Instruction: Generate impression based on findings.

Input: There are postoperative findings related to total thyroidectomy. There is no evidence of measurable locoregional tumor, or cervical lymphadenopathy. The salivary glands are unchanged. There is degenerative cervical spondylosis, which is most pronounced at C7-T1, where there is indentation upon the spinal cord. The imaged intracranial contents are unremarkable without mass effect, midline shift, or abnormal enhancement. The orbits and paranasal sinuses are unremarkable.

Output: Postoperative findings related to total thyroidectomy with no evidence of locoregional tumor recurrence or cervical lymphadenopathy. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with history of spinal stenosis and now worsening pain and one month of urinary incontinence. Concern for cord compression. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. The marrow signal characteristics are mildly heterogeneous with a well-circumscribed fatty signal lesion in the L4 vertebral body compatible with a hemangioma. This appearance has not changed from prior.The visualized spinal cord and conus are within normal limits. Details regarding the cauda equina are discussed by level below.Loss of disc T2 signal is evident from L3-4 through L5-S1. Additional level specific findings are as follows:L1-2: Facet hypertrophy and ligamentum flavum thickening. Moderately sized central disc extrusion extending slightly above and below the level of the adjacent endplates without significant interval change in size. This lesion effaces the ventral thecal sac causing a mild to moderate spinal canal stenosis and displacement of the adjacent cauda equina, again without significant interval change. No significant foraminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a small superimposed right paramedian protrusion. Mild generalized spinal canal stenosis without cauda equina impingement. No significant foraminal narrowing. No significant interval changes. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a small annular fissure centrally. Severe generalized spinal canal stenosis with crowding of the cauda equina, perhaps very slightly progressed from prior. Mild bilateral foraminal narrowing. No other significant interval changes.L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild to moderate generalized spinal canal narrowing without significant change. Mild right and moderate left foraminal narrowing without significant interval change. L5-S1: Moderate facet hypertrophy and ligamentum flavum thickening. Left paracentral disc protrusion, slightly larger than prior. Mild effacement of the left ventral thecal sac, again slightly progressed. Moderate left and mild right foraminal narrowing, unchanged.

Output: 1. Stable moderately sized disc extrusion at L1-2 resulting in a stable mild to moderate generalized spinal canal stenosis and displacement of the adjacent cauda equina.2. Possible slight interval progression of severe spinal canal stenosis at L3-4 which is due largely to posterior element hypertrophy.3. Mild interval increase in size of a left paracentral disc protrusion at L5-S1 causing slight progression of thecal sac effacement.4. Relatively mild degenerative findings at other levels are not significantly changed.


Instruction: Generate impression based on findings.

Input: Pituitary lesion and adenoid cystic carcinoma. There is an unchanged subcentimeter lesion within the right pituitary gland with associated foci of T2 hypointensity and no appreciable enhancement. There is no mass effect upon the optic apparatus or cavernous sinus. The infundibulum is intact. The brain and ventricular system also appear unremarkable, aside from a few nonspecific foci of cerebral white matter T2 hyperintensity. There is no evidence of acute infarction or intracranial hemorrhage. There is no evidence of perineural tumor involvement in the region of the skull base. There are partially imaged post-treatment findings in the tongue.

Output: 1. No interval change in the subcentimeter pituitary lesion, which may represent a pituitary adenoma or Rathke cleft cyst.2. No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Headache, rule out structural cause. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Partial empty sella incidentally noted. Bilateral orbits are unremarkable. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain is essentially within normal limits for age. There are a few scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific. Partially empty sella is also seen which is usually an incidental finding but can be seen with intracranial hypertension in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Hand mass There is a mass within the palm of the hand situated between the flexor tendons of the middle and ring fingers, volar to the intraosseous muscles. It is approximately 1.5 cm in transverse dimension and 2.5 cm in longitudinal dimension, subjectively appearing slightly larger on the current exam when compared to the prior. The mass is isointense to skeletal muscle on T1 sequences and heterogeneously hyperintense to skeletal muscle on fat suppressed T2 sequences while demonstrating peripheral, slightly irregular enhancement following administration of intravenous gadolinium. A tail of edema and enhancement extends proximally from the mass towards the wrist terminating at the level of the distal carpal row deep within the carpal tunnel. Similar edema and enhancement extends distally through the lumbrical to the level of the metacarpal head. The mass splays the flexor tendons of the third and fourth fingers.We see no additional masses. The remaining soft tissue and bones otherwise appear normal.

Output: Mass within the palm of the hand as described above. Although this may represent a ganglion cyst, the slightly irregular nature of the peripheral enhancement, the signal heterogeneity on T2W sequences, and the adjacent tail-like enhancement/edema are somewhat atypical features for a ganglion. Other entities such as a nerve sheath tumor should also be considered. Note that on the basis of these images, malignancy cannot be excluded.


Instruction: Generate impression based on findings.

Input: History of lymphoma with brain and spine lesions on recent PET. Brain: No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. More focal area of FLAIR hyperintensity seen in the left periatrial white matter with adjacent dilatation of the left lateral ventricle atrium which is favored to be on an ex vacuo basis. There is minimal prominence of the ventricular system which is likely related to volume loss although component of communicating hydrocephalus cannot entirely be excluded.. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Mild mucosal thickening is noted throughout the paranasal sinuses, which are otherwise clear.Small enhancing lesions with low T1 hyperintensity are noted in the right frontal calvarium including the right superior orbital wall. T1 hypointensity and enhancement is also noted involving the clivus/basiocciput and occipital condyles.Complete spine:There is diffuse low T1 marrow signal throughout the cervical, thoracic, and lumbar spine with multiple more focal areas of T2 hyperintensity and enhancement noted. Relatively more prominent of these are at the C2 and C4 vertebral bodies in the cervical spine and essentially all levels in the thoracic and lumbar spine. Posterior elements are also involved. Abnormal marrow signal with heterogeneous enhancement is also noted in the visualized ribs, sternum, and pelvis.Degenerative changes are seen throughout the cervical spine with relatively more prominent disc osteophyte complex at the C5-C6 level which mildly indents the left ventral cord. Minimal disc osteophyte complex also seen at the C6-C7 level. There is mild to moderate left-sided neural foraminal stenosis at this level. Mild degenerative changes are also seen in the lumbar spine with multilevel small disc bulges and small central protrusion at the L5-S1 level. There is mild right foraminal narrowing oat L3-L4 and L4-L5.No high-grade spinal canal or neural foraminal stenosis is appreciated at any level in the cervical, thoracic, or lumbar spine.. No cord signal abnormality or evidence of epidural tumor.Nonspecific T2 hyperintense lesion involving the subcutaneous tissues in the midline posterior neck at the C6 level. Large left clavicular mass is partially visualized. Minimal bilateral pleural effusions.

Output: 1. No intracranial mass or abnormal parenchymal or meningeal enhancement to suggest neoplasm. There are mild chronic small vessel ischemic changes. There is also more focal area of FLAIR hyperintensity involving the left periatrial white matter compatible with gliosis, possibly related to treatment change versus remote ischemic injury. No associated enhancement, restricted diffusion, or mass effect to suggest active lymphoma in the brain. No discrete lesion within the nasal cavity is appreciated.2. Extensive bone marrow signal abnormality involving the cervical, thoracic, and lumbar spine as well as the right frontal calvarium with multifocal areas of T2 hyperintensity and enhancement. Findings are consistent with known lymphoma. Comparison with prior brain and spine MRI would be helpful if available. No compression fractures, epidural tumor, or cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Chiari malformation decompression, s/p 3 month follow up. Brain: There are postoperative findings related to Chiari decompression. The inferior cerebellum extends to the inferior tip of the clivus. CSF flow is present across the anterior and posterior aspects of the neo-foramen magnum. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a cystic pineal gland that measures up to 7 mm. 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 and paranasal sinuses appear unremarkable.Cervical Spine: There is slight straightening of the vertebral column alignment in the sagittal plane. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. Aside from the expected postoperative findings, the paravertebral soft tissues are unremarkable.

Output: Expect postoperative findings related to Chiari decompression without evidence of pseudomeningocele, hydrocephalus, or syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Clinical question: Lung cancer. Please evaluate for metastases. Signs and symptoms: Lung cancer. Nonenhanced CT of brain:There is no evidence of intracranial hemorrhage, mass-effect, midline shift or hydrocephalus. Previously noted large area of vasogenic edema in the left frontal lobe under the left frontal craniotomy flap is no longer identified and only residual encephalomalacia is noted. Findings of a small vessel disease of indeterminate age. There is no definitive evidence of metastases lesion on this non-infused exam however to entirely exclude possibility of metastases disease post enhanced CT or MRI is recommended.

Output: 1.Findings of a small vessel disease and focal area of left frontal lobe cortical and subcortical encephalomalacia.2.No evidence of metastatic disease on this non-infused head CT. To entirely exclude metastases enhanced CT or an MRI is recommended.


Instruction: Generate impression based on findings.

Input: History of hilar/intrahepatic stricture status post stenting and ERCP with brushings showing reactive changes. Now with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size and signal intensity.Right hepatic lobe cyst. No new suspicious liver lesion.Demonstrated again is left greater than right intrahepatic biliary ductal dilatation to the level of Klatskin's point, slightly improved from the prior study. The previously described adjacent region of poorly defined enhancement on delayed imaging (series 18/54) is less conspicuous on today's study. The main common bile duct is normal in caliber with mild circumferential thickening.Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Redemonstrated cystic lesion at the pancreatic head/neck junction measuring 4.5 x 2.9 cm (series 5 image 18), compared to 2.7 x 2.6 cm previously. The lesion appears to communicate with the main pancreatic duct. The main pancreatic duct is normal in caliber. Small additional cystic foci in the pancreatic head and body are noted.No evidence of acute pancreatic inflammation. Several prominent peripancreatic lymph nodes, the largest measuring 2.3 x 1.5 cm (series 10/20) disease, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Persistent intrahepatic biliary ductal dilatation to Klatskin's point, slightly improved. The previously described adjacent region of poorly defined enhancement on delayed imaging (series 18/54) is less conspicuous on today's study.2.Mild interval increase in size of the cystic lesion at the pancreatic head neck junction which communicates with the main pancreatic duct, a pancreatic pseudocyst or a cystic neoplasm (such as a mucinous cystic neoplasm fistulized to the duct) remain diagnostic possibilities. No suspicious post-contrast enhancement of this lesion.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago with sciatica, right sideClinical question: lower back pain with right sided sciatica r/o disc diseaseSigns and Symptoms: lower back pain with right sided sciatica r/o disc disease Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild disk dessication and a minor disk bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is disk dessication and a minor disk bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are mild degenerative changes in the lumbar spine without compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Reason: cause of abd pain, back pain, lipase with dilated common bile duct on abd us? History: abd pain, back pain, lipase with dilated common bile duct on abd us ABDOMEN:LIVER, BILIARY TRACT: Common bile duct is mildly prominent measuring 9 mm, with smooth tapering of the distal common bile duct, likely representing stenosis. Mild intrahepatic biliary ductal dilatation. Status post cholecystectomy.SPLEEN: Wedge-shaped region of low T2 signal within the kidney with scarring may represent an old infarct.PANCREAS: Increased T2 signal and diffusion restriction in the pancreatic head may reflect mild acute pancreatitis.Mildly prominent main pancreatic duct measuring 3 mm with mild atrophy of the pancreatic tail. A cystic lesion within the pancreatic head measures 1.0 x 0.8 cm (501/16), likely a side branch IPMN.Additional smaller lesions are present in the pancreatic tail (501/23) comma also likely sidebranch IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic kidneys. Subcentimeter T2 hyperintensities, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right lower pulmonary opacity.

Output: 1.Mild intrahepatic and extrahepatic biliary ductal dilatation with narrowing of the distal common bile duct, likely reflecting stenosis from external compression.2.Mild pancreatitis of the pancreatic head3.Cystic lesion in the pancreatic head likely represents a side branch IPMN.4.Wedge-shaped abnormal signal in the spleen may represent an old infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: 48-year-old male with history of SCLC with metastases to liver, brain, now with weakness. Signs and symptoms: Evaluate intracranial process versus metastases. Pre-and post-enhanced brain MRI:Examination demonstrates very significant interval progression of metastatic disease. There are numerous varying size nonhemorrhagic and enhancing metastatic lesions in bilateral cerebral and cerebellar hemispheres as well as the pons. Thickening and enhancement of the ependymal lining the lateral ventricles are also highly suggestive for additional metastatic lesions. There is a small amount of peritumoral edema with the lesions all were without appreciable mass effect on the lateral ventricles and with maintained midline.There is a slight interval increased size of lateral ventricles however with maintained midline. Calvarium is intact.Unremarkable images through the orbits including axial fat sat post contrast series.

Output: 1.Significant interval progression of metastatic disease with numerous supratentorial and infratentorial parenchymal nonhemorrhagic enhancing metastatic lesions. Diffuse metastatic lesions involving the ependymal lining of the lateral ventricles.2.There is no significant mass effect or midline shift.3.Unremarkable calvarium and orbits.


Instruction: Generate impression based on findings.

Input: 60 year old male with diabetes, hypertension, hyperlipidemia, peripheral arterial disease who presented with myocardial infarction. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 136 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 62 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 84 g (normal range 164+/-36). There are regional wall motion abnormalities. In the inferior wall there is dyskinesis at the base and mid ventricle with small pseudoaneurysm formation. This area appears black on LGE sequences which is consistent with significant microvascular obstruction. The basal to mid inferoseptum and inferolateral walls are akinetic. There is transmural late gadolinium enhancement in the basal to mid inferior and inferolateral walls. The basal to mid inferior, inferoseptum and inferolateral walls are not likely to be viable. There is a small patch of late gadolinium enhancement in the mid anteroseptum which is not transmural. The anterior, anteroseptum, lateral and apical walls are all viable. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 138 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 71 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is a small pleural effusion on the left. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function (LVEF 54%). 2. There are regional wall motion abnormalities in the basal to mid inferoseptum, inferior and inferolateral walls. There is a small pseudoaneurysm in the mid inferior wall corresponding to an area of microvascular obstruction due to myocardial infarction. There is transmural late gadolinium enhancement in the basal to mid inferior and inferolateral walls. These areas are not likely to be viable. 3. There is a small patch of late gadolinium enhancement in the mid anteroseptum which is not transmural. The anterior, anteroseptum, lateral and apical walls are all viable. 4. The right ventricle is normal in size with low normal systolic function (RVEF 48%)5. Small pericardial effusion6. Small left sided pleural effusionI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 20 years old, with eye pain on movement. Assess for myositis of the ocular muscles. The extraocular muscles are of normal caliber, are free of edema, and demonstrate normal enhancement on postcontrast images. The globes are round and symmetric. The optic nerves show normal morphology and are free of pathologic signal abnormality and enhancement. The orbital fat is clean. No masslike lesions are identified.

Output: Unremarkable evaluation of the orbits with no specific radiologic findings to indicate myositis or to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: NMO: weakness in legs. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate foci of white matter T2 hyperintensity in the bilateral frontal lobes. 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 and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.Orbits: There is diffuse volume loss of the left orbital segment of the left optic nerve with associated high T2 signal. The right optic nerve appears to be unremarkable. The globes, extraocular muscles, lacrimal glands, and orbital fat also appear to be intact bilaterally. There is no evidence of intraorbital mass lesions.Spine: There has been marked interval decrease in the degree of upper spinal cord edema with residual patchy high T2 signal and enhancement measuring up to 35 mm in length at the C2-3 to C4-5 levels. The thoracic spinal cord is unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a hemangioma in the T5 vertebral body. The vertebral bone marrow signal is otherwise unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. However, there are multiple thyroid nodules, the largest of which measures up to approximately 15 mm.

Output: 1. Marked interval decrease in the degree of upper spinal cord edema patchy high T2 signal and enhancement measuring up to 35 mm in length at the C2-3 to C4-5 levels, which may be a manifestation of NMO. 2. Left optic nerve atrophy, which may a chronic sequela of NMO involvement.3. Nonspecific bilateral punctate frontal lobe white matter lesions. 4. Multiple nonspecific thyroid nodules.


Instruction: Generate impression based on findings.

Input: Male, 47 years old, with altered mental status, recent questionable subarachnoid hemorrhage with artery wrapping, assess for vasoconstriction. Findings are seen compatible with recent left pterional craniotomy. Epidural thickening beneath the craniotomy flap is seen measuring up to 8 mm and causing mild effacement of the adjacent frontal lobe sulci. There may also be trace subarachnoid blood product within the adjacent frontal sulci.Very mild restricted diffusion and correlating T2 signal abnormality is seen along the medial anterior aspect of the left thalamus (see key images).T2 hyperintensity is seen involving the posterior left gyrus rectus and olfactory gyri. A small amount of associated T1 hyperintensity is also seen possibly indicating minimal blood product.Numerous scattered small foci of T2 hyperintensity are evident elsewhere in the cerebral white matter. No other areas of significant parenchymal edema or mass effect are detected. No other significant areas of intracranial hemorrhage are seen. The ventricles are normal in size and morphology.Patchy enhancement is seen along the left anterior sylvian fissure. The dura and some of the frontal lobe sulci beneath the craniotomy also show mild enhancement.MRA images of the intracranial circulation are suboptimal due to motion artifact. No significant stenosis or occlusion is seen within the proximal circle of Willis branches, but beyond the first order branches, assessment is unremarkable.

Output: 1.Findings compatible with mild subacute ischemic injury to the anterior medial left thalamus.2.Findings compatible with parenchymal injury involving the posterior left gyrus rectus and olfactory gyri which, given the location, are probably postoperative in nature.3.Epidural thickening subjacent to the craniotomy is seen measuring up to 8 mm but with no evidence of restricted diffusion. Mild enhancement of the adjacent dura and some of the frontal lobe sulci is seen. Given the lack of parenchymal edema, these findings are felt to be reactive to surgery rather than inflammatory or infectious.4.Scattered small foci of white matter signal abnormality are seen, a nonspecific finding which can reflect chronic microvascular ischemic disease among many other etiologies.


Instruction: Generate impression based on findings.

Input: Diagnosis: WeaknessClinical question: brain tumorSigns and Symptoms: weakness There is a hemorrhagic mass present centered in the right postcentral gyrus associated with surrounding vasogenic edema. On T2 imaging it measures approximately 38 x 37 mm in axial dimensions on the current exam and on the prior exam it measured 38 x 36 mm axial dimensions on the August exam the lesion was different in appearance than that there was not a thick capsule surrounding the more central hemorrhagic component. The more central hemorrhagic component measures 18 x 18 mm on the current exam and on the prior exam measured similar dimensions. The enhancement pattern of this lesion of this lesion has changed over time. Surrounding vasogenic edema has regressed since prior exams.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrates some mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells demonstrate scattered opacities. The visualized portions of the orbits are intact.

Output: There is a hemorrhagic lesion present in the right parietal lobe. Changing MR appearance may be attributed to evolution of blood products within the lesion as well as adjacent reaction. Differential considerations include vascular metastasis as well as other entities such as an infectious process.


Instruction: Generate impression based on findings.

Input: Increasing headache frequency. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, cerebellum, and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is staphylomatous deformity of the left globe.

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


Instruction: Generate impression based on findings.

Input: T10 vertebral body lesion. Possible metastatic disease. Head and neck cancer. 49-year-old male. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: T10 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Recurrent, disseminated glenohumeral tumor. Treated with chemotherapy and radiation treatment. Last MRI showed new contrast enhancement. Brain: There are postoperative findings related to left temporal craniotomy and tumor resection. The enhancing T2 hyperintense mass within the left middle cranial fossa surgical bed has not significantly changed. Likewise, there is unchanged is encephalomalacia surrounding the treatment bed. There is extensive enhancement within supratentorial and infratentorial sulci and basal cisterns, which has is overall similar in extent. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unchanged. There is a right maxillary sinus retention cyst.Spine: Spine imaging is limited by patient motion. There is diffuse linear and nodular leptomeningeal enhancement in the spinal canal. There is also unchanged volume of enhancing tumor within the sacral spinal canal though the enhancement is more intense which may relate to postinjection delay. The spinal cord signal otherwise appear normal. A left paracentral disc protrusion at L5-S1 and a mild disc bulge at C3-4 are also unchanged. The spinal column alignment is unchanged. The vertebral body morphology and signal characteristics are unremarkable.

Output: 1. Unchanged residual tumor in the left middle cranial fossa and extensive leptomeningeal tumor dissemination.2. Unchanged drop metastases in the spinal canal.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of parotid gland infiltrating surrounding structures seen on recent CT scan with right facial droop. Neck: There is a bulky, infiltrative, and partly necrotic right neck mass that involves the right parotid gland with extension into the right stylomastoid foramen, and involvement of the adjacent sternocleidomastoid muscle, parapharyngeal space, retropharyngeal space, paravertebral tissues, and right visceral space. The tumor measures up to approximately 13.5 cm. There is also surrounding extensive right cervical and retropharyngeal lymphadenopathy. There is also partially imaged mediastinal lymphadenopathy. There is diffuse swelling of the subcutaneous tissues and skin thickening in the right neck. The right internal carotid and right artery is encased by tumor, but does not appear to be significantly narrowed. Tumor also appears to extend into the right C2 transverse foramen, where it may contact the vertebral artery, without narrowing the vessel. There are bilateral hypoattenuating thyroid nodules. The osseous structures are unremarkable. There are multiple nodules in the imaged portions of the lungs. Brain: There is mild nonspecific patchy cerebral white matter T2 hyperintensity, but no evidence of acute infarction. There is no evidence of intracranial tumor. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: 1. Interval increase in size of a large infiltrative malignant right neck mass, with compromise of the right facial nerve and associated extensive right neck lymphadenopathy. In addition, the right internal carotid artery is encased by tumor, but does not appear to be significantly narrowed. Swelling of the overlying subcutaneous tissues may be related to lymphedema.2. No evidence of intracranial tumor or acute infarction.3. Nonspecific thyroid nodules. Thyroid ultrasonography may be useful for further evaluation.4. Nodules in the lungs may represent metastases. A dedicated chest CT or whole body PET may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 29-year-old female with TMJ pain and clicking, evaluate TMJ for arthritic changes and disk derangement. History of bilateral mandibular condyle fractures. Right temporomandibular joint: There is anterior dislocation of the TMJ disc with no recapture on the open-mouth sequences. The disc itself demonstrates normal low signal intensity on all sequences. The mandibular condyle is centered on the glenoid fossa, however the head of the mandibular condyle demonstrates contour irregularity and spur formation protruding into the joint space. On the open-mouth sequences the mandibular condyle remains centered over the glenoid fossa.Left temporomandibular joint: There is anterior dislocation of the TMJ disc with no recapture on the open-mouth sequences. The disc itself demonstrates normal low signal intensity on all sequences. The mandibular condyle is centered on the glenoid fossa, however the head of the mandibular condyle demonstrates contour irregularity and spur formation protruding into the joint space. On the open-mouth sequences the mandibular condyle remains centered over the glenoid fossa. The previously noted mandibular condyle fracture is partially visualized and better evaluated on recent CT study.

Output: 1. Bilateral TMJ disc dislocation with no recapture. 2. The mandibular condyles remain centered over the glenoid fossa on the closed and open sequences. In addition there are osteoarthritic changes affecting the mandibular condyles with spur formation protruding into the expected region of the temporomandibular joints.


Instruction: Generate impression based on findings.

Input: Female 69 years old Reason: 69 y.o. F with Graves disease. Please evaluate History: graves disease RIGHT LOBE MEASUREMENTS: 1.1 x 0.8 x 2.6 cmLEFT LOBE MEASUREMENTS: 1 x 1 x 2.1 cmISTHMUS MEASUREMENTS: 0.1-cmRIGHT LOBE: Thyroid tissue is extremely heterogeneous and atrophic. There is a 6 x 5 mm nodule at the inferior aspect of the right lobe.LEFT LOBE: Extremely heterogeneous and atrophic thyroid tissue. There are two nodules in the left lobe. Largest one measures 1.4 x 0.9 cm. This nodule is partially solid with cystic components.More superior smaller nodule measures 5 x 8 mm. This nodule is also solid and contains microcalcifications.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Very heterogeneous atrophic thyroid secondary to patient's known Graves' disease and treatment changes. Bilateral small solid nodules. Carcinoma cannot be excluded.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule-out bleed versus ischemia. Signs and symptoms: Dizziness, syncope, intermittent blurry vision. CT of brain without infusion:No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected. No definitive evidence of small vessel disease on this non-infused CT of brain as it was noted on prior MRI examination.A small calcific density in the subcortical white matter of the left posterior frontal is noted (axial image 19). The finding may represent a small dystrophic calcification or a small cavernoma. Calvarium is unremarkable. Mastoid air cells and limited view of paranasal sinuses are unremarkable.

Output: Essentially unremarkable CT of brain without infusion. Please see above comments.


Instruction: Generate impression based on findings.

Input: Headache and dizziness. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant steno-occlusive lesions in the head and neck arteries. There is no evidence of cerebral saccular aneurysms. The left vertebral artery arises directly from the aortic arch, which is an anatomic variant.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive lesions in the head and neck arteries.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, with metastatic triple negative breast cancer, assess for brain metastases. A single nonspecific focus of FLAIR hyperintensity is seen within the right centrum semiovale. No evidence of edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is observed. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.

Output: No evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Right upper extremity weakness, hyperreflexia, and multiple falls. There are scattered foci of cortical and subcortical high T2 signal with restricted diffusion as well as punctate enhancement in the left frontal and parietal lobes in a distribution that coincides with the ACA-MCA watered territory. There is no evidence of intracranial hemorrhage, mass, or midline shift. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive mucosal thickening and secretions within the left maxillary and sphenoid sinuses. There is fluid and enhancement within the left mastoid air cells.

Output: 1. Subacute infracts in the left ACA-MCA watered territory, without midline shift or hemorrhagic transformation.2. Findings suggestive of acute sinusitis and mastoiditis.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with epilepsy status post laser ablation on 8/18, three-month follow-up exam. Post ablation findings in the anterior medial left temporal lobe have evolved now demonstrating features of chronicity. Specifically, the rim of enhancement seen on the immediate postprocedural images has nearly completely resolved and there is further encephalomalacia of the amygdala and hippocampus. Cerebral morphology is otherwise unremarkable. A small area of gliosis at the site of the left occipital burr hole is unchanged. A few scattered small nonspecific foci of FLAIR hyperintensity in the cerebral hemispheres are also unchanged. No edema or mass effect is detected. No new pathologic intracranial enhancement is observed. Allowing for ex vacuo dilatation of the left temporal horn, the ventricular system remains within normal limits.

Output: Expected evolution of post ablation findings in the left anterior medial temporal lobe.


Instruction: Generate impression based on findings.

Input: Images are slightly limited by patient motion. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is a stable single focus of nonspecific FLAIR hyperintensity in the right paramedian frontal lobe on 1001/48, without enhancement. Please note that sagittal FLAIR images of the brain were inadvertently not obtained. No extra-axial fluid collection is identified. There is mild scattered mucosal thickening in the paranasal sinuses.The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. There is minimal disc narrowing at 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 caliber and signal. There is no pathological enhancement.There has been interval minimal progression of trace cervical spondylotic changes at C5-C6 and C6-C7 with perhaps minimal left foraminal narrowing at these levels. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine.

Output: 1.Continued stable appearance of single nonspecific nonenhancing focus of FLAIR hyperintensity in the right paramedian frontal lobe.2.Minimal interval progression of trace spondylotic changes along the lower cervical spine.


Instruction: Generate impression based on findings.

Input: 62-year-old female with pain and weakness after fall. Evaluate for rotator cuff tear. ROTATOR CUFF: There is a large tear in the subscapularis tendon with retraction. There is an additional tear in the supraspinatus tendon.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Tear of the subscapularis and supraspinatus tendons.


Instruction: Generate impression based on findings.

Input: Reason: prostate cancer active surveillance History: prostate cancer, low grade low volume x 4 biopsies, last biopsy in 2014Biopsy 12/12/2014: Right apex lateral Gleason 6Biopsy 10/22/2012: Right mid lateral Gleason 6 PELVIS:PROSTATE:Prostate Size: 5.8 x 3.7 x 4.1 cm.Peripheral Zone: There is a lesion in the right peripheral zone measuring 5 x 9 mm which is dark on T2/ADC without restricted diffusion or early enhancementCentral Gland: BPH nodules. There is a 1.8 x 0.8 cm T2 hypointense lesion in the right anterior aspect of the apex with questionable early enhancement.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A 5 mm utricle cyst is present.

Output: 1.Lesion in the right mid peripheral zone is considered indeterminate.2.Indeterminate lesion in the right anterior apex.3.Small utricle cyst.


Instruction: Generate impression based on findings.

Input: Pain and effusion. Check menisci MENISCI: The lateral meniscus demonstrates mildly diminutive posterior horn with a suspected small anterior defect along with associated blunting of the inner image. The body however appears intact without discrete linear components to suggest an associated tear. The medial meniscus is otherwise intact again free of focal abnormality in both menisci are anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Mild edema like changes in the lung involving the tibial plateau, particularly small contusions. Specifically no discrete linear component to support a definite fracture. Mild diffuse thinning of the cartilage without discrete superimposed focal abnormality, changes are most pronounced underlying the patella and the lateral facet. Scattered associated degenerative changes including small early subchondral cysts.LIGAMENTS: Ligaments are uniformly well visualized and no discrete acute abnormality is noted other than mild increased questionable signal along the ACL, representing a possible mild sprain. Intact fibers are observed throughout. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Questionable mild sprain of the ACL and questionable nonspecific signal abnormality involving the anterior aspect of the posterior horn of the lateral meniscus. These findings are associated with possible minimal contusion involving the lateral tibial plateau and a moderate effusion. Scattered mild to moderate degenerative changes larger with cartilaginous thinning and early degenerative osteoarthritic changes.


Instruction: Generate impression based on findings.

Input: Reason: rule out L SF osteomyelitis History: Contracture. There is deformity of the phalanges of the little finger. The distal phalanx is dislocated volarly relative to the middle phalanx. The base of the distal phalanx is not well defined on this study, which could be due to prior trauma or erosion. There is abnormal low signal intensity on T1-weighted images within the remaining distal phalanx. There appears to be angular deformity of the middle phalanx possibly representing a healing fracture; there is low signal intensity on T1-weighted images and high signal intensity on fat saturated T2 weighted images with mild enhancement following contrast administration. The PIP joint ankylosis suspected on the patient's recent radiographs is not clearly evident on this MRI study, but the PIP joint is held in approximately 50 degrees of flexion. There is abnormal signal intensity and enhancement of the head of the proximal phalanx with poor definition of the articular surface of the head of the proximal phalanx. There is mild edema type signal seen on the fluid sensitive sequences within the remainder of the proximal phalanx with relative preservation of fatty marrow signal intensity on T1-weighted images. The fifth metacarpal appears normal. The extensor tendon can be followed to the level of the PIP joint, after which it is not clearly defined. There is prominence of the soft tissues dorsal to the middle phalanx with low signal intensity of the soft tissues which presumably represents scarring. We see no fluid collection to suggest abscess formation. There is also bowstringing of the flexor tendon volar to the middle phalanx and distal half of the proximal phalanx suggesting disruption of the A3 and A4 pulleys. There is a small 5th MCP joint effusion.

Output: 1. Deformity and abnormal signal intensity of the distal, middle, and proximal phalanges of the fifth digit as described above. We cannot determine to what extent this signal abnormality is related to infection, prior trauma, or postsurgical changes.2. The extensor tendon can be followed to the level of the PIP joint, distal to which there appears to be scar tissue. Again we are uncertain if this is related to prior surgery or trauma.3. Bowstringing of the flexor tendon suggesting disruption of the A3 and A4 pulleys.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (10/1/15, 10/7/15), images from stereotactic biopsy of right breast and postprocedural right mammographic images (10/16/15), breast MRI (10/26/15), images from MRI guided biopsy of left breast and postprocedural left mammographic images (11/13/15), images from needle localization of right and left breast (11/24/15), digital mammographic images of right breast (12/4/15) performed at Northwestern Memorial Hospital. For comparison, digital mammographic images (9/25/14, 9/16/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (10/1/15, 10/7/15):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. There is a cluster of pleomorphic calcifications at 6:00 position in the right breast measuring 12 x 10 mm (AP x LR). No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. Benign appearing lymph nodes are projected both axillae.IMAGES FROM STEREOTACTIC BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (10/16/15):Stereotactic biopsy was performed for the cluster of calcifications in the right breast at 6:00 position. Postprocedural mammograms demonstrate a marker clip at 6:00 position, slightly inferior to the site of cluster of calcifications. There are no definite residual calcifications. Per outside radiology report, the pathology result was malignant; DCIS, grade 3.BREAST MRI (10/26/15):Breast MRI was performed with a protocol outlined in the outside radiology report.There is a regional non-mass enhancement, measuring 40 x 17 x 26 mm (AP x LR x CC) at 6:00 position in the right breast, corresponding to the site of biopsy-proven DCIS. Enhancement extends to the skin. A marker clip is identified near the skin, at the anterior aspect of the non-mass enhancement. There is a small lobulated mass measuring 8 x 7 x 8 mm at anterior 4:00 position in the left breast.IMAGES FROM MRI GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (11/13/15):MRI guided biopsy was performed for the enhancing mass in the left breast. Targeting appears appropriate. Post procedural mammographic images show a marker clip at anterior 4:00 position. Pathology result was benign and concordant; fragments of intraductal papilloma with apocrine metaplasia and microcalcifications.IMAGES FROM NEEDLE LOCALIZATION OF RIGHT AND LEFT BREAST (11/24/15):Single wire localization was performed for right and left breast. For the right breast, a wire was placed by inferior-superior approach. The wire placed immediately posterior to the clip and through the site of cluster of calcifications. For the left breast, a wire was placed by lateral-medial approach, immediately posterior to the clip. No specimen radiograph of either breast has been submitted. Per outside pathology report, DCIS present within 1 mm of the inferior, anterior, and medial margins.DIGITAL MAMMOGRAPHIC IMAGES OF RIGHT BREAST (12/4/15):Postsurgical seroma with a few surgical clips are seen at 6:00 position in the right breast. There are no residual suspicious calcifications at the site of surgery.

Output: Status post lumpectomy of right breast for DCIS, and left breast for papilloma. No mammographic evidence for residual suspicious calcifications in the right breast on the postsurgical mammographic images (12/4/15).BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Evaluate for possible recurrence of cavernous malformation: Breakthrough seizures, punctate hyperdense lesion in mesial right temporal lobe on CT. There are postoperative findings in the medial right temporal lobe with areas high T2 signal and volume loss. There is also a small amount of susceptibility effect in the right hippocampus. There is no evidence of acute intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The ventricles are uncahnged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is scattered mild paranasal sinus mucosal thickening. There is a subcentimeter midline nasopharyngeal cyst.

Output: Postoperative findings in the medial right temporal lobe with areas of encephalomalacia and perhaps gliosis, as well as a small amount of chronic blood products versus a small amount of residual component of a cavernous malformation in the right hippocampus.


Instruction: Generate impression based on findings.

Input: 56 years, Male, behavior changes, possible limbic encephalitis.. Examination is motion degraded. There is moderate degree of global parenchymal volume loss, which is advanced for age and has progressed since prior MRI from 1/28/2012. There is volume loss involving the hippocampi but is not disproportionate. No diffusion abnormality. No abnormal signal involving the medial temporal lobes or elsewhere to suggest evidence of encephalitis. No abnormal parenchymal or meningeal enhancement. No evidence of hemorrhage, intracranial mass, or mass effect. No extra-axial collections. Bone marrow signal and extracranial soft tissues are unremarkable.

Output: Global parenchymal volume loss, which is advanced for patient's age and has progressed since 1/28/2012. No specific MRI findings to suggest limbic encephalitis. CSF evaluation can be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: 36 year old female with a history of poorly controlled hypertension referred for cardiac MRI after new diagnosis of heart failure with reduced ejection fraction.MEDICATIONS: None First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 129 ml/m2 (normal range: 65+/-11), the LVEDV is 326 ml (normal range 109+/-23), the LV end systolic volume index is 80 ml/m2 (normal range 18+/-5), the LVESV is 203 ml (normal range 31+/-10), the LV mass index is 62 g/m2, and the LV mass is 157 g. There is global hypokinesis. Native pre-contrast myocardial T1 relaxation time is upper limits of normal (1072 ms). Normal global relative enhancement ratio. The ECV fraction is within normal limits. Left AtriumThe left atrium is mildly dilated. 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 84 ml/m2 (normal range 69+/-14), the RVEDV is 205 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 107 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal. 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 moderately dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small to moderate sized pericardial effusion. The pericardium has evidence of mild increased T2-signal and also mild late gadolinium enhancement. These findings are consistent with mild pericardial inflammation. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is severely dilated with moderately reduced systolic function (LVEF 38%). There is no evidence of an underlying myocardial infiltrative or fibrosing process. 4. The right ventricle is normal in size with mildly reduced systolic function (RVEF 48%).5. Small to moderate sized pericardial effusion with evidence of mild pericardial inflammation. 6. The main pulmonary artery is moderately dilated. 7. Mild biatrial enlargement. 8. Mild mitral and tricuspid regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 15 month old male with blunt head trauma The attenuation and morphology of the brain parenchyma is within normal limits for patient's stated age. No evidence of hemorrhage, edema, mass-effect or midline shift is detected. Cortical sulci, ventricular system and all CSF cisterns are within normal limits. A CSF signal density cystic lesion is noted in the pineal region, measuring approximately 21 x 14 mm on image 19. A MRI study is warranted for further evaluation.Calvarium and skull base are negative for displayed fracture. The visualized orbits and mastoid air cells are unremarkable. Small subcutaneous hematoma is seen overlying the forehead.

Output: 1. No evidence of acute intracranial abnormality.2. Pineal region cystic lesion. A MRI study is warranted for further evaluation.3. Small subcutaneous hematoma is seen overlying the forehead.


Instruction: Generate impression based on findings.

Input: 62 years Male (DOB:5/11/1954)Reason: evaluate for cental nervous system cause of syncope. History: Hx of brain trauma as a child - fall from heightPROVIDER/ATTENDING NAME: JAMES X TAO JAMES X TAO The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.On susceptibility weighted imaging is a punctate focus of signal loss present in the left pons which is unchanged since prior exam. Previously noted susceptibility effect adjacent to the thalamus and hippocampal tail probably represent vascular structures including an asymmetrically large right-sided basal vein of Rosenthal and inferior ventricular vein. This is evident on the postcontrast images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The intracranial cerebral vasculature appears mildly ectatic.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Examination is somewhat degraded due to patient motion artifact.

Output: 1.Examination is mildly degraded due to patient motion artifact which may obscure more subtle abnormalities. Simulation is stable compared to the previous exam from September.2.Microhemorrhages present in the left pons which in isolation is probably of little clinical significance.3.Intracranial cerebral vascular ectasia is a nonspecific finding.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with history of metastatic urothelial cancer. Most recent CT shows new lesions to the thoracic spine. Please assess. Signs and symptoms: Metastatic cancer. Pre-and post-enhanced thoracic MRI:Examination demonstrate a focus of marrow signal replacement involving the posterior aspect of T7 vertebrae and left pedicle with enhancement and highly suggestive of a metastatic focus. There is no evidence of extra osseous extension of enhancement into the perispinal space or epidural space. There is also no detectable decreased height of T7 vertebrae to suggest fracture. The alignment of the vertebral column is also within normal. There is no evidence of any additional foci of marrow signal replacement of vertebral column or abnormal enhancement.The signal intensity and caliber of thoracic cord remains within normal limits and with out abnormal enhancement.Mild degenerative changes of spine is detected however without evidence of spinal canal or neural foraminal compromise at any level.The perispinal soft tissues are also within normal limits and without abnormal enhancement.

Output: 1.Mixed signal intensity and partially enhancing sclerotic metastatic lesion of T7 vertebrae as detailed. No evidence of compression deformity or extra osseous extension of enhancement and no spinal canal or neural foraminal compromise.2.Unremarkable pre-and post enhanced MRI of thoracic spine otherwise.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: chronic low back pain History: back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. 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.There is focal bulging of disc at the level of L45 toward right L45 neural foramen.At the level of L5S1, there is broad based disc protrusion toward right L5S1 neural foramen.

Output: 1. Disc herniation toward right L5S1 neural foramen and disc bulging toward right L45 neural foramen.2. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: GTC, myoclonic and atonic seizures. Intermittent toe walking though normal tone. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of potential seizure foci.2. Normal degree of myelination.


Instruction: Generate impression based on findings.

Input: History of primary sclerosing cholangitis. Evaluate for concerning lesion. ABDOMEN:LIVER, BILIARY TRACT: There is mild left liver lobe atrophy. There is multifocal bilobar left greater than right irregular stricturing and dilatation of the intrahepatic bile ducts and the common bile duct consistent with primary sclerosing cholangitis. This most prominently involves the lateral segment of the left hepatic lobe, but this is improved from the prior study, for example, duct measuring up to 5 mm today, compared to 7 mm previously. No underlying lesion is evident on today's study. No new dominant stricture or discrete mass lesion is evident. Segment 5 subcentimeter simple hepatic cyst. Normally distended gallbladder. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy with susceptibility artifact in the nephrectomy bed. No evidence of residual recurrent tumor in the nephrectomy bed.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: Redemonstrated multifocal areas of severe dilatation and stricturing of the intra and extrahepatic biliary tree most pronounced in the left lobe laterally appearing slightly improved from the prior study without a discrete masslesion evident. An underlying masslesion cannot be entirely excluded but the interval mild decrease in bile duct dilatation favors a benign PSC stricture.


Instruction: Generate impression based on findings.

Input: Right knee pain. Decreased range of motion.IMAGE ACQUISITIONS: Nonenhanced CT of the right knee There are tiny osteophytes and small cysts in the tibial plateau indicating mild osteoarthritis. A tiny, 3 mm, density projects just above the central aspect of the tibial plateau and could conceivably represent a loose body but more likely represents a small focus of calcification in the distal fibers of the anterior cruciate ligament. Please note, the integrity of the menisci and ligaments can be better assessed with MRI but the posterior cruciate ligament is well seen and appears intact. The collateral ligaments likewise appear grossly intact. The anterior cruciate ligament is largely indistinct but we cannot ascertain if this is abnormal on this study. The extensor mechanism is intact. There is a small amount of fluid within the semimembranosus/gastrocnemius bursa (Baker's cyst).

Output: Mild degenerative changes as described above. If further imaging evaluation is clinically warranted, MRI can be considered.


Instruction: Generate impression based on findings.

Input: Loss of consciousness. Comparison is size. Patient has history of esophageal cancer. Please see seen punctate focus of enhancement involving the right post central gyrus is no longer appreciated. No abnormal parenchymal or meningeal enhancement is appreciated on the current study to suggest metastatic disease. No suspicious intracranial mass or evidence of mass effect. No evidence of acute ischemia or hemorrhage. There are multiple scattered foci of T2/FLAIR hyperintensity in the subcortical and periventricular white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes.Again seen is a cystic lesion that measures approximately 10 x 8 mm in the anterior right temporal lobe and appears contiguous with the right sylvian cistern. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a non-enhancing ovoid lesion in the left occipital scalp that measures up to 22 mm, which likely represents an inclusion cyst. There is an intrinsically T1 hyperintense lesion in the left parietal calvarium, which may represent a hemangioma.

Output: 1. Previously seen punctate focus of enhancement in the right postcentral gyrus is no longer appreciated. There is no abnormal enhancement or intracranial mass to suggest metastatic disease.2. Unchanged cystic lesion in the anterior right temporal lobe without enhancement which most likely represents a benign entity such as a neuroglial cyst.


Instruction: Generate impression based on findings.

Input: Female, 85 years old, with low back pain. Thoracic:Spinal alignment is anatomic. Vertebral body heights are preserved. Scattered areas of marrow signal change, largely T1 isointense and T2 hyperintense, within the T9 and T10 vertebral bodies, and the T8 left lamina, were present on the prior examination and likely reflect benign hemangiomas. No worrisome marrow replacement is seen.The spinal cord demonstrates normal signal intensity throughout. No epidural lesions are suspected. Multilevel disc degeneration is seen, appearing similar to the prior examination. At T10-11, disc bulging with facet arthropathy and ligamentum flavum thickening produce a mild spinal canal stenosis and mild foraminal narrowing. At T11-12, disc bulging along with facet arthropathy, left greater than right, and ligamentum flavum thickening produce a moderate spinal canal stenosis with slight cord deformation and severe left foraminal narrowing.A hiatal hernia is noted incidentally. The thyroid contains multiple nonspecific nodules.Lumbar:An S-shaped scoliotic curvature of the lumbar spine is seen. Grade 1 anterolisthesis of L4 relative to L5, and L5 relative to S1 is seen. Evidence of posterior instrumented fusion from L4 to L5 is demonstrated. Alignment is grossly unchanged. A laminectomy defect is also redemonstrated at L4-5. Marrow signal characteristics are extremely heterogeneous. This likely reflects degenerative endplate signal alteration. Apart from some lateral wedging related to scoliosis, the vertebral body heights are preserved.The distal spinal cord and conus are within normal limits. No significant impingement of the cauda equina is seen. No epidural abnormalities are detected.General progression of degenerative findings is seen with further loss of disc height and endplate irregularity at most levels. Additional level specific findings are as follows:L1-2: Progressive facet arthropathy, particularly on the right. Slightly progressive disc bulging without significant spinal canal stenosis. Severe progressive right foraminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening slightly progressed. Progressive disc bulging with greater effacement of the left lateral recess and a mild generalized canal stenosis. Moderate bilateral foraminal narrowing, progressed. L3-4: Postoperative changes. Facet arthropathy grossly similar to prior. Bulging disc and mild spinal canal narrowing, similar to prior. Severe left and mild right foraminal narrowing, unchanged. L4-5: Postoperative changes. Facet arthropathy grossly similar to prior. No significant spinal canal or foraminal stenosis. L5-S1: Facet arthropathy and ligamentum flavum thickening grossly similar to prior. Disc bulging, unchanged. No significant spinal canal stenosis. Mild bilateral foraminal narrowing, unchanged.

Output: 1.Severe disc and posterior element degeneration is again seen in the lumbar spine with progression at most levels. No high-grade spinal canal stenosis is seen. However, scattered severe foraminal narrowing is noted as above. Postoperative findings are redemonstrated compatible with posterior instrumented fusion and laminectomy at L4-5.2.Moderate degenerative findings are seen in the thoracic spine without significant interval change. There is narrowing of the spinal canal at T10-11 and T11-12. No acute lesions are seen.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with worsening sciatica and radiculopathy with lower extremity weakness. Signs and symptoms: As above. Nonenhanced lumbar MRI:T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable. Incidental note is 12 x 12 mm focus of T1 and T2 hyperintense and the L2 vertebral body posteriorly consistent with a benign skeletal capillary hemangioma.L2-L3 demonstrate mild disc desiccation and loss of disc height, shallow broad-based disc protrusion laterally and far laterally on the left is noted. There is also mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Mild left neural foraminal compromise and mild central spinal stenosis is present.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet hypertrophy changes (right greater than left). There is also mild grade 1 anterolisthesis at this level secondary to degenerative disease. There is resultant moderate central spinal stenosis with significant right and mild left neural foraminal compromise.L4-L5 demonstrate moderate disc disease with mild loss of disc height, moderate (left greater than right) ligamentum flavum hypertrophy and moderate right and mild left facet hypertrophic changes. Degenerative changes at this level also includes mild grade 1 anterolisthesis. There is no central spinal stenosis however moderate right neural foraminal compromise and mild on the left is noted. There is also slight compromise of the left lateral recess present.L5-S1 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy is present. Moderate right facet disease and including facet effusion is noted. There is no central spinal stenosis however moderate left neural foraminal compromise is noted.Perispinal soft tissues are unremarkable.

Output: 1.Mild to moderate degenerative changes of the lumbar spine with resultant central spinal stenosis only at L3-L4 level of moderate degree as detailed.2.Multilevel mild-to-moderate neural foraminal compromise as detailed per level above.3.Unremarkable lower most visualized thoracic spine and thoracic cord.


Instruction: Generate impression based on findings.

Input: 29-year-old female with intramural leiomyoma of the uterus. PELVIS:UTERUS, ADNEXA: Numerous, enhancing intramural and submucosal fibroids are noted. Few pedunculated enhancing fibroids are also noted. The largest is a posterior uterine wall intramural fibroid measuring 8.4 x 8.6 x 8.3 cm. The junctional zone is within normal limits.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple uterine fibroids as described above.


Instruction: Generate impression based on findings.

Input: 58 years, Female, diplopia, left sixth nerve palsy, rule out central cause. Brain: Examination is technically degraded due to motion, as well as using the neck coil, which was used because of patient's body habitus. There is however no evidence of restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is trace mucosal thickening involving the right posterior ethmoid air cells as well as bilateral maxillary sinuses. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits. Orbits: No intraorbital mass or abnormal enhancement. Bilateral globes are grossly unremarkable. Bilateral extraocular muscles appear within normal limits. Optic nerves demonstrate no appreciable abnormality.No lesions along the visualized course of the sixth cranial nerves are appreciated. Bilateral cavernous sinuses demonstrate symmetric, normal enhancement. No lesions involving the superior orbital fissure, clivus, or prepontine cistern.

Output: Examination is somewhat technically degraded as described above. However, the brain and orbit MRI studies appear within normal limits. Specifically, no lesion in the brainstem or along the course of the sixth cranial nerves is appreciated.


Instruction: Generate impression based on findings.

Input: Female, 45 years old. Knee injury. Suspected patellar dislocation. MENISCI: There is mild fraying of the menisci, medial greater than lateral, without discrete tear identified.ARTICULAR CARTILAGE AND BONE: There are high-grade focal cartilage defects of the lateral patellar facet and patellar apex on the background of severe generalized thinning, without significant underlying bone marrow signal abnormality. There is also mild to moderate diffuse thinning of the medial and lateral femoral condyles without focal cartilage defects. Bone marrow signal is normal.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Severe cartilage thinning of the patella with full-thickness defects involving the apex and lateral patellar facet. Mild diffuse cartilage loss elsewhere in the knee.2.Mild meniscal fraying, without meniscal tear identified.3.Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: 69-year-old male with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. Hypodensities in periventricular white matter most consistent with small vessel ischemic disease, which were present on prior MRI.The ventricles and basal cisterns are normal in size and configuration.Several small, round bony excrescences are seen arising from outer table of skull, of unclear etiology but doubtful clinical significance (sagittal series 80475, image 26). The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Unspecified abnormalities of gait and mobility [R26.9], Reason for Study: ^Reason: rule out structural lesions including MS, stenosis, nerve root impingement History: gait abnormality and neck pain There is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The paraspinal soft tissues and musculature are unremarkable.Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: diffuse minimal bulging of disc with slightly prominent osteophyte-disc complex left more than right, no neuroforaminal narrowing or spinal stenosis. C4-C5: diffuse minimal bulging of disc with slightly prominent osteophyte-disc complex left more than right, no neuroforaminal narrowing or spinal stenosis. C5-C6: diffuse minimal bulging of disc with slightly prominent osteophyte-disc complex left more than right, no neuroforaminal narrowing or spinal stenosis. C6-C7: slightly prominent osteophyte-disc complex left more than right, no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Degenerative changes of mid cervical spine discs including C34, C45 and C56 with minimal left side neuroforaminal stenosis but no significant spinal canal stenosis.2. Spinal cord signal intensity appears to be normal.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review areDiagnostic mammogram dated 11/5/2015Diagnostic mammogram and ultrasound 11/10/2015 Ultrasound biopsy and post mammogram dated 11/13/2015MRI dated 12/8/2015 All of the images were performed at Advocate Christ Medical Center, Oaklawn Illinois. No comparison studies are available. SCREENING MAMMOGRAM: Two standard views of both breasts and static tomosynthesis views were submitted. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There is a focus of architectural distortion the left upper outer breast seen best on the static tomosynthesis views. Loosely scattered benign calcifications are seen bilaterally.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast. DIAGNOSTIC MAMMOGRAM:Focal architectural distortion and asymmetry in the left breast upper outer quadrant on persists on the additional mammographic views. This spans approximately 1.2 cm on the mammogram.LEFT BREAST ULTRASOUND: Static images of the left breast 2:00 position 3 cm from nipple demonstrate a hypoechoic mass with posterior acoustic shadowing and spiculated margins measuring up to 1.5 x 1.8 x 1.2 cm, highly suspicious for malignancy (these largest measurements are shown on pre-biopsy ultrasound). Normal left axillary nodes are also shown. ULTRASOUND GUIDED BIOPSY AND POST MAMMOGRAM:Ultrasound core biopsy of the left breast 2:00 position 3 cm from nipple mass demonstrates appropriate targeting. Marking clip placement is not shown.Post biopsy mammogram show a coil-shaped clip in the left upper-outer quadrant along the posterior aspect of the architectural distortion with post biopsy hematoma/changes.Pathology indicated on the report report as "malignant infiltrating lobular carcinoma, grade 2, a single focus of LCIS also present."BILATERAL BREAST MRI:There is mild background parenchymal enhancement. Moderate amount of heterogeneously fibroglandular tissue seen bilaterally. Dynamic images could not be interpreted on DynaCad and were reviewed instead on PACS without kinetic data.In the left upper outer quadrant near the 2:00 o'clock location, there is a heterogeneously enhancing mass with irregular borders measuring up to 1.3 x 1.1 x 0.7 cm. Clip artifact is seen along the posterior aspect of the mass. This correlates with the findings on mammogram and ultrasound. There is no additional enhancing mass, suspicious morphology or focus of temporal enhancement in the left breast.No abnormal findings in the right breast. A few typically benign foci are present, scattered in the right breast. No suspicious axillary lymph nodes.

Output: Unifocal biopsy-proven concordant left upper-outer cancer measuring up to 1.3 cm on MRI.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 24-year-old girl with history of Crohn's disease status post ileocecostomy, now with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. Gallstones are noted without evidence of cholecystitis. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal. There is no pancreatic duct dilatation.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys appear normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Patient is status post ileocecectomy. Loops of jejunum are collapsed. There is no evidence of bowel wall thickening. There is no small bowel dilatation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bilateral ovarian follicles are noted.BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis, but no evidence of small bowel inflammation or etiology of abdominal pain.2.Examination limited by lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: 70-year-old female with progressive knee pain and known Baker's cyst. Evaluate for meniscus tear or ligament tears and degree of degenerative changes of the joint. MENISCI: There is a branching linear increased signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial and femoral articular surfaces with associated deformity and blunting of the meniscus consistent with complex tearing that extends to the body of the meniscus. There is lateral extrusion of the body of the meniscus. The anterior horn appears intact.There is globular signal abnormality within the posterior horn and body medial meniscus consistent with intrasubstance degeneration. Some of this signal abnormality extends to the tibial articular surface within the body of the meniscus, indicating undersurface tearing. The posterior and anterior horns appear intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle, posteriorly, above the posterior horn of the meniscus and lateral aspect of the lateral tibial plateau with associated degenerative subchondral signal abnormality. There is full-thickness articular cartilage degeneration along the lateral facet of the patella with underlying degenerative subchondral signal abnormality. There are foci of full-thickness articular cartilage degeneration along the medial facet of the patella with associated degenerative underlying subchondral signal abnormality. There is also full-thickness articular cartilage degeneration along the lateral facet of the femoral trochlea with underlying subchondral signal abnormality. The medial facet of the femoral trochlea appears relatively spared. There is tricompartmental osteophyte formation.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the lateral meniscus.2. Undersurface tearing/fraying of the medial meniscus.3. Tricompartmental osteoarthritic changes with full-thickness articular cartilage degeneration as described above.4. Moderate size joint effusion and Baker's cyst.


Instruction: Generate impression based on findings.

Input: 58-year-old female with chronic history of sinusitis. Patient has history of complex pituitary surgery there is a moderate. Small amount of soft tissue and air density within the sphenoid sinus is noted. There is also presence of air within the sella and a defect across the floor of the sella and across the floor of the sphenoid sinus. All these findings are believed to be secondary to transsphenoidal hypophysectomy. No clinical information regarding the date of the procedure is provided. The amount of Bob soft tissue/fluid density within the sphenoid sinus is more than what was noted on prior study of 9 -- 24 -- 07.Very minimal mucoperiosteal thickening within the dependent portion of bilateral maxillary sinuses is again identified. These were noted on prior MRI examination from 2/27/08 and prior CT examination of the sinuses dated 9 -- 24 -- 07. TheOMUs of maxillary sinuses remain patent.

Output: 1.Postoperative changes of the sphenoid sinus and sella as detailed above.2.Very minimal residual mucoperiosteal thickening in the dependent portion of maxillary sinuses as detailed.3.4.


Instruction: Generate impression based on findings.

Input: 45-year-old woman. Evaluate for myositis. Right femur:There is serpentine geographic signal abnormality within the distal femoral diaphysis and femoral metaphysis, with internal fatty signal, findings representing bone infarct. Otherwise, bone marrow signal intensity of the femur is within normal limits. There is nonspecific diffuse muscle atrophy. There is no evidence of myositis or osteomyelitis.Left femur:Bony marrow signal intensity of the femur is within normal limits. There is nonspecific diffuse muscle atrophy. There is no evidence of myositis or osteomyelitis.

Output: 1. Bone infarct of the distal right femur.2. No evidence of myositis or osteomyelitis.


Instruction: Generate impression based on findings.

Input: Brain: Motion artifact somewhat limits evaluation. There are approximately fiveT2/FLAIR hyperintense lesions involving the periventricular and subcortical white matter compatible with known demyelinating disease. These lesions include a juxtacortical lesion involving the left superior frontal gyrus and periventricular lesions adjacent to the left frontal horn and atria of the bilateral lateral ventricles. There is T1 hypointensity associated with the right parietal lesion. No intracranial mass or mass effect. There is minimal global parenchymal volume loss for age. Thoracic Spine: There are multiple T2 hyperintense lesions throughout the thoracic cord consistent with known demyelinating disease. These lesions are best seen on the sagittal T2 and STIR sequences and include T1-T2, T3-T4, T4-T5, T6, T8, T9, and T10 levels. The right dorsal T1-T2 lesion is associated with mild volume loss similar to prior. At least majority if not all of the remainder of the lesions are present on prior study but more apparent on the current study likely due to differences in technique, and perhaps evolution of the lesions. The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Approximately 5 T2/FLAIR hyperintense lesions in the supratentorial white matter consistent with known demyelinating disease. No prior brain MRI is available for comparison. Addendum can be issued if prior imaging is made available.2. Multiple T2 hyperintense lesions throughout the thoracic cord consistent with demyelinating disease. Prior thoracic spine MRI study was limited due to artifact however in retrospect, the lesions identified on the current study appear to be present (although more subtle) on the prior study. As such there is no convincing evidence of progression of demyelinating disease in the thoracic cord.


Instruction: Generate impression based on findings.

Input: Low back pain, history of herniated disk and lumbar radiculopathy. There is an eccentric left disc protrusion at L5-S1 that results in mild-to-moderate left neural foraminal stenosis, but no significant right neural foraminal or spinal canal stenosis. There is slight disc bulge at L4-5 with minimal left neural foraminal stenosis. There are fatty and edematous degenerative endplate signal alterations at L4-5 and L5-S1 with loss of fluid signal and loss of height of the discs. There is no significant degenerative spondylosis at the other lumbar spine levels. The vertebral column alignment is within normal limits. The vertebral body are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable, aside from mild dependent edema in the posterior subcutaneous tissues.

Output: Mild-to-moderate left L5-S1 neural foraminal stenosis related to a disc protrusion.


Instruction: Generate impression based on findings.

Input: Left vestibular schwannoma resection. Internal Auditory Canal: There has been interval evolution of postoperative findings related to left translabyrinthine surgery with fat graft in the mastoid bowl. There is a heterogeneously enhancing, well-defined, extra-axial mass within the left cerebellopontine angle cistern and skeletonized internal auditory canal that measures 15 AP x 32 RL x 20 SI mm. There is persistent mass effect upon the adjacent left cerebellar hemisphere and pons.Brain: There is no evidence of intracranial hemorrhage or acute infarct. There is unchanged left cerebellar hemisphere encephalomalacia. The ventricles and basal cisterns are unchanged in size and configuration.

Output: Postoperative findings related to left translabyrinthine surgery with residual vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with memory loss, repeating questions, some executive problems on MOCA. Numerous scattered foci of T2 hyperintensity are seen within the subcortical and periventricular white matter. No restricted diffusion is seen. No parenchymal edema or mass effect is detected. There is no evidence to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular size is within normal limits. The sulci are diffusely prominent compatible with underlying parenchymal volume loss.

Output: 1.Scattered white matter signal abnormality which likely reflects chronic microvascular ischemic disease.2.No acute intracranial abnormality.3.Global parenchymal volume loss without specificity of pattern.


Instruction: Generate impression based on findings.

Input: Left thyroid nodule RIGHT LOBE MEASUREMENTS: 6.4 x 2.0 x 2.0 cmLEFT LOBE MEASUREMENTS: 6.6 x 1.8 x 1.8 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Innumerable nodules. The largest measures 1.7 x 1.5 x 1.1 cm it is complex in appearance with several micro-calcificationsLEFT LOBE: Innumerable nodules with the largest measuring 1.3 x 1.2 x 1.3 cm. Similar nodule in the right lobe, it is partially cystic partially solid with microcalcifications.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Innumerable bilateral complex nodules as described. Some are predominately cystic. Most contain microcalcifications.


Instruction: Generate impression based on findings.

Input: 66-year-old female. Left shoulder pain, concern for a rotator cuff tear. ROTATOR CUFF: There is increased signal intensity within the supraspinatus tendon at the 12 o'clock position indicating tendinosis and perhaps mild associated surface fraying. There are small cysts in the underlying humeral head. We see no discrete rotator cuff tear. The supraspinatus muscle is intact. The infraspinatus, subscapularis, and teres minor tendons and muscles are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint resulting in minimal impression on the superior fibers of the supraspinatus. There is trace fluid in the subdeltoid bursa without frank bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Although we see no fluid signal intensity within the superior labrum, intermediate signal intensity within the labrum may reflect a tear. Apparent enlargement of the anterior superior labrum on the axial images may be due to an adherent middle glenohumeral ligament. Both the anterior and posterior labrum are slightly ill-defined, which may reflect additional tearing. There is increased linear signal intensity within the articular cartilage along the anterior inferior glenoid suggesting delamination. Small glenohumeral joint osteophytes are noted. There is a small amount of fluid in the glenohumeral joint without a frank effusion.BICEPS TENDON: The tendon of the long head of the biceps appears normal given the limitation of this non-arthrogram study.ADDITIONAL

Output: 1. Increased signal intensity in the supraspinatus tendon suggests tendinosis but we see no discrete tear.2. Mild osteoarthritis affects the acromioclavicular and glenohumeral joints.3. Findings suggesting degeneration or tearing of the labrum as described above, of questionable clinical significance. This can be further evaluated with MR arthrography if clinically warranted.4. Enlargement and increased signal intensity of the coracoclavicular ligament may reflect mucoid degeneration, perhaps from old trauma.


Instruction: Generate impression based on findings.

Input: 70 years Female (DOB: 6/19/1946)Reason: R/O C5/C6 root impingement History: Neck pain radiating to the LUEPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature which could be related to muscle spasm or patient positioning.At C2-3 there is no significant compromise to the spinal canal. There are right-sided uncovertebral osteophytes present this level associated with encroachment of the nerve roots in the right neural foramen.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal. There is left-sided facet hypertrophy present at this level associated with small uncovertebral osteophytes bilaterally. There is encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At C5-6 there are endplate and uncovertebral osteophytes present at this level associated with a disc bulge and encroachment of the exiting nerve roots within the neural foramina bilaterally. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level with overall mild degree of spinal stenosis.At C6-7 there is no significant compromise to the spinal canal. There are endplate uncovertebral osteophytes present this level associated with disc material and encroachment of the left-sided exiting nerve roots within the neural foramen.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are multilevel degenerative changes present in the cervical spine resulting in neural foramen encroachment of exiting nerve roots on the left side at C4-5, bilaterally at C5-6 and on the left side at C6-7 with lesser degrees of neural foraminal encroachment at other levels. There is a mild degree of spinal stenosis present at C5-6 due to degenerative changes.


Instruction: Generate impression based on findings.

Input: 39-year-old female patient with continued pain after left shoulder arthroscopy partial rotator cuff repair. Evaluate rotator cuff. ROTATOR CUFF: There is linear fluid signal intensity within the anterior fibers of the distal supraspinatus tendon at its insertion indicating a tear. The tear involves the majority of the thickness of the tendon, although the anterior and bursal surface fibers may be spared. We see no frank retraction of the tendon. The tear is approximately 1 cm in AP dimension. There is signal abnormality in the underlying greater tuberosity likely representing cysts and edema. Mild tendinosis affects the adjacent tendon. There is mild fatty infiltration along the myotendinous junction of the supraspinatus muscle, but the muscle otherwise appears normal. The infraspinatus, teres minor, and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. There is a small amount of fluid in the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. We see no joint effusion. The labrum appears normal given limitation of a non-arthrogram study.BICEPS TENDON: The biceps tendon appears intact. A small amount of fluid in the biceps tendon sheath is of doubtful clinical significance.ADDITIONAL

Output: Insertional tear, perhaps "concealed", of the distal fibers of the distal supraspinatus tendon and other findings as described above.