Instruction: Generate impression based on findings.

Input: Generalized weakness. Evaluate for stroke. Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. There is heterogeneous low T1 marrow signal involving the calvarium is nonspecific. No destructive osseous lesions are seen.Cervical Spine:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is reversal of normal cervical lordosis with apex at the C5-C6 level which may be in part positional. Alignment is otherwise maintained. There is mild diffuse low T1 marrow signal as well as degenerative endplate signal changes C5-C6. There is nonspecific 7-mm focus of T2 hyperintensity involving the C7 vertebral body. No destructive osseous lesions.The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Small disk osteophyte complex with effacement of the ventral thecal sac greater on the left. There is mild stenosis. No significant compromise to the spinal canal or neural foramina.C6-7: Small disk osteophyte complex with partial effacement of the ventral thecal sac. No significant compromise to the spinal canal or neural foramina.C7-T1: Small disk osteophyte complex with partial effacement of the ventral thecal sac. Minimal left neural foramina narrowing otherwise no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Endotracheal tube and enteric tube noted.

Output: 1. No evidence of acute ischemia or intracranial mass effect.2. Minimal chronic small vessel ischemic changes. MRI the brain is otherwise unremarkable for age.3. Mild degenerative changes in the cervical spine. There is mild spinal canal narrowing at C5-6 on the left. Otherwise no significant spinal canal or neural foramina stenosis in the cervical spine. No abnormal cord signal or evidence of cord compression.4. Nonspecific diffuse low T1 marrow signal which is nonspecific but can be seen in conditions such as chronic anemia.5. Subcentimeter T2 hyperintense lesion at the C7 vertebral body is nonspecific. Possibilities include an atypical hemangioma as well as other etiologies; follow-up CT or MRI can be considered as clinically appropriate.


Instruction: Generate impression based on findings.

Input: 9-year-old male with history of epidural lipomatosis, status post T3 to T8 laminotomy with upper extremity weakness, evaluate for swelling of spinal cord. Redemonstrated is increased T2 signal intensity within the cord extending from C5 inferiorly through the entire thoracic cord and reaching the conus. This is associated with progressive enhancement, with a ring enhancing pattern involving the cervical component. There has interval diminution of the central canal beginning at the approximate T3 level and extending inferiorly through T10. This is worse at C6/7 where the central canal now measures 3 x 2 mm in transaxial dimension. Redemonstrated are postoperative changes of multi-level laminotomy with epidural enhancement at the surgical site as well as enhancement of posterior soft tissues.

Output: 1.Redemonstrated is increased T2 signal intensity within the cord extending from C5 inferiorly through the entire thoracic cord and reaching the conus. This is associated with progressive enhancement, with a ring enhancing pattern involving the cervical component.2.There has interval diminution of the central canal beginning at the approximate T3 level and extending inferiorly through T10. This is worse at C6/7 where the central canal now measures 3 x 2 mm in transaxial dimension. It is uncertain if this represents compression upon the thecal sac by epidural components, progressive atrophy of the cord with loss of volume, or a combination thereof.3.Findings were discussed with Dr. Ramos on 4/27/2015 at approximately 4:00 PM.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right wrist was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 4 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 40 seconds

Output: Successful fluoroscopic guided right wrist arthrogram.


Instruction: Generate impression based on findings.

Input: Male, 24 years old, with left cerebellar lesion, follow up exam. Redemonstrated is a T1 iso-intense, mildly T2 hyper-intense lesion within the left upper cerebellum just off midline. The lesion measures up to 20 mm in maximal diameter, and has not significantly changed from the prior exam in size. The inferior margin of the lesion is sharply defined and very distinct from the normal cerebellar parenchyma. The superior margin is less well defined and seems to blend with the cerebellar folia which are slightly distorted as a result. No restricted diffusion or significant susceptibility is evident within the lesion. A 6 mm focus of enhancement internal to the lesion is similar in size to that seen previously. Elevated rCBV and rCBF are seen correlating with the enhancing nodule, but not with the remainder of the lesion. Single and multi-voxel spectroscopy of the lesion demonstrate a marked elevation of choline and marked reduction of NAA within the lesion with an abrupt return to a normal pattern beyond the lesion margins.The lesion induces no edema in the surrounding parenchyma, and only minimal mass effect is evident in the form of a slight indentation of the 4th ventricular margin. The brain parenchyma is otherwise normal. No additional areas of signal abnormality are seen. No other pathologic parenchymal or extra-axial enhancement is seen. Incidental developmental venous anomalies are present in the right parietal and left frontal lobes. No abnormal collections are seen and there is no evidence of acute intracranial hemorrhage. The ventricular system is otherwise normal in size and morphology. Bone marrow signal characteristics are normal. Mucosal thickening is seen in the right maxillary sinus.

Output: Since the prior exam, there has been no significant change in the size or morphology of a lesion in the left upper cerebellum. A focus of enhancement internal to the lesion is also unchanged. This enhancing nodule corresponds to elevated rCBV and rCBF, but the remainder of the lesion does not. Spectroscopic assessment of the lesion reveals a marked elevation of choline and reduction of NAA. While some morphologic features of this lesion are suggestive of a dysplastic gangliocytoma (Lhermitte-Duclos), the marked reversal of choline and NAA argues against this diagnosis (most references, in fact, quote a reduction of choline in Lhermitte-Duclos). Perfusion data are also somewhat at odds with this diagnosis as the entire lesion would most typically show elevations of rCBF and rCBV.Given these findings, the possibility of a neoplastic process is considered more likely. Assuming that metastasis has been excluded, the statistically most likely primary tumor to be found in the cerebellum in this age group would be a hemangioblastoma. Other lower grade neoplasms can also be considered. However, the spectroscopic result suggests the possibility of a higher grade neoplasm. In particular, the desmoplastic variant of medulloblastoma can have a similar appearance. Higher grade astrocytoma is also a reasonable consideration.


Instruction: Generate impression based on findings.

Input: Slurred speech, dizziness, concern for TIA There is no evidence of intracranial hemorrhage, mass or edema. 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: Drug resistant temporal lobe epilepsy treated with laser ablation of the left mesial temporal lobe 12/2015. There are expected findings related to left medial temporal lobe laser ablation. There is no gross evidence of other intracranial abnormalities. The ventricles are unchanged is size.

Output: Expected postoperative findings related to left medial temporal laser ablation.


Instruction: Generate impression based on findings.

Input: Left arm pain, rule out cervical spine process Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained with mild straightening which may be positional. Bone marrow signal is benign without focal suspicious osseous lesions. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina. Mild left and minimal right neural foraminal stenosis.C5-6: No significant compromise to the spinal canal. Minimal bilateral neural foraminal stenosis.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.Mild diffuse facet arthropathy. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Very mild degenerative changes in the cervical spine as detailed above. There is no high-grade spinal canal or neural foraminal stenosis at any level. Minimal to mild neural foraminal stenosis is seen at C4-C5 and C5-C6.


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB:11/21/1975)Reason: severe back and leg pain please evaluate for lumbar radiculitis History: back and leg painPROVIDER/ATTENDING NAME: MAGDALENA ANITESCU MAGDALENA ANITESCU 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. A perineural cyst is present within the sacral spinal canal on the right side.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height this desiccation and a broad-based right paramedian disc protrusion at this level. There is mild ligamentum flavum hypertrophy at this level. This is stable compared to the prior exam.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a broad-based central disc protrusion at this level. This is stable compared to the prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in the lumbar spine mainly in the form of disc disease with disc protrusions at L4-5 and L5-S1 without significant compromise to spinal canal or neural foramina.2.A small perineural cyst is present in the sacral spinal canal on the right side.


Instruction: Generate impression based on findings.

Input: Female 50 years old Reason: evaluate for lateral meniscal tear History: knee pain playing sports and history of prior partial menisectomy. MENISCI: There is attenuation and blunting of the anterior horn and body of the lateral meniscus consistent with stated history of prior partial meniscectomy. There is slight lateral extrusion of the body of the lateral meniscus. There is intrasubstance signal in the body and anterior horn which likely represents degeneration. Within the anterior horn this signal extends to the tibial articular surface but appears similar to before and may not be of clinical significance. We see no fluid signal intensity within the meniscus or other findings to suggest an unstable meniscal tear.The medial meniscus is of normal signal intensity and morphology.ARTICULAR CARTILAGE AND BONE: There is abnormal signal intensity within the weight-bearing aspect of the lateral femoral condyle likely representing a combination of degenerative cyst formation and post microfracture changes. The overlying cartilage is thinned and heterogeneous indicating moderate degeneration with what appears to be a full thickness or near full thickness cleft, best seen on coronal T2 weighted sequence. Overall the articular cartilage appears similar to prior study. Edema within the lateral femoral condyle seen on prior study has largely resolved. There is edema in the posterior aspect of the medial femoral condyle which is new but nonspecific. The overlying cartilage appears intact.There is mild heterogeneity of the articular cartilage of the patella indicating mild degeneration but we see no fluid-filled defects. There is a small partial thickness defect centrally and superiorly within the cartilage of the femoral trochlea.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Lateral meniscus abnormalities as described above are favored to be post operative in etiology. We see no findings to suggest unstable lateral meniscal tear.2. Cartilage degeneration, loose bodies and other findings as described above.


Instruction: Generate impression based on findings.

Input: 36-year-old male with history of back pain. Evaluate for psoas abscess. Limited study due to patient motion.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: There is air within the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No evidence of psoas abscess in the pelvis.The bone marrow is diffusely abnormal which may be secondary to leukemia.OTHER: Anasarca

Output: 1. Limited study, however no evidence of psoas abscess in the pelvis as clinically queried.2. Diffusely abnormal bone marrow likely secondary to leukemia.


Instruction: Generate impression based on findings.

Input: Clinical question: NSCLC; new lesions throughout spine. Signs and Symptoms: NSCLC; new lesions throughout spine Pre and post enhanced thoracic MRI:Examination demonstrates diffuse intraosseous enhancing metastatic lesions of the thoracic spine primarily involving vertebral bodies and to a lesser degree of the posterior elements. There is no evidence of fracture or malalignment.There is no detectable extraosseous spread of tumor into the spinal canal or neural foraminal and no evidence of spinal canal or neural foraminal compromise at any level.There is no detectable signal abnormality of the cord or abnormal enhancement.Incidental note is made of right-sided pleural effusion measuring maximum of 14 mm in thickness.Pre and post enhancement lumbar MRI:This examination also demonstrate fairly extensive enhancing osseous metastatic lesions involving nearly all visualized bony structures of the region of the exam.There is no evidence of fracture or malalignment. There is a large Schmorl's node along the superior endplate of L2.There is no evidence of extraosseous spread of tumor into the spinal canal/epidural space or the neural foramina.Normal signal intensity of the lower most visualized thoracic cord, conus and cauda equina without detectable abnormal enhancement.

Output: 1.Examination of thoracic spine demonstrate diffuse enhancing osseous metastatic lesions without detectable extraosseous spread of tumor. No fracture or malalignment. No spinal stenosis or neural foraminal compromise. Normal signal intensity and caliber of thoracic cord and without abnormal enhancement.2.Examination of the lumbosacral spine demonstrate diffuse enhancing osseous metastatic lesions without evidence of fracture or malalignment or extraosseous spread of tumor. Normal signal intensity of conus and cauda equina without abnormal enhancement. No spinal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Right anterior superior iliac spine and groin pain. Evaluate for lesion or pathologic fracture. Evaluation of the lower lumbar spine and sacrum and adjacent soft tissues is limited by metallic artifact related to posterior fixation hardware.PELVIS:The right anterior superior iliac spine and its tendinous attachments appears normal.There are mild osteoarthritic changes of both hips.There is mild peritrochanteric edema and enhancement bilaterally which is not necessarily of any clinical significance.Although this study was not protocoled for detailed evaluation of the labrum, there is a tiny collection of fluid signal intensity adjacent to the right posterosuperior labrum with intra-osseous extension; these findings suggest an underlying labral tear.There are multiple foci of metallic susceptibility artifact within the soft tissues of the right groin suggesting prior surgery. In the same vicinity there are 2 adjacent collections of abnormal signal intensity medial to the femoral vessels and anterior to the superior pubic ramus measuring approximately 3 cm in greatest dimension. They are isointense to muscle on T1-weighted images, heterogenously isointense-to-hyperintense to muscle on T2-weighted images, and show mild enhancement following contrast administration. We suspect these represents postoperative changes related to a possible hernia repair but correlation with the patient's surgical history is recommended as we cannot exclude the possibility of a mass in this location.

Output: 1.Postoperative changes of the right groin region may reflect prior hernia repair. A collection of abnormal signal intensity in the right groin may represent a hernia plug. Correlation with surgical history is recommended as we cannot entirely exclude the possibility of a mass at this site.2.2. Mild osteoarthritis affects the right hip. Although this study is not protocoled for detailed evaluation of the labrum, there appears to be a small paralabral cyst with extension into the acetabulum which may reflect a labral tear.3.3. Postoperative changes of the lumbosacral spine.4.4. No evidence of fracture.


Instruction: Generate impression based on findings.

Input: 57-year-old woman with history of vaginal adenocarcinoma and bleeding. Additional history as per chart: Patient status post hysterectomy and bilateral salpingo-oophorectomy in 2011 for benign disease. 2 x 1 cm midline lower one third vaginal mass biopsy and path consistent with poorly differentiated adenocarcinoma. PELVIS:UTERUS, ADNEXA: Patient status post hysterectomy and bilateral salpingo-oophorectomy. There is thickening with irregular intermediate T2 signal seen in the anterolateral left vaginal wall (6/37). Additional masslike intermediate T2 signal seen in the posterior urethra and described below.BLADDER: There is a large saddle urethral diverticulum (5/39). Within this diverticulum, there is a 25 x 17 mm intermediate T2 mass (5/39) extending from the posterior lateral left urethral wall into the anterolateral vaginal wall. This mass is seen extending over a length of approximately 2.4 cm superiorly into the bladder base. Additionally, there is local infiltration into the pelvic floor and surrounding fat along with significant enhancement.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The rectosigmoid colon appears normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Soft tissue mass extending from the posterior lateral left urethra to the anterolateral left vaginal wall. The differential for this mass includes an adenocarcinoma within a urethral diverticulum, Mullerian duct remnant adenocarcinoma, or vaginal adenocarcinoma of the anterior wall (considered less likely given location).2.This mass is locally infiltrative involving the base of the bladder and the pelvic floor. No lymphadenopathy noted.3.Large saddle urethral diverticulum.


Instruction: Generate impression based on findings.

Input: 53-year-old man with right elbow pain. Evaluate for distal biceps tendon tear. LIGAMENTS: No significant abnormality noted. TENDONS: There is thickening and increased signal abnormality affecting the biceps tendon consistent with moderate tendinosis. There are foci of increased fluid signal abnormality in the surrounding area consistent with partial thickness tearing/grade 2 strain of the biceps tendon just proximal to its insertion on the bicipital tuberosity of the proximal radius. No full-thickness or near full-thickness tear is evident. There is no evidence of retraction. The imaged portion of the biceps muscle belly appears intact. ARTICULAR SURFACES AND BONE: There is increased bone marrow signal abnormality within the biceps tuberosity of the proximal radius which may represent reactive osteitis. Heterogeneous bone marrow signal abnormality may represent residual islands of red marrow.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Grade 2 strain of the biceps brachii tendon as described above.


Instruction: Generate impression based on findings.

Input: Reason: HCC screening History: cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Patent hepatic vasculature. No suspicious focal hepatic lesion.Cholelithiasis. No intrahepatic or axial hepatic biliary ductal dilatation. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Porta hepatis lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic morphology without suspicious focal hepatic lesion.


Instruction: Generate impression based on findings.

Input: Female, 14 years old, with complex seizures, evaluate for focal change providing potential explanation. Image quality is degraded on several sequences by motion artifact. Within this limitation, the following observations are made.An ill-defined focus of T2 hyperintensity is seen within the right frontal white matter just superior to the level of the insula (best seen on image 10 series 501, and image 21 series 801). A thin strand of T2 hyperintensity extending peripherally from this lesion to the brain surface, seen on coronal imaging, is favored to represent a sulcus or perhaps a vessel.No other discrete parenchymal lesions are seen. No restricted diffusion, edema or mass effect is detected. There are no findings to suggest acute or chronic intracranial hemorrhage. No abnormal extra-axial collections are seen. The ventricles are normal in size and morphology. The medial temporal lobe structures are symmetric and morphology and signal.

Output: A nonspecific, ill-defined focus of T2 hyperintensity is seen within the right frontal white matter just superior to the level of the insula. The significance of this finding relative to the patient's seizures is uncertain, though some forms of cortical dysplasia or mild migrational anomaly could represent similarly. Follow-up imaging is suggested.


Instruction: Generate impression based on findings.

Input: Recent resection of pituitary adenoma (on Feb 5, 2016) with residual mass on the left side. Recent seizure in the setting of hyponatremia. Assess for recurrent, enlarging mass. The midline and slightly eccentric to the left, well-circumscribed, heterogeneously predominantly peripherally contrast-enhancing tissue, which measures up to 12 mm, has not changed since the previous examination. Also, a smaller, more posteriorly located component, which is located along the medial aspect of the left cavernous sinus measuring approximately 7 x 5 mm, is unchanged. These 2 areas were contiguous on the initial preoperative study. Pituitary infundibular deviation to the right is unchanged. Enhancement involving the right lateral aspect of the sella likely represents residual normal pituitary tissue.While the larger residual mass still has suprasellar extension, there continues to be no significant mass-effect. In fact, there is unchanged inferior displacement and thinning of the floor of the third ventricle and the optic chiasm. There are other changes related to previous transsphenoidal approach, including fat-intensity packing material.Also, the two adjacent enhancing extra-axial masses along the left superior frontal convexity meningioma are unchanged. Included brain shows unchanged volume loss.

Output: 1.Unchanged residual tissue in the sella and along the medial aspect of the posterior left cavernous sinus compatible with residual macroadenoma.2.Unchanged left frontal convexity meningiomas.


Instruction: Generate impression based on findings.

Input: Clinical question: Multiple sclerosis. Compared to prior exam. Signs and symptoms: Lower extremity numbness, right-sided weakness and blurry vision. Pre and post enhanced brain MRI: Examination demonstrate several chronic nonenhancing demyelinating plaques both in the supratentorial and infratentorial brain parenchyma without detectable abnormal enhancement. There is no convincing evidence of any new lesions since prior study. There is however mild interval decrease size of a few of the previously seen plaques since prior studyThe cerebral cortex, cortical sulci, ventricular system and CSF spaces are within normal for patient of stated age of 47 and without change since prior exam. The visualized cisternal component of bilateral optic nerves and the chiasm is unremarkable and without abnormal enhancement.Bilateral mastoid air cells, middle ear cavities and paranasal sinuses demonstrate normal pneumatization signal patterns.Pre- and post enhanced cervical MRI:Examination is performed utilizing multiple sclerosis protocol.Multiple previously seen demyelinating plaques of the lower medulla and the cervical spinal cord are again identified. The largest lesion similar to prior exam is at C2 level.There no convincing evidence of a new lesion and no detectable enhancing plaque. There is apparent change in cord caliber and similar to prior exam.Mild to moderate degenerative changes of the cervical spine without spinal stenosis similar to prior exam is again observed.

Output: 1.Brain table demonstrate chronic findings of demyelinating disease in both supra and infratentorial space without interval change or detectable enhancing plaque.2.Cervical MRI demonstrate stable finding of chronic nonenhancing demyelinating disease without change since prior exam.


Instruction: Generate impression based on findings.

Input: Reason: pain, swelling History: pain, swelling MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Again seen is an elongated dysmorphic and slightly high riding patella appearing similar to the prior study. There is subjective thinning of the articular cartilage along the patellofemoral articulation with areas along the lateral facet of the femoral trochlea completely devoid of articular cartilage. There is subchondral cyst formation within the lateral facet of the femoral trochlea. There is increased bone marrow signal abnormality within the medial and inferior pole of the patella on fluid sensitive sequences which is nonspecific but could conceivably represent a direct bone contusion.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteoarthritis of the knee as well as findings consistent with the known history of cerebral palsy.2. Bone marrow signal abnormality within the medial aspect of the patella may reflect a direct bone contusion in the correct clinical context. Nonspecific subcutaneous edema most pronounced along the medial retinaculum.


Instruction: Generate impression based on findings.

Input: Female 86 years old Reason: h/o cirrhosis and hcc, evaluate progression of liver disease History: elevated lfts ABDOMEN: Liver has a cirrhotic morphology with a nodular contour. There is now severe hepatic biliary ductal dilatation with bile duct irregularity. The left hepatic lobe shows progressive atrophy and biliary ductal dilatation. There is a focal area of narrowing about the Klatskin point with findings suggestive of a mass. Patient is status post cholecystectomy. Distal common bile duct is normal in caliber.Hepatic vessel patency cannot be evaluated due to the lack of intravenous contrast. The left portal vein flow void is not well visualized.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: Multiple portacaval and upper abdominal lymph nodes which are borderline enlarged.BOWEL, MESENTERY: Bowel wall thickening which may be due to hypoalbuminemia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large volume upper abdominal ascites.

Output: 1.Progression of biliary ductal dilatation with suggestion of a mass near the Klatskin point. Further evaluation with ERCP as previously suggested is recommended.


Instruction: Generate impression based on findings.

Input: Right inguinal mass. Evaluate depth of invasion. Ovarian cancer. PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: The extensive right inguinal lymphadenopathy is again seen extending along the inguinal fascial planes and partly entering the right inguinal canal (series 1201, image 194). The medial superficial conglomerate lymphadenopathy invading the anterior aspect of the pectineus muscle near the pubic symphysis to approximately 50% of the muscle depth is unchanged at 4.0 x 1.2 cm (series 1201, image 137). The separate metastatic nodule completely within the right pectineus muscle is unchanged at 1.6 x 1.4 cm (series 1201, image 107).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Extensive right inguinal lymphadenopathy, extending partly into the right inguinal canal and involving the right pectineus muscle, as described above. These findings are not significantly changed from 7/10/2015.


Instruction: Generate impression based on findings.

Input: 12-year-old female with pain with wrist extension LIGAMENTS: The lunotriquetral and scapholunate ligaments appear intact. Intra-articular contrast stays within the mid carpal joint does not communicate with the radiocarpal joint.TRIANGULAR FIBROCARTILAGE COMPLEX: Triangular fibrocartilage complex is grossly intact.TENDONS: Intermediate signal collection with increased T2 signal over the dorsum of the wrist, deep to the extensor digitorum tendons, measures 8 x 5 mm (series 601, image 13). The tendons are within normal limits. BONES: No significant abnormality noted.ADDITIONAL

Output: 1.No evidence of tear of the intrinsic ligaments of the wrist as clinically queried. 2.Cystic lesion in the dorsum of the wrist, deep to the extensor digitorum tendons, likely represents a ganglion cyst and may be the cause of the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Worsening cardiac function, evaluate for infiltrative disease. Left VentricleThe left ventricle is dilated with globally decreased function. The overall LV ejection fraction is 21%, the LV end diastolic volume index is 170 ml/m2 (normal range: 74+/-15), the LVEDV is 358 ml (normal range 142+/-34), the LV end systolic volume index is 135 ml/m2 (normal range 25+/-9), the LVESV is 283 ml (normal range 47+/-19), the LV mass index is 89 g/m2 (normal range 85+/-15), and the LV mass is 186 g (normal range 164+/-36). . There is noted late gadolinium enhancement in the basal and mid inferior portion of the myocardium to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is not calculated in setting of underlying arrhythmia. There is [ no ]myocardial iron overload. There is [no noted ]LV thrombus. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is borderline dilated. The overall RV ejection fraction is 15%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 195 ml (normal range 142+/-31), the RV end systolic volume index is 79 ml/m2 (normal range 31+/-9), and the RVESV is 166 ml (normal range 54+/-17).Right AtriumThe right atrium is dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium with no noted pulmonary vein stenosis.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 FindingsPatchy pulmonary findings, right lung greater than left, which may be consistent with resolving pulmonary edema vs pneumonia/infection/pulmonary hemorrhage - clinical correlation recommended. 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. Severely decreased LV EF with global LV dysfunction. There is a focus of delayed gadolinium hyperenhancement in the basal to mid inferoseptal portion of the left ventricle which may represent right-sided volume or pressure overload. Localized scar, inflammation, or an infiltrative process is less likely.2. Decreased RV function. 3. Severely dilated left atrium and dilated right atrium.4. Moderate mitral regurgitation5. Pulmonary findings as above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Adenoid cystic carcinoma of the left external ear with positive margins treated with TFHX, now with metastatic disease. There are postoperative findings related to left lateral temporal bone resection with diffuse patchy enhancement in the region of the surgical bed. There is also diffuse regional linear dural enhancement, which is likely reactive in nature. However, there are small nodular dural-based enhancing lesions along the anterior left frontal and posterior right frontal convexities, the largest of which measures up to 10 mm, without significant mass-effect upon the brain parenchyma. There is also a nodular enhancing lesion involving the pituitary infundibulum that measures up to 18 mm, with assocated mild vasogenic edema in the adjacent hypothalamus and optic apparatus. In addition, there is a punctate enhancing lesion in the posterior right occipital lobe. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral artery flow voids are intact. There appears to be relatively slow flow through the asymmetrically narrow left sigmoid sinus. The orbits are grossly unremarkable.

Output: 1. Multiple dural-based lesions, a pituitary infundibular lesion, and a punctate right occipital lobe lesion likely at least in part represent metastatic disease.2. Postoperative findings related to left lateral temporal bone resection with nonspecific diffuse enhancement in the overlying soft tissues.


Instruction: Generate impression based on findings.

Input: VHL and history of multiple hemangioblastoma; evaluate for growth and new lesions History: 54 yo female with VHL and history of multiple hemangioblastoma; evaluate for growth and new lesions. There is evidence of posterior element resection at most levels of the cervical spine. There is no evidence of spinal cord lesions. The cervical lordosis is mildly straightened. The vertebral body heights are preserved. Level specific findings are as follows:C2-3: There is no spinal canal stenosis or neuroforaminal narrowing. C3-4: There is a small posterior disk osteophyte, but no significant spinal canal stenosis or neural foraminal narrowing.C4-5: There is a small posterior disk osteophyte, but no significant spinal canal stenosis or neural foraminal narrowing.C5-6: There is posterior disk osteophyte formation along with ligamentum flavum thickening, which results in a moderate spinal canal stenosis, as well as severe left and moderate right neural foraminal narrowing. C6-7: There is left facet hypertrophy and a small posterior disk osteophyte, but no significant spinal canal stenosis. However, there is moderate left and mild right neural foraminal narrowing. C7-T1: There is no significant spinal canal stenosis or neural foraminal narrowing. Thoracic spine: The thoracic kyphosis is mildly exaggerated at T12 secondary to mild vertebral body wedging without change. The bone marrow signal is unremarkable. There is no definite evidence of any spinal cord signal abnormality. There is a small central disk protrusion is present at T8-9 along with a left paracentral protrusion at T11-12. There is no significant spinal canal or neuroforaminal stenosis. There are innumerable bilateral renal and pancreatic cystic lesions, some of which contain heterogeneous material and/or fluid-fluid levels. The findings appear similar to those seen on the prior examination, though this examination is not adequate for assessment of individual lesions.

Output: 1. Degenerative spondylosis at multiple levels of the spine, but bi definite evidence of hemangioblastomas in the imaged spinal cord, although the lack of intravenous contrast limits evaluation.2. Innumerable bilateral renal and pancreatic cystic lesions are compatible with stigmata of VHL.


Instruction: Generate impression based on findings.

Input: Mrs. Cyrus is a 39-year-old female with a family history of breast cancer in her sister at the age of 40 and a maternal aunt. She has a personal history of benign left breast MRI guided biopsy in 2014. She has no current breast related complaints. Moderate background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Susceptibility artifact from benign biopsy marker clip is seen in the left upper outer breast. There is no abnormal axillary lymph nodes 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: 4 y/o male with headaches. Evaluation of ventricular size s/p Chiari I decompression There is no evidence of intracranial hemorrhage, mass or edema. The lateral, third, and fourth ventricles are enlarged, compatible with hydrocephalus. The ventricles appear larger when compared to the MRI dated 6/18/2009.There is evidence of an occipital decompression with post-surgical changes. There is fluid present in the post-surgical bed. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Enlarged lateral, third, and fourth ventricles. Hydrocephalus consistent with prior history of Chiari I malformation. 2. Post-operative changes as described above.


Instruction: Generate impression based on findings.

Input: Metastatic thyroid carcinoma to brain, status post resection, SRS, with bitemporal visual field defects. This is a motion degraded exam. There are postoperative findings related to right occipital craniotomy. There is redemonstration of mild dural thickening along the posterior falx and right cerebral convexity, as well as patchy parenchymal enhancement measuring up to 12 mm in maximum dimension in the right paramedian occipital lobe. Allowing for the differences in technique and motion degradation, these findings remain grossly unchanged. There is confluent T2 hyperintensity along the margins of the resection cavity compatible with gliosis, similar to prior. No convincing new abnormal intracranial enhancement is identified. There are bilateral cerebral periventricular white matter hyperintensity, which may represent chronic small vessel ischemic disease and/or treatment effects, which are grossly unchanged. The ventricles and basal cisterns are prominent due to cerebral volume loss, but unchanged. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. There are bilateral lens implants. The paranasal sinuses are grossly unremarkable. There is an unchanged T1 hyperintense focus in the left frontal calvarium, which likely represents a hemangioma.

Output: No significant interval change in the posttreatment findings in the right occipital lobe and no definite evidence of new intracranial metastasis, although the exam is limited by patient motion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of a GBM. Difficulty ambulating, weakness and vomiting. Since prior CT, there has been increased edema in the right posterior parietal with more mass effect on the right lateral ventricle, which has been completely effaced and the left lateral ventricle has been dilated. Also, there is a 16.4 mm leftward midline shift. The calcification within the edema is again noted. In addition, there are a hypodensity in the genu of corpus callosum and hyperdensity in the head of the left caudate, which are new findings since prior CT, however, are visualized on prior MRI dated 2/12/08 and now appear more pronounced. The left frontal encephalomalacia remains unchanged. No intracranial hemorrhage or abnormal extraaxial fluid collection is detected.

Output: 1. Interval increased right posterior parietal edema with increased mass effect causing effacement of the right lateral ventricle, hydrocephalus and a leftward midline shift, suggesting tumor progression. 2. Interval new abnormal densities in the genu of corpus callosum and in the head of the left caudate. These may represent tumor spreading. A brain MRI is recommended for further evaluation. 3. Stable left frontal encephalomalacia.


Instruction: Generate impression based on findings.

Input: Pain and instability. Check for meniscal injury and possible patellar tendon rupture MENISCI: The lateral meniscus appears intact, however marked destruction of the medial meniscus is observed throughout with only the posterior and anterior anchoring components moderately well preserved.ARTICULAR CARTILAGE AND BONE: Diffuse cartilaginous thinning is observed without discrete focal abnormality along articular surfaces. Mild degenerative changes, however please see subsequent description below concerning marrow signal and bone contusionsLIGAMENTS: Marked thinning and signal at valley throughout the MCL is also observed compatible with thinning as well as severe high-grade strain and partial tearing. The LCL appears grossly intact yet thinned.The ACL isn't intact, however the PCL demonstrates associated marked similar thinning and redundancy. Although fibers can be traced from origin to insertion, the appearance with abnormal draping around the ligament of Humphries is concerning for chronic change and injury. Correlation with physical exam would be helpful.EXTENSOR MECHANISM: Abnormally high riding patella with associated underlying contusion within the lateral femoral condyle. The underlying patellar tendon however appears elongated yet intact. Marked soft tissue stranding and changes are observed throughout the anterior knee with associated tearing of the retinaculum which is not visualized. Concern for acute or subacute rupture. Associated medial to lateral displacement is also observed of the patella without associated significant abnormality of the patellar body other than minimal to signal change in the patellar cartilage.ADDITIONAL

Output: 1. Patellar alta with associated underlying osseous changes yet grossly intact patellar tendon is observed. Retinacular tearing and associated additional acute and subacute changes described, along with an abnormal appearing PCL and MCL.2. Marked destruction of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Brain: There is interval increase in size of left parietal and posterior frontal periventricular demyelinating lesions. Multiple other demyelinating lesions are otherwise not significantly changed. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild left maxillary sinus mucosal thickening.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is a subcentimeter T2 hyperintense nodule in the right tracheoesophageal groove, which may represent a thyroid nodule.

Output: 1. Interval increase in size of left parietal and posterior frontal periventricular demyelinating lesions. Multiple other demyelinating lesions are otherwise not significantly changed, although characterization is limited without intravenous contrast. 2. No evidence of demyelinating lesions in the spinal cord. 3. Nonspecific subcentimeter T2 hyperintense nodule in the right tracheoesophageal groove, which may represent a thyroid nodule. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Postcontrast images demonstrate no pathological enhancement. There is redemonstration of the previously identified extensive encephalomalacia and gliosis along the left greater than right subcortical and periventricular cerebral white matter, with corresponding areas of T1 hypointensity. No significant abnormal susceptibility is appreciated. There is stable ex vacuo dilatation of the left lateral ventricle.

Output: No evidence of pathological enhancement or abnormal susceptibility.


Instruction: Generate impression based on findings.

Input: There is a 2.8 cm transverse x 3.7 cm AP x 3.8 cm craniocaudal lesion within the posterior right parietal lobe associated with vasogenic edema and adjacent mass effect upon the right lateral ventricle. Mass effect effaces the right occipital horn, effaces adjacent right hemispheric sulci, and results in mild right to left midline shift measuring 4 mm.A second lesion is present within the left cerebellar hemisphere measuring 2.0 cm transverse x 1.6 cm AP x 1.7 cm craniocaudal with associated vasogenic. The fourth ventricle remains normal in size and shape.There are no herniations. The cerebellar tonsils remain in normal position. Incidental note is made of a partially to sella. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1.Given the history of known metastatic breast cancer, there are 2 brain metastases; one in the right parietal lobe, the other in the left cerebellar hemisphere, as described in detail above.2.There are no herniations.


Instruction: Generate impression based on findings.

Input: Male; 58 years old. Reason: Evaluate for ductal dilitation/stone impaction in the setting of likely gallstone pancreatitis History: Abdominal pain, pancreatitis on imaging ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic biliary ductal dilation. Cholelithiasis with multiple gallstones seen in the region of the gallbladder neck. Mild nonspecific gallbladder wall thickening. A small T2 dark filling defect is seen within the proximal cystic duct, suspicious for cystic duct stone (series 1201/26). A small T2 dark filling defect is seen within the proximal common hepatic duct, suspicious for common duct stone (series 1201/27). Common duct is mildly diffusely dilated measuring up to 10 mm. No evidence of distal impacted stone at the level of the ampulla.SPLEEN: No significant abnormality noted.PANCREAS: Nearly diffuse pancreatic edema, compatible with acute pancreatitis. No focal pancreatic lesions. No pancreatic ductal dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cysts and other too small to characterize T2 hyperintense lesions in both kidneys, likely additional cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Dilation of upper abdominal small bowel loops, suggestive of ileus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of abdominal ascites.

Output: 1.Acute pancreatitis.2.Mild dilation of the common duct with findings suspicious for small stones in the cystic and common ducts.3.Findings suggestive of ileus.


Instruction: Generate impression based on findings.

Input: 65 year old female with a history of syncope and normal stress test referred for cardiac MRI. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 75 ml/m2 (normal range: 65+/-11), the LVEDV is 126 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10), the LV mass index is 30 g/m2 (normal range 67+/-11), and the LV mass is 52 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of any underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 70 ml/m2 (normal range 69+/-14), the RVEDV is 119 ml (normal range 110+/-24), the RV end systolic volume index is 23 ml/m2 (normal range 22+/-8), and the RVESV is 39 ml (normal range 35+/-13). No focal right ventricular wall motion abnormalities noted. Right AtriumThe right atrium is mildly dilated (100ml). Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 a small pericardial effusion and evidence of increase T2-signal in the pericardium. This finding suggests that the pericardium is actively inflamed. Extracardiac FindingsA hepatic mass is noted and is statistically most likely to be an hemangioma. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 62%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is normal in size and systolic function (RVEF 67%) without evidence of arrhythmogenic right ventricular dysplasia. 3. The right atrium is mildly dilated.4. There is evidence of mild pericarditis in active inflammatory stage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Unspecified fracture of unspecified lumbar vertebra, initial encounter for closed fracture [S32.009A], Reason for Study: ^Reason: lumbar fracture 3 month follow up History: lumbar fracture 3 month follow up For the purpose of this dictation, and to be continuous with the prior MR scan, the fractured vertebral body was numbered as L5. Comparing to prior scan, the vertical fracture line of the L5 vertebral body traversing from the superior endplate to inferior endplate is more conspicuous on the scan. Regarding the bone marrow edema of L5 vertebral body, the extent this is significantly decreased than prior scan are still remained especially on the anterior aspect of the L5 vertebral body. In addition, the degree of compression fracture of L5 vertebral body appears to be slightly aggravated since prior scan.Schmorl's node on the inferior endplate of L2 vertebral body does not show any significant interval change.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-L2 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L3-L4: Diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: Broad-based disc protrusion central to left which extends toward left lateral recess creating mild left neuroforaminal narrowing. No change since prior scan. L5-S1: Diffuse bulging of disc, minimal anterolisthesis of L5S1, mild to minimal right lateral recess stenosis, no change since prior scan.

Output: 1. More conspicuous visualization of cortical fracture line of L5 vertebral body and slightly progressed the degree of compression fracture since prior scan.2. Interval decrease of bone marrow edema of L5 vertebral body.3. No change of Schmorl's node.4. No change of left lateral recess stenosis at the level of L45 and right lateral recess stenosis of L5S1.


Instruction: Generate impression based on findings.

Input: Lung cancer. ALK+. Failed treatment with Crizotinib. Now starting new chemotherapy with baseline status to evaluate CNS status. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter which are nonspecific. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No evidence of intracranial metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: BRAIN: There is diffusion restriction with gyral enhancement involving the left thalamus, left fusiform gyrus, left forceps major, parahippocampal gyrus and left occipital lobe involving the lingual gyrus consistent with subacute infarct. There are additional scattered areas of T2/FLAIR hyperintensity in the periventricular and subcortical white matter compatible with chronic small vessel ischemic disease. The ventricles and sulci are prominent, consistent with mild age-related volume loss. No evidence of hemorrhage or significant mass effect. There is no midline shift. No extra-axial fluid collection is identified.ORBITS: The optic nerves are normal in signal intensity. The right optic nerve is slightly asymmetrically smaller than the left. No abnormal enhancement or mass is seen in the orbits. Globes and extraocular muscles are unremarkable. No bone destruction of the orbital walls is seen.

Output: 1. Evolving left PCA territory subacute infarction primarily involving the left temporo-occipital lobes and thalamus.2. No abnormal signal involving the optic nerves or orbital lesions. The right optic nerve is slightly smaller than the left which is of uncertain significance. 3. Chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Osteomyelitis First ray: Normal marrow signal. A small lobulated tarsometatarsal joint focus of low T1/high STIR signal is identified at the and MTP joint which may reflect a small amount of joint fluid or cystic structure however this is incompletely characterized on this exam..Second ray: Normal marrow signal.Third ray: Normal marrow signal.Fourth ray: Normal marrow signal.Fifth ray: There has been amputation of the fifth ray to the level of the mid metatarsal diaphysis. Although there is soft tissue ulceration to the level of the surgical margins, the margins margins appear sharp and there is no definite evidence of residual osteomyelitis given the absence of discrete low T1 signal intensity. Increased STIR signal is noted within the remaining metaphysis which may be reactive in nature given the recent surgery. There is ill-defined heterogeneous signal intensity within the surgical bed containing areas of increased T1 signal. This may in part represent a postsurgical hematoma but absent intravenous contrast, it cannot be further characterized.There is mild diffuse subcutaneous edema particularly within the plantar soft tissues. Within the limits of this exam, there is no discrete fluid collection.

Output: Surgical changes of fifth ray amputation to the level of the mid metatarsal diaphysis. There is no definite evidence of residual osteomyelitis but close follow-up is recommended.


Instruction: Generate impression based on findings.

Input: 32 year old female with history of stiffness and inflammatory pain. Evaluate for sacroiliitis. BONE MARROW: There are scattered foci of decreased signal intensity within the iliac bones, probably reflecting benign bone islands.SOFT TISSUES: The visualized musculature is unremarkable. JOINTS: The SI joints appear normal without evidence of inflammation. There is a small amount of fluid in both hips, but we see no frank joint effusion.

Output: Normal appearing SI joints with no specific findings to account for the patient's pain and stiffness.


Instruction: Generate impression based on findings.

Input: Reason: Disease progression History: schwannomatosis and bone lesions Please note that comparison to the prior examination is suboptimal due to technical differences between the protocols.Pelvis:Several small foci of signal abnormality are identified within the bones of the pelvis bilaterally. The reference lesion(s) seen on the prior study, presumably within the right ilium posteriorly, appears less confluent on the current study than on the prior study. For future reference purposes, a ring-enhancing lesion within the right ilium, lateral to the right sacroiliac joint, measures approximately 1.4 cm in its greatest transverse diameter. There is low signal intensity within the left ilium, posteriorly, which may represent a site of prior surgical biopsy with adjacent foci of metallic susceptibility artifact in the overlying soft tissues. There are small foci of abnormal signal intensity and enhancement also noted within the proximal femoral, bilaterally. Mild osteoarthritis affects both hips. Mild osteoarthritis affects the sacroiliac joints. Degenerative disc disease affects the lower lumbar spine. There is a fluid collection with thin peripheral enhancement within the lateral subcutaneous fat of the right hip, measuring approximately 4 cm in the craniocaudal dimension, perhaps representing a seroma from prior surgery. There is a small minimally enhancing mass along the S2 nerve root which may represent a small schwannoma. There is an ovoid mass measuring approximately 1 cm within the vastus lateralis muscle on the left which may also represent a peripheral nerve sheath tumor.Right femur:There is poorly defined intermediate signal intensity within the femoral diaphysis which may simply represent red marrow. There are small subcentimeter schwannomas in the right sciatic nerve within the proximal thigh and also in the distal thigh which measures approximately 1.3 cm in its greatest diameter. There is an additional schwannoma within the vastus lateralis measuring approximately 1.2 cm in its greatest diameter. There is a small amount of fluid within the knee joint.

Output: 1. Multiple small marrow-based lesions within the pelvis and proximal femora, as described above, of uncertain etiology.2. Multiple small nerve sheath tumors as described above.


Instruction: Generate impression based on findings.

Input: 58 year old woman with history of AVR who has dyspnea on exertion and palpitations. She is referred to rule out ischemia. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 60 ml/m2 (normal range: 65+/-11), the LVEDV is 95 ml (normal range 109+/-23), the LV end systolic volume index is 19 ml/m2 (normal range 18+/-5), the LVESV is 31 ml (normal range 31+/-10), the LV mass index is 58 g/m2, and the LV mass is 92 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 50 ml/m2 (normal range 69+/-14), the RVEDV is 79 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 33 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveAn aortic valve replacement is noted. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 68%).4. Normal RV size and systolic function (RVEF 59%).5. Aortic valve replacement is noted.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for intracranial hemorrhage, worsening metastases. Signs and symptoms: Seizures, history of cancer with brain metastases. Non-enhanced CT of brain:There is no detectable acute intracranial findings. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. The cortical sulci, ventricular system and all CSF cisterns as well as the gray white matter differentiation remains within normal. Further follow-up with an MRI is recommended. This examination is suboptimal due to motion artifact.

Output: No areas of acute intracranial findings and essentially unremarkable CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: Clinical question: History of Parkinson's, planning for DBS. Signs and symptoms: Preop planning for DBS. Pre-and post enhanced surgical planning MRI:This examination is performed utilizing surgical planning protocol and is not a true diagnostic exam.Within this limitation susceptibility weighted images demonstrate no parenchymal signal abnormality.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.There is a focus of encephalomalacia along the medial aspect of the left mid to posterior temporal lobe and extending into the left occipital with resultant ex vacuo dilatation of the left trigone and occipital horn of left lateral ventricle. In addition a small focus of T2 hyperintensity in the left thalamus is present. Combination of findings is believed to be secondary to a chronic ischemic stroke in the entire distribution of left PCA.Slight prominence of cortical sulci for patient's stated age. Unremarkable exam otherwise.

Output: 1.Large chronic ischemic stroke involving the entire distribution of left PCA and with resultant significant extra-axial dilatation of trigone and occipital horn of left lateral ventricle. Mild prominence of cortical sulci for age.2.Essentially unremarkable exam otherwise and without detectable abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Reason: assess for r shoulder labral tear and pathology History: has hx of instability w/ Bankart on xr ROTATOR CUFF: There is intermediate signal along the distal aspect of the supraspinatus tendon consistent with tendinopathy. The remainder of the musculature and tendons of the rotator cuff are unremarkable.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a tear through the anteroinferior aspect of the glenoid labrum, consistent with a cartilaginous Bankart lesion.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Tear through the anteroinferior aspect of the right glenoid labrum, compatible with cartilaginous Bankart.2.Compression deformity of the posterolateral aspect of the right humeral head, compatible with a Hill-Sachs lesion. 3.Tendinopathy of the distal right supraspinatus tendon.4.Degenerative changes in the right humeral head.


Instruction: Generate impression based on findings.

Input: 35 years, Female, Chiari, evaluate abnormal spinal cord T2 signal change, worsening symptoms. Left arm weakness, poor balance, headaches, syrinx, Chiari. Brain: There is evidence of Chiari I malformation with evidence of cerebellar tonsillar herniation which extend to the C1 level. There is also caudal herniation of the brainstem with the lower aspect of the pons just above the level of the foramen magnum and portions of the medulla inferior to the foramen magnum. Peglike cerebellar tonsils measure up to 8 mm below the foramen magnum. There is cervicomedullary kinking. There is mild prominence of the ventricular system without evidence of transependymal CSF flow. There is severe crowding at the foramen magnum with severely diminished CSF flow focally at this level.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Tiny nonspecific focus of T2/FLAIR hyperintensity in the right frontal lobe is nonspecific. No intracranial mass. No suspicious parenchymal or meningeal enhancement. Left frontal developmental venous anomaly incidentally noted. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Mild mucosal thickening is seen in the left maxillary sinus.Cervical spine:There is a small syrinx at the C2 level measuring 2 x 3 mm. There is also trace prominence of the central canal measuring 1 to 2 mm at the C6 level. Vertebral body heights and alignment in the cervical spine are maintained. There is a T2 hyperintense lesion involving the C6 vertebral body measuring approximately 1 cm in diameter with mild nodular enhancement peripherally. Bone marrow signal is otherwise unremarkable. No significant spinal canal or neural foraminal stenosis appreciated at any level in the cervical spine.

Output: 1. Findings of Chiari I malformation including cerebellar tonsils which measure up to 8 mm below the foramen magnum. There is significant crowding at the foramen magnum with severely diminished CSF flow at this level. Small syrinx at the C2 level measures 2 x 3 mm. There is also trace prominence of the central canal at the C6 level measuring 1 to 2 mm. No significant change since 10/30/2015.2. Unchanged mild prominence of the ventricular system. No transependymal flow is appreciated.3. T2 hyperintense lesion involving the C6 vertebral body may represent an atypical hemangioma but is nonspecific. This lesion appears similar to prior.


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB:8/21/1947)Reason: evaluate for possible encephalomalacia History: dysarthria and dysphagiaPROVIDER/ATTENDING NAME: NAOUM ISSA NAOUM ISSA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is an 18 x 11 mm extra-axial mass adjacent to the right cavernous sinus and internal carotid artery. It encircles the right anterior clinoid.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is an extra-axial mass suspicious for meningioma located in the right paraclinoid region. It abuts the right optic nerve. If clinically appropriate postcontrast imaging may be of further benefit in evaluating this.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 58-year-old woman with personal history of right breast cancer status post lumpectomy and sentinel node biopsy in 2014 presents for screening MRI. Patient also received radiation, chemotherapy and hormonal therapy. No current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Right breast: There are postsurgical changes of lumpectomy involving the lower inner quadrant which include distortion and scarring. Postsurgical changes sentinel node biopsy are also noted upper-outer quadrant extending into the axilla. No abnormal enhancement is seen. Left breast: There is no abnormal enhancement.Axilla: There is postsurgical scarring in the right axilla. No abnormal lymph nodes are identified in either axillary region.

Output: Postsurgical changes of right lumpectomy and sentinel node biopsy. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Male 32 years old Reason: Right knee pain MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Focal chondral fissuring involving the medial patellar facet. LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Focal chondral fissuring of the medial patellar facet. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Pre B-ALL, admitted for neutropenic fever with no current source of infection identified. Has headaches and concern for possible meningitis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The cerebellar tonsils are perhaps slightly low-lying, but do not have pointed morphologies. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial abscess, mass, or acute infarct. Mild diffuse cerebral white matter T2 hyperintensity may be treatment-related.


Instruction: Generate impression based on findings.

Input: 59-year-old female with history of vulvar melanoma. PELVIS:UTERUS, ADNEXA: There is a multilobulated peripherally enhancing lesion based in the right perineum extending to the skin surface of the right labia minora with some areas of intrinsic high T1 and intermediate T2 signal abnormality which is compatible with patient's known history of melanoma. The medial border abuts the anus but does not seem to invade it. The urethra is spared.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent right inguinal lymph noes are present measuring up to 12 mm in short axis (26/401).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Probable injection granulomata in the anterior abdominal soft tissues versus metastatic deposits.

Output: 1.Multilobulated lesion centered with the right perineum compatible with patient's known history of melanoma as described above.2.Suspicious right inguinal lymph node.


Instruction: Generate impression based on findings.

Input: 42 year-old female with personal history of left breast lumpectomy in July 2014 for ER positive IDC followed by chemotherapy and radiation therapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.A surgical scar is seen in the left posterior lower inner aspect.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 40-year-old male patient with knee pain and snapping. Evaluate for tendinosis/chondral lesion status post patellar tendon repair. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a patella alta deformity as seen on prior radiographs. Evaluation of bone marrow signal intensity in the proximal tibia is limited by metal artifact from an orthopedic screw. Small surgical tunnels are noted within the patella. Otherwise, bone marrow signal is within normal limits.There is moderate to severe degeneration of the articular cartilage of the patella with near-full-thickness to full-thickness cartilage loss inferiorly along the median eminence. There is relatively mild degeneration of the articular cartilage of the femoral trochlea. The tibiofemoral compartment articular cartilage appears relatively preserved.LIGAMENTS: The cruciate and collateral ligament are intact. EXTENSOR MECHANISM: The patellar tendon is thickened with linear increased signal intensity extending longitudinally within its substance and anterior to the patella. These findings likely represent a combination of tendinosis, insertional tearing, and surgical changes. We see no fluid signal intensity traversing the tendon to indicate rupture. The distal quadriceps tendon appears normal. There is a small amount of edema in Hoffa's fat pad superiorly.

Output: Postsurgical changes of patellar tendon repair with tendinosis and interstitial tearing without evidence of rupture. There is a patella alta deformity with moderate to severe degeneration of the articular cartilage of the patella.


Instruction: Generate impression based on findings.

Input: Forgetfulness and MOCA out of proportion to anxiety or bipolar disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, and cerebellum appear unremarkable. The pituitary gland is intact. 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: No evidence of cerebral atrophy, intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Possible PDA Left VentricleThe left ventricle is normal in size. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch. PDA raising from the aortic arch to the main pulmonary artery, of approximately 16 mm length and 2.8 mm in diameter is visualized. (Series 1601 image 292)Pulmonary ArteryThe main pulmonary artery is normal in size. Normal size of the left and right pulmonary arteries. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.Extracardiac FindingsPartial visualization of the hollow viscus of the abdomen is normal on this nonenhanced MR.

Output: 1. PDA as described.


Instruction: Generate impression based on findings.

Input: 64-year-old female patient with incidental pancreatic body cystic lesion measuring 22 x 14 mm on US. Aspirate CEA of 62.9 and amylase of 765. Needs MRCP to evaluate for change. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: There are many mildly T2 hyperintense, T1 hypointense lesions throughout the spleen that do not enhance.PANCREAS: Multilobulated T2 hyperintense lesion with thin septations in the pancreatic body appears to communicate with the pancreatic duct and measures 2.5 x 1.9 cm (series 5 image 55). There are multiple smaller probable side branch IPMNs. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a T1 hyperintense lesion in the superior pole of the right kidney that likely represents hemorrhagic cyst. The lesion does not enhance.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion of interest in pancreatic body favored to be a side branch IPMN containing thin septations (pancreatic pseudocyst considered less likely given no reported pertinent clinical history or findings suggesting prior pancreatitis), multiple additional punctate side branch IPMNs also seen.2.Multiple lesions throughout the spleen, may reflect sequelae of prior infectious/inflammatory process, correlation with patient's clinical history recommended.


Instruction: Generate impression based on findings.

Input: 3 years, Female, crying spells, headache, motion sickness. Brain parenchyma appears within normal limits. Myelination and sulcation are within normal limits. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No evidence of infarct or hemorrhage. No extra-axial collections. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: 56 years, Female, Reason: 56 y.o female with ileocolonic Crohns w/perianal disease, SBR, TI resection, hemicolectomy. new feeling of air and stool passage through vagina. please eval for fistula. History: passage of air and stool through vagina. PELVIS: FemaleUTERUS, ADNEXA: No rectovaginal fistula is identified No abscess is identified. No evidence for active Crohn's.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A large amount of stool is present in the colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of a rectovaginal fistula.


Instruction: Generate impression based on findings.

Input: 61-year-old female with hip pain ACETABULAR LABRUM: There is degenerative tearing of the anterior and superior labrum. The transverse ligament is thickened as is the ligamentum teres at its attachment on the transverse ligament.ARTICULAR CARTILAGE AND BONE: There are foci of full-thickness cartilage loss involving the superior acetabulum. There are osteoarthritic changes involving the superior acetabulum in the area of underlying labral tear. Bone marrow signal intensity is within normal limits. No evidence of fracture or malalignment.SOFT TISSUES: No muscle atrophy or edema is noted. The tendinous origins of the iliopsoas, hamstring and gluteal muscles are intact.ADDITIONAL

Output: Tear of the anterosuperior labrum with underlying osteoarthritic changes.


Instruction: Generate impression based on findings.

Input: Left subcortical stroke: right face and arm weakness. There is an area of restricted diffusion and T2 hyperintensity in the left corona radiata that measures up to 20 mm. There is a background of mild cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or mass. There is encephalomalacia in the left posterior occipital lobe and perhaps in the inferior parietal lobe with ex vacuo dilatation of the occipital horn of the left lateral ventricle. There is mild diffuse cerebral white matter hypoattenuation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Acute infarct in the left corona radiata.2. Chronic left posterior cerebral artery territory infarct and background of mild probable chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental status, unspecified. Multiple sclerosisClinical question: Evaluate for etiology of altered mental status, somnolenceSigns and Symptoms: worsening MS, altered mental status, somnolence The CSF spaces are appropriate for the patient's stated age with no midline shift. T2 and FLAIR hyperintense and T1 hypointense periventricular and subcortical white matter lesions of a moderate degree are present, some of which are perpendicularly oriented to the lateral ventricles. Similar lesions are also present in the brain stem and cerebellum. There are also T2/FLAIR signal hyperintense lesions present in the medial thalami, the right precuneus gray matter and the right superior frontal gyrus gray matter.Sagittal FLAIR imaging suggests a FLAIR hyperintense lesion in the cervical spinal cord at the C3-4 level without any evidence of enhancement on the postcontrast sagittal T1 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a small mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Multiple lesions scattered throughout the brain predominantly in the white matter as detailed above support the clinical history of demyelinating disorder. There are no enhancing lesions appreciated to suggest acute demyelinating plaque.2.Findings suggest possible demyelinating focus in the cervical spinal cord at C3-4


Instruction: Generate impression based on findings.

Input: MRI BRAIN: The exam is mildly motion degraded limiting evaluation. There is an acute infarct involving the right frontal and parietal operculum, right insular cortex with additional small focus of infarction in the inferior frontal lobe with mild regional sulcal effacement and mass effect. Tiny focus of diffusion hyperintensity involving the paramedian left parietal lobe medially may be related to procedure. Susceptibility sequence is motion degraded, however no obvious hemorrhage is appreciated. There is an old infarct in the left occipital lobe, left cerebellar hemisphere, left posterior limb of the internal capsule, and the left corona radiata with encephalomalacia. There are moderate periventricular and subcortical nonspecific T2 signal abnormalities which likely represent moderate chronic microvascular ischemic changes. There is no hydrocephalus. There is no midline shift or herniation. A nasogastric tube is partly imaged.MRA BRAIN: The anterior and posterior circulation is intact without flow limiting stenosis or intracranial aneurysm. Both vertebral arteries join to form the basilar artery. Tiny bilateral posterior communicating arteries are present. The anterior communicating artery is not definitely visualized.MRA NECK: The proximal right vertebral artery is not well seen which may be artifactual or related to mild non-flow limiting stenosis. right. There is separate origin of the brachiocephalic, left common carotid and left subclavian arteries. The right vertebral artery is nondominant. Bilateral common carotid and internal carotid arteries are patent. There is no flow-limiting stenosis in the bilateral carotid bifurcations (less than 50% by NASCET criteria bilaterally).

Output: 1.Acute right MCA territory infarcts involving the right frontoparietal operculum, insula, right frontal coronal radiata and a small focus in the inferior right frontal lobe. No significant mass effect. Susceptibility sensitive sequence is motion degraded however no obvious hemorrhage is appreciated. Tiny focus of restricted diffusion involving the paramedian left parietal lobe medially may be related to procedure or represent an additional tiny focus of infarct. 2.Chronic infarcts in the left occipital lobe and the left cerebellar hemisphere as detailed above. Moderate chronic small vessel ischemic disease.3.No significant steno-occlusive lesions in the intracranial or extracranial circulation in the neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of prostate cancer status post prostatectomy. Rising PSA. PELVIS:PROSTATE: Status post prostatectomy. No evidence of tumor recurrence in the prostatectomy bed. The vesicourethral junction is unremarkable.BLADDER: The vesicourethral junction is unremarkable.LYMPH NODES: No enlarged pelvic lymph nodes. Nonspecific small inguinal lymph nodes.BONES, SOFT TISSUES: No enhancing osseous lesion is identified. Colon diverticulosis. Right inguinal hernia repair, small 2.5 cm fat-containing left inguinal hernia.OTHER: No significant abnormality noted.

Output: No specific evidence of locoregional tumor recurrence.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Increased seizure frequencies. History of developmental delay (language, gross motor, fine motor), failure to thrive, with complicated pre-natal and natal course (with suspected hypoxic ischemic injury), developmental delay (language, gross motor, fine motor), failure to thrive, with complicated pre-natal and natal course (with suspected hypoxic ischemic injury). There is no evidence of intracranial hemorrhage, mass, or acute infarct. The corpus callosum is relatively diffusely thin and there is mild paucity of periventricular white matter in the bilateral cerebral hemispheres bilaterally. There are diffuse confluent areas of increased T2 hyperintensity in the bilateral cerebral periventricular and deep white matter. There is no evidence of hydrocephalus. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening involving the bilateral ethmoid and maxillary sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is fluid within the left mastoid air cells and middle ear.

Output: 1. Diminished periventricular white matter bulk and signal abnormality likely represents periventricular leukomalacia.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.3. Left otomastoid effusion may represent mastoiditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Left knee chondromalacia History: Left knee pain MENISCI: The lateral meniscus appears intact. The medial meniscus appears intact. There is increased signal abnormality within the posterior horn of the medial meniscus indicating very mild intrasubstance degeneration. Some of the signal extends to the femoral articular surface indicating superficial fraying.ARTICULAR CARTILAGE AND BONE: There is a partial-thickness articular cartilage fissure along the medial facet of the patella, inferiorly. There is focal partial-thickness articular cartilage defect along the far medial aspect of the medial facet of the femoral trochlea with a small amount of underlying subchondral signal abnormality. There are small tricompartment osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is thickening of the patellar tendon with intermediate signal intensity indicating mild to moderate patellar tendinosis. There is a large enthesophyte along the superior aspect of the tibial tubercle at the level of the insertion of the patellar tendon which may represent the sequela of prior Osgood Schlatter's disease.ADDITIONAL

Output: 1. Focal partial-thickness cartilage defect and fissuring affecting the patellofemoral articulation.2. Findings indicating mild to moderate patellar tendinosis.3. Possible mild strain injury of the gastrocnemius as described above.


Instruction: Generate impression based on findings.

Input: Steroid responsive, waxing-waning encephalopathy. Additional clinical history from electronic medical records: Past medical history significant for right hemiparesis/right hemianesthesia following gunshot wound sustained combat in 1969. Subsequently, the patient developed seizure disorder and is on multiple antiepileptic medications. He also carries the diagnosis of steroid responsive autoimmune encephalitis. Underneath a superior left frontoparietal craniectomy defect, there is cystic lesion with minimal bulging of the bran parenchyma. There is also adjacent white-matter T2-hyperintensity. There is no associated mass-effect, no midline shift or brain herniation. Otherwise, there are a few punctate T2 hyperintense foci in the frontal white-matter bilaterally. There is no acute infarct or intracranial hemorrhage, accounting for foci of susceptibility artifact at the site of previous surgery. There is a background of mild diffuse cerebral volume loss. There is no abnormal parenchymal or leptomeningeal contrast enhancement. The major vascular flow voids are preserved, accounting for a small/hypoplastic right vertebral artery. There is a right orbital fracture with inferior bulging of the orbital fat but no fat stranding or hemorrhage. The orbits are grossly unremarkable otherwise.

Output: 1.Left frontoparietal cystic lesion and superimposed surgical alterations may represent remote injury manifesting as cystic encephalomalacia and gliosis. Underlying neoplasm is a potential consideration, although no discrete enhancing mass is identified.2.Punctate T2-hyperintensity in the frontal white-matter is very nonspecific and may reflect chronic microvascular ischemia.3.Chronic right orbital floor blowout fracture.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: ? cuff tear History: pain. ROTATOR CUFF: The supraspinatus, infraspinatus, teres minor, and subscapularis tendons and muscles are intact.SUPRASPINATUS OUTLET: There is normal variant os acromiale. Mild osteoarthritis affects the AC joint with small inferior osteophytes. No fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Within the limitations of a nonarthrographic study, the glenoid labrum is grossly intact.BICEPS TENDON: The long head of the biceps tendon is intact. ADDITIONAL

Output: 1.The rotator cuff is intact.2.Mild AC joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain and spinal cord(198.3) [198.3], Reason for Study: ^Reason: Eval brain mets. History: Hx CVAs. NSCLC. Redemonstration of left frontal lobe encephalomalacia seen of with the susceptibility artifacts indicating prior hemorrhage is lesion, no change since prior scan.There is a focal lacunar infarct on the left thalamus, no change since prior scan.There is no evidence of abnormal enhancement.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No change of left frontal lobe chronic hemorrhagic lesion with encephalomalacia since prior scan.No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Glasgow coma scale score 3-8, at arrival to emergency department [R40.2432], Reason for Study: ^Reason: stroke?, vascular occlusion? History: AMS Brain MRIMultifocal new restricted diffusion lesions on bilateral frontal lobe indicating acute/subacute ischemic infarct.Due to the nature of emergency circumstances and per the request of the ordering service, no other MR sequence has been obtained but diffusion weighted sequence.Therefore, other information such as hemorrhagic transformation, evolution of prior ischemic stroke lesions and brain edema can not be evaluated. Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate significant (more than 50%) luminal narrowing of the left MCA distal M2 segment. Unchanged since prior scan.There are also multifocal various degree luminal stenosis of bilateral MCA M2 and M3 segment branches indicating intracranial atherosclerotic changes. Vertebrobasilar system appears to be normal.

Output: 1. Acute/subacute ischemic infarctions on bilateral frontal lobes.2. Significant (more than 50%) luminal stenosis of the left MCA M1 segment, unchanged since prior scan.