Instruction: Generate impression based on findings.

Input: Pain of the left shoulder ROTATOR CUFF: There is increased signal intensity of the anteriormost fibers of the supraspinatus tendon proximal to its insertion at the greater tuberosity. This likely represents anterior edge fraying. There is an additional focus of intermediate signal intensity in the supraspinatus at its attachment to the greater tuberosity, which may represent focal tendinosis. We see no fluid-filled full-thickness rotator cuff tear. There is no significant supraspinatus muscle atrophy. Infraspinatus, subscapularis, and teres minor tendons and muscles appear normal.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the AC joint. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is mild degenerative cyst formation in the humeral head. Within the limitation of non-arthrogram study, the labrum appears normal.BICEPS TENDON: No significant abnormality noted.

Output: 1. Mild to moderate osteoarthritis of the AC joint appearing similar to prior study.2. Mild fraying of the anterior surface of the supraspinatus tendon as it courses along the rotator interval, but no full-thickness rotator cuff tear is present.


Instruction: Generate impression based on findings.

Input: Neck pain, car accident, shooting pain down arms Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. No evidence of fracture within the limits of MRI. Ligamentous structures are intact. The cervical spinal cord has normal signal characteristics and overall morphology.Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Cervical spine MRI is within normal limits for age. No evidence of spinal canal or neural foraminal stenosis at any level. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Clinical question: Preoperative planning for seizure examination. Signs and symptoms: Seizure. Pre and post infusion brain MRI:Examination is performed utilizing surgical/treatment planning protocol and is not a true diagnostic test. There is no detectable abnormal parenchymal or leptomeningeal enhancement.There is a linear focus of T2 hypointensity extending from the inner table of left stereotactic bone across the brain parenchyma and terminating in the medial aspect of the left anterior temporal lobe representing track of surgical ablation device. Small loculated focus of T2 hyperintense and T1 hypointense along the medial aspect of the left mid temporal lobe deep to represent focus of surgical ablation for seizure. This finding measures approximately at 11 x 14 mm in transaxial dimensions.Unremarkable study otherwise.New since prior exam there is a focus of T2 hyperintensity and T1 hypointensity in the left anterior frontal lobe involving the cortex and subcortical white matter which is best appreciated on axial series 201 on images 125 through 141 which is at the sites of previously placed surface electrodes. There is subtle superficial enhancement which may represent a meningioma scarring.Postoperative changes of a left anterior temporal craniotomy is also noted. Ventricular system remains within normal and with maintained midline.

Output: 1.Focus of encephalomalacia in left anterior frontal lobe is new since prior exam.2.No acute intracranial process.3.Expected postoperative changes of laser ablation in the left medial temporal lobe.


Instruction: Generate impression based on findings.

Input: 55 year old man with history of atrial arrhythmias who presents for pre-ablation cardiac MRI to evaluate. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 98 ml/m2 (normal range: 74+/-15), the LVEDV is 210 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 93 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 124 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native T1 myocardial relaxation time is normal (<1000ms).Left AtriumThe left atrium is mildly dilated, and measures 124mL (indexes to 58mL/m2). Right VentricleThe right ventricle is upper normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 242 ml (normal range 142+/-31), the RV end systolic volume index is 54 ml/m2 (normal range 31+/-9), and the RVESV is 115 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size measures 138mL (indexes to 64mL/m2).Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll pulmonary veins drain normally into the left atrium.The left pulmonary veins appear to have a common ostia which measures 35 x 19mm. The right upper pulmonary vein measures 20 x 26mm. The right lower pulmonary vein measures 20 x 13mm. Pulmonary ArteryThe main pulmonary artery is mildly dilated (31mm)Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with normal systolic function (EF 56%). No late gadolinium enhancement is present to suggest underlying fibrotic, infiltrative or inflammatory disease.2. Normal size right ventricle with normal systolic function (EF 53%).3. The left atrium is mildly enlarged with pulmonary vein anatomy and dimensions as reported above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Assess IPMN ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense, enhancing lesions in segment II and segment VI compatible with hemangiomas, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Again seen is a focus of increased fluid signal in the pancreatic body measuring 11 mm, which communicates with the main pancreatic duct compatible with a branch type IPMN (series 4, image 95). There are smaller cystic lesions in the pancreatic tail communicating with the main pancreatic duct, unchanged. The main pancreatic duct is not dilated.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: Cystic pancreatic lesions compatible with branch type IPMNs, the largest in the pancreatic body. No interval change.


Instruction: Generate impression based on findings.

Input: Male, 13 years old. Dislocated left hip BONE MARROW: Bone marrow signal intensity is normal.SOFT TISSUES: No significant abnormality noted. JOINTS: Both acetabula are shallow with pulvinar hypertrophy bilaterally. There is coxa valga deformity of both hips. Evaluation of the labrum is limited on nonarthrographic examination, but there is no labral interposition between the femoral heads and acetabula. Small hip joint effusions bilaterally.ADDITIONAL

Output: 1.Bilateral dysplastic hips.2.Small hip joint effusions.


Instruction: Generate impression based on findings.

Input: No definite new intracranial metastasis is identified. Redemonstrated are numerous small to punctate intra-axial high intrinsic T1 signal lesions with enhancement consistent with known metastases. 1.Stable to slightly smaller left medial frontal enhancing lesion on series 1201 image 126 which measured 4 mm previously, now measuring 3 mm.2.Larger left frontal lobe lesion on series 1201 image 116 measuring 5 mm3.Stable punctate focus of enhancement in the left middle cerebellar peduncle on series 1201 image 554.Stable 6 millimeter lesion in the right temporal lobe on series 1201 image 645.Stable to slightly smaller left temporal lobe lesion measuring 7 mm, previously 8 mm on series 1201 image 756.Stable right temporal lobe lesion on series 12 on image 77 measuring 5 mm7.Slightly smaller left posterior insula lesion measuring 4.5 mm compared to 6 mm previously on series 1201 image 100There is a stable focus of somewhat gyriform susceptibility effect involving the left precentral gyrus and the left middle frontal gyrus. No significant edema or mass-effect with any of these lesions. No evidence of acute infarct. No hydrocephalus. There is left maxillary sinus mucosal thickening.

Output: 1. Mixed response to interval therapy with mostly stable lesions. There is one lesion in the left frontal lobe which appears slightly larger than the prior examination, as described above. No definite new metastatic lesion is identified.2. No significant edema or mass effect with any of the lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 12 months old Reason: r/o cardiomyopathy Left VentricleThe left ventricle is normal. There are no regional wall motion abnormalities present. There is no intracardiac thrombus.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal. The overall RV ejection fraction is %, the RV end diastolic volume index is ml/m2 (normal range 69+/-14), the RVEDV is ml (normal range 110+/-24), the RV end systolic volume index is ml/m2 (normal range 22+/-8), and the RVESV is ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation visualized. Dedicated through plane imaging was not performed.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation visualized. Dedicated through plane imaging was not performed.Pulmonic ValveThe pulmonic valve is mildly stenotic. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging was not performed.AortaThe ascending thoracic aorta is normal in size measuring 12.5 mm. There is a left sided aortic arch. The descending aorta is measuring 8.3 mm.Pulmonary ArteryThe main pulmonary artery is remarkably enlarged measuring 19 mm in diameter. Right and left pulmonary arteries are remarkably enlarged as well measuring 14 and 12 and 13 mm in diameter respectively. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.Extracardiac Findingsnormal liver and spleen and partial view of the kidneys are normal as well.

Output: 1. Unremarkable dilation of the main, right and left pulmonary arteries.2. Pulmonary valve stenoses.3. No evidence of right or left ventricle wall motion defects or near cardial hypertrophy. The noted vesicles ARVD.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: Male 77 years old Reason: liver lesion interpreted as hemangioma on US, please confirm History: hep C s/p eradication, s/p kidney transplant ABDOMEN:LIVER, BILIARY TRACT: Liver has mildly widened fissures but does not have an overt cirrhotic morphology. Within the right lobe of the liver there is a mildly T2 hyperintense lesion that measures 9 x 10 mm. The lesion does not show enhancement centrally or peripherally. It is unchanged in size from the prior study where it measured approximately 12 mm. No new suspicious lesions have developed. There are few scattered hypervascular arterial enhancing foci that do not demonstrate definite washout. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: Subcentimeter cystic focus in the pancreatic head possibly represents a small I PMN. Pancreatic duct normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: End-stage kidneys with scattered small cysts. There is a right lower quadrant allograft without hydronephrosis. There is a small amount of adjacent ascites or fluid.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.Anteriorly located right hepatic lobe lesion without significant size change from 2005. The lesion does not show enhancement. Differential considerations include a small thrombosed hemangioma, or complex cyst. The hypervascular lesion along the posterior aspect of the right hepatic lobe seen during the 2005 MR is not present on the current study.2.No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: There is a small focal area of encephalomalacia with thin linear marginal high T2 signal in the left superior frontal gyrus posteriorly at the junction of the left precentral gyrus. There is a punctate nonspecific focus of high T2 signal in the left middle frontal gyrus. There is no evidence of heterotopic gray matter or hippocampal volume loss. There is no evidence of acute infarct, mass effect, herniation, or midline shift. The ventricles are within normal limits. There is no hydrocephalus. There are retained secretions within the left petrous apex. There are secretions within the left anterior ethmoid air cells. There appear to be mildly prominent nonspecific lymph nodes in the partially-imaged upper cervical spine.

Output: Small area of chronic infarction in the left superior frontal gyrus posteriorly, at the junction with the left precentral gyrus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache, evaluate for structural abnormality. Susceptibility artifact from patient's braces slightly limits the examination. There is however no intracranial mass or mass-effect. Diffusion-weighted and susceptibility weighted images are particularly limited but demonstrate no obvious infarct or hemorrhage. The ventricles are within normal limits in size and configuration. Brain parenchyma is unremarkable for age. Major flow-voids are preserved. Craniocervical junction is unremarkable. Limited evaluation of the sella is unremarkable. Bone marrow signal and extracranial soft tissues are within normal limits. No pathologic enhancement.

Output: No intracranial mass or evidence of mass effect. Susceptibility artifact from patient's braces slightly limits evaluation; within this limitation, however, examination is unremarkable.


Instruction: Generate impression based on findings.

Input: Pilonidal dimple. 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. The conus medullaris is located at the L1-2 level. There is no evidence of fibrofatty filum. The paravertebral soft tissues are unremarkable.

Output: No evidence of congenital anomalies involving the lumbar spine.


Instruction: Generate impression based on findings.

Input: Low back pain for weeks with right sciatica getting worse. There is moderate leftward scoliosis of the lumbar spine. The vertebral body heights are preserved. There is disc desiccation and loss of disc height at L4-5. The vertebral bone marrow signal is unremarkable for age. There is no significant spinal canal stenosis. The spinal cord displays normal signal and terminates at L1. The paravertebral soft tissues are unremarkable. Interspace observations:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is a right foraminal/lateral protrusion with severe right neural foraminal narrowing, but no significant compromise to spinal canal or left neural foramen.L5-S1: There is a small central protrusion without significant compromise to spinal canal or neural foramina.

Output: 1.Right foraminal/lateral protrusion at L4-5 with severe right neural foraminal narrowing, but no significant central stenosis.2.Moderate convex left scoliosis of the lumbar spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 83-year-old female with history of hypertension, coronary artery disease status post CABG, diabetes mellitus, PE on Coumadin. Patient status post fall. Patient hit head on side of rail per witnessed. INR equals 2.4. Evaluate for subdural hematoma. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of hypoattenuation in the periventricular and subcortical white matter distribution consistent with small vessel ischemic disease common age indeterminate. If there is clinical concern for ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for ischemia, MRI may be considered.


Instruction: Generate impression based on findings.

Input: Female 66 years old Reason: PD dilation and possible pancreatic head lesion on USG History: HCV, ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent.There is mild common bile duct dilatation without significant intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic duct is dilated up to 7 mm up to the level of the ampulla. Motion artifact limits evaluation of the pancreatic head. Within this limitation, no discrete pancreatic head mass is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Probable renal column of Bertin involving the midpole of the right kidney corresponding to the abnormality seen on ultrasound. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Findings suggestive of pulmonary fibrosis in the right lower lobe.

Output: 1.Dilated pancreatic duct to the level of the ampulla of unclear etiology. Follow-up is suggested.2.Renal column of Bertin probably the cause of the abnormality seen on ultrasound.


Instruction: Generate impression based on findings.

Input: 21-year-old male with persistent right knee pain, positive McMurray after injury MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact. No abnormal bone marrow signal.LIGAMENTS: The anterior cruciate ligament is intact. Diffuse signal abnormality within the posterior cruciate ligament is compatible with a tear. This may represent a stretching injury, as we see no frank transection. The medial collateral ligament is intact. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Abnormal signal intensity of the PCL compatible with a tear.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: There is minimal increased signal supraspinatus tendon but without evidence of tear. The remaining rotator cuff tendons are normal. There is an atypical morphology of the teres minor muscle with the proximal belly appearing unusually small.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Minimal tendinopathy of the supraspinatus tendon. There is no rotator cuff tear.2. Atypical appearance of the teres minor muscle with the proximal belly appearing unusually small. This may represent normal variation however the clinical significance is uncertain.


Instruction: Generate impression based on findings.

Input: 30 year-old female status post Chiari repair 2/20/2015, currently experiencing headache There has been interval suboccipital craniotomy for Chiari repair with reconstitution of a CSF space posterior to the cerebellar tonsils. There is an approximately 32 x 7 mm sagittal dimension collection which is slightly hyperintense on both T1 and T2 technique compared to CSF located within the posterior aspect of the surgical site. Posteriorly it is bounded by a thick hypointense line contiguous with the dura, and anteriorly there is a thin hypointense line which tapers to communicate with the dura at both ends. This is poorly imaged on axial images. CSF demonstrates biphasic flow posteriorly at the level of the cerebellar tonsils, which does not extend into the aforementioned posteriorly located collection.The visualized spinal cord is morphologically normal. No evidence of syrinx formation is seen. Spinal alignment is anatomic. No pathologic marrow replacement or marrow edema is suspected.A small central disk protrusion at C5-6 is unchanged. No significant degenerative disk disease is seen elsewhere in the cervical spine. No spinal canal or neuroforaminal stenosis is detected.

Output: There has been interval suboccipital craniotomy for Chiari repair with reconstitution of a CSF space posterior to the cerebellar tonsils. There is an approximately 32 x 7 mm sagittal dimension collection which is slightly hyperintense on both T1 and T2 technique compared to CSF located within the posterior aspect of the surgical site. Posteriorly it is bounded by a thick hypointense line contiguous with the dura, and anteriorly there is a thin hypointense line which tapers to communicate with the dura at both ends. CSF demonstrates biphasic flow posteriorly at the level of the cerebellar tonsils, which does not extend into the aforementioned posteriorly located collection. This collection may represent extradural fluid behind a thin dural patch versus a loculated collection just anterior to the dural patch.


Instruction: Generate impression based on findings.

Input: Clinical question: Secondary GBM. Signs and symptoms: Secondary GBM. Pre-and post-enhanced brain MRI:Negative diffusion weighted images for restricted diffusion.Examination redemonstrates a large focus of flair/T2 hyperintensity involving the left anterior temporal and left inferior frontal lobe and with extension into the left basal ganglia consistent with patient's previously known tumor. There is no appreciable change in the extent or size/morphology of this finding since prior study. On post enhanced images however previously noted large focus of enhancement representing tumor in the right inferior frontal lobe demonstrate interval decreased size since prior exam. This finding on current exam measures at 18 times 19-mm compared to prior study measurement of 19.3 x 23-mm. This focus of enhancing tumor on sagittal SPGR post enhanced series measured maximum of 25 mm in (cc) compared to today's exam measurements of between 13.7 to 17.8-mm.A second smaller satellite focus of enhancement demonstrate minimal interval decrease size however with significantly less intensity of enhancement. The lesion measured approximately at 6 x 6.3-mm compared to current study measurement of 5.5 x 5 mm. There is no detectable additional foci of parenchymal or leptomeningeal enhancement.Flair hyperintensity in the periventricular white matter of bilateral cerebral hemispheres (left greater than right) consistent the residual peritumoral edema and post-treatment/radiation change without appreciable interval progression.

Output: 1.Interval decreased size of focus of enhancing tumor in the left inferior frontal lobe compared to prior study as detailed/measured above.2.Minimal interval decreased size of a small satellite focus of enhancement in the left hemisphere however with significantly less intensity of enhancement since prior exam as detailed/ measured above.3.Stable extensive focus of nonenhancing flair hyperintensity with increased volume in the left frontal, left anterior temporal and left inferior frontal lobe.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is thinning and focal cartilage loss within the femoral trochlea centrally. There is also underlying bony irregularity on these findings may reflect the sequela of prior impaction injury. Otherwise the articular cartilage along the patellar facet is preserved. The articular cartilage of the medial and lateral compartments is also maintained.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Mild cartilage loss within the femoral trochlea centrally with underlying bony irregularity which may be the result of prior impaction injury. Remaining evaluation of the knee otherwise demonstrates no internal derangement.


Instruction: Generate impression based on findings.

Input: Low back pain and radicular symptoms: evaluate for nerve root involvement. There are mild disc bulges and facet hypertrophy at L4-5 and L5-S1 with mild to moderate neural foraminal stenosis bilaterally, but no significant spinal canal stenosis. However, there is also edema in the paraspinal soft tissues adjacent to the right L4-5 facet joint. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There are hypertrophic changes in the bilateral sacroiliac joints with bridging osteophytes. The spinal cord displays normal signal and morphology.

Output: 1. Degenerative spondylosis at L4-5 and L5-S1 with mild to moderate neural foraminal stenosis bilaterally and signs of right L4-5 facetitis.2. Findings suggestive of bilateral sacroiliitis.


Instruction: Generate impression based on findings.

Input: Reason: sarcoidosis? MS? History: L sided headache, L eye pain, numbness tingling in her hands The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the left maxillary sinus and left posterior ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.MRI of the brain is within normal limits. There is no convincing evidence for demyelination or sarcoidosis.


Instruction: Generate impression based on findings.

Input: Nontraumatic back pain with elevated WBC and diabetic patient. Evaluate for discitis-osteomyelitis or epidural abscess. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. No abnormal enhancement to suggest discitis-osteomyelitis, epidural abscess, or paraspinous infection.There is mild generalized lumbar facet arthropathy. Additional minimal degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: Disc desiccation with small dorsal annular fissure. Minimal disc protrusion. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. There is a cyst seen on the sagittal sequences which appears to be along the right anterolateral aspect of the uterus which is incompletely imaged but measures 5.4 x 3.5 cm.

Output: 1. No evidence of discitis-osteomyelitis or epidural abscess.2. Minimal degenerative changes without significant spinal canal or neural foraminal stenosis at any level.3. Partially imaged cystic lesion measuring approximately 5.4 x 3.5 cm adjacent to the uterus. Ultrasound can be considered for further assessment as clinically indicated.


Instruction: Generate impression based on findings.

Input: 61 years Male (DOB:6/7/1955)Reason: back pain with hx of spinal cor History: Outside orderPROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. The patient is status post left hemilaminectomy at L5-S1 and laminectomies at L1-2 and L2-3.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal. There is loss of disk space height, disk dessication and diffuse disk bulge at this level associated with narrowing of the left neural foramen and mild to moderate encroachment of the left sided exiting nerve roots. This is stable since the prior exam.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk dessication and diffuse disk bulge at this level associated with narrowing of the neural foramina. The exiting nerve roots are surrounded by fat. This is stable since the prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a well circumscribed16 mm enhancing lesion in the right posterior lobe of the liver which is bright on T2 and isointense to the rest of the liver on T2 .This was not included on the prior exams.There is a small cystic lesion in the right kidney.

Output: 1.The patient is status post lumbar spine surgery. The appearance is not changed since the prior exam.2.There is a16 mm lesion in the right lobe of the liver. If clinically appropriate additional imaging of the liver may be helpful to further evaluate this.3.No abnormal mass lesions are identified in the lumbar or thoracic spinal canal.4.There are degenerative changes in the lower lumbar spine which are worse at L4-5 and L5-S1 with some mild encroachment of left sided exiting nerve roots at L5-S1 which are stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Stage IV CRC. Evaluate for syncope. Enhanced CT of brain: Examination demonstrates no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. There is no evidence of any abnormal enhancement of brain parenchymal or the leptomeninges. The cortical sulci, ventricular system and all CSF cisterns remain within normal for patient's stated age. The gray -- white matter differentiation is well-preserved.Slight prominence of the left cavernous sinus is noted. This finding could be secondary to tortuosity of internal carotid artery within the cavernous sinus considering the patient's age. If patient has symptoms related to be peroneal nerves within the cavernous sinus follow-up exam with a dedicated MRI is recommended. Possibility of a mass or atherosclerotic aneurysm is also another differential diagnosis.

Output: 1.Unremarkable CT examination of brain with enhancement.2.Left cavernous sinus demonstrates expansion on its posterior aspect. This finding could be secondary to tortuosity and atherosclerotic ectasia of internal carotid artery considering patient's age. To exclude possibility of underlying mass or an aneurysm a dedicated MRI is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Memory loss for 2 years. Signs and symptoms: As above. Nonenhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrate patchy periventricular and to a lesser degree subcortical confluent foci of FLAIR hyperintensity in bilateral cerebral hemispheres. Minimal similar signal changes in bilateral basal ganglia and pons is detected. There is no associated susceptibility signal changes with the findings which are highly suggestive of chronic small vessel ischemic strokes of mild degree.There is also mild generalized prominence of cortical sulci and the supratentorial ventricular system for patient's stated age of 61.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial findings.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.3.Generalized mild prominence of cortical sulci and supratentorial ventricles for stated age of 61.


Instruction: Generate impression based on findings.

Input: Knee pain. Four views of the right knee demonstrate severe osteoarthritic changes including tricompartmental osteophytes and bone-on-bone apposition in the medial tibiofemoral compartment. There is a mild varus deformity of the knee. Components of a left total knee arthroplasty device are situated in near-anatomic alignment as seen on the frontal views.

Output: Severe osteoarthritis.


Instruction: Generate impression based on findings.

Input: Solitary sporadic left pontine lesion: yearly follow-up. There is a multilocular left pons cavernous malformation that measures up to 10 mm, which is not significantly changed. There is no evidence of acute hemorrhage or associated vasogenic edema. However, there is an associated developmental venous anomaly within the left pons and midbrain. There is no evidence of acute infarct. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. There is minimal scattered paranasal sinus mucosal thickening. The skull and extracranial soft tissues are unremarkable.

Output: No significant interval change in the left pons cavernous malformation and associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: 63-year-old female with persistent MRSA bacteremia. Evaluate for recurrent infection/abscess. Suboptimal examination secondary to patient motion artifact. Again seen is a collection fluid between the deltoid muscle and anterior aspect of the humeral head. Based on the fat-suppressed T2-weighted imaging, the collection appears similar to the prior study, however, the collection is now better delineated on the postcontrast images. It measures approximately 4.0 x 1.0 cm in the transverse dimension and 3.5 cm in the craniocaudal dimension. Again, while these measurements are larger than the stated on the previous examination, the collection appears similar in size to the prior study on the corresponding T2-weighted imaging. There are foci of signal void within this fluid collection consistent with foci of internal gas. There is enhancement of the soft tissue surrounding this collection. There is additional enhancement of the subdeltoid bursa laterally and posteriorly with small pockets of nonenhancing fluid. Overall the subdeltoid synovitis appears similar to the prior study based on the fat-saturated T2-weighted images. This fluid also appears to extend across a torn rotator cuff. Although there is a synovitis of the glenohumeral joint, there is only a small amount of fluid within the joint. There is a small collection of nonenhancing fluid noted beneath the coracoid process perhaps representing the coracoid bursa. Also again seen is a collection of nonenhancing fluid within the anterior subcutaneous fat of the shoulder with similar measurements when compared to the prior study. Again seen are foci of signal void consistent with air within this fluid collection. There is edema and enhancement of the underlying musculature reflecting inflammation. There is also edema and enhancement of the rotator cuff musculature. This edema is comparable to that seen on the prior examination. There are small foci of abnormal signal intensity and enhancement within the greater tuberosity of the humerus which are probably degenerative in etiology. We see no specific findings to suggest osteomyelitis.

Output: Inflammatory changes of the shoulder with fluid collections as described above. While the fluid collections are better defined on the current study due to the presence of contrast-enhanced sequences, their overall size appears similar to the prior study on the fat-saturated T2-weighted images.


Instruction: Generate impression based on findings.

Input: History of CVA x 2, complaining of weakness and acute mental status changes. Rule out CVA. There is no evidence of intracranial hemorrhage, mass or midline shift. Areas of subcortical and periventricular white matter hypodensity and an area of lacunar infarction in the left basal ganglia indicate advanced small vessel ischemic disease of indeterminate age. This appears slightly more prominent than on the prior examination. If there is concern for an acute stroke, an MRI may be considered for further evaluation.Prominence of the ventricles and sulci indicate corticomedullary volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Foci of increased density of the right globe are identified. These may represent dystrophic calcification or may be artifactual. The right eye is only partially included in the field of view.

Output: Advanced small vessel ischemic disease of indeterminate age. If there is concern for an acute stroke, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Other musculoskeletal symptoms referable to limbs(729.89) [729.89], Reason for Study: ^Reason: r/o stroke vs. Metastases History: transient right sided weakness and dysarthria, hx of cancer No evidence of acute ischemic or hemorrhagic lesion on the scan.Multiple scattered patchy high signal intensities on bilateral deep white matter on FLAIR imaging indicate nonspecific small vessel ischemic disease.There is no abnormal enhancing lesion.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 mastoid air cells are clear. Small retention cyst on the right maxillary sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Nonspecific small vessel ischemic lesion as described above.


Instruction: Generate impression based on findings.

Input: 54-year-old male with pancreatic lesion, assess for IPMN. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter nonenhancing T2 hyperintense foci of the right hepatic lobe are likely small cysts (series 7 images 6, 21). Otherwise normal parenchyma. No intra or extrahepatic biliary ductal dilatation. Normal gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: Stable appearance of a 4 mm cystic lesion of the pancreatic tail without clear communication to the pancreatic duct, likely a sidebranch IPMN. No pancreatic ductal dilatation. The pancreatic duct measures less than 3 mm in diameter.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or nephrolithiasis. Bilateral punctate T2 hyperintense foci are too small to fully characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace bilateral pleural effusions.

Output: 1.Stable 4 mm cystic lesion of the pancreatic tail, likely a sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: Reason: TRANSVERSE MYELITIS History: WEAKNESS. MRI brain:There is no evidence of intracranial hemorrhage or mass. There is a 7 mm nonenhancing focus of diffusion restriction and increased T2 signal immediately adjacent to the occipital horn of the left lateral ventricle. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and paranasal sinuses are grossly unremarkable. Multiple scalp lesions likely represent sebaceous cysts.MRI cervical spine:Alignment is anatomic. Vertebral body heights are intact. Multilevel disc desiccation with minimal degenerative disc disease at C6-C7. No abnormal signal within the cord. No abnormal signal within the cord. C2-C3: No significant spinal or neuroforaminal stenosis. C3-C4: No significant spinal or neuroforaminal stenosis. C4-C5: No significant spinal or neuroforaminal stenosis. C5-C6: No significant spinal or neuroforaminal stenosis. C6-C7: Mild posterior disc osteophyte complex without significant central or neural foraminal stenosis. C7-T1: No significant spinal or neuroforaminal stenosis.

Output: 1.Small focus of diffusion restriction in the white matter adjacent to the left occipital horn likely represents a focus of ischemia, although early demyelinating disease may also be considered.2.Minimal degenerative changes of the cervical spine without evidence of demyelinating disease or other cord pathologies.


Instruction: Generate impression based on findings.

Input: Reason: r/o labral tear History: pain ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No significant fluid or intra-articular gadolinium is identified within the subacromial subdeltoid bursa. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is a prominent middle glenohumeral ligament with a diminutive anterior superior glenoid labrum likely representing a Buford complex. No discrete labral tear is evident. No articular cartilage defects are identified.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Normal appearing shoulder. No evidence to suggest a labral tear.


Instruction: Generate impression based on findings.

Input: Female, 42 years old. Reason: Osteo of the 2nd toe History: toe infection and pain There is abnormal bone marrow signal diffusely involving the second proximal and middle phalanges. Signal is decreased on T1-weighted images and increased on T2-weighted images, with enhancement of the bone marrow. The second distal phalanx and metatarsal have normal bone marrow signal. There is additional signal abnormality in the surrounding soft tissues. These findings are compatible with osteomyelitis.There is also abnormal signal at the head of the first metatarsal, with decreased signal on T1-weighted images and increased signal on T2-weighted images, with enhancement of the bone marrow. There is additional signal abnormality in the surrounding soft tissues. The mid and proximal first metatarsal and of the first phalanges have normal bone marrow signal. These findings are compatible with additional focus of osteomyelitis.The remainder of the bones appear normal. The visualized tendons and ligaments appear intact.

Output: Findings compatible with osteomyelitis involving the second middle and proximal phalanges as well as the first metatarsal head.


Instruction: Generate impression based on findings.

Input: As noted on the prior MRI orbits, there is stable asymmetric prominence of the lateral aspect of the ophthalmic segment of the left internal carotid artery, with a small area of outpouching measuring 4 mm AP x 2 mm transverse. Comparing back to the CT neck with contrast from October 2014, this is grossly similar.The intracranial internal carotid arteries are otherwise normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or other suspected aneurysm.

Output: Area of focal prominence along the lateral aspect of the ophthalmic segment of the left internal carotid artery which may represent a small aneurysm measuring 2 x 4 mm versus an area of focal atherosclerotic related ectasia of the vessel, although could be better characterized on CTA of the head.


Instruction: Generate impression based on findings.

Input: Clinical question: History of brain metastases from an NSCLC. Signs and symptoms: None. Pre- and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates no detectable abnormal parenchymal enhancement to suggest recurrence of disease. This is a similar observation is prior study.Patchy foci of primarily periventricular FLAIR hyperintensity similar to prior exam and likely representing post treatment changes. Possibility of mild overlapping chronic small vessel ischemic strokes cannot be entirely excluded. Tiny focus of FLAIR hyperintensity in the right posterior parietal lobe without enhancement is believed to represent a focus of gliosis.A tiny focus of extra-axial enhancement along the floor of left anterior cranial fossa is a nonspecific finding and demonstrate no definitive change since immediate prior exam from 2-20-15.Unremarkable calvarium and orbits including axial fat sat post enhanced series. Mild chronic pansinusitis without significant change since prior exam.

Output: 1.Negative diffusion weighted images.2.No evidence of residual or recurrence of tumor in the brain parenchyma or the leptomeninges since prior exam.3.Stable tiny foci of extra-axial enhancement along the floor of the left anterior cranial fossa.4.Primarily periventricular foci of FLAIR hyperintensity likely representing posttreatment changes. Overlapping chronic small vessel ischemic strokes cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: 49 year old female. Abdominal pain. Is there a persistent GE junction leak? CHEST:LUNGS AND PLEURA: Bilateral lower lobe consolidation and volume loss. Small bilateral pleural effusions. There is possible abscess or small hematoma in the cysts splenic bed, left sub-diaphragmatic region seen best on coronal image 79.MEDIASTINUM AND HILA: Endotracheal tube is present in the expected position. Low lung volumes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Marked hepatomegaly. The liver measures 27 cm craniocaudally.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic and scarred kidneys without evidence of hydronephrosis. There is a questionable 3-cm mass adjacent to the right lung hilum on coronal image 69 and axial image 106. This may be further evaluated with dedicated renal MRI examination and/or noncontrast CT scan.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post a vertical sleeve gastrectomy with innumerable surgical clips under the left hemidiaphragm. A stent is present in the gastric remnant. There are multiple surgical drains in the upper abdomen, one in the gastrohepatic region and another at the left lateral aspect of the gastrectomy site.A percutaneous jejunostomy tube is present in the expected position.No free air. No definite leak at the GE junction, but this may be difficult to detect on an examination without esophageal enteric contrast.BONES, SOFT TISSUES: Open midline abdominal wound in the supraumbilical region. OTHER: IVC filter is in expected position.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: A Foley catheter is present in the decompressed urinary bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A rectal tube is in expected position.BONES, SOFT TISSUES: There is scoliosis of the thoracolumbar spine. Degenerative changes in the lumbosacral spine and pelvis.OTHER: Anasarca.

Output: Bibasilar lower lobe consolidation. Hepatomegaly. Anasarca. Questionable right renal mass at the hilum. Status post splenectomy with questionable hematoma or subdiaphragmatic fluid collection on the left. Multiple additional findings, as described above. Postop changes after partial gastrectomy.


Instruction: Generate impression based on findings.

Input: History of breast cancer presents with altered mental status. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered areas of high T2 signal in the cerebral and pontine white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are subcentimeter foci of enhancement in the right frontal and left parietal bones. The calvarium otherwise displays diffusely heterogeneous signal. There is partially-imaged tumor involving the C3 and C4 vertebrae with marked narrowing of the spinal canal. There are retained secretions in the right sphenoid sinus and mild mucosal thickening in the left maxillary sinus.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. Mild scattered areas of high T2 signal in the cerebral and pontine white matter may represent chronic small vessel ischemic disease.2. Partially-imaged tumor involving the C3 and C4 vertebrae with marked narrowing of the spinal canal, which may have progressed since November 2015.3. Subcentimeter foci of enhancement in the right frontal and left parietal bones may represent venous lakes versus metastases. The calvarium otherwise appears heterogeneous diffusely, which is nonspecific.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Scattered sporadic foci of mucosal thickening can be found within the paranasal sinuses. There are no air-fluid levels. The mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Scattered sporadic foci of mucosal thickening can be found within the paranasal sinuses without air-fluid levels. Otherwise negative MRI of the brain including gadolinium enhancement.


Instruction: Generate impression based on findings.

Input: 33-year-old male, presenting with nausea vomiting abdominal pain ABDOMEN:LUNG BASES: Small bilateral pleural effusions, new from previous study. pleuralLIVER, BILIARY TRACT: Stable thrombosis of the right anterior portal vein.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites. Postsurgical changes around the ileostomy takedown in the right lower quadrant. Mild dilatation of the distal small bowel loops without any obvious transitional point may represent ileus. Multiple enlarged mesenteric lymph nodes which are slightly increased in size compared to previous study.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Possible collection posterior to the pouch which was drained previously. Interval removal of drainage catheter. The collection cannot be clearly differentiated from the anterior pouch. MRI of the pelvis may be helpful for better evaluation of this collection.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Postsurgical changes reflecting the ileostomy takedown.Patient's known presacral collection is again noted, however, this cannot be well differentiated from the anterior pouch. MRI of the pelvis may be helpful for further evaluation.Dr. Kosoko was notified technologist and acknowledged about these findings at the time of the patient.


Instruction: Generate impression based on findings.

Input: 48-year-old female s/p trauma to L knee with OA, persistent pain particularly with varus stress on medial side r/o cartilage/ligament injury. MENISCI: There is a branching high signal intensity in the body of the lateral meniscus, compatible with a complex tear. An additional complex tear of the body of the medial meniscus is seen extending into the posterior horn. Moderate extrusion of the medial meniscus is also noted.ARTICULAR CARTILAGE AND BONE: There is a focal area of cortical depression of the medial femoral condyle measuring approximately 8 mm in width with surrounding high T2 signal intensity, likely representing a subacute subchondral fracture with moderate associated marrow edema. Full thickness cartilage loss in the weight-bearing portion of the medial femoral condyle is also present. Diffuse chondral thinning is also seen in the articular surface of the lateral femoral condyle. Fissuring and approximately 50% chondral loss is seen in the medial patellar facet extending to the median ridge.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. Components of the medial and lateral collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Small insufficiency fracture of the medial femoral condyle.2.Complex medial and lateral meniscal tears, as above.


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. Right vertebral artery is dominant. Left vertebral artery terminates as the left posterior inferior cerebellar artery. Right posterior communicating artery and anterior communicating artery are patent. Left posterior communicating artery is not well seen and may be diminutive. No evidence of aneurysms or vascular malformations within the limits of mild motion degradation.

Output: No significant stenosis in the intracranial vasculature.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to occipital craniotomy and C1 laminectomy for partial resection of a posterior fossa mass with subjacent susceptibility effect compatible with chronic blood products. There is a right parietal approach ventriculostomy catheter that terminates near the foramen of Monro. The ventricles are minimally decreased in size compared to prior exam. The tumor centered in the right cerebellar hemisphere and brainstem with encasement of the basilar artery and right 7th and 8th cranial nerves has increased in size. Indeed, the tumor overall measures 29 x 40 mm, previously 27 x 36 mm. In particular, a T2 hyperintense portion involving the medulla and upper cervical cord measures 28 x 18 mm, previously 28 x 11 mm. There has also been interval development of nodular enhancement throughout the tumor. There is also new thin linear enhancement surrounding the posterior resection margins. There is unchanged tumor extension along the cisternal portion of the right trigeminal nerve and into Meckel cave. A partially imaged syrinx within the upper cervical cord is slightly decreased in size. There is no evidence of acute infarct. The major cerebral flow voids are intact. The skull and scalp soft tissues are unchanged.

Output: Interval increase in size and enhancement of the residual posterior fossa pilocytic astrocytoma compatible with tumor progression. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Bilateral parotid cystic masses status post left parotidectomy, which yielded oncocytic cyst. There are postoperative findings related to left partial parotidectomy. There is a 3 mm diameter cystic lesion in the remaining left parotid gland. There are also several subcentimeter cystic right parotid gland lesions, which have not significantly changes since 2014. The imaged thyroid and submandibular glands are unremarkable. There is no significant cervical lymphadenopathy. There is filler material within the bilateral cheeks and lips. The orbits and imaged intracranial structures are unremarkable. There is mild scattered paranasal sinus mucosal thickening. There are postoperative findings related to C4-C5 fusion.

Output: Postoperative findings related to left partial parotidectomy, with a 3 mm diameter cystic lesion in the remaining left parotid gland and several subcentimeter cystic right parotid gland lesions.


Instruction: Generate impression based on findings.

Input: Meningioma. Headache. Assess for change. The 2 cm lobulated dural based, intensely contrast enhancing mass in the posterior fossa at midline has not changed. It abuts and probably invades into the torcular herophili and the adjacent parts of the straight and left transverse sinuses. The remainder of these sinuses remain patent. The mass abuts but does not invade into the right transverse sinus or the superior sagittal sinus. Of note, the superior sagittal sinus predominantly drains through the right transverse sinus. The overlying skull is unremarkable. The adjacent cerebellar vermis and medial aspect of the right cerebral hemisphere are unremarkable, apart from mild mass-effect. Flow voids and corresponding contrast-enhancing vessels on the surface of the mass probably represent displaced superficial vessels.There is no other dural based mass. There is no contrast enhancing brain lesion. Tiny central CSF intensity with surrounding rim of T2/FLAIR hyperintensity inferior to the left putamen may represent chronic infarct. There is no acute infarct. Foci of T2 FLAIR hyperintensity in the cerebral white-matter are nonspecific but may reflect chronic microvascular ischemia. The ventricles are mildly dilated reflecting mild brain volume loss. There is no midline shift or brain herniation. Major intracranial arterial flow voids are preserved.There is moderate anterior ethmoid mucosal thickening. There is mild mucosal thickening in the remaining paranasal sinuses. The orbits are unremarkable.

Output: 1.The posterior fossa meningioma which seems to involve the junction between the left transverse and the straight sinuses (torcular herophili) has not significantly changed when allowing for differences in technique since October 2015. Patency of these sinuses is probably better assessed by MR venography, if clinically warranted. The other dural sinuses are patent.2.Mild cerebral white-matter changes of chronic microvascular ischemia. Small left putaminal chronic infarct.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute infarct. There are multiple patchy foci of T2 hyperintensity within the supratentorial and infratentorial white matter that are most compatible with chronic small vessel ischemic disease. There are also a few small foci of T2 hyperintensity and enhancement with minimal associated susceptibility effect in the left cerebellar hemisphere.There is an ectatic distal intracranial right vertebral artery that makes a prominent impression upon the right aspect of the medulla of doubtful clinical significance. The major cerebral flow voids are intact. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: 1.No evidence of acute infarct, however, a few patchy foci of signal abnormality and enhancement within the left cerebellar hemisphere are most compatible with subacute lacunar infarcts. A follow-up MRI in 8 weeks may be helpful to ensure resolution of enhancement as clinically indicated.2.Supratentorial and infratentorial chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: MRI BRAIN WWO: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Unchanged focal T2/FLAIR hyperintense signal with mild enhancement most compatible with a capillary telangiectasia in the right paramedian pons. Unchanged small developed frontal venous anomaly in the left orbital gyrus.MRA BRAIN WO:The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRI CERVICAL SPINE WWO: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.

Output: 1.Incidental note is made of a lesion in the right pons most likely representing capillary telangiectasia.2.No evidence of intracranial hemorrhage, mass, or acute infarct.3.No evidence of flow-limiting stenosis or aneurysm.4.There is no compromise cervical spinal canal or exiting nerve roots appreciated.


Instruction: Generate impression based on findings.

Input: Elevated PSA PELVIS:PROSTATE:Prostate Size: 2.8 x 5.2 x 4.1 cm ( AP x TR x CC).Peripheral Zone: No focus of signal abnormality to suggest prostate cancer.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No MRI evidence of prostate cancer.


Instruction: Generate impression based on findings.

Input: There is no significant change in the size or appearance of a punctate non-enhancing focus of susceptibility effect in the right postcentral gyrus measuring 1 to 2mm in diameter. There are no new intracranial lesions. There is unchanged diffuse confluent cerebral white matter T2 hyperintensity, which is likely related to radiation therapy. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage or acute infarction. The ventricles, sulci, and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is no midline shift. There are bilateral maxillary sinus retention cysts and persistent fluid signal within the bilateral mastoid air cells.

Output: Post-treatment findings in the brain without evidence of progressive or new metastatic disease.


Instruction: Generate impression based on findings.

Input: Leg pain There is increased marrow signal within the left proximal fibular diaphysis compatible with stress injury. There is no discrete fracture line appreciated. Mild associated muscle and soft tissue edema is seen adjacent to the abnormal marrow signal. The marrow edema of the tibia is normal. Limited evaluation of the right leg demonstrates no discrete marrow abnormality.The muscles of the leg are normal in caliber and signal otherwise.

Output: Stress reaction of the left proximal fibula without discrete fracture line. The tibia is normal.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with seizures and status epilepticus. Assess for CNS pathology. Also period of unresponsiveness. Assess for sinus thrombosis. Two or three small scattered foci of white matter T2 hyperintensity are demonstrated, an entirely nonspecific finding. No evidence of mass, mass effect, or parenchymal edema is seen. No restricted diffusion is detected.There is no evidence of any significant intracranial hemorrhage. The ventricular system is normal in size and morphology. As noted on prior exams, there is an area of CSF prominence along the left parietal lobe which may reflect an arachnoid cyst or anatomic variation.On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected. On dedicated venous imaging, no venous sinus or deep venous thrombosis is detected.

Output: 1.No acute intra-cranial abnormality and no specific findings to account for the patient's symptoms. 2.Again seen is prominence of the CSF space along the left parietal lobe which may reflect an arachnoid cyst or congenital variation.3.No venous thrombosis is detected.


Instruction: Generate impression based on findings.

Input: There is 2-mm retrolisthesis of C4 on C5 and C5 on C6. Vertebral body heights and alignment are otherwise maintained. Bone marrow signal is benign. There is loss of disk height and disk osteophyte complex formation at the C4-5, C5-6 and C6-7 levels. There are mild degenerative changes at the C1-2 level. Individual levels as below:C2-3: No spinal canal or neural foraminal stenosis.C3-4: Disk osteophyte complex with left uncovertebral hypertrophy and facet arthropathy causing mild left neural foraminal stenosis. No significant spinal canal stenosis.C4-5: Disk osteophyte complex and bilateral uncovertebral hypertrophy with facet arthropathy causing moderate bilateral neural foraminal stenosis, worse on the right. Mild spinal canal stenosis.C5-6: Disk osteophyte complex and bilateral uncovertebral hypertrophy causing mild to moderate spinal canal and moderate bilateral neural foraminal stenosis.C6-7: Disk osteophyte complex, bilateral uncovertebral hypertrophy and facet arthropathy causing mild to moderate spinal canal stenosis with moderate to severe right and mild left neural foraminal stenosis.C7-T1: No significant spinal canal or neural foraminal stenosis.

Output: Multilevel degenerative changes in the cervical spine including C4-C5, C5-C6, and C6-C7. There is at least moderate right-sided neural foraminal stenosis at C4-C5, C5-C6, and C6-C7 as detailed above. There is mild to moderate spinal canal stenosis. .


Instruction: Generate impression based on findings.

Input: Reason: Eval for osteo, abscess History: pain There is significant soft tissue swelling about the foot, particularly surrounding the first and fifth toes. Foci of gas are seen in the subcutaneous tissues surrounding the great toe. There is no discrete fluid collection. Marked cortical destruction of the head of the proximal phalanx and amputation margin of the distal phalanx of the great toe with low T1 signal abnormality and corresponding high T2 signal abnormality is consistent with osteomyelitis. Similar but less pronounced findings are seen within the proximal phalanx of the fifth toe, likely reflecting an additional focus of osteomyelitis.

Output: Osteomyelitis of the first and fifth metatarsals as above.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, status post transsphenoidal hypophysectomy, postoperative evaluation. Evidence of recent transsphenoidal hypophysectomy is seen with surgical disruption of the sphenoid bone. Nonenhancing low and intermediate T1 signal material fills the sphenoid sinuses and the posterior nasal cavity compatible with postoperative fluid/blood product and/or packing.The previously seen large sellar and suprasellar cystic lesion has been significantly decompressed. A small residual area of presumed cystic material remains in the posterior aspect of the sella measuring 8 mm AP, 4 mm CC and 11 mm TV. The native pituitary gland appears to sit anterior to and above the residual cystic cavity. The pituitary stalk is at midline and enhances normally. Some residual deformity of the optic apparatus is seen compatible with chronic displacement and stretching from the prior cystic lesion.

Output: Expected findings status post transsphenoidal surgery. The previously seen large cystic sellar and suprasellar lesion has been significantly reduced in size. A relatively small residual cystic cavity is evident in the posterior aspect of the sella with measurements as above.


Instruction: Generate impression based on findings.

Input: Clinical question: eval for stenosis, abnormality. Signs and Symptoms: bilateral upper ext weakness. Nonenhanced cervical spine MRI:Examination demonstrates extensive postoperative changes of corpectomy and anterior fusion extending from C4 through C6. The alignment of the vertebral column remains anatomical.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative disc disease and mild bilateral ligamentum flavum hypertrophy with resultant subtle left neural foraminal compromise.C3-C4 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy, moderate left and mild right facet hypertrophic changes.Tiny focus of T2 hyperintensity within the hypertrophied left ligamentum flavum (axial T2 series 601 image 25 and sagittal T2/T2 STIR image 7) is believed to represent a tiny synovial cyst. Constellation of findings results in subtle mass effect, flattening deformity and effacement of subarachnoid space and moderate central spinal stenosis. Moderate left and mild right neural foraminal compromise is also detected. There is localized T2 signal intensity within the cord at this level representing myelopathy. No prior exams for comparison.C4-C5 demonstrate postop changes of anterior fusion, residual ventral hypertrophic spur and mild facet and ligamentum flavum hypertrophy. Constellation of changes results in mild to moderate central spinal stenosis, moderate bilateral (L>R) neural foraminal compromise.C5-C6 demonstrate anterior corpectomy with resultant expansion of thecal sac anteriorly and without evidence of central spinal stenosis. Degenerative changes however results in significant bilateral (R>L) neural foraminal compromise.C6/C7 demonstrate anterior fusion and including placement of a fixating screw, moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum and mild bilateral facet hypertrophic changes. Constellation of above findings results in moderate central spinal stenosis and significant bilateral neural foraminal compromise.There is a long focus of T2/T2 STIR hyperintensity with associated decreased cord caliber extending from C4-C5 disc level inferiorly to the mid C7 level concerning for myelomalacia secondary to adenopathy.C7-T1 demonstrate minimal degenerative changes and unremarkable otherwise.Upper most visualized thoracic spine and thoracic cord to T5 level is unremarkable.

Output: 1.Postoperative changes of corpectomy at C5-C6 and anterior fusion extending from C4 through C6 as detailed.2.Degenerative changes immediately superior to the anterior fusion at C3-C4 results in moderate central spinal stenosis and with a focus of T2 hyperintensity within the cord concerning for myelopathy. 3.Mild to moderate central spinal stenosis is also noted at C4-C5 level.4.Moderate Central spinal stenosis at C6-C7secondary to degenerative disease is noted.5.Long segmental focus of T2 hyperintensity with cord volume loss at C5 and C6 levels as detailed.6.Multilevel bilateral neural foraminal compromise (some severely) as detailed per level above.7.There are no prior exams for comparison, however if such studies are available and are provided to the radiology Department an addendum to this report will be submitted after comparison.


Instruction: Generate impression based on findings.

Input: Chronic intractable neck pain There is edema involving the left C1 and C2 lateral masses with abnormal enhancement and small amount of synovial fluid distending the joint at this level on prior brain MRI from 6/28/2014. The cervical vertebral bodies are appropriate in height. There is minimal retrolisthesis of C5 on C6 and C6 on C7 and mild loss of cervical lordosis. Alignment is otherwise maintained. The cervical spinal cord has normal signal characteristics and overall morphology.Mild 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: No significant compromise to the spinal canal or neural foramina. Left-sided facet arthropathy.C4-5: No significant compromise to the spinal canal or neural foramina. Left-sided facet arthropathy.C5-6: Minimal retrolisthesis and small disc osteophyte complex with partial effacement of the ventral thecal sac. There is no significant spinal canal or neural foraminal stenosis.C6-7: Minimal disc osteophyte complex and retrolisthesis. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Edema involving the lateral mass articulation of C1 and C2 on the left. Prior brain MRI from 6/28/2014 also demonstrates mild edema, mild joint distention, and surrounding enhancement at this level. Findings may be on a degenerative basis versus a chronic inflammatory arthropathy. CT may be helpful to better assess the osseous anatomy and degenerative changes in this region.2. Mild degenerative changes elsewhere in the cervical spine including left-sided facet arthropathy as described above, without significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: There is normal myelination for the patient's 9 months of age with no evidence of migrational anomalies. Ventricular size is normal. No abnormal focus or asymmetry is seen in the temporal lobes. No evidence of hemorrhage, mass effect, or edema. Ventricular size is normal with no midline shift.

Output: Unremarkable evaluation with no specific findings to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is some increased T2 signal in the supraspinatus tendon, consistent with tendinopathy however there is no discrete tear. The supraspinatus, infraspinatus, teres minor, and subscapularis muscles and tendons are intact.SUPRASPINATUS OUTLET: There is a small amount of fluid in the acromioclavicular joint with associated degenerative changes including multiple small subchondral cysts.GLENOHUMERAL JOINT AND GLENOID LABRUM: Degenerative changes affect the glenohumeral joint with several small cysts in the posterior humeral head. There is a small amount of fluid in the joint space. The anterior and posterior labrum are intact without evidence of tearing. BICEPS TENDON: The biceps tendon is intact without evidence of tearing. ADDITIONAL

Output: Supraspinatus tendinopathy and degenerative changes of the acromioclavicular and glenohumeral joints as described above.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with back pain. Evaluate for cord compression. No evidence of cord compression is seen. Spinal cord signal intensity is within normal limits throughout. Posterior disc-osteophyte complex formation is demonstrated at several levels in the cervical region without high-grade spinal canal stenosis. Disc and posterior element degeneration is also evident in the lumbar spine where there are areas of mild-to-moderate spinal canal and foraminal narrowing. Spinal alignment in the sagittal plane is grossly anatomic and vertebral body heights are preserved. Osseous fusion is evident along the anterior vertebral bodies through much of the thoracic and upper lumbar regions.

Output: 1.No evidence of cord compression.2.Degenerative findings are noted in the cervical and lumbar spine which can be better assessed with dedicated nonemergent imaging if clinically warranted.3.Note is made of vertebral body ossification involving the majority of the thoracic and upper lumbar regions. The differential would include diffuse idiopathic skeletal hyperostosis and perhaps less likely ankylosing spondylitis.


Instruction: Generate impression based on findings.

Input: 49 year old with history of heart transplant in 4/2015 with recent volume overload and hyponatremia presenting for evaluation of biventricular function and/or scar or fibrosis. Left VentricleThe left ventricle is normal in size with normal systolic function, there is mild concentric left ventricular hypertrophy. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 60 ml/m2 (normal range: 74+/-15), the LVEDV is 129 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 49 ml (normal range 47+/-19), the LV mass index is 36 g/m2 (normal range 85+/-15), and the LV mass is 78 g (normal range 164+/-36). There are no regional wall motion abnormalities present, there is mild paradoxical motion of the septum and anterior wall, possibly conductional in etiology. There is no late gadolinium enhancement or intracardiac thrombus.Left AtriumThe left atrium is within limits of normal size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 59 ml/m2 (normal range 82+/-16), the RVEDV is 126 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium normal size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch has a common origin to the right innominate and left common carotid artery. he aortic root is normal in size. The mid ascending aorta, at the level of the main pulmonary artery, demonstrates mild caliber change compatible with suture line from cardiac transplant. 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 significant pericardial effusion. There is a localized fluid collection lateral to the right atrium with signal changes suggestive of proteinaceous or possibly hemorrhagic component, suspected to be postoperative in nature. There is mild mediastinal lipomatosis. Extracardiac FindingsSternotomy wires present consistent with previous cardiac surgery. There is asymptomatic gynecomastia (left greater than right). This appears unchanged compared to CT chest 5/2015. Suggest correlation to physical examination. No associated lymphadenopathy. No pulmonary edema or pleural effusion

Output: 1. The left ventricle is normal in size with normal systolic function, there is mild concentric left ventricular hypertrophy (LVEF 62%). No abnormal enhancement is present.2. The right ventricle is normal in size and systolic function(RVEF 56%). 3. Localized fluid collection lateral to the right atrium, likely postoperative in nature.4. Asymmetric gynecomastia.


Instruction: Generate impression based on findings.

Input: RIght lower extremity hyperreflexia with normal spinal imaging. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right maxillary sinus.

Output: No evidence of intracranial demyelinating lesions.


Instruction: Generate impression based on findings.

Input: Dementia and gait disorder, question of NPH: wide base gait. There is no evidence of intracranial hemorrhage or acute infarct. There is interval increased subcortical white matter T2 hyperintensity in the posterior left temporal lobe, without discernible associated mass. There are also slightly progressed mild scattered areas of T2 hyperintensity in the cerebral white matter, particularly in a periventricular distribution. The ventricles and sulci are diffusely prominent, but similar to 2012. There is no apparent prominent CSF flow jet in the third ventricle. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Diffuse cerebral volume loss appears to be unchanged since 2012 without a pattern to suggest a particular neurodegenerative condition. 2. Increased subcortical white matter signal abnormality in the posterior left temporal lobe and slightly progressed cerebral white matter lesions elsewhere may be related to chronic ischemic disease, but are incompletely characterized and nonspecific.3. No evidence of acute intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on findings.

Input: Contrast rapidly opacified the radiocarpal joint and also entered the distal radioulnar joint, indicating a tear of the articular disc of the triangular fibrocartilage. Although the scapholunate interval is widened, no contrast was noted extending across the scapholunate ligament. The lunotriquetral ligament likewise appeared intact.. Please refer to the subsequent MRI report for further information.Exposure time: One minute 55 seconds

Output: Tear of the triangular fibrocartilage.


Instruction: Generate impression based on findings.

Input: Male 62 years old Reason: evaluate for recurrence of prostate cancer; s/p prostatectomy with PSA now 0.17 History: none PELVIS:PROSTATE:Prostate Size: Status post prostatectomyPeripheral Zone: Status post prostatectomyCentral Gland: Status post prostatectomySeminal Vesicles: Status post prostatectomyExtracapsular Extension: N/ABLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific evidence for recurrent disease. Please note the study was ended early per patient's request.


Instruction: Generate impression based on findings.

Input: 19-year-old female with previously reported distal ileal bowel wall thickening after ileal resection. Please evaluate current status of ileal bowel wall thickening and any other evidence of Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is partially imaged, though appears of normal morphology and signal intensity. No cholelithiasis evident. No biliary ductal dilation.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 distal small bowel in the region of the suspected neoterminal ileum is collapsed (series 4, images 15-20), without suspicious enhancement. No additional sites of abnormal bowel wall enhancement are seen. No stricturing or fistulization is evident. No intra-abdominal fluid collections are noted.BONES, SOFT TISSUES: 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 distal small bowel in the region of the suspected neoterminal ileum is collapsed (series 4, images 15-20), without suspicious enhancement. No additional sites of abnormal bowel wall enhancement are seen. No stricturing or fistulization is evident. No intra-abdominal fluid collections are noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Collapsed distal small bowel, without sites of abnormal bowel wall enhancement, stricturing, or fistulization seen.


Instruction: Generate impression based on findings.

Input: 69-year-old with known left breast cancer presents for MRI directed diagnostic ultrasound of the left breast. Additionally, ultrasound-guided biopsy of the target finding on diagnostic ultrasound is requested. Left ultrasound identified the index lesion and a target lesion for biopsy. The lesion to be targeted is a hypoechoic area measuring up to 8 mm at the 12 o’clock position with increased vascularity, 2 cm from the nipple. The lesion was somewhat subtle.BIOPSY:PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, four 14-gauge core needle (InRad) specimens were obtained of the lesion. Targeting was judged excellent. Two specimens sank to the bottom of the prefilled container of 10% formalin. Two specimens partially sank. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a ribbon clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location in the anterior depth, similar in position to the MRI finding. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Schacht. Dr. Schacht was present during the procedure at all times.

Output: Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Pathology is pending at this time. Clip position correlates well with the MRI finding.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 63 year-old male with ampullary lesion and stable segment 7 liver lesion. Evaluating extent of disease if any in liver. ABDOMEN:LIVER, BILIARY TRACT: Previously seen nonenhancing, low-attenuation lesion in hepatic segment 7 on prior CT measures 1.5 x 2.1 cm on the current MRI, unchanged in size (series 1102/81). The lesion is homogeneously T2 bright and T1 dark with gradual peripheral enhancement superiorly, compatible with hemangioma. Additional scattered T2 bright subcentimeter lesions are too small to characterize but likely due to cysts. No suspicious hepatic lesions. Status post cholecystectomy. Moderate intrahepatic biliary ductal dilation with dilation of the common bile duct usually measuring up to 1.7-cm. At the level of the ampulla, there is a small, low T2 signal ampullary lesion demonstrating enhancement and measuring up to 1.5 x 1.3 cm (series 5/46 and series 1102/34), most compatible with known ampullary adenocarcinoma. Previously seen common bile duct stent is not visualized. Mild circumferential wall thickening of the common bile duct with enhancement, likely related to inflammation given recent instrumentation though tumor infiltration cannot be excluded. Few punctate distal common bile duct stones are seen (series 5/43 and 45).SPLEEN: Small splenule is seen at the splenic hilum near the pancreatic tail. Mild splenomegaly with the spleen measuring up to 16.2-cm in length. No focal splenic lesions.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable subcentimeter T2 bright hypoattenuating lesions in both kidneys, most likely due to simple cysts.RETROPERITONEUM, LYMPH NODES: Portacaval lymphadenopathy is similar to prior CT.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable degenerative arthritic changes of the lumbosacral spine with mild superior endplate compression deformities of the L1 and L3 vertebral body.OTHER: No significant abnormality noted.

Output: 1.Ampullary lesion compatible with the known ampullary adenocarcinoma causing biliary tree dilation. Mild circumferential wall thickening and enhancement of the distal common bile duct, likely related to inflammation given recent instrumentation though tumor infiltration cannot be excluded.2.Mild choledocholithiasis.3.No suspicious hepatic lesions.4.Portacaval lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 64-year-old female with shoulder pain. Rule out rotator cuff tear. ROTATOR CUFF: There is marked thinning of the supraspinatus tendon at the 12 o'clock position, just proximal to its insertion. On the coronal oblique images, the tendon is thinned to 1 mm or less over a longitudinal distance of approximately 1 cm, reflecting tearing along both the articular and bursal surfaces. There appears to be delamination of the articular surface and bursal surface fibers with approximately 1 cm of retraction. The tear is approximately 1 cm in the AP dimension, although it appears to extend posteriorly to involve the anterior fibers of the infraspinatus tendon to a lesser degree. There is tendinosis of the anterior fibers of the supraspinatus tendon at its insertion. There is interstitial tearing along the myotendinous junction of the supraspinatus tendon more proximally. Additionally, there is interstitial tearing along the myotendinous junction of the infraspinatus proximally. There is mild fatty infiltration along the myotendinous junction of the supraspinatus and infraspinatus which otherwise appear normal. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa. There is an os acromiale.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is no joint effusion. There is mild increased signal intensity within the superior labrum which may represent degenerative tearing, within the limitations of this non arthrogram study. There are subchondral cysts within the humeral head.BICEPS TENDON: The tendon of the long head of the biceps appears normal.

Output: 1. Marked thinning of the distal supraspinatus tendon as a result of articular and bursal surface tearing with additional interstitial tearing of the supraspinatus and infraspinatus tendons as described above.2. Mild osteoarthritis of the acromioclavicular joint.3. Os acromiale.


Instruction: Generate impression based on findings.

Input: Diagnosis: Demyelinating disease of central nervous system, unspecifiedClinical question: eval for demyelinating diseaseSigns and Symptoms: paresthesias MRI brain: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. These were also present on the prior exam.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI 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 the normal cervical curvature 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 or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They're stable when compared to the prior exam. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 2.No abnormal lesions are identified in the spinal cord.3.There is no compromise of the cervical spinal canal or exiting nerve roots. No abnormal lesions are identified within the cervical spinal cord.4.There is no compromise of the thoracic spinal canal or exiting nerve roots. No abnormal lesions are identified within the cervical spinal cord.5.There is mild reversal of the normal cervical curvature present which could be related to patient positioning or muscle spasm.


Instruction: Generate impression based on findings.

Input: 12-year-old female with JIA and history of TMJ arthritis; off therapy with worsening headaches and stiffness Right: There is redemonstration of flattening of the articular surface of the mandibular condyle representing chronic erosion. The extent of these findings is similar to the prior exam. There is mild enhancement of the synovium and bone marrow suggesting mild synovitis. There is thinning of the articular disc centrally which also appears similar to the prior exam. There is no obvious disc displacement between open and closed mouth views.Left: There is redemonstration of flattening of the articular surface of the mandibular condyle with a new articular defect indicating progression of erosion. There is similar mild synovitis compared to the right side. Thinning of the articular disc is also seen which may represent disruption. Again, there is no obvious displacement between open and close mouth views.

Output: Inflammatory arthritis involving the temporomandibular joints bilaterally with progression of erosion on the left.