Instruction: Generate impression based on findings.

Input: Reason: Right SI Joint Irritation History: Pain Pelvis:2 tubular foci of signal abnormality within the right ischium presumably represent suture anchors. The semimembranosus tendon can be seen originating from the ischium and appears intact, although it is slightly thickened perhaps representing tendinosis. Although some of the fibers of the conjoined tendon can be seen originating from the ischium on the coronal sequence, the proximal fibers of the conjoined tendon are largely indistinct on the axial sequence with a small amount of fluid signal intensity between the ischium and the tendon suggesting a partial-thickness tear. These findings appear similar to those seen on the prior study. The left hamstring tendons appear intact. The remaining visualized musculature and tendons appear intact. Focus of low signal intensity within the uterus is incompletely characterized but likely represents a uterine fibroid. There is a small amount of free fluid within the pelvis which is likely physiologic. Note is made of an IUD. There is severe degenerative disc disease at the level of L5/S1 and grade 1 anterolisthesis of the L5 vertebral body and what appears to be bilateral spondylolysis of L5. The hip joint alignment is anatomic.Right femur:Again seen are findings suggestive of partial thickness tearing of the conjoined tendon. A small amount of fluid also tracks between the semimembranosus and ischium, although this may simply represent fluid extension from the aforementioned tear of the conjoined tendon rather than a tear of the semimembranosus itself. The bone marrow signal intensity of the femur is normal. The imaged musculature of the right thigh is otherwise unremarkable.

Output: 1) Postoperative changes of hamstring repair with findings suggestive of a partial tear of the conjoined tendon.2) Bilateral L5 spondylolysis with spondylolisthesis and severe degenerative disk disease.


Instruction: Generate impression based on findings.

Input: 73-year-old man with history of spondylolisthesis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5 and minimal retrolisthesis of L5 on S1, slightly more prominent at L4-5 than the prior examination. Alignment is otherwise within normal limits. Bone marrow signal is benign with hemangioma at L3. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T12-L1: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L1-L2: Disc bulge, eccentric to the left. There is mild to moderate left neural foraminal stenosis. There is minimal right neural foraminal stenosis. There is no significant spinal canal stenosis.L2-L3: Disc bulge, eccentric to the left. There is mild to moderate left neural foraminal stenosis and mild right neural foraminal stenosis. There is no significant spinal canal stenosis.L3-L4: Disc bulge. There is facet arthropathy with ligamentum flavum thickening. There is mild bilateral neural foraminal stenosis. There is minimal spinal canal stenosis.L4-L5: There is a significant disc bulge along with bilateral facet joint arthropathy and ligamentum flavum thickening with increased distention of the facet joints since the prior exam. There is moderate bilateral neural foraminal stenosis. There is partial effacement of the lateral recesses and mild to moderate central spinal canal stenosis.L5-S1: There is a disc bulge, eccentric to the left. The thecal sac terminates at this level and there is prominent epidural fat. There is effacement of the lateral recesses and moderate to severe bilateral left greater than right neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine, minimally progressed from the prior exam. There is moderate to severe bilateral L5-S1 and moderate bilateral L4-L5 neural foraminal stenosis. There is effacement of the lateral recesses at these levels and mild to moderate central spinal canal stenosis at L4-L5.


Instruction: Generate impression based on findings.

Input: Reason: S/P SCFE Evaluation of the right hip is slightly limited due to metallic susceptibility artifact, resulting from an orthopedic screw in the femoral neck.ACETABULAR LABRUM: Evaluation of the labrum is somewhat limited due to metal susceptibility artifact, however, given this limitation, there is increased signal intensity within the undersurface of the anterior labrum, extending from the 2 to 3 o'clock position, suggesting an undersurface labral tear. The location of the tear, beneath the crossing of the iliopsoas tendon, suggests the possibility of iliopsoas impingement. A possible second tear along the posterior superior labrum, at approximately the 11 o'clock position, is seen on image 14 of series 901.ARTICULAR CARTILAGE AND BONE: Deformity of the femoral head, related to the patient's known slipped capital femoral epiphysis, results in a CAM-type deformity along the anterior and lateral aspects of the femoral head/neck junction, however, the aforementioned metallic susceptibility artifact precludes accurate measurement of an alpha angle. Evaluation of the articular cartilage is likewise limited, but we see no large fluid-filled defect. The remainder of the bone marrow in the pelvis appears normal. SOFT TISSUES: The soft tissues appear normal.

Output: 1. Evaluation of the right hip is slightly limited due to metallic susceptibility artifact, resulting from an orthopedic screw in the femoral neck.2. CAM-type deformity resulting from patient's known slipped capital femoral epiphysis.3. Suggestion of labral tearing, as above.


Instruction: Generate impression based on findings.

Input: Reason: HCC with right thigh and lung mets please assess and provide index lesion measurements for RECIST prior to start of therapy History: As above Again seen is an intramuscular mass in the right biceps femoris at the level of the mid femur. The mass demonstrates low signal on T1-weighted images and high signal on T2-weighted images in addition to heterogeneous enhancement. The underlying osseous structures are intact. The mass measures 5.6 x 5.3 x 10.4 cm, compared to 5.1 x 5.2 x 8.3 cm previously.The remaining soft tissues appear unremarkable and the vessels appear patent. The soft tissues of the left thigh and the left femur are grossly unremarkable as seen on the coronal view.

Output: Mass in the right posterior thigh remains suspicious for a primary soft tissue sarcoma or metastatic carcinoma and appears to have increased in size relative to the prior exam.


Instruction: Generate impression based on findings.

Input: 9 years, Female, Reason: eval the prepontine cists ern, and interval change since yesterday History: improved clinical status, pre op planning for ventriculoscopy. Examination is limited to sequences for operative planning. Again seen is diffuse ventriculomegaly involving the lateral, third, and fourth ventricles consistent with hydrocephalus related to fourth ventricular outflow obstruction. There is evidence of transependymal flow as seen previously. Right transfrontal EVD has been placed with its tip in the right frontal horn abutting the septum pellucidum. Ventricular size is similar to examination from 4/19/2016. There is effacement of the prepontine cistern as noted previously and deformity of the posterior aspect of the pons related to mass effect. Postsurgical changes related to Chiari decompression are again seen.

Output: Limited sequences for operative planning demonstrate interval placement of right transfrontal EVD for obstructive hydrocephalus. No significant change in size of the ventricular system compared to 4/19/2016.


Instruction: Generate impression based on findings.

Input: Right arm numbness and weakness. History of non-small cell lung cancer. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. No masses or abnormal enhancement involving the cervical spine.The cervical spinal cord has normal signal characteristics and overall morphology.Minimal 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: There is a disc bulge with a central disc extrusion component which contacts the ventral aspect of the cord. No cord signal abnormality. Dorsal thecal sac is patent without significant spinal canal stenosis at this level. There is minimal left neural foraminal narrowing. No significant right neural foraminal narrowing.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 bilateral facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No evidence of metastatic disease in the cervical spine. 2. Mild degenerative changes including small disc extrusion at the C5-C6 level which contacts the ventral aspect of the cord, without evidence of cord impingement or signal abnormality. There is minimal left C5-C6 neural foraminal narrowing, otherwise no significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Male; 31 years old. Reason: Evaluate for ligamentous injury, occult fx History: Patient is 2 months s/p severe sprain, initial radiographs at OSH negative, persistent pain with weight bearing, most at top of ankle and medially. TENDONS: No significant abnormality noted.LIGAMENTS: There is increased signal within a thickened and heterogeneous deltoid ligament, suspicious for at least a partial tear. The anterior and posterior talofibular ligaments are visualized and unremarkable. ARTICULAR SURFACES AND BONE: Bone marrow edema in the medial malleolus, likely secondary to contusion associated with ligamentous injury described above. No acute fracture or osteochondral defect. Articular cartilage is within normal limits.ADDITIONAL

Output: Findings compatible with at least a partial tear of the deltoid ligament as described above.


Instruction: Generate impression based on findings.

Input: Recurrent right upper extremity and shoulder pain Again seen are postoperative changes of anterior cervical discectomy and fusion at C6-C7. Hardware is better assessed on recent CT.Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Mild narrowing of the neural foramina related to uncovertebral hypertrophy. No significant spinal canal stenosis.C5-6: There is mild to moderate right-sided and mild left neural foraminal stenosis related to uncovertebral hypertrophy. No spinal canal stenosis.C6-7: Postoperative changes of anterior fusion. No evidence of recurrent disc herniation. Neural foramina are patent. No significant spinal canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Postoperative changes of ACDF at C6-C7 without evidence of recurrent disc herniation at this level. 2. Mild degenerative changes including mild to moderate narrowing of the right C5-C6 neural foramen and mild narrowing of the bilateral C4-C5 and left C5-C6 neural foramina related to uncovertebral hypertrophy.


Instruction: Generate impression based on findings.

Input: Possible exocrine pancreatic insufficiency. ABDOMEN:LIVER, BILIARY TRACT: Mild hepatic steatosis. No focal liver lesion or vascular abnormality. The patient is status post cholecystectomy. The common bile duct measures up to 1 cm and there is mild intrahepatic biliary duct dilatation. At the distalmost CBD there is persistent focal circumferential narrowing measuring approximately 11 mm in length, appearance consistent with that of a benign stricture. No discrete mass lesion or intraductal filling defect seen. This likely represents postcholecystectomy state.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: The pancreas is normal in morphology, size, signal intensity and enhancement. The main pancreatic duct is normal in caliber. No evidence of inflammation. Following secretin administration there is adequate main pancreatic ductal compliance and parenchymal excretory function without side branch ectasia.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate bilateral simple appearing cysts. No hydronephrosis or suspicious renal lesion.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: Benign distal CBD stricture (measuring 11 mm in length) suspected with mild upstream extrahepatic and intrahepatic biliary ductal dilatation also seen. Hepatic steatosis. Otherwise no findings to suggest pancreatic exocrine insufficiency.


Instruction: Generate impression based on findings.

Input: 44-year-old male complaining of headache, to evaluate There is hyperdensity abnormal signal and fullness in the sella. MRI study is recommended for further evaluation of this region.The attenuation and morphology of the brain parenchyma is within normal limits for patient's stated age. No evidence of hemorrhage, edema, mass-effect or midline shift is detected. Cortical sulci, ventricular system and all CSF cisterns are within normal limits. Calvarium, visualized paranasal sinuses, orbits and mastoid air cells are also normal.

Output: There is hyperdensity abnormal signal and fullness in the sella. MRI study is recommended for further evaluation of this region. No acute intracranial hemorrhage or cortical ischemia is identified.


Instruction: Generate impression based on findings.

Input: 78 years, Male, memory loss No intracranial mass or mass-effect. There is moderate degree of global parenchymal volume loss. No disproportional volume loss involving the hippocampi or particular lobar distribution of volume loss is suggested. There is prominence of the lateral ventricles which may be slightly out of proportion to the degree of volume loss. No diffusion abnormality. No intracranial hemorrhage. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial mass or mass effect.2. Minimal chronic small vessel ischemic changes.3. Moderate degree of global parenchymal volume loss. There is prominence of the ventricular system which is favored to be related to the volume loss however, component of communicating hydrocephalus/NPH is possible and should be considered in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Mid to low back pain for months. 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 and cauda equina nerve roots display normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: No evidence of spondylosis or mass lesions in the spine.


Instruction: Generate impression based on findings.

Input: Patient presenting with left facial droop, dysarthria, left-sided weakness and altered mental status, evaluate for stroke. There is a slightly linear, apparent area of diffusion restriction in the left side of pons, as seen on image 11 of series 6, with corresponding low signal and ADC sequence with a possibility of an acute infarct. There is no associated T2 signal abnormality however. There are multiple areas of increased FLAIR signal and volume loss consistent with encephalomalacia throughout the cerebral hemispheres, particularly bilateral frontal lobes, bilateral parietal lobes, and left occipital lobe, as well as the bilateral cerebellar hemispheres which are consistent with chronic infarcts. Additional FLAIR signal abnormalities in the periventricular white matter and brainstem are nonspecific but are suggestive of a component of mild chronic microvascular ischemic disease. There is no evidence of mass. The ventricles and and sulci are prominent, consistent with parenchymal volume loss, advanced for patient's age. There is a small focus of susceptibility signal changes in left peri-Rolandic area, which may represent a chronic microhemorrhage or mineralization. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Bilateral maxillary sinus mucus retention cysts and mild right mastoid opacification are noted.

Output: 1.Apparent focus of restricted diffusion and ADC hypointensity without clear corresponding T2 signal abnormality in the left aspect of the pons, which may represent a hyperacute infarct, although artifact is a possibility.2.Multiple chronic infarcts throughout the bilateral cerebral and cerebellar hemispheres as described above.


Instruction: Generate impression based on findings.

Input: Reason: cholestasis, eval for biliary disease, last MRI in 2012 shows capsular retraction, f/u History: cholestasis ABDOMEN:LIVER, BILIARY TRACT: Capsular retraction along the inferior lateral aspect of the right hepatic lobe is unchanged. Underlying subcentimeter nonenhancing focus has decreased in size (series 13 images 30). Previously seen subcentimeter T2 hyperintense lesion within the right hepatic lobe with signal characteristics suggestive of a cavernous hemangioma is not well identified on today's examination. No new or suspicious focal hepatic lesion. No intrahepatic or extrahepatic biliary ductal dilatation.No cholelithiasis or choledocholithiasis is evident. Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subtle capsular retraction stable with decreasing underlying nonenhancing focus. 2.Previously seen probably hemangioma not well seen. 3.No new or suspicious focal hepatic lesion.4.No biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Clinical question: CVA. Signs and symptoms: CVA. Nonenhanced head CT:Patchy periventricular and subcortical foci of low-attenuation likely result of small vessel disease of indeterminate age are noted.There is no evidence of residual subdural hematoma as was noted on prior exam.There is no evidence of intracranial hemorrhage, mass effect, midline shift or hydrocephalus. No evidence of acute cortical stroke. Recommend follow-up with an MRI if concern for acute stroke persists. Bilateral frontal burr holes are again noted in calvarium is otherwise unremarkablelimited view of paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage or cortical stroke.2.Small vessel disease of indeterminate age.3.No evidence of residual subdural as was noted on prior exam.


Instruction: Generate impression based on findings.

Input: Reason: s/p crani History: ha The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam, the patient has undergone right sided craniotomy for removal of a middle cranial fossa and right anterior cranial fossa extra-axial mass. Residual T2 signal hyperintensity is present in the pattern suggestive of vasogenic edema in the adjacent right temporal lobe and right internal capsule. The extent of signal hyperintensity is stable compared to the preoperative exam. A couple new centimeter sized gyral T2 signal hyperintensities are present in the right frontal lobe and the right middle frontal gyrus and the orbital gyrus.Midline shift of the septum pellucidum to the left on the coronal imaging at the level of foramina of Monro is currently 11 mm and was previously 8 mm. There is redemonstration of uncal herniation. The sylvian fissure is displaced superiorly.There is some enhancing meningeal based tissue in the right middle cranial fossa measuring up to 7 mm in thickness at the anterior aspect of the right middle cranial fossa. There is dural thickening along the dura in the right calvarium.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post recent right sided removal of a meningioma centered in the right middle cranial fossa with associated post-operate changes. There is residual dural thickening at the anterior aspect of the right middle cranial fossa which may represent a small amount of residual neoplasm. A follow-up MRI may help further assess for this.2.Mild increase in midline shift. Please correlate with the patient's clinical symptoms.


Instruction: Generate impression based on findings.

Input: Female, 41 years old, with L5-S1 herniated nucleus pulposus. Assess preoperative change and morphology. Loss of disc height and T2 signal is seen at L5-S1. The previously demonstrated right foraminal disc extrusion with extension superiorly into the right lateral recess has significantly diminished in size with only trace residual herniated disc material. There is mild disc bulging at this level but without significant spinal canal or foraminal stenosis.The remaining intervertebral discs are preserved with no areas of significant spinal canal or foraminal stenosis. Facet arthropathy is seen at L4-5 and L5-S1. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.

Output: Interval significant decrease in the size of a right foraminal/lateral recess disc extrusion at L5-S1.


Instruction: Generate impression based on findings.

Input: 25-year-old male with left knee pain. Rule out meniscal or ligament pathology. MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. No bone marrow signal abnormality is seen.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: Mild patella alta with an elevated tibial tubercle to trochlear groove distance which can be seen in patients with patellofemoral instability.


Instruction: Generate impression based on findings.

Input: There has been slight interval progression in the size of multiple foci of T2 hyperintensity within the supratentorial white matter. There are multiple unchanged foci susceptibility effect throughout the cerebral and cerebellar hemispheres, mostly likely secondary to radiotherapy. There is minimal unchanged punctate enhancement within the previously treated left precentral gyrus lesion. There is otherwise no significant enhancement in the locations of the previously treated brain metastases. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No significant change in the post-radiotherapy appearance of the brain, including the treated brain metastases.


Instruction: Generate impression based on findings.

Input: GBM. There are post-surgical changes at the right inferior frontal lobe, insula, and anterior temporal lobe. There is extensive T2 hyperintensity in the surrounding white matter. There is predominantly linear enhancement along the anteromedial aspect of the surgical bed and extending across the corpus callosum just beyond midline. This appears similar to the prior outside MRI, accounting for differences in technique and there is no appreciable elevated perfusion. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild paranasal sinus mucosal thickening and fluid in the right mastoid air cells. The skull and scalp soft tissues are unchanged.

Output: Post-treatment findings in the right cerebral hemisphere with persistent periventricular enhancement in the anterior lateral ventricle regions that may predominantly represent treatment effects, such as radiation necrosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Symptoms of vague numbness and burning pain involving the arms in recent months. The spinal cord displays normal signal and morphology. The tip of the conus medullaris is located at the L1 level and shifts appropriately between the prone and supine positions. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are no dross dysraphic defects. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. The cerebellar tonsils are mildly low-lying on the limited localizer images that include the cervical spine.

Output: No evidence of syringohydromyelia in the imaged portions of the spinal cord. The conus medullaris is not low-lying and shifts appropriately between the prone and supine positions.


Instruction: Generate impression based on findings.

Input: Suspected posterior vertebral body scalloping identified on prior x-ray is not appreciated on the current MRI exam. Levoscoliosis is present with its apex centered at approximately L1/2. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. There is a partially imaged mass in the right upper quadrant which is both T1 and T2 hyperintense.T12/L1: UnremarkableL1/2: UnremarkableL2/3: Mild bilateral facet hypertrophy without stenosis.L3/4: Diffuse annular disc bulge, slight ligamentum flavum thickening, and mild bilateral facet hypertrophy. There are no significant stenoses.L4/5: Diffuse annular disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There are no significant stenoses.L5/S1: Mild disc bulge and mild bilateral facet hypertrophy. There are no significant stenoses.

Output: 1.Levoscoliosis is present with its apex centered at approximately L1/2.2.There is a partially imaged mass in the right upper quadrant which is both T1 and T2 hyperintense. This may represent a distended gallbladder, however is only partially imaged secondary to lumbar spine acquisition technique. Recommend evaluation with abdominal ultrasound for a more thorough characterization.3.Mild degenerative changes without significant stenoses.4.Findings were discussed with Dr. Blackman (covering for Dr. Cotts) on 2/16/2015 at approximately 2:35 p.m.


Instruction: Generate impression based on findings.

Input: 37-year-old female with right knee pain. Assess for lateral meniscus tear. MENISCI: There is abrupt truncation of the inner half of the posterior horn of the lateral meniscus indicating a radial tear. The tear extends in a longitudinal fashion along the periphery of the posterior horn toward its root. The anterior horn and body appear intact. There is marked attenuation of the body and posterior horn of the medial meniscus indicating extensive tearing. The root of the medial meniscus is not clearly visible, also likely representing tearing. The anterior horn of the medial meniscus appears intact. Foci of low signal intensity within the medial gutter above the body of the meniscus may represent displaced meniscal fragments.ARTICULAR CARTILAGE AND BONE: There is a large full-thickness defect of the articular cartilage of the weightbearing portion of the medial femoral condyle measuring approximately 1.5 cm in diameter. There is mild edema type signal within the underlying subchondral bone. There is additional mild edema type signal abnormality within the proximal tibia which may reflect resolving contusion. There is minimal heterogeneity of the articular cartilage of the lateral compartment suggesting mild degeneration but no fluid-filled defect is evident. The articular cartilage of the patellofemoral compartment appears intact. LIGAMENTS: The ACL is indistinct likely representing a chronic tear with a few horizontal fibers noted along the tibial plateau. The PCL, MCL and LCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Lateral and medial meniscus tears as described above.2. Full-thickness defect of the articular cartilage of the medial femoral condyle.3. Chronic ACL tear and other findings as described above.


Instruction: Generate impression based on findings.

Input: 29-year-old male with a history of remote trauma to the left foot presents with worsening left foot pain localized to the left fifth toe. Evaluate for Lisfranc injury. There is edema within the middle phalanx of the fifth toe surrounding a band of low signal intensity likely representing a nondisplaced fracture. Edema is also noted within the distal phalanx suggesting coalition of the middle and distal phalanges. The remaining phalanges are normal. The metatarsals and bones of the midfoot are unremarkable, although the proximal extents of the navicular and cuboid are not visualized in their entirety.The dorsal component of the Lisfranc ligament appears intact. Although the remaining components are not well visualized, there is no signal abnormality in the vicinity of the ligament or malalignment to suggest injury. The remainder of the soft tissues appear normal.

Output: 1. Fracture of the middle phalanx of the fifth toe.2. No findings to suggest Lisfranc ligament injury.


Instruction: Generate impression based on findings.

Input: Diagnosis: Headache(784.0)Other diseases of lung, not elsewhere classifiedClinical question: Inflammatory pseudotumor, f/u progressionSigns and Symptoms: headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The patient is status post left parietal craniotomy. There is adjacent dural enhancement which is unchanged from the prior exam.There is a focus of encephalomalacia present along the posterior aspect of the left paracentral lobule and the anterior aspect of the left precuneus. This has not changed since the prior examThe cerebellar tonsils are low lying extending 3 mm below the level of the foramen magnum.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening along the left maxillary sinus. The visualized portions of the mastoid air cells redemonstrate partial opacification of the right mastoid air cells and middle ear. The patient is status post right mastoid surgery. The visualized portions of the orbits are intact.

Output: 1.The patient is status post left parietal craniotomy. There is encephalomalacia present in the left medial parietal lobe associated with adjacent dural thickening all of which is stable and compared to the prior exam. The patient has a prior diagnosis of dural pseudotumor.2.Opacification of the right mastoid air cells and middle ears persists and is associated with contrast enhancement is a stable compared to the prior exam. The patient is status post right mastoid surgery. Please correlate with surgical findings.3.Low-lying cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:5/4/1971)Reason: hx cervical spondylosis. Eval abnormality/stenosis History: neck pain, left arm painPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a broad-based central disc protrusion present this level which impresses on the ventral aspect of the thecal sac and partially effaces spinal fluid ventral to the spinal cord. There are some endplate reactive changes at this level which are high signal on T2 imaging and low signal on T1 imaging.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There are small T2 hyperintense foci in the right thyroid lobe measuring up to 6 mm in diameter.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. There are some endplate reactive changes present there is some mild ligamentum flavum hypertrophy present at this level.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. There is a disc bulge.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 4 cm cyst present along the right kidney along its inferior pole.

Output: 1.There are degenerative changes present in the cervical spine which are worse at C4-5 where there are subacute endplate reactive changes and a central disc protrusion without significant compromise to the spinal canal or exiting nerve roots.2.There are mild degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots.3.There is a cyst along the right kidney.


Instruction: Generate impression based on findings.

Input: Medial joint pain MENISCI: There is a small branching focus of increased signal intensity arising from the posterior third of the medial meniscus which may extend to the tibial articular surface; however this is equivocal and only seen on a single slice. This may represent a small undersurface tear within the vascularized portion of the meniscus or alternatively represent a small vessel. The remaining medial meniscus is intact.There is slight blunting of the posterior horn of the lateral meniscus which is suspected to reflect post meniscectomy changes although could represent attritional tearing if the patient only underwent meniscal repair. A small vertically oriented focus of signal intensity is seen within the periphery of the posterior horn which extends to the femoral articular surface. This could represent the area of prior meniscal repair and we see no fluid signal intensity to entering the meniscus to suggest an unstable tear. Additional small foci of increased signal are noted within the body of the lateral meniscus which may represent suture from prior repair but again we see no fluid signal entering the meniscus to suggest unstable tear.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: There is mild subcutaneous edema along the medial aspect of the patella which is nonspecific.ADDITIONAL

Output: 1. Mild edema along the medial aspect of the patella which is nonspecific in nature.2. Mild abnormal signal intensity within the peripheral fibers of the medial meniscus is favored to represent vascularity as opposed to a true small tear. There are no findings to suggest an unstable tear.3. Lateral meniscal abnormalities further detailed above are favored to reflect surgical changes as opposed to true meniscal tearing.


Instruction: Generate impression based on findings.

Input: Male, 83 years old, with back pain radiating down the legs. A dextroscoliosis of the lumbar spine is seen with right lateral subluxation of L3 relative to L4. Sagittal alignment is grossly within normal limits. Chronic left lateral wedging of the L1 to L3 vertebrae, and right lateral wedging of L4, is seen related to scoliosis. Otherwise, vertebral body heights are preserved. No evidence of significant marrow edema is seen.The visualized distal spinal cord and conus are within normal limits. Within the right posterolateral spinal canal at the L5-S1 level, there is a collection which measures 20 x 7 mm in the axial plane and 25 mm in the sagittal plane. The collection is T1 and T2 bright with a hypointense circumferential rim and a hypointense internal septation. This collection narrows the thecal sac and displaces the adjacent nerve roots, though the sac was capacious to begin with and there is no significant crowding or impingement of the nerve roots.L1-2: Facet arthropathy and ligamentum flavum thickening have minimally progressed. Progressive loss of disc height but disc bulging is relatively unchanged. Mild generalized spinal canal narrowing, particularly affecting the left lateral recess. Moderate left foraminal narrowing, progressed. L2-3: Facet arthropathy and ligamentum flavum thickening have minimally progressed. Progressive loss of disc height but disc bulging is unchanged. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing, progressed. L3-4: Facet arthropathy and ligamentum flavum thickening have minimally progressed. Loss of disc height and disc bulging are unchanged. Mild spinal canal narrowing without change. Moderate to severe left foraminal narrowing without change. L4-5: Facet arthropathy and ligamentum flavum thickening without change. Loss of disc height and disc bulging, asymmetric to the right foraminal zone, unchanged. Mild to moderate narrowing of the spinal canal, particularly the right lateral recess, without change. Severe right foraminal narrowing without change. L5-S1: Facet arthropathy and ligamentum flavum thickening, progressed. A dorsally projecting synovial cyst is seen on the right. Disc bulging with progression in the right foraminal zone. Mild spinal canal narrowing due to the right posterolateral collection as above. Severe right foraminal narrowing with likely nerve root impingement, progressed.

Output: A collection is evident within the right posterolateral spinal canal at the L5-S1 level. The collection may be either epidural or subdural in location. Internal signal characteristics suggest that the fluid is proteinaceous or hemorrhagic in nature. The collection does narrow the thecal sac and displace adjacent nerve roots. However, the sac was capacious at this level to begin with and the degree of overall narrowing is mild.Multilevel disc and posterior element degeneration is seen in the context of a scoliotic deformity. Progression of degenerative disease is seen at most levels. Of note, foraminal narrowing is moderate to severe on the left at L3-4, and severe on the right at L4-5 and L5-S1.


Instruction: Generate impression based on findings.

Input: 99-year-old female with headache. There is no evidence of intracranial hemorrhage, mass or edema. Mild, diffuse hypodensities in the periventricular and subcortical white matter distribution consistent with mild small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: 60 year old with BRCA positive, strong family history of breast cancer Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.No significant change in the 7 mm oval mass, likely an intramammary lymph node, in the central left 6:00 position. 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: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Male; 58 years old. Reason: evaluate source of pain near kidney History: pain upper back ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal simple cysts. Additional cysts demonstrate high T1 signal, likely due to internal proteinaceous or hemorrhagic debris, though these are incompletely characterized without intravenous contrast.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate hiatal hernia, similar to prior exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No acute abdominal abnormality.2. Bilateral renal cysts are incompletely characterized without intravenous contrast.


Instruction: Generate impression based on findings.

Input: There is an infiltrating T2 hyperintense lesion within the left insular cortex and amygdala with mild associated mass effect. While measurements are difficult, it is unchanged in size compared with the 10/29/2014 exam with the amygdala portion measuring 14 mm in AP thickness and 18 mm in height. There is no associated elevated relative cerebral blood volume. There are a few scattered unchanged punctate foci of susceptibility effect within the left parietal lobe compatible with chronic microhemorrhages or cavernous malformations. There is a punctate focus of enhancement, diffusion restriction, T2 hyperintensity, and susceptibility effect within left post central gyrus that is unchanged compared with the 3/25/2015 exam and not present previously. There is no associated elevated relative cerebral blood volume and the pattern is most compatible with small vascular anomaly. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Infiltrating nonenhancing lesion within the left insular cortex and amygdala is unchanged dating back to at least October 2014.


Instruction: Generate impression based on findings.

Input: Stroke. Cranial MR Angiography:The intracranial internal carotid arteries are of preserved caliber and flow-related signal. Similarly, the anterior and middle cerebral arteries as well as their major branches are normal as well. The basilar artery is codominantly supplied by the vertebral arteries. The posterior cerebral arteries are unremarkable. There is no aneurysm.Neck MR Angiography:While there is no significant abrupt change in vessel caliber, the vessels cannot be accurately assessed given the nature of MR angiography technique (non contrast enhanced MRA of the neck vessels). The vertebral arteries are normal.

Output: There is no significant steno-occlusive disease in the head and neck. However, the assessment of the neck vessels is limited given the technical limitation of used MR angiography.


Instruction: Generate impression based on findings.

Input: History of dilated pancreatic duct on MRCP, stricture, acute pancreatitis and cystic lesions in the pancreas. ABDOMEN:LIVER, BILIARY TRACT: Heterogeneous T2 hyperintensity of the peripheral posterior hepatic segment is unchanged. Stable 7 mm hepatic lobe cyst. No suspicious liver lesion.The liver is otherwise normal in morphology, size and signal intensity.Stable minimal intrahepatic biliary ductal irregularity.The portal vein is replaced by numerous collateral vessels in the hepatic hilum, unchanged.SPLEEN: The splenic vein is not well opacified and is suspected to be thrombosed. The spleen is normal in size. There are small gastroepiploic collateral vessels.PANCREAS: The pancreatic body/tail lobular cystic lesion measures 1.4 x 1.2 cm (series 3/19), not significantly changed from the prior where it measured 1.5 x 0.9 cm. It has internal thin enhancing septations. No mural nodularity or soft tissue enhancement. It does not definitively communicate with the main pancreatic duct which is normal in caliber.Approximately 7 mm pancreatic tail intermediate T2-weighted signal and low T1 weighted signal intensity lesion without enhancement.The pancreas demonstrates normal intrinsic T1-weighted signal. No evidence of acute inflammation. Demonstrated again is a stricture of the pancreatic tail with mild obstructive dilatation. Following secretin administration there is an adequate exocrine response with fluid extending to the level of the ligament of Treitz.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild atherosclerotic disease of the abdominal aorta without aneurysmal dilatation.OTHER: No significant abnormality noted.

Output: 1.1.4 x 1.2 cm pancreatic body/tail lobular cystic lesion with internal thin enhancing septations but no mural nodularity or other suspicious features. Stable nonspecific 7 mm cystic lesion in the pancreatic tail.2.Stable pancreatic duct stricture at the level of the pancreatic tail. 3.The portal vein is replaced by numerous small collateral vessels, unchanged. Suspected splenic vein thrombosis.


Instruction: Generate impression based on findings.

Input: There is no evidence of leptomeningeal mass lesions or abnormal enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a subcentimeter defect in the left basal ganglia. There is also mild scattered cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are posterior disc-osteophyte complexes in the upper cervical spine with a certain degree of spinal canal stenosis.

Output: 1. There is no evidence of leptomeningeal carcinomatosis or other forms of intracranial metastases.2. Chronic left basal ganglia lacunar infarct and mild probable chronic small vessel ischemic disease. 3. Posterior disc-osteophyte complexes in the upper cervical spine with a certain degree of spinal canal stenosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 68-year-old female with joint pain. Evaluate for fracture.IMAGE ACQUISITIONS: CT through the right ankle performed without contrast enhancement and reformatted images obtained for sagittal, coronal and axial reconstructions. In addition, 3-D reconstruction was done at an independent work station. Non-infused CT of the right ankle shows no evidence of acute fracture. Severe osteoarthritis affects the talonavicular joint, with bone-on-bone apposition and prominent subchondral cysts. Subchondral cysts are also seen at the subtalar and calcaneocuboid joints. Mild osteoarthritis at the tibiotalar joint. There is a large os trigonum posterior to the talus. The navicular appears to be slightly inferiorly subluxed with respect to the talus. There is eversion of the calcaneus with resultant osteoarthritic changes of the calcaneofibular articulation. There are small loose bodies in the lateral gutter of the ankle. Recent radiographs suggest a severe planovalgus deformity.Soft tissue attenuation along the head of the talus and the distal fibula may represent edema or scar tissue, and obscures the ligamentous structures of the ankle. The Achilles tendon is intact and the remaining ankle tendons are grossly intact, given the inherent limitations of CT or examination; however, we cannot exclude a partial-thickness tendon tear on CT, and if further imaging is warranted clinically, MRI can be considered.

Output: 1. No evidence of acute fracture.2. Arthritic changes as described above, including eversion of the calcaneus and plantar subluxation of the navicular, which may reflect a neuropathic arthropathy or chronic posterior tibialis tendon dysfunction.


Instruction: Generate impression based on findings.

Input: 72-year-old male has intracranial mass with possible NPH. Memory difficulty and gait instability. Evaluate ventricular system and lesion if possible and Large extra-axial mass at the level of the left petroclinoid ligament, left cerebellopontine and prepontine cistern lesion consistent with a meningioma is redemonstrated. The lesion appears to extend into the left cavernous sinus. The density and size of lesion remains is stable since prior exam. Mass-effect on the pons is identical to prior study. Minimal difference in the appearance of tumor can be explained based on the slice angulation and positioning. Further evaluation with an MRI is recommended. No evidence of parenchymal edema adjacent to the tumor is identified. Images through posterior fossa demonstrate slight prominence of the lateral ventricles with no definitive interval change since prior exam.

Output: 1.Redemonstration of left petroclinoid ligament meningioma with no definitive evidence of change. Further evaluation with an MRI would be significantly more sensitive.2.Stable CT examination of brain with prominence of the supratentorial ventricular system.


Instruction: Generate impression based on findings.

Input: 64-year-old female with persistent right knee pain. MENISCI: There is a radial tear of the posterior horn of the medial meniscus, at or just medial to its root, that appears to involve the full thickness of the meniscus. There is globular signal within the posterior horn and body of the medial meniscus indicating intrasubstance degeneration. There is slight medial extrusion of the body of the medial meniscus. There is intrasubstance degeneration of the lateral meniscus, but we see no tear.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the patellofemoral joint with full-thickness cartilage loss, particularly along the lateral facet of the patella and femoral trochlea with underlying subchondral cysts. There are multiple near full-thickness to full-thickness cartilage defects also affecting the tibiofemoral articulations with small subchondral cysts and mild degenerative edema type signal within the tibial plateau and medial femoral condyle. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is a thin focus of fluid signal intensity deep to the iliotibial band extending superficial to the lateral collateral ligament proper that may reflect a mild bursitis.EXTENSOR MECHANISM: The extensor mechanism appears intactADDITIONAL

Output: 1. Full-thickness radial tear of the posterior horn of the medial meniscus at or near its root.2. Severe osteoarthritis of the patellofemoral joint with moderate osteoarthritis of the tibiofemoral compartments.3. Fluid/edema along the iliotibial band may reflect a bursitis.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are are multiple patchy subcentimeter foci of T2/FLAIR hyperintensity within the bilateral frontal subcortical white matter as well as an additional focus within the left occipital subcortical white matter. The myelination pattern is appropriate for age. The ventricles and basal cisterns are normal in size and configuration. The midline structures and craniocervical junction are within normal limits.There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mild paranasal sinus mucosal thickening and fluid within the left mastoid air cells.

Output: 1.Multiple nonspecific patchy foci of signal abnormality within the bilateral frontal and left occipital subcortical white matter. These are nonspecific but may represent atypical perivascular spaces or foci of gliosis from prior insults. There is no evidence of congenital malformation. 2.Mild non-specific paranasal sinus mucosal thickening and fluid within the left mastoid air cells. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 31 year old female with nausea/vomiting, headache, fatigue, history of VP shunt placed 2/02/12 currently on intrathecal chemotherapy for history of breast cancer with leptomeningeal/thoracic metastases. Shunt unable to be opened status post chemotherapy on 2/22/12. There is redemonstration of a right frontal approach VP shunt terminating in the region of the left foramen of Monro, unchanged in position when compared to the previous study. Interval enlargement of the lateral ventricles bilaterally and the third ventricle. The frontal horn of the left lateral ventricle measures 16 mm (15; series 4), previously 13 mm. The third ventricle measures 10 mm, previously 9 mm. There is no evidence of transependymal CSF flow. The sulci are normal in size and configuration. There is no midline shift or basal cistern effacement.There is no evidence of acute intracranial hemorrhage, extra-axial fluid collection, mass or edema. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. The leptomeningeal metastatic disease seen on the prior MRI is not resolved on this noncontrast CT.The calvaria and skull base are radiographically normal. Previously seen swelling over the right scalp has subsided. The visualized mastoid air cells and paranasal sinuses are clear apart from some debris within the sphenoid sinuses, unchanged.

Output: Stable positioning of right sided VP shunt with mild interval enlargement of the lateral ventricles and third ventricle. No transependymal CSF resorption, acute intracranial hemorrhage, or mass effect.


Instruction: Generate impression based on findings.

Input: 76-year-old female with a history of breast cancer, presenting with dizziness, lightheadedness and near-syncope for one week. No evidence of acute intracranial hemorrhage or infarction. No evidence of edema or mass. Scattered hypoattenuating regions in the cerebral white matter roughly correlate with hyperintensities seen on prior MRI form 2003.The ventricles and basal cisterns are unremarkable in size and configuration.The calvaria and skull base are radiographically unremarkable. Scattered lucent lesions in the calvarium are nonspecific, but do not appear aggressive. Visualized paranasal sinuses and mastoid air cells are normally pneumatized. Bilateral internal carotic artery calcifications are noted.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: A 51 year old male with personal history of coronary artery disease and diabetes mellitus, now hospitalized with acute on chronic heart failure while the echocardiography showed a severely reduced systolic function. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 147 ml/m2 (normal range: 74+/-15), the LVEDV is 327 ml (normal range 142+/-34), the LV end systolic volume index is 127 ml/m2 (normal range 25+/-9), the LVESV is 283 ml (normal range 47+/-19), the LV mass index is 76 g/m2 (normal range 85+/-15), and the LV mass is 170 g (normal range 164+/-36). The base to mid segments of the lateral, inferolateral and inferior walls are hypokinetic, the other segments are akinetic. There is intermediate signal of late gadolinium enhancement at the mid-myocardium, which may be artifactual. No convincing evidence of an infiltrative or fibrotic process. No evidence of infarct on delayed hyperenhancement MRI. No myocardial iron overload.The native myocardial T1-times are normal.No intracavitary thrombus was seen.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderately dilated with severely reduced systolic function. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 144 ml/m2 (normal range 82+/-16), the RVEDV is 321 ml (normal range 142+/-31), the RV end systolic volume index is 104 ml/m2 (normal range 31+/-9), and the RVESV is 231 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is trace pericardial effusion.Extracardiac FindingsA moderate right pleural effusion was seen. 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 severely dilated with severely reduced systolic function, the LVEF is 14%. The base to mid segments of the lateral, inferolateral and inferior walls are hypokinetic, the other segments are akinetic. 2. No convincing evidence of myocardial infarction. No evidence of an infiltrative or fibrotic process within the LV myocardium.3. The right ventricle is moderately dilated with severely reduced systolic function, the RVEF is 28%. 4. There is bilateral atrium dilation.5. At least mild MR and moderate TR.6. Moderate right pleural effusion.


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 left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 0:12

Output: Successful intra-articular contrast injection for a left hip MRI arthrogram.


Instruction: Generate impression based on findings.

Input: Reason: History of headache, evaluate for intracranial process or infection. The ventricles and sulci are prominent, consistent with mild age-related volume loss. The subarachnoid spaces remain somewhat more prominent anteriorly. The basal cisterns are patent. There is no midline shift or mass effect. Scattered punctate foci of increased T2/FLAIR signal within the subcortical and periventricular white matter are nonspecific but compatible with chronic small vessel ischemic changes, not significantly changed. Multiple small chronic cortical infarcts are seen within the cerebellum, also appearing similar to prior. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is a partially empty sella, not significantly changed.There is minimal patchy opacification within the paranasal sinuses. There is mild rightward nasal septal deviation.

Output: 1.No acute ischemia or other acute intracranial abnormality.2.Mild chronic small vessel and cerebellar cortical ischemic lesions.


Instruction: Generate impression based on findings.

Input: 58-year-old female presents with right wrist pain, evaluate for scapholunate ligament tear. There is separation of the scaphoid and lunate with rotary subluxation of the scaphoid. The contrast injected into the midcarpal space extends into the radiocarpal space consistent with a scapholunate ligamentous tear. No contrast is identified in the distal radioulnar joint indicating an intact triangular fibrocartilage. The osseous structures, and musculature, and soft tissues are otherwise unremarkable.

Output: Findings consistent with tearing of the scapholunate ligament.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with brain mass. Preoperative assessment and planning exam is required. A large centrally necrotic and rim-enhancing mass is present occupying the entire right anterior temporal lobe with extension superiorly to involve the insula and the corona radiata. This lesion measures 63 x 47 mm in the axial plane and 48 mm in the craniocaudal dimension. The lesion is mildly hemosiderin stained internally.The lesion is in contact with the right lateral ventricular atrium and there is clear subependymal enhancement along the atrium. No definite contralateral enhancement or masslike signal abnormality is seen.The lesion exerts significant regional mass effect with sulcal effacement and midline shift to the left of up to 10 mm. The right lateral ventricle is effaced. The right uncus is medialized, but the basal cisterns are otherwise patent. Extensive T2 signal abnormality spreads superiorly and posteriorly from the lesion reaching the right occipital lobe, the basal ganglia and the right frontal and parietal centrum semiovale.No other significant parenchymal signal abnormality is seen. The left lateral ventricle is slightly prominent but this likely reflects atrophy rather than entrapment. The cerebellum shows evidence of volume loss.

Output: A large rim-enhancing right temporal lobe mass is seen with extension superiorly to involve the insula and corona radiata. The mass contacts the right ventricular atrium and there is evidence of subependymal spread. Significant regional mass effect is also seen.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease with perianal abscess. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Originating at approximately the 1:00 position of the anal canal is a very thin T2-weighted fluid tract which proceeds caudally within the intersphincteric space terminating on the left gluteal cleft. Proximally this is associated with a 2 mm non-drainable fluid focus near its origin.Additional, probably blind-ending sinus tract origination from the 6:30 position (series 8/50). In the distal anal canal there is a vague region of linear T2-weighted mild hyperintensity extending through the 8:00 position extending trans-sphincterically where there is mild edema type signal in the perirectal ischioanal fossa. This may represent a small sinus tract with inflammation or granulation/healed tissue.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Perianal fistula and sinus tract disease without a drainable fluid collection.


Instruction: Generate impression based on findings.

Input: 46 years Female (DOB:10/18/1969)Reason: persistent right temporal headaches; evaluate for mass or vascular changes History: persistent right temporal headachesPROVIDER/ATTENDING NAME: NICOLE M LEONG NICOLE M LEONG The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small air-fluid levels.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for intracranial mass or other intracranial lesion that would explain the patient's headaches2.There were air-fluid levels present in the maxillary sinuses. The possibility of acute sinusitis cannot be excluded. Another possibility is that this represents retained secretions due to other cause. Patient reportedly has a history of allergic retinitis and sinusitis.


Instruction: Generate impression based on findings.

Input: T4aN2b BOT SCC, p16+ on OPTIMA IC with carbo/Abraxane. There has been marked interval decrease in size of a right tongue base tumor, without measurable residual tumor. There is no evidence of residual significant lymphadenopathy in the neck. For example, a necrotic right level 2B lymph node measures 6 mm in short axis and an ill-defined right level 2A lymph node measures 5 mm in short axis. The thyroid and salivary glands are unremarkable. The larynx appears to be intact. There is multilevel degenerative cervical spondylosis with mild spinal canal narrowing at C3-4 and C4-5. The orbits and imaged intracranial structures are unremarkable.

Output: No evidence of residual measurable tumor in the right tongue base and no evidence of residual significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Dysphonia [R49.0], Reason for Study: ^Reason: neuro History: same Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Retention cyst is seen on the left maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 5 mm sized right paraophthalmic aneurysm.Otherwise, bilateral MCAs and ACAs appears to be normal., Vertebrobasilar system appears to be normal. No evidence of significant luminal stenosis.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. About 5 mm sized right paraophthalmic aneurysm. No other intracranial aneurysm is seen. 3. No evidence of arterial luminal stenosis on both intracranial and extracranial arterial system.


Instruction: Generate impression based on findings.

Input: Clinical question: Brain metastases? Breast-cancer. Signs and symptoms: Confusion. Post-enhanced brain MRIunremarkable diffusion weighted series.Examination demonstrates mild periventricular and subcortical findings of chronic small vessel ischemic strokes. Extensive similar findings are also detected in pons without evidence of similar lesions in the basal ganglia or thalami. Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise for patient's stated age of 66.The signal void of major intracranial arterial branches are identified.Images through the orbits, paranasal sinuses, mastoid air cells, calvarium and soft tissues of the scalp are unremarkable.There is no detectable abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement to suggest metastatic disease.

Output: 1.No evidence of metastatic disease.2.Negative diffusion weighted images and findings of chronic non-hemorrhagic small vessel ischemic strokes as detailed above.


Instruction: Generate impression based on findings.

Input: 32-year-old female with history of multiple sclerosis presenting with left upper extremity pain and left numbness from the chest wall to the foot, worsening gait. MRI BRAIN: There are approximately 20 T2/FLAIR hyperintense lesions within the periventricular and subcortical white matter with morphology and distribution compatible with known demyelinating disease. There is a lesion involving the left middle cerebellar peduncle extending to the superior cerebellar peduncle. There is mild burden of T1 hypointense lesions. Two of these lesions demonstrate enhancement, one of which is located within the right posterior temporal lobe and the other within the left parietal lobe.Brain parenchymal volume is grossly preserved. There is no mass effect or midline shift. There is no evidence of intracranial hemorrhage. The ventricles basal cisterns are normal in size and configuration.MRI CERVICAL SPINE: Straightening of the cervical spine likely related to patient positioning. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There are two T2/STIR hyperintense lesions related to known demyelinating disease within the spinal cord along the left posterolateral aspect of C1 and the left posterior aspect of C2-C3 levels. The lesion along the posterior aspect of C2-C3 demonstrates enhancement consistent with active demyelination.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.

Output: Findings compatible with known demyelinating disease within the brain and upper cervical spinal cord. A left parietal, right posterior temporal, and a left C2-C3 cervical cord lesion demonstrate enhancement consistent with active demyelination.


Instruction: Generate impression based on findings.

Input: CT of the maxillofacial region without the infusion:Examination demonstrates a large destructive bony metastasis of the right frontal bone involving the floor of the right anterior cranial fossa and with a significant extracranial component which measures 80-mm in AP axis and 40-mm in transverse axis (axial image 6 of 50). Although not as well-visualized on this exam as it was noted on MRI of brain dated 10 -- 10 -- 2009 there is a large intracranial extension of tumor into the right anterior and middle cranial fossas. Extensive destructive changes of the frontal bone along the floor of the right anterior cranial fossa, lateral orbital ridge and greater wing of the sphenoid on the right is noted. There is a large extraconal retro-orbital spread of tumor which does not extend to the apex of the orbit. This component of the mass measures 53-mm times 26-mm in transaxial dimensions (axial image 50). There is significant mass effect on the retro-orbital content, including lateral rectus, superior rectus, right optic nerve and globe which is significantly deformed. There is also suggestion of extension of tumor into the right frontal sinus. This component of tumor within the right frontal sinus may be a second smaller metastatic lesion. There is no apparent involvement of the cavernous sinus. No extension of tumor into the apex of the orbit, no involvement of the lamina papyracea. The extracranial component of the tumor appears to extend inferiorly into the right infratemporal fossa. The paranasal sinuses are well pneumatized and demonstrate only minimal opacification of right anterior ethmoid air cells. Mastoid air cells and middle ear cavities are unremarkable.CT of the soft tissues of the neck with infusion:Redemonstration of large destructive mass involving the right frontal bone with extension into the right anterior cranial fossa and right middle cranial fossa. There is extension of the mass into the right orbit with significant mass-effect on the retro-orbital content. No evidence of involvement of the cavernous sinus is detected. Large extracranial soft tissue component the tumor in the right frontal and temporal region is also present. There is evidence of edema in the right frontal lobe.Images through the skull base and clinic cavernous sinuses are unremarkable otherwise. Paranasal sinuses and mastoid air cells are well pneumatized. The small amount of tumor within the right frontal sinus laterally is also noted.Images through the neck demonstrate no evidence of pathologic adenopathy. The vasculature of the neck remains intact. The thyroid gland is within normal limits. Bony structures of the area of exam are otherwise negative for any additional metastatic lesions.Images through the apices of the lungs demonstrate extensive emphysematous changes and multiple large emphysematous bulla of the right lung apex. No definite metastatic lesion to the lung is detected. No definitive mediastinal lymph nodes.

Output: 1.Large destructive mass involving the right frontal bone along the floor of right anterior cranial fossa with extension into the right orbit, right frontal sinus, right anterior and middle cranial fossas, right frontal temporal extracranial region and right infratemporal fossa. Please see above detailed report.2.Paranasal sinuses are well pneumatized. Please see above comments.3.CT of soft tissues of the neck demonstrate intense enhancement of metastatic lesion to the right frontal bone with extensive intracranial, retro-orbital and extracranial extent as detailed above.4.No evidence of metastatic osseous lesions in other regions.5.No areas of pathologic adenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Diagnosis: Paralysis agitans. Abnormal involuntary movements(781.0)Clinical question: resting tremor concern for Parkinson's The CSF spaces are appropriate for the patient's stated age with no midline shift. On susceptibility imaging there is a signal hypointensity present in the anterior aspect of the right inferior parietal lobule measuring 2mm on the T1 sagittal.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.

Output: There is a microhemorrhage in the right parietal lobe which in isolation is of unknown clinical significance.


Instruction: Generate impression based on findings.

Input: New-onset seizure-like activity. History of HTN, HLD, and dementia thought to be Alzheimer's. Some of the images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a defect in the right corona radiata. There is extensive cerebral white matter T2 hyperintensity, which has progressed since 2012. There are scattered punctate foci of susceptibility effect in a predominantly peripheral lobar distribution. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss, which is more pronounced in the medial temporal lobes. 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 scattered paranasal sinus mucosal thickening and suggestion of a fluid level in the left maxillary sinus. There is a pannus posterior to the dens, which appears to be somewhat eroded.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarction.2. Extensive chronic probable small vessel ischemic disease or hypertensive encephalopathy, which has progressed since 2012, and chronic lacunar infarct in the right corona radiata.3. Scattered punctate foci of susceptibility effect in a lobar distribution may represent amyloid angiopathy. 4. Diffuse cerebral volume loss, which is more pronounced in the medial temporal lobes, suggests Alzheimer's disease.5. Suggestion of acute sinusitis.6. Pannus posterior to the dens, which appears to be somewhat eroded. This may be a manifestation of rheumatoid arthritis or crystalopathy, for example.


Instruction: Generate impression based on findings.

Input: 54-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.7 x 3.4 x 4.7 cm.Peripheral Zone: A small (0.5 x 0.3 cm) focus of T2 and ADC hypointensity in the midline mid gland (series 501 image 73, series 608 image 244) is identified. Linear peripheral zone decreased T2 signal intensity is not felt to represent neoplasm.Central Gland: A well-defined symmetric T2 and ADC hypointense focus in the anterior midline transitional zone (series 901 image 13, series 608 image 204) measuring 1.2 x 0.6 cm could represent an additional focus of malignancy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small focus of T2 and ADC hypointensity in the midline mid gland and additional well-defined T2 and ADC hypointense focus in the anterior midline transitional zone are concerning for malignancy. Both lesions are amendable to biopsy as needed.


Instruction: Generate impression based on findings.

Input: Right-sided neck pain, right upper extremity radicular symptoms, and right lower back pain. Cervical Spine: A posterior disc osteophyte complex and uncovertebral joint hypertrophy at C3-4 result in mild central and bilateral neural foraminal stenosis. There are no significant degenerative changes identified at the other cervical spinal levels. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Lumbar Spine: There are small annular fissures at L2-3 and L5-S1, with associated slight posterior disc bulges. However, there is no significant central canal or neuroforaminal narrowing at these or other lumbar spine levels. The vertebral body heights are preserved and there is no spondylolisthesis. The vertebral bone marrow signal is unremarkable. The distal spinal cord and cauda equina display normal signal and morphology. The conus medullaris tip is located at the T12-L1 level. The paravertebral soft tissues are unremarkable.

Output: 1.Mild spinal canal and bilateral neural foraminal stenosis at C3-4.2.Small annular fissures associated slight posterior disc bulging at L2-3 and L5-S1, but no significant central canal or neuroforaminal narrowing.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: metastatic NSCLC with brain mets, s/p SRS, assess for recurrence/progression History: post-treatment follow-up Previously seen enhancing lesions including right inferior parietal lobule, left post central gyrus and left temporo-occipital (only seen on fat saturated axial scan, series 10, image #20/32) lesions appear to be stable in size and enhancement degree since prior scan.There is no other abnormal enhancing lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Stable multiple enhancing lesions in terms of size, enhancement degree and pattern since prior scan.2. No evidence of new abnormal enhancement. No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 43-year-old female with a known cavernoma. Reason: 3T Scanner, CCM Protocol, QSM/permeability, solitary CCM vs tumor History: surveillance; HAs, vertigo, difficulty w balance. Redemonstrated is a 4 x 6 mm (transaxial dimension) T1 and T2 hypointense lesion in the left pons that demonstrates susceptibility abnormality. Stable peripheral enhancement surrounding the central hypointensity is again noted indicating an anomalous draining vein. There is no perilesional edema. These findings are unchanged compared to the prior exam and are compatible with a small cavernous malformation. There are no other similar appearing foci.There is no evidence of acute infarct. 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. Scattered mucosal thickening can be found and the paranasal sinuses without superimposed fluid levels. Mastoid air cells are clear. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Stable small cavernous malformation of the left pons and adjacent small anomalous draining vein.


Instruction: Generate impression based on findings.

Input: Evaluate language area in a patient with intractable epilepsy for surgical planning purposes. Of the tested language paradigms, the most reliable language related cortical activation is seen with the sentence completion, rhyming, and verb generation paradigms. All paradigms demonstrate similar patterns of activity. Language is left dominant. Broca's area is identified in the left pars triangularis and orbitalis, and Wernicke's area is identified along the posterior left superior temporal sulcus.

Output: Successful functional MRI for identification of language areas. Language is left dominant. Broca's and Wernicke's areas are identified in their customary locations.


Instruction: Generate impression based on findings.

Input: Male 66 years old Reason: Left knee pain that is persistent and associated with clicking, evaluating for meniscal injury MENISCI: Mixed globular and linear signal within the posterior horn and body of the medial meniscus indicating intrasubstance degeneration. This signal extends in more vertical fashion to the tibial articular surface on several sagittal sequences indicating a large and probably complex undersurface tear. The anterior horn of the medial meniscus is relatively preserved. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full thickness loss of cartilage along the anterior aspect of the lateral femoral condyle extending along the femoral trochlea with underlying subchondral cyst formation. There is mild superficial degeneration of the articular cartilage of the lateral tibial plateau posteriorly. There is full-thickness cartilage loss along the lateral facet of the patella superiorly with additional foci of cartilage loss and fissuring along the medial facet and median ridge with underlying subchondral cyst formation. There is focal full-thickness degeneration of cartilage of the medial facet of the femoral trochlea with underlying subchondral degenerative signal. There is also near full-thickness/full-thickness degeneration of the articular cartilage of the weight-bearing portion of the medial femoral condyle.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Degeneration and tearing of the medial meniscus as described above.2. Osteoarthritis as described above.3. Probable small cartilaginous loose bodies within the joint.4. Baker's cyst.5. Attenuation of the popliteal vein which would be better assessed with Doppler sonography to exclude occlusion/deep venous thrombus.


Instruction: Generate impression based on findings.

Input: ACTH-dependent hypercortisolism. There appears to be a hypoenhancing area in the left pituitary that measures up to 3 mm. The pituitary gland is otherwise not enlarged, measuring up to 7 mm in craniocaudal dimension. The infundibulum is intact. There is no mass effect upon the optic apparatus or cavernous sinuses. The imaged portions of the brain are unremarkable.

Output: An apparent hypoenhancing area in the left pituitary that measures up to 3 mm may represent a pituitary microadenoma.


Instruction: Generate impression based on findings.

Input: Male, 45 years old, with low back pain. Spinal alignment is anatomic the vertebral in morphology and signal characteristics are within normal limits. No evidence of marrow edema is detected. The spinal cord, conus and cauda equina are within normal limits.L1-2: Unremarkable. No significant interval changes. L2-3: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L3-4: Mild facet hypertrophy. Mild laterally bulging disk. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L4-5: Moderate facet hypertrophy. Loss of disk T2 signal. Laterally bulging disk with a left paracentral annular fissure. On the prior examination, there was a small protrusion at the level of the annular fissure which seems to have resolved. No significant spinal canal stenosis. Mild bilateral foraminal narrowing L5-S1: Moderate facet hypertrophy. Mild bulging disk with a small central annular fissure which was questionably present on the prior examination. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No significant interval changes.

Output: 1. Mild degeneration of the intervertebral disks without evidence of any high-grade spinal canal or neuroforaminal stenosis. 2. A small left paracentral disk protrusion seen on the prior examination at L4-5 seems to have resolved. 3. No additional findings are seen which would account for the patient's low back pain.


Instruction: Generate impression based on findings.

Input: Male; 44 years old. Reason: Cirrhotic male with hepatic hydrothorax. Requesting a triple phase liver protocol MRI pre TIPS History: Cirrhotic male with hepatic hydrothorax. Requesting a triple phase liver protocol MRI pre TIPS ABDOMEN:LUNG BASES: Very large right pleural effusion and right lower lobe atelectasis, similar to prior study. Gynecomastia.LIVER, BILIARY TRACT: Small, nodular cirrhotic liver. No focal hepatic lesions. Portal veins and hepatic veins are patent. Stable mild narrowing of the proximal main portal vein due to probable chronic marginal thrombus. SPLEEN: Marked splenomegaly. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel wall thickening, likely related to hypoproteinemia.BONES, SOFT TISSUES: Large amount of body wall anasarca.OTHER: Extensive portosystemic collateral varices throughout the abdomen, similar to prior study. Moderate ascites.

Output: 1. Cirrhotic liver without focal mass.2. Evidence of portal hypertension including splenomegaly and ascites.3. Very large right pleural effusion.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Tiny tricompartmental osteophytes are present. Bone marrow signal is within normal limits. The articular cartilage is intact.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Minimal osteoarthritic changes without evidence of internal derangement.


Instruction: Generate impression based on findings.

Input: Sciatica, history of herniated disc at L4,L5. Please reevaluate. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild straightening of the lumbar spinal curvature, alignment is otherwise maintained. Bone marrow signal is benign. Alignment is within normal limits. No focal suspicious osseous lesions are seen. There is mild diffuse low T1 marrow signal which is suboptimally evaluated due to motion degradation and nonspecific. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is disc desiccation and right paracentral disc protrusion which effaces the lateral recess and may be impinging on the descending L5 nerve root. No significant central canal stenosis. There is no significant narrowing of the neural foramina. L5-S1: There is disc desiccation with mild bulge and possible tiny right paracentral disc protrusion. There is however no significant spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Degenerative changes at the L4-L5 and L5-S1 levels. There is a right paracentral disc protrusion at the L4-L5 level which effaces the lateral recess and may be impinging on the right L5 nerve root. There is otherwise no significant spinal canal or neural foraminal stenosis elsewhere in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Known breast cancer patient metastasis to brain, seizure, new facial droop. No evidence of acute ischemic or hemorrhagic lesion on the scan.Patch bilateral periventricular white matter high signal intensity on FLAIR imaging indicate likely nonspecific small vessel ischemic disease.There are matching high signal intensities on FLAIR imaging and T2-weighted imaging corresponds to previously noted enhancing metastatic lesions, however, further MR characterization cannot be performed due to lack of contrast enhancement scans.No change of left parietal skull lesion, likely represents hemangioma.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. Bilateral mastoid air cells show fluid collection.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Left P-comm artery is patent, right ACA A1 segment is hypoplastic.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. Nonspecific small vessel ischemic disease, scattered multiple high signal intensity foci corresponding to previously noted metastatic lesions on FLAIR and T2-weighted images are again seen, and no significant interval change. However, further MR characterization cannot be performed due to lack of contrast enhanced the scan.3, normal brain MRA and neck MRA.


Instruction: Generate impression based on findings.

Input: 66-year-old male. Evaluate for prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.9 x 6.6 x 7.4 cm.Peripheral Zone: Mild restricted strictured diffusion is seen in the right base posteriorly, suspicious for underlying prostate cancer (series 803/164).Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings suspicious for prostate cancer in the right base without evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: 58 year old man with left bundle branch block and paroxysmal atrial fibrillation referred to evaluate for ischemia. First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact was noted.Viability/ Myocardial ScarThere is no evidence of prior myocardial infarction. However there is mild epicardial late gadolinium enhancement involving the basal inferior wall suggesting that there is a degree of myocardial fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 68 ml (normal range 47+/-19), the LV mass index is 45 g/m2, and the LV mass is 93 g. There is abnormal septal motion related to LBBB. Left AtriumThe left atrium is normal in sizeRight VentricleThe right ventricle is normal in size and systolic function . The overall RV ejection fraction is 54%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 90 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic 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 66%) with evidence of mild late gadolinium enhancement in a pattern that is atypical for prior myocardial infarction but suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. The pattern is non-specific but may represent old myocarditis among other possibilities.4. Normal RV size and systolic function (RVEF 54%).