Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:11/1/1970)Reason: Dr. Kramer would like this study to be WITH contrast to evaluate the vasculature. Has ischemic stroke, R hemiplegia, and global aphasia History: pls see abovePROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER MRI of the brainThere are patchy foci of diffusion restriction in the left middle cerebral artery territory particularly in the watershed zones involved areas include the left caudate nucleus left middle frontal gyrus, left pre and postcentral gyri and portions of the left superior parietal lobule and portions of the left inferior parietal lobule. These are associated with FLAIR signal hyperintensity. There is intravascular enhancement and some leptomeningeal enhancement along the left middle cerebral artery territory suggestive of early subacute phase infarction.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and FLAIR hyperintense patchy lesions are present in the brainstem.There are multiple punctate foci of signal hypointensity present in the brainstem, thalami and basal ganglia as well as the right insular cortex and right frontal lobe. There are foci of signal loss within the patchy areas in the inferior infarction in the left frontal and parietal lobes.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.MRA brain: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. There is a high-grade 90% stenosis present proximal left middle cerebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There is a high-grade stenosis present at the proximal left middle cerebral artery M1 segment. It is not clear whether this is related to acute thrombus or stenosis due to other cause.2.There are patchy foci of subacute infarction the left middle cerebral artery territory some of which display some petechial blood.3.There are multiple microhemorrhages predominantly in the distribution suggestive of hypertension.4.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific, however, given the patient's other findings most likely they are vascular related.5.Patchy lesions in the brainstem are likely vascular related as well.


Instruction: Generate impression based on findings.

Input: 24 year old female. Nausea/vomiting. Family history of IBD. SBFT suggested separation of ileal bowel loops and distal ileal narrowing consistent with possible Crohn's. Colonoscopy was normal. Evaluate for small bowel Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal course and caliber of the small bowel. No evidence of active or chronic inflammatory bowel disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal course and caliber of the small bowel. No evidence of active or chronic inflammatory bowel disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of inflammatory bowel disease or other significant abnormality.


Instruction: Generate impression based on findings.

Input: 18-year-old female with pain at the scaphoid tuberosity LIGAMENTS: Evaluation of the intrinsic ligaments is limited due to a lack of intra-arterial contrast. The scapholunate ligament appears intact. The lunotriquetral ligament is not as well visualized, although we see no findings to suggest disruption of this ligament.TRIANGULAR FIBROCARTILAGE COMPLEX: Given the limitations of a nonarthrogram study, the triangular fibrocartilage complex appears intact. TENDONS: A small amount of fluid is present adjacent to the tendons of the second extensor compartment which may be normal. The tendons appear intact.BONES: Bone marrow signal intensity is normal.ADDITIONAL

Output: Small ganglion cyst within the subcutaneous fat volar to the scaphoid.


Instruction: Generate impression based on findings.

Input: Male 63 years old with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: Post prostatectomy.Peripheral Zone: Post prostatectomy.Central Gland: Post prostatectomy.Seminal Vesicles: Status post prostatectomy.Extracapsular Extension: Post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Severe fatty replacement of the right gluteal musculature. Heterogeneous bone marrow may relate to red marrow regeneration.OTHER: Soft tissue in the right inguinal region likely relates to prior hernia repair.

Output: 1.No evidence of tumor recurrence within the prostatectomy bed.


Instruction: Generate impression based on findings.

Input: Knee pain after injury MENISCI: There is blunting of the free edge of the body of the lateral meniscus and deformity of the inner third of the adjacent posterior horn which indicates tearing along the inner third of the meniscus over a length of approximately 1.5 cm. The anterior horn appears spared. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the lateral compartment is intact. There is focal partial-thickness degeneration of the articular cartilage along the medial femoral condyle laterally. An additional low signal intensity focus is noted within the articular cartilage of the femoral trochlea centrally which may represent an additional site of degeneration. The bone marrow signal of the knee is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Elongated tear of the inner third of the lateral meniscus with additional findings as described above.


Instruction: Generate impression based on findings.

Input: 54-year-old male with right shoulder pain ROTATOR CUFF: Postoperative changes of rotator cuff repair There is increased T2 signal and thickening of the distal supraspinatus and infraspinatus tendons consistent with moderate to severe tendinopathy without retraction or full-thickness tear. Foci of fluid signal intensity within the distal supraspinatus and infraspinatus tendons indicate intrasubstance tearing. No significant muscular atrophy.SUPRASPINATUS OUTLET: Moderate AC joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate degenerative changes affect the glenohumeral joint. There is degeneration and degenerative tearing of the posterior and superior labrum. The superior labrum tear appears unchanged from the prior exam.BICEPS TENDON: The biceps tendon is not visualized. ADDITIONAL

Output: 1. Postoperative changes of rotator cuff repair with moderate to severe tendinosis and intrasubstance tearing as described above, but no full-thickness rotator cuff tear.2. Degeneration and tearing of the posterior and superior labrum.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified site of unspecified female breast [C50.919], Reason for Study: ^Reason: Metastatic breast cancer - restaging History: foot drop Motion artifacts degraded image quality.For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Nodular and somewhat tubular signal voids seen within L1, L4 and L5 vertebral bodies indicate previously infused PMMA for kyphoplasties, unchanged since prior scan.There are evidence of L34 and L45 laminectomy with postoperative changes such as enhancement of paraspinal muscles and laminectomy sites with localized fluid collections on incision site.Previously seen enhancing soft tissue masses encircling spinal canal are not seen. And there is no evidence of spinal stenosis at the level of L45.Enhancing lesions indicating metastatic foci are seen at L1, L4 and L5 as well as bilateral iliac bones. Comparing to prior scan, the enhancing portion of each lesion appear to be smaller than prior.The spine alignment is anatomic. The conus medullaris terminates at the T12-L1 level. There is no evidence of cord compression. Degenerative changes are specified by the intervertebral level as follows: T12-L1: There is linear/tubular signal void lesion on the superior aspect of the left neuroforamen indicating extracorporeal PMMA. No evidence of neuroforaminal narrowing or nerve root compression due to this PMMA material. Previously seen soft tissue component extending toward anterior epidural space of the vertebral metastasis is not visualized on today's scan. There is no evidence of neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Post laminectomy status. Right neuroforaminal narrowing due to enhancing soft tissue lesion, again, the enhancing soft tissue component appears to be slightly decreased in its extent. No spinal stenosis. L4-L5: Post laminectomy status. Redemonstration of enhancing lesions of the L4 vertebral body with bilateral mild neuroforaminal narrowing, slightly decreased enhancing component comparing to prior scan. No spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Interval near complete resolution of L45 level soft tissue mass with postoperative changes.2. Interval decrease of soft tissue component of vertebral body metastasis as well as the extent of enhancing portion at the level of L1, L4 and L5.3. Unchanged neuroforaminal narrowing at the level of L34 and L45. 4. There is no evidence of new abnormal enhancing lesion of vertebral body nor bilateral ilium on this scan.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: assess for new stroke, h/o numerous strokes in posterior circulation History: assess for new stroke, h/o numerous strokes in posterior circulation. Brain MRI:Multifocal scattered diffusion restriction lesions on the left basal ganglia, left external capsule, left cerebellar hemisphere and left inferior thalamus indicating acute ischemic infarction without evidence of hemorrhagic transformation.There are multifocal tissue defects indicating prior ischemic infarctions including right external capsule, left upper pons, and left cerebellar hemisphere.Underlying brain shows multiple patchy high signal intensities on FLAIR images on bilateral periventricular white matter indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal intracranial arterial luminal stenosis. Especially the left MCA distal M1 segment shows more than 70% of luminal stenosis. The right MCA M1 segment shows luminal irregularities but without significant (more than 70%) stenosis. The vertebrobasilar system shows luminal irregularity of the basilar artery and bilateral PCAs without significant luminal narrowing. The distal left vertebral artery lumen is narrowed and irregular. In addition, the C1 and C2 portions of the left vertebral artery are smaller than that of the right side indicating possible hypoplastic nature or could be atherosclerotic stenosis. Neck MRA: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 left vertebral artery origin shows about less than 50% luminal stenosis, however, this could be an artifactual finding. There is focal luminal stenosis at the level of C1-skull base junction which could represent atherosclerotic stenosis.There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Multifocal acute ischemic strokes on the left basal ganglia, external capsule and left cerebellar hemisphere without evidence of hemorrhagic transformation.2. Multifocal various degree intracranial arterial luminal stenosis indicating atherosclerotic changes of intracranial arterial system. Especially the left MCA distal M1 segment stenosis appears to be significant (more than 70% stenosis).3. No evidence of significant (more than 50%) luminal stenosis of extracranial arterial system except the left vertebral artery ostium.


Instruction: Generate impression based on findings.

Input: Other malformations of cerebral vessels [Q28.3], Reason for Study: ^Reason: 3 t scanner History: cavernoma Multiple fiducial markers attached on the scalp.There is brain parenchymal lesion with peripheral hemosiderin deposition with central T2 high signal intensity at the left inferior fronto-polar gyrus with slight extension toward left frontomarginal gyrus.The size is measured about 7mm on axial scan. Above findings are consistent with cavernous malformation, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Preoperative STEALTH scan.2. Left inferior fronto polar gyrus cavernous malformation is seen, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out new CVA. Signs and symptoms: Left upper extremity pain Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Small focal low attenuation in the subcortical and periventricular white matter of right frontal lobe is again identified however it appears larger than prior to study. Possibility of a new overlapping stroke cannot be ruled out and follow-up with an MRI is recommended. The density of area of low attenuation however is suggestive of an old chronic stroke.

Output: Focal area of low-attenuation in the subcortical white matter of right frontal lobe consistent with an old stroke as described above.


Instruction: Generate impression based on findings.

Input: 35 years Female (DOB:6/18/1981)Reason: 3 t ccm History: ha, s/p bleedPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hemorrhagic lesion present in the left temporal lobe anteriorly is overall dimensions are 37 x 16 mm. It appears to be composed of 2 components one anterior laterally measuring 16 x 17 mm which has heterogeneous is signal and one posteriorly which is predominantly T2 hyperintense. There is a hemosiderin ring surrounding the whole dimensions on the prior exam the overall measurements were 40 x 20 mm axial dimensions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a left temporal lobe hemorrhagic lesion present which has some characteristics which are suspicious for cerebral cavernous malformation with recent hemorrhage. Compared to the prior exam it is slightly smaller in overall dimensions.


Instruction: Generate impression based on findings.

Input: Chronic recurrent Achilles tendinitis. Lateral posterior calcaneal pain. Evaluate Achilles and ankle ligaments. There is a small cyst within the posterior calcaneal tuberosity laterally just beneath the insertion of the Achilles tendon, with surrounding marrow edema. There are small linear foci of increased signal intensity within the adjacent Achilles tendon likely represent insertional interstitial tears, but otherwise the Achilles tendon appears normal. The remaining ankle tendons are normal. Signal intensity of the remaining bone marrow is normal. There is thickening of the anterior talofibular ligament with what appears to be a small ossicle in the substance of the ligament, suggesting prior trauma. The calcaneofibular ligament and posterior talofibular ligament are within normal limits. The distal tibiofibular syndesmotic complex appears normal. Mild heterogeneity of the deep tibiotalar component of the deltoid ligament may reflect old trauma as well. There are tiny tibiotalar joint osteophytes suggesting mild osteoarthritis. There is an os trigonum posterior to the talus. I see no osteochondral defect. There is a small amount of fluid within the tibiotalar and subtalar joints but no large effusion. There is mild subcutaneous edema involving the lower leg and ankle, nonspecific.

Output: 1.Enthesopathic changes at the Achilles insertion on the calcaneus, including mild interstitial insertional tearing of the Achilles tendon and cyst formation/edema in the underlying calcaneus.2.Findings suggestive of old injury to the anterior talofibular ligament; other findings as above.


Instruction: Generate impression based on findings.

Input: Foot pain Moderate osteoarthritis affects the first MTP joint. Small plantar and posterior calcaneal spurs are noted. The Achilles tendon silhouette appears thickened and slightly indistinct; this may reflect tendinosis but if there is clinical concern for tear, MRI can be obtained.

Output: Osteoarthritis of the first MTP joint with other findings described above.


Instruction: Generate impression based on findings.

Input: 31-year-old male with perianal Crohn's disease with recent perianal abscess. Evaluate for perianal fistula or abscess. PELVIS:PROSTATE/SEMINAL VESICLES: Suspected tiny fistula between the anterior rectum and the prostate noted on the diffusion weighted sequence (series 10 image 95).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace free fluid in the dependent pelvis. BONES, SOFT TISSUES: Complex linear tract of fluid signal intensity extending from the left perineum extending anteriorly towards the scrotum, superiorly along the perianal soft tissues, connecting with irregular T2 fluid signal intensity in the presacral region with a thin fistulous connection to the posterior/6:00 position of the lower rectum (series 5 image 46). A separate left/5:00 position fistulous connection is also identified (series 8 image 48). The fluid tract measures 7 cm in craniocaudal length (series 6 image 40). OTHER: No significant abnormality noted.

Output: 1.Complex perianal fistula with connection at the left/5:00 position and possibly at the posterior/6:00 position. This fistula is a transsphincteric type. The fluid tract extends along the left perianal soft tissues, extends anteriorly towards the scrotum, and connects to irregular presacral fluid signal.2.There is a suspected fluid connection between the anterior rectum and the prostate.


Instruction: Generate impression based on findings.

Input: Clinical impression: Rule out CVA. Signs and symptoms: Aphasia. Nonenhanced brain MRI:Severely limited exam due to extensive motion artifact which precludes detection of subtle findings.Diffusion-weighted images are diagnostic and demonstrate no evidence of an acute ischemic strokes.Examination demonstrates fairly extensive subcortical and periventricular flair hyperintensity of bilateral cerebral hemispheres consistent with advanced chronic and minimally hemorrhagic small vessel ischemic strokes. Extensive similar findings are also present in bilateral basal ganglia and thalami as well as pons.Images through posterior fossa demonstrate multiple small varying size chronic ischemic strokes primarily in the distribution of pica branches.In addition there is a large left MCA territory chronic nonhemorrhagic ischemic stroke extensively involving the left temporal and occipital lobes.Above findings results in an ex vacuo enlargement of cortical sulci and ventricular system consistent with parenchymal volume loss.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and calvarium.

Output: 1.No acute ischemic stroke.2.Very extensive chronic and minimally hemorrhagic ischemic strokes as detailed.3.Multiple small nonhemorrhagic cerebellar strokes and a large left MCA territory chronic ischemic stroke involving the left temporal and occipital lobes.4.Ventriculomegaly and prominence of cortical sulci as result of extensive chronic strokes as detailed.


Instruction: Generate impression based on findings.

Input: History of bilateral lumpectomies for bilateral breast cancer. BRCA2 carrier. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Areas of scarring, distortion and clip artifact in the left upper outer breast and right retroareolar region are again noted. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: Please Eval for new stroke History: right sided hemiparesis, slurred speech, aphasia, left field cut MRI brain:Multiple punctate foci of diffusion restriction with matching ADC hypointensity is present in the posterior left frontal lobe, right cerebellar vermis, left putamen as well as in the right frontal and parietal lobes representing acute ischemia. There is volume loss and encephalomalacia from prior right PCA stroke. Additional scattered foci of increased T2 signal including pontine and left parietal T2 hyperintense regions are unchanged and represent foci of chronic small vessel ischemic disease.There is no evidence of intracranial hemorrhage or mass. There is mild ex vacuo dilatation of the right occipital horn adjacent to the evolving infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. Complete opacification of the left maxillary sinus is unchanged.MRA brain:Multifocal areas of luminal irregularity throughout the anterior and posterior circulation. Stenosis of the right M1 segment to about 30% is unchanged. Luminal irregularities in the vertebrobasilar system are also unchanged, however no significant regions of stenosis are identified. No aneurysms are identified.MRA neck:There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.

Output: 1.Multiple punctate foci of diffusion restriction consistent with acute ischemia in both supratentorial and tentorial brain suggestive of an embolic origin.2.Expected evolution of old right PCA infarct.3.Multifocal regions of intracranial luminal narrowing suggests diffuse atherosclerotic disease and is unchanged.4.No significant stenosis, aneurysm or dissection in the extracranial carotid or vertebrobasilar systems.


Instruction: Generate impression based on findings.

Input: 2-year-old male with concern for osteomyelitis in the distal left tibia Coronal T1-weighted imaging of the bilateral lower extremities demonstrates multiple abnormalities in bone marrow signal intensity in the tibiae, localized in the proximal and distal metadiaphyses bilaterally. Coronal STIR imaging of the bilateral lower extremities shows signal abnormality in a similar distribution, with additional signal abnormality in the soft tissues of the ankles, left greater than right. Dedicated axial and sagittal imaging of the left lower extremity shows geographic serpiginous pattern of enhancement of some of the foci of signal abnormality in the left tibia. No fracture or malalignment is seen.

Output: Multiple bilateral tibial bony infarcts of indeterminate chronicity with probable superimposed osteomyelitis of the left ankle.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Essential (primary) hypertensionClinical question: assess vasculatureSigns and Symptoms: left facial droop, patellar hyperreflexia, subtle left sided weakness MRI of the brainA focus of diffusion restriction is present in the right centrum semiovale and internal capsule.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Punctate foci of T2/FLAIR signal hyperintensity are present in the left thalamus and adjacent internal capsule as well as the left side of the pons.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Exam is degraded by patient motion. There is wrap around artifact obscuring the left cerebellar tonsil and medial left cerebellar hemisphere on T2 axial imaging.MRA brain:There is artifact obscuring visualization of the left vertebral artery and the left PICA. 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.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is large. The right A1 segment is larger than the left A1 segment.There is fetal origin of the right PCA. The right p1 segment is small. There is asymmetry in size of the vertebral arteries with left larger than right vertebral artery.

Output: 1.Acute lacunar infarct is present in the right centrum semiovale.2.Lesions the left thalamus and brainstem are suspected to be related to chronic stage lacunar infarcts.3.Visualization of the left vertebral artery and the left PICA is partly obscure by artifact. Findings as they stand suggest the presence of a 5mm aneurysm at the PICA origin. A CTA would be helpful to further evaluate. Alternatively, a repeated MRA when the patient is able to better tolerate it would be helpful.4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 5.Exam is degraded by patient motion and other artifacts which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 44-year-old male complains of right leg and knee pain and inability to bear weight. MENISCI: The lateral meniscus appears normal. There is mild intrasubstance degeneration of the medial meniscus with additional poorly defined increased signal intensity within its inner fibers, suggesting fraying; however, we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There is full thickness degeneration of the articular cartilage of the femoral trochlea centrally. There is mild to moderate degeneration of the articular cartilage of the medial facet of the patella. There is also a full-thickness defect of the articular cartilage of the medial femoral condyle just above the posterior horn of the medial meniscus. The articular cartilage of the lateral compartment appears intact.LIGAMENTS: There is minimal increased signal intensity within the proximal fibers of the LCL proper suggesting mild degeneration, but otherwise the cruciate and collateral ligaments are unremarkable. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Cartilage degeneration involving the patellofemoral and medial compartments as described above.2. Mild degeneration and possible fraying of the medial meniscus without a discrete tear.3. Other findings as above.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:11/17/1959)Reason: Patient with recurrent left sided neck and upper chest pain. Rule out cervical radiculopathy. History: Left sided neck and upper chest pain.PROVIDER/ATTENDING NAME: ELBERT S. HUANG ELBERT S. HUANG The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C3-4 there is a small central disc protrusion present at this level which impresses on the ventral aspect of thecal sac and effaces spinal fluid ventral and posterior the spinal cord. Mild degree of spinal stenosis.At C4-5 there is a left paramedian disc extrusion present with disc material extending behind the adjacent endplate. This disc extrusion effaces spinal fluid ventral to the left hemicord and mildly displaces and compresses the left hemicord. There is a high signal focus on T2-weighted imaging within this disc extrusion.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small right paramedian disc protrusion present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is opacification of left mastoid air cells.

Output: 1.There is a mild to moderate degree of spinal stenosis present at C3-4 related to a central disc protrusion.2.There are some encroachment of the left hemicord at the C4-5 level related to a small disc extrusion.3.There is opacification of the left mastoid air cells which are incompletely visualized on this exam.


Instruction: Generate impression based on findings.

Input: 27 years, Male, Reason: Evaluate for signs of small bowel Crohns disease History: abdominal pain, obstructive symptoms. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: 42-year-old female with locally recurrent cervical cancer undergoing external beam radiation with brachytherapy. Routine monitoring during treatment with MRI. PELVIS:UTERUS, ADNEXA: Large nearly circumferential cervical mass is redemonstrated, extending to the mid to low uterine body. It measures approximately 6.5 x 5.3 x 7.0 cm (AP by ML by CC dimensions), previously 6.7 x 5.0 x 8.5 cm. Invasion into the vagina, parametrium and posterior bladder is again seen, with large fistulous communication between the bladder and vagina/uterine cavity redemonstrated (series 901, image 28). Total tumor volume appears to have slightly decreased in size, as evidenced by aforementioned measurements and extent of tumor into the uterine body. Tumor is again noted abutting the rectum posteriorly without definite evidence of invasion.BLADDER: Invasion of the posterior bladder by cervical mass, as described above. Bilateral nephroureteral stents are again noted.LYMPH NODES: Multiple pathologically enlarged bilateral inguinal pelvic lymph nodes are redemonstrated. A right pelvic lymph node measures 1.8 x 0.9 cm (series 1301, image 223), previously 2.8 x 1.9 cm. Other pelvic and inguinal lymph nodes are also stable to mildly decreased in size.BOWEL, MESENTERY: New rectal wall thickening likely represents radiation-related effects.BONES, SOFT TISSUES: The partially imaged anterior L5 vertebral body lesion demonstrating hypointense T1 and T2 signal and rim peripheral enhancement on postcontrast images is suspicious for osseous metastasis and is more prominent than seen on prior imaging.OTHER: No significant abnormality noted.

Output: 1.Large cervical mass has slightly decreased in size. Invasion and fistulization with the posterior bladder is redemonstrated.2.Lymphadenopathy is stable to slightly decreased, as above.3.Increased size of a peripherally enhancing L5 anterior vertebral body lesion, suspicious for metastasis though may also represent radiation-related effects.


Instruction: Generate impression based on findings.

Input: 43 year-old male with a history of FAP and intestinal obstructions. Screen for desmoid tumors. Presents with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Loss of signal on phase sequences, consistent with hepatic steatosis.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: Postoperative changes of total colectomy with ileoanal anastomosis. There is dilation of the distal ileum immediately proximal to the anastomosis measuring up to 5.9 cm in diameter. This may be related to diminished peristalsis secondary to the presence of a anastomotic site, however, submission of prior examinations for comparison could be considered if clinically indicated.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of total colectomy with ileoanal anastomosis. There is dilation of the distal ileum immediately proximal to the anastomosis measuring up to 5.9 cm in diameter. This may be related to diminished peristalsis secondary to the presence of a anastomotic site, however, submission of prior examinations for comparison could be considered if clinically indicated.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Postoperative changes without evidence of focal mass lesion to suggest desmoid tumor formation, as clinically questioned.2. Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:12/10/1970)Reason: please do dr javed MS protocol compare to prior History: weakness and fatiguePROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD There is a marked degree of periventricular , subcortical, corpus callosum and to a lesser degree cerebellar white matter lesions which are hyperintense on T2 and FLAIR MRI but not associated with contrast enhancement and not significantly changed since the prior exam.An ill defined 6mm focus of enhancement adjacent and anterior to the right putamen is present and unchanged since the previous exam..A10 mm extra axial mass adjacent to the right occipital lobe is stable since May but measured 8 mm in 2011.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.There is nasopharyngeal soft tissue thickening present. This was also present on the prior exam.

Output: 1.Extensive white matter lesions are stable since the prior exam.2.An enhancing lesion adjacent to the right putamen is not associated with T2/FLAIR signal abnormality and is thus of uncertain significance. It is unchanged since the prior exam.3.An extra-axial mass adjacent to the right occipital lobe is stable since May but has slightly enlarged wince 2011. Presumably this represents a small meningioma.4.There is nasopharyngeal soft tissue thickening present. This is non-specific. Please correlate with clinical exam findings. It is stable compared to the prior exam


Instruction: Generate impression based on findings.

Input: 71 year old female with history of hypertension, premature ventricular contractions and near syncope presenting for cardiac evaluation. MEDICATIONS: amlodipine, aspirin and hydrochlorothiazide First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact is noted.Viability/ Myocardial ScarThere is no evidence of prior myocardial infarction; however, there is a small amount of an atypical pattern of late gadolinium enhancement involving the mid myocardium in basal inferolateral wall suggesting that there is underlying myocardial fibrosis, inflammation, or infiltration. This pattern is commonly described in old myocarditis but the differential diagnosis is broad.Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 81 ml/m2 (normal range: 65+/-11), the LVEDV is 162 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 79 ml (normal range 31+/-10), the LV mass index is 39 g/m2, and the LV mass is 77 g. The systolic dysfunction is global without regional wall motion abnormalities. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 129 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 62 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. Normal LV size with low normal systolic function (LVEF 52%) with evidence of an atypical pattern of a small amount of late gadolinium enhancement involving the mid-wall of the basal inferolateral wall. The pattern does not represent prior myocardial infarction or disorders such as cardiac amyloid. It is often described in patients with old myocarditis but can be seen in several other disorders.3. Normal RV size and systolic function (RVEF 52%).4. Mild mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 19 years Male (DOB:2/10/1997)Reason: Hx of choroid plexus papilloma History: as abovePROVIDER/ATTENDING NAME: KATARINA VESKOVIC KATARINA VESKOVIC The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post posterior fossa craniotomy as well as left frontal craniotomy. The left lateral ventricle remains asymmetrically larger than the right lateral ventricle. There is redemonstration of a defect along the body of the corpus callosum.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.

Output: The patient status post left frontal craniotomy and posterior fossa surgery. A portion of the body of the corpus callosum has been removed. These findings are stable compared to previous exams. Since the prior exam there is no evidence for recurrence


Instruction: Generate impression based on findings.

Input: History of recently diagnosed Gleason 8 prostate cancer. PELVIS:PROSTATE:Prostate Size: 6.7 x 5.8 x 7.3 cm.Peripheral Zone: There is a large, exophytic mass arising from the right base and mid gland which demonstrates decreased T2 and ADC signal which is compatible with neoplasm.Central Gland: Hyperplastic nodules compatible with prostatic hypertrophy.Seminal Vesicles: There is abnormal signal within the right seminal vesicle adjacent to the aforementioned right peripheral zone mass compatible with seminal vesicle invasion.Extracapsular Extension: There is extensive extracapsular extension associated with the large right peripheral zone exophytic mass including involvement of the right neurovascular bundle. The aforementioned lesion also abuts the rectal wall.BLADDER: No significant abnormality noted.LYMPH NODES: There are are a few subcentimeter perirectal and internal iliac lymph nodes which are nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 12/2/2016 10:15:00)RIGHT PERIPHERAL ZONE LESION: 4.1 x 2.6 cm (Image 61, Series 501); 3.9 cm (Image 72, Series 503).

Output: Large, exophytic mass arising from the right peripheral zone compatible with neoplasm with associated extracapsular extension, invasion of the right seminal vesicle, invasion of the right neurovascular bundle, abutment of the rectal wall, and possible pelvic lymph node involvement.


Instruction: Generate impression based on findings.

Input: 77-year-old female with cirrhosis and HCV ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Cholelithiasis. Stable fluid signal lesion in the dome of the liver, possible subcapsular cyst. Prominent, unchanged gastric ligament and porta hepatis lymph nodes are likely reactive secondary to chronic liver disease.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 10 mm right superior pole cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Susceptibility artifact from lumbar stabilization hardware is again noted. T2 coronal large field-of-view sequences demonstrate severe degenerative and dysplastic changes of the left hip with a moderate joint effusion, similar to the prior exam.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology without focal lesion suspicious for HCC.2.Degenerative and dysplastic changes of the left hip with moderate joint effusion, similar to the prior exam.3.Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: Female, 28 years old, with demyelinating disease, concern for MS. An equivocal small T2 hyperintense lesion is evident within the right lateral spinal cord at C5-6 (see image 24 series 8). No other obvious spinal cord lesions are demonstrated. No epidural abnormalities are suspected.Reversal of the cervical lordosis is likely positional. Spinal alignment is otherwise anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is observed.There may be a very small left foraminal disc protrusion or annular fissure at C4-5 with mild narrowing of the foramen. Otherwise, the intervertebral discs are preserved. No other areas of spinal canal or foraminal stenosis are seen.

Output: 1.Only one equivocal focal lesion is evident within the right lateral spinal cord at C5-6.2.Minimal disc degeneration is seen at C4-5.


Instruction: Generate impression based on findings.

Input: Male, 27 years old, with hand numbness, history of basilar invagination, Chiari malformation. Evaluate for worsening stenosis or cord edema. Suboccipital craniectomy and resection of the C1 posterior arch are redemonstrated. The thecal sac becomes tight at the C1 level with effacement of the CSF and some cord deformation, but this is similar to the prior postoperative exam. Above and below this level, the thecal sac is more capacious. The cerebellar tonsils are not crowded.The clivus is dysmorphic and the odontoid process projects through the foramen magnum. The odontoid process impresses upon the brainstem which has assumed a kinked morphology. T2 signal abnormality and slight volume loss affect the left lateral cord at C1. Faint signal abnormality is also detected in the left lateral cord throughout the cervical region. Findings are unchanged.Spinal alignment is otherwise anatomic. Vertebral body heights are preserved. Marrow signal characteristics are within normal limits. No disc herniations are seen. The spinal canal and neural foramina are otherwise patent.

Output: 1.Findings are redemonstrated compatible with Chiari decompressive surgery. At the C1 level, the thecal sac is tight with effacement of the CSF and cord deformation, but this appearance is unchanged. Above and below this level, the thecal sac is of adequate caliber. 2.Basilar impression is redemonstrated. The odontoid process impinges upon the brainstem which is kinked. Findings are unchanged. 3.Cord signal abnormality suggestive of myelomalacia is seen in the left lateral cord at C1, and faintly through the remainder of the left lateral cord. These findings are also unchaged.4.No definite new findings or significant interval changes are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: There is a disc-osteophyte complex and uncovertebral hypertrophy at C5-6 with moderate left and mild right neural foraminal narrowing, but no significant spinal canal stenosis. There is also an eccentric left disc-osteophyte and uncovertebral joint hypertrophy at C6-7 with moderate left neural foraminal stenosis, but no significant right neural foraminal or spinal canal narrowing. There is a trace posterior disc osteophyte complex at C4-5, but no significant spinal canal or neural foraminal stenosis at this level. There is no significant degenerative spondylosis at C2-3, C3-4 or C7-T1. There is straightening of the cervical spine alignment in the sagittal plane. There is a degenerative bone marrow signal alteration at C5 and C6, but no evidence of marrow infiltration processes. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The imaged intracranial structures are unremarkable.

Output: Degenerative spondylosis with moderate left and mild right neural foraminal narrowing, but no significant spinal canal stenosis. There is also an eccentric left disc-osteophyte and uncovertebral joint hypertrophy at C6-7 with moderate left neural foraminal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are a few punctate foci of FLAIR hyperintensity within the bifrontal subcortical white matter, all of which correlate with apparent perivascular spaces on conventional T2 technique and are thus not felt to be clinically significant. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are essentially clear. Pituitary MRI:High-resolution images of the sella demonstrate the pituitary gland to be normal in size measuring 7 mm in height. There is a subtle focus of relative hypoenhancing heterogeneity within the posterior left paramedian pituitary without a discrete convincing focus to confirm pituitary microadenoma. There is no macroadenoma. The pituitary infundibulum inserts on the midline of the gland. There are no suprasellar or parasellar masses and the cavernous sinuses are symmetric bilaterally.

Output: 1.Negative noncontrast brain MRI.2.There is a subtle focus of relative hypoenhancing heterogeneity within the posterior left paramedian pituitary without a discrete convincing focus to confirm pituitary microadenoma. Please note that microadenomas may become heterogeneous or even indistinguishable if there has been pharmaceutical treatment.


Instruction: Generate impression based on findings.

Input: 24-year-old man with injury to the right knee 3 days ago, presenting with pain, swelling and decreased range of motion. Patient has history of knee dislocation x5 and prior surgery. MENISCI: The medial and lateral menisci are normal in appearance.ARTICULAR CARTILAGE AND BONE: There is edema within the patella inferomedially, as well as within the lateral femoral condyle anterolaterally, likely representing bone contusions related to recent transient patellar dislocation. The femoral trochlea is abnormally shallow, indicating dysplasia. There is irregularity of the articular cartilage along the medial facet inferiorly, indicating tearing. There is slight depression of the underlying subchondral bone, suggesting an osteochondral fracture. There is also heterogeneity of the articular cartilage of the lateral facet of the femoral trochlea indicating degeneration or chronic tearing. There is also curvilinear low density in the lateral femoral condyle, anteriorly, representing a subchondral fracture. The articular cartilage of the tibiofemoral compartment appears relatively spared.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is edema and irregularity of the medial retinacular structures suggesting injury/tearing. Specifically, the femoral attachment of the medial patellofemoral ligament is not well visualized. There is also increased signal within the fibers of the patellar attachment of the retinaculum, suggesting tearing. Thickening and irregularity of the lateral retinacular structures may be due to prior surgery.  EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact.ADDITIONAL

Output: Findings indicating recent transient patellar dislocation with lipohemarthrosis and other findings as above. Findings were discussed with Maricela Sandoval on 6/21/2016 at 8:55am.


Instruction: Generate impression based on findings.

Input: 60 years, Female, Reason: Incidental Find on OSH CT Scan, 9mm pancreatic mass head/body. Please Evaluate for Change in Lesion, six 6 months from last scan 8/2014. History: none. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Lesion in the right hepatic lobe measuring 8 mm which is bright on T2 with progressive enhancement likely represents a hemangioma.Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: There is a 9 mm cystic lesion in the head of the pancreas which communicates with the pancreatic duct, likely a side branch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cystic lesion in head of pancreas is stable and likely represents a sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with right leg weakness, pain, status post minimally invasive procedure with blood products. Postoperative findings are seen compatible with laminotomy and facetectomy on the left at L3-4 and L4-5. Fluid which was seen previously in the operative bed has resolved and has been replaced by hypointense tissue perhaps representing scarring. There is no longer any mass effect upon the underlying thecal sac.The vertebral bodies are otherwise intact and demonstrate normal height. Alignment is within normal limits. Scattered Schmorl's node deformities and degenerative endplate signal abnormality is redemonstrated similar to the prior examination. The visualized distal spinal cord and conus are within normal limits.L1-2: Mild facet arthropathy and ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Facet arthropathy and ligamentum flavum thickening. A 4-mm cystic structure has newly developed along the right ligamentum flavum. This lesion projects into the spinal canal, displacing several adjacent nerve roots. Disc bulging is seen. Findings contribute to produce a mild spinal canal stenosis, and mild right foraminal narrowing. Except as above, no other interval changes are seen. L3-4: Postoperative findings. Resolution of prior fluid in the operative bed and reexpansion of the thecal sac. Advanced facet arthropathy. Disc bulging. Mild spinal canal stenosis, improved from prior. Mild bilateral foraminal narrowing, similar to prior. L4-5: Postoperative findings. Resolution of prior fluid in the operative bed and reexpansion of the thecal sac. Advanced facet arthropathy. Disc bulging. No significant spinal canal stenosis, improved from prior. Moderate bilateral foraminal narrowing, unchanged. L5-S1: Advanced facet arthropathy. Ligamentum flavum thickening. Bulging disc with a superimposed right paracentral extrusion which may contact the descending S1 nerve root. The spinal canal is narrowed similar to prior. Moderate to severe left and moderate right foraminal narrowing, unchanged.

Output: 1.Postoperative findings are seen compatible with laminotomy and facetectomy on the left at L3-4 and L4-5. Fluid which was seen previously in the operative bed has resolved. Associated mass effect on the adjacent thecal sac has also resolved.2.A new 4 mm cyst of the right ligamentum flavum has developed at L2-3 resulting in displacement of several of the adjacent nerve roots.3.Disc bulging with a right paracentral extrusion is redemonstrated at L5-S1 without significant interval change. As before, this lesion may impinge upon the descending right S1 nerve root.4.Degenerative findings at the other levels are not significantly changed.


Instruction: Generate impression based on findings.

Input: Familial cerebral cavernous malformation. Brain: The supratentorial and infratentorial cavernous malformations have not appreciable changed. There is no associated edema or acute infarction. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.Cervical spine: There is a 1 cm diameter cavernous malformation in the spinal cord at the C2 level with associated surrounding T2 hypointensity, which appears to have slightly increased in extent. There is no other cervical spinal cord intramedullary lesion. There are postoperative findings related to previous C1-C3 posterior decompression via laminectomies. There is reversal of the normal lordosis, centered at C3-C4. There is also minimal anterior subluxation of C3 relative to C4 and C2 relative to C3. There is loss of disc T2 signal from C2 through C7 associated with minimal disc height loss and bulges. The vertebral bodies are preserved in height. The vertebral bone marrow signal is also unremarkable. There is no significant spinal canal or neural foraminal stenosis.

Output: 1.The punctate cerebral and brainstem cavernous malformations are not significantly changed since May 2015.2.Increased chronic hemorrhage surrounding the upper cervical spinal cord cavernous malformation since August 2014. 3.Postoperative findings related to C1-C3 posterior decompressive laminectomies with persistent reversal of the normal cervical lordosis centered at C3-C4 and slightly more pronounced upper cervical subluxations.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with secondary GBM on Avastin. Assess for growth, compare to past two MRIs. Sequelae of extensive prior left-sided craniotomy is seen with a large left frontal resection cavity.A masslike T2 hyperintense lesion remains evident involving portions of the left frontal lobe, the insula and basal ganglia, and the anterior left temporal lobe. When compared to the immediate prior examination, this large lesion has not significantly changed in size. When compared to the examination of 4/30/2015, however, there has been a slight increase in size. For reference, the lesion measures 63 x 43 mm in the coronal plane (image 14 series 801), whereas previously it measured 60 x 40 mm.Most of the above-mentioned lesion is nonenhancing. However, at the level of the left inferior frontal resection cavity, projecting into the cavity, there is a persistent enhancing nodule which measures 18 x 15 mm. This lesion shows no significant or convincing change in size from the prior examinations.The above lesion contains several small foci of susceptibility perhaps related to chronic blood product. Some of these may be new relative to the prior examination. Elsewhere, no significant intracranial hemorrhage is suspected.Patchy white matter T2 hyperintensity within the right cerebral hemisphere has not significantly changed, possibly representing a combination of chronic microvascular ischemic disease and treatment related white matter injury. The size and configuration of the ventricles is approximately stable relative to the prior examination, but there is slightly more effacement of the left frontal horn relative to older exams due to lesion growth as above.

Output: A large tumor-like process is redemonstrated involving portions of the left frontal lobe, left insula/basal ganglia, and left anterior temporal lobe. When compared to the immediate prior examination, this lesion has not significantly changed in size. When compared to older exams, however, there has been a mild generalized increase in bulkiness.Most of the above-mentioned lesion is nonenhancing. However, at the level of the inferior left frontal lobe, projecting into the resection cavity, there remains a nodule of enhancing tissue which shows no significant interval change in size over several prior exams.


Instruction: Generate impression based on findings.

Input: Please evaluate for brain metastases 70-year-old femaleTechnique: 100 mL Omnipaque 350 was used and injected at two mL/sec via the right wrist using a 22-gauge needle. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. There are subcortical and periventricular white matter hypodensity is present which are also identified on the MRI from 12/08. A calcific lesion is present along the faults cerebri and the right side measuring 1 cm in size and is suspected to represent a burned out meningioma.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear with the exception of a minor opacity in the left posterior ethmoid air cells unchanged since the 5/03 exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Compared to the exam of 5/29/03 there is no change in the appearance of the calvarium.

Output: No evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: 65-year-old male with elevated INR and mental status change. Evaluate for hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodense region within the subcortical and periventricular white matter consistent with small vessel disease, age indeterminate. Well defined hypodense region within the left MCA territory and left cerebellum consistent with previous strokes. No acute cortical stroke is seen, however, if there is clinical concern for acute ischemia, an MRI may be considered. Dense atherosclerotic calcifications noted throughout the large vessels.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No interval change. 2. Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 64 years Male (DOB:3/3/1952)Reason: hx cervical disc, eval for abnormality. History: Right arm pain, thumb numbnessPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is straightening of the normal cervical curvature present. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There are right-sided uncovertebral osteophytes and a disc bulge at this level associated with encroachment of the right-sided exiting nerve roots. This has not changed significantly since prior exam. There is mild narrowing of the spinal canal at this level. At C4-5 there is no significant compromise to the spinal canal. There is a disc bulge present and uncovertebral osteophytes predominantly on the left side where there is encroachment of the left-sided exiting nerve roots. This was also present on the prior exam it appears to have slightly progressed.At C5-6 there is a disc bulge associated with uncovertebral osteophytes predominantly in the right side with encroachment of the nerve roots in the right neural foramen. There is mild narrowing of the left neural foramen at this level. These findings have not changed substantially compared the prior exam. Overall there is a mild to moderate degree of spinal stenosis at this levelAt C6-7 there are bilateral uncovertebral osteophytes present and a disc bulge associated with effacement of spinal fluid ventral and posterior the spinal cord. Overall is a moderate degree of spinal stenosis present at this level. These findings have not changed substantially compared the prior exam.At C7-T1 there are endplate uncovertebral osteophytes present associated with encroachment of the neural foramina bilaterally and encroachment of the exiting nerve rootsThe vertebral artery flow voids appear to be intact. The left vertebral artery is larger than the right vertebral artery.

Output: There are multilevel degenerative changes present in the cervical spine with moderate spinal stenosis at C6-7 and neural foraminal encroachment of exiting nerve roots bilaterally at C6-7, on the right side at C5-6, on the left side at C4-5 and on the right-sided C3-4. There is mild to moderate spinal stenosis C5-6


Instruction: Generate impression based on findings.

Input: Myxopapillary ependymoma status post surgery and proton RT in 2014. There are stable postoperative findings related to myxopapillary ependymoma resection and radiation therapy with confluent fatty bone marrow signal in the lumbosacral vertebrae. There is no evidence of tumors within the spinal canal. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. However, there is prominence of the ligamentum flavum at multiple levels of the thoracic spine, which results in neural foramen stenosis, but no spinal cord compression. There appears to be clumping of cauda equina nerve roots in the upper lumbar spine region. There is an unchanged mass in the region of the right adrenal gland that displays fat signal characteristics.

Output: 1. Stable post-treatment findings without evidence of recurrent tumor in the spine.2. Possible arachnoiditis in the upper lumbar region.3. Unchanged mass in the region of the right adrenal gland that displays fat signal characteristics, which may represent a lipoma or angiomyolipoma.


Instruction: Generate impression based on findings.

Input: Parkinson's disease; planning for DBS. There is apparent absence of the "swallow tail sign" in the bilateral substantia nigrosomes. There is no evidence of intracranial mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with Parkinson's disease. Otherwise, unremarkable MRI for preoperative planning.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 14 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 43 seconds.

Output: Successful fluoroscopic right hip arthrogram injection.


Instruction: Generate impression based on findings.

Input: Ms. Brennan is a 66 year old female with BRCA2 mutation carrier and a strong family history of breast and ovarian cancer, including in her mother and three maternal cousins. Personal history of left breast benign MRI guided biopsy in 2011 There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Susceptibility artifact from biopsy marker clip is identified in the left breast, at site of prior benign breast biopsy. Scattered foci of enhancement are seen bilaterally, none of which appear more suspicious than the rest. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Incidental note is made of non-enhancing fluid within the subacromial subdeltoid bursa of the left humerus.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 71 year old man with history of CAD s/p PCI to RCA x 2, referred for evaluation of possible ascending aorta dilation seen on echo. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 108 ml/m2 (normal range: 74+/-15), the LVEDV is 224 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 65 g/m2 (normal range 85+/-15), and the LV mass is 134 g (normal range 164+/-36). There are no regional wall motion abnormalities present. The late gadolinium enhancement images along the basal quarter of the left ventricle are difficult to interpret due to image artifact. The remainder of the left ventricle is free of late gadolinium enhancement suggesting no underlying myocardial fibrosis, inflammation, or infiltration.Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 109 ml/m2 (normal range 82+/-16), the RVEDV is 226 ml (normal range 142+/-31), the RV end systolic volume index is 53 ml/m2 (normal range 31+/-9), and the RVESV is 110 ml (normal range 54+/-17).Right AtriumThe right atrium is mild dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. No thoracic aortic dissection or aneurysm noted. The aortic root is mildly dilated. The dimensions are as below:Sinus of Valsalva: 40x38mmST Junction: 32x31mmAscending Aorta (5cm from AV plane): 38x39mmAortic Arch: 28x32mmDescending Aorta: 28x29mmAbdominal aorta (at renal artery) 21mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 60% without evidence of obvious underlying myocardial fibrosis, inflammation, or infiltration; however, the basal quarter of the left ventricle is not well visualized due to image artifact. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%.3. No thoracic aortic aneurysm or dissection. Aortic root mildly dilated. 4. Mild to moderate left atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of prostate cancer.Additional history per electronic medical record:Marc Copland is a 67 Yr old male with prostate cancer treated with focal laser ablation June 2013 for Gleason 3+3=6 prostate cancer and a PSA between 6-7. His last PSA was 7.37 ng/ml from June 2014. His PSA was 8.37 ng/mL in October 2014. His PSA was 10.2 in June 2015. His PSA was 7.9 in August 2015. His PSA was 9.9 ng/mL in February 2016. His most recent prostate biopsy from June 2014 did not reveal evidence of disease. PELVIS:PROSTATE:Prostate Size: 5.0 x 6.3 x 6.0 c.m.Peripheral Zone: Post-ablation changes in the left apex and mid gland. Scattered areas of heterogeneously decreased T2 signal within the peripheral zone not significantly changed and without focal discrete lesions identified.Central Gland: Nodules compatible with BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Post-ablation changes at the left apex and mid gland, without residual or new tumor evident.


Instruction: Generate impression based on findings.

Input: Reason: 38 y/o female with reports of hallucinations/ delusions/confusion. On Clinical Trial for metastatic rectal carcinoid History: see above. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered periventricular and subcortical punctate T2 hyperintensities which are nonspecific and may treatment related or secondary to prior inflammation. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. A cavum septum pellucidum is incidentally noted. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. Mild mucosal thickening of the right maxillary sinus. A partial empty sella is noted, which may be a normal variant or associated with intracranial hypertension in the appropriate clinical setting.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Medial knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is mild signal heterogeneity of the cartilage of the medial femoral trochlea inferiorly reflecting mild degeneration. There is no fluid-filled articular cartilage defect within the patellofemoral compartment or elsewhere in the knee.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Mild degeneration of the articular cartilage of the medial femoral trochlea. The remaining evaluation of the knee is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 31-year-old man with history of PSC strictures and cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal hepatic lesion is identified.The gallbladder is normal. Alternating areas of intrahepatic biliary stricturing and dilatation are again seen, similar to the prior examination. Of note, these areas of stricturing appear to affect the central and left hepatic lobe ducts.Hyperenhancement of the ducts is seen without mass or nodularity.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: Prominent portacaval nodes are noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ventral incisional scar noted.OTHER: No significant abnormality noted.

Output: 1.Stable appearance of intrahepatic biliary narrowing and dilatation, similar to the prior exam, compatible with given history of PSC.2.Liver normal in signal and morphology without evidence of HCC or cholangiocarcinoma.


Instruction: Generate impression based on findings.

Input: Moyamoya disease [I67.5], Reason for Study: ^Reason: 13 y/o ho brain tumor History: none Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Scattered FLAIR high signal intensity lesions on bilateral centrum semiovale are redemonstrated, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the left MCA M1 and proximal M2 segment. The left distal MCA M2 segment is reconstituted and visualized on this MRA. The right distal ICA and proximal right MCA M1 segment show mild to moderate luminal stenosis, considering the difference of imaging technique, it is likely to be unchanged. Bilateral ACA A1 segments' luminal stenosis are again seen, unchanged. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Unchanged bilateral centrum semiovale FLAIR high signal intensity lesions since prior scan.3. Progressed obliteration of the left MCA M1 segment. 4. Stable distal right ICA, proximal right MCA M1 segment and bilateral ACA A1 segment stenosis since prior scan.5. Normal neck MRA.


Instruction: Generate impression based on findings.

Input: 58 year-old female with back pain radiating to lower abdomen. Reason: look for high lumbar radiculopathy. Per EMR: DJD of C-spine. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is mild loss of disc space at L4-L5 and L5-S1. There are degenerative marrow changes at L4-L5, but marrow signal is otherwise unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with conus termination at mid-L1. The paravertebral soft tissues are unremarkable.Degenerative changes are seen in the lumbar spine as described below:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-L5: There is no significant compromise to spinal canal or neural foramina. There is a small central/left paracentral annular fissure along a mild diffuse posterior disc bulge that abuts the bilateral descending L5 nerve roots and causes mild flattening of the ventral thecal sac. There is mild thickening of the ligamentum flavum and hypertrophy of the facet joints. There is mild bilateral foraminal narrowing, likely due to loss of disc height.L5-S1: There is no significant compromise to spinal canal or neural foramina.There is enlargement of the visualized portion of the uterus likely relating to history of known fibroids.

Output: Mild degenerative changes at L4-L5 with disc bulge abutting bilateral L5 descending nerve roots.


Instruction: Generate impression based on findings.

Input: 72-year-old female with known left breast cancer presents for ultrasound study of the left axilla. Recent MRI (5/18/2016) showed a prominent lymph node in the left axilla. Ultrasound of the left axilla is performed. There is a low-lying axillary lymph node with mildly thickened cortex measuring 4.6 mm, with increased flow, likely corresponding to the prominent lymph node detected on the MRI. Additionally, there are a few normal appearing lymph nodes in the left axilla.

Output: A borderline suspicious lymph node in the left axilla at lower aspect.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Known history of brain mets status post WBRT in 4/2014. Baseline exam. There has been overall interval increase in size of the enhancing component of numerous supratentorial and infratentorial masses as well as the associated vasogenic edema. For example, a heterogeneously enhancing mass in the right medial temporal lobe measures up to approximately 30 mm, previously up to 15 mm, a partially cystic or necrotic mass in the right superior frontal gyrus measures up to approximately 20 mm, previously 15 mm, and an enhancing tumor in the right cerebellar hemisphere measures up to approximately 10 mm, previously 5 mm. Many of the lesions contain susceptibility effect, which may represent hemorrhage or calcifications. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and imaged portions of the cervical spine are diffusely heterogeneous. There are bilateral lens implants.

Output: 1. Interval progression of numerous supratentorial and infratentorial brain metastases with associated vasogenic edema, but no midline shift. 2. Extensive osseous metastases.Discussed with Dr. Hoffman on 1/21/2015 11 AM.


Instruction: Generate impression based on findings.

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

Output: Successful fluoroscopically guided intra-articular injection of dilute gadolinium for right hip MR arthrogram.


Instruction: Generate impression based on findings.

Input: Left-sided sciatica, lumbago.Patient has lumbar disc disease and spinal stenosis scoliosis and decreased sensation to the upper back and hyperreflexia Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is a 5 mm T2 hyperintense nodule in the left thyroid gland lobe which is also high signal on T1.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.There is no compromise to cervical spinal canal or thoracic spinal canal or the associated exiting nerve roots.2.No abnormal lesions are identified in the cervical spinal cord or the thoracic spinal cord to explain the patient's symptoms of hyperreflexia.3.Small left thyroid gland lobe nodule is nonspecific


Instruction: Generate impression based on findings.

Input: Instability. Evaluate for ACL tear. MENISCI: The anterior horn and body of the lateral meniscus are intact. The anterior inferior popliteal fascicle appears thickened and indistinct, likely representing injury with mildly increased signal intensity in the adjacent peripheral fibers of the posterior horn of the lateral meniscus, perhaps representing a small undersurface tear in the red zone.There is intrasubstance signal within the posterior horn and body of the medial meniscus which may represent intrasubstance degeneration or perhaps contusion. There is also more vertically oriented linear signal within the red zone of the posterior horn that extends to the tibial articular surface which is suspicious for a small tear. The anterior horn of the medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: Edema within the posterior aspect of the lateral tibial plateau as well as within the lateral femoral condyle above the anterior horn of the lateral meniscus represent bone contusions.A small focus of curvilinear low signal intensity within the subchondral bone of the lateral femoral condyle of the anterior horn of the lateral meniscus likely represents a small impaction fracture.There is prominence of the lateral aspect of the patella which likely represents a partially fused bipartite patella or perhaps old trauma with mild increased signal intensity within the overlying cartilage suggesting focal degeneration, but we see no discrete fluid-filled defect of the articular cartilage.LIGAMENTS: The ACL is thickened, enlarged and of increased signal intensity representing a full-thickness or near full-thickness tear. The PCL, MCL and LCL are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. ACL tear with bone contusions as described above.2. Findings suggestive of small peripheral tears of the posterior horns of the medial and lateral menisci.3. Other findings as above.


Instruction: Generate impression based on findings.

Input: Evaluate for cerebellar abnormalities. History: ataxia, abnormal finger-to-nose testing. Some of the images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintnesity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. However, there is diffuse paranasal sinus mucosal thickening and secretions with suggestion of air-fluid levels.

Output: 1. The cerebellum appears grossly unremarkable. No evidence of intracranial hemorrhage, mass, or acute infarction.2. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. There is an enhancing left parietal bone lesion that measures up to 16 mm. There is also sclerotic areas in the posterior calvarium. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia in the anterior right temporal lobe. There are also a few scattered punctate foci of nonspecific T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Skull metastases, but no evidence of intracranial metastases. 2. Right anterior temporal lobe encephalomalacia.


Instruction: Generate impression based on findings.

Input: Reason: hx failed back syndrome. s/p epidural injection: c/o pain down leg and weakness/ back pain. r/o abnormality History: back and leg pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. The patient is status post instrumentation with posterior effusion with a pedicle screws at L3, L4 and L5 bilaterally, laminectomies at L3, L4 and L5 and disk spacer at L4-5. There is epidural fat accumulation in the lower lumbosacral canal.There is mild ill-defined dural enhancement present at L4, L5 and S1.At L5-S1 there is no significant compromise to spinal canal or neural foramina. L5 is minimally posteriorly subluxed relative to S1. There is a disk bulge present at this level associated with the signal hyperintensity on T2 within the posterior aspect of the annulus fibrosis. This is stable when compared to the prior examAt L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild intra-subluxation of L4 on L5 which is unchanged when compared to the prior exam.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.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Findings suggest an inflammatory reaction in the lower lumbar spinal canal. It is possible this represents reaction to epidural injection, given the clinical history, although any inflammatory process including early infection may have a similar appearance.2.Status post lumbar spine surgery with instrumentation for fusion and laminectomies from L3 through L5 .3.There is mild anterior subluxation of L4 on L5 which is stable.4.There is no significant compromise of spinal canal or exiting nerve roots appreciated.5.Findings suggest epidural lipomatosis in the lower lumbosacral canal. This is not changed substantially the prior exam


Instruction: Generate impression based on findings.

Input: Ms. Thompson is a 66-year-old female presenting for imaging evaluation of a suspicious cluster of calcifications in the left upper inner breast. Patient is to have a stereotactic guided biopsy following this Breast MRI. There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Specifically, there is no abnormal enhancement seen at the site of mammographically detected calcifications in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Specifically, no abnormal enhancement seen at the site of mammographically detected calcifications in the left breast. A stereotactic biopsy continues to be the recommendation for sampling of these calcifications.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Right lower quadrant pain, assess small bowel ABDOMEN:LIVER, BILIARY TRACT: No focal parenchymal lesion in the visualized liver. The hepatic and portal veins are patent. No biliary ductal dilation.SPLEEN: No significant abnormality in the visualized spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: See below.BOWEL, MESENTERY: Extensive inflammation in the right lower quadrant best seen on series 11, image 1520 with avid enhancement and marked bowel wall thickening involving the distal 7 cm of terminal ileum, ileocecal valve, and cecum / proximal ascending colon. The cecum and terminal ileum are adhesed. The affected terminal ileum is significantly narrowed with mild prestenotic distention of a proximal small bowel loop measuring up to 2.3 cm (series 13, image 56). Marked regional mesenteric lymphadenopathy and inflammatory changes are noted. Underlying fistula can not be excluded. No evidence of abscess. Angulated loops of bowel in the abdomen are compatible with adhesive disease.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Marked right lower quadrant inflammatory changes with involvement of the terminal ileum, and cecum / proximal ascending colon as described compatible with active inflammatory bowel disease. No evidence of abscess. Underlying fistula can not be excluded.


Instruction: Generate impression based on findings.

Input: Stage IV thyroid cancer status post treatment. There are postoperative findings related to total thyroidectomy with vitamin E capsules positioned over the site of the surgical scar. There is ill-defined patchy enhancement within the thyroidectomy bed, but otherwise no evidence of discrete measurable mass lesions or significant lymphadenopathy in the neck. The upper aerodigestive tract and salivary glands are unremarkable. The osseous structures appear to be intact. The orbits are grossly unremarkable. There is a subcentimeter nodular focus of enhancement in the right paraspinal muscles at the level of C6 that appear continuous with the adjacent veins, which likely represent a prominent segment of vein. There is an enhancing nodule that measures up to 16 mm in the left cerebellar hemisphere with surrounding vasogenic edema.

Output: 1. Post-treatment findings without convincing evidence of recurrent tumor in the neck.2. A lesion in the left cerebellar hemisphere likely represents metastatic disease. A dedicated brain MRI would be useful for further evaluation of intracranial metastases.Discussed with Dr. Cohen at 4:25 PM on 7/24/15.


Instruction: Generate impression based on findings.

Input: Reason: glenohumeral congruency. Morphology of humeral head and glenoid History: right brachial plexus palsy No evidence of glenohumeral dislocation. Morphology of the humeral head and glenoid appear within normal limits. Normal bone marrow signal.

Output: No evidence of glenohumeral dislocation.


Instruction: Generate impression based on findings.

Input: Minimal anterolisthesis of C3 on C4 and C4 on C5 is noted. Heterogeneity of the bone marrow signal is likely related to red marrow reconversion. Spinal canal is uniformly narrowed, a component of which may be congenital. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: T2 hyperintensity along the posterior aspect of the disc likely represents an annular fissure. Mild spinal canal stenosis seen at this level without neural foraminal narrowing.C3/4: Diffuse disc bulge and uncovertebral hypertrophy results in moderate spinal stenosis, severe right neural foraminal narrowing, and moderate left neural foraminal narrowing.C4/5: Central disc protrusion and uncovertebral hypertrophy results in moderate spinal stenosis and moderate bilateral neural foraminal narrowing. C5/6: Posterior disc osteophyte complex extends from the right paracentral to right far lateral regions and causes narrowing of the right lateral recess, moderate spinal stenosis, and moderate bilateral neural foraminal narrowing, right greater than left.C6/7: Posterior disc osteophyte complex causes mild to moderate spinal stenosis and moderate bilateral neural foraminal narrowing.C7/T1: No disc bulge or significant spinal canal or neural foraminal narrowing.

Output: Degenerative changes of the cervical spine as described above with moderate spinal stenosis and scattered moderate to severe neural foraminal stenoses. Spinal cord is normal in signal.


Instruction: Generate impression based on findings.

Input: Left-sided thyroid nodule RIGHT LOBE MEASUREMENTS: 2.9 x 1.9 x 0.9 cmLEFT LOBE MEASUREMENTS: 6.8 x 4 x 2.9 cmISTHMUS MEASUREMENTS: 8mmRIGHT LOBE: Multiple small subcentimeter nodules largest measuring 9 x 6 by 8mm. echodensity of the right lobe is again heterogeneous.LEFT LOBE: Dominant nodule in the left lobe measures 4.2 x 3 cm, not significantly changed from previous study. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple thyroid nodules. Dominant solid nodule in the left thyroid lobe is unchanged compared to previous study.