Instruction: Generate impression based on findings.

Input: 66 years Female (DOB:4/9/1949)Reason: r/o cervical spondylosis, ro/ cord impingement History: neck pain, brisk reflexes, lower extremity sensory symptomsPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ 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 mild reversal of normal cervical curvature. 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 is mild loss of disc space height, disc desiccation and a disc bulge at this level associated with bilateral uncovertebral osteophytes and narrowing of the neural foramina bilaterally.At C4-5 there is no significant compromise to the spinal canal. There is a loss of disc space height, disc desiccation and disc bulge at this level associated bilateral uncovertebral osteophytes and encroachment of the exiting nerve roots within the neural foramina bilaterally.At C5-6 there is no significant compromise to the spinal canal. There is a loss of disc space height, disc desiccation and disc bulge at this level associated bilateral uncovertebral osteophytes and encroachment of the exiting nerve roots within the neural foramina bilaterally but worse on the right side when compared to the left.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present this levelAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. The patient is status post intraspinous fixation at L4-5. There is mild anterior subluxation of L4 and L5.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a diffuse disc bulge at this level associated with chronic endplate reactive changes and some mild narrowing of the spinal canal. There is mild facet and ligamentum flavum hypertrophy at this level.At L4-5 there is mild anterior subluxation of L4 on L5 associated with loss of disc space height, disc desiccation and diffuse disc bulge as well as bilateral facet hypertrophy. There is crowding of the nerve roots within the thecal sac at this level and overall a moderate degree of spinal stenosis. The exiting nerve roots within the neural foramina are surrounded by fat at this level. The spinal stenosis is regressed compared to the 10/2/2012 exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and mild bilateral facet and ligamentum flavum hypertrophy at this level.At L2-3 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with mild facet and ligamentum flavum hypertrophy. There is partial effacement of the spinal fluid surrounding the cauda equina at this level. Overall there is a moderate degree of spinal stenosis at this level. This has progressed since the prior exam of 10/2/2012.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are Schmorl's nodes present at T12-L1. There is a vertebral body hemangioma present at T12 and another one at T11

Output: 1.The patient is status post intraspinous posterior fusion at L4-5 since the prior exam. There is spinal stenosis at L4-5 has regressed compared to the prior exam but is still present.2.Moderate spinal stenosis due to degenerative changes at L2-3 has developed since the prior exam from 2012.3.Degenerative changes are present in the cervical spine mainly resulting in encroachment of exiting nerve roots within the neural foramina at C3-4, C4-5 and C5-6.


Instruction: Generate impression based on findings.

Input: 41 year old woman with newly diagnosed breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The index right breast lesion is an oval, enhancing mass located in the central right breast at the 9:00 position, measuring 2.2 x 1.6 x 1.4 cm in size. Susceptibility artifact inside this lesion represents a biopsy clip. Satellite masses surround the index lesion in close proximity with a 7 mm lesion superolaterally and additional, smaller lesions superiorly. The extent of non-mass enhancement surrounding the index lesion in the right lateral breast measures 8.2 x 3.4 cm and extends from the chest wall to 1.9 cm posterior to the nipple. The non-mass enhancement is primarily inferior to the index mass. An enlarged right axillary lymph node is seen measuring 1.5 x 1.0 cm and appears abnormal in morphology.No suspicious foci of abnormal enhancement are noted in the left breast. Left axillary lymph nodes are unremarkable.There is a trace right pleural effusion.

Output: 1.Right breast cancer measures up to 2.2 cm and has surrounding satellite lesions.2.Extent of right breast non-mass enhancement measures up to 8.2 cm.3.Enlarged right axillary lymph node with abnormal morphology.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: eval malabsorption- looking for small bowel inflammation or diverticuli History: multiple vitamin deficiencies 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: No bowel wall thickening or dilatation. No abnormal enhancement. No evidence of obstruction. The terminal ileum appears normal. Jejunal and ileal fold pattern is within normal limits. No small bowel diverticula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal MR enterography without findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Underlying the marker is a focal subcutaneous soft tissue prominence in the posterior lower neck. This lesion measures approximately 16 x 40 mm (AP x CC) and follows fat signal intensity on all sequences and with suppression on the T1 fat saturation sequence, although the lesion contains some prominent internal linear septations. There is no evidence of myelocele. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: A mass in the posterior lower neck subcutaneous tissues likely represents a lipoma. However, given the lack of intravenous contrast administration and the presence of internal architecture in the lesion, an atypical lipomatous lesion cannot be entirely excluded. Further evaluation with post-contrast imaging may be useful.


Instruction: Generate impression based on findings.

Input: 49-year-old female. Status post liver transplant, hyperbilirubinemia. EPIC history: liver transplant 3/10, 3/11 for subcapsular hematoma, 3/23 for abdominal washout and liver biopsy for work-up of cholestasis. ABDOMEN:LIVER, BILIARY TRACT: Post surgical findings of a liver transplant. Surgical drain terminates over the anterior right hepatic dome and a new drain has been placed adjacent to the left hepatic lobe. Perihepatic packing material appears to have been removed with residual peripheral T1 hyperintensity at the lateral aspect of the liver that likely represents residual hematoma. Heterogeneous signal in segment 7 of the liver is concerning for an infarct. Very mild scattered intrahepatic biliary ductal dilatation.Limited evaluation of the hepatic vasculature on this noncontrast exam. Normal vascular flow-voids of the portal vein and hepatic veins are present on T2 sequences. The common hepatic artery signal flow void is seen 1 cm from its take off from the celiac axis; the rest of the artery is not visualized. SPLEEN: Splenomegaly measuring 17.1 cm. Peripheral heterogeneous signal in the spleen is concerning for splenic infarcts.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter.BOWEL, MESENTERY: Proximal small bowel dilatation up to 4.3 cm with a partially collapsed distal terminal ileum, concerning for a partial small bowel obstruction. Nonspecific small bowel wall thickening. Enteric tube terminates in the proximal jejunum.BONES, SOFT TISSUES: Anasarca. Midline skin staples.OTHER: Small amount of abdominopelvic ascites.

Output: 1.Very mild scattered intrahepatic biliary ductal dilatation. Hepatic veins and portal vein are patent with normal vascular flow voids. Common hepatic artery flow void is seen 1 cm from its take-off from the celiac axis, rest of the artery is not well-visualized. 2. Findings concerning for a segment 7 hepatic infarct and multiple splenic infarcts.3. Dilated small bowel likely due to a partial small bowel obstruction.4. Small amount of ascites.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with low back pain. Assess for signal changes. Cervical:Straightening of the cervical lordosis is seen. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No pathologic parenchymal or leptomeningeal enhancement is detected within the limitations of motion artifact. No epidural abnormalities are seen.C2-3: Left facet arthropathy. No significant spinal canal stenosis. Minimal left foraminal narrowing.C3-4: Left facet arthropathy. No spinal canal stenosis. No significant foraminal narrowing. C4-5: Left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis related moderate left foraminal narrowing. C5-6: Loss of disc height with posterior disc-osteophyte complex formation. Effacement of the ventral thecal sac but no significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. C6-7: Loss of disc height with posterior disc-osteophyte complex formation. Effacement of the ventral thecal sac but no significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Thoracic:A slight exaggeration of the thoracic kyphosis is seen. Sagittal alignment is otherwise unremarkable. Vertebral body heights are preserved. No pathologic marrow replacement, edema or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No areas of pathologic parenchymal or leptomeningeal enhancement are detected. No epidural lesions are suspected.Minimal degenerative findings of the intervertebral disks and posterior elements are seen. No areas of significant spinal canal or foraminal stenosis are observed.

Output: 1.No evidence of marrow edema or pathologic spinal enhancement is seen. The spinal cord is within normal limits.2.Degeneration of the intervertebral discs and left-sided facets is seen in the cervical region. No high-grade spinal canal stenosis is detected. However, significant foraminal narrowing is evident on the left at C4-5 and bilaterally at C5-6 and C6-7.3.No significant abnormalities are detected in the thoracic spine.


Instruction: Generate impression based on findings.

Input: 60 year old woman with history of ischemic cardiomyopathy and 3V CAD, referred for cardiac MRI to evaluate myocardial viability. Left VentricleThe left ventricle is mildly dilated with moderately decreased systolic function. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 110 ml/m2 (normal range: 65+/-11), the LVEDV is 216 ml (normal range 109+/-23), the LV end systolic volume index is 76 ml/m2 (normal range 18+/-5), the LVESV is 149 ml (normal range 31+/-10), the LV mass index is 49 g/m2 (normal range 67+/-11), and the LV mass is 95 g (normal range 114+/-24). There is hypokinesis of the mid anteroseptal, anterior, and anterolateral walls and the apical anterior and septal walls. There is no late gadolinium enhancement of the myocardium. There is extensive viability throughout the myocardium. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 160 ml (normal range 110+/-24), the RV end systolic volume index is 45 ml/m2 (normal range 22+/-8), and the RVESV is 88 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve has bi-leaflet tethering with moderate to severe mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are large bilateral pleural effusions, there is evidence of pulmonary edema,and there is consolidation in the left lower lung which could represent atelectasis or infiltrate. There is a large hiatal hernia. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with moderately decreased systolic function. The overall LV ejection fraction is 31%. There is extensive viability in all 3 coronary artery territories without evidence of any myocardial infarction. 2. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%.3. Moderate to severe mitral regurgitation.4. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient with episodes of nonresponsiveness, weakness for past two days, rule out TIA. There is no evidence of intracranial hemorrhage, mass or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. These changes appear minimally more prominent than on the prior study. If there is concern for an acute stroke, an MRI is recommended for further evaluation.The ventricles appear unchanged compared to the prior examination. Small choroid plexus cysts appear stable since 2002.The calvaria and skull base are radiographically normal. The left sphenoid sinus demonstrates evidence of chronic inflammatory changes but now appears mostly aerated. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate by CT. If there is concern for an acute stroke, an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of hippocampal sclerosis on this scan.There is however, about 3mm sized fluid, likely CSF, filled space at the junction of subiculum and CA1. The lesion appears to be in continuum of hippocampal fissure.Underlying brain shows scattered of high signal intensity lesions on bilateral hemispheres and periventricualr white matter indicating non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No MR evidence of hippocampal sclerosis or abnormal enhancement. However, if clinically indicated dedicated temporal lobe MRI can be considered since it will provide much precise and detailed evaluation for temporal lobe imaging analysis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Thyroid cancer. Head CT:Nonspecific cerebral white matter hypoattenuation is compatible with small vessel ischemic changes. There is no evidence of intracranial mass, hemorrhage or infarction. No enhancing abnormality is seen. Neck CT:There is a large, irregular, heterogeneous mass at the thyroid bed, measuring 44 x 34-cm (series 4, image 56). There is likely involvement of the bilateral sternocleidomastoid muscles. The mass invades the trachea and extends to the right tracheo-esophageal groove, likely also involving the esophagus. There are satellite lesions in the right sternocleidomastoid muscle.A necrotic nodule measuring 13 x 16-mm (image 52, series 4) is seen, consistent with right level 6 adenopathy. There is extracapsular extension, and partial encasement of the right carotid artery.There is prominent soft tissues thickening along the tectorial membrane at C1 and C2 levels of uncertain etiology. Nonspecific lucent lesions are seen in C2 vertebra. MRI of cervical spine is recommended to exclude neoplasm. Degenerative disease of the cervical spine is seen, with disk osteophyte complex at C4 - C5 level, causing spinal canal stenosis. Severe neural foramina narrowing is also seen at multiple levels.

Output: 1. Large, necrotic mass in thyroid bed, with involvement of bilateral sternocleidomastoid muscles, and invasion of the trachea. There is also likely involvement of the esophagus.2. Right level 6 adenopathy with extracapsular extension and partial encasement of right carotid artery.3. Nonspecific vague lucent lesions in C2 vertebra, with soft tissue thickening along tectorial membrane. Correlation with MRI is recommended.4. Degenerative disease of cervical spine, resulting in spinal canal stenosis and foraminal stenosis..


Instruction: Generate impression based on findings.

Input: Female 46 years old Reason: 46 y/o F with SCC of the anus w/ liver mets here with worsening RUQ pain. Please assess for worsening met disease. Please focus on the liver. History: pain ABDOMEN:LIVER, BILIARY TRACT: Multiple liver lesions are again identified.A hypoenhancing lesion consistent with an ablation defect is noted within segment 7 measures 4.9 x 1.1 cm (series 801, image 323) and is unchanged compared to prior study. A hypoenhancing lesion at the hepatic dome, posterolateral to the IVC measures 1.2 x 0.9 cm (series 801, image 368). This is stable in size compared to prior CT 05/09/2015 and smaller when compared to more remote studies.There is hypoenhancing lesion peripherally in the right hepatic lobe with overlying capsular retraction. This measures approximately 1.1 x 1.1 cm (series 801, image 333). There is surrounding arterial hyperenhancement, best appreciated on subtraction images which may reflect flow phenomenon however ongoing surveillance is recommended. There is adjacent perihepatic and intercostal fluid. There is capsular retraction overlying the left hepatic lobe with subtle confluent hyperenhancement, more obvious on delayed phases of imaging and suggestive of fibrosis. This may represent posttreatment changes. No discrete measurable lesion is identified.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.

Output: 1.Multiple liver lesions are again noted some of which demonstrate posttreatment changes. A peripheral right hepatic lobe lesion with overlying capsular retraction and surrounding arterial hyperenhancement requires ongoing close surveillance is active metastatic disease is not excluded.


Instruction: Generate impression based on findings.

Input: Several sequences are motion degraded. Given this caveat:The right cerebellar tonsil lies 11 mm below the level of the foramen magnum, and the left 10 mm. Both demonstrate abnormal pointed morphology and efface the adjacent posterior CSF spaces. There is a small prominence within the cervical cord at the level of C4, only partially imaged.There is a 10 mm ovoid T2 hyperintense, T1 hypointense, nonenhancing lesion within the soft tissues overlying the right paramedian maxilla.The ventricles and sulci are normal in size. 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. Mucosal thickening is present within the left sphenoid sinus. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Coronal images of the temporal lobes demonstrate the temporal horns, hippocampal formations and parahippocampal gyri to be normal in size and symmetric bilaterally without signal abnormalities, masses, or abnormal enhancement identified within the medial temporal lobes on either side. There is no evidence of mesial temporal sclerosis and there are no foci of heterotopic gray matter.

Output: 1.Several sequences are motion degraded.2.MRI evidence of Chiari malformation. A small prominence within the cervical cord at the level of C4, only partially imaged, may represent a small syrinx.3.There is a 10 mm ovoid T2 hyperintense, T1 hypointense, nonenhancing lesion within the soft tissues overlying the right paramedian maxilla. This is felt to represent an incidental nasolabial cyst.


Instruction: Generate impression based on findings.

Input: Reason: Eval for myositis History: weakness, elevated CK Right thigh: The signal intensity within the musculature is within normal limits, without evidence of myositis or frank atrophy. The remaining soft tissues are unremarkable. The bone marrow signal intensity is within normal limits. Mild osteoarthritis affects the hip and knee joints.Left thigh: A small, elongated collection of fat signal intensity within the distal semimembranosus may represent a small lipoma, otherwise, the signal intensity of the musculature is normal. The signal intensity within the remaining soft tissues and bone marrow is unremarkable. Mild osteoarthritis affects the hip and knee joint.The signal intensity of the prostate gland is heterogeneous, compatible with BPH; please note, however, that this study was not protocoled for detailed assessment of the prostate gland, including detection of prostate cancer. There are small bilateral hydroceles.

Output: Essentially normal-appearing muscles, without evidence of myositis or frank atrophy. Other findings as above.


Instruction: Generate impression based on findings.

Input: Word finding difficulty. Evaluate for central cause. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are postoperative findings related to endoscopic sinus surgery. There are mucus retention cysts in the bilateral maxillary sinuses. The skull and extracranial soft tissues are unremarkable. There are bilateral lens implants.

Output: 1. Nonspecific scattered foci of cerebral white matter T2 hyperintensity without evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Postoperative findings related to endoscopic sinus surgery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 48-year-old male with shoulder pain. Suboptimal examination secondary to inability to use a dedicated shoulder coil. A flex coil was utilized resulting in suboptimal image quality. Patient motion artifact limits examination.ROTATOR CUFF: There is a small partial-thickness insertional tear of the supraspinatus, measuring approximately 5 mm in the AP dimension, without significant retraction, involving less than one third of the tendon width. There is intermediate signal abnormality within the supraspinatus tendon consistent with mild tendinosis. The supraspinatus muscle appears intact. The infraspinatus and teres minor muscles and tendons appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: Again seen are postsurgical changes of prior distal clavicle osteotomy. Foci of metallic susceptibility artifact in the surrounding area are presumably postsurgical in etiology.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small glenohumeral joint effusion with foci of low signal debris internally suggesting synovitis. Moderate to severe degenerative changes affect the glenohumeral joint. Although this examination was not protocoled for evaluation of the glenoid labrum, there is heterogeneity and increased signal abnormality within the posterior labrum suggestive of degenerative tearing.BICEPS TENDON: There is circumferential fluid within the tendon sheath of the long head of the biceps suggestive of a tenosynovitis versus fluid extension from the glenohumeral joint. There is a foci of decreased signal abnormality within the tendon sheath of the long head of the biceps likely represent loose bodies within the tendon sheath.ADDITIONAL

Output: 1. Small insertional tear of the supraspinatus without evidence of a full-thickness rotator cuff tear.2. Small glenohumeral joint effusion and findings suggesting synovitis.3. Loose bodies within the tendon sheath of the long head of the biceps. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: There is a vertical tear of the posterior horn of the medial meniscus which extends to the inferior articular surface. Signal irregularity is also noted in the posterior horn of the medial meniscus which may reflect a small radial tear.ARTICULAR CARTILAGE AND BONE: Bony contusions are present within the lateral femoral condyle and posterolateral tibial plateau. Additional contusion is seen within the posteromedial tibial plateau and medial femoral condyle.LIGAMENTS: The ACL is ruptured. There is buckling and partial tearing of the lateral collateral ligament. The remaining ligamentous structures are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Ruptured ACL with at least partial tearing of the lateral collateral ligament.2. Vertical tear of the posterior horn of the lateral meniscus with findings suspicious for a small radial tear of the posterior horn of the medial meniscus.3. Bony contusions of the femoral condyles and tibial plateau.4. Moderate suprapatellar joint effusion.


Instruction: Generate impression based on findings.

Input: Brain:Scattered small foci of white matter T2 hyperintensity are redemonstrated without significant interval change. No clearly new lesions are seen. No evidence of edema or mass effect is detected. Diffusion-weighted images are within normal limits. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. As on the prior examination, the medulla is slightly flattened and deviates to the right likely to accommodate the prominent vertebrobasilar junction.Cervical spine:The visualized spinal cord shows normal signal intensity and morphology. No focal lesions are seen. No epidural abnormalities are suspected.Since the prior MRI examination, anterior instrumented fusion has been performed from C5 through C7. Intervertebral devices have been placed at C5-6 and C6-7. Disc osteophyte complexes and associated spinal canal narrowing seen at these levels on the prior examination have resolved or improved. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Postoperative findings. Improved spinal canal caliber without significant stenosis. Mild left foraminal narrowing. C6-7: Postoperative findings. Improved spinal canal caliber without significant stenosis. Mild left foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Lumbar spine:The first non rib-bearing vertebral body is designated L1. This yields 4 fully lumbar type vertebral bodies with a transitional L5 vertebral body.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics of the lumbar spine are unremarkable. However, the sacral ala are edematous, particularly on the left where there is a thick band of traversing T1 hypointensity.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are seen.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Facet arthropathy with effusions. Mild bulging disc. No significant spinal canal or foraminal stenosis. L4-5: Facet arthropathy. Mild bulging disc. No significant spinal canal or foraminal stenosis. L5-S1: No significant spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Scattered small lesions in the brain are unchanged compatible with the patient's stated history of multiple sclerosis. No definite evidence of any new lesion is seen. No acute intracranial abnormalities are detected.2.Interval anterior instrumented fusion has been performed from C5 through C7. Areas of spinal canal stenosis through this region seen on the prior examination have improved. No significant spinal canal stenosis is seen. No spinal cord abnormalities are detected.3.Edema is evident primarily within the left sacrum though to a lesser extent in the right sacrum as well. The pattern of the signal abnormality is suggestive of an insufficiency fracture. However, dedicated pelvic imaging is suggested to confirm this and exclude other etiologies.4.Relatively mild degenerative findings elsewhere in the lumbar spine without significant spinal canal or foraminal compromise.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: one episode of loss of consciousness concerning for seizure, evaluate for structural abnormality The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 3 x 5 mm coronal dimension lesion in the subcortical white matter of the right frontal lobe at the level of the inferior frontal gyrus which is bright on T2 and FLAIR MRI imaging and lower signal on T1-weighted imaging. It is also brighter on the SWI imaging. It is not associated with contrast enhancement.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The hippocampi are symmetric.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: 1.There is no convincing evidence for mesial temporal sclerosis on the basis of this exam.2.There is a small right frontal lobe lesion present within the subcortical white matter which is nonspecific in isolation.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago with sciatica, left sideClinical question: s/p lumbar fusion, new onset left leg pain/low back painSigns and Symptoms: s/p lumbar fusion, new onset left leg pain/low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are present in the spinal cord or nerve roots.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a central disc protrusion present at this level which impresses on the ventral aspect of thecal sac. It is associated with adjacent contrast enhancement which extends into the adjacent fat planes of the left lateral recess. The patient is status post left hemilaminectomy at this level. There is enhancement along the left perivertebral soft tissues. There is a ring-enhancing lesion present within the left laminectomy site measuring 16 x 9 mm axial dimensions. At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a right far lateral disc protrusion present at this level which mildly encroaches on the right-sided exiting nerve root as it exits the neural foramen. There is diffuse disc bulge and mild ligamentum flavum hypertrophy present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a 14 x 8 mm axial dimension enhancing focus present just lateral to the left neural foramen at this level. There is a left far lateral disc protrusion present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a mass present along the right kidney which is exophytic to the right kidney and measures 55 x 47 mm axial dimensions. It is associated with some heterogeneous enhancement following gadolinium and administration. It is heterogeneous on T2. It is hypointense on T1 but somewhat heterogeneous on T1 as well.

Output: 1.There is a mass present along the right kidney. The possibility this represents a neoplasm cannot be excluded. Current exam does not include the entire mass. If clinically appropriate additional imaging may be of benefit.2.Findings raise the question of a abscess at the left hemilaminectomy site at the L5-S1 level. 3.There is a small disc protrusion associated with the inflammatory changes consistent with scar formation at the left lateral recess of L5-S1 affecting the nerve roots at the left lateral recess at L5-S1.4.There is an inflammatory lesion present associated with the left-sided exiting nerve root at L3-4 along the lateral aspect of the neural foramen which is likely related to recent microdiscectomy performed at this site and may represent scar tissue for example. Please correlate with patient's clinical symptoms.5.At the time of this dictation the above findings were discussed with Dr. Mok.6.There is a right far lateral disc protrusion present mildly affecting the right-sided exiting nerve root at L4-5. This was also present on the prior MRI of the lumbar spine from January 2014 .


Instruction: Generate impression based on findings.

Input: Multilevel laminectomies and C5-7 ACDF with neck pain, but normal neurological exam. There are postoperative findings related to spinal fusion of C4 though C7. There is mature osseous ankylosis of the C6-7 disc space. At C3-4, there is right uncovertebral hypertrophy, which results in moderate right neural foraminal narrowing. At C5-6, there is bilateral uncovertebral hypertrophy, which results in moderate bilateral neural foraminal narrowing. At C6-7, there is a small left facet spur that mild narrowing the left neural foramen. There is no significant spinal canal at any of the cervical spine levels. The vertebral column alignment is near-anatomic. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable, beyond the portions obscured by surgical hardware artifact. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable, aside from the expected postoperative findings.

Output: Postoperative findings related to spinal fusion of C4 though C7 with mature osseous ankylosis of the C6-7 disc space. At C3-4, there is right uncovertebral hypertrophy, which results in moderate right neural foraminal narrowing. At C5-6, there is bilateral uncovertebral hypertrophy, which results in moderate bilateral neural foraminal narrowing. At C6-7, there is a small left facet spur that mild narrowing the left neural foramen. There is no significant spinal canal at any of the cervical spine levels.


Instruction: Generate impression based on findings.

Input: There are T2/FLAIR hyperintensities in the corona radiata, in the central semiovale, in the midline brain, and in the pons and medulla, representing chronic small vessel ischemic changes. Ventricular size is normal. No midline shift. No mass effect or acute hemorrhage. There is no abnormal enhancement. There are no diffusion or susceptibility abnormalities.There is fluid in the maxillary sinuses.Status post cataract surgery bilaterally.

Output: 1. No evidence of acute infarction. No mass effect or hemorrhage.2. T2/FLAIR hyperintensities in the centrum semiovale, corona radiata, pons, midbrain and medulla, representing chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 72-year-old female with history of diabetes and hypertension. Presents with slurred speech. Rule out stroke This examination demonstrates no evidence of any acute intracranial abnormality in particular no definite evidence of stroke is detected. If patient's clinical symptoms persist an MRI is recommended.The cortical sulci, ventricular system and all CSF cisterns remain within normal limits. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus is detected.Calvarial, mastoid air cells are unremarkable.Extensive inflammatory sinus disease of all paranasal sinuses that are visualized on this exam is noted.

Output: 1.No evidence of acute intracranial findings.2.Pansinusitis.3.4.


Instruction: Generate impression based on findings.

Input: Successful left wrist arthrogram. No fluoroscopic findings to suggest scapholunate or lunotriquetral ligament injury. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 42 seconds

Output: Successful left wrist arthrogram.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: fallopian tube cancer with brain mets s/p whole brain radiationSigns and Symptoms: assess for EOD There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.There is T2 and FLAIR signal hyperintensity redemonstrated along the right anterior medulla. There is redemonstration multiple foci of enhancement associated with T2 hyperintensity and FLAIR hyperintensity in the posterior fossa. One in the right cerebellar hemisphere measuring 10 mm x 8 mm axial dimensions. It previously measured approximately the same dimensions. Another ring-enhancing lesion in the left cerebellar hemisphere measures 12 x 8 mm and previously measured similar dimensions. Another enhancing lesion is present in the midbrain and measures 11 x 16 mm axial dimensions and previously measured similar dimensions. Other lesions are also similar in size compared to the prior exam. The lesion located in the cerebellar vermis measures 7 x 9 mm in sagittal dimensions on the current exam and previously measured 12 x 10 mm.There are also multiple enhancing foci in the supratentorial brain which are less numerous than in the posterior fossa. One in the left parietal lobe along the precuneus measures 10 x 14 mm on the current exam and previously measured the same. It has a peripherally enhancing nodule associated with it other smaller lesions are scattered in the parietal lobes and right occipital lobe. Multiple punctate foci of enhancement are identified in the parietal and occipital lobes which were not as readily appreciated on the prior exam.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: 1.There are multiple foci of enhancement scattered in the posterior fossa as well as supratentorial brain which are suspicious for metastatic disease. Compared to the October 28 exam there appears to be some minimal progression of some of the lesions and some regression of other lesions. Some but not all of the differences can be attributed to difference in scan technique between the two studies.2.Periventricular white matter lesions are attributable to posttreatment change.


Instruction: Generate impression based on findings.

Input: Shoulder instability Note that the examination is limited by motion artifact and by the patient's body habitus.ROTATOR CUFF: There is increased signal intensity within the infraspinatus tendon at its insertion upon the greater tuberosity indicating a combination of tendinosis and undersurface tearing. No full-thickness tear is identified. There is a small interstitial tear of the supraspinatus tendon but again there is no full-thickness tear identified. The supraspinatus and infraspinatus muscles are normal in caliber and signal. The teres minor and subscapularis muscles and tendons are intact.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. There is no gadolinium or fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. There is flattening of the posterolateral aspect of the humeral head indicating a Hill-Sachs deformity. There is truncation of the majority of the anterior labrum suggesting prior tearing with focal low signal intensity along the anterior margin of the scapular neck which may reflect displaced labral tissue (ALPSA lesion). There is attenuation of the superior labrum which may represent chronic attritional tearing but this is equivocal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Limited examination secondary to motion artifact and patient body habitus. There is a Hill-Sachs deformity and attenuation of the anterior labrum reflecting chronic tearing and the sequela of prior anterior dislocation.2. Partial undersurface tearing of the infraspinatus tendon at its insertion on the greater tuberosity.


Instruction: Generate impression based on findings.

Input: A 48 years old female with non-ischemic cardiomyopathy, moderate to severe left ventricular and mild right ventricular systolic dysfunction. Referred to MRI to evaluate ischemia and etiology.MEDICATIONS: Aspirin, Carvedilol, Glipizide, Lisinopril, metformin, Simvastatin First Pass PerfusionDuring hyperemia, there is a mild perfusion defect involving the apical septum and the mid inferior and inferoseptal walls. There is additionally a prominent dark rim artifact making image interpretation difficult.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is severely dilated with moderate to severe systolic dysfunction. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 105 ml/m2 (normal range: 65+/-11), the LVEDV is 207 ml (normal range 109+/-23), the LV end systolic volume index is 72 ml/m2 (normal range 18+/-5), the LVESV is 142 ml (normal range 31+/-10), the LV mass index is 56 g/m2, and the LV mass is 111 g. There is global hypokinesis with regional variation. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mild systolic dysfunction. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVEDV is 138 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal 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 a trace pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is mild ischemia in the usual distribution of the right coronary artery.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is severely dilated with moderate to severe systolic dysfunction (LVEF 31%).4. The right ventricle is normal in size with mild systolic dysfunction (RVEF 46%). 5. Left atrium is moderately dilated.6. Mild tricuspid and mitral regurgitation.


Instruction: Generate impression based on findings.

Input: Reason: assess for tenosynovitis or other injury History: left hand pain, weakness There is 1.2 x 1.1 x 2.4 cm nonspecific mass adjacent to the flexor tendons (series 1501 image 21, series1401 image 14), most likely ganglion cyst, but other pathology cannot be ruled out. There is mild mass effect on the adjacent flexor digitorum profundus and flexor digitorum superficialis. This lesion slightly extends into the carpal tunnel (series 1501 image 15), and may have mass effect on median nerve, although this is equivocal. We see no increased signal in the tendons to suggest tendinosis. Extensor tendons appear within normal limits. The bone marrow signals are within normal limits. Osseous alignment is anatomic.

Output: Nonspecific lesion adjacent to flexor digitorum tendons, most likely ganglion cyst, but other pathology cannot be ruled out. Contrast enhanced MRI may be helpful for further evaluation.


Instruction: Generate impression based on findings.

Input: 43Yrs old with a history of recurrent VTE/PE, central retinal vein occlusion in 7/2016, significant EtOH use (1 pint a day) and recently diagnosed severe LV dysfunction with EF 20% - who was referred for cardiac MRI to help ascertain the etiology of his cardiomyopathy. MEDICATIONS: aspirin, carvedilol, lisinopril, metoprolol, warfarin First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is moderately dilated with moderately depressed systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 127 ml/m2 (normal range: 74+/-15), the LVEDV is 261 ml (normal range 142+/-34), the LV end systolic volume index is 81 ml/m2 (normal range 25+/-9), the LVESV is 166 ml (normal range 47+/-19), the LV mass index is 86 g/m2, and the LV mass is 176 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with mildly depressed systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 118 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThere 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 drain normally into the right atrium.PericardiumThere is no pericardial disease.Extracardiac FindingsFocal areas of abnormal signal intensity in the right lower lobe represent scarring after prior pulmonary infarction.This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction or abnormal late gadolinium enhancement to suggest infiltrative, fibrotic or inflammatory disease. The entire myocardium is viable.3. Moderately dilated LV with moderately depressed systolic function. LVEF 37%4. Normal sized RV with mildly depressed systolic function. RVEF 43%


Instruction: Generate impression based on findings.

Input: Follow up of enhancing lesions in the brain. There is no significant interval change in the areas of subcortical white matter T2 hyperintensity with a component of enhancement and mild volume loss rather than mass-effect, within the anterior right temporal lobe, although this appears to be less extensive than in 2012. Likewise, a subcentimeter focus of high T2 signal and enhancement in the left frontal lobe white periventricular matter is unchanged since the last exam and slightly smaller than in 2012. There are also unchanged patchy areas of high T2 signal elsewhere in the cerebral white matter without associated enhancement. There are scattered areas of susceptibility effect in the supratentorial sulci, particularly the right frontal lobe. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: 1. No significant interval change in the areas of subcortical white matter T2 hyperintensity with a component of enhancement, but no mass-effect, within the anterior right temporal lobe, although this appears to be less extensive than in 2012. Likewise, a subcentimeter focus of high T2 signal and enhancement in the left frontal lobe white periventricular matter is unchanged since the last exam and slightly smaller than in 2012. These lesions may represent the sequela of inflammatory process, including a paraneoplastic syndrome, or vasculitis process rather than neoplasm.2. Unchanged nonspecific patchy areas of high T2 signal elsewhere in the cerebral white matter without associated enhancement, which may represent chronic small vessel ischemic disease and/or additional areas of a prior inflammatory process. 3. Redemonstration of scattered areas of supratentorial superficial siderosis, which may be related to a previous vasculitis process. An angiographic exam may be useful for follow up.


Instruction: Generate impression based on findings.

Input: Meningioma status post CyberKnife in May 2014 and orbital pseudotumor. Brain: There are postoperative findings related to left suboccipital craniotomy for resection of a meningioma with encephalomalacia in the left cerebellar hemisphere. There is slight interval decrease in size of the tumor, which now measures up to 13 mm in thickness, previously 16 mm. There is a persistent nodular extra-axial lesion that is T2 hypointense with susceptibility effect and mild peripheral enhancement along the floor of the left posterior fossa, adjacent to the craniotomy defect that measures up to 15 mm. There is unchanged mild nonspecific periventricular T2 hyperintensity. There is no evidence of acute infarct or hemorrhage. The ventricular system is stable in size and configuration. There has been interval partial resection of a left earlobe keloid.Orbit: There are postoperative findings related to orbitozygomatic craniotomy. There is interval decrease in size of a right inferior intraconal nodular lesion, abutting the optic nerve, measuring up to 12 mm, previously 24 mm. There is persistent associated surrounding enhancement of the right orbital fat and multiple extra-ocular muscles. There is staphylomatous deformity of the bilateral globes.

Output: 1.Slight interval decrease in size of the treated left posterior fossa meningioma.2. Persistent small nodular extra-axial lesion in left posterior fossa adjacent to the craniotomy margin may represent an organizing hematoma. 3. Decrease in size of the lesion within the inferior right orbit, abutting the optic nerve.


Instruction: Generate impression based on findings.

Input: 70 years Male (DOB:12/11/1945)Reason: assess for residual changes from stroke that may explain on going aspiration, pt undergoing OHT workup History: aspirationPROVIDER/ATTENDING NAME: SIRTAZ ADATYA NITASHA SARSWAT The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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: Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. There is no evidence for acute ischemic cerebral infarction or intracranial mass lesion.


Instruction: Generate impression based on findings.

Input: Reason: 19-year-old male with history of NK/T-Cell lymphoma s/p transplant with recurrent osteomyelitis now with bilateral foot pain History: 19-year-old male with history of NK/T-Cell lymphoma s/p transplant with recurrent osteomyelitis now with bilateral foot pain There is perhaps soft tissue irregularity along the medial and lateral aspects of the ankle which may represent ulceration. There is nonspecific enhancing subcutaneous edema most pronounced along the lateral aspect of the ankle which may represent a cellulitis in the correct clinical context. There is no evidence to suggest osteomyelitis of the underlying bone. Note is made of multiple serpentine foci of signal abnormality within the distal tibia, calcaneus, talus, navicular, cuboid, second cuneiform, and base of the fourth metatarsal consistent with osteonecrosis/bone infarcts. No osteochondral defects are identified. There is nonspecific diffuse edema affecting the imaged musculature of the ankle and foot involving both the flexor and extensor compartments. While these findings are nonspecific they may represent a myositis. There is a focus of susceptibility artifact within the subcutaneous plantar soft tissues along the plantar aspect of the cuboid which may represent a metallic foreign body (image 24; series 501). There is subcutaneous edema in the surrounding area which is nonspecific but may be inflammatory in etiology. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.

Output: 1. Extensive bone infarcts affecting the left ankle and midfoot as described above. There is no evidence of osteomyelitis.2. There is diffuse edema within the imaged musculature of the ankle and foot which is nonspecific but may represent a myositis.3. Soft tissue ulceration and subcutaneous edema may reflect a cellulitis in the correct clinical context, however, no focal fluid collection is seen to suggest abscess formation.4. Focus of metallic susceptibility artifact within the subcutaneous tissue along the plantar aspect of the midfoot may represent a foreign body.


Instruction: Generate impression based on findings.

Input: Recent CT scan showing terminal ileitis and regional lymph nodes, evaluate for small bowel inflammation. 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: Subcentimeter renal cysts are present on the right.RETROPERITONEUM, LYMPH NODES: The previously described mildly prominent mesenteric lymph nodes have decreased in size.BOWEL, MESENTERY: Portions of the proximal small bowel are underdistended which mildly limits evaluation. The small and large bowel are normal in caliber without evidence of obstruction. There is no abnormal bowel wall thickening or enhancement. The previously described mildly increased enhancement involving the terminal ileum has improved.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No intraperitoneal free air or free fluid.

Output: No specific evidence of inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Reason: MCL Sprain? History: pain MENISCI: There is increased signal abnormality within the medial meniscus indicating intrasubstance degeneration. There is deformity and blunting of the posterior horn of the medial meniscus indicating a complex degenerative tearing. The anterior horn appears intact. There is increased signal within the lateral meniscus indicating intrasubstance degeneration. Some of this signal extends to the tibial articular surface indicating degenerative tearing. There is associated parameniscal cyst formation confirming a tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the medial aspect of the medial tibial plateau with underlying subchondral signal abnormality. There is partial-thickness articular cartilage degeneration with superficial fraying along the weightbearing surface of the medial femoral condyle. There is full-thickness articular cartilage degeneration along the medial facet of the patella with large areas completely devoid of articular cartilage. There is underlying subchondral signal abnormality. There is superficial fraying and partial-thickness degeneration of the articular cartilage along the medial facet of the femoral trochlea.LIGAMENTS: There is increased signal abnormality about the superficial band of the MCL indicating a mild sprain. The PCL appears intact. The ACL appears intact. The LCL appears intactEXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Mild sprain of the MCL.2. Degeneration and complex tearing of the medial meniscus. 3. Full-thickness articular cartilage degeneration most pronounced along the patellofemoral articulation.


Instruction: Generate impression based on findings.

Input: Clinical question:? Acute intracranial pathology. Signs and symptoms: Altered mental status. Unenhanced CT of brain:The examination demonstrates multiple areas of bihemispheric and right middle cerebellar low-attenuation with subtle associated focal mass effect on the adjacent cortical sulci. These findings were noted on prior MRI exam, however there appears to be worsening of the findings in particular in the supratentorial brain parenchyma. There is no evidence of acute hemorrhage, midline shift or hydrocephalus. There is no change in the normal size of lateral ventricles.

Output: 1.In comparison to prior exam there appears to be worsening of findings in bilateral cerebral hemispheres. 2.No evidence of acute hemorrhage, midline shift or hydrocephalus.


Instruction: Generate impression based on findings.

Input: 24-year-old male with bilateral knee pain. Evaluate for patellar tendinitis. MRI of the right knee:MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: There is mild thickening and increased signal intensity of the proximal patellar tendon as it inserts into the inferior pole of the patella, most compatible with mild patellar tendinopathy.ADDITIONAL

Output: Mild bilateral patellar tendinopathy.


Instruction: Generate impression based on findings.

Input: 60-year-old woman with history of left lower back pain and radiculopathy. Five lumbar type vertebral bodies are presumed to be present and there is a transitional lumbosacral vertebral body. Vertebral body heights are within normal limits. Alignment is within normal limits. There is a T1 and T2 hyperintense, round lesion in the posterior T11 vertebral body, favor to represent a hemangioma. Otherwise, the bone marrow signal is benign. The conus medullaris is normal in position. There is congenital narrowing of the spinal canal below the L2 level.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is mild facet arthropathy and ligamentum flavum thickening without significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is moderate facet arthropathy and ligamentum flavum thickening with mild narrowing of the lateral recesses. No spinal canal or neural foraminal stenosis.L4-L5: There is facet arthropathy and ligamentum flavum thickening bilaterally, moderate on the left and mild on the right. There is mild narrowing of the left lateral recess, but no spinal canal or neural foraminal stenosis.L5-S1: There is facet arthropathy and ligamentum flavum thickening with moderate narrowing of the right lateral recess. Additionally, there is minimal narrowing of the right neural foramen. No spinal canal stenosis.A loculated cystic lesion in the pelvis is partially visualized and measures at least 5 cm. Otherwise, the paraspinal soft tissues are within normal limits.

Output: 1.Degenerative change, mostly involving the facet joints with narrowing of the lateral recesses. Minimal narrowing of the right L5/S1 neural foramen, otherwise no significant foraminal or spinal canal stenosis.2.Partially imaged large, septated pelvic cyst, consider gynecologic ultrasound for further evaluation.


Instruction: Generate impression based on findings.

Input: Brain: Examination is limited to axial T2 sequences. Increased dilatation of the lateral, third, and fourth ventricle when compared to the prior study. For example, the third ventricle previously measured 16 mm, currently 20 mm in diameter. The fourth ventricle is particularly expanded when compared to prior study, currently measuring 30 mm in transverse dimension, previously 24 mm, with dilatation extending caudally to the level of the obex. There is increased effacement of the prepontine cistern and increased dorsal scalloping of the brainstem. There is no midline shift or uncal herniation. There is evidence of transependymal flow. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is minimal scattered mucosal thickening in the right maxillary sinus and anterior ethmoid air cells. There are postoperative findings related to Chiari decompression.Cervical Spine: Limited sagittal T2 images were acquired. Patient is status post Chiari decompression. The septated cervicothoracic syringohydromyelia now extends cranially to the obex. At the C1 level, the syrinx currently measures 11 x 13 mm in the axial plane, previously 3 x 4 mm. Based on sagittal imaging, there is increase in dimension of the syrinx, particularly within the upper cervical spine, with associated increase in expansion of the cervical cord. However, there is slight decrease in size of the syrinx within the upper thoracic cord. There is focal severely diminished CSF flow ventrally and dorsally at the foramen magnum. Straightening of the normal cervical lordosis. No worrisome focal marrow signal abnormality is appreciated. There is no significant spinal canal stenosis.

Output: 1.Interval increase in dilatation of the lateral, third, and fourth ventricles compared to MRI from 9/2/2015.2.Increase in caliber of the syrinx particularly at the upper cervical cord level and obex. Syrinx involving the partially imaged upper thoracic cord appears decreased since 9/2/2015 based on the sagittal images.3.Examinations of the brain and cervical cord were abbreviated due to patient's condition.


Instruction: Generate impression based on findings.

Input: Check status of ulnar nerve for compression. Recurrent paresthesias and pain. Patient is status post cubital tunnel surgery. Exam limited without prior images for comparison given interval described surgery. The following comments are made within this limitation. In addition the patient was unable to complete the exam and this exam represents only 5 sequences.LIGAMENTS: The elbow ligaments appear intact. Particular attention was placed in the cubital tunnel, demonstrating specifically an intact arcuate ligament and ulnar collateral ligament. The ulnar nerve is also visualized throughout its entire course without discrete evidence of deviation or change in the expected intermediate signal demonstrated. No evidence of definite distinct flattening of the nerve. The overlying ligaments also do not demonstrate discrete abnormal signs of inflammation, specifically the flexor carpi ulna there is unremarkable. There is minimal stranding in the surrounding fat within the tunnel, presumably postsurgical scarring. Specifically fat is observed throughout the majority with relatively clear isolation of the ulnar nerve.TENDONS: As aboveARTICULAR SURFACES AND BONE: Minimal degenerative changes are partially visualized. SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Intact ulnar nerve visualized throughout the cubital tunnel as described. Please see details and limitations observed


Instruction: Generate impression based on findings.

Input: Evaluate for sacral mass. 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: A skin marker was placed along the dorsal aspect of the sacrum. Deep to the skin marker is an encapsulated low T1 and high T2 weighted signal lesion extending in the subcutaneous fat dorsal to the sacrum measuring 1.4 x 0.9 cm in maximal axial cross section and 7.3 cm in craniocaudal dimension (series 701/29 and series 501/34), compatible with a pilonidal sinus cyst. There is mild surrounding inflammatory changes of the soft tissues with T2 weighted fat stranding and mild postcontrast enhancement suspicious for superinfection. The lesion does not extend to the adjacent bony structures.There is a T2-weighted hyperintense tract extending from approximately the 6:00/dorsal aspect of the anal canal extending in the left gluteal fold suspicious for a fistulous tract (series 701/6 and series 901/6) with possible mild enhancement. No discrete abscess.There is very mild T2-weighted/STIR focal hyperintensity within the left iliac bone adjacent to the sacroiliac joint. No significant signal abnormality on the corresponding sacral side of the joint. No significant sacroiliac joint fluid. Otherwise the bone marrow signal intensity of the visualized osseous structures is unremarkable.Nonspecific subcentimeter inguinal lymph nodes.Please note that this study was not protocoled for the detailed evaluation of the acetabular labra.OTHER: No significant abnormality noted.

Output: 1.Suspected superinfected pilonidal sinus extending 7.3 cm in the craniocaudal dimension.2.6:00/dorsal perianal transsphincteric fistulous tract extending along the left gluteal fold.3.Very mild nonspecific left iliac bone T2-weighted/STIR hyperintensity.


Instruction: Generate impression based on findings.

Input: 68-year-old male with abdominal pain, vomiting ABDOMEN:LUNG BASES: Calcified granuloma in the right lung baseLIVER, BILIARY TRACT: Subcentimeter hypodensity at the dome of the liver may represent a hemangioma, suggested on prior MRI.SPLEEN: The spleen is mildly enlargedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple mildly enlarged mesenteric and retroperitoneal lymph nodes are identified, stable. A left paraaortic lymph node (series 2; image 66) is unchanged, measuring 1.4 cm.Scattered calcified lymph nodes are identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate gland is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No acute abnormality. Stable scattered adenopathy.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is an oblique tear of the posterior horn of the medial meniscus. There is thinning of the lateral meniscus with mildly increased intrasubstance signal representing degeneration however no discrete tear is identified.ARTICULAR CARTILAGE AND BONE: There is mild diffuse thinning of the articular cartilage of the medial compartment with a small full-thickness defect identified along the femoral condyle anteriorly. Mild diffuse thinning of the articular cartilage also affects the lateral and patellofemoral compartments although no focal full-thickness defect is identified.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Oblique tear of the posterior horn of the medial meniscus. The lateral meniscus demonstrates thinning and intrasubstance degeneration but without focal tear.2. Mild diffuse tricompartmental cartilage thinning with a small focal full-thickness defect within the medial femoral condyle anteriorly.


Instruction: Generate impression based on findings.

Input: Reason: left wrist pain (flare up), hx: lunate cyst History: above Again seen is a round lucency within the lunate likely representing an intraosseous ganglion as seen on the prior MRI examination, appearing similar to the prior study. The remaining carpal bones appear normal.

Output: Lunate cyst appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: 27-year-old female with history of abdominal pain and 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: The terminal ileum appears normal. No bowel dilation. No evidence of obstruction or abnormal enhancement.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: The terminal ileum appears normal. No bowel dilation. No evidence of obstruction or abnormal enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of chronic or active inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Spinal cord tumor of unknown etiology. Brain parenchyma is normal in attenuation and morphology. The ventricles are symmetric and normal in volume. No abnormal enhancing lesions are seen in the brain parenchyma. Focal enhancing mass is seen at the level of the foramen magnum which measures 2.8 x 2.1 cm transaxially (image 2 of series 7) x 3.1 cm sagittally (image 41 series 80273). The mass enhances homogeneously and appears extramedullary in location. It is unclear if the mass is extradural or intradural in origin. There is no evidence of associated bony destruction or remodeling. Few foci of high density are seen within the mass consistent with calcification. The upper cervical spinal cord is displaced posteriorly and laterally along the right aspect of the canal. No additional enhancing lesions are seen in the spinal canal. Differential considerations include a meningioma and a hemangiopericytoma. Findings can further evaluated with cervical spine MRI.The visceral and vascular structures of the neck are normal. No pathologic lymphadenopathy or abnormal enhancing masses are seen in the soft tissues of the neck. Airway is widely patent. Visualized osseous structures demonstrate degenerative changes without other abnormality. Visualized lung apices are unremarkable.

Output: Enhancing mass at the foramen magnum which appears extramedullary in location and causes mass effect on the spinal cord. Differential considerations include meningioma and hemangiopericytoma.


Instruction: Generate impression based on findings.

Input: Redemonstrated is the patient's infiltrative, heterogeneously contrast-enhancing mass involving the right frontal lobe. Mass effect partially effaces the right lateral ventricle and shifts the anterior midline structures leftward. Given differences in techniques, these findings are unchanged.

Output: Redemonstrated is the patient's infiltrative, heterogeneously contrast-enhancing mass involving the right frontal lobe. Mass effect partially effaces the right lateral ventricle and shifts the anterior midline structures leftward. Given differences in techniques, these findings are unchanged.


Instruction: Generate impression based on findings.

Input: Ms. Dooley submitted outside studies for review. Submitted for review are:-Bilateral breast MRI: 05/10/2016This examination was performed at Little Company of Mary Hospital. Multisequence MRI breast imaging with and without intravenous contrast was performed as per outside MRI breast protocol. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST:Spanning the entire right superior breast is a large area of clumped non-mass enhancement measuring approximately 4.5 x 2.9 x 2.7 cm (AP x ML x SI). Subtle susceptibility artifact from the two biopsy marker clips are noted in the superior and lateral aspects of this enhancement, compatible with biopsy proven DCIS. The anterior margin of this enhancement is approximately 1.4 cm from the right nipple base. Of note, there is a centrally dilated retroareolar duct seen with high T1 signal intensity internally, which courses through the area of non-mass enhancement. This duct is filled with either hematogenous or proteinaceous products. LEFT BREAST:There is no abnormal enhancement in the left breast.AXILLA:No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) 4.5 cm area of clumped non-mass enhancement spanning the entire right superior breast, with two biopsy marker clips at the superior and lateral margins, compatible with biopsy proven malignancy. (2) No MRI evidence for malignancy in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: new ischemia History: left sided neglect, right gaze preference The CSF spaces are appropriate for the patient's stated age with no midline shift. There are small foci of diffusion restriction present in the right middle cerebral artery territory in the right centrum semiovale as well as right postcentral gyrus and right supramarginal gyrus.A focus of high signal on diffusion weighted imaging in the left inferior parietal lobule extending to the adjacent temporal lobe is associated with a gyriform T1 signal hyperintensity but not diffusion restriction on ADC maps. It is associated with some gyriform susceptibility effect.There is encephalomalacia involving the right occipital lobe.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are similar signal changes in the brainstem and thalami.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 demonstrate mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is reversal of the normal cervical curvature present.

Output: 1.There are several small foci of acute infarction distributed in the right middle through artery territory as indicated above2.a focus of late subacute infarction is suspected in a left inferior parietal lobule.3.encephalomalacia in the right occipital lobe present probably related to an old focus of infarction.4.Periventricular and subcortical white matter changes of a moderate degree and signal changes in the brainstem and thalami are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Female; 34 years old. Reason: gallstones, pancreatitis History: lipase >3000, gallstone on bedside u/s ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions.Multiple small gallstones. Mild pericholecystic fluid and gallbladder wall thickening, which could be due to early acute cholecystitis. Normal caliber of the biliary tree. Common bile duct and distal cystic duct appear patent without evidence of choledochalithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Severe acute pancreatitis with diffuse interstitial pancreatic edema and large amount of peripancreatic free fluid, particularly in the left upper quadrant. No loculated fluid lesions. No pancreatic hemorrhage. Mild patchy enhancement of the pancreas due to pancreatitis. No evidence of pancreatic necrosis. No pancreatic ductal dilation. Splenic vein is patent. No splenic artery pseudoaneurysm is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Severe acute pancreatitis as detailed above.2. Mild pericholecystic fluid and gallbladder wall thickening, which could be due to early acute cholecystitis.Findings discussed with the GI fellow (Dr. Coronel) at 9:50 a.m. on 4/17/15.


Instruction: Generate impression based on findings.

Input: Cirrhosis, assess for HCC ABDOMEN:LIVER, BILIARY TRACT: Cirrhosis and trace perihepatic ascites. Scattered T2 hyperintense foci but no arterially enhancing lesion. Hepatic vasculature appears patent.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the right lower quadrant.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Upper abdominal varices.

Output: Cirrhosis without evidence of HCC.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for impingement from DJD History: RLE weakness and chronic back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal. There is mild bilateral facet and ligamentum flavum hypertrophy at this level associated with a disk bulge and disk dessication. There is partial effacement of the fat at the right lateral recess and partial effacement of the facet surrounding the exiting nerve roots at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height and a disk bulge at this level associated with mild facet and ligamentum flavum hypertrophy. There is mild narrowing of the neural foramina at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are mild degenerative changes in the lower lumbar spine with mild encroachment of the nerve roots at the left lateral recess and bilateral neural foramina at L5-S1.


Instruction: Generate impression based on findings.

Input: 50-year-old female with knee pain and calcifications of the MCL. MENISCI: Intrasubstance signal within the lateral and medial posterior horns and body of the menisci suggests mucoid degeneration, but we see no meniscal tear.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the patella and much of the lateral facet is devoid of articular cartilage. There is also focal degeneration of the cartilage of the femoral trochlea inferiorly with underlying subchondral cysts. There are full-thickness and near full-thickness cartilage defects along the lateral femoral condyle anteriorly. Small additional subchondral cysts are noted anteriorly and posteriorly along the femur.LIGAMENTS: There is heterogeneous signal intensity adjacent to the superior fibers of the MCL consistent with edema and mineralization as seen on recent radiographs. There is signal abnormality within the fibers of the proximal ligament, suggestive of sprain/partial tear. The proximal fibers of the medial patellofemoral ligament are not well-visualized and may be torn.EXTENSOR MECHANISM: The quadriceps extensor mechanism appears intact. There is a small amount of edema within the superolateral aspect of Hoffa's fat pad.ADDITIONAL

Output: 1. There is a sprain/partial thickness tear of the proximal fibers of the MCL with associated periligamentous inflammation and heterotopic mineralization. The proximal fibers of the MPFL are not well visualized and we cannot exclude a tear.2. Osteoarthritis most severely affecting the patellofemoral joint.


Instruction: Generate impression based on findings.

Input: Clinical question: Small cell lung cancer. Status post 6 cycles of chemotherapy. Evaluate for disease status. Signs and symptoms: Small cell lung cancer. Pre and post enhanced brain MRI:Negative diffusion weighted series. Examination demonstrate scattered tiny foci of FLAIR and T2 hyperintensity along the in the periventricular and subcortical white matter of cerebral hemispheres without evidence of hemorrhagic changes or enhancement. Although nonspecific findings are highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes and without significant change since prior exam from 3-5-15.Unremarkable signal intensity and overall anatomical morphology of brain otherwise and stable since prior exam.Post enhanced images are severely degraded due to motion artifact as well as extensive pulsation artifact. Within this limitation however there is no convincing evidence of abnormal parenchymal or leptomeningeal enhancement. This is a similar observation as prior study from earlier this month.Calvarium demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits including axial fat sat postcontrast enhanced series.Mild left maxillary chronic sinus disease and otherwise well pneumatized paranasal sinuses and bilateral mastoid air cells.

Output: 1.Negative diffusion weighted series.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter.3.Degraded post enhanced images due to motion and pulsation artifact however without convincing evidence of abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.


Instruction: Generate impression based on findings.

Input: Clinical question: 87 year-old female with altered mental status, posturing. Signs and symptoms: Altered mental status. Non-enhanced CT of brain:There is no evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns remain within normal. Very subtle small vessel disease is suspected.Follow-up with an MRI is recommended.Calvarium, visualized orbits, mastoid air cells and middle air cavities are unremarkable.Paranasal sinuses are unremarkable with the exception of minimal sphenoid sinusitis.

Output: No evidence of acute intracranial findings.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dizziness and giddiness Essential (primary) hypertension Essential (primary) hypertension Dizziness and giddinessClinical question: evaluate for causes of reflex abnormalitiesSigns and Symptoms: weakness, abnormal reflexes 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.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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: Periventricular and subcortical white matter signal changes of a moderate degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: 68-year-old female evaluate complex right renal cyst ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nonspecific subcentimeter hypodensity in the left lobe of the liver on image number 23, too small to accurately characterize but most likely benign.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The cyst incidentally discovered on previous MRI in the lower pole of the right kidney does not demonstrate any enhancement and measures 4-cm in diameter. Its consistent with a simple cyst. There are smaller cysts in the right kidney, some of which are too small to characterize. Largest cyst in the left kidney is in the lower pole and measures 11 x 19 mm image number 52, series number 7.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Bilateral benign-appearing cysts.


Instruction: Generate impression based on findings.

Input: There is heterogeneous bone marrow in the sacrum and imaged portions of the iliac bones attributable to incomplete fatty marrow replacement. The lumbar vertebral bone marrow otherwise appears unremarkable. There is a normal alignment of the vertebral bodies. The conus medullaris ends at the level of L1. The imaged spinal cord appears unremarkable. There are slight disc bulges and facet hypertrophy at L3-L4, L4-L5, and L5-S1, with mild neural foraminal narrowing on the right side at L3-4 and bilateral mild neural foraminal narrowing at L4-5 and L5-S1, as well as mild narrowing of the spinal canal at L4-5. There is also annular fissuring and discal enhancement at L5-S1, which may represent granulation tissue infiltration. There is partial sacralization of L5 on the right with associated hypertrophic changes at the L5-S1 transverse process articulation. There is a partially-imaged pancreatic cystic lesion.

Output: 1. No evidence of lumbar spine metastatic lesion.2. Mild lower lumbar spine degenerative spondylosis.3. Partial sacralization of L5 on the right with associated hypertrophic changes at the L5-S1 transverse process articulation, which can be implicated in Bertolotti syndrome.4. Partially-imaged pancreatic cystic lesion. Please refer to the prior body CT report for additional details.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of breast (female), unspecified site [174.9], Reason for Study: ^Reason: altered mental status History: fatigue There are multifocal various sized bihemispheric supra and infratentorial mainly gyriform enhancing lesions. In addition, there are some parenchymal nodular enhancing lesions such as right periventricular white matter and bilateral anterior temporal lobes. Dominant gyriform enhancing lesions as well as some nodular lesions are associated with surrounding edema without evidence of hemorrhage. There is no evidence of restricted diffusion.The location and MR characteristics of these lesions are suggesting the possibility of inflammatory or infectious lesions instead of tumorous condition. Since clinical history does not suggest abrupt development of symptoms, thus the possibility of vascular lesion would be less likely. Thus, diagnostic possibilities include toxic/metabolic lesions possibility related to the patient's prior or recent chemotherapy, paraneoplastic syndrome, PRES or unusual infectious condition. Possibility of neoplastic/metastatic origin would be lower.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal mainly gyriform enhancing lesions associated surrounding edema as described above. No evidence of acute ischemic or hemorrhagic lesion.2. Diagnostic possibilities include inflammatory or infectious lesions instead of tumorous condition. Since clinical history does not suggest abrupt development of symptoms, the possibility of vascular origin lesion would be lower.


Instruction: Generate impression based on findings.

Input: 46-year-old female with right neck and arm pain and tingling in right 1-3rd digits. Evaluate for degenerative changes. The craniovertebral junction appears within normal limits. There is straightening of the cervical spine with minimal retrolisthesis of the of the C6 vertebral body on C7. The vertebral body heights are maintained. The bone marrow signal is within normal limits. There is variable disc height loss most prominent at the lower cervical levels and there is multilevel disc desiccation. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3 : No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex with a small central component and mild right neuroforaminal narrowing but no left neuroforaminal or spinal canal stenosis.C4-5: Small disc osteophyte complex causes minimal bilateral neuroforaminal narrowing. There is mild spinal canal stenosis.C5-6: Disc osteophyte complex with a prominent right paracentral disc extrusion which causes moderate to severe right neuroforaminal stenosis. There is moderate left neural foraminal narrowing as well as moderate spinal canal stenosis particularly involving the right aspect of the spinal canal.C6-7: Disc osteophyte complex with a prominent right paracentral disc extrusion which extends to the lower C7 level and causes severe right neuroforaminal stenosis. There is mild left neuroforaminal narrowing as well as moderate spinal canal stenosis particularly involving the right aspect of the spinal canal. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel spondylosis and prominent right paracentral disc extrusions involving the C5-6 and C6-7 levels with resultant moderate spinal canal stenosis involving the right aspect of the spinal canal. No cord signal abnormality. The disc extrusions also contribute to moderate to severe right neural foraminal stenosis at the C5-6 level and severe right neural foraminal stenosis at the C6-7 level.


Instruction: Generate impression based on findings.

Input: 54 year old female with history of right breast carcinoma status post lumpectomy in 2004 with chemoradiation and hormone therapy. Family history of breast cancer diagnosed in maternal grandmother at age 52 and ovarian cancer diagnosed in mother. Patient is BRCA 1 positive. Recent 7/31/2014 MRI demonstrated new left 4 mm focus of enhancement in the left central breast that was no longer visualized on 8/4/2014 when attempted MRI guided biopsy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Postsurgical changes in the right lateral breast. Benign intramammary lymph node is stable. No new or abnormal enhancement.No abnormal enhancement in the left breast. Stable adjacent normal appearing low left axillary lymph nodes. The focus seen on last year's diagnostic exam does not enhance suspiciously or significantly this year. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. An annual diagnostic mammogram will be due in July 2015. Annual MRI follow up can also be considered. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Amnesia, ringing in ears, abnormal EEG. There is a partially empty sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is extensive artifact related to dental braces limits evaluation of the temporal lobes. The brain parenchyma otherwise appear unremarkable. The lateral ventricles are remain relatively narrow. 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 pseudotumor cerebri. Otherwise, extensive artifact related to dental braces limits evaluation of the temporal lobes.


Instruction: Generate impression based on findings.

Input: Medial pain MENISCI: There is an oblique horizontal tear of the posterior horn of the medial meniscus which extends into the body. Additionally, there is complex tearing of lateral meniscus which involves the anterior horn, body, and posterior horn.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the medial compartment, particularly along the femoral condyle. A 4 mm focal defect is also noted in the posterior aspect of the lateral femoral condyle. Mild cartilaginous thinning of the patellofemoral articulation is also noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tear of the lateral meniscus involving anterior horn, posterior horn, and body segment.2. Oblique horizontal tear of the posterior horn and body of the medial meniscus.3. Mild tricompartmental thinning of the articular cartilage with a 4 mm focal defect seen in the posterior aspect of the lateral femoral condyle.