Instruction: Generate impression based on findings.

Input: Redemonstrated is a left middle frontal gyrus mixed intensity/enhancement lesion which is unchanged compared to the 9/3/2015 exam, associated with vasogenic edema but no significant mass effect. There is a new 4 mm ring-enhancing lesion in the lateral aspect of the right cerebellar hemisphere without associated mass effect. There are no other abnormal enhancing foci. Expected vascular flow voids are demonstrated..

Output: 1.There is a new 4 mm ring-enhancing lesion in the lateral aspect of the right cerebellar hemisphere without associated mass effect.2.Results were discussed with Dr. Lesniak on 9/14/2015 at approximately 7:55 AM.


Instruction: Generate impression based on findings.

Input: 65 year-old woman lingular revision, left-sided numbness and vomiting x 3 days Portable CT examination of brain without infusion was performed.No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected. Further evaluation with an MRI is recommended. Cortical sulci, ventricular system and all CSF cisterns remain within normal limits.Calvarium, mastoid air cells and limited view of paranasal sinuses are unremarkable.

Output: Normal MRI of brain.


Instruction: Generate impression based on findings.

Input: 9-year-old male with brain malformation, bilateral open lip schizencephaly, absent septum pellucidum, hypoplastic corpus callosum and dilated ventricles, persistent vomiting Redemonstrated is bilateral open lip schizencephaly connecting lateral ventricles and sylvian fissures, causing "bat-wing" appearance of ventricular system. The ventricles appear dilated but are stable in size. There is absence of septum pellucidum and hypoplasia of corpus callosum. The calvarium appears thinned. These findings are stable in appearance. Gray-white matter differentiation is maintained. There is no acute brain edema, midline shift, hemorrhage, or restricted diffusion/acute infarct. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Stable appearance of bilateral open lip schizencephaly, absence of septum pellucidum and hypoplasia of corpus callosum.


Instruction: Generate impression based on findings.

Input: Other specified postprocedural states [Z98.89], Reason for Study: ^Reason: s/p l4-5 microdisc History: same For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. 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 conus medullaris terminates at the T12-L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: There is evidence of left side laminectomy. There is non enhancing T1 and T2 low signal intensity lesion seems to be attached to remained L45 disc seen on the left side lateral recess. Considering this exam was obtained within 2-3months after microdiscectomy, the diagnostic possibility of this lesion include 1) residual or recurrent disc material or 2) postoperative blood products. The disc height has decreased, unchanged. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Post laminectomy and microdiscectomy status of L45 extruded disc.2. Non enhancing lesion located on the left side lateral recess of L45 disc space, diagnostic possibilities include 1) residual or recurrent disc material and 2) postoperative blood products.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with history of spinal meningioma status post lumpectomy and decompression. Evaluate for residual or recurrent tumor. Since the prior examination, acute postoperative findings related to T2-T4 laminectomy and tumor resection have resolved. There is no longer any significant fluid within the operative bed, and only minimal residual edema is seen in the paraspinal soft tissues.Postcontrast images are limited by motion artifact. Given this caveat, the dorsal epidural soft tissues in the operative bed are enhancing compatible with scar. In addition, the right lateral epidural soft tissues at T3 are slightly thickened and enhancing with involvement of the right T3-4 neural foramen. This thickening is similar to that seen on the prior examination and improved when compared to the preoperative study.The previously demonstrated left lateral epidural enhancement at T11-12 is not appreciated on the present examination. However, motion degradation may contribute to this. No other definite intraspinal enhancing lesions are seen. The spinal cord demonstrates normal signal intensity throughout.Spinal alignment is anatomic. Vertebral body height and morphology are grossly unremarkable. Degenerative endplate signal abnormality at T3-4 has perhaps slightly increased. No worrisome marrow signal abnormality is detected. Multilevel disc osteophyte formation is redemonstrated similar to prior. There may be mild associated spinal canal narrowing at T3.

Output: 1.Postoperative findings are redemonstrated compatible with laminectomy and tumor resection from the upper thoracic spine. Dorsal epidural soft tissue thickening in the operative bed is likely related to scarring. 2.Thickening in the right lateral epidural space and adjacent neural foramen at T3-4 is similar to the prior postoperative exam and could reflect scarring, residual tumor or a combination of the two. 3.A previously demonstrated area of enhancement within the left lateral epidural space at T11-12 is not appreciated on the current study, though this could be due to motion related image degradation.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate for intracranial process, metastases. Signs and symptoms: Altered mental status, metastatic disease or joint cancer. Non-enhanced CT of brain:Examination demonstrates no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. There is revisualization of nonspecific periventricular and subcortical white matter patchy area of low-attenuation that are believed to represent small vessel disease. These findings were present on prior exam and demonstrate no gross interval change. No evidence of metastatic lesion to the brain on this non-infusion study. Lack of intravenous contrast enhancement significantly reduces the sensitivity of this exam for detection of small metastatic lesions. Follow up with an enhanced study or an MRI is recommended.Calvarium is intact. Limited images of orbits are unremarkable. Mastoid air cells and limited real paranasal sinuses are unremarkable.

Output: 1.Findings consistent with small vessel disease of indeterminate age and with no gross interval change since prior exam.2.Enhanced examination will significantly increase the sensitivity of the test for detection of metastatic lesions. This non-infused study demonstrate no large metastatic lesions.3.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.


Instruction: Generate impression based on findings.

Input: 13-year-old male with blunt trauma to cervical spine now with difficulty walking and pain. The spinal cord is normal in caliber and signal throughout. No evidence of any pathologic intradural or extradural fluid is seen. The conus tip terminates at the T12-L1 level which is within normal limits.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are normal. No evidence of marrow edema is seen. The spinal canal and neural foramina are patent throughout. No disc abnormalities are seen.

Output: Unremarkable evaluation of the spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: L gastrocnemius AVM, please evaluate extent of mass History: above BONES: The distal femurs, proximal tibias, and proximal fibulas have normal bone marrow signal.SOFT TISSUES: Within the left medial head of the gastrocnemius (series 601, image 25) there is a area of T2 and T1 hyperintensity with enhancement on the postcontrast images measuring 19 x 18 mm, previously 15 x 7 mm. Susceptibility artifact and posttreatment changes are noted in this location. No significant flow voids identified on T2 weighted images. Normal muscular branches are seen without large feeding vessel identified.The remaining musculature of the distal thigh and lower leg appears normal.VASCULATURE: Normal popliteal artery, proximal anterior tibial, posterior tibial, and peroneal artery are seen without evidence of significant stenosis, occlusion, or aneurysm. Please note that the technique was optimized for imaging of major vessels and does not resolve small caliber arteries such as the geniculate arteries.

Output: Slight increase in size of previously treated AVM without large feeding vessel or flow voids to suggest rapid flow. IR consultation with diagnostic angiogram and possible re-embolization can be considered if clinically warranted.


Instruction: Generate impression based on findings.

Input: Ms. Kerulis is a 37 year old female with biopsy proven malignancy of the left breast and metastatic left axillary lymph node. She is currently on the I-SPY 2 research protocol. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left upper outer breast, there is an irregular enhancing mass identified measuring approximately 7.4 x 3.9 x 6.0 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen within the central aspect of this lesion, compatible with biopsy-proven malignancy. There is no additional abnormal enhancement identified in the left breast.At least 4 abnormal lymph nodes are identified in the left axilla, the largest of which measures approximately 3.6 cm. Susceptibility artifact from biopsy marker clip is seen within the peripheral aspect of this lymph node, compatible with biopsy-proven metastatic left axillary lymph node.RIGHT BREAST: In the right lower inner breast, there is an oval subcentimeter enhancing mass with internal fat signal intensity identified. This corresponds to the mammographically seen benign morphology mass, and is compatible with a benign intramammary lymph node. No abnormal enhancement is seen in the right breast.No abnormal axillary lymph nodes are identified in the right axillary region.

Output: (1) Biopsy proven malignancy of the left breast with metastatic left axillary lymph node.(2) No MRI evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Right shoulder injury, thrown from car. Check for rotator cuff and labral issues ROTATOR CUFF: The rotator cuff is well visualized and demonstrates mild to moderate changes within the supraspinatus including thickening and a small linear signal abnormality along the undersurface of the supraspinatus approximately 1 cm from its attachment representing a small split tear. No full-thickness abnormality is observed and fibers are intact throughout. Remainder of the rotator cuff is otherwise intactSUPRASPINATUS OUTLET: Mild to moderate osteoporotic changes with minimal narrowing.GLENOHUMERAL JOINT AND GLENOID LABRUM: Labrum is grossly intact in this nonaugmented exam. Minimal degeneration along the superior anterior aspect cannot entirely be excluded. Mild to moderate degenerative changes are otherwise observed including AC joint.BICEPS TENDON: A longitudinal split tear is observed along the biceps tendon in which the components remain within the bicipital groove appropriately ADDITIONAL

Output: Small-to-moderate undersurface tear of the supraspinatus and split tear of the biceps tendon, as described.


Instruction: Generate impression based on findings.

Input: word finding deficit, history of NSCLC. Multiple restricted diffusion lesions on bilateral hemispheres, right thalamus and right cerebellar hemisphere indicating acute ischemic infarctions. No evidence of hemorrhagic conversion.The left side of clivus shows relatively well marginated, subtle enhancing lesion (22mm x 17mm) about mainly low signal intensity on T1 and low signal intensity on T2 weighted images. Considering the patient's history of NSCLC and prior PET scan, this lesion is likely represent metastatic bony lesion. The ventricles, sulci and cisterns are symmetric and unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage,or abnormal contrast enhancement. The midline structures are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal flow enhancement in bilateral ICAs, bilateral MCAs and ACAs. Acom artery is patent and right Pcom artery is patent but the left Pcom is not seen. There is no intracranial aneurysm. There is no intracranial large vessel occlusion.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. 3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Multifocal acute ischemic infarctions on bilateral hemispheres, right thalamus and right cerebellar hemisphere without evidence of hemorrhagic conversion.2. 22mm x 17mm sized lesion on the left side of clivus likely represent metastatic lesion.3. No evidence of intracranial arterial aneurysm. No intracranial arterial stenosis.4. Normal extracranial craniocervical arterial system.5. Normal intracranial superficial and deep venous system on MRV.


Instruction: Generate impression based on findings.

Input: Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: mid brain damage History: bilateral blown pupils There is right thalamic acute ICH extended toward midbrain and possibly upper pons associated with IVH and mass effects.Midline shift toward left side at the level of foramen of Monroe is measured about 12mm, no significant interval change since prior scan.Ventriculostomy tube was inserted through the left frontal burr hole with track hematoma.There is evidence of right frontal burr hole with linear white matter high signal intensity indicating prior ventriculostomy tube track.No evidence of acute ischemic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Mucosal thickenings on paranasal sinuses and fluid collections on bilateral mastoid air cells.

Output: 1. Large right thalamic ICH which extends through the midbrain and possibly upper pons with IVH and surrounding edema. Midline shift toward left side is measured about 12mm.2. Ventriculostomy tube inserted through the left frontal burr hole with minimal track hematoma.


Instruction: Generate impression based on findings.

Input: 59 year-old BRCA1 positive with family history of breast and ovarian cancer. MRI high risk screening study IR 13073B There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Pain, check for meniscal tear. Acute onset right-sided pain and swelling. MENISCI: A radial tear is observed involving the posterior medial meniscus adjacent to the midline with relative preservation of the remaining medial meniscus and lateral meniscus entirelyARTICULAR CARTILAGE AND BONE: Diffuse cartilaginous thinning in both the medial and lateral compartments with more pronounced loss and irregularity observed in the patellofemoral compartment. Associated underlying mild to moderate degenerative changes and cysts, similar to the plain film evaluation. Marrow signal otherwise unremarkableLIGAMENTS: Specifically the ligaments are intact without a definite acute abnormality other than a mild changes representing a suspected minimal strain of the medial collateral ligament.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Posterior medial meniscal radial tear with a moderate effusion. Scattered moderate degenerative changes, see detail provided


Instruction: Generate impression based on findings.

Input: Right parapharyngeal mass, possibly right paraganglioma: evaluate extent of mass to vessels. MRI: There is a heterogeneous right parapharyngeal mass that measures up to approximately 25 mm. The mass appears to encase the right internal carotid artery, which is slightly narrowed. The mass also compresses the right internal jugular vein. The mass appears to be distinct from the deep lobe of the parotid gland. There are multiple enlarged right cervical lymph nodes, involving levels 2 through 5. For example, a right level 2B lymph node measures 17 x 24 mm. There is asymmetric enlargement of the right palatine tonsil with an apparent mass that measures up to approximately 10 mm in width. The nasopharynx, hypopharynx, and larynx appear to be intact. The thyroid and salivary glands appear unremarkable. There is multilevel degenerative spondylosis with mild spinal canal stenosis from C4 to C7. The orbits are unremarkable. There is mild bilateral maxillary sinus mucosal thickening. There is a cystic lesion in the left sella, which measures up to approximately 10 mm. MRA: Aside from mild narrowing of the right internal carotid artery due to encasement by tumor, the other major cervical arteries are patent.

Output: 1. A right parapharyngeal mass may represent an abnormal lymph node that encases the internal carotid artery, rather than a paraganglioma. Indeed, multiple right cervical lymph nodes are also pathologic.2. Asymmetric enlargement of the right palatine tonsil with what appears to be a mass may represent a squamous cell carcinoma, with metastatic disease to the right neck lymph nodes.3. A cystic lesion in the left sella measures up to approximately 10 mm. A dedicated pituitary exam may be useful for further evaluation.Discussed with Maureen Crowley at 4:35 PM on 10/22/15.


Instruction: Generate impression based on findings.

Input: 65 year old male with SVT sp ablation with 22 % PVCs and new LV dysfunction (LVEF 41%) Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 39%. The LVEDV is 323 ml (normal range 142+/-34), the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVESV is 197 ml (normal range 47+/-19) and the LV end systolic volume index is 78 ml/m2 (normal range 25+/-9). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is <1050 ms in the septum and lateral wall suggestive of absence of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 56%. The RVEDV is 228 ml (normal range 142+/-31), RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVESV is 101 ml (normal range 54+/-17), and the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9).There is no abnormal wall motion or evidence of pseudoaneurysms in the right ventricular wall. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is severely dilated with moderately reduced systolic function. LVEF 39%.2.The right ventricle is mildly dilated with normal systolic function. RVEF 56%. No imaging findings to suggest ARVC.3.Moderate left atrial dilation.4.No areas of late gadolinium enhancement to suggest a fibrotic, infiltrative or inflammatory process.


Instruction: Generate impression based on findings.

Input: Ms. Levin is a 53-year-old female with family history of breast cancer in mother. Personal history of benign left breast biopsy. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Per our records, the patient's last screening mammogram was in 8/2013. If she obtained one at an outside institution, then this can be submitted for comparison purposes and an addendum can be issued. Otherwise, the patient is due for an annual screening mammogram.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Any brain tumor or other abnormalities. History of neurofibromatosis type 2, migraines, meningioma orbital ridge, ptosis. Brain/Orbits/IAC: Again seen are multiple extra-axial masses in the brain. The relatively largest of these is an enhancing lesion along the right anterior frontal convexity measures 23 x 26 x 18 mm in the AP, transverse, and craniocaudal dimensions. There is mass effect on the right superior frontal gyrus. Previously this lesion measured approximately 23 x 16 x 11 mm. There are multiple small additional lesions along the falx and convexities likely representing small meningioma and are stable to slightly larger compared to 7/7/2008 with differences in technique slightly limiting comparison.There is an 8 x 9 mm extra-axial lesion involving the interpeduncular cistern on the right which is also larger and may represent a schwannoma of the third nerve. Additional tiny lesion is seen on the left as well. There is a 17 x 13 mm lesion involving the right Meckel's cave which appear slightly larger.  There is a 7 x 8 mm area of abnormal enhancement at the right cerebellopontine angle at the nerve root entry zone of the seventh and eighth nerves which is increased since prior and suspected to represent a recurrent schwannoma at the right cerebellar pontine angle cistern. No significant mass effect. There is abnormal enhancement involving the right internal auditory canal which appears more confluent then prior. There are postsurgical changes of prior retrosigmoid craniotomy and encephalomalacia along the right lateral cerebellar hemisphere.There is abnormal enhancement involving the right geniculate ganglion measuring approximately 9 x 7 mm, previously approximately 6 x 6 mm on prior. There is subcentimeter area of abnormal enhancement at the level of the geniculate ganglion of the facial nerve on the left which is more prominent in the interval. There is enlargement of enhancing right orbital mass measuring 27x20x17 mm, previously 20 x 19 x 15 mm likely representing a right optic sheath meningioma. There is increased mass effect on the right optic nerve.There is a 18x14x18 mm enhancing lesion in the left parotid gland minimally large since prior and likely represents a schwannoma. Again seen are multiple T2/flair hyperintense foci involving the periventricular and subcortical white matter similar to prior. No significant intracranial mass effect aside from the right frontal lobe. No midline shift or herniation. No hydrocephalus. There is a nonspecific focus of T1 hyperintensity involving the right anterior ethmoid sinus.Lumbar Spine:Vertebral body heights in the lumbar spine are normal. Alignment is normal. Bone marrow signal is benign. There is no significant spinal canal or neural foramina stenosis. There is enhancing lesion involving the cauda equina nerve roots at the L2 level measuring approximately 6 x 5 x 7 mm and not significantly changed since 3/29/2007. There is also a 3-mm lesion involving the cauda equina nerve roots on the left at L2 level, which is better seen on the axial T2 sequence, and also appears to be present on prior. There are additional multiple lesions involving the cauda equina nerve roots as was noted previously but not well seen on the current study as the axial post gad sequence is motion degraded. No largely lesion however is seen.There is 4-cm T1 hyperintense lesion in the right adnexa which is incompletely evaluated and can be assessed with pelvic ultrasound as clinically appropriate.

Output: 1. Stigmata of neurofibromatosis type II with multiple enhancing masses likely representing meningiomas and schwannomas as detailed above. Although differences in technique limit direct comparison, there does appear to be enlargement with many of these lesions. 2. Relatively largest of the lesions is a right frontal meningioma measuring 23 x 26 x 18 mm and larger. There is mild associated mass effect.3. Right orbital mass likely representing optic nerve sheath meningioma is larger. 4. There is increase in enhancement of within the right internal auditory canal as well as a a small right cerebellopontine angle lesion which is slight larger suspected to represent tumor recurrence at site of prior resection. Right Meckel's cave, bilateral geniculate ganglia, left parotid, and interpeduncular cistern lesions also slightly larger likely representing schwannomas.5. Lumbar spine images again demonstrate multiple subcentimeter intradural extramedullary lesions involving the cauda equina nerve roots and not significantly enlarged since 3/29/2007.


Instruction: Generate impression based on findings.

Input: Edema, open wound, nonhealing LLE. Assess for "osteo", fluid collection Bandage material overlies the lower leg. There is swelling and ulceration of the anterior soft tissues. There is chronic appearing periosteal reaction along the tibial and fibular diaphyses that is new when compared with the prior radiograph study, although likely corresponds to the chronic periosteal reaction seen on the more recent CT and MRI examinations. This may reflect chronic osteomyelitis, but I see no frank osteolysis to confirm acute osteomyelitis at this time. I see no gas density within the deep soft tissues. Severe osteoarthritis affects the knee.

Output: Soft tissue swelling and ulceration as described above. Chronic tibial and fibular periosteal reaction may reflect chronic osteomyelitis, but I see no frank osteolysis to confirm acute osteomyelitis. If further imaging evaluation is clinically warranted, MRI may be considered.


Instruction: Generate impression based on findings.

Input: 25-year-old man with history of ulcerative colitis and biliary strictures, now with elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology.There is mild irregularity of the intrahepatic bile ducts (10/89 and 10/98) with subtle stricturing but only minimal intrahepatic biliary ductal dilatation. Extrahepatic bile duct is normal in caliber.Portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is normal in caliber. No focal parenchymal lesion identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent peripancreatic and portacaval lymph nodes noted (8/32 and 8/28).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild intrahepatic biliary ductal irregularity with minimal intrahepatic biliary ductal dilatation and no dominant stricture or evidence of mass.


Instruction: Generate impression based on findings.

Input: 47-year-old male with left-sided weakness, evaluate for stroke There is no restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. 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. Mild gliosis and subtle volume loss in the right anterior temporal lobe is unchanged. There is also global parenchymal volume loss, which is stable. No hydrocephalus. Major flow-voids are preserved. Note is made of a partially to sella. Paranasal sinuses and mastoid cells are clear.

Output: 1.No evidence of acute infarct.2.Stable mild chronic small vessel ischemic changes.3.Stable global parenchymal volume loss, which is advanced for age, similar to prior. 4.Stable mild right anterior temporal encephalomalacia is also unchanged, which may be related to remote trauma or other injury.


Instruction: Generate impression based on findings.

Input: Reason: HCC and CCA s/p resection, followup History: hep B ABDOMEN:LIVER, BILIARY TRACT: Status post resection of right hepatic lobe with compensatory left hepatic lobe hypertrophy. No suspicious lesion. Patent portal and hepatic veins. Stable mild ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Benign intracranial hypertension [348.2] / Encounter for other specified aftercare [V58.89] / Compression of brain [348.4], Reason for Study: ^Reason: Chiari malformation , please do with CSF flow study post Chiari decompression. Brain MRI:There is evidence of suboccipital craniectomy. No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-Spine MRI:Suboccipital craniectomy is again seen.There is normal cervical lordosis. The cervical 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. There are minimal central focal bulging of discs at the level of C34, 45, 56 and C67 without evidence thecal sac compression.CSF Flow study:The brain CSF flow study does not include phase imaging sets. On magnitude images which might include some of phase images, demonstrated normal craniofugal and cranio petal flow of the CSF through the foramen magnum. However, there is minimal craniofugal flow on the posterior aspect of the foramen magnum including upper cervical level CSF flow. There are however, minimal cranio petal flow on the posterior aspect of the cerebellar hemisphere. Above findings suggest the CSF flow of the posterior aspect of foramen magnum and upper cervical cord appears to be restricted but the anterior aspect of foramen magnum and upper cervical cord appears to be maintained and the magnitude of the flow appears to be slightly decreased comparing to that of the anterior aspect of the brain stem.

Output: 1. Post suboccipital craniectomy status due to Chiari malformation.2. No evidence of acute ischemic or hemorrhagic lesion. Ventricle size appears to be normal.3. CSF study shows decreased flow but maintaining pulsatile flow on the anterior aspect of the foramen magnum and upper cervical cord. However, posterior aspect of the foramen magnum and upper cervical cord level appears to be restricted.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of brain, unspecified site Other postprocedural status(V45.89)Clinical question: 11-year-old male with history of cerebellar juvenile pilocytic astrocytoma, follow-up evaluationSigns and Symptoms: 6 month follow up for changes The patient is status post posterior fossa surgery. A surgical defect is present along the medial aspect of the left cerebellar hemisphere which is stable compared to the previous exam and associated with minor FLAIR/T2 signal hyperintensity and SWI hypointensity at the surgical margins. No abnormal enhancing lesions are appreciated within the brain parenchyma to suggest recurrence.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The patient is status post suboccipital craniotomy for tumor removal. The examination is stable when compared to the previous exam. There is no convincing evidence for local recurrence.


Instruction: Generate impression based on findings.

Input: 72-year-old female with incidentally found right complex renal cyst. Surveillance imaging. ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology. No parenchymal lesions. Status post cholecystectomy. The common bile duct measures 9 mm in diameter, which can be normal for age status post cholecystectomy. Stable mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No discrete lesion or significant enhancement within the anterior aspect of the pancreatic neck corresponding to the enhancing focus on the 2/13/2016 CT exam. No pancreatic ductal dilatation. Unusual orientation of the pancreatic tail anteriorly (axial series 701 image 251), however there is no change in size or appearance since the 2/13/2016 CT exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts, some of which demonstrate T1 hyperintense signal. No enhancing components are identified. Bilateral cysts are stable in size. No hydronephrosis.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. Bilateral nonenhancing renal cysts. Some cysts again demonstrate T1 hyperintense signal, which could represent hemorrhagic or mucinous cysts. No significant interval change.2. No suspicious lesion or focal enhancement of the pancreatic neck parenchyma.


Instruction: Generate impression based on findings.

Input: Altered mental status demyelination versus concussion related injury. Left upper extremity and left lower extremity hyperreflexia. Brain: Brain parenchyma appears within normal limits. No lesions to suggest demyelinating disease. No evidence of hemorrhage or traumatic encephalomalacia. No restricted diffusion to suggest acute ischemia. 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.Cerebellar tonsils are borderline low without evidence of crowding at the foramen magnum. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Examination is slightly motion degraded but no discrete lesion or signal abnormality in the cervical cord is appreciated. No abnormal enhancement. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Brain and cervical spine MRI appear within normal limits. Specifically, no findings to suggest demyelinating disease. No appreciable evidence of traumatic injury to the brain or cervical cord.


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: Concern for neurodegenerative disease History: numbness, weakness There is no evidence of abnormal enhancement.There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and 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 cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of L1. No change of central protrusion of L5S1 disc.

Output: No evidence of abnormal enhancement on this scan.No change of L5S1 disc protrusion since prior scan.


Instruction: Generate impression based on findings.

Input: 62 years Male (DOB:12/29/1953)Reason: hx cervical stenosis. Eval for abnormality. History: Left arm pain/ hx ulnar nerve decomp. Claw handPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The patient status post anterior fusion at 3 C6-7 with anterior plate and screws.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a broad-based central disc protrusion present this level which is unchanged compared to the prior examAt C3-4 there is redemonstration of a broad-based left lateral recess disc protrusion which encroaches on the left-sided exiting nerve roots within the neural foramen. There are some endplate and uncovertebral osteophytes at this level and There are some endplate reactive changes present which are bright on T2 STIR and dark on T1.At C4-5 there is loss of disc space height, disc desiccation and a disc bulge associated with endplate and uncovertebral osteophytes. There is partial effacement of spinal fluid ventral but not posterior the spinal cord at this level. There is narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots within the neural foramina bilaterally this was also present on the previous exam and has not changed substantially.At C5-6 there is some loss of disc space height, diffuse disc bulge and ligamentum flavum hypertrophy associated with some uncovertebral osteophytes bilaterally and encroachment of the exiting nerve roots within the neural foramina bilaterally due to disc material and uncovertebral osteophytes. These findings were also present on the previous exam and have not changed substantially. Overall there is a mild to moderate degree of spinal stenosis at this level which is also stable compared to the prior exam.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this levelThe vertebral artery flow voids appear to be intact.There is a disc bulge at T2-T3 associated with neural foramen encroachment of exiting nerve roots. This remains stable compared to the previous exam.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with the narrowing of the neural foramina more on the left than the right side. There is associated facet hypertrophy at this level. There are some encroachment of the left-sided exiting nerve roots within the neural foramen at this level. There are some endplate reactive changes at this level which are high signal on T1 and T2. There is a right lateral recess disc protrusion at this level which extrudes behind the adjacent S1 segment and encroaches on the nerve root at the right lateral recess.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height and a disc bulge at this level associated with facet and ligamentum flavum hypertrophy.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level and a right far lateral disc protrusion there is crowding of the nerve roots within the thecal sac at this level and overall a mild to moderate degree of spinal stenosis.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present in the cervical spine with mild to moderate spinal stenosis at C5-6 and mild spinal stenosis at C3-4 which has not progressed significantly since the previous exam. Associated encroachment of exiting nerve roots at C3-4, C4-5 , C5-6 and T2-3 has also not progressed significantly compared to the prior exam.2.Since prior exam some endplate reactive changes at C3-4 have entered acute or subacute phase. This would suggest some active inflammation predominantly on the left side at this level.3.There is a right lateral recess disc extrusion at L5-S1 which encroaches on the nerve roots at the right lateral recess (probably right S1 nerve roots).4.There are degenerative changes present lumbar spine with associated mild-to-moderate spinal stenosis at L2-3 and encroachment of the left-sided exiting nerve roots at L5-S1 (probably left L5 nerve roots).


Instruction: Generate impression based on findings.

Input: Left-sided weakness. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a partially empty sella and mild distention of the optic sheaths. Otherwise, the orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no flow-limiting stenosis, occlusion or aneurysm. Anatomy at the circle of Willis is conventional.MRV: The right transverse sinus and upper right internal jugular are small/hypoplastic. The major venous sinuses appear to be patent.

Output: 1.MRI of the brain is within normal limits. Specifically no evidence of acute infarct. 2.There is a partially empty sella and mild prominence of the optic nerve sheaths, which can be normal variant but also can be associated with intracranial hypertension in the appropriate clinical setting.3.Normal brain MRA. 4.Normal brain MRV.


Instruction: Generate impression based on findings.

Input: Chronic ankle pain TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Moderate joint effusion with tenosynovitis of the flexor hallucis longus.


Instruction: Generate impression based on findings.

Input: Unremitting headache for 2 weeks, with opening pressure of 27. 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 orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening.MRV: The major cerebral venous sinuses appear to be intact.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or ventriculomegaly.2. No evidence of venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: Arm weakness. Rule out stroke.. Brain MRI: There is a punctate lesion in the periventricular white matter of the right occipital lobe is associated with diffusion restriction. There is encephalomalacia in the pons. There are also multiple T2 hyperintense lesions in the cerebral white matter without restricted diffusion. There is no acute intracranial hemorrhage. There is no intracranial mass lesion or midline shift. The ventricles are normal in size and symmetric. The pituitary gland appears unremarkable. The orbits, skull and scalp soft tissues are grossly unremarkable. A T1 hyperintense retention cyst in the maxillary sinus is present. In the left posterior neck, there is a subcutaneous lesion that measures up to 3 cm in diameter and likely represents an inclusion cyst, but is incompletely characterized. Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. Recent punctate infarct in the periventricular white matter of the right occipital lobe. 2. Chronic infarction of the pons and a background of probable chronic small vessel ischemic white matter disease. 3. No evidence of significant steno-occlusive lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 80 year-old female with history of metastatic breast cancer. Evaluate for metastatic disease. There are diffuse areas of decreased signal abnormality present within the calvarium and visualized cervical vertebrae likely secondary to extensive sclerotic osseous metastasis. There is an enhancing mass occupying the left occipital condyle. Furthermore, there is a briskly enhancing nodule present just inferior to the left transverse sinus involving the paramedian occipital bone with dural and probable intradural components. It is difficult to assess whether this nodule invades the transverse sinus. There is no evidence of surrounding parenchymal abnormality.There is no evidence of intracranial hemorrhage or acute ischemia. There are scattered foci of T2/flair hyperintensity within the periventricular and subcortical white matter. There are no areas of abnormal parenchymal enhancement. The ventricular configuration is age appropriate. The orbits are unremarkable. The visualized paranasal sinuses and mastoid air cells are clear. Normal intracranial that flow voids are present.

Output: 1.No evidence of metastatic disease to the brain parenchyma.2.Diffuse osseous metastatic disease as above.3.Briskly enhancing nodule adjacent to the left transverse sinus with osseous, dural and probable intradural extension, also likely representing a metastatic lesion given the context. An atypical meningioma or hemangiopericytoma may also be considered in the differential.4.Scattered foci of T2/flair hyperintensity within the periventricular and subcortical white matter likely represents chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with history of non-small cell lung cancer with brain metastases, restaging examination. Faint punctate enhancing cortical foci are seen along the superior surface of the left superior temporal gyrus (see image 113 series 1202), and along the superior lateral right occipital lobe (see image 112 series 1202). These lesions were both larger and better visualized on the prior examination.No additional pathologic parenchymal enhancement is seen. However, there is a 12 mm homogeneously enhancing mass at the left cranial vertex which abuts the adjacent dura and the superior sagittal sinus with perhaps minimal ingrowth into the overlying calvarium. This lesion mildly displaces the underlying brain parenchyma but causes no edema. When compared to the prior examination, there has been no significant interval change.Scattered nonspecific foci of parenchymal T2 hyperintensity are unchanged. No evidence of significant parenchymal edema or mass effect is observed. Diffusion-weighted images are within normal limits. No intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. Ventricular size and morphology are within normal limits.

Output: 1.Two small foci of enhancement are vaguely perceived, one along the left superior temporal gyrus, and one in the superior lateral right occipital lobe. Both these lesions are smaller and more difficult to visualize than on the prior examination. This could reflect the effect of treatment and/or differences in technique.2.A homogeneously enhancing extra-axial mass at the left paramedian vertex is seen. The features of this lesion are most consistent with a meningioma. Metastatic disease would be much less likely, though continued attention on follow-up examinations is advised.3.No definite additional enhancing lesions are seen.


Instruction: Generate impression based on findings.

Input: Lung cancer, pancreatitis, and brain metastases. There are numerous supratentorial and infratentorial enhancing lesions with associated mild vasogenic edema. For example, a left superior cerebellar lesion measures up to 9 mm, a left pontine lesions measures up to 7 mm, and a right parietal lobe lesion measures up to 6 mm. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: Numerous subcentimeter supratentorial and infratentorial brain metastases without midline shift.


Instruction: Generate impression based on findings.

Input: Reason: fall from treadmill, pain to left hip, 81F hx of HTN Mild osteoarthritis affects the left hip, appearing similar to that seen on the 2012 study. Mild irregularity of the anterior cortex of the femoral neck likely represents osteophyte formation, but if there is strong clinical concern for fracture, MRI may be considered. Osteoarthritis affects the lower lumbar spine and the left sacroiliac joint.

Output: Osteoarthritis of the left hip without fracture, however if there is strong clinical concern for hip fracture MRI may be considered.


Instruction: Generate impression based on findings.

Input: 21 years, Male, GTC seizures, generalized discharges on EEG. Juvenile myoclonic epilepsy.. Brain parenchyma appears within normal limits for age. There are no findings to suggest a seizure focus. No cortical lesions or evidence of gray matter heterotopia. Bilateral hippocampi are symmetric in size and signal characteristics with preserved internal architecture. No intracranial mass or mass effect. No evidence of ischemia or hemorrhage. Ventricles and sulci are within normal limits. No extra-axial collections. No abnormal parenchymal or meningeal enhancement. There are mucous retention cysts in the bilateral maxillary, left frontal, and sphenoid sinuses. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.

Output: No findings to suggest seizure focus.


Instruction: Generate impression based on findings.

Input: Reason: altered mental status to evaluate for stroke History: weakness, altered mental status MRI of the brainThere is a focus of diffusion restriction present along the left half of the splenium of the corpus callosum.There is a mild to moderate degree of periventricular and subcortical punctate and partly confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eye lens is thin.MRA brain:Exam is degraded by patient motion.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The distal left PCA at the P3 segment appears slight more attenuated than the left.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left A1 segment is small. The posterior communicating arteries are intact. The vertebral arteries are asymmetric in size - left larger than right.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. There is a moderate amount of patient motion present. Antegrade flow in the carotid and vertebral vasculature can be discerned, however, stenosis may be obscured by the motion artifact.

Output: 1.Exam is degraded by patient motion which may obscure subtle abnormalities.2.There is an acute/subacute infarction involving the left half of the splenium of the corpus callosum.3.The distal left PCA at the P3 segment appears slight more attenuated than the left. However, given the patient motion this may very well be artifactual.4.There is antegrade flow in the cervical vertebral and carotid arteries, however, stenosis may be obscured by the motion artifact.5.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 6.If additional information is needed, a CTA may be helpful given its shorter acquisition time relative to MRI/MRA


Instruction: Generate impression based on findings.

Input: 41-year-old female with generalized abdominal pain. History of scleroderma. Rule out obstruction. ABDOMEN:LUNG BASES: Moderate cardiomegaly. Moderate pericardial effusion. Interstitial lung disease at both lung bases may be due to scleroderma. Diffuse esophageal wall thickening and dilatation.LIVER, BILIARY TRACT: Diffuse infiltrative changes in the liver, especially the right hepatic lobe, narrows the hepatic veins near the intrahepatic IVC. This may be due to fatty infiltration or other etiology. Dedicated hepatic CT or MRI examination may be helpful for further evaluation, if indicated.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: A mesenteric lymphadenopathy is present, most prominently at the mesenteric root. For reference, a mesenteric node measures 1.3 x 2.4 cm axial image 71/144 of series 3.BOWEL, MESENTERY: Diffuse small bowel wall thickening. No definite evidence of bowel ischemia. Normal appendix in the right lower quadrant. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of ascites is present.PELVIS:UTERUS, ADNEXA: Uterus is atrophic or absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted

Output: Cardiomegaly with moderate pericardial effusion. Ascites. Infiltrative changes in the right hepatic lobe, see above. Chronic changes in lung and bowel from scleroderma. Mesenteric lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female, 48 years old, with history of left parotid cancer status post surgery. Assess for recurrence. Pain and numbness in the right shoulder. History of cervical spine surgery. Cervical spine:Evidence of instrumented anterior fusion is again seen from C4 through C6 similar to prior. The cervical lordosis is straightened, but the alignment is otherwise unremarkable. Vertebral body heights are preserved. No concerning marrow signal abnormality is seen. No pathologic enhancement is detected. The visualized spinal cord is unremarkable except as discussed below.C2-3: Unremarkable. C3-4: Mild facet hypertrophy. Posterior disc-osteophyte complex formation. Mild to moderate spinal canal narrowing slight flattening of the ventral cord. Mild right foraminal narrowing. No interval changes. C4-5: Left paracentral osteophytic spurring causing slight flattening of the ventral cord and mild generalized spinal canal stenosis. No significant foraminal narrowing. No interval changes. C5-6: Left paracentral osteophytic spurring with minimal spinal canal narrowing and no significant cord impingement. No significant foraminal narrowing. No interval changes. C6-7: Broad disc osteophyte complex resulting in a mild to moderate spinal canal stenosis. Moderate to severe left and moderate right foraminal narrowing. No interval changes. C7-T1: Unremarkable. Evidence of left parotidectomy is discussed more fully below.Neck soft tissue:Sequelae of left parotidectomy is seen with minimal residual parotid tissue. Scarring and volume loss are noted. No evidence of nodular or masslike soft tissue or worrisome enhancement is seen in the operative bed.The remaining salivary glands are unremarkable. No pathologic adenopathy is detected in the neck by size criteria. Two or three subcentimeter T2 hyperintense nodules are evident within the left thyroid lobe. There may be a 1 cm heterogeneous nodule along the posterior aspect of the right thyroid lobe.

Output: 1.Redemonstration of postoperative findings in the cervical spine without significant interval change.2.Scattered mild to moderate cervical degenerative disease is unchanged.3.Redemonstration of sequelae of left parotidectomy. No evidence to suggest recurrent primary tumor is seen. No pathologic adenopathy is detected in the neck.4.No other specific findings are seen to account for the patient's right-sided symptoms.5.Nonspecific thyroid nodules are seen for which dedicated ultrasound assessment can be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: left side hemiparess No evidence of acute ischemic or hemorrhagic lesion.There is focal encephalomalacia on the right side of pons which does not show any significant interval change since prior exam.Few scattered high signal intensity lesions on bilateral hemispheres on FLAIR images are non specific, no change since prior exam.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No change of right pontine focal encephalomalacia since prior exam.


Instruction: Generate impression based on findings.

Input: Reason: pain / eval for AVN History: pain. ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Bone marrow edema with the femoral head and neck. Serpiginous low signal within the femoral head compatible with AVN. No flattening of the femoral head. SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Left femoral head AVN.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There is partial tearing of the superior fibers of the supraspinatus and infraspinatus tendon with minimal retraction of the tendon. This is superimposed upon moderate tendinopathy of the supraspinatus. There is a mild amount of increased signal within the subdeltoid bursa likely reflecting mild bursitis. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Partial tears superior fibers of the supra and infraspinatus tendons with minimal retraction. There is a mild amount of associated subdeltoid bursitis and the associated muscles are normal in caliber.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma with headaches. Preop planning for tumor resection. Limited stealth MRI of the brain for presurgical planning again demonstrates a large parenchymal lesion within the right frontal lobe with heterogeneous internal characteristics. The lesion previously showed prominent susceptibility artifact compatible with blood product. Adjacent to the left anterior aspect of this lesion again demonstrates a small triangular region of tissue with some degree of enhancement. There is significant surrounding edema, mild subfalcine herniation, and mass effect on the right lateral ventricle.Redemonstrated is a resection cavity at the convexity of the left frontal lobe which appears unchanged. An additional lesion within the right precuneus, now measuring no more than 9 x 8 mm, previously 9 x 7 mm.

Output: 1. Limited stealth MRI of the brain for presurgical planning. No significant interval change in the lesions in the right frontal lobe and right parietal lobe. 2. Stable left frontal lobe resection cavity.


Instruction: Generate impression based on findings.

Input: MRI Brain:Image quality is significantly limited by motion artifact. There are numerous small foci of restricted diffusion in the supra and infratentorial parenchyma compatible with acute infarcts. There is no focal mass effect, and no indication of hemorrhagic conversion. There are a few areas of punctate susceptibility abnormality not correlated with the areas of restricted diffusion, likely related to chronic microinfarcts. There is severe underlying periventricular and subcortical T2/FLAIR white matter signal abnormality including within the brainstem, middle cerebellar peduncles and white matter tracks of the cerebellar hemispheres. There is also mild diffuse volume loss out of portion to patient's age.MRA Brain: There is minimal luminal irregularity involving the cavernous and paraclinoid portions of the intracranial ICAs bilaterally. There is also multifocal atherosclerotic irregularity involving the anterior cerebral arteries. A moderately severe focal stenosis affects the distal left M1 segment with scattered mild to moderate focal stenoses more distally in both MCA distributions. Mild luminal narrowing affects the bilateral V4 segments. The basilar artery is within normal limits. Scattered mild to moderate focal stenoses are evident in the distal PCAs, left side more than right. No evidence of aneurysms or vascular malformations.

Output: 1.Numerous small nonhemorrhagic infarcts involving the supra and infratentorial brain parenchyma without mass effect or hemorrhagic conversion.2.Multifocal scattered mild to moderate atherosclerotic stenoses of various aspects of the intracranial vasculature with details as above.3.Underlying severe chronic small vessel ischemic disease and diffuse volume loss.


Instruction: Generate impression based on findings.

Input: Evaluate for changes from last MRI, osteoarthritis, joint or ligamentous or meniscal abnormalities History: h/o HIV, car accident; R knee pain/swelling. MENISCI: The menisci are within normal limits.ARTICULAR CARTILAGE AND BONE: The previously noted minor focal marrow edema type signal within the far medial aspect of the medial tibial plateau is no longer visualized. Focal cartilage degeneration involving the anterolateral to the medial femoral trochlea appears unchanged, without significant underlying marrow abnormality.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is within normal limits.ADDITIONAL

Output: 1.Interval resolution of marrow signal abnormalities in the medial aspect of the tibial plateau.2.Focal cartilage degeneration anterolateral to the medial femoral trochlea, unchanged.3.Ligaments and menisci are intact.


Instruction: Generate impression based on findings.

Input: Clinical question: Facial droop, rule out stroke. Signs and symptoms: Facial droop Not infused CT of brain:A subtle suspected low attenuation of cortex and subcortical white matter of the left inferior frontal lobe and possibly the operculum of left frontal lobe is noted. I cannot entirely rule out possibility of an artifact. Follow-up exam with an MRI is recommended if this finding could explain presenting symptoms. Provided clinical data is not detailed.This finding is notice on axial image 17 through 19.This examination is otherwise unremarkable. Cortical sulci, ventricular system and all CSF cisterns are within normal limits.Calvarium, paranasal sinuses, mastoid air cells and middle ear cavities are well visualized and unremarkable.

Output: 1.Suspected area of low-attenuation in the left frontal lobe may represent an ischemic stroke, possibility of an artifact in this case can not be entirely ruled out. Follow-up with an MRI is recommended.2.Negative CT of brain otherwise.


Instruction: Generate impression based on findings.

Input: 49 year old with known right breast cancer for staging MRI There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is an enhancing unifocal mass in the far lateral right breast (axillary tail), measuring 10 x 7 x 9 mm (AP x LR x CC), corresponding to the known cancer. A metallic artifact from marker clip is seen posterior aspect of this mass.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal cancer in the right axillary tail.2. No abnormal enhancement in left breast. 3. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: T4a N2c right oral tongue squamous cell carcinoma treated with induction chemotherapy and TFHX on protocol 12-1712. There are post-treatment findings in the upper neck, with diffuse swelling of the supraglottic tissues and suggestion of mucositis. There is no evidence of residual measurable right oral tongue tumor. There is also no significant residual cervical lymphadenopathy. For example, a left level 1B lymph node measures 6 x 10 mm in axial cross-section, previously 7 x 9 mm, a left level 4 lymph node measures 6 x 11 mm, previously 7 x 10 mm, and a right level 2A lymph node measures 5 x 8 mm, previously 5 x 7 mm, for example. There is a punctate left thyroid cyst. The salivary glands, orbits, and imaged intracranial structures are unremarkable. There are small posterior disc-osteophyte complexes at C5-6 and C5-6.

Output: Post-treatment findings without evidence of measurable residual right oral tongue tumor or residual significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Male, 15 years old, status post craniotomy for tumor resection. Since the prior examination, near complete resection of the previously seen large left parietal lobe enhancing tumor been performed. An irregular resection cavity is evident containing blood product. Mild enhancement surrounding the superior margin of the cavity is nonspecific and may reflect postoperative change or mild residual tumor. Areas of residual enhancing tumor are seen along the inferior resection cavity margin and extending along the adjacent ependyma of the left lateral ventricular atrium.Extensive vasogenic edema centered on the resection cavity and involving the left posterior frontal, parietal, occipital and temporal lobes shows no significant change in extent. However, there has been some reduction of regional mass effect with improvement in midline shift and less effacement of the ventricular system.Postoperative findings are seen compatible with prior resection of an enhancing mass from along the left anterior temporal lobe. No residual enhancement is seen at this operative site.A 4 mm enhancing nodule is seen within the left lateral ventricle, adjacent to the septum pellucidum, which shows no significant interval change from the immediate prior examination. This lesion was not evident on the examination of 11/16/2015.

Output: 1.Interval near complete resection of the previously seen large left parietal lobe tumor. A small amount of residual tumor is evident along the inferior margin of the resection cavity, and extending along the ependyma of the left ventricular atrium. Mild enhancement along the superior margin of the resection cavity could represent residual tumor or postoperative change.2.The overall extent of vasogenic edema associated with this lesion is not significantly changed, though there has been some improvement in regional mass effect.3.A 4 mm intraventricular enhancing nodule within the left lateral ventricle, adjacent to the septum pellucidum, is unchanged from the immediate prior examination and likely represents a small tumor deposit. No additional enhancing lesions are seen.


Instruction: Generate impression based on findings.

Input: Right foot drop. Evaluation of cause of foot drop, radiculopathy, sensorimotor neuropathy. Five lumbar type vertebral bodies are presumed to be present. The conus medullaris is normal in position. There is depression involving the superior endplate of the L4 vertebral body suggesting a mild chronic compression fracture and Schmorl's node. Vertebral body heights are otherwise maintained. There is minimal retrolisthesis of L1 on L2 and L2 on L3 as well as grade 1 anterolisthesis of L4 and L5. Bone marrow signal is benign. There is moderate to severe disc height loss throughout the lumbar spine, particularly at the L2-L3 and L5-S1 levels where there is severe disc height loss with adjacent edematous endplate marrow signal changes which are on a degenerative basis. Edematous marrow signal changes are also present involving the inferior endplate of the T12 vertebral body. Additional details regarding degenerative changes as described below:T11-T12: No significant spinal canal or neural foraminal stenosis. There appears to be a subligamentous central disc extrusion which extends caudally along the posterior aspect of the T12 vertebral body to the T12-L1 level. T12-L1: No significant spinal canal or neural foraminal stenosis. Minimal disc bulge as well as bilateral facet arthropathy.L1-L2: Mild disc bulge, ligamentum flavum thickening and facet arthropathy. There is no significant spinal canal stenosis. There is mild left neural foraminal stenosis.L2-L3: Prominent disc bulge, ligamentum flavum thickening, as well as facet arthropathy. There is resulting moderate to severe central spinal canal stenosis. There is also effacement of the lateral recesses, particularly on the right. There is moderate left and minimal right neural foraminal stenosis. There may be impingement of the exiting left nerve root extraforaminally.L3-L4: Disc bulge, advanced bilateral facet arthropathy, and ligamentum flavum thickening with moderate to severe spinal canal stenosis including partial effacement of the lateral recesses. There is moderate left neural foraminal stenosis and mild to moderate right neural foraminal narrowing.L4-L5: Advanced facet arthropathy with grade 1 anterolisthesis. There is prominent ligamentum flavum thickening and disc uncovering. There is severe spinal canal stenosis at this level. There is also severe right and mild to moderate left neural foraminal stenosis.L5-S1: There is disc bulge, moderate facet arthropathy, ligamentum flavum thickening. There is no significant central spinal canal stenosis. There is however partial effacement of the right lateral recess with contact of the right S1 nerve root. There is mild to moderate bilateral neural foraminal stenosis.Paraspinous soft tissues are within normal limits. There are multiple bilateral renal cysts. Linear enhancement involving the spinal canal is at least predominantly vascular in etiology. There are no suspicious enhancing lesions.

Output: 1. Advanced degenerative changes throughout the lumbar spine, worst at the L4-5 level where there is grade 1 degenerative spondylolisthesis, severe spinal canal stenosis, and severe right-sided neural foraminal stenosis.2. There is also moderate to severe spinal canal stenosis at the L3-L4 and L2-L3 levels. Additional details including foraminal stenosis at additional levels as detailed above.3. Linear enhancement within the spinal canal is at least predominantly related to normal vascular structures. Possibility that some of the linear enhancing structures represent enhancing cauda equina nerve roots is not entirely excluded, but this can also be related to the high-grade stenosis described above rather than imply an inflammatory process.


Instruction: Generate impression based on findings.

Input: 52-year-old female with right fourth toe pain, history of rheumatoid arthritis Low T1, high T2/STIR signal within and replacing the fourth middle phalanx. Edema signal is noted within the fourth digit. The proximal phalanx and distal phalanx are normal in signal. No fluid collection to suggest abscess. The remainder of the osseous structures are normal in signal and appearance.The visualized tendons are normal in signal and appearance.

Output: Low T1, high T2/STIR signal within and replacing the fourth middle phalanx with surrounding edema type signal may represent a fracture as clinically queried. A radiograph is recommended as this would demonstrate periosteal reaction at this time. Alternatively, this noncontrast imaging appearance may represent osteomyelitis in the correct clinical context.


Instruction: Generate impression based on findings.

Input: Reason: Please evaluate liver and biliary system for signs of PSC. History: 27 yo M with Crohn's disease , and an unverified report of PSC, now admitted with abdominal pain, nausea, and severely elevated Alk phos and (intrahepatic?) biliary dilation. ABDOMEN:LIVER, BILIARY TRACT: No suspicious focal hepatic lesions. No significant change in the mild irregularity and prominence of the central intrahepatic biliary ducts without dominant stricture or mass. The common bile duct measures up to 9 mm, stable. 1.4 cm cholelithiasis again noted. Portal and hepatic veins are patent.SPLEEN: Mild splenomegaly measuring up to 13.5 cm.PANCREAS: No significant abnormality noted. No pancreatic ductal dilatation or mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atelectasis/consolidation at the lung bases.

Output: 1.No significant change in appearance of the biliary system with mild irregularity as above.2.Cholelithiasis without evidence of acute cholecystitis.3.Stable mild splenomegaly. 4.Atelectasis/consolidation at the lung bases.


Instruction: Generate impression based on findings.

Input: 37-year-old female with right hip pain. Evaluate for right hip FAI, labral tear. ACETABULAR LABRUM: There is a tear along the anterosuperior labrum with an adjacent para labral cyst best seen on the radial view (series 1201, images 5 and 6).ARTICULAR CARTILAGE AND BONE: Articular cartilage appears normal. Bone marrow signal is normal.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Right anterosuperior labral tear with an adjacent para labral cyst.


Instruction: Generate impression based on findings.

Input: Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: Hx of breast cancer with new weakness on the left side leg> arm R/o brain mets/ infarct History: weakness on the right side There is no evidence of acute ischemic or hemorrhagic lesion on this scan.On DWI, there is focal high signal intensity on the right inferior thalamus, cerebral peduncle junction area (series 801, image 271/72) which likely to be an artifact. Clinical correlation and if needed, follow up imaging can be considered.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There is focal retention cyst on the left maxillary sinus.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Rotator cuff injury, limited range of motion. ROTATOR CUFF: Supraspinatus/infraspinatus-There is mild intermediate signal intensity within the supraspinatus tendon and anterior portion of the infraspinatus tendon indicating tendinosis and perhaps mild interstitial tearing. No full-thickness fluid-filled rotator cuff tear is identified. Muscle bulk and signal of the infraspinatus and supraspinatus muscles are within normal limits. The teres minor tendon is intact and the muscle demonstrates normal bulk and signal intensity. There is a hypointense focus immediately anterior to the lesser tuberosity with surrounding edema. Edema appears to involve the distal fibers of the subscapularis tendon. Additionally, there is thickening of the subscapularis tendon which could in part reflect redundancy of the tendon as the patient's arm is held in internal rotation. The 'transverse ligament' component of the subscapularis tendon is not well visualized.SUPRASPINATUS OUTLET: AC joint and acromiohumeral intervals are maintained. There is trace fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is maintained. Small amount of fluid in the glenohumeral joint. The labrum is intact, given limitations of a non-arthrogram exam.BICEPS TENDON: The intra and extra-articular portions of the biceps tendon are within normal limits ADDITIONAL

Output: 1. Abnormal signal intensity of the distal fibers of the subscapularis tendon and adjacent soft tissues with moderate edema. This could represent an insertional subscapularis tendon injury if there is a recent history of trauma. However, a focus of low signal intensity seen anterior to the lesser tuberosity raises the possibility of calcium hydroxyapatite deposition with surrounding inflammation (calcific tendinopathy). Radiographs of the shoulder, including an axillary view, are recommended for further evaluation.2. Edema of the subcutaneous fat anterior to the deltoid muscle may reflect sequelae of recent intervention such as injection, or contusion. Other findings as above.


Instruction: Generate impression based on findings.

Input: Ms. Nichols is a 47-year-old female with a personal history of right breast mastectomy in 2008 from mucinous IDC/DCIS treated with chemotherapy and hormonal therapy. Personal history of benign left breast biopsy. She has no current breast related complaints. Patient is status post right breast mastectomy with bilateral retropectoral silicone implants in place. Mild parenchymal enhancement is noted in the left breast.Few benign enhancing foci, including a focus in the inferomedial right chest wall, are unchanged from multiple prior studies. There is no abnormal enhancement seen in the right chest wall or left breast. Susceptibility artifact from biopsy marker clip seen in the left upper outer breast, at site of prior benign breast biopsy. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: 70 yo F with ESRD, CVA, PAD s/p recent revision of R great toe amputation admitted with AMS, eval for osteomyelitis of the R foot History: AMS, recent amputation Severely limited examination secondary to the patient's inability to cooperate with the examination. The examination was terminated early due to the patient's inability to follow instructions. Only sagittal T1 and STIR images were obtained. The sagittal STIR sequences markedly limited due to extensive patient motion artifact. There is destruction of the first metatarsal to the level of the mid diaphysis with associated decreased T1 signal abnormality about the distal bone marrow of the remnant of the first metatarsal. These changes are incompletely characterized on this severely limited examination. There is decreased signal abnormality in the surrounding soft tissues on T1-weighted images. The remainder of the imaged bones of the foot are unremarkable on the T1-weighted images.

Output: Destruction of the first metatarsal to the level of the mid diaphysis with associated decreased signal abnormality on T1-weighted images. While these findings are suggestive of osteomyelitis, this is incompletely characterized on this severely limited examination.


Instruction: Generate impression based on findings.

Input: PSA ranging from 5.8 to as high as 10.7 going back to July 2015. His most recent PSA was 6.1ng/mL values on 11/19/15. Of note, he had been on Finasteride just up until the time of his PSA in July 2015, but the medication was stopped in July 2015. Prior to this, his PSA was around 4.0 in 2008, but it is unclear what the PSA did in the interval. He underwent previous TRUS biopsy in 2008 without any cancer. PELVIS:PROSTATE:Prostate Size: 5.5 x 6.3 x 7.2 cmPeripheral Zone: The peripheral zone is relatively homogeneously T2 hyperintense without a discrete lesion.Central Gland: Marked BPH enlargement.Several regions in the central gland demonstrate mild low T2-weighted signal intensity but do not have associated restricted diffusion or arterial enhancement, and are likely related to BPH changes (series 701, 27 - right periphery of the median lobe) and fibromuscular stroma (series 701,11 - anterior apex symmetric focus). 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: No significant abnormality noted.

Output: Marked BPH without a discrete dominant lesion.


Instruction: Generate impression based on findings.

Input: Male 56 years old Reason: Eval for meniscus injury History: Lateral Knee Pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is diffuse cartilage thinning at the patellofemoral joint. There is a full thickness cartilage defect, measuring at least 1.3 cm, in the lateral patellar facet with reactive marrow edema in the underlying patella. There is a full thickness cartilage defect in the lateral femoral condyle which measures approximately 1.5 cm with reactive marrow edema in the underlying femur. There is cartilage thinning in the medial joint compartment without full thickness cartilage defect. Osteophytes are identified projecting off the medial and lateral femoral condyles.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Full thickness cartilage defect as described above with at least 3 ossified loose bodies within the joint.2. 3.4-cm multilobulated fluid collection at the insertion of the medial gastrocnemius is suspicious for a ganglion cyst.


Instruction: Generate impression based on findings.

Input: Female, 55 years old. Right knee pain and instability. MENISCI: There is blunting of the anterior horn of the medial meniscus at the apical margin consistent with fraying of the medial edge. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema within the medial aspect of medial femoral condyle and the posterior patella. There is a focal articular defect along the anterior femoral condyle. There is also a focal defect of the articular cartilage along the lateral facet of the patella near the apex. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is decreased signal within the medial retinaculum which may represent a sprain. The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: Questionable patellar dislocation with constellation of findings as described above.


Instruction: Generate impression based on findings.

Input: Ms. James is a 47-year-old female with biopsy-proven triple negative left breast cancer status post lumpectomy in March 2015. She had a recent MRI examination on 05/08/2015 which demonstrated three benign morphology masses in both breasts. Upon physical exam at the MRI directed areas of concern, no discrete masses are appreciated.Targeted ultrasound was performed for the MRI directed areas of concern.- In the left breast 7:00 location, there is an oval hypoechoic mass measuring 0.6 x 0.6 x 0.6 cm. There is minimal to no vascularity associated with this mass.- In the left breast retroareolar location, there is a lobulated hypoechoic mass measuring 1.3 x 0.8 x 0.8 cm.- In the right breast 3:00 location, there is an additional oval hypoechoic mass measuring 0.6 x 0.3 x 0.5 cm.All three of these masses correspond in size, appearance, and location to the MRI-detected masses. They are most compatible with benign fibroadenomas.

Output: Bilateral benign morphology masses, most likely representing benign fibroadenomas. A short term 6 month MRI versus ultrasound follow-up examination is recommended to confirm stability of these findings. All results and recommendations were relayed to the patient and to Dr. Jaskowiak. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Female, 66 years old, history of metastatic breast cancer with progressive intracranial metastases. Please evaluate for radiosurgery planning. Findings are again seen related to prior left parieto-occipital craniotomy. Encephalomalacia of the underlying parenchyma appears similar to prior.An enhancing nodule within the right parietal lobe now measures 6 mm in diameter, previously 5 mm (image 117 series 501). Enhancing lesion along the inferior surface of the right cerebellum measures 7 x 6 mm, previously 6 x 6 mm (image 29 series 501). An enhancing focus within the primary cerebellar fissure on the right is unchanged (image 48 series 501).Two punctate enhancing lesions are identified within the right cerebellum, one of which is not significantly changed (image 50 series 501), while the other is new (image 47 series 501). A 6 mm enhancing lesion along the superior midline vermis (image 64 series 501), is new or at least significantly more conspicuous compared to the prior exam.Enhancement within the right IAC is unchanged. A developmental venous anomaly is redemonstrated within the pons. Three foci of susceptibility are evident within the pons the largest of which is in proximity to the developmental venous anomaly, all unchanged.

Output: 1. Slight increase in size of previously noted lesions in the right parietal lobe and inferior right cerebellum.2. New punctate lesion in the right cerebellar hemisphere, while two other small right cerebellar lesions are not significantly changed.3. New small lesion in the cerebellar vermis.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for etiology of Left shoulder pain History: Left shoulder pain after fall on ice ROTATOR CUFF: There is thickening and increased signal intensity affecting the supraspinatus and infraspinatus tendons indicating moderate tendinosis. There is more focal increased signal intensity within the posterior fibers of the supraspinatus at approximately the 12 o'clock position, 1 cm proximal to the tendon insertion, extending from the bursal surface fibers across the majority of the tendon thickness towards the articular surface fibers, measuring approximately 7 to 8 mm in AP dimension. The signal intensity is not as high as fluid and it is therefore possible that this could represent a more focal manifestation of the patient's tendinosis, however, we cannot exclude the possibility of a near full-thickness tear partially filled with granulation tissue or blood. There is mild increased signal intensity more proximally along the myotendinous junction of the supraspinatus which could represent a strain injury. There is thin fluid signal intensity along the myotendinous junction of the infraspinatus suggesting interstitial tearing. The teres minor and subscapularis tendons and muscles appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small glenohumeral joint effusion. There is minimal posterior translation of the humeral head relative to the glenoid, but no frank dislocation. The anterior inferior labrum appears unusually prominent and is perhaps partially detached from the underlying glenoid. The superior and posterior labrum appear attenuated, but this may reflect normal anatomy for this patient.BICEPS TENDON: There is fluid within the tendon sheath of the long head of the biceps which may represent fluid extension from the joint. ADDITIONAL

Output: 1. Rotator cuff tendinosis and interstitial tearing as described above. Although we see no full-thickness fluid-filled rotator cuff tear, there is focal increased signal intensity within the posterior fibers of the supraspinatus tendon which could represent a near full-thickness tear involving the bursal surface fibers that is not of fluid signal intensity due to granulation tissue or blood products.2. Deformity of the anterior inferior labrum could represent a tear, particularly if there is a history of prior dislocation.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Male, 30 years old, with headache status post head trauma in motor vehicle accident. No evidence of hyperintense signal abnormal is seen in the area of suspected chronic hemosiderin staining in the high right frontal lobe. A small patch of nonspecific hyperintensity is evident in the left parietal white matter. No significant parenchymal edema or mass effect is detected. Prominence of the CSF space anterior to the left temporal lobe, completely suppressing on FLAIR, may represent an incidental arachnoid cyst, appearing similar to prior.

Output: No acute intracranial abnormality. Also noted is prominence of the CSF space anterior to the left temporal lobe which may represent an incidental arachnoid cyst.


Instruction: Generate impression based on findings.

Input: 72 year old man with history of ischemic cardiomyopathy and previous PCI, with worsening exertional fatigue, referred for cardiac MRI with vasodilator stress testing.MEDICATIONS: aspirin, atorvastatin, carvedilol, clopidogrel, digoxin, furosemide, hydralazine, spironolactone, valsartan First Pass PerfusionDuring hyperemia, there is no residual ischemia out of regions with myocardial scar.Viability/ Myocardial ScarThere is transmural late gadolinium enhancement involving the mid-apical inferolateral wall and apical inferior wall. This pattern is consistent with transmural myocardial infarction and these segments are not viable. There is also non-transmural infarction involving the mid anterolateral wall. This segment has an intermediate probability of viability. There is another region epicardial late gadolinium enhancement involving the basal inferoseptum, inferior, and inferolateral walls that spares the endocardium and is atypical for myocardial infarction. This suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. Viability within these segments can not be determined as the scar is not "ischemic" in nature. The remainder of the myocardium is viable.Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 56 ml/m2 (normal range 25+/-9), the LVESV is 119 ml (normal range 47+/-19), the LV mass index is 49 g/m2, and the LV mass is 106 g. There is akinesis of the apical inferior, mid-apical inferolateral walls. There is hypokinesis of the mid anterolateral wall. Left AtriumThe left atrium is mild-moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 169 ml (normal range 142+/-31), the RV end systolic volume index is 40 ml/m2 (normal range 31+/-9), and the RVESV is 85 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 ValveThere is thickening of the anterior mitral leaflet tip. The 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 trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is grossly normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is no residual "ischemia" noted. 2. The LV is normal in size with moderately reduced systolic function (EF 40%). 3. There is akinesis of the apical inferior and mid-apical inferolateral wall with reduced wall thickness and transmural late gadolinium enhancement. Taken together these findings suggest previous myocardial infarction, with no evidence of viability in these segments. 4. Additionally, there is a non-transmural myocardial infarction involving the mid anterolateral wall. This segment has an intermediate probability of viability. 5. There is a non-myocardial infarction pattern of late gadolinium enhancement involving the base of the left ventricle suggesting that the patient's LV dysfunction is due to both ischemic and non-ischemic etiologies.6. Normal size RV with normal systolic function (EF 50%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.