Minimal parenchymal enhancement is noted bilaterally.Susceptibility artifact from biopsy marker clip is seen in the right superior breast with minimal associated enhancement, compatible with recent benign MR-guided biopsy with subsequent mild hematoma formation. There is also susceptibility artifact from biopsy marker clip in the left lower inner breast, compatible with prior benign MR-guided biopsy. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Female, 41 years old. Lateral right knee pain after injury MENISCI: There is a large complete radial tear through the junction of the anterior horn and body of the lateral meniscus. The posterior horn of the lateral meniscus is intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: We see no fluid-filled articular cartilage defects.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Full-thickness radial tear of the lateral meniscus and other findings as above.


Instruction: Generate impression based on findings.

Input: There is straightening of cervical spine which is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. A partially imaged 13 x 16 mm axial dimension T2 hyperintense nodules noted within the right thyroid lobe. The remaining visualized paraspinal contents are unremarkable.Modic type I discogenic reactive endplate changes are present at C5/6.C2/3: UnremarkableC3/4: UnremarkableC4/5: Mild posterior osteophyte disc complex and uncinate hypertrophy without significant resulting stenosis.C5/6: Posterior osteophyte disc complex eccentric to the right causes anterior right hemicord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy (right greater than left). There is moderate right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex causes slight anterior cord flattening without intrinsic cord signal abnormality. There are no significant stenoses.C7/T1: Unremarkable

Output: 1.A partially imaged 13 x 16 mm axial dimension T2 hyperintense nodules noted within the right thyroid lobe. Full characterization of this could be obtained via thyroid ultrasound.2.C5/6: Moderate right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: r/o tear of ACL graft History: pain, swelling MENISCI: There is linear decreased signal abnormality which traverses the posterior horn of the lateral meniscus and extends to the tibial articular surface indicating an oblique tear which extends into the body of the meniscus, new from prior examination. The anterior horn appears intact. The there is undersurface fraying of the posterior horn of the medial meniscus which otherwise appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. There is thinning of the articular cartilage of the patellofemoral articulation. There is bone marrow signal abnormality within the lateral femoral condyle and lateral tibial plateau likely representing bone contusions. Note is made of osseous tunnels from prior ACL graft reconstruction.LIGAMENTS: Note is made of postsurgical changes of prior ACL graft reconstruction. There is near complete to complete rupture through the mid substance and distal fibers of the ACL graft, although some of the fibers of the graft may be intact. The PCL appears intact. The LCL appears intact. The imaged components of the anterolateral ligament appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Near complete to complete rupture of the ACL graft as described above. 2. Tearing of the lateral meniscus as described above. 3. Bone contusions and other findings as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Sciatica, right side. Spondylolisthesis, multiple sites in spine. Sciatica, right side. Spondylolisthesis, multiple sites in spineClinical question: hx of L4-5 spondylolisthesis, hx of Lung ca. Evaluate for abnormality, stenosis.Signs and Symptoms: Right leg pain and weakness MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is higher marrow signal on T1-weighted imaging at the T6, T7 and T8 vertebral bodies which suppresses on the inversion recovery images indicate that there is greater fatty replacement these levels. This could be a result of radiation effect. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.There are some interstitial thickening present in the right lung.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is mild anterior subluxation of L4 on L5 which has not changed substantially since 2009.. There is redemonstration of a large perineural Tarlov cysts in the sacral spinal canal at the S2 segment level associated with expansion of the sacral spinal canal and displacement of the adjacent nerve roots. These were also present on the prior exam and have remained stable. One on the left side measures 16 x 17 mm axial dimensions and one on the right side measures 15 x 15 mm axial dimensions.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is bilateral facet hypertrophy present associated with a diffuse disc bulge and some endplate reactive changes. Endplate reactive changes are relatively lower signal on T1 and some higher signal on T2 and predominate on the right side. There is some associated vague signal enhancement associated with the endplate reactive change. Endplate reactive changes were not present on the prior exam Since prior exam there has been further loss of disc space height. There are some effacement of the fat at the right lateral recess which was also present on the prior exam. There are some encroachment of the nerve roots of the right lateral recess which is unchanged since the prior exam. The exiting nerve roots within the neural foramina are surrounded by fat.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a moderate degree of bilateral facet and ligamentum flavum hypertrophy present at this level which was also present on the prior exam as well. There is mild anterior subluxation of L4 on L5.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild degree of facet and ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is redemonstration of a small left renal cortical cyst along the superior medial aspect of the left kidney. It remains stable.

Output: 1.There are degenerative changes present in the lumbar spine which are worse at L5-S1 where there is some encroachment of the nerve roots at the right lateral recess due to combination of a disc bulge and facet hypertrophy. There is been minimal progression of this encroachment however there is been progression of loss of disc space height at this level and some subacute endplate reactive changes.2.There are moderate-sized Tarlov cysts present in the sacral spinal canal.3.Postradiation treatment changes in the midthoracic spine. 4.Some interstitial thickening is present in the right lung. Please refer to chest CT from August 26 2015 for further comments.


Instruction: Generate impression based on findings.

Input: Reason: eval lunate History: potential Kienböck's? Eval cartilage n proximal capitate Multiple sequences are limited by patient motion artifact.LIGAMENTS: Although this examination is not protocoled for evaluation of the intrinsic ligaments of the wrist, there is heterogeneity and intermediate signal in intensity within the scapholunate and lunotriquetral ligaments which likely represent degeneration and perhaps degenerative tearing, however, no full-thickness tear is evident. TRIANGULAR FIBROCARTILAGE COMPLEX: There is a focal disruption of the volar aspect of the triangle fibrocartilage disc at the level of its insertion on the radius.TENDONS: The flexor and extensor tendons appear intact. There is a small amount of fluid within the tendon sheath of the extensor carpi radialis brevis and extensor carpi ulnaris which may reflect a very mild tenosynovitis. BONES: There is fragmentation of the lunate and decreased signal abnormality on T1 and T2-weighted images consistent with the patient's known history of avascular necrosis. There is increased bone marrow signal abnormality on fluid sensitive sequences within the scaphoid which may represent degenerative change. There is also increased bone marrow signal abnormality within the triquetrum with associated subchondral cyst formation likely degenerative in etiology. Note is made of increased bone marrow signal abnormality within the ulnar styloid which may be degenerative in etiology. There is a small amount of fluid within the distal radioulnar joint. There is a subchondral cyst within the capitate indicating degenerative changes. There is fraying of the articular cartilage about the lunocapitate articulation with partial thickness articular cartilage degeneration. There is subchondral cyst formation within the distal radius.ADDITIONAL

Output: 1. Fragmentation of the lunate and bone marrow signal abnormality consistent with the patient's history of avascular necrosis.2. Focal perforation of the triangular fibrocartilage at the level of its insertion on the radius. 3. Bone marrow signal abnormality within the scaphoid, lunate, triquetrum, ulnar styloid, distal radius, and capitate may be degenerative in etiology. There is partial-thickness articular cartilage degeneration affecting the lunocapitate articulation. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.Multiple scattered T2/flair high signal intensity lesions on periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No evidence of intracranial arterial aneurysm. No evidence of significant arterial luminal stenosis. Bilateral P-comm arteries are patent and a common artery is also patent.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Nonspecific small vessel ischemic disease, otherwise unremarkable. No acute ischemic or hemorrhagic lesion.2. Normal brain MRA, normal neck MRA.


Instruction: Generate impression based on findings.

Input: Male 58 years old; Reason: L ulnar sided wrist pain (TFCC) LIGAMENTS: The ligaments of the wrist are intact, without abnormal signal characteristics.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is intact, without features to suggest tearing. TENDONS: No significant abnormality noted. The tendons of the wrist are intact without abnormal signal characteristics.BONES: No significant abnormality noted. Note is made of a subcentimeter bone island in the distal ulna.ADDITIONAL

Output: Intact triangular fibrocartilage complex. No specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 66-year-old female with pain and limited motion of the right shoulder. Rule out right rotator cuff tear. ROTATOR CUFF: There is thickening and increased signal abnormality of the supraspinatus tendon consistent with tendinosis. Note is made of a full-thickness tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity. This measures approximately 14 mm in AP dimension. There is approximately 12 mm of retraction. There is atrophy of the supraspinatus muscle belly. There is full-thickness tearing of the anterior fibers of the infraspinatus tendon. There is atrophy of the infraspinatus muscle. The tears minor and subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa and acromioclavicular joint. Moderate degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted within the limitations of this non arthrogram enhanced study.BICEPS TENDON: There is a small amount of circumferential fluid identified along the long head of the biceps tendon which may represent fluid extending from the glenohumeral joint. There is thickening, deformity, and increased signal abnormality within the poorly visualized intra-articular portion of the long head of the biceps tendon, which may be disrupted.ADDITIONAL

Output: 1. Full-thickness tearing of the supraspinatus tendon and anterior fibers of the infraspinatus tendon with retraction.2. The intra-articular portion of the long head of the biceps tendon is poorly visualized and may be disrupted.


Instruction: Generate impression based on findings.

Input: 80 year-old woman with right leg numbness x 2 days and headache. There is no evidence of intracranial hemorrhage, mass or edema. In the left, high convex frontal lobe there is a region of dystrophic, cortical calcification. This finding is present on the MRI dated 8/25/2007.The ventricles are normal in size and configuration. There is a mega cisterna magna, a non-pathological finding, noted.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No CT findings of acute process. If stroke is a clinical concern, recommend MRI.


Instruction: Generate impression based on findings.

Input: 71 year-old female with history of CVA in 2006. Breast cancer oblique radiation and now with (unreadable ward), MR presurgical evaluation No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. A very small area of increased soft tissue density overlapping the ependymal lining of the right trigone is noted this finding measures approximately 6 mm times 7-mm on axial image 15. This finding is not associated with any edema and no definitive enhancement. Further follow-up with an MRI scan is recommended to exclude metastatic lesion.Calvarium, partially visualized paranasal sinuses and mastoid air cells remain within normal limits.

Output: 1. Localized increased soft tissue density on the ependymal lining of the trigon of right lateral ventricle is concerning for metastatic lesion and should be further evaluated with an MRI. Please see above comments. 2.Unremarkable CT examination of brain and calvarium otherwise.


Instruction: Generate impression based on findings.

Input: 25-year-old female with bilateral knee pain and stiffness and swelling. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. No bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. Note is made of lobulated foci of fluid signal intensity along the anterior aspect of the posterior cruciate ligament measuring approximately 3.5 x 1.5 cm, which may represent ganglion formation or mucoid degeneration of the PCL. Parameniscal cyst formation is considered less likely as no underlying meniscal tear is evident. The PCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Lobulated foci of fluid signal along the posterior cruciate ligament which may represent ganglion formation or mucoid degeneration of the PCL. Parameniscal cyst formation is considered less likely as no underlying meniscal tear is evident. 2. Nonspecific subcutaneous edema along the anterior aspect of the patella.


Instruction: Generate impression based on findings.

Input: 64-year-old female patient with history of acute pancreatitis, EUS on 08/21/2015 demonstrated "hyperechoic strands and lobularity of the entire pancreas." ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Common bile duct is normal caliber and morphology and measures 5 mm in diameter. No focal liver lesion seen. Hepatic vasculature is patent. No intrahepatic biliary ductal dilatation. There is decreased signal in the hepatic parenchyma on in-phase imaging, which can be seen in the setting of intrahepatic iron deposition.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct is normal in caliber and morphology. There is subtle T1 heterogeneity in the head of the pancreas, which may be a sequelae of prior pancreatitis. No significant peripancreatic edema to suggest acute pancreatitis or focal areas of necrosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is a focus of fat signal intensity with peripheral rim enhancement abutting the anterior margin of the left hepatic lobe, compatible with fat necrosis. Hiatal hernia noted. Again seen is a distended stomach containing ingested material throughout the examination. There is no evidence of mechanical gastric outlet obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of acute pancreatitis or biliary pathology.2.Subtle T1 heterogeneity in the head of the pancreas, which may be a sequelae of prior pancreatitis.3.Decreased signal in the hepatic parenchyma on in-phase imaging, which can be seen in the setting of hepatic iron deposition.4.Stomach distended throughout examination. This finding raises question of gastroparesis and can be further evaluated with a nuclear medicine gastric emptying study as clinically indicated.


Instruction: Generate impression based on findings.

Input: 45-year-old female with a mass removed but still has pain with a neuroma was removed. Again seen is a lobulated focus of fluid signal intensity along the anterior aspect of the proximal fibula which enhances on postcontrast sequences measuring 7 x 5 x 9 mm (series 17; image 30) corresponding to the findings seen on prior MRI knee examination dated 7/5/2013 which is not definitively changed when compared to the prior study. There is linear decreased signal abnormality along the lateral aspect of the knee with foci of signal void presumably representing postsurgical change and scarring. There is a vitamin E marker is situated along the lateral aspect of the knee presumably corresponds to the patient's surgical scar. No bone marrow signal abnormalities identified in the underlying area. The imaged musculature is normal in appearance. Although this examination was not protocoled for detailed evaluation of the knee, there is full-thickness articular cartilage degeneration along the medial facet of the patella with underlying degenerative subchondral signal abnormality. There is nonspecific subcutaneous edema along the anterior aspect of the patellar tendon.

Output: No significant interval change in the subcentimeter enhancing lobulated focus of fluid signal intensity along the proximal fibula which is nonspecific but may represent a neuroma or perhaps an atypical ganglion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 25 years old, with multiple sclerosis on the CHORDS MS study. Scattered T2 hyperintense lesions are demonstrated within the white matter of both cerebral hemispheres. These are unchanged in size and morphology. No new lesions are appreciated. Most of the visualized lesions demonstrate moderate to marked T1 hypointensity. No enhancing lesions are seen. No evidence of edema or mass effect is seen. No abnormal extra-axial collections are detected. Ventricular size and morphology are within normal limits.

Output: Multiple lesions are identified compatible with multiple sclerosis, unchanged in size and number. No enhancing lesions are seen.


Instruction: Generate impression based on findings.

Input: Male 51 years old Reason: prostate cancer History: prostate cancer PELVIS:PROSTATE:Prostate Size: 4.0 x 2.5 x 3.4 cmPeripheral Zone: There is a focus of abnormal T2 hyperintense signal within the left mid gland/apex which measures approximately 1.2 x 0.9 cm (series 604, image 104). This is also dark on ADC map where it is best appreciated.Central Gland: Heterogeneous.Seminal Vesicles: No evidence of some of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular 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: 1.1.2-cm focus of signal abnormality within the left mid gland/apex, suspicious for prostatic carcinoma. No evidence of seminal vesicle invasion or extracapsular extension.


Instruction: Generate impression based on findings.

Input: 52 year old patient with cerebral cavernous malformations. Annual surveillance. Redemonstrated are numerous supratentorial and infratentorial foci of susceptibility effect related to numerous bilateral cavernous malformations, as demonstrated previously. The largest of these lesions are located the left dorsolateral thalamus into the centrum semiovale measuring up to 33 mm, spanning the superior and middle temporal gyri posteriorly as well as within the right lateral pons adjacent to the fifth cranial nerve root measuring up to 7 mm, unchanged. No lesions demonstrate perilesional edema. There appear to be developmental venous anomalies associated with the larger lesions. There are no signal characteristics suggestive of acute hemorrhage. There is no hydrocephalus or ischemia. Also redemonstrated is mild pansinus mucosal thickening. Mastoid air cells are clear. Expected vascular flow voids are demonstrated.

Output: No significant interval change of numerous supratentorial and infratentorial cerebral cavernous malformations.


Instruction: Generate impression based on findings.

Input: Reason: Eval for Radiculopathy History: Neck and RUE Pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the cervical curvature at C5-6 (also present on the prior exam). There is opacification of the sphenoid sinus present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor left lateral disk protrusion present at this level and mild disk dessication. There is mild loss of disk space height.At C5-6 there is disk dessication and a broad based central disk protrusion associated with effacement of CSF ventral and posterior to the spinal cord. This has mildly progressed wince the prior exam. There is no T2 signal hyperintensity in the adjacent vertebral bodies on T2 STIR imaging. There are minor/mild endplate osteophyte formation present at this level. There is mild loss of disk space height at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is mild disk dessication at this level with a minor disk bulge and minor loss of disk space height.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.A disk protrusion at C5-6 has mildly progressed since the prior exam and creates mild to moderate spinal stenosis.2.There are mild degenerative changes in the cervical spine mainly in the form of disk disease as detailed above.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. 40 mL of Kenalog was injected into the joint. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 31 seconds

Output: Successful intra-articular injection of gadolinium for MR arthrography and Kenalog into the right hip joint.


Instruction: Generate impression based on findings.

Input: Reason: MS evaluate for progression History: paresthesias legs MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of patchy T2 and flair signal hyperintensity within the white matter of the supratentorial brain as well as the middle cerebellar peduncles and brainstem compared compared to the previous exam this does not appear to have changed substantially, however, the prior exam acquired using different technique compared with current exam and as a result a more subtle change would not be readily appreciated..Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:There is a redemonstration of ill-defined patchy signal hyperintensity within the cervical spinal cord at approximately C5.The cervical vertebral bodies are appropriate in overall alignment and height. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.There are ill-defined the lesions present throughout the brain parenchyma which have been present since prior exams. They are located within the white matter of the supratentorial brain as well as brainstem and cerebellum. There is an additional lesion present within the cervical spinal cord. Compared to the prior exam there is no appreciable interval change. Etiology is uncertain. Please note that given the subtlety of these lesions in the brain and cervical spinal cord, any similar thoracic spinal cord lesions may be relatively less apparent due to lower sensitivity of thoracic spinal cord imaging and as a result not readily appreciated.


Instruction: Generate impression based on findings.

Input: Rule out spinal stenosis, history of positive straight leg raise test on the left, asymmetric ankle jerks. Five lumbar type vertebral bodies are presumed to be present. There is osseous fusion involving the visualized T11, T12, and L1 vertebral bodies. There is also T1 and T2 hyperintensity involving the L1-L2 disc which likely represent calcification. Ventral bridging osteophytes at the thoracolumbar junction also partially visualized. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: There are foci of calcification involving the disc. Otherwise no significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L5-S1: Minimal disc bulge. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Mild facet arthropathy is seen throughout the lumbar spine.

Output: 1. No significant spinal canal or neural foraminal stenosis at any level in the lumbar spine. There are minimal degenerative changes.2. Osseous fusion involving the T11-L1 vertebral bodies with intradiscal calcifications as well as calcifications involving the L1-L2 disc. These are nonspecific but can be seen in entities such as CPPD and other spondyloarthropathies.


Instruction: Generate impression based on findings.

Input: Year old female a history of metastatic thyroid carcinoma and supraclavicular lymph node enlargement LUNGS AND PLEURA: Stable scattered small micronodules with a calcified granuloma in the left paramediastinal region. No new suspicious pulmonary masses or nodules. No evidence of a pleural effusion.MEDIASTINUM AND HILA: Right paratracheal enlarged lymph node (image 28, series 4) now measures 17 mm by 17 mm, previously, measuring 22 mm x 21 mm. Right hilar lymph node cannot be accurately measured without intravenous contrast material.CHEST WALL: Progressive sclerosis involving the T9 osteolytic lesion. A radiolucency is still noted in the T11 vertebrae. MRI of the thoracic spine can better evaluate these lesions.UPPER ABDOMEN: No significant abnormality noted.

Output: 1.Interval decrease in the mediastinal lymphadenopathy.2.No suspicious pulmonary nodules. Stable scattered micronodules.3.Progressive sclerosis involving the T9 osteolytic metastasis. Radiolucency is identified in the T11 vertebrae. MRI of the spine is is recommended for better evaluation.


Instruction: Generate impression based on findings.

Input: 64-year-old man with right shoulder pain. Evaluate for glenoid labrum tear or torn rotator cuff. History of pseudogout as well as osteoarthritis. The patient is not externally rotating, limited evaluation. Interpretation of the study is also limited by patient motion artifact.ROTATOR CUFF: The muscles and tendons of the supraspinatus, infraspinatus, teres minor and subscapularis appear within normal limits.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: No abnormalities are identified on this right shoulder MRI to account for the patient's shoulder pain.


Instruction: Generate impression based on findings.

Input: 67-year-old man with history of elevated alkaline phosphatase and white blood cell count, evaluate for cholangitis. Please note that this examination is severely limited by artifact from the dielectric effect and the lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour with widened fissures. A punctate focus of T2 hyperintensity in segment 4A of the liver (series 5, image 30) is too small to accurately characterize but is likely benign. There is no loss of parenchymal signal with out-of-phase sequences. No intrahepatic biliary duct dilatation is identified. Small stones are seen in the gallbladder including a stone in the gallbladder neck (series 9, image 24). The common bile duct is normal in size and there is no choledocholithiasis or obstructing mass.SPLEEN: The spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple parapelvic cysts are seen in the left kidney and there are additional cortical cysts seen in the kidneys bilaterally.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Mildly dilated loops of large and small bowel are seen without transition point.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a large amount of ascites. There are moderate bilateral pleural effusions with adjacent atelectasis.

Output: 1.Examination limited by the large volume of ascites causing dielectric artifact and lack of intravenous contrast. Please consider paracentesis prior to future MR studies.2.Cirrhotic liver, however no evidence of intra or extrahepatic biliary duct dilatation.3.Mildly dilated loops of large and small bowel in a pattern suggestive of ileus.


Instruction: Generate impression based on findings.

Input: Status post right pleurectomy decortication. Evaluate for postop changes. CHEST:LUNGS AND PLEURA: The extensive opacity in the right hemithorax consistent with atelectasis and a non-specific consolidation, mainly in a peripheral location.There is probably some loculated fluid at the apex and I cannot exclude residual pleural disease.Radiopaque surgical material is present at the right base probably at the site of partial diaphragmatic resection.A moderately large loculated subpulmonic effusion this present.MEDIASTINUM AND HILA: Lower right and left paratracheal lymphadenopathy with several nodes measuring greater than 10 mm in short axis, unchanged from the previous scan and suspicious for metastatic involvement.Extensive coronary artery calcification.CHEST WALL: No specific evidence of chest wall invasion.Extensive degenerative abnormalities in the spine.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific hypodense lesion measuring about 10 mm x 25 mm in segment 4 B.. This was not visible previously but likely obscured by respiratory motion. The differential diagnosis includes hemangioma, atypical cyst and, less likely, metastasis. If clinically indicated this could be further evaluated with by dedicated CT with multiphase contrast, or MRI scan. Alternatively, a follow-up scan could be performed to confirm stability.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal calculi which may be in the collecting systems. Irregular renal margins with perirenal fat stranding.PANCREAS: 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. Loculated right pleural effusion and atelectasis. 2. Mediastinal lymphadenopathy, unchanged.


Instruction: Generate impression based on findings.

Input: History of pilocytic astrocytoma for surveillance. There are postoperative findings related to right transfrontal biopsy. There is no significant interval change in size of the exophytic right parahippocampal gyrus lesion, measuring 21 x 11 x 17 mm (AP x TR x CC). There is no associated nodular or mural enhancement. There is no evidence of acute cerebral infarction. The ventricles and basal cisterns are unchanged in in size and configuration. There is no midline shift or herniation.

Output: No significant interval change in size or appearance of the right medial temporal lobe glial tumor. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with chronic lumbago. Evaluate for progression of lumbar degenerative disease. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or edema is seen. The visualized distal spinal cord, conus and cauda equina are unremarkable.L1-2: Unremarkable. L2-3: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Facet arthropathy has progressed. Minimal disc with mild spinal canal narrowing, slightly progressed. No significant foraminal compromise. L4-5: Facet arthropathy has progressed. Disc degeneration is also progressed with loss of disc height and disc bulging. Moderate spinal canal narrowing, progressed. Mild foraminal narrowing, progressed. L5-S1: Facet arthropathy has progressed. No significant spinal canal or foraminal stenosis.

Output: Progression of disc degeneration is seen most notably at L4-5. In combination with posterior element degeneration, this produces a moderate narrowing of the spinal canal. Mild progression is seen at additional levels but without high-grade spinal canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for change in C6-7 stenosis History: as above The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal. There is left-sided facet hypertrophy present at this level associated with mild narrowing of the left neural foramen. This is not significant change since prior exam.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small central disk protrusion present at this levelAt C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a small left paramedian disk protrusion present at this level . Compared to the prior exam the patient's disk protrusion has regressed substantially.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Since the previous exam the patient's C6-7 disk protrusion has regressed.2.There are degenerative changes present in the cervical spine as detailed above


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for ischemia, etiology of LUE stiffening, shaking. Signs and symptoms: LUE stiffening and shaking. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrate multiple small foci of T2/FLAIR hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres and pons and with normal signal intensity of brain parenchyma otherwise on all MRI sequences. One of the foci of FLAIR hyperintensity is in the left precentral gyrus (axial flair series 701 image 28). Although the findings are nonspecific this appearance is more suggestive of chronic small vessel ischemic strokes however possibility of other white matter lesions and including demyelinating disease cannot be entirely excluded.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Nonenhanced cervical MRI:The alignment of vertebral column is anatomical however there is mild reversal of cervical lordosis secondary to advanced disc disease and loss of disc height at C5-C6 level.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative/hypertrophic changes of posterior elements with mild left neural foraminal compromise and unremarkable otherwise.C4-C5 demonstrate mild degenerative changes and unremarkable otherwise.C5-C6 demonstrate advanced disc disease with near complete loss of disc height, moderate bilateral ligamentum flavum and mild facet hypertrophic changes. There is a hypertrophic spur traversing the entire transverse axis of the spinal canal at this level which results in effacement of subarachnoid space, flattening and posterior displacement of the cord and moderate central spinal stenosis and moderate bilateral neural foraminal compromise. Examination is degraded due to motion artifact and several sagittal T2 and T2 STIR series were repeated. On repeat sequences there is evidence of a large focus of T2/T2 STIR hyperintensity within the cord and extending from approximately C4-C5 disc level inferiorly to C6-C7 disc level and consistent with myelitis secondary to degenerative disease.C6-C7 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord to T4 level is unremarkable.

Output: 1.Nonenhanced brain MRI demonstrate no acute intracranial process. Several small foci of FLAIR hyperintensity primarily in the subcortical/periventricular white matter (and including the lesion in the left precentral gyrus) and pons are noted. Findings are nonspecific however considering patient's stated age chronic small vessel ischemic strokes of mild degree should be considered. Less likely possibility of other white matter diseases and including demyelinating disease cannot be entirely excluded. Please see above comments.2.Nonenhanced MRI of cervical spine demonstrate advanced disc disease, loss of disc height and hypertrophic changes of posterior elements at C5-C6 with resultant moderate central spinal stenosis and bilateral neural foraminal compromise. There is increased T2 signal intensity of the cord extending from C4-C5 disc level to approximately C6-C7 disc level concerning for myelitis secondary to degenerative disease. No spinal stenosis or significant neural foraminal compromise at other levels however please review detailed report per level above.


Instruction: Generate impression based on findings.

Input: Prior spinal cord untethering and scoliosis. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There are postoperative findings related to cord detethering and scoliosis surgery. The spinal cord is low lying, with the conus medullaris extending to the level of the L3 vertebra. The conus medullaris does not shift in position between prone and supine positioning. There is also thin linear T1 hyperintensity along the filum terminale. There is no evidence of syringohydromyelia. There is mild thoracolumbar dextroscoliosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to cord detethering with a low-lying and apparently immobile conus medullaris, which may represent tethered cord associated with a small fibrolipoma of the filum terminale.2. No evidence of Chiari I malformation, acute intracranial hemorrhage, mass, or acute infarct.3. Postoperative findings related to scoliosis surgery with persistent mild thoracolumbar dextroscoliosis.


Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: uterine fibroid History: uterine fibroid PELVIS:UTERUS, ADNEXA: The uterus is markedly enlarged measuring 13.7 x 10.0 x 17.1 cm (AP x TV x CC). Multiple, predominantly submucosal enhancing masses of varying T2 signal are identified within the uterus. The largest measures approximately 8.5 x 11.8 x 9.6 cm (AP x TV x CC) within the uterine fundus. Some of the lesions demonstrate central cystic degeneration. These are consistent with multiple fibroids. The junctional zone is measured within normal limits. Multiple small nabothian cysts are identified. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple enhancing lesions identified throughout the uterus which are consistent with multiple fibroids.


Instruction: Generate impression based on findings.

Input: Clinical question: Malignant neoplasm of brain, unspecified site. Signs and symptoms: History of GBM status post TMZ/RT, surveillance scan. Signs and symptoms: Headache. Pre- and post enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrates a large necrotic rim-enhancing mass in the right posterior temporal-parietal region with evidence of interval increased size since prior study. On axial postenhanced series isMass measures maximum of 40 x 28 mm in transaxial compared to prior study measurement of 33 x 26. There is a thick focus of rim enhancement along the superior/anterior aspect of necrotic tumor measuring 13 mm in thickness and 21 mm along the necrotic cavity wall. There is also subtle interval overall increased thickness of rim enhancing tumor since prior exam. Findings are suggestive of interval progression of disease. There is extensive surrounding vasogenic edema interval increased extent since prior exam.Previously noted small thin rim enhancing lesion at the site of prior surgical resection in the right frontal lobe demonstrate decreased size and decreased surrounding vasogenic edema. No definitive evidence of tumor.Ventricular system remains within normal heads with maintained midline and without change.

Output: 1.Interval increased size of a necrotic rim-enhancing tumor in the right hemisphere. There is generalized as well as focal interval thickening of rim enhancement of tumor and surrounding edema consistent with progression of disease as detailed/measured above.2.Interval decreased size and reduced surrounding edema at the site of right anterior frontal lobe resection cavity since prior exam.


Instruction: Generate impression based on findings.

Input: 69-year-old female with nystagmus and ataxia. Evaluate for cerebellar degeneration or ischemia. MRI brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI C-spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Interspace observations:C2-3 and C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex and mild facet hypertrophy. Mild left neuroforaminal narrowing. No right neuroforaminal or spinal canal stenosis.C5-6: Small disc osteophyte complex and left greater than right facet hypertrophy which causes mild to moderate left and mild right neuroforaminal narrowing. There is no spinal canal stenosis.C6-7: Small disc osteophyte complex and mild facet hypertrophy without significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. Mild cervical degenerative changes most prominent at C4-5 and C5-6 levels where there is at most mild/moderate left neural foraminal narrowing. There is no spinal canal stenosis at any point in the cervical region.


Instruction: Generate impression based on findings.

Input: Evaluate anterior fontanelle lesion -- cystic lesion on CT. There is a non-enhancing T1 hypointense and T2 hyperintense nodule that measures up to 8 mm in the midline frontal region at the location of the anterior fontanelle, without intracranial extension. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There is a normal degree of myelination for age. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Findings compatible with a subcentimeter dermoid or epidermoid cyst associated with the anterior fontanelle.


Instruction: Generate impression based on findings.

Input: History of prostate cancer with known tumor in the right mid gland and apex (Gleason 8). Evaluate for additional extent of disease. PELVIS:PROSTATE:Prostate Size: 5.2 x 5.3 x 3.5 cmPeripheral Zone: Within the medial aspect of the right peripheral zone mid gland and apex there is confluent low T2 signal which has restricted diffusion and early arterial enhancement compatible with tumor. This measures 16 x 6 mm (series 901 image 11). There is a small adjacent focus of increased T1 signal presumably reflecting hemorrhage from prior biopsy. Abnormal signal extends minimally across midline into the left peripheral zone.Within the right base there is an additional area of more mild mildly decreased T2 signal measures 10 x 8 mm (series 901 image 18). This has questionable restricted diffusion and early arterial enhancement (series 1501 image 2329). It is unclear if this represents a benign nodule or possible additional tumor.Central Gland: Extensive nodular hypertrophy compatible with a pH.Seminal Vesicles: No evidence of tumor involvement.Extracapsular Extension: There is mild thickening of the posterior capsule adjacent to the right apical tumor concerning for capsular invasion (series 901 image 12). BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with tumor in the medial right peripheral zone mid gland and apex correlating with the patient's positive biopsy results.2.Additional focus of possible tumor in the right base as described.3.Questionable thickening/irregularity of the posterior capsule in the right mid gland/apex concerning for tumoral invasion.


Instruction: Generate impression based on findings.

Input: Dizziness. Rule out intracranial mass. There is a 5 mm wide contrast-enhancing dural based nodule along the lateral floor of the left anterior cranial fossa, which slightly indents the left lateral orbitofrontal gyrus without associated parenchymal signal abnormality. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a left occipital developmental venous anomaly. Otherwise, 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. There are bilateral lens implants. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. A 5 mm wide left inferior frontal convexity mass likely represents a meningioma. 2. Right occipital developmental venous anomaly. 3. No evidence evidence of intracranial hemorrhage or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Assess for lateral meniscal tear; assess ligament integrity History: Lateral knee pain on deep flexion, positive McMurray test MENISCI: There is a large fluid-filled complete longitudinal tear of the posterior horn of the medial meniscus extending into the body of the medial meniscus seen on 6 consecutive sagittal images. The anterior horn of the medial meniscus is intact. There is a thin band of linear intermediate signal intensity within the peripheral fibers of the posterior horn of the lateral meniscus extending to the femoral articular surface. Although the signal is continuous with the interface of the meniscofemoral ligament of Wrisberg and the posterior horn of the lateral meniscus, its lateral extension through the meniscus is suggestive of a true longitudinal tear (Wrisberg rip). Of note, the suspected tear is of intermediate signal intensity and may be healed. The anterior horn and body of the lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: We see no articular cartilage defects.LIGAMENTS: The proximal fibers of the ACL are indistinct, which may represent an old tear; however there are no bone contusions to indicate a recent tear. The PCL and LCL complex are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: 1. Large and likely unstable complete longitudinal tear of the medial meniscus.2. Poor definition of the proximal fibers of the ACL suggests prior injury/tear although we see no bone contusion on the current study to suggest recent injury.3. Findings suggestive of a partial thickness peripheral tear of the posterior horn of the lateral meniscus (Wrisberg rip). This tear is not fluid-filled and may be healed.


Instruction: Generate impression based on findings.

Input: Extradural and subdural abscess, unspecified [G06.2], Reason for Study: ^Reason: Evaluate interval change History: CNS abscess Previously seen right temporo-occipital intra axial hemorrhagic lesions (larger posterior one and relatively smaller anterior one) shows interval decrease in size and decreased extent of surrounding edema since prior scan.The lesion is now more confined with peripheral susceptibility rim indicating hemosiderin deposition.On enhancement, there is somewhat nodular and linear enhancement especially around the smaller and anterior one which the extent of enhancement appears to be much smaller than before.Both larger one and smaller one show restricted diffusion, thus indicating possibility of abscess.Previously seen multifocal nodular intra axial enhancing lesions are now not demonstrated except the one on the posterior aspect of the left superior temporal gyrus which again shows significant reduction in its size.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Mucosal thickening on all paranasal sinuses indicating possible pansinusitis.Bilateral mastoid air cells show fluid collections.

Output: 1. Interval decrease in size and the extent of enhancement (especially smaller anterior one) as well as the extent of surrounding edema of right temporo-occipital hemorrhagic lesions which likely represent abscess.2. Interval regression of multifocal intra axial enhancing lesions and decreased size of left superior temporal gyrus enhancing nodule since prior scan.3. No change of pansinusitis and bilateral mastoid fluid collection since prior scan.


Instruction: Generate impression based on findings.

Input: There is heterogeneously enhancing tissue within the sella measuring 25 x 11 x 9 mm with a convex upper border mildly encroaching upon the suprasellar cistern without significant mass-effect on the optic chiasm. Additionally, there is a 7 x 7 mm focus of nodular enhancement adjacent to the sella along the left dorsum sella/petroclival ligament. The cavernous sinuses enhance symmetrically without thickening.There is no suspicious enhancement or mass along the cranial nerves 7/8 complexes. The inner ear structures are within normal limits. There is no suspicious intracranial enhancement elsewhere. There is no acute infarct, mass effect or midline shift. There are mild periventricular and subcortical white matter T2 signal abnormalities likely representing chronic microvascular ischemic changes. The extracranial soft tissues and calvarium are within normal limits.

Output: 1.Mass like process in the sella with an additional small nodular enhancing lesion along the left dorsum sella/petroclival ligament. It is conceivable that these two lesions reflect distinct processes such as a macroadenoma/sequela of prior pituitary injury, and a separate small petroclival meningioma. Alternatively, a single unifying diagnosis of either a macroadenoma spreading along the dorsum sella/petroclival ligament, or an sellar meningioma extending along the left petroclival ligament would be possible. An atypical inflammatory or granulomatous etiology could also be considered. Regardless, these findings would not explain the patient's left unilateral peripheral vestibular weakness and asymmetric sensorineural hearing loss, and they may therefore be incidental.2.Unremarkable exam of the IACs.3.Mild chronic microvascular ischemic changes.


Instruction: Generate impression based on findings.

Input: 52-year-old female. Swelling. Wrist pain. LIGAMENTS: The scapholunate and lunotriquetral ligaments are grossly intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The TFCC is grossly intact.TENDONS: Trace fluid in the extensor carpi radialis brevis tendon sheath; the tendon itself is intact. The other tendons of the wrist are intact.BONES: T1 hypointense line through the distal radial metadiaphysis with surrounding edema type signal consistent with a nondisplaced fracture. No intra-articular extension is evident. Small cysts in the capitate and lunate are likely degenerative in etiology.ADDITIONAL

Output: Distal radius nondisplaced fracture, as above.


Instruction: Generate impression based on findings.

Input: 63 years Male (DOB:11/30/1952)Reason: lower back pain and RLE radiculopathy History: abovePROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE There is a transitional vertebra present. Five non-rib bearing lumbar vertebrae are presumed to be present which are appropriate in overall height. L5 is therefore partially sacralized. The left renal vein crosses at the L1 vertebral level.The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is moderate bilateral face hypertrophy and ligament flavum hypertrophy, loss of disk space height, a diffuse disk bulge present as well as disk desiccation. There is effacement of the fat at the lateral recess at this level. There is mild anterior subluxation of L4 on L5. There is effacement of fat at the lateral recesses and fat surround in the exiting nerve roots within the neural foramina resulting encroachment of the exiting nerve roots and nerve roots at the lateral recesses.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild bilateral face hypertrophy and ligament flavum hypertrophy, loss of disk space height, a mild diffuse disk bulge present as well as disk desiccation. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. There are subacute endplate reactive changes anteriorly at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, a mild diffuse disk bulge present as well as disk desiccation. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. There are subacute endplate reactive changes anteriorly at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height present as well as disk desiccation. There are Schmorl's nodes present at T12-L1

Output: 1.Please not that L5 is a transitional vertebra and partially sacralized.2.There are multilevel degenerative changes in the lumbar spine as detailed above which are worse at L4-5 where there is mild subluxation, mild spinal stenosis and nerve root encroachment of the exiting nerve roots and nerve roots at the lateral recesses.


Instruction: Generate impression based on findings.

Input: Bilateral severe to profound sensorineural hearing loss. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is an appropriate degree of myelination, with terminal zones of myelination that are most pronounced in the bilateral parietal periventricular regions. Indeed, the brain parenchyma, brainstem, cerebellum, and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No discernible inner ear anomalies of cochlear nerve deficiency.


Instruction: Generate impression based on findings.

Input: Female, 83 years old, with lateral left lower extremity numbness and tingling after spinal drain placement. Assess for spinal cord ischemia, abscess or hematoma. Thoracic:The thoracic kyphosis is exaggerated. Alignment is otherwise unremarkable. Degenerative endplate signal abnormality and enhancement is evident scattered at several levels, but no worrisome narrow replacement is detected.The spinal cord demonstrate normal signal intensity and morphology. No evidence of pathologic intraspinal enhancement is seen.Mild facet hypertrophy develops at lower thoracic levels. In addition, disk bulging is seen at T10-11 and T11-12. No significant spinal canal or neuroforaminal stenosis is suspected.Partially visualized is a large descending aortic aneurysm status post endovascular repair.Lumbar:A trace anterolisthesis of L4 relative to L5 is seen. Spinal alignment is otherwise unremarkable. Vertebral body height morphology are normal allowing for endplate degenerative abnormalities most significantly affecting L5-S1. No evidence of concerning marrow replacement or enhancement is seen.The visualized conus and cauda equina are within normal limits. No intrathecal enhancement is observed. The reported spinal catheter is not presently visualized and has likely been removed. Mild thickening and subtle enhancement of the ligamentum flavum on the right at L2-3 is nonspecific but could reflect the prior site of catheter placement. It may also be related to facet degeneration as the lumbar facets become progressively hypertrophic at lower levels and do show evidence of mild edema and inflammatory enhancement.T12-L1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant spinal canal or foraminal stenosis.L1-2: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild narrowing of the subarticular aspects of the spinal canal. No significant generalized canal stenosis or cauda equina impingement. Mild bilateral foraminal narrowing. L2-3: Moderate to severe facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild narrowing of the subarticular aspects of the spinal canal. Mild generalized spinal canal stenosis but without cauda equina impingement. Moderate right and mild left foraminal narrowing. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal narrowing which particularly affects the right lateral recess. A perineural root sleeve cyst is seen in the right foramen. Mild bilateral foraminal narrowing.L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Minimal bulging disk. No significant generalized spinal canal stenosis. Mild right foraminal narrowing.L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk asymmetric towards the left foraminal zone. No significant generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. Aneurysmal dilatation of the abdominal aorta is also partially visualized on this exam.

Output: 1.No specific findings identified in the thoracic spine to account for the patient's symptoms.2.Mild disk degeneration is seen through the lumbar region with more pronounced facet arthropathy, particularly at lower lumbar levels. These findings result in at most moderate spinal canal stenosis and moderate foraminal narrowing as discussed by level above.3.Thickening and mild enhancement of the ligamentum flavum on the right at L2-3 may reflect granulation from prior lumbar catheter placement, if indeed it had been placed at this level. It may also be related to facet arthropathy. In any event, no evidence of epidural or paraspinal abscess is seen.4.Thoracic and abdominal aortic aneurysms are partially visualized on this examination.


Instruction: Generate impression based on findings.

Input: Oligodendroglioma status post radiation and surgery, now on chemotherapy. There are post-treatment findings in the left frontal lobe with unchanged patchy enhancement, susceptibility effect, and confluent high T2 signal surrounding the resection cavity. There is no discernible elevated perfusion. There is no evidence of acute infarct. There is no midline shift or herniation. The ventricles are unchanged in size and configuration. The major cerebral flow voids are intact. The extracranial structures are unchanged.

Output: Stable post-treatment findings in the left frontal lobe without evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: There are a few punctate foci of T2 hyperintensity in bifrontal subcortical white matter locations without restricted diffusion, mass effect, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Minimal mucosal thickening can be found within the maxillary sinuses. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: There are a few punctate foci of T2 hyperintensity in bifrontal subcortical white matter locations without restricted diffusion, mass effect, susceptibility abnormality, or enhancement. These are nonspecific in appearance, and the differential diagnosis would most likely include minimal small vessel disease, migraine sequelae, or residua from previous head trauma. Given lesional appearance and locations, demyelination is felt to be unlikely.