Instruction: Generate impression based on findings.

Input: Reason: eval knee History: pain MENISCI: There is intrasubstance degeneration of the medial meniscus with mild surface irregularity of the posterior horn suggesting surface fraying, but we see no fluid-filled tear. There is intrasubstance degeneration of the lateral meniscus particularly involving the body and posterior horn. Within the posterior horn, this signal extends to the tibial articular surface likely representing degenerative undersurface tearing. Furthermore, there is extensive signal abnormality within the root of the lateral meniscus likely representing extensive degenerative tearing. There is increased signal within the body of the meniscus extending to the free edge likely representing additional degenerative tearing. The anterior horn appears relatively spared.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the patella with large areas essentially devoid of cartilage, particularly along the lateral facet. There is also full-thickness loss of the articular cartilage of the femoral trochlea, particularly along the lateral facet, with subchondral cyst formation and edema within the underlying subchondral marrow. There is near full-thickness cartilage loss along the lateral tibial plateau posteriorly, with underlying subchondral cyst formation as well as moderate degeneration of articular cartilage of the lateral femoral condyle. There is relatively mild degeneration of the articular cartilage of the medial compartment.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteoarthritis most severely affecting the patellofemoral joint.2. Degenerative tearing of the lateral meniscus with relatively mild degeneration/fraying of the medial meniscus.3. Joint effusion, Baker's cyst, and other findings as described above.


Instruction: Generate impression based on findings.

Input: Male 74 years old with pain of the right ankle and foot, evaluate Right ankle:Mild soft tissue swelling along the medial aspect of the ankle. Mild spurring along the medial malleolus that may reflect old trauma, but no acute fracture evident. Small ossicle dorsal to the neck of the talus may also reflect old trauma, however, no acute fracture evident.Right foot:Severe osteoarthritis affects the first metatarsophalangeal joint with mild to moderate osteoarthritis affecting the interphalangeal joints. Mild osteoarthritis affects the midfoot. Note is made of an accessory navicular bone situated approximately 5 mm from the navicular tuberosity. If there is clinical concern for posterior tibial tendon dysfunction MRI can be obtained. Vascular calcifications also noted.

Output: Osteoarthritis of the right foot and other findings as described above.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of bone and bone marrow(198.5)Other malignant neoplasm without specification of site Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the T9 vertebral lesion. Post biopsy images show no significant change.

Output: T9 vertebral bone biopsy under CT guidance. A total of eight samples were delivered to pathology for analysis in two formalin jars.


Instruction: Generate impression based on findings.

Input: Ms. Gabel is a 52 year old female with a personal history of benign right breast biopsy in 2011. She is a BRCA1 mutation carrier. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: No MRI evidence for malignancy. Breast imaging is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms are submitted, then comparisons will be made for future exams. Otherwise, patient is due for an annual screening mammogram. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 63 years, Female, altered mental status. History of metastatic breast cancer.. Evaluate for metastatic brain lesion. Brain: There is redemonstration of multiple heterogeneously enhancing lesions involving the calvarium similar to prior although markedly improved when compared to remote MRI brain study from 1/12/2015. The relatively largest of these lesions is seen involving the occipital bone with mild residual epidural extension and mass effect on the torcula herophili. There is no evidence of abnormal brain parenchymal enhancement or leptomeningeal enhancement.There is no diffusion abnormality. There is patchy periventricular white matter T2 hyperintensity stable to minimally increased since prior and likely related to posttreatment changes. The ventricles and sulci are unchanged in size and configuration. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.  There is trace fluid in the mastoid air cells and minimal mucosal thickening in the paranasal sinuses similar to prior. There is unchanged deformity of the right lamina papyracea with protrusion of the orbital fat compatible with chronic trauma. Cervical spine: Again seen are numerous areas of abnormal marrow signal and enhancement throughout the visualized cervical and thoracic vertebrae, including posterior elements. There has been decrease in enhancement associated with some lesions for example at the C2 level and the in the upper thoracic spine although there is increase in enhancement at the C4 and C5 levels. Confluent low T1 signal in the lower cervical and upper thoracic region related to diffuse tumor infiltration previously demonstrates an interval more heterogeneous appearance, likely reflecting treated tumor. A relatively large lesion involving the posterior elements of T1 has decreased in size. There is no abnormal leptomeningeal or epidural epidural tumor in the cervical spine. No cord signal abnormality. The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. Minimal degenerative changes are seen at C3-C4, C5-C6, and C6-C7 levels without significant spinal canal or neural foraminal stenosis.

Output: 1. No evidence of intraparenchymal or leptomeningeal metastases in the brain. Again seen are multiple calvarial metastases similar to most recent prior, but much improved when compared to remote MRI study from 1/12/2015. There is minimal residual epidural extension in the occipital region surrounding the torcula Herophili without evidence of progression since prior from 2/27/2016.2. Stable to minimal increase in confluent FLAIR hyperintensity in the periventricular and subcortical white matter likely reflecting combination of posttreatment changes and chronic small vessel ischemic disease.3. Diffuse osseous metastatic disease in the cervical spine is again seen with overall improvement since 1/27/2015. There are areas of increased osseous enhancement as described above which are nonspecific in the setting of treated disease, and can be assessed with follow-up bone scans. There is however no evidence of epidural or leptomeningeal tumor or cord signal.


Instruction: Generate impression based on findings.

Input: Small cell lung cancer. There are multiple solidly and peripherally enhancing supratentorial and infratentorial lesions. For example, the largest in the right cerebral hemisphere is located in the inferior parietal lobe and measures up to 38 mm, the largest in the left cerebral hemisphere is located in the left precentral gyrus region and measures up to 26 mm, and the largest infratentorial lesion is located in the left cerebellar hemisphere and measures up to 26 mm. A few of the lesions display mild surrounding vasogenic edema, but there is no midline shift or herniation. There is a chronic infarct in the right basal ganglia and corona radiata. There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse cerebral volume loss. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are secretions and mucosal thickening throughout the left maxillary sinus. There is a mildly expansile enhancing lesion in the left frontal bone that measures up to 26 mm and displays slight epidural and subgaleal extension.

Output: 1. Numerous supratentorial and infratentorial metastases without midline shift or herniation.2. Left frontal bone metastasis.3. Chronic lacunar infarct in the right basal ganglia and corona radiata.


Instruction: Generate impression based on findings.

Input: There is no restricted diffusion to suggest acute infarct. There are several scattered T2/FLAIR hyperintense foci in the subcortical and periventricular white matter, which are nonspecific but compatible with mild chronic small vessel ischemic changes. There are numerous punctate foci of susceptibility effect in the bilateral coronary radiata and centrum semiovale.The ventricular size is normal with no midline shift. The basal cisterns are patent. There are preserved vascular flow voids.There are small mucous retention cysts in the right maxillary sinus and mucosal thickening in the left maxillary sinus. Evidence of chronic left medial orbital fracture.

Output: 1. No evidence of acute infarction.2. Mild chronic small vessel ischemic disease.3. Numerous foci of susceptibility throughout the brain parenchyma consistent with chronic microhemorrhages. These while nonspecific, given the history of renal disease may be related to thrombotic microangiopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Radiculopathy, lumbar region [M54.16], Reason for Study: For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1.  There is focal left foraminal type disc protrusion at the level of L34 (series 801, image 16/25).Central disc protrusion at the level of L45 which abuts thecal sac as well as broad based disc protrusion toward left side neural foramen at the level of L5S1 are seen.Mild disc dessication at the level of L45 and L5S1 are seen.There is no significant spinal canal stenosis.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.

Output: Multifocal disc protrusions L34 left side neuroforaminal, L45 central and L5S1 left neuroforaminal type as described above.


Instruction: Generate impression based on findings.

Input: Lumbago with sciatica, unspecified side [M54.40], Reason for Study: ^Reason: evaluate for cord irritation History: new buttock and lower back pain, known L1 mets For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are extensive metastatic lesions involving thoracic, lumbar and sacral vertebral bodies as well as bilateral iliac bones and some ribs indicating interval progression since prior scan. Those lesions show enhancement on Gad.In addition, there are multiple various sized new enhancing soft tissue lesions involving paraspinal muscle and subcutaneous tissues which indicate soft tissue metastatic nodules.In particular, the left pedicle of L1 shows high signal intensity on STIR images indicating possible pedicular fracture.The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. There is minimal retrolisthesis of L4 on L5 and L5 on S1.Multilevel disc bulges with bilateral fact joint hypertrophy are seen without causing significant spinal canal stenosis, no change since prior scan.

Output: 1. Interval progression of metastatic lesions since prior scan. At this point, those lesions involve lower thoracic and lumbar spine, sacrum and bilateral iliac bones.2. Multiple soft tissue enhancing lesions likely represent metastatic nodules.3. Possible left pedicular fracture of the L1 vertebral body.4. Spinal cord signal intensity appears to be normal.


Instruction: Generate impression based on findings.

Input: Clinical question: Slurred speech, RUV/RLE weakness, on therapeutic AC, concerning for possible acute stroke. Signs and symptoms : As above. Nonenhanced brain MRI:Diffusion weighted images demonstrate no evidence of an acute ischemic stroke.Examination demonstrates extensive periventricular and to a lesser degree subcortical foci of flair/T2 hyperintensity in bilateral cerebral hemispheres and suggestive of moderate chronic hemorrhagic small vessel ischemic strokes. Very minimal similar findings are also identified in bilateral basal ganglia and moderate degree and bilateral paramedian pons. Unremarkable cerebral cortex and cortical sulci. Mild dilatation of lateral ventricles likely ex vacuo. The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses and images through the orbits.

Output: 1.No acute intracranial process.2.Findings of mild to moderate chronic non-hemorrhagic small vessel ischemic strokes as detailed.3.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: 67-year-old male. Cirrhosis. HCC screening. Exam is degraded by dielectric effect due to ascites; for future exams, consider doing paracentesis prior to exam for improved diagnostic quality.ABDOMEN:LIVER, BILIARY TRACT: The liver contour is nodular consistent with cirrhotic morphology.Features of portal hypertension: Recanalization of the umbilical vein with paraumbilical varices, esophageal and perigastric varices. Large amount of abdominal ascites.Portal vein: Patent proximal to the TIPS. Patency of the TIPS cannot be assessed due to shunt artifact. Hepatic veins: Middle and left are patent. Right hepatic vein is obscured by the shunt.Hepatic artery: Patent. No suspicious hepatic mass. Subcentimeter T2 hypointense lesion in the right hepatic lobe is consistent with a calcified granuloma, as seen on prior CT.SPLEEN: Splenomegaly measuring 15 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhosis with no suspicious hepatic mass. Findings consistent with portal hypertension.


Instruction: Generate impression based on findings.

Input: Myelopathy, spastic paraparesis Vertebral body heights in the thoracic spine are normal. Alignment is normal. Bone marrow signal is within normal limits. Limited evaluation of the cervical spine on the sagittal counting sequence demonstrates a low T1 and T2 signal structure dorsal to the C2-C3 disc space which may represent focus of ligamentous calcification or extruded disc material. There appears to be at least mild spinal canal stenosis at this level.At multiple levels in the thoracic spine, there is low T1 and low T2 signal involving the dorsal spinal canal likely representing ligamentum flavum calcifications. These lesions are seen at T2-T3, T3-T4, T4-T5, and T6-T7 levels in the upper thoracic spine without significant spinal canal stenosis. There is however a larger focus which extends from the upper T9 to the upper T10 level which results in moderate to severe spinal canal stenosis and deforms the thoracic cord. There is questionable T2 cord signal abnormality at this level (sagittal T2 and STIR image 10). More inferiorly, mild spinal canal narrowing is seen at T10-T11, moderate spinal canal narrowing at the T11-T12 level, and moderate to severe canal narrowing at the T12-L1 level at the level of the conus related to ligamentous flavum calcifications. Mild foraminal narrowing is seen associated with the aforementioned calcifications. No high-grade foraminal stenosis. No abnormal enhancement. Paraspinous soft tissues are unremarkable.

Output: 1. Significant multilevel thoracic spinal canal narrowing related to what likely represents ligamentum flavum calcifications. CT may be helpful to better visualize the extent of calcifications. There is resulting moderate to severe spinal canal stenosis and mild cord deformity extending from the upper T9 to the upper T10 levels. There is subtle cord signal abnormality suspected at this level. 2. There is also moderate to severe spinal canal narrowing at the T12-L1 level and to a slightly lesser degree at the T11-T12 levels. Lesser degrees of spinal canal narrowing related to the ligamentum flavum calcifications as detailed above. 3. No intrinsic cord lesions or masses.


Instruction: Generate impression based on findings.

Input: 13 day old male born at 36 weeks with perinatal depression and whole body cooling protocol. Exam is limited secondary to motion artifact. No restricted diffusion. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Myelination is appropriate for age.Midline structures are within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Motion limited exam but grossly unremarkable.


Instruction: Generate impression based on findings.

Input: 40 year-old male status post flap for rhabdomyosarcoma on back with syncope x 2. History of neurofibromatosis. Please evaluate if neurofibroma intracranially are present to explain the syncope. Syncope is not believed to be cardiac in etiology. HEAD CT:Multiple superficial neurofibromas are identified within the scalp. (image 25/32). No evidence of abnormal intracranial enhancement.The cerebral hemispheres, cerebellum and brainstem are normal in structure and attenuation. No intracranial hemorrhage, infarctions, edema or areas of mass effect are identified. No abnormal extra-axial fluid collections are identified. The ventricles are normal in volume and are midline.The visualized paranasal sinuses and mastoid air cells are normally aerated.There is a bony dehiscence between the right jugular fossa and the middle ear with an enlarged right jugular fossa. This can result in pulsatile tinnitus. Differential considerations for this finding include a normal large dominant right jugular vein secondary to a large right lateral and sigmoid sinuses, a high riding jugular fossa most likely due to the increased size of the sigmoid sinus, and a paraganglioma resulting from the pars nervosa in this location. An MRI is recommended to exclude tumor given the patient history of neurofibromatosis.

Output: 1. The right jugular fossa appears enlarged as described. An MRI of the internal auditory canal with contrast is recommended to exclude the presence of a nerve sheath tumor given the history of neurofibromatosis. Findings were discussed with Dr. Hofer following interpretation.2. No evidence of abnormal intracranial enhancing masses. 3. Superficial neurofibromas in the scalp.


Instruction: Generate impression based on findings.

Input: brain tumor, MRI was performed as preoperative planning. There are appendiceal markers attached on the scalp.Again demonstrated homogeneously enhancing multilobulated extra-axial mass on the left CP angle, the size was measured around 19.8 mm x 36.1 mm, no interval change since prior scan.There is no other abnormal enhancing lesion.There is a mass effect towards left side of lower pons and left middle cerebellar peduncle which are displaced toward right side and posteriorly, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Preoperative planning MRI scan weight fiducial markers attached.Left CP angle extra-axial mass with mass effect was again demonstrated, no interval change of the size and MR characteristics since prior scan.


Instruction: Generate impression based on findings.

Input: Female, 32 years old. Status post right shoulder arthroscopy. ROTATOR CUFF: The rotator cuff muscles and tendons are intact, without evidence of tear. Injected contrast material remains in the joint space.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The anterior labrum has an irregular contour, which may represent degeneration. There is a discrete tear of the anterior-inferior labrum, without displacement of the torn fragment. This abnormality is well demonstrated on the ABER view.BICEPS TENDON: The tendon of the long head of the biceps has a normal appearance. ADDITIONAL

Output: Discrete tear of the anterior-inferior labrum superimposed on labral degeneration, without displacement of the torn fragment.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with low back and hip pain. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow replacement is seen. Mild superior endplate edema is seen at L4 which is new from prior.Significant degeneration of the L4-5 facet joints is seen with edema in the joint spaces and in the surrounding soft tissues. There may be mild edema within the right aspect of the partially visualized sacrum. The SI joints also appear to be sclerotic. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Mild facet arthropathy. No significant spinal canal or neuroforaminal stenosis. No interval changes. L3-4: Moderate facet arthropathy. Minimal disc bulging. Mild generalized spinal canal narrowing. No significant foraminal stenosis. No interval changes. L4-5: Advanced facet arthropathy and ligamentum flavum thickening. Mild disc bulging. Mild spinal canal narrowing. Mild bilateral foraminal narrowing. No interval changes. L5-S1: Advanced facet arthropathy. No significant spinal canal or foraminal narrowing. No interval changes.

Output: Multilevel facet arthropathy is seen, most severely affecting the L4-5 and L5-S1 levels. In particular, there is edema associated with the L4-5 facets which could indicate an inflammatory component.Relatively mild disc degeneration is redemonstrated without areas of high-grade spinal canal stenosis and without significant interval change.Sclerosis of the SI joints and possible right sacral edema are partially evaluated on this examination.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. There is moderate disc narrowing at C4-C5 and C5-C6. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal signal.At C4-C5, there is a large left paramedian central disc extrusion which migrates cranially by 3 mm and caudally by 9 mm. The extruded disc material may be somewhat sequestered given its slightly differential signal. There is an underlying mild posterior osteophyte disk complex and bilateral uncovertebral hypertrophy resulting in overall severe central spinal canal stenosis at this level as well as moderate right and mild-moderate left foraminal narrowing. There is significant deformity of the cord with indentation focally in the left paracentral location.At C5-C6, there is a mild posterior osteophyte disk complex with slight left paracentral prominence. There is mild deformity of the ventral cord with overall moderate central spinal canal stenosis. Right greater than left uncovertebral hypertrophy contributes to overall mild-moderate right foraminal narrowing.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine. There is trace left and moderate right mastoid air cell fluid signal. The right lobe of the thyroid gland is incidentally larger than the left with greater heterogeneity and there is a focal T2 hyperintensity and susceptibility suggested posteriorly, likely representing cystic change and calcification.

Output: 1.Significant cervical spondylotic changes especially at C4-C5 there is a large dental disc extrusion with possible sequestered disc material extending predominantly caudally resulting in severe central spinal canal stenosis and deformity of the cord without definite cord signal abnormality. Please correlate with physical exam and clinical symptoms.2.Asymmetric enlargement of the right lobe of thyroid gland with heterogeneous signal and focal areas of probable calcification and cystic change in the posterior aspect. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: Low back pain for months with left sided pain and weakness. There is slight disc dessication at L4-5 and a small disc protrusion eccentric to the left with impingent upon the adjacent left lateral recess nerve roots and mild neural foraminal stenosis. The other lumbar spine levels are unremarkable and there is no significant spinal canal stenosis. The vertebral body heights are preserved. The vertebral column alignment is within normal limits. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Slight disc dessication at L4-5 and a small disc protrusion eccentric to the left with impingent upon the adjacent left lateral recess nerve roots and mild neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 75 year old male with a history of scimitar syndrome, repaired in the 1970s, and persistent atrial fibrillation which is not responsive to medication. Referred for cardiovascular MRI to evaluate pulmonary veins and for atrial fibrosis. Situs and Cardiac PositionThere is cardiac situs solitus, with dextro-position, and anterior orientation of the apex. Abdominal situs is normal.Left VentricleThe left ventricle is normal in size and low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 158 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 104 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 171 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The descending aorta is tortuous.Pulmonary VeinsThe left upper and left lower pulmonary veins drain normally to the left atrium. The right pulmonary veins are tortuous and drain through a single ostium to the left atrium. There is no obvious evidence of late gadolinium enhancement in the left atrial wall. Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium. IVC is dilated.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a small right pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is cardiac situs solitus, with dextro-position, and anterior orientation of the apex. Abdominal situs is normal2. Right pulmonary veins are tortuous and drain through a single orifice to the left atrium. Left pulmonary veins drain normally to the left atrium.3. There is no obvious evidence of late gadolinium enhancement of the left atrial wall.4. Left ventricle is normal in size with low-normal systolic function (LVEF 54%)5. Right ventricle is normal in size with mildly reduced systolic function (RVEF 48%)6. There is a small right pleural effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Several sequences are motion degraded. Given this caveat:T2 hyperintense foci are present throughout the white matter, basal ganglia, and pons, confluent in some locations. This is not associated with restricted diffusion, susceptibility abnormality, or enhancement. There is diffuse volume loss, slightly more affecting the bilateral mesial temporal lobes. 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. Note is made of dolichoectasia and elongation of the posterior circulation. Mucosal thickening is present within a single right ethmoid air cell. Otherwise the paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Several sequences are motion degraded.2.Advanced chronic small vessel ischemic disease.3.There is diffuse volume loss, slightly more affecting the bilateral mesial temporal lobes which is a pattern that can be seen in the clinical setting of Alzheimer dementia.


Instruction: Generate impression based on findings.

Input: Diagnosis: Low back pain WeaknessClinical question: new L4 weakness and foot drop with back pain, please evaluate for CES and central stenosisSigns and Symptoms: back pain 4 nonrib-bearing lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. For the purpose of this exam it appears that L5 is incorporated into the sacrum and is sacralized and will therefore be named S1. The conus medullaris on sagittal imaging is grossly intact.There is a formed disc present at S1-S2. At L4-S1 there is a diffuse disc bulge present at this level associated with disc desiccation and some mild to moderate facet and ligamentum flavum hypertrophy. There is mild encroachment of the nerve roots at the lateral recesses bilaterally at this level but worse on the left when compared to the right side.At L3-4 there is a diffuse disc bulge present associated mild ligamentum flavum hypertrophy and partial effacement of the fat at the lateral recesses bilaterally. There is partial effacement of spinal fluid surrounding the nerve roots within the thecal sac and mild encroachment of the nerve roots at the left lateral recess 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.

Output: 1.Please note that there are 4 nonrib-bearing lumbar-type vertebrae present. Apparently L5 has been incorporated into the sacrum and can be considered S12.There are degenerative changes present in the lower lumbar spine with a mild degree of spinal stenosis at L3-4 with mild encroachment of the nerve roots at the lateral recess on the left side at L3-4 and L4-5.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: eval for L-spine pathologySigns and Symptoms: LBP/ RLE pain 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 a levocurvature to the lumbar spine. There is multilevel disc desiccation presentAt L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level associated with disc desiccation and a minor disc bulge.At L4-5 there is a diffuse disc bulge present associated with moderate to severe bilateral facet hypertrophy. The facet hypertrophy is worse on the left compared to the right side. There is fluid within the facet joints which can be visualized on this exam. The fat located the lateral recesses is effaced bilaterally at this level. There is a partial effacement of the fat surrounding the exiting nerve roots within the neural foramen at this level. Overall there is a moderate degree of spinal stenosis present at this level.At L3-4 there is a diffuse disc bulge present associated with disc desiccation and loss of disc space height as well as a mild to moderate degree of bilateral facet and ligamentum flavum hypertrophy. The facet hypertrophy is worse on the right than the left side. There is mild (2-3 mm) left lateral translation of L3 on L4. There is effacement of the fat at the lateral recesses bilaterally (right worse than left) and effacement of spinal fluid within the thecal sac at this level. There is effacement of the fat surrounding the right exiting nerve root at this level. Overall there is a moderate to severe degree of spinal stenosis at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild facet and ligamentum flavum hypertrophy present at this level associated with a minor disc bulge.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level.There is a large cyst present along the right kidney measuring 4 cm x 3.5 cm in coronal dimensions. This cortically based and at the midportion of the right kidney.

Output: 1.There are multilevel degenerative changes present in the lower lumbar spine with moderate-to-severe spinal stenosis at L3-4 and moderate spinal stenosis at L4-5 as well as encroachment of exiting nerve roots within the neural foramina bilaterally at L4-5 and on the right side at L3-4.2.There is a rotatory levocurvature to the lumbar spine centered at approximately L3-4 there is a mild degree of left lateral translation of L3 on L4.3.There is a large cyst present along the right kidney measuring 4 cm in size


Instruction: Generate impression based on findings.

Input: 60 year old male with unstable angina, worsening ejection fraction and anterior wall motion abnormality, assess for viability with dobutamineMEDICATIONS: metoprolol, aspirin, plavix, midodrine, ranolazine Viability/ Myocardial ScarThere is a non-transmural myocardial infarction involving the mid anterior wall. There is a second non-transmural myocardial infarction involving the basal inferoseptum and basal to mid inferior wall. All of these segments have an intermediate probability of viability. Following infusion of 20mcg/kg/min of dobutamine there is augmentation of the overall ejection fraction. However, the basal to mid inferior wall and basal inferoseptal wall do not augment significant, suggesting these segments are less likely to be viable. The mid anterior wall, on the other hand, has improved contractility suggesting this segment is viable. The remainder of the myocardium is free of myocardial infarction and viable. Left VentricleThe left ventricle is normal in size with systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVEDV is 170 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 74 ml (normal range 47+/-19), the LV mass index is 65 g/m2, and the LV mass is 148 g. At rest, there is hypokinesis of the myocardium in the basal and mid inferior walls and the basal inferoseptum. Additionally there is hypokinesis of the mid anterior wall.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 146 ml (normal range 142+/-31), the RV end systolic volume index is 27 ml/m2 (normal range 31+/-9), and the RVESV is 61 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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. There is a non-transmural myocardial infarction involving the mid anterior wall which is likely to be viable. There is a second non-transmural myocardial infarction involving the basal inferoseptum and basal to mid inferior wall; these segments are not likely to be viable. The remainder of the myocardium is free of myocardial infarction and viable. 2. Normal LV size and systolic function (LVEF 57%) with resting regional wall motion abnormalities in the (1) basal to mid inferior wall and basal inferoseptum and in the (2) mid anterior wall.3. Normal RV size and systolic function (RVEF 59%).4. Mild left atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Altered mental status and cognitive slowing, history of induction chemotherapy for relapsed therapy related AML also with history of ependymoma resection. There is redemonstration of postsurgical changes in the posterior fossa related to suboccipital and right occipital craniotomies for resection of ependymoma with associated ex vacuo dilatation of the fourth ventricle appearing similar to prior. There is no evidence of mass or acute infarct. There are scattered punctate foci of susceptibility artifact which appear grossly similar to the prior exams and which are nonspecific but may reflect treatment effect.The brain parenchyma signal is otherwise within normal limits. There is no pathological intracranial enhancement. Prominence of the cortical sulci and ventricles is compatible with mild parenchymal volume loss greater than expected for patient's stated age, appearing similar to prior. There is no midline shift or herniation. The basal cisterns remain patent. The major cerebral flow voids are intact. There is again mild patchy opacification of the right mastoid air cells. The orbits and scalp soft tissues are grossly unremarkable. Patchy decreased T1 signal within the cervical spine bone marrow is nonspecific but may be related to patient's AML.

Output: 1.No acute abnormality or specific evidence of brain tumor recurrence.2.Bone marrow signal abnormality which may be related to patient's AML.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, with metastatic thyroid cancer. Follow up exam. Thoracic:An enhancing lesion in the left anterior aspect of the T5 vertebral body measures is unchanged from the prior exam measuring approximately 13 x 9 mm on axial images. The lesion is associated with mild superior endplate concavity, also unchanged.Lesions within the left transverse process and pars interarticularis of T5 and T6 also show no significant interval change.Instrumented fusion of T10 through T12 is again seen. The T11 vertebral body has been at least partly resected and replaced by an orthopedic spacer device. The residual vertebral body remains compressed demonstrating diffusely abnormal signal characteristics compatible with metastatic involvement. Findings are stable.No new lesions are seen. No epidural disease extension is identified. The spinal canal is not significantly narrowed. Mild kyphotic angulation and scoliosis centered at T11 are stable.T1 shortening in the thoracic and lumbar spine is likely related to prior radiation. Increased signal within the T9 and L1 vertebral bodies on fat-suppressed T1 post contrast images is at least in part artifactual and due to metal related failure of fat suppression.Lumbar:Lesions within the right aspect of the L2 vertebral body, the left aspect of the L3 vertebral body, and the left aspect of the L5 vertebral body are unchanged. For reference, the L5 lesion measures 18 x 16 mm. A small nonspecific lesion along the inferior endplate of L4 is also unchanged.No new lesions are detected. No epidural disease extension is identified. The spinal canal and neural foramina remain patent. The conus and cauda equina are normal.

Output: Stable exam with no evidence of new or progressive metastatic disease in the thoracic or lumbar spine.


Instruction: Generate impression based on findings.

Input: Bilateral knee pain. MENISCI: The medial and lateral menisci are intact. ARTICULAR CARTILAGE AND BONE: There is near full thickness to full-thickness loss of articular cartilage of the inferior aspect of the femoral trochlea with underlying focal subchondral edema. Additionally there is thinning and degeneration of the articular cartilage of the posterior lateral femoral condyle. Increased T2 signal within the posterior lateral femoral condyle likely represents edema and a degenerative cyst. There is thinning of the medial facet articular cartilage of the patella. LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Chondromalacia as described above.2. Loose body within the suprapatellar pouch.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with low back pain. Evaluate for stenosis. Spinal alignment is anatomic. Vertebral body heights are preserved. Endplate degenerative signal alteration is seen, but otherwise, no pathologic marrow replacement is seen. There is mild edema of the bilateral L4-5 facet complexes.The visualized distal spinal cord and conus are within normal limits. The cauda equina becomes crowded at lower lumbar levels due to both degenerative changes and prominence of the epidural fat.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Facet arthropathy. Ligamentum flavum thickening. Loss of disc height and mild disc bulging with a new right foraminal protrusion. In combination with prominence of the epidural fat, there is a moderate generalized spinal canal stenosis. The right neural foramen is mildly narrowed. No interval changes except as discussed. L3-4: Advanced facet arthropathy. Ligamentum flavum thickening. Loss of disc height with mild disc bulging and a small left paracentral extrusion. Mild spinal canal stenosis. The neural foramina are patent. No interval changes. L4-5: Advanced facet arthropathy. Ligamentum flavum thickening. Loss of disc height and disc bulging. Prominence of the epidural fat. Moderate spinal canal stenosis with crowding of the cauda equina. Moderate bilateral foraminal narrowing. No interval changes. L5-S1: Facet arthropathy. Loss disc height with disc bulging. Prominence of the epidural fat. No significant spinal canal stenosis. Mild to moderate foraminal narrowing.

Output: Multilevel disc and posterior element degeneration is again seen. Along with prominence of the epidural fat, these findings result in narrowing of the thecal sac most notably at L4-5 where there may be some crowding of the cauda equina. A small right foraminal disc protrusion at L2-3 seems to be new. Otherwise, no significant interval changes are noted.


Instruction: Generate impression based on findings.

Input: 56-year-old male with a history of rotator cuff repair on 6/2015. Presents with pain. Suspect supraspinatus/infraspinatus tears. ROTATOR CUFF: Note is made of postoperative changes of prior rotator cuff repair. There are foci of metallic susceptibility artifact and signal void along the superior lateral aspect of the shoulder which are likely postoperative in etiology. There is a near complete to complete tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity with approximately 4 cm of retraction of the proximal tendon. There is extension of this tear posteriorly to involve the anterior fibers of the infraspinatus, although some of these fibers can be traced to the level of their insertion on the humerus. The subscapularis and teres minor muscles and tendons appear intact. There is fatty infiltration and apparent atrophy of the supraspinatus, although some of this may be related to the aforementioned retraction. There is fatty infiltration of the infraspinatus.SUPRASPINATUS OUTLET: There is a moderate amount of fluid within the subacromial subdeltoid bursa which communicates with the glenohumeral joint. Mild to moderate degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Mild degenerative changes affect the glenohumeral joint. There is heterogeneity of the anterior superior labrum which may reflect degeneration/degenerative tearing within the limitations of this non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. Circumferential fluid within the tendon sheath of the long head of the biceps may represent fluid extension from the joint versus a mild tenosynovitis. ADDITIONAL

Output: 1. Postoperative changes of prior rotator cuff repair. Near complete to complete rotator cuff tear with retraction as described above.2. Small joint effusion with foci of low signal intensity suggestive of a synovitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 9 years old, with urinary incontinence, assess for tethered cord. Five lumbar vertebral bodies are present with mild transitional morphology of L5. Vertebral body height and morphology are normal. No segmentation anomalies are detected. Spinal alignment is anatomic. Marrow signal characteristics are within normal limits. No evidence of marrow replacement or marrow edema is seen.The visualized spinal cord and conus are unremarkable. The conus tip terminates at the L1 level which is normal. The nerve roots of cauda equina disperse evenly through the thecal sac. The filum terminale is not thickened and appears dark on T2 weighted sequences. On some slices (see image 22 and 26, series 601), there is minimal T1 hyperintensity adjacent to the filum which could reflect the sequelae of prior instrumentation, or less likely fatty infiltration. On prone images, the conus and cauda equina demonstrate clear evidence of anterior displacement.The intervertebral disks demonstrate normal morphology and signal characteristics. No evidence of spinal canal or neuroforaminal stenosis is seen.

Output: No definite evidence is seen to suggest persistent tethered cord. In particular, the conus and cauda equina are clearly anteriorly displaced on prone imaging. The filum terminale is not thickened and appears T2 hypointense throughout. On some slices, there is the appearance of mild T1 hyperintensity adjacent to the filum which could represent sequelae of prior instrumentation or, less likely, residual fatty infiltration.


Instruction: Generate impression based on findings.

Input: An 18 year old female with WPW and episode of syncope referred to cardiac MRI to rule out anomalous coronary artery origins. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 78 ml/m2 (normal range: 65+/-11), the LVEDV is 121 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 41 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 62 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 94 ml/m2 (normal range 69+/-14), the RVEDV is 146 ml (normal range 110+/-24), the RV end systolic volume index is 42 ml/m2 (normal range 22+/-8), and the RVESV is 66 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild-moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Normal coronary artery origins. No anomalous coronary arteries.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%3. Normal origins of coronary arteries.


Instruction: Generate impression based on findings.

Input: Images are motion degraded, and repeated sequences were attempted. Given this caveat:Note is made of transitional anatomy with lumbarization of S1, including an S1/2 disc.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cord and conus are normal in signal. The cauda equina is unremarkable. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no osseous dysplasias or stenoses. There is no MRI evident ligamentous injury.

Output: 1.Images are motion degraded, and repeated sequences were attempted.2.No fractures or subluxations.3.Normal cord, conus, cauda equina appearance.4.There are no osseous dysplasias or stenoses.5.There is no MRI evident ligamentous injury.


Instruction: Generate impression based on findings.

Input: Female 42 years old Reason: fibroid uterus, considering UFE History: heavy menses, flooding PELVIS:UTERUS, ADNEXA: The uterus is enlarged. It measures 11 x 11 cm. There is a large submucosal probable leiomyoma measuring 9.2 x 8.8 cm which enhances. There are some nonenhancing components along the superior aspect of the leiomyoma.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.Large submucosal 9 cm leiomyoma.


Instruction: Generate impression based on findings.

Input: MRI head: There is no definite evidence of acute ischemia. There are punctate foci of diffusion hyperintensity involving the right thalamus as well as the left occipital lobe with adjacent foci of chronic microhemorrhage. These foci of chronic microhemorrhages were present on prior study from 4/14/2014. Multiple small foci of T2 hyperintensity involving the bilateral thalami are unchanged. Confluent and patchy T2/FLAIR hyperintensities in the periventricular and subcortical white matter as well as in the pons are compatible with chronic small vessel ischemic disease and are again seen. There is no evidence of intracranial mass effect, midline shift, or herniation. Ventricular size is normal. There is moderate supratentorial and infratentorial volume loss similar to prior.Again seen are multiple punctate foci of susceptibility related to chronic microhemorrhages including the bilateral basal ganglia and thalami as well as in the pons similar to prior. Relatively larger focus of chronic hemorrhage along the left lateral ventricle is also unchanged. Additional scattered foci of susceptibility in the cerebral hemispheres are also not significantly changed. There is a mucous retention cyst in the right maxillary sinus.MRA brain: There are mild atherosclerotic changes in the intracranial circulation without significant stenosis. The intracranial internal carotid arteries are patent. The anterior, the middle, and posterior cerebral arteries are patent. The basilar and vertebral arteries are patent. There is no flow-limiting stenosis or aneurysm.MRA neck: The common carotid arteries, the cervical internal carotid arteries, and the vertebral arteries are patent with no evidence of aneurysm or flow-limiting stenosis. There is common origin of the brachiocephalic artery and the left common carotid artery, which is a normal variant.

Output: 1. No definite evidence of acute ischemia. There are punctate foci of diffusion hyperintensity in the right thalamus as well as in the left occipital lobe immediately adjacent to chronic microhemorrhages. These are suspected to be artifactual given absence of new T2 hyperintensity within this region, although acute ischemia, particularly in the right thalamus is not entirely excluded.2. Chronic small vessel ischemic disease with multiple lacunar infarcts and multiple microhemorrhages, which are predominantly in a distribution favoring chronic hypertension, appear similar to prior.3. The MRA of the brain and neck demonstrates no evidence of flow-limiting stenosis.


Instruction: Generate impression based on findings.

Input: Reason: worsening left shoulder pain; OA and calcific changes on xray History: worsening left shoulder pain; OA and calcific changes on xray Patient motion artifact limits multiple sequences.ROTATOR CUFF: There is interstitial tearing of the supraspinatus approximately 2 cm proximal to the level of its insertion on the greater tuberosity. There is no significant retraction. There is also low signal intensity along the articular surface fibers of the supraspinatus at this level corresponding to the findings of calcific tendinopathy on recent radiographs. There is mild fatty infiltration of the supraspinatus at the level of the myotendinous junction. There is a tiny full-thickness tearing of the anterior fibers of the infraspinatus. There is no significant retraction. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a moderate amount of fluid within the subacromial subdeltoid bursa which may reflect a bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is full-thickness articular cartilage degeneration along the glenoid with underlying subchondral cyst formation. There is heterogeneity and increased signal abnormality within the posterior, superior and anterior labrum which likely reflects a combination of degeneration and degenerative tearing. The anterior superior labrum is separated from the underlying glenoid indicating a SLAP tear. There is a small amount of fluid within the glenohumeral joint which extends into the subscapular recess.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is circumferential fluid within the tendon sheath which likely represents fluid extension from the glenohumeral joint.ADDITIONAL

Output: 1. Findings consistent with calcific tendinopathy of the rotator cuff. 2. Interstitial tearing of the supraspinatus and tiny full-thickness tear of the infraspinatus without evidence of retraction. 3. Osteoarthritis of the shoulder with a loose body within the axillary recess. 4. Findings suggestive of subacromial subdeltoid bursitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 2-year-old male with hepatoblastoma status post cycles of chemotherapy. ABDOMEN:LIVER, BILIARY TRACT: Again seen is a large solid heterogeneously enhancing liver mass with lobulated contours occupying a majority of the left hepatic lobe measuring 4.6 x 6.9 x 5.1 cm, AP x transverse x craniocaudal (series 501, image 10; series 401, image 12). This is decreased in size compared to the prior study where this measured 6.8 x 8.3 x 10.3, TR x AP x CC. No intra-or extrahepatic biliary ductal dilatation.The right portal vein appears completely spared. The tumor is adjacent to the left portal and just distal to the division from the main portal vein. The left portal vein may not be distal to the tumor. The mass is supplied by several branches of the left hepatic artery. The hepatic veins appear spared.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys enhance symmetrically. Kidneys excrete contrast symmetrically.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large heterogeneously enhancing liver mass occupying a large portion of the left hepatic lobe known to be a hepatoblastoma is significantly decreased in size compared to the prior exam.2.No evidence of metastatic disease


Instruction: Generate impression based on findings.

Input: 49-year-old male with recurrent left paresthesias. Rule out thrombosis which was possibly seen on MRI/MRA.IMAGE ACQUISITIONS: Brain CTA with contrast, neck CTA with contrast. 120 cc nonionic Omnipaque 350 at 4.5 cc/sec. Left carotid artery: Mild noncalcified stenosis at the origin of the internal carotid artery. There is calcifications of the cavernous portion of the internal carotid artery.Right carotid artery: Calcifications of the cavernous portion of the internal carotid artery. No significant stenosis or septations elsewhere.Left are two artery:Left vertebral artery: Severe narrowing of the left vertebral artery from its origin to the basilar artery with only faint wisps of contrast seen. This is either due to marked hypoplasia or intrinsic disease.Right vertebral artery: No significant stenosis or calcification.BRAIN

Output: 1. Left vertebral artery is severely narrowed, either due to hypoplasia or intrinsic disease.2. P1 segments of the PCAs are not well visualized, either due to absence or hypoplasia3. Mild stenosis of the origin of the left internal carotid artery4. Noncontrast brain CT shows small vessel ischemic disease of indeterminate age and multiple bilateral lacunar infarcts


Instruction: Generate impression based on findings.

Input: Clinical question: metastatic Prostate cancer, Biopsy needed form a metastatic site for a study from L4 (approved by Dr Christoforidis)Signs and Symptoms: metastatic site biopsy Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: L4 vertebral bone biopsy under CT guidance. A total of six samples were delivered to for analysis.


Instruction: Generate impression based on findings.

Input: Male, 44 years old, with radiculopathy. Please note that only a partial examination consisting of sagittal T2, T1 and STIR sequences was obtained due to patient discomfort requiring early termination.The typical cervical lordosis is reversed. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is suspected. The visualized spinal cord demonstrates normal signal intensity throughout. No epidural abnormality is suspected.There appears to be a combination of multilevel disc osteophyte disease and thickening of the posterior longitudinal ligament from C2 through C6. This contributes to a generalized spinal canal narrowing through this region. There is little visible CSF space anterior or posterior to the cord in this region. However, the cord does not appear to be significantly deformed.

Output: 1.Limited examination for reasons discussed above. Only sagittal imaging could be obtained.2.Generalized narrowing of the spinal canal is seen between C2 and C6 apparently due to a combination of disc osteophyte disease and thickening of the posterior longitudinal ligament.


Instruction: Generate impression based on findings.

Input: Right thigh mass Large heterogeneous mass is again seen in the proximal medial right thigh measuring approximately 8 cm TV x 7 cm AP x 8 cm CC. The prior CT measurements likely included portions of muscle fibers due to lack of contrast resolution of non-contrast CT. This appears similar in size to the prior CT when retrospectively re-measured. The mass contains portions of bright T2 signal compatible with cystic changes and portions of high T1 signal with fluid-fluid levels compatible with blood. A definite soft tissue component cannot be excluded. Similar 2-3 cm smaller cystic structures lateral to the proximal femoral diaphysis with high T1 and STIR signal, compatible with blood, likely represent a related process.This mass is located between the pectineus and obturator externus muscles with splaying of the musculature. An intramuscular component cannot be excluded. The vasculature of the right thigh remains separate from this lesion. This lesion abuts the right pubis and ischium without osseous changes evident. This lesion does not extend to the underlying femur. There is mild soft tissue edema at the medial aspect of the proximal right thigh. The visualized intra-abdominal and soft tissue structures are otherwise unremarkable.

Output: Large proximal right thigh mass unchanged in size since 2/12/14. Although IV contrast was not administered, the features of this mass are suggestive of hematoma. Close serial follow up to assess for evolution and resolution is recommended. Ultrasound evaluation for internal vascularity may be helpful to exclude a neoplasm such as synovial sarcoma as a definite soft tissue component to this mass cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: Male, 79 years old, with altered mental status. A 5 mm focus of restricted diffusion is evident along the right single gyrus. No definite additional restricted diffusion is seen in the brain.Fairly extensive and nearly confluent periventricular T2 hyperintensity is seen. Scattered additional lesions are also evident more peripherally in the cerebral hemispheres and within the pons.No evidence of significant parenchymal edema or mass effect is detected. No abnormal extra-axial collections are seen. No acute intracranial hemorrhage is observed, though please note that susceptibility weighted images are degraded of the posterior fossa.MRA images of the head are degraded by motion artifact. Within this limitation, no significant stenosis or occlusion of the large proximal vessels is suspected. Some degree of narrowing may be present along the visualized left ACA branches, but this can also be technical.MRA images of the neck are similarly degraded, but again, no large or significant vascular stenosis is suspected. The right vertebral artery is dominant.

Output: 1.Small focus of acute ischemia along the right cingulate gyrus.2.Extensive chronic microvascular ischemic disease.3.No large or significant stenosis of the proximal circle of Willis vessels is seen. Examination is not reliable for the assessment of more distal or smaller vessels.4.No large or significant stenosis of the neck vessels is suspected.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for shoulder involvement of infection/abscess History: abscess, previous septic joint The previously described heterogeneous abnormal signal collection in the left deltoid musculature, posterior and lateral to the humeral head/neck as well as proximal diaphysis, compatible with abscess, has decreased in size when compared to the previous study, currently measuring 4 x 3 cm, previously 4.5 x 3.2 cm. Additionally, focal fluid collections within this lesion have also decreased in size, the largest currently measures 13 x 6 mm. Within this collection are increased T1 signal intensity regions, which suggests subacute blood products or granulation tissue as well as amorphous decreased T1 signal intensity, which may represent a combination of scar tissue and chronic blood products. There is abnormal enhancement which extends from this collection within the deltoid muscle to the subcutaneous surface, which suggests a draining superficial wound/ulceration. Edema and inflammation also extends inferiorly along the deltoid musculature to its insertion on the humerus. There are multiple enlarged supraclavicular and axillary lymph nodes, as seen previously.ROTATOR CUFF: There is undersurface tearing with delamination/retraction of the fibers of the supraspinatus and infraspinatus, similar to prior study. There is evidence of tendinosis of the subscapularis tendon. The rotator cuff musculature is normal. SUPRASPINATUS OUTLET: There is a small amount of fluid in the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND LABRUM: Glenohumeral joint alignment is anatomic. There is an effusion within the glenohumeral joint which demonstrates synovial enhancement compatible with synovitis, however, the amount of fluid has decreased when compared to the prior study. There are erosions in the humeral head which appear slightly more pronounced than on the prior study. There is mild edema in the base of the coracoid and humeral head which is nonspecific and may be reactive due to adjacent synovitis. There is also mild signal abnormality in the humeral diaphysis, which is nonspecific but may represent serous atrophy in the setting of HIV.BICEPS TENDON: The long head of the biceps is intact, however there is evidence of synovitis within the biceps tendon sheath.

Output: 1.Overall decrease in size of the fluid collections in the deltoid musculature as above.2.Decreased glenohumeral joint effusion with synovitis.3.Erosions in the humeral head appear more slightly prominent than on the previous study.4.Supraclavicular and axillary lymphadenopathy and other findings as above.


Instruction: Generate impression based on findings.

Input: 18-year-old female soccer player with right groin pain. Assess for femoral neck stress fracture versus iliopsoas strain. ACETABULAR LABRUM: The acetabular labrum appears intact within the limitations of a non arthrogram study.ARTICULAR CARTILAGE AND BONE: There is no evidence of stress reaction/fracture affecting the right femur. The right hip joint alignment is anatomic. There is a small focus of increased bone marrow signal abnormality on fluid sensitive sequences within the sacrum about the left inferior sacroiliac joint suggesting a peculiar cyst or perhaps stress reaction. No discrete fracture line is identified. There is no signal abnormality within the adjacent iliac bone to suggest a sacroiliitis. SOFT TISSUES: The imaged musculature in normal in appearance. ADDITIONAL

Output: 1. No evidence of iliopsoas strain or right femoral stress fracture as clinically questioned. Otherwise no findings to account for the patient's right groin pain. 2. Small nonspecific focus of signal abnormality within the sacrum about the inferior aspect of the left sacroiliac joint may represent an atypical subchondral cyst or stress reaction.


Instruction: Generate impression based on findings.

Input: 66-year-old with history of T3 N1 rectal cancer status post chemo/RT and surgical resection on 9/3/2008. Baseline prior to receiving chemotherapy. CHEST:LUNGS AND PLEURA: 1 to 2-mm pleural-based right upper lobe nodules have not increased in size as compared to the prior examination. These are nonspecific.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Calcified granuloma within the spleen are unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ostomy has been created in the interval. There is a nonobstructive peristomal hernia. No other abnormalities identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: 1.7-cm near density exophytic lesion off of the uterus is nonspecific. This could represent a leiomyoma. This could not be identified on the previous exam due to lack of intravenous contrast. This could be further evaluated with MRI or gynecologic ultrasound. The uterus is fluid-filled. BLADDER: No significant abnormality noted.LYMPH NODES: No definite lymphadenopathy is identified. The previously described lymph nodes are not identified on the current study. Loops of bowel are in the current location of the previously described lymph nodes.BOWEL, MESENTERY: The rectal wall is thickened, consistent with either the patient's primary malignancy or post treatment changes.BONES, SOFT TISSUES: Degenerative changes affect the lower lumbar spine. There is no evidence of osseous metastatic disease.OTHER: No significant abnormality noted.

Output: 1. Rectal thickening is reidentified, consistent with either patient's primary mass or post treatment changes.2. Nonspecific pulmonary micronodules are unchanged from the prior examination.3. Nonspecific 1.7 cm hypodense exophytic lesion off of the uterus. This is nonspecific by CT and could be further evaluated with gynecologic ultrasound or MR as clinically indicated.


Instruction: Generate impression based on findings.

Input: Chronic pain at lateral hip. Evaluate for gluteus medius tear. ACETABULAR LABRUM: Evaluation of the labrum is limited by lack of intra-articular contrast, but we see no fluid-filled labral tear. ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. There is perhaps a minimal CAM deformity of the anterior aspect of the right femoral head/neck junction but the alpha angle is within normal limits (<55 degrees). The articular cartilage of the right hip appears intact.SOFT TISSUES: The musculature appears normal. The gluteus tendons are intact. Specifically, there is no evidence of a gluteus medius tendon tear. Minimal peritrochanteric edema seen bilaterally is not necessarily of any clinical significance.ADDITIONAL

Output: Minimal peritrochanteric edema bilaterally is not necessarily of any clinical significance. We see no gluteus medius tear or other specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 31-year-old man with history of NASH cirrhosis, evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour with parenchymal loss of signal on the opposed phase images. No focal hepatic lesion is identified. The gallbladder is normal.SPLEEN: The spleen is enlarged at 172-mm.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: There is no significant lymphadenopathy.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Fatty, cirrhotic liver without suspicious focal lesion.


Instruction: Generate impression based on findings.

Input: Patellar dislocations x3 MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is a shallow trochlear groove consistent with trochlea dysplasia. In addition there is bone marrow edema in the medial aspect of the patella and in the lateral femoral epiphysis consistent with the patella dislocations.  LIGAMENTS: No significant abnormality noted.

Output: Findings consistent with recurrent patellar dislocations


Instruction: Generate impression based on findings.

Input: History of elevated PSA and negative prior transrectal ultrasound-guided biopsy. PELVIS:PROSTATE:Prostate Size: 4.4 x 6.0 x 6.1 cm.Peripheral Zone: In the right base there is a subtle punctate 4mm T2-weighted hypointensity with restricted diffusion (series 604/404 and series 1101/12)Central Gland: Changes of BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right base signal abnormality may reflect a site of prostate carcinoma. The findings were discussed with the patient and he agreed to have a same-day MRI guided biopsy of this abnormality for tissue diagnosis.


Instruction: Generate impression based on findings.

Input: 67-year-old male with HCV, cirrhosis, HCC, status post TACE/RFA. Evaluate liver lesions, masses, HCC screening, coronary calcification, liver vessel patency. ABDOMEN:LIVER, BILIARY TRACT: The segment 8 ablation cavity has slightly decreased in size measuring 2.3 x 1.2 cm (series 9 image 159) (prior 2.8 x 1.5 cm). No evidence for residual or recurrent disease. No new suspicious lesions with washout are identified.Decreased parenchymal signal intensity on out of phase images compatible with hepatic steatosis. The hepatic vasculature is patent. No intra or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Persistent heterogenous bone marrow signal intensity with stable areas of increased T2 signal, nonspecific and unchanged.OTHER: No significant abnormality noted.

Output: 1.The segment 8 ablation cavity has slightly decreased in size. No evidence for residual or recurrent disease.2.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Seizure. Follow-up of brain lesion. New daily persistent headache. The poorly defined increased T2 signal lesion involving the mesial right temporal lobe (both the amygdala and the hippocampus) has improved since the previous examination. Both the bulkiness of this tissue and the degree of T2 signal abnormality have diminished, particularly within the amygdala, with some reexpansion of the right temporal horn. Minimal enhancement within this lesion seen on the prior examination has resolved.However, there are 2 new small foci of contrast enhancement: one situated in the anteromedial aspect of the right temporal lobe (see image 123 series 1101) and one in the right subinsular region (see image 175 series 1101). Both lesions correlate with focal T2 hyperintensity which also was not present previously. Neither lesion is associated with diffusion restriction. On single voxel MR spectroscopy (TE 35 ms), there is a decreased NAA peak within the right mesial temporal lobe lesion, with no significant change in the other major metabolites when comparison is made to the contralateral normal side. Single voxel spectroscopy was also performed of the right subinsular lesion which shows minimal if any elevation of the choline peak relative to the contralateral side and an otherwise normal pattern.There is new diffuse increased sulcal contrast enhancement, most pronounced in the right cerebral sulci, best visualized on the postcontrast FLAIR sequences (see series 1601). These findings probably reflect a combination of hyperemia and increased sulcal vascular permeability.The remainder of the brain is free of significant abnormalities. The dural venous sinuses and major intracranial arterial flow voids are preserved. There is a small retention cyst in the right maxillary sinus. There is mild right ethmoid mucosal thickening.

Output: 1.Compared to the previous examination of November 2015, the abnormal signal and mild expansion involving the mesial right temporal lobe have improved, and a small focus of enhancement seen previously within this lesion has resolved. MR spectroscopy of this lesion shows no evidence of a high-grade proliferative process, but rather, is suggestive of parenchymal injury and some neuronal loss.2.However, two new foci of T2-hyperintensity and contrast enhancement have developed in the anterior medial right temporal lobe and right subinsular region. MR spectroscopy of the subinsular lesion shows minimal if any choline elevation with an otherwise normal pattern which is nonspecific.3.New diffuse, predominantly right supratentorial sulcal contrast enhancement is probably reflective of hyperemia and increased regional vascular permeability suggesting the presence of an inflammatory process. 4.While a neoplastic process cannot be entirely excluded, the combination of improved mesial temporal signal abnormality and edema with development of new foci of contrast enhancement as well as signs of diffuse supratentorial hyperemia are more in favor of an inflammatory process. An encephalitic process should be considered including autoimmune or limbic encephalitis. In particular, anti-NMDA receptor encephalitis has been shown to present similarly.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for ischemia. Signs and symptoms: Right face/arm/leg numbness/pain. Nonenhanced brain MRI:No evidence of acute ischemic stroke is present.Examination demonstrates diffuse patchy foci of flair hyperintensity involving the subcortical and periventricular white matter, minimally off bilateral basal ganglial, right thalamus and extensively of the pons which considering patient's stated age of 74 findings are highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes. There is no detectable signal abnormality cerebral cortex or the cerebellum -- vermis. The signal void of major intracranial arterial branches are identified.The intracranial venous sinuses demonstrate normal signal intensity.Images through the orbits are unremarkable however in the distal prior cataract surgery is noted.All paranasal sinuses demonstrate normal pneumatization signal pattern.

Output: 1.No acute ischemic stroke.2.Chronic nonhemorrhagic small vessel ischemic strokes as detailed above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for intracranial lesion; patient had APL, is receiving induction chemotherapy and has new onset of visual and head discomfort and 10-6-15. Signs and symptoms: Intermittent visual field blurriness of few seconds duration. Pre and post enhanced brain MRI:There is normal anatomical morphology of brain parenchyma and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricles and brain myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement. Images through the orbits and including axial fat sat post enhanced series are unremarkable.Calvarium and skull base are unremarkable.Visualized paranasal sinuses demonstrate small air- fluid level in the sphenoid sinus and unremarkable otherwise. Bilateral mastoid air cells and middle ear cavities are well pneumatized.

Output: Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are:Ultrasound of the right breast dated 9/2/2016, ultrasound-guided core biopsy of the right breast dated 9/7/2016, performed at AMita health care institute. Bilateral breast MRI dated 9/19/2016 performed at Loyola hospital.For comparison,none are available. 1: Ultrasound of the right breast dated 9/2/2016:As per the report diagnostic mammogram was performed of both breast which are not submitted. Patient has history of a palpable mass in the right breast. Ultrasound demonstrates an irregular hypoechoic mass that measures 2.4 x 2.9 x 3.6 cm with apical blood flow corresponding to the palpable abnormality at 11:00 position 11 cm from the nipple. Located at 12:00 position 3 cm from the nipple is another suspicious hypoechoic mass with irregular margins, taller than wide that measures 1.7 x 1.5 x 1.3 cm with apical blood flow. This mass also demonstrates some anterior intraductal extension with hyperechoic areas possibly calcifications within it, labeled at right breast 12:00 2 cm from the nipple with apical blood flow.2. Ultrasound of the right breast dated 9/7/2016:Patient underwent ultrasound-guided core biopsy of the index mass, palpable in the right breast 11:00 position 11 cm from the nipple. 5 cores were obtained. Targeting appears adequate, clip coil was placed as per the imaging. Second site at 12:00 position 2 cm from the nipple was biopsied, 5 cores were obtained, ribbon clip was placed. Postprocedure mammogram was obtained as per the biopsy report however not submitted for review. Specimen radiograph was obtained from the cores of the biopsy sites (which site is not specified) and calcifications were noted at the biopsy site.Final pathology indicates DCIS grade 3 solid type at both sites.3: Bilateral breast MRI dated 9/19/2016:MRI images were uploaded on to Dyna CAD for postprocessing and were interpreted on Dyna CAD.Heterogenous dense breast parenchyma noted bilaterally. Moderate parenchymal enhancement noted bilaterally.Right breast 11:00 position palpable mass corresponds to biopsy-proven DCIS. A clip artifact is noted within the mass. The mass is irregular in shape with heterogenous enhancement and irregular margins, measuring 33 x 29 x 41 mm (AP X ML X CC). Second biopsy-proven area of DCIS is located anteriorly, approximately 19 mm anterior and medial to the previously described index mass. It presents as an irregular heterogeneously enhancing mass with a clip artifact within it that measures 22 x 24 x 31 mm (AP X ML X CC) located at 12:00 position anterior depth.Multiple additional masses are identified in the right breast that are located medial, posterior and anterior to the index mass. The posterior-most mass is located 2.5 cm posterior to the index cancer and approximately measures 9 x 8 x 13 mm (AP X ML X CC), located at 12:00 position posterior depth. There is non mass enhancement adjacent to the masses seen extending anterior to the anteriormost biopsy-proven area of DCIS reaching up to the nipple.Total extent approximately measures 11.6 x 7.2 x 8.4 cm (AP X ML X CC).No abnormality noted within the left breast. No suspicious bilateral axillary lymph nodes noted.

Output: 1. Multicentric right breast cancer, with maximum extent measuring up to 11.6 cm on MRI. 2 sites biopsied at outside hospital with results consistent with DCIS. The palpable mass in the right breast 11:00 position is highly worrisome for invasive cancer and multiple additional masses also appear very some for invasive cancer.2. No abnormality noted within the left breast or bilateral axillary lymph nodes.3. Diagnostic mammogram or postprocedure mammograms have not been submitted.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Headache, migraine No evidence of acute ischemic or hemorrhagic lesion.Multifocal bihemispheric high signal intensities especially subcortical white matter on FLAIR imaging were seen.These lesions are nonspecific. Differential diagnosis includes vasculitis, demyelinating and dysmyelinating disease. Clinical correlation is recommended.There is a large susceptibility artifacts on the right high parietal lobe.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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal bihemispheric subcortical high signal intensity lesions on FLAIR as described above.These are non specific lesions, with wide differential diagnosis including vasculitis, demyelinating disease and dysmyelinating disease, small vessel ischemic disease is less likely, clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: There are patchy foci of diffusion restriction, T1 hyperintensity, and T2 hypointensity within the bilateral cerebral white matter in a deep watershed distribution. There is minimal T1 hyperintensity along the occipital convexities compatible with subacute subdural blood products. The myelination pattern is appropriate for age. The ventricles and basal cisterns are normal in size and configuration. The midline structures and craniocervical junction are within normal limits. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull is unremarkable. There is 4 mm thick caput succedaneum overlying the vertex.

Output: 1.Mild bilateral deep watershed infarcts with superimposed mild subacute petechial hemorrhage.2.Minimal subacute subdural hematoma along the occipital convexities, likely birth related.3.4 mm thick caput succedaneum overlying the vertex may correspond to the previous abnormality seen on ultrasound, perhaps previously more focal.


Instruction: Generate impression based on findings.

Input: Male 24 years old Reason: Assess for perianal fistula and or abscess History: 24 yo with complicated SLE, admitted on 4/9/2015 with septic shock. symptoms included abd pain, n/v, diarrhea. ct imaging w/o contrast on admission with c/f possible fistula PELVIS:PROSTATE/SEMINAL VESICLES: Prostate is atrophic. Testicles are atrophic.BLADDER: The bladder is thickened and partially emptied by the indwelling Foley catheter.LYMPH NODES: There are multiple inguinal lymph nodes which are enlarged and are possibly reactive.BOWEL, MESENTERY: Mild wall thickening of the rectosigmoid. There is a midline tract extending from the anorectal junction to the gluteal crease from the 6 o'clock position.BONES, SOFT TISSUES: There is a large left gluteal defect extending to the left interpubic ramus and left posterior acetabulum, and left proximal femur. There is sclerosis of the underlying bone. There is a large fluid-filled tract and soft tissue defect. The underlying bone is considered infected.There is also destruction of the lower sacrococcygeal segments with abnormal enhancement of the soft tissues.Additional tracks also noted to the right gluteus and partially imaged is a tract to the right greater trochanter.There is a small right hip effusion.Extensive body wall anasarca.There is extensive edema of the body wall and pelvic musculatures.OTHER: Moderate amount of pelvic ascites.

Output: 1.Findings of a perianal extending to the midline gluteal crease.2.Extensive soft tissue defects in the gluteus bilaterally, left worse than right with sclerotic changes of the underlying bone.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, with history of left T2 N2 nasopharyngeal carcinoma status post treatment, follow-up examination. The nasopharynx is partially imaged on the axial sequences and completely imaged on the coronal sequences. There is no discrete mass evident to suggest recurrent tumor. No evidence of perineural tumor spread. There is no suspicious osseous lesion. There is T1 shortening involving the bone marrow likely reflecting prior radiation.Bilateral orbits demonstrate no mass or abnormal enhancement. Globes, optic nerves, and extraocular muscles are unremarkable.There is mild mucosal thickening involving the bilateral maxillary sinuses and also mild opacification of the bilateral anterior and posterior ethmoid air cells.

Output: No evidence of recurrent nasopharyngeal tumor on the current MRI orbit study. Imaging of the neck with CT is pending at the time of this report.


Instruction: Generate impression based on findings.

Input: 55-year-old man with history of meningioma status post radiation therapy; surveillance. Patient has history of HIV infection. Again seen is a homogenously enhancing extra-axial lesion with dural tail along the left planum sphenoidale measuring approximately 13 x 8 mm on sagittal postcontrast images, unchanged as compared to prior exam of 2/24/2016. There continues to be mild local mass effect on the adjacent left gyrus rectus. There is no evidence of intracranial hemorrhage or acute infarct. Scattered patchy areas of T2/FLAIR hyperintensity in the periventricular white matter are nonspecific but may represent chronic small vessel ischemic disease or changes related to HIV infection, appearing similar to prior exam. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Stable exam, with no change in size of left planum sphenoidale meningioma as compared to exam from 2/24/2016.2.Stable foci of periventricular T2/FLAIR hyperintensities which are nonspecific but may represent changes related to HIV infection or chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Knee instability, pain, and edema. MENISCI: Globular signal is present in the posterior horn of the medial meniscus, likely degenerative, without discrete tear. The lateral meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: There is moderate soft tissue edema at the anterior aspect of the knee along the extensor mechanism. Thickening and increased signal within the anterior fibers of the distal quadriceps tendon likely represents tendinosis or partial tearing, though this extends beyond the field of view of this study. The undersurface fibers are intact. ADDITIONAL

Output: Findings suggestive of tendinosis or partial tearing of the anterior fibers of the distal quadriceps tendon.


Instruction: Generate impression based on findings.

Input: 38 years, Male, multiple sclerosis, follow-up for progression. Paresthesias. Again seen are multiple scattered punctate and linear foci of T2/FLAIR hyperintensity within the periventricular and juxtacortical white matter, some of which are oriented perpendicular to the long axis of the lateral ventricles. These are consistent with demyelinating lesions. Some of the lesions appear more conspicuous on prior study performed at 3 Tesla. No new lesions are seen. No definite posterior fossa lesions are identified. There is mild burden of T1 hypointense lesions. Brain parenchymal volume appears preserved.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Incidental note is again made of a partially empty sella. There is mild to moderate mucosal thickening in the maxillary sinuses as well as mild ethmoid opacification.

Output: No new lesions to suggest progression of demyelinating disease.


Instruction: Generate impression based on findings.

Input: Reason: R sacral mass--abscess vs leukemic infiltrate History: low back pain, CML in blast crisis, mass on CT Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the sacral lesion.

Output: Sacral bone biopsy of a right sided sacral lesion under CT guidance. A total of 9 samples were delivered for analysis as detailed above.


Instruction: Generate impression based on findings.

Input: 77 year old female status post fall. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse areas of periventricular white matter hypodensity consistent with microangiopathic changes. If there is clinical concern for stroke an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Diffuse microangiopathic changes. If there is clinical concern for stroke an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Male, 17 years old. Reason: evaluate OCD lesion History: same MENISCI: The menisci are unremarkable.ARTICULAR CARTILAGE AND BONE: There is a focal osteochondral defect in the lateral aspect of the medial femoral condyle. There is a small amount of fluid at the junction of the osteochondral defect in the underlying condyle (series 5, image 14), raising the possibility of instability. There is mild edema diffusely throughout the medial femoral condyle.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Osteochondral lesion at the lateral aspect of the medial femoral condyle, with a small amount of fluid between the lesion in the underlying condyle, raising the possibility of instability.


Instruction: Generate impression based on findings.

Input: Possible diabetes insipidus, profound hypoglycemia, and excessives urine output. Brain: There appears to be trace extra-axial hemorrhage along the right parieto-occipital convexities along the venous sinuses is likely artifactual. High FLAIR signal throughout the cerebral sulci are likely attributable to supplemental oxygen. Otherwise, there is no evidence of intracranial mass, or acute infarct. The brain parenchyma appears unremarkable. There is a normal degree of myelination. 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. High FLAIR signal throughout the cerebral sulci are likely attributable to supplemental oxygen. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Pituitary: The pituitary gland is normal in size and signal characteristics. The pituitary infundibulum is intact and situated in the midline. There is no ectopic posterior pituitary. The cavernous sinuses and optic apparatus are intact.

Output: 1. No convincing stigmata of hypoglycemic encephalopathy.2. Unremarkable pituitary gland.


Instruction: Generate impression based on findings.

Input: NF1 and frequent headaches and plexiform of left eyelid and orbit. Orbit: There is an infiltrative and enhancing left preseptal and postseptal mass, which does not appear to have significantly changed. There is mild mass effect upon the other left intraorbital structures. The left optic nerve is intact. The right orbits is unremarkable.Brain: There are new T2 hyperintense lesions in the anterior and posterior portions the corpus callosum, eccentric to the left, as well as a new T2 hyperintense lesion in the right cerebellar hemisphere white matter. Otherwise, many of the supratentorial and infratentorial T2 hyperintense lesions are unchanged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. New bright spots related to neurofibromatosis type 1 in the anterior and posterior portions the corpus callosum, eccentric to the left, as well as a new bright spot in the right cerebellar hemisphere white matter. Otherwise, many of the supratentorial and infratentorial T2 hyperintense lesions are unchanged. 2. The left preseptal and postseptal plexiform neurofibroma has not significantly changed.