Instruction: Generate impression based on findings.

Input: No evidence of epidural hematoma. Alignment is anatomic. Vertebral body heights are normal. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. Mild disc dessication at L4/5 and L5/S1 levels with mild disk bulges; no significant spinal canal or neural foraminal stenosis. The visualized intra-abdominal and paraspinal contents are unremarkable.

Output: No epidural hematoma. Minimal disc bulges at L4-5 and L5-S1 without significant spinal canal or neural foraminal stenosis.Findings discussed with Dr. Deshmukr on 3/25/2015 at 4:45PM.


Instruction: Generate impression based on findings.

Input: 54-year-old male with head and neck cancer, evaluate response to therapy CHEST:LUNGS AND PLEURA: Scattered areas of scarring in both lungs are unchanged. Volume loss in the left lower lobe. No suspicious nodules or masses can be identified. No evidence of pleural effusion. Bronchial wall thickening, particularly at the left lung base is unchanged. The left upper lobe mucoid impaction is stable.Mild paraseptal and centrilobular emphysema.MEDIASTINUM AND HILA: Tracheostomy tube in place. Right Port-A-Cath with its tip in the SVC. Mediastinal lymph node enlargement is stable.CHEST WALL: Right chest port. Soft tissue collection of air is identified in the region of the right subclavian vein may be secondary to recent instrumentation. Increasing areas of sclerosis involving the T1, T2, and T3 vertebrae may be near the radiation therapy. Osseous metastases cannot be definitely excluded. MRI of the cervical and thoracic spine is recommended. Large soft tissue mass in the lower portion of the left neck partially visualized on this exam. Will be evaluated on CT of the head and neckABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G-tube in placeBONES, SOFT TISSUES: Sclerotic areas in the upper vertebrae and impending collapse of the T2 vertebrae may represent post radiation changes and/or metastatic disease.OTHER: No significant abnormality noted

Output: 1.No evidence of pulmonary metastatic disease. Stable mediastinal adenopathy.2.Low left neck mass better evaluated on CT of the head and neck.3.Sclerotic lesions in the T1, T2, T3 vertebrae with impending collapse of the T2 vertebrae may represent post radiation changes or metastatic disease. Recommend MRI and he cervical and thoracic spine for further evaluation.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for episodic left facial numbness History: as above The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus and to a lesser degree in the left. 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. Mucosal thickening in the paranasal sinuses is likely inflammatory in nature.


Instruction: Generate impression based on findings.

Input: 40-year-old female with right knee pain after right knee dislocation. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is edema type signal abnormality within the anterior aspect of the medial femoral condyle consistent with contusion. No findings to suggest an acute fracture. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: There is complete rupture of the ACL. Increased signal abnormality within the proximal and midsubstance fibers of the PCL suggesting complete rupture. There is increased signal abnormality and indistinctness of the meniscofemoral component of the deep portion of the MCL, suggesting a tear. There is also increased signal abnormality between the medial meniscus and superficial band of the MCL.EXTENSOR MECHANISM: There is increased signal abnormality about an indistinct medial retinaculum, suggesting complete rupture. The extensor mechanism appears intact. ADDITIONAL

Output: 1. Complete rupture of the ACL and PCL. Findings suggestive of tearing of the deep portion of the MCL.2. Bone contusion of the medial femoral condyle and rupture of the medial retinaculum without evidence of acute fracture.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are diagnostic mammogram (3/18/15), left breast ultrasound (3/18/15), images from ultrasound guided biopsy and post procedural unilateral left mammogram(3/18/15) performed at Memorial SB, and MRI (4/7/15) performed at Elkhart General Hospital. For comparison, mammograms dated 4/4/14 and 2/12/13 are available. MAMMOGRAM (3/18/15): Three standard views of both breasts, and a single spot compression view of the left breast, were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There has been interval development of a 3.4 cm mass in the upper inner left breast, which persists on spot compression imaging. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast. ULTRASOUND (3/18/15): Images labeled "Left breast PALP" at the 9-10:00 position, 6-8 cm from the nipple demonstrate a lobulated hypoechoic mass with angular margins measuring 2.1 x 1.5 x 2.4 cm. IMAGES FROM US GUIDED LEFT BREAST BIOPSY and POST-PROCEDURAL MAMMOGRAM (3/18/15): Submitted images from ultrasound guided biopsy of the hypoechoic mass at the 10:00 position of the left breast demonstrate appropriate targeting. A clip was placed. Post-procedural mammogram demonstrates a twist-shaped clip along the posterior margin of the mass.MRI (4/7/15): MRI was performed without and with contrast as per outside hospital protocol. There is a unifocal enhancing mass at the 10:00 position of the left breast measuring 4.2 x 3.7 x 4.1 cm. No further areas of enhancement are appreciated in the left breast. A 0.5 cm benign focus of enhancement is present at the 6:00 position of the right breast. No further areas of enhancement are present in the right breast. No abnormal axillary lymph nodes are appreciated.PATHOLOGY: Per outside report, pathology at 10:00 Left breast reveals poorly-differentiated invasive ductal carcinoma.

Output: Unifocal 4.2 cm mass at the 10:00 position of the left breast, corresponding to the patient's known invasive ductal carcinoma. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There is large area of restricted diffusion involving the majority of the left cerebral hemisphere, in the left MCA and the left PCA territories. There is diffuse cytotoxic edema in left cerebral hemisphere associated with T2/FLAIR hyperintensity and sulcal effacement. There are cortical foci of susceptibility in the infarcted left cerebral gyri, probably related to petechial hemorrhage. There is rightward subfalcine herniation of approximately 7 mm. The left lateral ventricle is partially effaced and there is prominence of the right temporal horn and the trigone, concerning for early trapping. There is a very early left uncal herniation.Additional foci of restricted diffusion are seen in the right pons, right globus pallidus, right midbrain, left cerebellum, and the right occipital white matter with diffuse confluent T2/FLAIR hyperintensity in the brainstem especially ventrally.There is symmetric bilateral increased T1 signal in the caudate nuclei and in the putamen bilaterally with associated susceptibility, concerning for mineralization. There is no surrounding FLAIR abnormality to suggest vasogenic edema.There is fluid in the ethmoids and in the left sphenoid sinus. Air-fluid level noted in the left maxillary sinus. Fluid is seen in the right maxillary sinus. Fluid is seen in the mastoids, left more than the right. There is a diffuse amount of fluid in the nasal cavity.There is cavum septum pellucidum et vergae, normal variant.MRA BRAIN:The left ICA is slightly larger than the right as there is a hypoplastic right A1. The flow-related enhancement in the distal left M1 proximal to the trifurcation is slightly attenuated, probably representing a partial thrombus. The distal left MCA branches are attenuated as compared to the right.There is mild focal narrowing of the left M1 origin.The right V4 segment is irregular with a severe focal narrowing proximal to its midportion. The V4 segment of the left vertebral artery distal to the PICA is developmentally diminutive.MRA NECK:Evaluation limited due to lack of contrast. The right vertebral artery is diminutive, with suboptimal flow-related enhancement distally.Note is made of bovine aortic arch, normal variant. There are apparent irregularities of the distal internal carotid arteries at the skull base, which are probably artifactual. Underlying pathology cannot be excluded.

Output: 1. Extensive acute infarct involving the left MCA and PCA territories, although left deep grey nuclei are spared.2. The flow in the distal left M1 is severely attenuated, which may represent a partial thrombus. The distal branches of the left MCA are severely attenuated, as compared to the right, which may relate to slow flow.3. Severely narrowed right V4 segment proximal to its midportion, and nondominant cervical right vertebral artery not well visualized distally.4. There is symmetric bilateral increased T1 signal in the caudate nuclei and globus pallidi bilaterally with associated susceptibility, consistent with mineralization. Toxic or metabolic abnormalities are in the differential.


Instruction: Generate impression based on findings.

Input: Ms. Renaud is a 57 year old female with a personal history of benign left stereotactic biopsy in 2010 (pathology of UDH, focal adenosis) and benign left breast biopsy in 2001 (pathology of apocrine metaplasia). Family history of breast in mother (diagnosed at the age of 60) and sister (diagnosed at the age of 34). There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally.There is continued visualization of multiple patchy foci of enhancement in both breasts, all of which are stable when compared to multiple prior MRI examinations. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 84 years, Male, left frontal lesion, altered mental status, recent seizure. Limited sequences were obtained as patient could not tolerate the full study including the postgadolinium sequences.There is a masslike lesion involving the left superior frontal gyrus measuring 3.3 x 2.4 cm with T1 and T2 hyperintensity and peripheral rim of low T2 signal. Finding is favored to represent a subacute hematoma. There is associated diffusion restriction.There is moderate global parenchymal volume loss. There is prominence of the extra-axial spaces along the bilateral cerebral convexities likely related to combination of volume loss and bilateral subdural hygromas without local mass effect. There are scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but compatible with chronic small vessel ischemic disease. There is ex vacuo dilatation of the left lateral ventricle. No hydrocephalus. No midline shift or herniation. There is mild soft tissue swelling in the right periorbital region.

Output: 1. Limited study due to motion degradation, limited sequences, and absence of gadolinium. 3.3 x 2.4 cm masslike lesion in the left frontal lobe is most suggestive of a subacute intraparenchymal hematoma, but would suggest complete brain MRI study with gadolinium for further evaluation and exclude a potential underlying lesion.2. Bilateral subdural hygromas without significant mass effect.3. Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 59-year-old male with fatigue and history of smoldering multiple myeloma. Evaluate for myelomatous lesions. BONE MARROW: Small cystic lesion located anteriorly at the left femoral head-neck junction, most compatible with a benign synovial herniation pit. No additional or suspicious focal bone lesion.Mild intermediate signal intensity of the medullary bone with mild enhancement follows the typical appearance and distribution of red marrow; however, low-burden infiltrating disease cannot be entirely excluded.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: 1. No suspicious focal bone lesion.2. Medullary bone with typical appearance for red marrow; however, low-burden infiltrating disease cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: 29-year-old female with liver lesion seen on recent CT requiring further evaluation. ABDOMEN:LIVER, BILIARY TRACT: 2.7 x 2.8 cm mass in the right hepatic lobe near the dome (series 4/3) which demonstrates T2 isointensity with smaller central T2 hyperintense component, homogeneous arterial enhancement, and retention of contrast on hepatobiliary phase, compatible with focal nodular hyperplasia with central scar. Numerous small T2 hyperintense cystic foci throughout the liver without significant enhancement, most compatible with benign biliary hamartomas. No biliary ductal dilation. Normal appearance of the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent nonspecific left anterior juxtaphrenic lymph node measuring up to 8 mm in short axis (series 11/21).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild abdominopelvic ascites.PELVIS:UTERUS, ADNEXA: Stable large complex, multiloculated cystic mass arising from the pelvis and extending into the lower abdomen. Most of the septae of the mass are thin and demonstrate mild enhancement. A few the loculated components demonstrate mild mural nodularity. For example, there is a round soft tissue nodule with apparent enhancement measuring 1 cm within a component of the mass in the right posterior cul-de-sac (series 15/44). Normal right ovary is likely seen (series 15/55). Normal left ovary is not visualized. These findings should be correlated with pelvic ultrasound.BLADDER: High T1, low T2 signal material dependently within the bladder is most likely due to contrast. However, hemorrhage cannot be excluded as there were no precontrast images of the pelvis performed. Clinical correlation for hematuria can be performed.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild abdominopelvic ascites.

Output: 1.Stable large complex, multiloculated cystic lesion likely arising from the left ovary and highly suspicious for cystic ovarian neoplasm such as serous or mucinous cystadenoma or cystadenocarcinoma. Findings should be correlated with pelvic ultrasound.2.Right hepatic lobe mass is consistent with focal nodular hyperplasia. No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: Having fatigue. Signs and symptoms: New fatigue, cognitive complaints for last few years and blurred vision. Pre-and post enhanced brain MRI:Unremarkable diffusion weighted series. There is normal anatomical morphology and signal intensity of brain parenchyma on all MRI sequences.Unremarkable CT cortex, cortical sulci, ventricular system, CSF spaces and myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement.The signal void of intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses and pattern of enhancement is unremarkable. Calvarium demonstrate a focus marrow signal abnormality in right anterior frontal bone. The lesion measures approximately 16 x 38-mm in transaxial dimensions (axial image 23). It has a thick rim of T2 hypointensity and internal foci of nearly isointense signal which demonstrates enhancement. There is no evidence of edematous changes of the adjacent lateral, no evidence of expansion into the epidural or subcutaneous spaces. The finding is suggestive of a benign lesion such as a calvarial hemangioma or possibly fibrous dysplasia. Follow up with a CT examination is recommended for further assessment.Unremarkable images through the orbits including axial fat sat post enhanced series.Unremarkable images through the sinuses.Pre-and post enhanced cervical MRI:The anatomical alignment the vertebral column is within normal.The signal intensity of vertebral column is unremarkable other than subtle changes secondary to degenerative disease.There is normal signal intensity and caliber all cervical and uppermost visualized thoracic cord.There is no detectable concerning abnormal enhancement the vertebral column, cord or the leptomeninges.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild asymmetric left-sided facet hypertrophy with resultant mild left neural foraminal compromise.C4 -- C5 demonstrate mild degenerative changes and unremarkable otherwise.C5 -- C6 demonstrate mild disk disease and loss of disk height and minimal hypertrophic changes of posterior elements. There is moderate to severe right neural foraminal compromise. Minimal left neural foramina compromise and no central spinal stenosis.C6 -- C7 demonstrate moderate disk disease and loss of disk height, mild facet and ligamentum flavum hypertrophy. There is a right-sided disk osteophyte complex with several effacement of ventral subarachnoid space, moderate to severe right neural foraminal compromise and no central spinal stenosis.C7 -- T1 is unremarkable.

Output: 1.Pre-and post enhanced brain MRI demonstrate no detectable intracranial abnormalities. There is a well demarcated right frontal skull lesion with a thick rim of T2 hypointensity and with central focus of enhancement measuring approximately at 16 x 38-mm. Finding is suggestive of a benign lesion such as a fibrous dysplasia or a hemangioma. Recommend follow-up with CT examination is recommended.2.Pre-and post enhanced MRI of the cervical spine demonstrate mild degenerative with resultant pain severe right and mild left neural foraminal compromise at C5 -- C6, moderate to severe right neural foraminal compromise at C6 -- C7 however without central spinal stenosis at any level. Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: 45-year-old female with history of Crohn's ileitis and right lower quadrant pain. Evaluate for activity and extent. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesion. No intrahepatic biliary ductal dilatation. Cholelithiasis.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: Mild gastric distention. No evidence of small bowel obstruction. No definite evidence of ileal wall thickening or abnormal enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No definite evidence of ileal wall thickening or abnormal enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No MRI evidence of Crohn's disease or Crohn's ileitis.


Instruction: Generate impression based on findings.

Input: 3-year-old female with history of nonaccidental trauma leading to liver laceration or traumatic pancreatitis with pseudocysts measuring 2 x 3.3 cm on outside hospital MRI, presenting with abdominal pain, evaluate. LIVER:There is liver is normal in echotexture and size. No intrahepatic biliary dilatation is identified. Portal vein has normal direction velocity and direction of flow.GALLBLADDER, BILIARY TRACT: Gallbladder is normal in appearance. Common bile duct measures 0.23 cm in diameter.PANCREAS: Complex cystic collection adjacent to the pancreas measuring 3.5 x 3.0 x 3.2 cm compatible with pseudocyst reported on prior MRI. The pancreas is not visualized due to bowel gas.SPLEEN: The spleen is normal in size and echotexture, measuring 7.4 cm in length.KIDNEYS: The right kidney is normal in echotexture and size and measures 7.6 cm in length. The left kidney is normal in echotexture and measures 7.4 cm in length.ABDOMINAL AORTA: Abdominal aorta is normal in size, direction and velocity of flow.INFERIOR VENA CAVA: Inferior vena cava is normal in appearance.OTHER: Small amount of ascites is noted in the upper abdomen.

Output: Complex cystic collection adjacent to the pancreas measuring 3.5 x 3.0 x 3.2 cm, compatible with pancreatic pseudocyst with small amount of ascites in the upper abdomen.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, cervical regionClinical question: Eval for cervical stenosisSigns and Symptoms: cervical radiculopathy The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.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. There is a small central disc protrusion present at this level. Was also present on the prior exam and has not changed substantially.The vertebral artery flow voids appear to be intact.Incidental note is made of partial empty sella.

Output: 1.There is no compromise cervical spinal canal or exiting nerve roots. No abnormal spinal cord lesions are appreciated. There are some mild degenerative changes present in the cervical spine without compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Status post tumor resection. Compared to MRI dated 5/19/2015, interval postsurgical changes of right temporoparietal craniotomy for resection of previously seen enhancing mass at the right temporo-occipital junction. There is minimal slightly nodular enhancement surrounding the resection cavity which may represent minimal residual tumor. Otherwise the tumor appears to have been completely resected. There is minimal restricted diffusion along the surgical cavity margin as well as separate tiny focus just medial to it compatible with cytotoxic edema. Again seen is vasogenic edema involving the right posterior temporal lobe extending slightly into the occipital lobe. There is small extra-axial collection along the right cerebral convexity and dural enhancement consistent with postsurgical change. There is minimal local mass effect related to the vasogenic edema. No midline shift or uncal herniation. No hydrocephalus. Mild global parenchymal volume loss is noted. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Major flow-voids are preserved. Blood products are seen within the resection bed as well as small amount of pneumocephalus. There is focus of susceptibility consistent with chronic microhemorrhage in the left left temporal lobe, lateral to the temporal horn, which is nonspecific.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Aside from postsurgical changes, bone marrow signal and extracranial soft tissues are within normal limits.

Output: Expected postsurgical changes of resection of previously seen tumor at the right temporo-occipital junction. There is minimal rim of slightly nodular enhancement surrounding the resection cavity which may represent minimal residual tumor. The tumor appears otherwise completely resected. There is surrounding vasogenic edema without midline shift or herniation.


Instruction: Generate impression based on findings.

Input: Left eye pain and vision changes, evaluate for optic neuritis. Per EPIC, pain OU after waking up 2 nights ago and egg/oval shaped spot in FOV (nasally about 9 o'clock) OD. Also has chorioretinal scar, right and bilateral ocular rosacea. There is mild asymmetric prominence of the cerebrospinal fluid surrounding the left optic nerve, which appears similar to prior examinations. The optic nerves themselves are symmetric and normal in size and signal intensity. The extraocular muscles are unremarkable. There is no intraorbital mass or abnormal enhancement. However, there appears to be mild diffuse thickening and enhancement of the bilateral eyelids. There is no optic chiasm mass or parasellar abnormality. The imaged portions of the brain parenchyma are unremarkable.

Output: 1.Mild unchanged asymmetric prominence of the cerebrospinal fluid surrounding the left optic nerve, which may be a normal variant, but no evidence of optic neuritis.2.The bilateral eyelids appear to be mildly swollen, which may correspond to the clinically reported blepharitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 51-year-old female with history of syncope. Evaluate for ischemia. There are no areas of restricted diffusion to suggest acute ischemia. There is no evidence of acute intracranial hemorrhage. There is no midline shift or mass effect. No hydrocephalus. There are no areas of abnormal signal or pathologic enhancement. Normal flow-voids are demonstrated in major intracranial vessels. The visualized paranasal sinuses and mastoid air cells are clear. Nonspecific heterogenous low T1 marrow signal. The calvarium and soft tissues of the scalp are otherwise unremarkable.

Output: No evidence of acute ischemia, mass, or mass effect. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Clinical question: History of metastatic esophageal cancer; previously received SRS to left precentral gyrus lesion. Evaluate disease status. Signs and symptoms: Metastatic breast cancer. Pre and post enhanced brain MRI:Examination demonstrates a small enhancing metastatic lesion superficially in the cortex of left precentral gyrus measuring approximately 10.5 mm in length compared to prior study measurement of approximately 7.8 mm. There is minimal surrounding FLAIR hyperintensity representing edema. Examination additionally demonstrate metastatic lesions in the right postcentral gyrus (axial post enhanced series 12 image 9) measuring approximately 4 mm in transaxial dimensions which was not present on prior exam. There is also a second smaller 3 mm enhancing lesion (axial post enhanced series 12) image 8) which was noted as a punctate focus of enhancement on prior study and with interval progression.Also new since prior exam is a 3.8 mm focus of enhancement (sagittal post enhancement series 13 image 19) in the medial aspect of the left posterior temporal lobe measuring. This lesion demonstrate no associated vasogenic edema or mass effect.Post enhanced images also redemonstrate a small developmental venous anomaly in the left angular generous.Moderate scattered subcortical, periventricular and basal ganglia FLAIR hyperintensity consistent with chronic small vessel ischemic strokes without significant change since prior exam.No detectable calvarial lesions.Unremarkable images through the orbits and including axial fat sat post enhanced series.

Output: 1.Interval increased size and edema of metastatic lesion in the left precentral gyrus at 10.5 mm compared to prior study measurement of 7.8mm.2.Metastatic lesion in the right postcentral gyrus with interval increased size as detailed.3.Interval increased size of a punctate lesion in the medial aspect of the left posterior temporal lobe to 3.8 mm compared to prior study.4.Additional tiny enhancing metastatic lesions in the right postcentral gyrus which cannot be identified on prior exams.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness. Face numbness. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Brain MRI is within normal limits for age.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with breast cancer. Nonexpansile heterogeneous marrow replacement and patchy enhancement is seen within the left aspect of the L5 vertebral body including the left transverse process and to a lesser extent the left pedicle. Since the prior examination, there has been no significant interval change in the appearance or geographic extent of this lesion.The L5 vertebral body demonstrates overall preserved height allowing for focal collapse of the left superior endplate. No evidence of significant epidural disease spread is seen. No spinal canal or neuroforaminal stenosis is suspected.Fatty marrow replacement involving L4, L5 and the sacrum is compatible with prior radiation. Marrow signal is otherwise unremarkable. No additional metastatic lesions are suspected.The visualized spinal cord, conus and cauda equina are unremarkable. No intraspinal masses are seen.No significant disc degeneration is seen. Mild facet hypertrophy is noted at L4-5 and L5-S1. No significant spinal canal or neuroforaminal stenoses are detected.

Output: 1.Stable metastatic lesion involving the left aspect of the L5 vertebral body.2.No new spinal or paraspinal lesions are seen.


Instruction: Generate impression based on findings.

Input: 54 year old male. Left great toe with erythema around the nail bed. History of diabetes. Evaluate for osteo/abscess. A superficial small ulcer at the medial aspect of the left great toe without associated abscess or evidence for osteomyelitis. There is a confluent fluid signal intensity collection at the dorsum of the foot that measures 8 mm in thickness and spans from the base of the toes into at least the midfoot, to the most proximal margin of this study. While this may simply represent confluent edema, infection cannot be excluded, though there are no specific features such as pathologic rim enhancement to suggest abscess formation. Diffuse atrophy of the plantar musculature of the foot.

Output: 1. Superficial small ulcer at the medial aspect of the great toe without evidence of osteomyelitis.2. Confluent fluid signal intensity collection at the dorsum of the foot, which may simply represent confluent edema although superimposed infection is not excluded. No specific features of this collection to indicate mature abscess formation.


Instruction: Generate impression based on findings.

Input: 42 year-old female with atrial fibrillation and multiple questionable TIAs. There is no evidence of intracranial hemorrhage, mass or edema. Previously described low density in right posterior parietal region is most likely due to encephalomalacia but has an unusual appearance. This well-defined area appears to exert local mass effect on the adjacent parenchyma and measures CSF density. Congenital malformations such as schizencephaly or arachnoid cyst cannot be ruled out. MRI may be considered as clinically warranted for further evaluation of this area.No acute change and no abnormal postcontrast enhancement.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No interval change.2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Pain. Left knee: There is a small joint effusion, but the knee otherwise appears normal. Avascular necrosis of the distal femur seen on the recent MRI examination is not clearly evident on these radiographs.Right knee: The knee appears normal with no specific findings to account for the patient's pain.Left ankle: There is a lucency with thin sclerotic margins in the anterior aspect of the calcaneal body that may represent an intraosseous lipoma or unicameral bone cyst. It is not necessarily of any current clinical significance. The ankle otherwise appears normal with no specific findings to account for the patient's pain.Right ankle: The ankle appears normal with no specific findings to account for the patient's pain.

Output: Small left knee joint effusion but otherwise no specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: The patient is a 9-week-old male with history of apnea for two minutes. Rule out bleed or mass. There is no evidence of intracranial hemorrhage, mass or edema. The parenchyma of the cerebrum, cerebellum and brainstem is normal in attenuation and morphology.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: Normal brain CT.


Instruction: Generate impression based on findings.

Input: There is mildly decreased diffusion and T2 hyperintensity within the corticospinal tracts of the pons. There are no additional areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a partially empty sella.

Output: Limited examination terminated early by the patient reveals nonspecific mild diffusion restriction and edema within the corticospinal tracts of the pons of uncertain etiology and significance, although this is an area prone to artifact and correlation with patient symptomatology recommended for confirmation


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: Evaluate for intermittent lightheadedness, generalized nonspecific symptoms of mild intermittent headache associated with lightheadedness History: pls see above No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels.Retention cyst is on bilateral maxillary sinuses. Scattered minimal fluid collections within bilateral mastoid air cells.

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


Instruction: Generate impression based on findings.

Input: Female, 46 years old. Pain and limited rom. ROTATOR CUFF: There is minimal supraspinatus tendinopathy without discrete tear. The supraspinatus muscle is intact. The infraspinatus, teres minor, and subscapularis tendons and muscles are intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: The tendon of the long head of the biceps is normal in position and morphology. ADDITIONAL

Output: Minimal rotator cuff tendinopathy without discrete tear identified.


Instruction: Generate impression based on findings.

Input: MRI Brain:Images are somewhat limited by patient motion. There has been no significant interval change in appearance of the large peripherally T1 hyperintense right periventricular parenchymal hematoma, with associated surrounding residual vasogenic edema and localized mass effect. The leftward midline shift measuring 3 mm is unchanged. Trace T1 hyperintense intraventricular blood products are again seen along the left occipital horn. Posterior right cerebral sulcal effacement remains. There is no pathological enhancement.There are small scattered T2 hyperintense lacunar infarcts within the cerebellum bilaterally. A prominent chronic lacunar infarcts also seen along the right basal ganglia and the posterior aspect of the left basal ganglia. There are innumerable foci of susceptibility located throughout the cerebral hemispheres both centrally and peripherally. The extensive underlying periventricular and subcortical T2/FLAIR hyperintensities are consistent with chronic small vessel ischemic changes. The ventricular caliber is stable. The major cerebral flow voids are intact.MRA Brain: Severely motion limited exam. Within these limitations, there may be mild atherosclerotic irregularity within the M1 segments bilaterally. There is no significant intracranial stenosis. There is a mildly hypoplastic left A1 segment. The distal right V4 segment is developmentally diminutive. No evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is mild flattening of the carotid bulbs bilaterally. The common carotid arteries and cervical internal carotid arteries are otherwise normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion involving the cervical neck arteries. The right vertebral artery is smaller than the left.

Output: 1.Large evolving right intracerebral hemorrhage with localized mas effect, vasogenic edema and trace intraventricular hemorrhage, without significant change compared to the prior exam allowing for differences in technique.2.Extensive scattered punctate foci of susceptibility abnormality diffusely throughout the brain is most compatible with amyloid angiopathy and is may provide etiology for the underlying right sided hemorrhage.3.Extensive underlying chronic small vessel ischemic disease with multiple chronic lacunar infarcts.4.Limited MRA due to patient motion, although without definite flow-limiting stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 35 years old; Reason: Evaluate osteochondral injury, ligamentous injury. History: L knee pain, likely h/o patellar dislocation MENISCI: No significant abnormality noted. The menisci are intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. The bone marrow signal is normal, without evidence of edema. No definite cartilage defects are seen. The femoral trochlea appears normal in morphology. No osteochondral defect is evident.LIGAMENTS: No significant abnormality noted. The cruciate and collateral ligaments are intact. The medial and lateral retinacula are within normal limits.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 51-year-old female with epigastric pain and fever. Status post pancreatic abscess with percutaneous drainage. Allergic to IV contrast. Known choledochocyst and cholangitis. Right upper quadrant pain and fever. This examination is limited by the absence of intravenous contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: This patient is status post percutaneous choledochocyst drainage on 4/17/09 with catheter removal on 5/12/09. Subsequent hepaticojejunostomy was performed. Compared with the MRI examination dated 7/17/09, the previously drained cyst measured 2.3 x 1.8 cm initially and now measures 4.9 x 4.2 cm. There is new increase in the adjacent serpiginous low density tubular structure compatible with new biliary duct dilatation and obstruction which predominantly affects the left hepatic lobe. The expected pneumobilia is seen in this patient who is status post hepaticojejunostomy. Multiple splenic and gastric varices are present. Mild hepatomegaly, the liver measures 18.5 cm overall.SPLEEN: Mild splenomegaly, the spleen measures 12 cm in length.PANCREAS: No definite evidence of pancreatic cyst as clinically questioned. Further examination examination for smaller cysts or abscess would require contrast enhancement.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the dependent pelvis.

Output: Interval development of enlarged choledochal cyst with probable obstruction of the left biliary tree. Multiple additional findings appear stable since MR examination of 7/17/09.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for new vascular changes; Hb SS; CVAs; moyamoya; s/p EDAS 11/22/06 History: increasing headache frequency (twice weekly) all July 2015 (no headaches for several months before July) MRI brain:There is redemonstration of right parietal encephalomalacia within the right MCA/ACA watershed territory which appears similar to the prior exam. Additional scattered small foci of increased T2 signal within the left caudate and bilateral frontal lobes is minimally, if any, increased in the right posterior frontal lobe. Widening of the right cerebral hemispheric sulci is unchanged and reflects volume loss. The ventricles are unchanged in size and configuration. No evidence of an acute infarct. No mass effect, midline shift or basal cistern effacement. The major cerebral flow voids are grossly unchanged, however see below for further details. The orbits and scalp soft tissues are grossly unremarkable, including visualization of the area of the right lateral synangiosis. Diffusely low T1 marrow signal within the calvarium is unchanged and likely reflects chronic anemia.MRA brain:The right internal carotid artery is diminutive with absent flow related enhancement distally and reconstitution immediately proximal to the MCA origin, appearing similar to the prior exam. Minimal attenuation of the right distal MCA branches appear similar to the prior exam. The right A1 segment is better visualized than the prior exam appearing normal, which is likely due to differences in technique.The left A1 is not well visualized and A2 is diminutive, similar to the prior exam. Mild narrowing of the left ICA at the terminus appears less prominent than the prior exam which is likely due to differences in technique. Left MCA branches have normal flow related enhancement, unchanged. There is irregularity and narrowing at the right P1/P2 junction with multiple collaterals, similar to the prior exam. The left P1 segment is better visualized than the prior exam without stenosis, likely due to differences in technique. The vertebral and basilar arteries are normal without evidence of stenosis or aneurysm.Numerous suprasellar collaterals appear similar to the prior exam. Right MCA collateralization from a transposed superficial temporal artery is unchanged.

Output: 1.Chronic ischemic changes appear overall similar to the prior exam with minimal, if any, increase in T2 signal. No evidence of acute ischemia.2.Arterial changes of moyamoya, most significant in the right distal ICA, are likely unchanged accounting for differences in technique. A few regions of apparent stenosis on the prior exam, including the right A1 segment and left P1 segment, appear normal on the current exam which is likely due to differences in technique (3T versus 1.5 T, also with prior artifact). Recommend requesting future MRA exams be done only on 3T MRI.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch)Clinical question: h/o pituitary adenoma; preop planningSigns and Symptoms: preop planning The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 29 x 21 mm axial dimension mass located within the sella eccentric towards the left side with the suprasellar extension and extension into the left cavernous sinus which abuts the optic chiasm and of the left internal carotid artery. It partially surrounds the left internal carotid artery. It does not appear substantially different than on the prior exam.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: This is a limited exam for the purpose of stereotactic guidance during surgery. There is a sellar and suprasellar mass present which presumably represents a pituitary adenoma. It abuts the adjacent optic chiasm.


Instruction: Generate impression based on findings.

Input: H/o renal cell carcinoma with known cerebellar metastasis. Examination demonstrates postoperative change of a left suboccipital craniotomy, including edema and trace amount of blood product at the surgical site. The mass in the left medial cerebellum identified on prior MRI has been resected. The one in the left lateral cerebellum is still present and appears hemorrhagic. It measures 1 x 1 cm. The cerebral hemispheres appear normal in attenuation and morphology. Supratentorially, there is no intracranial hemorrhage, or midline shift. The ventricles appear enlarged. A left frontal arachnoid cyst with remodeling of the adjacent frontal bone is noted. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Postoperative change of a left suboccipital craniotomy. 2. Left cerebellar hemorrhagic metastatic lesion. 3. Hydrocephalus. 4. Left frontal arachnoid cyst.


Instruction: Generate impression based on findings.

Input: Lumbago with sciatica, left side [M54.42], Reason for Study: ^Reason: hx of scoliosis. assess for nerve impingement History: pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal thoraco-lumbar scoliosis. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: mild disc dessication, no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: minimal diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Thoracolumbar scoliosis.2. Minimal dessication of L23 disc and minimal diffuse bulging of L45 disc, otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 29-year-old with history of Hodgkin's lymphoma status post chest radiation, high risk for breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A few scattered enhancing foci are present, none uniquely suspicious. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 35 years old, Female, Reason: thyroid nodules History: thyromegaly RIGHT LOBE MEASUREMENTS: 6.0 x 2.5 x 1.7 centimetersLEFT LOBE MEASUREMENTS: 5.7 x 2.7 x 2.3 cmISTHMUS MEASUREMENTS: 2.2 cmRIGHT LOBE: There are multiple nodules within the right thyroid lobe. The more superior of the nodules within the inferior pole of the right lobe has peripheral calcification, heterogeneous appearance and central vascularity and measures 0.9 x 1.0 x 0.9 cm. A more inferiorly located relatively homogeneous hypoechoic nodule displays vascularity and measures 0.8 x 0.7 x 0.6 cm.LEFT LOBE: A large left heterogeneous predominantly solid mass with somewhat irregular contours, a discontinuous hypoechoic rim, coarse calcification and central vascularity measures 2.4 x 2.2 x 2.1 cm. Another smaller more medial nodule also appears to have peripheral calcification and measures 0.8 x 0.8 x 0.8 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing right level 2 lymph node measures 0.7 x 0.6 x 0.3 cm. Benign appearing left level 2 lymph node measures 1.5 x 0.9 x 0.3 cm.

Output: 1.Right peripherally calcified nodule measuring up to 1 cm is amenable to biopsy.2.Dominant left thyroid lesion is indeterminate on ultrasound examination, please correlate with reported prior biopsy results.3.No evidence of suspicious lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 55-year-old male with left knee swelling. Evaluate for left knee meniscal tear. MENISCI: There is blunting/deformity and increased signal abnormality of the posterior horn of the medial meniscus which extends into the body of the meniscus consistent with the patient's known history of a meniscal tear. There is blunting and increased signal abnormality of the posterior horn of the lateral meniscus which extends to the tibial articular surface, consistent with a re-tear of the meniscus. ARTICULAR CARTILAGE AND BONE: There is fraying of the articular cartilage of the femoral trochlea as well as along the medial and lateral facets of the patella. There is near full-thickness articular cartilage degeneration along the medial femoral condyle. There is a small amount of bone marrow signal abnormality in the underlying area, likely degenerative. There is mild articular cartilage degeneration along the lateral femoral condyle. LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intactADDITIONAL

Output: 1. Tearing of the medial and lateral meniscus as described above.2. Articular cartilage degeneration as described above.3. Knee joint effusion.


Instruction: Generate impression based on findings.

Input: Female; 67 years old. Reason: History of ovarian CA on Gemcitubine presenting from OSH with acute liver failure and AKI, no known history of liver/renal disease. Please evaluate for obstruction and/or underlying biliary etiology. ABDOMEN: Lack of intravenous contrast limits sensitivity for solid organ pathology. Limited MRCP images due to large pleural effusions, and large amount of ascites, and body wall anasarcaLIVER, BILIARY TRACT: No focal liver lesions are apparent on T2 weighted images. No biliary ductal dilation. Status post cholecystectomy.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large pleural effusions, and large amount of ascites, and body wall anasarca.

Output: 1. No focal liver lesions or biliary ductal dilation.2. Large pleural effusions, and large amount of ascites, and body wall anasarca.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is increased signal within the distal fibers of the supraspinatus reflecting some tendinopathy and interstitial tearing however there is no evidence of a full-thickness tear of the supraspinatus or other rotator cuff tendons. The infraspinatus, teres minor, and subscapularis tendons are intact. There is no significant muscle atrophy.SUPRASPINATUS OUTLET: There is mild arthrosis of the acromioclavicular joint. A trace amount of fluid is noted within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. Increased signal noted within the anterior and superior labrum likely represents age related degeneration. The posterior labrum appears intact.BICEPS TENDON: The biceps tendon is intact within the intertubercular groove.ADDITIONAL

Output: Tendinosis with partial articular surface tearing of the supraspinatus tendon but there is no evidence of full-thickness rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 53-year-old woman with right medial knee pain MENISCI: There is a radial tear of the posterior horn-root junction of the medial meniscus with a small associated medial parameniscal cyst. There is no meniscal extrusion. There is mild undersurface fraying of the body of the medial meniscus. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is diffuse chondral thinning in the medial compartment. There is diffuse thinning of the medial facet articular cartilage of the patella, and full thickness cartilage loss of the medial trochlea with underlying degenerative cyst formation.There are nonspecific degenerative/cystic changes in the posterosuperior humeral head.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Radial tear of the posterior horn-root junction of the medial meniscus with an associated parameniscal cyst.


Instruction: Generate impression based on findings.

Input: Reason: eval for tendon injury, r/o foreign body History: dorsomedial foot pain, injury to plantar foot with question of retained glass Right foot: A marker was placed along the ball of the foot. Deep to the marker, we see no mass or focal abnormality suggestive of a foreign body. There is a small amount of fluid along the tendons just proximal to the knot of Henry, which is incompletely imaged and may represent a mild tenosynovitis but is of questionable clinical significance. Mild osteoarthritis affects the first MTP joint and there is a small amount of fluid within the joint. We see no marrow signal abnormalities to suggest a fracture. The remaining soft tissue structures appear normal.Left foot: A marker was placed along the ball of the foot. Deep to the marker, we see no mass or focal abnormality suggestive of a foreign body. There is a small amount of fluid along the tendons just proximal to the knot of Henry, which is incompletely imaged and may represent a mild tenosynovitis but is of questionable clinical significance. Mild osteoarthritis affects the first MTP joint and there is a small amount of fluid within the joint. We see no marrow signal abnormalities to suggest a fracture. The remaining soft tissue structures appear normal.

Output: 1. Mild osteoarthritis of the first MTP joints bilaterally.2. Small amount of fluid at the knot of Henry bilaterally may represent a mild tenosynovitis but is of questionable clinical significance.3. We see no findings to confirm a retained foreign body. If further imaging evaluation is clinically warranted, targeted ultrasound may be considered.


Instruction: Generate impression based on findings.

Input: History of pseudoseizures, seizures, presents with right arm and leg weakness. Severely motion limited exam with a limited number of sequences available as described in the technique section. Within these limitations there is no evidence of acute intracranial hemorrhage. There is no T2/FLAIR signal abnormality to indicate acute pathology. Assessment for acute ischemia is not possible in the absence of diffusion weighted images. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Only a few sequences are available secondary to the patient undergoing cardiac arrest. Within these limitations, there is no gross evidence of acute intracranial hemorrhage or abnormalities as might be detected by T2/Flair sequences.


Instruction: Generate impression based on findings.

Input: Achilles tendinopathy and ankle pain TENDONS: There is increased intrasubstance signal and thickening of the Achilles tendon particularly its insertion upon the calcaneus. Small areas of near fluid signal intensity are seen as well suggesting some intrasubstance tearing superimposed upon diffuse tendinopathy. There is no evidence of full-thickness tear. Abnormal increased signal and thickening also affects the peroneus brevis tendon suggesting tendinopathy with probable split tearing. The remaining flexor and extensor tendons are intact.LIGAMENTS: The anterior tibiofibular ligament is poorly delineated which may be the result of chronic or remote tearing. The anterior and posterior talofibular ligaments are intact.ARTICULAR SURFACES AND BONE: Mild osteoarthritis affects the midfoot. The ankle mortise is intact.ADDITIONAL

Output: 1. Partial tearing and tendinopathy of the Achilles tendon upon its insertion on the calcaneus.2. Tendinopathy and split tearing of the peroneus brevis tendon.


Instruction: Generate impression based on findings.

Input: 81-year-old male who was found to have 8 cm hepatic dome lesion on AAA surveillance examination. Evaluate hepatic lesion. ABDOMEN:LIVER, BILIARY TRACT: There is a T1 hypointense, T2 heterogeneous isointense/hyperintense segment 7 and 8 hepatic lesion measuring approximately 11 x 8.3 cm (series 6, image 7) with satellite lesions. This lesion demonstrates heterogeneous delayed peripheral enhancement without evidence of washout. Mild dilatation of the intrahepatic biliary ducts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst. RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm at the level of the bifurcation with evidence of graft material; the aneurysmal sac measuring up to 4.1 cm in dimension (series 3, image 17). Mildly prominent aortocaval lymph nodes. Additionally, there is a enlarged portacaval lymph node measuring 2.3 x 1.3 cm (series 6, image 19).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Segment 7 and 8 hepatic lesion with satellite nodules and associated mild biliary ductal dilatation as detailed above. Findings suspicious for cholangiocarcinoma.2.Prominent portacaval lymph node.3.Partially seen abdominal aortic aneurysm at the level of the bifurcation with the sac measuring up to 4.1 cm in dimension. Comparison to outside CT examination may be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The degree of myelination is normal for corrected age. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits. There is no evidence of structural abnormality.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of bone, soft tissue, and skin [D49.2], Reason for Study: ^Reason: s/p resection of L1-2 tumor History: postop Post left L1 hemilaminectomy with L1-L2 external fixations using screws and rod. In addition, the left posterior inferior aspect of the L1 vertebral body shows partial resection status with ovoid signal voids (series 601, image 37) likely indicating postoperative changes such as blood products, Gelfoam or metal fragments. Follow up imaging can be considered. There is no evidence of abnormal enhancement.In particular previously seen abnormal enhancing left L1-2 neuroforaminal lesion is not seen on today's scan.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation except minimal disc dessication of L5S1.

Output: 1. Complete resection of previously seen left L1-L2 neuroforaminal enhancing mass with postoperative changes.2. No evidence of residual lesion on this scan.3. Ovoid signal void lesion on the left posterior inferior aspect of the L1 vertebral body likely represent postoperative changes. Follow up imaging can be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: Pain in shoulder with movement. Rotator cuff tear? ROTATOR CUFF: The supraspinatus tendon and muscle appear normal. There is a small (2-3mm) focus of intermediate signal intensity within the articular surface fibers of the infraspinatus tendon at its insertion on the greater tuberosity that may represent focal tendinosis, a small ganglion/cyst or perhaps a small undersurface tear, and is associated with a tiny cyst in the underlying greater tuberosity. This signal abnormality involves less than 50% of the tendon thickness and is of questionable clinical significance. The infraspinatus muscle appears normal. The teres minor tendon and muscle appear normal. The subscapularis tendon and muscle appear normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. I see no fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. I see no effusion. Given the limitations of a non-arthrogram study, the glenoid labrum appears normal.BICEPS TENDON: The tendon to the long head of the biceps appears slightly attenuated, but otherwise normal given the limitations of a nonenhanced study. ADDITIONAL

Output: 1.2 to 3 mm rounded focus of increased signal intensity within the distal fibers of infraspinatus tendon at its insertion on the greater tuberosity may represent focal tendinosis, a small ganglion/cyst, or perhaps a tiny undersurface tear. Its clinical significance is uncertain, and the remainder of the rotator cuff is unremarkable.2.Mild osteoarthritis of the acromioclavicular joint and other findings as described above.


Instruction: Generate impression based on findings.

Input: 51 year old man with history of inferior STEMI s/p PCI to RCA and LAD chronic total occlusion, referred for CMR for evaluation of LV function and underlying scar. Left VentricleThe left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 141 ml/m2 (normal range: 74+/-15), the LVEDV is 260 ml (normal range 142+/-34), the LV end systolic volume index is 88 ml/m2 (normal range 25+/-9), the LVESV is 162 ml (normal range 47+/-19), the LV mass index is 71 g/m2 (normal range 85+/-15), and the LV mass is 130 g (normal range 164+/-36). There is hypokinesis of the basal inferior/inferolateral walls and akinesis with associated myocardial thinning of the mid through apical inferior/inferolateral walls. There is apical akinesis. There is late gadolinium enhancement that is transmural in the apex and the mid through apical inferior/inferolateral walls. This is consistent with transmural infarction and this area is not likely to be viable. There is another area of subendocardial late gadolinium enhancement of the basal inferior/inferolateral walls and the mid anterior/anteroseptal walls. These areas are consistent with prior myocardial infarction and occupy about 50% of the myocardium thickness, indicating an intermediate probability of viability. The remainder of the myocardium appears viable. There is no LV thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 159 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with moderately reduced systolic function. The overall LV ejection fraction is 38%.2. There is hypo/akinesis of the inferior/inferolateral walls with apical akinesis. 3. There is transmural late gadolinium enhancement in the inferior/inferolateral walls and apex that is consistent with prior myocardial infarction. This area is not likely to be viable. There is another area of subendocardial late gadolinium enhancement of the basal inferior/inferolateral walls and the mid anterior/anteroseptal walls that have an intermediate probability of viability. The remainder of the myocardium appears viable.4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 16-year-old male with a cystic astrocytoma There is an 11 x 23 mm axial dimension nonenhancing mass located at the medial aspect of the right temporal lobe which is homogeneously high signal on T2 and homogeneously low signal on T1. It previously measured 12 x 23 mm. It displaces the right posterior communicating artery medially, protrudes into the suprasellar cistern along its posterior aspect, is within a millimeter of the infundibulum of the pituitary gland, impresses upon the right cerebral peduncle, and also displaces the basal vein of Rosenthal superiorly. 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. Subtle changes from previous right frontal approach biopsy are again noted. Ventricular sizes are stable without dilatation or hydrocephalus. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Minimal decrease in size of a nonenhancing right medial temporal lobe mass.


Instruction: Generate impression based on findings.

Input: Lung cancer to brain s/p SRS to the left cerebellum. There is unchanged susceptibility effect in the left cerebellar hemisphere without associated enhancement. Nonspecific punctate foci of susceptibility weighted image signal loss in the periventricular white matter are also unchanged. There is no evidence of intracranial hemorrhage or acute infarct. There are mild scattered nonspecific foci of non-enhancing T2 hyperintensity in the cerebral white matter. There is a tiny focus of encephalomalacia in the right cerebellar hemisphere. 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 fluid or mucosal thickening within the right mastoid air cells. There is fluid and mucosal thickening in the right maxillary sinus.

Output: 1. Stable treated left cerebellar hemisphere metastases, without evidence of new intracranial metastases.2. Findings suggestive of acute right maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: Abdominal pain. Pancreatic ductal dilatation on recent CT. ABDOMEN:LUNG BASES: Minimal pleural effusions.LIVER, BILIARY TRACT: Normal liver morphology without focal suspicious lesion or vascular abnormality. The patient is status post cholecystectomy. The common bile duct measures 11 mm, increased and may be secondary to prior cholecystectomy or ampullary stenosis. It tapers smoothly to the ampulla without a discrete mass or gallstone. There is mild left intrahepatic biliary ductal dilatation without a discrete mass evident.SPLEEN: Minimal perisplenic fluid. The splenic vein is chronically occluded with perisplenic collateral vessels.PANCREAS: The distal pancreatic body and tail is decreased in T1 weighted signal and is slightly hypoenhancing relative to the remainder of the kidney compatible with parenchymal dysfunction. The pancreatic duct at this level is irregularly dilated, findings compatible with chronic pancreatitis, as seen on recent CT. There is pancreatic divisum.There is no significant peripancreatic inflammatory changes or fluid collection. The splenic vein is chronically occluded with perisplenic collateral vessels. No additional arterial or venous complication.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Single right and left subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis. Normal bowel caliber. Redundant folding in the proximal duodenum versus a duodenal diverticulum. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid.

Output: 1.Findings of chronic pancreatitis with possible mild superimposed acute pancreatitis. Chronic splenic vein occlusion with collateral vessels. No evidence of pancreatic parenchymal necrosis, fluid collections or additional vascular complication.2.The common bile duct measures 11 mm, increased and may be secondary to prior cholecystectomy or ampullary stenosis. It tapers smoothly to the ampulla without a discrete mass or gallstone.3.Pancreatic divisum.


Instruction: Generate impression based on findings.

Input: Female 52 years old Reason: assess patient prior to surgery History: large recto-sigmoid colon mass UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right external iliac enlarged lymph node measuring 12 x 8 mm image #33, series #80295.BOWEL, MESENTERY: There is diffuse wall thickening of the rectum which may be compatible with patient's known history of rectal cancer. There is a 3 x 2.2 cm hypodense lesion posterior lateral to the rectum on the right side, best seen on image #40, series #80295. This lesion abuts the presacral space and may be communicating with the vagina. This lesion may represent an abscess. MRI may be more helpful for better delineation the lesion and its characterization.Right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Rectal wall thickening compatible with patient's known history of rectal cancer. Possible abscess with fistulous communication to the vagina. MR may be helpful for further evaluation of this lesion.Right pelvic adenopathy.


Instruction: Generate impression based on findings.

Input: 62 year od man referred for evaluation of infiltrative disease. Left VentricleThe left ventricle is severely hypertrophied and dilated with severely reduced systolic function. The IVSd=17mm. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 182 ml/m2 (normal range: 74+/-15), the LVEDV is 393 ml (normal range 142+/-34), the LV end systolic volume index is 129 ml/m2 (normal range 25+/-9), the LVESV is 278 ml (normal range 47+/-19), the LV mass index is 155 g/m2 (normal range 85+/-15), and the LV mass is 335 g (normal range 164+/-36). There is global hypokinesis which is most pronounced along the basal to mid inferior wall. The native myocardial T1 relaxation time is moderate to severely elevated along the basal anterior, mid anterior and anteroseptal, and apical anterior, septal, and lateral walls. No evidence of myocardial iron overload. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 29%, the RV end diastolic volume index is 197 ml/m2 (normal range 82+/-16), the RVEDV is 426 ml (normal range 142+/-31), the RV end systolic volume index is 140 ml/m2 (normal range 31+/-9), and the RVESV is 302 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. A catheter is noted in the SVC.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is significant thyromegaly. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LVH with severe LV dilation and severely reduced systolic function (LVEF 29%). 2. The native myocardial T1 relaxation time is moderate to severely elevated, which supports the presence of significant myocardial fibrosis or infiltration. 3. Severe RV dilation with severely reduced systolic function (RVEF 29%).4. Severe biatrial dilation.5. Mild to moderate mitral and tricuspid regurgitation.6. Moderate dilation of main pulmonary artery.7. Small pericardial effusion.8. Significant thyroid enlargement. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chiari malformation. Brain: There are postoperative findings related to Chiari decompression with an unchanged extradural fluid collection at the surgical bed, measuring up to 6 mm in thickness. There is mild deformity of the posterior inferior cerebellum and medulla associated with what appear to be linear hypointense band that extend to the overlying dura. There is CSF flow across the anterior foramen magnum, but cerebrospinal fluid flow appears to be relatively deficient posteriorly. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Cervical Spine: There are postoperative findings related to Chiari decompression. There is no evidence of syringohydromyelia. However, there area a few punctate foci of susceptibility effect in the spinal cord at the C2 and C3 levels, which may represent chronic blood products. The vertebral body heights are preserved. There is no significant spinal canal or neural foraminal stenosis. The vertebral bone marrow signal is unremarkable. The vertebral column alignment is unchanged with mild retroflexion of the dens and lack of the usual lordosis. There appears to be a left thyroid nodule.

Output: 1. Postoperative findings related to Chiari decompression with a persistent small pseudomeningocele and mild deformity of the posterior inferior cerebellum and medulla that may be related to adhesion formation2. Apparent punctate chronic blood products in the spinal cord at the C2 and C3 levels, but no evidence of syringohydromyelia.3. Apparent left thyroid nodule, which is incompletely characterized. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 51-year-old female with left shoulder pain, evaluate for left shoulder rotator cuff or labral tear ROTATOR CUFF: There is a small amount of gadolinium entering the distal fibers of the supraspinatus tendon indicating a poorly defined undersurface tear that extends longitudinally for approximately 8 mm within the articular surface fibers of the tendon and with additional extension towards the bursal surface fibers, but without disruption of the most superficial fibers. No full thickness tear identified. The remainder of the supraspinatus tendon and muscle appears normal.The infraspinatus tendon is intact. There is minimal fatty infiltration along the myotendinous junction but otherwise the muscle appears normal.The teres minor tendon and muscle are intact.The subscapularis tendon and muscle are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the AC joint. Trace fluid in the subacromial bursa is of doubtful clinical significance, and no gadolinium is seen within the bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The entire anterior labrum is separated from the glenoid indicating a Bankart lesion; the anterior aspect of the glenoid appears abnormally flattened suggesting a Bankart fracture that would be better evaluated with CT if clinically warranted. There is globular increased signal intensity of the superior labrum indicating degeneration and tearing that extends into the posterior labrum to approximately the 9 to 10 o'clock position. There is also a Hill-Sachs defect.BICEPS TENDON: There is increased signal intensity within the tendon of the long head of the biceps likely representing tendinosis or perhaps iatrogenic injection of gadolinium into the tendon during the procedure.

Output: 1. Bankart fracture and labral tears as described above as well as Hill-Sachs deformity.2. Small partial thickness tear of the supraspinatus tendon as described above.3. Mild osteoarthritis of the acromioclavicular joint and other findings as described above.


Instruction: Generate impression based on findings.

Input: 76-year-old male with known liver lesions. Follow-up for interval change. ABDOMEN:LIVER, BILIARY TRACT: 6.9 x 6.1 cm heterogeneous, enhancing mass with restricted diffusion in the right hepatic lobe (series 1003/54), unchanged in size since prior CT when it measured 6.9 x 6.1 cm and again most compatible with metastasis. 1.4 x 1.6 cm heterogeneous, enhancing mass with restricted diffusion in the right hepatic lobe adjacent to the above-described mass (series 100 3/41), unchanged in size since prior CT when it measured 1.4 x 1.6 cm and again most compatible with metastasis.A smaller T2 hyperintense lesion with peripheral enhancement with filling in on delayed phased images and without restricted diffusion in the right hepatic lobe is most compatible with a hemangioma (series 1003/66), not significantly changed in size since prior study.No biliary ductal dilation. Main portal vein and its branches are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cyst.RETROPERITONEUM, LYMPH NODES: Stable subcentimeter retroperitoneal lymph nodes, which are not pathologically enlarged by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially visualized cystic lesion near the right L5-S1 neuroforamen, most likely a Tarlov cyst.OTHER: Mild left basilar subsegmental atelectasis, similar to prior study. Trace left pleural effusion.

Output: Stable large right hepatic lesion with adjacent smaller satellite lesion, most likely representing metastases.


Instruction: Generate impression based on findings.

Input: 18-year-old female with left knee pain history of left ACL reconstruction, lateral meniscal repair and partial medial meniscectomy. Evaluate for failed ACL reconstruction. MENISCI: Note is made of branching linear increased signal abnormality traversing the posterior horn of the lateral meniscus which extends to the femoral and tibial articular surface which fills with intra articular gadolinium, consistent with a complex tear. Additionally, there is a horizontal component which fills with intra-articular gadolinium which extends into the body of the meniscus also consistent with re-tearing. The anterior horn appears intact. No gadolinium filled defects are identified within the medial meniscus to suggest a re-tear. There is deformity and increased signal abnormality within the body as well as the posterior horn of the medial meniscus near its root which extends to the tibial and femoral articular surfaces, which may represent post-surgical changes from prior meniscectomy versus prior tearing of the meniscus, appearing similar to the prior study.ARTICULAR CARTILAGE AND BONE: Note is made of osseous tunnels within the distal femur and proximal tibia consistent with prior ACL graft repair. Note is made of trace bone marrow edema type signal abnormality within the posterior aspect of the lateral tibial plateau which may represent a contusion.LIGAMENTS: There is complete rupture of the ACL graft. The PCL is buckled but appears intact. The medial and lateral collateral ligament appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Findings consistent with rupture of the ACL graft.2. Findings consistent with a complex re-tear of the posterior horn of the lateral meniscus.3. Findings consistent with postsurgical changes of prior medial meniscectomy, without evidence of a gadolinium-filled defect to confirm a re-tear.4. Bone marrow edema within the posterior aspect of the lateral tibial plateau consistent with a contusion.


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: stroke History: R weakness Brain MRIScattered restricted diffusion especially along the periventricular white matter on the left lateral ventricle indicating acute/subacute ischemic infarction.Since there is no Gradient Echo images, precise evaluation of acute hemorrhagic lesion or hemorrhagic conversion of those acute/subacute ischemic lesion is not possible.Patchy confluent high signal intensities on bilateral periventricular white matter on T2/FLAIR indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Acute/Subacute ischemic infarctions on the left periventricular white matter as described above.Underlying non specific small vessel ischemic disease.Brain MRA and neck MRA were not obtained due to patient's condition.


Instruction: Generate impression based on findings.

Input: Reason: Hx of relapsed Ewings in past, now with T10 vertebral body lesion History: above Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. following biopsy no hmatoma or complication was identified.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Dizziness and giddinessClinical question: repeated episodes of vertigo may have been caused by posterior circulation compromise MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There are several subcortical and periventricular white matter lesions which are hyperintense on T2 and FLAIR MR imaging. Given their small number there are of little clinical significance.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The left vertebral artery is smaller than the right vertebral artery. There is extracranial origin of the right posterior inferior cerebellar artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. There likely of little clinical significance given their small number. Several subcortical and periventricular white matter lesions are frequently seen in this age group.4.A small left vertebral artery is present intracranially. This could be variation of normal.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for rotator cuff tear and assess degree of arthritis History: Left shoulder pain after injury. ROTATOR CUFF: Increased signal intensity within the anterior fibers of the supraspinatus tendon compatible with tendinosis. Small foci of intermediate signal intensity along the articular and bursal surfaces of the supraspinatus tendon are compatible with fraying/superficial tearing. There is also a focus of intermediate signal intensity within the distal fibers of the supraspinatus tendon at its insertion which may represent a small concealed interstitial tear. We see no full-thickness supraspinatus tendon tear. The supraspinatus muscle is within normal limits for age. Undersurface fraying of the supraspinatus tendon extends into the anterior fibers of the infraspinatus tendon but we see no full-thickness infraspinatus tendon tear. There is perhaps mild fatty atrophy of the infraspinatus muscle. The teres minor muscle and tendon are intact. Streaky foci of increased signal intensity within the distal fibers of the subscapularis tendon likely representing a combination of tendinosis and interstitial tearing. There is mild fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the AC joint. Mild increased signal intensity within the subacromial/subdeltoid bursa on the fluid sensitive sequences as well as a small amount of fluid signal intensity may reflect mild bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. There is a small joint effusion. Mild osteoarthritis affects the glenohumeral joint. Intermediate signal intensity between the superior labrum and underlying glenoid is suggestive of a tear. Mild degeneration of the inferior labrum.BICEPS TENDON: At least a partial-thickness longitudinal tear of the tendon of the long head of the biceps at its transition from the intertubercular groove to the rotator interval. Distal to the biceps tendon tear, the biceps tendon is thickened suggestive of tendinosis. Fluid signal intensity surrounding the biceps tendon may reflect tenosynovitis. There is perching of the tendon upon the lesser tuberosity suggesting a pulley lesion. Edema within the lesser tuberosity likely is reactive in etiology.

Output: 1.Tear of the long head of the biceps tendon.2.Tendinosis and partial-thickness tearing of the rotator cuff as described above with no discrete full thickness rotator cuff tear.3.Additional degenerative arthritic changes as described above.


Instruction: Generate impression based on findings.

Input: History of dizzy spells with vertigo on and off since December 2009.. CT of brain without infusion:No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected.There is a slight prominence of the superior cerebellar cistern with a questionable mass effect on the superior aspect of vermis. Although this may be entirely within normal range however I cannot entirely exclude possibly of a cyst in this location. Images through the rest of posterior fossa are entirely within normal limits.Cortical sulci, ventricular system and all other CSF cisterns remain within normal limits. Considering the extent of patient's symptoms further follow-up with an MRI is recommended in particular to exclude possibly to a cyst in the superior cerebellar cistern.

Output: 1.Questionable cyst in the superior cerebellar cistern as detailed.2.Unremarkable CT examination of brain otherwise.3.Considering patient's clinical symptoms follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: 71 years Male (DOB:5/3/1945)Reason: preop eval for decompression. Evaluate stenosis History: back pain leg painPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is a right paramedian disc extrusion present which abuts the nerve root at the right lateral recess which is new since the 12/24/2013 exam.. Some disc material extends behind the inferior endplate of L5. There is loss of disc space height, disc desiccation and a disc bulge at this level. There is bilateral facet and ligamentum flavum hypertrophy at this level. The facet hypertrophy is worse on the left versus the right side. There are some encroachment of the nerve root at the left lateral recess at this level. There is narrowing of the neural foramina bilaterally at this level with some mild encroachment of the right-sided exiting nerve root foramen. There is some epidural lipomatosis at this level with effacement of the thecal sac.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with bilateral facet and ligamentum flavum hypertrophy. There is crowding of the nerve roots within the thecal sac at this level. There is effacement of fat at the lateral recesses and surrounding the thecal sac. Overall there is a moderate degree of spinal stenosis present which is stable compared to the prior exam.. Behind the L4 vertebral body there is epidural lipomatosis associated with crowding of nerve roots. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. There is a Schmorl's this level.At L3-4 there is loss of disc space height, disc desiccation and a disc bulge associated with some ligamentum flavum hypertrophy and partial effacement of fat at the lateral recesses bilaterally which was also present on the prior exam and has not changed significantly. There are Schmorl's nodes at this level. Overall there is mild to moderate spinal stenosis at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L2-3 there is loss of disc space height, disc desiccation and a disc bulge associated with Schmorl's nodes. A disc bulge has mildly progressed since the prior exam There is some ligamentum flavum hypertrophy at this level and some crowding of the nerve roots within the thecal sac. There is thickening of the right ligamentum flavum associated with it T2 signal hyperintense focus which was not present on the prior exam. Overall there is mild to moderate spinal stenosis at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation at this level.It appears that a bowel loop probably duodenum abuts the right renal pelvis.

Output: 1.There is epidural lipomatosis present in the lower lumbar spine from L4 down to S1. This results in spinal stenosis. It was also present on the prior MRI exam2.There is a moderate degree of spinal stenosis present at L4-5 related to degenerative changes. This was also present on the prior exam and has not changed substantially.3.There is a new right paramedian disc extrusion present which abuts the nerve root at the right lateral recess at L5-S1.4.There is encroachment of the nerve roots of the left lateral recess at L5-S1 due to facet hypertrophy and disc disease.5.There is mild to moderate spinal stenosis present at L3-4 and L2-3. At the L2-3 level there is some mild progression related to a ligamentum flavum cyst and a disc bulge.


Instruction: Generate impression based on findings.

Input: Nonenhanced cervical MRI:Examination demonstrates normal signal intensity and anatomical alignment of the vertebral column. There is no detectable signal abnormality of the bony structures overlying the soft tissues of the neck to suggest traumatic or inflammatory changes. There is no appreciable degenerative changes of the cervical spine and no detectable spinal canal compromise or stenosis and widely patent neural foramina bilaterally. Unremarkable paraspinal soft tissues. Unremarkable images at the level of the skull base and craniocervical articulation.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord to T3 level. The signal void of bilateral vertebral arteries are identified and without detectable abnormality on this nondedicated study.Incidental note is made of a retention cyst in the sphenoid sinus.

Output: Negative nonenhanced cervical MRI.