Instruction: Generate impression based on findings.

Input: Left third nerve palsy and vertical nystagmus. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is extensive bilateral cerebral white matter T2 hyperintensity in the bilateral cerebral hemispheres and in the anterior pons, but the midbrain appears to be intact. There is diffuse cerebral volume loss and disproportionate cerebellar volume loss. There are prominent bilateral basal ganglia calcifications. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly intact.Brain MRA: There is a broad-based 5 mm wide outpouching along the supraclinoid right internal carotid artery, at the origin of the posterior communicating artery. There appears to be mild narrowing of a portion of the right middle cerebral artery M1 segment. The A1 segment of the right anterior cerebral artery is diminutive. There is focal mild narrowing of the proximal left vertebral artery C4 segment. The rest of the anterior and posterior circulation appears to be grossly intact. Neck MRA: Artifact limits the assessment of the proximal neck arteries. Apparent lack of flow-related enhancement in the bilateral V3 segments of the vertebral arteries is likely technical, since these appear to be patent on the corresponding brain MRA sequence. There appears to be mild narrowing of the proximal right internal carotid artery. Otherwise, there is no evidence of significant steno-occlusive lesions in the more distal arteries of the neck.

Output: 1. Extensive bilateral cerebral white matter T2 hyperintensity the bilateral cerebral hemispheres and in the pons are likely related to chronic small vessel ischemic disease, but the midbrain appears to be intact and there is no evidence of acute infarct.2. A 5 mm wide outpouching along the supraclinoid right internal carotid artery, at the origin of the posterior communicating artery is compatible with a wide-neck aneurysm. 3. Apparent mild narrowing of a portion of the right middle cerebral artery M1 segment, diminutive A1 segment of the right anterior cerebral artery, and focal mild narrowing of the proximal left vertebral artery C4 segment. 4. Apparent mild narrowing of the proximal right internal carotid artery. Otherwise, no evidence of significant steno-occlusive lesions in the more distal arteries of the neck.5. Diffuse cerebral volume loss and disproportionate cerebellar volume loss may be related to antiepileptic medication.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate pituitary tumor. Signs and symptoms: History of transsphenoidal resection of pituitary tumor. Pre and post enhanced pituitary MRI:Examination demonstrates postoperative changes of a prior transsphenoidal hypophysectomy. There is a tiny focus of enhancement along the floor of the expanded sella sella in the midline measuring approximately 4 x 1.3 mm in size which could represent scar tissue or remaining pituitary gland. A decreased caliber to the extent with mild enhancement terminates to this focus of enhancement. There is no detectable mass. Enlarged sella likely secondary to priorSignal expansile mass. No detectable abnormality of the suprasellar visual complex and unremarkable cavernous sinuses bilaterally. All visualized paranasal sinuses are well pneumatized.

Output: 1.Postoperative changes of transsphenoidal hypophysectomy without evidence of tumor.2.4 x 1.3 mm focus of enhancement in the midline of floor of the sella which enhancing small caliber particularly stock terminates at.3.Unremarkable cavernous sinuses, basal cistern and the suprasellar visual complex.


Instruction: Generate impression based on findings.

Input: 69 year old female with left breast cancer presents for staging MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, known cancer is present at posterior 9 o'clock position, measuring 35 x 12 x 17 mm (AP x LR x CC). A marker clip is present at anterior-inferior aspect of the mass. The tumor is located just anterior to the pectoralis muscle, but there is no evidence of invasion to the muscle (no enhancement of the muscle). No other abnormal enhancement is present in the left breast.There is no abnormal internal mammary lymph node in left or right internal mammary region. In the right breast, a known benign mass is present in the central aspect, measuring 19 x 15 x 14 mm. At superior aspect of the retroareolar region in the right breast, there is an enhancing focus. This focus corresponds to the benign cluster of calcifications on mammogram, and this is likely a benign papilloma or fibroadenoma. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Known left breast cancer at posterior 9 o'clock position.2. No abnormal lymph node in either internal mammary region or axillary region.3. Known benign mass in the central aspect of right breast and a benign focus in the right retroareolar region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Paraneoplastic panel positive for calcium channel antibody. There is persistent T2 hyperintensity of the bilateral hippocampi, with minimal or no associated swelling. There is also an unchanged punctate focus of T2 hyperintensity in the right frontal centrum semiovale. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There are bilateral maxillary sinus retention cysts.

Output: Persistent T2 hyperintensity in the bilateral hippocampi, which is compatible with paraneoplastic calcium channel antibody limbic encephalitis.


Instruction: Generate impression based on findings.

Input: 57-year-old female with BRCA1 gene mutation and personal history of right breast carcinoma status post lumpectomy in 2006. Patient received radiation and chemotherapy. Family history of breast carcinoma in her paternal aunt, paternal great aunt, and paternal great-grandmother. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Postsurgical changes are present within the upper slightly outer right breast, unchanged. Multiple nonspecific foci of enhancement are present throughout the left breast, unchanged from prior examinations, representing background enhancement. No uniquely enhancing focus is identified. 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: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Male 74 years old Reason: Assess multiple liver lesions found on CT; colon cancer History: colon cancer ABDOMEN:LIVER, BILIARY TRACT: Liver morphology is normal. There are 2 classes of liver lesions. Five lesions with peripheral nodular enhancement with progressive filling located between segments 3 and 4, segment 8 ,segment 7, segment 5 and segment 6 are compatible with hemangiomas. Smaller foci scattered throughout the liver that are T2 hyperintense without enhancement are compatible with cysts.No definite hepatic metastases. Hepatic and portal veins are patent.No gallbladder gallbladder contains multiple calculi. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a solid enhancing mass at the upper pole of the right kidney measuring 1.5 cm compatible with a small renal cell carcinoma. There is a complex cyst in the left kidney with internal septations.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.Multiple cysts and hemangiomas within the liver without definite metastatic disease.2.1.5 cm enhancing lesion at the upper pole of right kidney with imaging features compatible with a small renal cell carcinoma.


Instruction: Generate impression based on findings.

Input: 82-year-old female patient with exophytic left renal lesion seen on prior ultrasound. Evaluate for malignancy. LUNG BASES: Basilar atelectasis and bronchiectasis.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology without suspicious appearing enhancing lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. The previously described lesion in the inferior left kidney is not seen on the current examination.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Incidental note of a left adnexal cyst that measures 2.6 x 2.5 cm (series 6 image 33). Does not demonstrate soft tissue enhancement. Recommend dedicated pelvic ultrasound as clinically indicated.

Output: 1.Bilateral renal cysts without suspicious appearing renal lesion. The previously described lesion in the inferior left kidney on sonography is not seen on this examination.2.Left adnexal cyst.


Instruction: Generate impression based on findings.

Input: 74-year-old male with prostate cancer on active surveillance PELVIS:PROSTATE:Prostate Size: 3.7 x 2.0 x 2.3 cm.Peripheral Zone: There is a T2 hypointense lesion in the left mid gland gland peripheral zone measuring 5 x 8 mm with corresponding restricted diffusion, slightly increased in size, particularly since MR 11/04/14. Central Gland: Mild grade benign prostatic hypertrophy. The post surgical changes of TURP.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: There is probable extracapsular extension. BLADDER: No significant abnormality noted.LYMPH NODES: Scattered subcentimeter external lymph nodes are unchanged.BONES, SOFT TISSUES: Posttreatment changes of bilateral inguinal hernia repair.OTHER: No significant abnormality noted.

Output: 1.Slight increase in size of left mid gland peripheral zone lesion. There may be extracapsular extension.


Instruction: Generate impression based on findings.

Input: Alignment is within normal limits. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. There is a disc osteophyte complex to the right of midline at C5-C6 that flattens the underlying spinal cord. There is also moderate to severe right neuroforaminal narrowing at C5-C6. There is no significant spinal canal narrowing and the remaining neuroforamina are within normal limits.Asymmetric soft tissue at the expected level of the right submandibular gland is noted.

Output: 1.Degenerative disc disease at C5-C6 with cord impingement and moderate to severe right neuroforaminal narrowing.2.Asymmetric soft tissue at the level of the right submandibular gland noted. If clinically indicated, this can be further evaluated with dedicated CT or MRI.


Instruction: Generate impression based on findings.

Input: 48 year old with history of constrictive pericarditis with history of pericardial stripping presenting for evaluation after abnormal finding on echocardiogram. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 109 ml/m2 (normal range: 74+/-15), the LVEDV is 202 ml (normal range 142+/-34), the LV end systolic volume index is 48 ml/m2 (normal range 25+/-9), the LVESV is 89 ml (normal range 47+/-19), the LV mass index is 49 g/m2 (normal range 85+/-15), and the LV mass is 91 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native T1 times are normal at 970 ms. No evidence of extrinsic compression of the left ventricle. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 124 ml/m2 (normal range 82+/-16), the RVEDV is 228 ml (normal range 142+/-31), the RV end systolic volume index is 59 ml/m2 (normal range 31+/-9), and the RVESV is 108 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 mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThe pericardium around the mid-ventricle to apex is not well seen. The pericardium is mildly thickened circumferentially around the basal to mid ventricle. There is minimal increase in pericardial T2-signal. There is mild late gadolinium enhancement of the pericardium. These findings are more suggestive of pericardial fibrosis rather than overt pericardial inflammation. Based on real-time cine image, there is mild respiratory variation in septal position, which is improved from before. There is no overt evidence of pericardial tethering.Extracardiac FindingsSternal wires are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No evidence of extrinsic compression of the heart. 2. The pericardium around the mid-ventricle to apex is not well seen. The pericardium is mildly thickened circumferentially around the basal to mid ventricle. There is minimal increase in pericardial T2-signal. There is mild late gadolinium enhancement of the pericardium. These findings are more suggestive of pericardial fibrosis rather than overt pericardial inflammation. Based on real-time cine image, there is mild respiratory variation in septal position, which is improved from before. There is no overt evidence of pericardial tethering.3. Mild left ventricular dilation with normal systolic function (LVEF 56%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Mild right ventricular dilation with normal systolic function (RVEF 52%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: diplopia, ptosis, progression MS. There are multiple, greater than 10, T2 hyperintense lesion in the supratentorial and infratentorial white matter, including in the juxtacortical, deep, and periventricular white matter region. In particular, bilateral punctate centrum semiovale, left posterior pontomedullary junction, left midbrain lateral to the red nucleus, right pons, and right periaqueductal lesions appear to be new since 2013. Many of the lesions display T1 hypointensity, but no associated enhancement. There is no evidence of intracranial hemorrhage, mass, or 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval progression of intracranial lesions associated with multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Neck tenderness and tension x 2 months, patient had a fall 2 months ago. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter probable hemangioma in the left frontal calvarium.Cervical Spine: There is mildly deficient lordosis. There is mild degenerative spondylosis in the lower cervical spine without significant spinal canal stenosis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Mild degenerative spondylosis in the lower cervical spine without significant spinal canal stenosis.3. No evidence of cervical vertebral bone marrow or paraspinal soft tissue edema.


Instruction: Generate impression based on findings.

Input: 70 year-old female with right shoulder pain. Concern for rotator cuff tear. The exam is mildly degraded by motion artifact.ROTATOR CUFF: Full thickness tear of the supraspinatus tendon is present. The remainder of the rotator cuff tendons are intact. While the majority of the muscle bulk is maintained, mild fatty atrophy of the infraspinatus muscle is noted.SUPRASPINATUS OUTLET: There is fluid seen in the acromioclavicular joint and subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint effusion is present. There is irregularity of the posterior inferior labrum, likely degenerative in etiology.BICEPS TENDON: There is fluid in the long head of the biceps tendon sheath. ADDITIONAL

Output: Full-thickness tear of the supraspinatus tendon.


Instruction: Generate impression based on findings.

Input: Female, 15 months old, with multiple episodes of Guillain Barre Syndrome-like symptoms. Evaluate for enhancing lesions or mass. Brain:Brain parenchymal morphology is within normal limits. No areas of pathologic signal abnormality, edema or mass effect are seen. No abnormal parenchymal or leptomeningeal enhancement is seen. There are no findings to suggest acute intracranial hemorrhage or abnormal extra-axial fluid. Ventricular size and morphology are within normal limits. The pattern of white matter myelination is appropriate for age.Spine:Mild diffuse enhancement of the cauda equina nerve roots is demonstrated. In addition, the cervical spinal cord is mildly T2 hyperintense beginning at C3 and continuing down to approximately T2. No abnormal cord enhancement is seen in this region.Spinal alignment is anatomic. There is a full complement of normally formed vertebral bodies. Marrow signal characteristics are within normal limits. No significant stenosis of the spinal canal or neural foramina is seen.

Output: 1.Diffuse cauda equina enhancement is seen compatible with an inflammatory or autoimmune polyradiculopathy such as Guillain-Barre.2.Mild nonenhancing T2 hyperintensity within the cervical spinal cord is also suspected. This would be somewhat of an atypical finding for Guillain-Barre. However, the coexistence of Guillain-Barre and transverse myelitis has been reported, and it may be that these two processes share the same underlying autoimmune etiology.3.Evaluation of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Targeted CT examination demonstrated a destructive lesion within the left scapula with associated soft tissue extension corresponding to the findings on the patient's recent MRI examination. Using CT guidance, a 14-gauge Achieve core biopsy needle was advanced into the lesion. Five 14-gauge core biopsy specimens were obtained. For specimens were placed in formalin. One specimen was placed in a sterile cup on a saline soaked Telfa pad. Touch preparations were performed and handed to cytopathology to confirm specimen adequacy.The core biopsy specimens were handed directly to the pathology service.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT guided biopsy of a left scapular lesion.


Instruction: Generate impression based on findings.

Input: Ms. Nagle is a 51-year-old female with a family history of breast cancer in her maternal grandmother diagnosed in her 40s. Personal history of benign left breast biopsy. No current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.Again noted is a high T2 signal intensity focus in the left hepatic lobe which is stable and can represent a cyst or hemangioma.

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


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Opacification is present within a single right posterior ethmoid air cell and there is mucosal thickening within the left maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear.Coronal images of the temporal lobes demonstrate the temporal horns, hippocampal formations and parahippocampal gyri to be normal in size and symmetric bilaterally without signal abnormalities or masses identified within the medial temporal lobes on either side. There is no evidence of mesial temporal sclerosis and there are no foci of heterotopic gray matter.

Output: Negative noncontrast MRI of the brain. Specifically, there are no MRI findings to explain the patient's seizure activity.


Instruction: Generate impression based on findings.

Input: BRAIN: Thin section postcontrast images are limited by patient motion artifact and are essentially nondiagnostic.There has been interval enlargement of the previously identified left cerebellar FLAIR hyperintense lesion with central punctate enhancement, which now measures 12 x 11 mm, with associated mild mass effect. Other scattered nonspecific foci of enhancement in the bilateral cerebellar hemispheres with subtle FLAIR hyperintensity are stable to slightly increased in conspicuity when allowing for differences in technique.There is a stable 19 x 16 mm high left anterior parietal high CSF signal intensity oval structure with mild mass effect upon the adjacent parenchyma and mild overlying calvarial remodeling. There is mild mass effect upon the subjacent parenchyma. There is no diffusion restriction. There is no midline shift or extra-axial fluid collection.There is mild mucosal thickening in the maxillary sinuses with scattered left greater than right ethmoidal thickening. Trace mucosal thickening is also noted in the right sphenoid sinus. There is prominence of the palatine tonsils bilaterally, which are nonspecific but likely represent reactive lymphoid tissue in a patient of this age. There is also enlargement of the right node of Rouviere which measures 13 mm in length, also possibly reactive.SPINE: Images are somewhat limited by patient motion especially postcontrast images. There is redemonstration of a tiny linear focus of enhancement at the T2 level within the dorsal aspect of the cord, slightly to the left of midline although this again cannot be confirmed on axial imaging due to motion artifact.There is grossly stable subtle linear high T2 signal abnormality in the left paramedian dorsal aspect of the cord at the T6 level again associated with ill-defined enhancement. There is persistent expansion and prominent high T2 signal abnormality within the thoracic cord beginning superiorly at the T8-9 level, extending inferiorly to the T11-12 level. There is a subcentimeter associated intramedullary enhancing nodule along the posterior aspect of the thoracic cord centered at T10-11 disk space, not as well delineated on the current exam on axial images secondary to motion artifact, although it appears grossly similar on sagittal images.The spine is in normal alignment. The vertebral body and disk heights are well-maintained. There is a 6-mm nonaggressive appearing enhancing lesion in the posterior inferior T9 vertebral body which is nonspecific, with corresponding T2/STIR hyperintensity and T1 hypointensity. A smaller T1 hyperintense lesion is again seen with peripheral lower signal in the T6 vertebral body superiorly. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.There stable mild disc height loss and desiccation at T11-12 with mild disk bulging and tiny annular fissure. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the spine. There are numerous cystic masses in the pancreas and kidneys. Please refer to the separately dictated report for MRI of the abdomen of the same date for further details.

Output: 1. Motion limited exam. Grossly stable enhancing nodule in the dorsal thoracic cord centered at T10-11 level with extensive nonenhancing T2 cord hyperintensity at least in part relating to cord edema. Differential is unchanged, again concerning for spinal cord hemangioblastoma provided patient's history of VHL.2. Grossly stable additional nonspecific T6 and T2 cord lesions with suspected enhancement. Continued follow-up is recommended.3. Interval increased size of a left cerebellar FLAIR hyperintense lesion with punctate central enhancement, now with mild localized mass effect, suspicious for a hemangioblastoma. A few other stable to very minimally increased in conspicuity scattered punctate enhancing lesions with associated T2 hyperintensity within the cerebellum bilaterally.


Instruction: Generate impression based on findings.

Input: 61 year old male patient with HCV, cirrhosis, HCC lesion 1.2 cm, 8/4a lesion. Evaluate liver, lesions, HCC screen, vascular patency. ABDOMEN:LIVER, BILIARY TRACT: A segment 8/4a lesion measures 13 x 7 mm, unchanged from the prior study. This lesion demonstrates T2 hypointensity and no appreciable arterial enhancement, however, continues to washout on more delayed images. An arterially enhancing segment 7/8 lesion which does not wash out on more delayed imaging appears similar to the prior study. No new arterially enhancing hepatic lesion is identified. Cholelithiasis without evidence of cholecystitis. The portal vein is patent. SPLEEN: No significant abnormality noted.PANCREAS: There is pancreatic divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A left lower pole subcentimeter T2 hyperintense lesion, likely a cyst, is unchanged. 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.Stable appearing segment 8/4a lesion. No new hepatic lesion is identified.2.Arterially enhancing segment 7/8 lesion without washout is unchanged and may be perfusional in etiology.3.Pancreatic divisum.


Instruction: Generate impression based on findings.

Input: 41 years Male (DOB:8/29/1975)Reason: RLE radiculopathy History: samePROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE 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. There is a well formed disc at S1-S2 and associated pseudoarticulation along the sacral alla. In general the lumbar spinal canal is small on a congenital basis. The nerve roots within the thecal sac at the L4 vertebral level and at the L3 vertebral level appear to be peripherally distributed. This pattern was present on the previous exam and is unchanged.At L5-S1 there is loss of disc space height, disc desiccation and a broad-based central disc protrusion without significant compromise to spinal canal or neural foramina.At L4-5 there is loss of disc space height, disc desiccation and a broad-based left paramedian disc extrusion. Since the prior exam patient is undergone left-sided facet and laminar surgery at this level there is contrast enhancing soft tissue present along the left hemicord canal and surgical site. There is effacement of the fat at the lateral recesses bilaterally at this level but worse on the left. The right. There is some crowding of nerve roots within the thecal sac present.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Status post L4-5 left posterior element and hemicanal surgery. Contrast enhancement within the left hemicord canal may be related to postsurgical change. Early scar formation cannot be excluded.2.There is a moderate degree of spinal stenosis present at L4-5 related predominantly to a broad-based left paramedian disc extrusion.3.The spinal canal is small congenital basis.


Instruction: Generate impression based on findings.

Input: Female, 29 years old, T3-T6 myelitis. T2 hyperintensity is evident within the spinal cord beginning at the T1-2 disc level and continuing down to the T9-10 disc level. Signal abnormality appears to affect the central cord more than the peripheral cord, but the cord is not significantly expanded. At the T5-6 level, there is a 7 mm focus of enhancement within the cord. Diffusion-weighted imaging shows mild hyperintensity within the upper thoracic cord, though this is difficult to interpret as the ADC map does not fully corroborate the DWI signal.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow enhancement is seen. The intervertebral discs are preserved with no significant bulge or herniation. The spinal canal and neural foramina are patent. Prominent dorsal epidural fat is noted which causes narrowing of the thecal sac through much of the thoracic spine.

Output: Central spinal cord signal abnormality is seen from T1-2 down to T9-10. Patchy enhancement is evident at the T5-6 level, though the majority of this abnormality does not enhance. Diffusion and ADC findings are difficult to interpret and should probably not be relied upon. As such, the differential diagnosis remains broad and would include infection, post infectious or autoimmune myelitis, demyelinating disease and ischemia.


Instruction: Generate impression based on findings.

Input: Trauma to spine and ataxia. Fall at home few days prior to presentation. Brain: There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific cerebral and pontine white matter T2 hyperintensity. There is also a small focus of encephalomalacia in the left thalamus. However, the cerebellum appears to be unremarkable. There is a punctate focus of susceptibility effect in the right thalamus, which may represent a chronic microhemorrhage. The ventricles and basal cisterns are normal in size and configuration. However, there are mild bilateral cerebral convexity subdural fluid collections, measuring up to 5 mm in thickness. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: There is intermediate to high T1 and low T2 signal material in the anterior epidural space of the cervical spinal canal at the C1-4 levels, measuring up to approximately 5 mm in thickness, with associated narrowing of the thecal sac. However, the spinal cord signal is normal. There is high T2 signal in the interspinous spaces at Oc-C1 and C1-2 levels. There is degenerative vertebral bone marrow signal alteration in the cervical spine, particularly at C6-7. There are small effusions in the bilateral C5-6 facet joints. There is 3 mm of anterolisthesis of C4 on C5. There is also slight retrolisthesis of C3 on C4. There are multilevel degenerative changes of the cervical spine with multilevel neural foraminal stenosis of varying degrees.

Output: 1. Chronic lacunar infarct in the left thalamus, but no evidence of acute infarct.2. Mild bilateral cerebral convexity subdural fluid collection may represent hygromas. 3. Findings suggestive of early subacute hemorrhage within the anterior spinal canal at the C1-4 levels with associated narrowing of the thecal sac. However, the spinal cord signal is normal.4. Findings suggestive of soft tissue strain and perhaps ligamentous injury in the interspinous spaces at Oc-C1 and C1-2 levels.Discussed with Dr. DEL BRUTTO ANDRADE at 11 AM on 3/13/16.


Instruction: Generate impression based on findings.

Input: Male, 27 years old, with lower extremity weakness and apparent sensory level. Thoracic:The thoracic kyphosis is mildly exaggerated. Sagittal alignment is otherwise unremarkable. Mild loss of vertebral body height is seen at T3 with edema and enhancement in the superior aspect of the vertebral body. No retropulsion is observed. A Schmorl's node deformity is evident superiorly at T5. No other areas of abnormal marrow replacement or enhancement are seen. Dorsal epidural lipomatosis is seen causing complete CSF effacement from T2 down to T9. No definite spinal cord signal abnormality or pathologic cord enhancement is demonstrated.Lumbar:Alignment is anatomic. Vertebral body heights are maintained. Small Schmorl's node deformities are evident at L2, L3 and L4. No areas of pathologic marrow replacement or enhancement are seen. Dorsal and ventral epidural lipomatosis is evident in the lower lumbar spine. This results in effacement of CSF and crowding of the cauda equina beginning at the L3 level and continuing into the sacrum. The distal spinal cord, conus and nerve roots of the cauda equina show normal signal and are free of pathologic enhancement. Mild edema is seen within the posterior paraspinal muscles.

Output: 1.A mild compression deformity of the T3 vertebral body is seen. The presence of edema and enhancement would suggest a relatively more recent time course. No associated retropulsion or osseous compromise of the spinal canal is seen.2.No other significant or acute osseous abnormalities are identified.3.Epidural lipomatosis is seen in the thoracic and lumbar spine. In both areas, this results in effacement of the CSF and, in the lumbar spine, crowding of the cauda equina.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with episodes of loss of awareness of surroundings. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The pattern of intracranial enhancement is within normal limits.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

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


Instruction: Generate impression based on findings.

Input: Male 67 years old Reason: atypical renal cyst, hematuria History: hematuria The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense lesions within the liver. These are incompletely characterized in the absence of intravenous contrast but have a benign appearance may represent cysts/hemangiomas. A T2 hyperintense lesion at the hepatic dome (series 701, image 30) demonstrates thin internal septations and in the absence of intravenous contrast is indeterminate.Mild loss of signal on in phase images raising the possibility of iron deposition.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered subcentimeter T2 hyperintensities within the left kidney which are most consistent with renal cysts. There is a 1.6 x 1.4 cm T2 hyperintensity within the mid/lower pole of the right kidney. This corresponds to the complex lesion identified on prior ultrasound. On axial and coronal T2 weighted images there is a suggestion of solid component on the medial wall (series 701, image 10; series 801, image 24). There is no diffusion restriction. Evaluation of this is limited however in the absence of intravenous contrast. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. T2 hyperintense lesion within the right kidney with internal complexity as detailed above. This is stable in size compared to prior studies however remains indeterminate in the absence of evaluation with intravenous contrast. Further discussion with the referring service provides a history of allergy to iodinated contrast. As there is no cross-reactivity between iodinated and gadolinium-based contrast agents, if patient's eGFR supports it, this lesion would be more optimally imaged with additional postcontrast sequences. 2. A T2 hyperintense lesion at the hepatic dome demonstrates thin internal septations and in the absence of intravenous contrast is indeterminate. This could also be further evaluated with additional postcontrast sequences.3. Mild loss of signal on in phase images raising the possibility of iron deposition.


Instruction: Generate impression based on findings.

Input: Reason: thoracic syrinx and fatty filum, follow up after hospitalization for pain crisis. please do on 3 T scanner with tethered cord protocol. Thoracic spine: Alignment is anatomic. The vertebral bodies are normal in height. There is no suspicious marrow signal abnormality. There is disc height loss at T7-T8 without significant disc herniation. The spinal canal and the neural foramina are preserved.Again seen is a thoracic syrinx predominate from the upper T5 to the upper T7 level with minimal prominence of the central canal more superiorly as well as inferiorly extending to the conus. There is no significant change in size. Syrinx is maximal at the T5-T6 level where it measures 2 x 3 mm in the AP and transverse dimension which is similar to prior.There are tiny pleural effusions, also present previously.Lumbar spine: Alignment is anatomic. The vertebral bodies are preserved in height. Of note, L5 is partially sacralized. The spinal canal and the neural foramina are preserved. Intervertebral disks are normal. The conus terminates at the inferior L1 level which is within normal limits. Fatty signal within the filum terminale at L2-L3 has not changed and remains very thin and short segment.Prone images demonstrate appropriate ventral motion of the conus.There are free fluid in the pelvis which appears prominent for patient's age.

Output: 1. Unchanged small thoracic syrinx compared to 11/20/2015. 2. Conus terminates at the inferior L1 level. Mild fatty infiltration of the filum terminale at L2-L3 again seen. There is appropriate ventral motion of the conus on prone sequences. There is no clear evidence of cord tethering by imaging but can be correlated with clinical findings.3. There is small to moderate amount of free fluid in the pelvis which appears slightly prominent for patient's age. This finding is nonspecific.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified psychosis Malignant neoplasm of breast (female), unspecified siteClinical question: R/O brain metastasisSigns and Symptoms: confusion, h/o metastatic breast cancer There are multiple enhancing lesions scattered in both hemispheres of the brain as well as the left cerebellar hemisphere which are associated with vasogenic edema. The largest one is located in the left frontal lobe and measures 30 1I 28 mm axial dimensions and is centered in the left middle frontal gyrus. One in the right middle frontal gyrus measures 10 x 13 mm axial dimensions. One in the left cuneus measures 12 mm. One in the left inferior parietal lobule measures 12 mm smaller lesions are located in the left temporal lobe and left and right frontal lobes as well as the right occipital lobe. A couple lesions are present in the left cerebellar hemisphere the largest one measuring 10 mm diameter.There is associated mass effect and midline shift. The septum pellucidum is shifted approximately 6 mm to the right of midline. The uncus is deviated medially.A small lesion in the right side of the corpus callosum measuring 6 mm diameter is associated susceptibility effect.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: Multiple lesions within the brain parenchyma are compatible with metastatic disease to the brain. One of the lesions in the corpus callosum is hemorrhagic. The largest one is located in the left frontal lobe and there is associated midline shift and subtle uncal deviation/herniation medially. There is a moderate amount of vasogenic edema associated with these lesions.


Instruction: Generate impression based on findings.

Input: 29-year-old female with history of trauma to the right knee with pain and swelling. MENISCI: Complete vertical tear of the posterior horn of the medial meniscus (series #2, image 22).ARTICULAR CARTILAGE AND BONE: The articular cartilage appears intact without significant abnormality.LIGAMENTS: There is diffuse signal abnormality within the anterior cruciate ligament with more focal horizontal appearing discontinuity indicative of significant tearing.EXTENSOR MECHANISM: The extensor mechanism appears intact. The Insall-Salvati index measures about 1.4, indicative of mild patella alta.ADDITIONAL

Output: 1. Findings compatible with complete tear of the anterior cruciate ligament of the right knee.2. Complete vertical tear of the posterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Female, 82 years old, status post fall with unsteady gait and trouble with speech. Corresponding to the CT finding of hyperattenuation at the left parieto-occipital junction, the parenchyma demonstrates ill-defined T2 hyperintensity suggesting edema and a prominent clustering of susceptibility foci along with one subcentimeter focus of intrinsic T1 hyperintensity. There is some very questionable mild diffusion restriction corresponding to this general location.Elsewhere in the brain, numerous scattered foci of susceptibility are seen within both cerebral hemispheres sparing the cerebellum. Also noted is extensive patchy periventricular T2 hyperintensity. No other areas of significant parenchymal edema are detected. No large extra-axial fluid collections are seen. No definite pathologic enhancement is evident. The ventricles are normal in size and morphology.The bone marrow signal characteristics are within normal limits. Mucous retention cysts are seen in the left maxillary and right sphenoid sinus. A small amount of layering secretions are seen in the right maxillary sinus.

Output: 1.Parenchymal edema is seen at the left parieto-occipital junction with clustered foci of susceptibility likely representing blood product. One of these foci demonstrates intrinsic T1 hyperintensity suggesting subacute blood. There may be very vague associated restricted diffusion, but this is equivocal. Findings could represent petechial hemorrhage in the context of a resolving late subacute infarct or simply hemorrhage and associated edema.2.The large number of scattered foci of susceptibility elsewhere in the brain raises the possibility of amyloid angiopathy. In addition, there is evidence of fairly extensive chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Previous MRI suggestive of periventricular heterotopias: Head jerking while asleep. There are several subcentimeter nodular foci with grey-matter signal characteristic along the margins of the bilateral lateral ventricles in the temporal and occipital lobes. There appear to be terminal zones of myelination. The degree of myelination is otherwise age-appropriate. There is no evidence of intracranial hemorrhage or infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is extensive diffuse paranasal sinus mucosal thickening and fluid. There is fluid within the right mastoid air cells. The orbits are unremarkable. Enlargement of the right endolymphatic duct is better depicted on the concurrent temporal bone CT.

Output: 1. Multiple nodular foci grey-matter signal within the bilateral periventricular white matter are compatible with grey matter heterotopia. 2. Right mastoid effusions may represent mastoiditis.3. Findings suggestive of acute sinusitis.4. Enlargement of the right endolymphatic duct is better depicted on the concurrent temporal bone CT.


Instruction: Generate impression based on findings.

Input: History of adenoid cystic carcinoma of the tongue: pain along tongue. The images are degraded by patient motion. There are post-treatment findings in the oral cavity, with a defect in the dorsum of the oral tongue. There is also diffuse ill-defined heterogeneous high T2 signal and enhancement in the portions of the oral tongue and tongue surrounding the defect, with areas of apparent elevated perfusion. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The imaged osseous structures and intracranial structures are unremarkable. There are subcentimeter right lung nodules.

Output: 1. Findings suggestive of residual right oral tongue tumor along the margins of a large defect with what appears to be associated surrounding inflammation and perhaps denervation changes.2. Subcentimeter right lung metastases. Please refer to the separate chest CT report for additional details.


Instruction: Generate impression based on findings.

Input: Multiple myeloma. Further assessment of epidural mass. Study is mildly to moderately limited by patient motion.The posterior epidural mass that extends from C6-C7 level to the mid T5 level shows intense, solid contrast enhancement, confirming its solid nature. . The abnormal contrast enhancement in fact extends craniocaudally beyond the mass on the noncontrast MRI but this may include a dural tail; from mid C6 to mid T6 level. The mass is more pronounced on the left side where it wraps and extends through the neural foramina and seems to be incongruity with the previously described left paraspinal mass at the T2 and T3 levels; specifically through the T3-T4 neural foramen. The mass does also invade the left posterior-lateral aspect of the T3 vertebral body/pedicle. In the axial plane, the paraspinal mass measures at mid T3 level 4.3 cm x 2.7 cm (including the T3 osseous invasion). The left neural foraminal involvement extends from C7-T1 through T4-T5.As described previously, the mass causes spinal cord compression with subtle increase of the cord T2-signal at the compressed segment. The spinal canal otherwise preserved; small anterior indentations by degenerative disc/endplate disease most pronounced at T6-T7 through T8-T9 cause no significant spinal canal narrowing.

Output: 1.The solid contrast enhancement in the left posterior epidural mass involving the cervicothoracic spine confirms its solid nature. The mass extends through the left-sided neural foramina and is contiguous with the left paraspinal mass described previously.2.The mass causes compression of the spinal cord with subtly increased T2 signal.


Instruction: Generate impression based on findings.

Input: Clinical question: Six-month follow-up post op. Signs and symptoms: As above. Pre and post enhanced brain MRI: No diffusion-weighted abnormalities.Examination demonstrates postoperative changes of a small left frontal particular tumor resection. Small surgical cavity with minimal susceptibility signal changes at the surgical site measures approximately at 16 x 12 mm in transaxial dimensions. Very subtle linear surrounding FLAIR hyperintensity remaining in the there are surgical parenchymal with significant interval improvement since prior exam. There is minimal expected linear leptomeningeal enhancement at the surgical site and unremarkable otherwise.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise and stable since prior study.

Output: 1.Significant interval improvement of postoperative changes of left frontal operculum tumor resection.2.No evidence of residual or recurrence of tumor. Further follow-up however is recommended.3.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: 43 years, Male, glioblastoma on TMZ + IDO inhibitor.. Again seen are postsurgical changes of right-sided craniotomy for resection of right temporoparietal mass. There is FLAIR hyperintensity in the right posterior temporal and occipital lobes along the inferior and posterior aspect of the resection cavity, which has increased since prior from 6/29/2016. Masslike FLAIR hyperintensity involving the right periatrial white matter, extending across the corpus callosum into the left parietal white matter has also increased in the interval. Slight further increase in FLAIR hyperintensity superiorly into the right posterior frontal lobe including the right precentral gyrus is also noted. Areas of mild restricted diffusion are present within the area of increased FLAIR hyperintensity and enhancement with also corresponding areas of elevated cerebral blood volumes. Some of the FLAIR hyperintensity surrounding the resection cavity as well as in the bilateral posterior periventricular region however demonstrates corresponding decreased CBV. Postcontrast images also demonstrate interval increase in enhancement surrounding the posterior inferior aspect of the resection cavity, along the ependymal surface of the occipital horn of the right lateral ventricle, extending across the corpus callosum, and into left periatrial region. There is also interval increase in ependymal enhancement surrounding the left frontal horn as well as along the fourth ventricle wall.Extra-axial lesion in the left middle cranial fossa which likely represents an arachnoid cyst is again seen and again demonstrates nonsuppression of signal on the FLAIR sequence which may be related to prior hemorrhage. No significant change in the interval. Extra-axial collections along the bilateral cerebral convexities demonstrate slight interval decrease in size as well as change in signal characteristics compatible with evolution. The relatively larger right-sided subdural collection measures up to 8 mm in thickness previously up to 11 mm, measured similarly. Associated mild mass effect on the right frontal sulci is also improved.There is no midline shift or uncal herniation. Ventricles are not significantly changed in size; no hydrocephalus.Unchanged small left frontal scalp lesion which may represent a sebaceous cyst.

Output: 1. Compared to 6/29/2016, there is interval increase in T2/FLAIR hyperintensity in the right posterior temporal and occipital lobes along the inferior and posterior aspect of the resection cavity with also increased T2/FLAIR hyperintensity extending into the right posterior frontal lobe, across the corpus callosum, and into the left parietal lobe. These findings are even more pronounced when compared to 4/28/2016. There is also interval increase in areas of enhancement and restricted diffusion with elevated cerebral blood volumes in the above-mentioned regions. Overall findings are suspicious for tumor progression. 2. Abnormal enhancement is noted to extend to the ependymal surface, which was present previously. There is however interval increase in periventricular enhancement surrounding the left frontal horn as well as along the fourth ventricle wall, findings which are suspicious for ependymal tumor spread.3. Decrease in size of bilateral subdural collections. 4. Left middle cranial fossa arachnoid cyst with complex fluid/blood products again seen.


Instruction: Generate impression based on findings.

Input: Male, 5 months old. Radiographs with findings suspicious for osteomyelitis. BONE MARROW: Extensive bone marrow signal abnormality involving the left proximal femoral metaphysis and diaphysis, with increased signal on fluid sensitive sequences, low signal on T1, and diffuse bone marrow enhancement, compatible with osteomyelitis. There is significant periosteal reaction involving the proximal femur. The region of the femoral neck appears shortened, with local fluid and inflammatory changes, and no normal bone marrow signal or cortex, suggesting near complete bone destruction in this region. The left femoral head remains relatively normal in morphology and is positioned slightly posteriorly in the acetabulum. Wedge-shaped areas of low signal within the femoral head may reflect small regions of nonvascularized tissue.There is a moderate left hip joint effusion with extensive enhancement, suggesting infectious/inflammatory fluid within the joint.Inflammatory changes extend into the soft tissues surrounding the left hip, along the left gluteal musculature and into the overlying subcutaneous soft tissues. Bone marrow signal on the right is normal. The right femoral head is located within the acetabulum, and the surrounding soft tissues are normal. Mildly prominent inguinal lymph nodes, left slightly greater than right, are likely reactive.

Output: 1.Findings compatible with osteomyelitis involving the left proximal femur with associated destruction of the femoral neck, and additional inflammatory changes of the surrounding soft tissues.2.The left femoral head retains its morphology and is positioned within the acetabulum. Small regions of possible decreased vascularity involving the femoral head.3.Inflammatory/infectious left hip joint effusion.Findings were discussed via telephone with Dr. Bielski at 10:40 AM on 07/06/2016.


Instruction: Generate impression based on findings.

Input: 73 year old female with right knee pain, worse with weightbearing and up/down stairs. MENISCI: There is a tear within the posterior horn of the medial meniscus extending into the body obliquely with extension to the superior and inferior articular surface and extension to the anchor. There is fraying of the inner edge of the meniscus. The lateral meniscus appears grossly normal.ARTICULAR CARTILAGE AND BONE: Moderate degenerative changes affect the knee with joint space narrowing, osteophyte formation and generalized articular cartilage thinning. There is inhomogeneity of the articular cartilage along the lateral facet of the patella without focal defects. There is subchondral bone marrow edema within the medial tibial plateau which may represent a contusion.LIGAMENTS: The cruciate and collateral ligaments appear grossly normal.EXTENSOR MECHANISM: The extensor mechanism appears normal.ADDITIONAL

Output: 1. Tear of the posterior horn of the medial meniscus as described above. 2. Moderate degenerative changes about the knee with associated articular cartilage thinning.


Instruction: Generate impression based on findings.

Input: Evaluate for bleed. 68-year-old female Examination is suboptimal due to extensive motion artifacts in particular in the posterior fossa. However no definitive abnormality within the posterior fossa is noted in 4 to remains within normal size and location.Several area of low-attenuation is suspected in the left posterior temporal occipital region. This was also partially visualized on the prior examination and may represent area of acute stroke. Several areas of subcortical lucencies are also noted in bilateral cerebral hemispheres. These may represent small vessel disease of undetermined age. An MRI examination is recommended since the quality of both of these recent CT exams are not very good for detection of very acute stroke.

Output: Suboptimal exam however suspected left posterior temporal -- occipital stroke and small vessel disease. MRI is recommended.


Instruction: Generate impression based on findings.

Input: 58 year old female with a BRCA 1 mutation presents for screening MRI. Family history of breast cancer in her paternal grandmother at age 55, aunt at age 36 and cousin at age 48 There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Numbness. 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.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: Small central disc protrusion has decreased in size since prior. There is no significant spinal canal or neural foraminal stenosis at this level. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.No abnormal enhancement within the cord or elsewhere in the spine. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. No cord signal abnormality. No evidence of demyelinating disease. 2. Minimal degenerative changes. Previously seen C5-C6 disc protrusion has decreased in size. No significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: r/o demyelinating disease or structural lesion History: bilateral lower extremity weakness There is no evidence of acute ischemic or hemorrhagic lesion.There is no abnormal enhancement.On FLAIR/T2 weighted images, there are patchy high signal intensity lesions on periventricular white matter and centrum semiovale. These lesions are nonspecific, however, could represent nonspecific small vessel ischemic disease. Other white matter disease such as demyelinating disease is a possibility but less likely. Clinical correlation is indicated.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, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.2. Nonspecific bilateral periventricular and centrum semiovale FLAIR/T2 high signal intensity lesions.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (4/21/15, 10/14/15), ultrasound images of right breast (10/14/15), images from ultrasound guided biopsy of right breast and postprocedural right mammographic images (10/21/2015) performed at Advocate Lutheran General Hospital. For comparison, digital mammographic images (5/27/14, 12/6/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (4/21/15, 10/14/15):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. Multiple surgical clips are present at 12:00 position in the right breast, at the site of prior surgery. There is a developing mass at the site of prior surgery in the right breast, measuring 35 x 30 mm on CC view of 10/14/2015. No abnormal findings are seen in the right retroareolar region, where breast MRI (11/2/15) demonstrated an enhancing mass.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (10/14/15):An irregularly shaped hypoechoic mass is visualized at 12:00 position in the right breast, measuring 21 x 18 x 23 mm, corresponding to the mass seen on the mammogram. No abnormal lymph nodes are visualized in 4 images of right axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (10/21/2015):Ultrasound guided needle biopsy was performed for the mass in the right breast with an appropriate needle placement. A marker clip (coil shaped) is present within the mass at anterior aspect.Per outside radiology report, the result was malignant; invasive ductal carcinoma.

Output: Biopsy proven carcinoma in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 82-year-old female history of pancreatic mass, evaluate for interval change or other abnormalities ABDOMEN:LIVER, BILIARY TRACT: Mild intra- and extrahepatic biliary ductal dilation. The common bile duct measures up to 11 mm in diameter possibly secondary to a distal stenosis. No evidence of choledocholithiasis. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesions in the pancreatic head and tail, which communicate with the main pancreatic duct and measure up to 13 mm in the tail, unchanged.Pancreatic duct measures 3mm in diameter.ADRENAL GLANDS: Bilateral adrenal nodularity.KIDNEYS, URETERS: Stable renal cysts. No hydronephrosis.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.Cystic lesions in the pancreatic head and tail communicate with the main pancreatic duct most consistent with IPMNs measuring up to 13 mm in the tail.2.Stable intra-and extrahepatic biliary ductal dilation possibly related to a distal CBD stenosis. No evidence of choledocholithiasis.


Instruction: Generate impression based on findings.

Input: 42-year-old male with new onset seizure. History of left frontal gliosarcoma status post resection. Again seen are extra-axial air and other changes of left frontal craniotomy. There is a low attenuation area in the left frontal lobe, likely representing encephalomalacia and edema. The presence of residual tumor cannot be evaluated on a non-contrast examination. There is mass effect on the left lateral ventricle, not significantly changed from prior MRI.There is no evidence of intracranial hemorrhageThe visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Post surgical changes with low attenuation area in left frontal lobe representing edema/encephalomalacia. The presence of residual tumor cannot be evaluated on a noncontrast examination.


Instruction: Generate impression based on findings.

Input: 60-year-old male with right arm intention tremor and question raised in outside MRI 3/2016 of low grade neoplasm in the pons. There has been evolution of the prior infarct involving the right thalamus extending into the midbrain on outside brain MRI from 10/17/2016. There is T2/Flair hyperintense signal involving the right midbrain cerebral peduncle with associated volume loss indicating chronic infarct and/or associated Wallerian degeneration. There is additional T2/FLAIR signal abnormality involving the right greater than left pons which is not significantly changed compared to the prior exams from 3/3/2016. There is no discrete evidence of pontine expansion or enhancement. Separately more dorsally in the pons is additional T2/FLAIR signal, again indicating an appearance most consistent with small vessel ischemic disease. There is additional scattered periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to underlying chronic small vessel ischemic disease. Chronic lacunar infarcts are evident in the right frontoparietal corona radiata similar to prior.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Compared to 10/17/2015, there has been evolution of the previously seen infarct involving the right thalamus extending into the right midbrain.2.T2/FLAIR signal abnormality involving the bilateral pons is not significantly changed since 3/3/2016 and favored to represent sequela of chronic small vessel ischemic disease or perhaps prior osmotic demyelination or other inflammation. Pontine glioma, as questioned, seems much less likely given absence of expansion or enhancement and evidence of prior infarcts. Additional follow-up can be considered as clinically warranted.3.Additional evidence of mild chronic small vessel ischemic disease including lacunar infarcts along the right frontoparietal corona radiata.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 47-year-old female with metastatic breast cancer to the brain. Evaluate for presence of new midline shift, lesions, edema. Chronic, large right subdural/epidural fluid collection is again noted with a small amount of more subacute blood layering dependently. Mass effect on the right cerebral hemisphere persists with mild effacement of the right lateral ventricle and approximately 6 mm midline shift to the left. Overall findings appear similar to most recent MRI study from 5/4/2010. Prominence of the left lateral ventricle as well as the periventricular and subcortical low attenuation in the left cerebral hemisphere appear similar to prior MRI as well. Low attenuation in left cerebellar hemisphere also correlates with previous MRI findings (stable).Catheter enters the right frontal skull through a burr hole and terminates in the right ventricle at the level of the foramen of Monroe (unchanged). The calvaria and skull base are otherwise radiographically normal. Note is made of a left maxillary retention cyst; otherwise the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Chronic, large right extra-axial fluid collection with stable mass effect and midline shift to the left. Accounting for differences in technique, findings are overall unchanged on comparison to most recent MRI from 5/4/2010.


Instruction: Generate impression based on findings.

Input: Male, 8 years old. Forearm cellulitis. Subcutaneous edema involving the ulnar and volar soft tissues of the elbow and forearm, compatible with cellulitis. Edema extends around the distal brachialis muscle, indicating myositis. No discrete fluid collection is identified. Many sequences are limited by motion, but bone marrow signal and cortical margins appear grossly normal. No significant joint effusion.

Output: Cellulitis and evidence of myositis, without evidence of joint effusion or osteomyelitis. See follow-up postcontrast study for additional findings.


Instruction: Generate impression based on findings.

Input: Ms. Miller is a 56-year-old female with personal history of right breast lumpectomy in 2013 for DCIS followed by radiation and tamoxifen therapy. She has a family history of breast cancer in mother (diagnosed at the age of 79) and sister (diagnosed at the age of 56). There is scattered fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.Expected postsurgical changes of the right lower inner breast are present. There continue to be multiple enhancing foci/small circumscribed masses (predominantly in the left breast), all of which appear similar in size and appearance when compared to the prior MRI from 2013. No new abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: There are multiple unchanged supratentorial cortical and subcortical regions of T2 hyperintensity. There is an unchanged 5 mm focus of T2 hyperintensity and susceptibility effect within one of these regions in the right superior parietal lobule that may represent mineralization or old hemorrhage. There are numerous subependymal mildly enhancing masses. Exact comparison is difficult due to differences in technique, however, the largest of these located within the atrium of the right lateral ventricle has mildly increased in size, measuring 17 x 17 mm, previously 15 x 15 mm. The second largest located within the left lateral ventricular body near the foramen of Monro has also mildly grown, measuring 9 x 9 mm, previously 8 x 8 mm. A previously measured subependymal mass within the right lateral ventricular body near the foramen of Monro is unchanged, measuring 4 x 4 mm. The ventricles and basal cisterns are unchanged in size and configuration. There is no evidence of acute intracranial hemorrhage or acute infarct. 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: Stigmata of tuberous sclerosis including unchanged cortical/subcortical tubers and multiple subependymal masses, the largest of which have mildly increased in size (about 1mm).


Instruction: Generate impression based on findings.

Input: Clinical question: Assess brain lesions. Signs and symptoms: seizure. Non-enhanced CT brain:Examination demonstrate a well demarcated low attenuation lesion in the inferior right frontal lobe. There is effacement of adjacent cortical sulci and minimal indentation of right frontal horn. There is no interval change since prior examination of 5 -- 11 -- 2010.Additional small foci of low attenuation adjacent to the trigone of right lateral ventricle is also again identified and read no interval change. There are two additional apparent cortical based low attenuation in the left mid temporal lobes with no evidence of interval change. Subcortical low-attenuation in the right frontal lobe along to its interhemispheric aspect extends inferiorly to the level of previously described right frontal lobe lesion.These findings on MRI examination of brain on the same date do not have the appearance of stroke.There is bony thickening and new bone formation along the floor of anterior cranial fossa with possibly some internal lytic changes. This finding may represent fibrous dysplasia. This finding is immediately at the level of large right frontal lobe lesion and I can't be certain whether this finding is related to intracranial findings.CTA of intracranial circulation:Carotid system.Right internal carotid. Normal interval carotid artery across the cavernous sinus and in its supraclinoid portion. There is normal appearing right anterior and middle cerebral arteries and their branches. Review of coronal, sagittal and axial 2-D MIP images demonstrate no definitive evidence of any detectable abnormality in the distal branches of anterior and middle cerebral arteries that are not well visualized on the 3-D reformatted images.Left carotid.The left internal carotid artery across the cavernous sinus and its supraclinoid portion remains within normal. There is also normal visualization of the left anterior annular cerebral arteries and their branches. To evaluate the distal branches of left anterior and middle cerebral arteries which are not visualized on 3-D reformatted images the 2-D MIP images in coronal, sagittal and axial sequences were reviewed. These 2-D images fail to demonstrate any detectable abnormality of distal branches.Vertebral basilar system.There is normal visualization of bilateral vertebral arteries and their intracranial component. Basilar artery and all of its branches are well visualized and unremarkable.65 cc of Omnipaque 350 was administered for above study.

Output: 1.Stable unenhanced CT examination of brain since prior exam. Multiple intracranial findings are highly suspect for masses and unlikely to represent strokes.2.Expansile bony lesion of right frontal bone along the floor of the right anterior cranial fossa may represent fibrous dysplasia, however the large right frontal lobe lesion that abuts the inner table of the skull in the right frontal lobe may represent a combined osseous and intracranial pathology like a neoplasm. Patient had a nonenhanced MRI of brain however an enhanced MRI is highly recommended to further evaluate multiple unusual intracranial lesions. Please reviewed report of an enhanced MRI of brain.3.Negative CTA of intracranial vasculature.4.CTA is not in the appropriate test for detection of intracranial enhancement.


Instruction: Generate impression based on findings.

Input: 20-year-old male with right shoulder pain and recurrent dislocations. Evaluate right shoulder for Bankart labral tear and Hill-Sachs lesion. ROTATOR CUFF: There is intermediate signal abnormality within the supraspinatus tendon indicating mild tendinosis. The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Note is made of a small to moderate-sized Hill-Sachs deformity of the humerus with no associated underlying bone marrow edema, suggesting this is chronic in etiology. There is heterogeneity and blunting of the anterior and anteroinferior glenoid labrum consistent with a tear. There is a focus of low signal intensity along the anterior and medial aspect of the inferior glenoid likely representing a displaced labral fragment (image 9; series 901) which may represent an ALPSA lesion. There is no definite osseous component. There is irregularity of the anterior-inferior margins of the glenohumeral joint capsule suggesting capsular injury.BICEPS TENDON: The long head of the biceps tendon appears intact. ADDITIONAL

Output: Findings consistent with a chronic Hill-Sachs fracture deformity of the humerus as well as a tear of the anteroinferior glenoid labrum with displaced labral fragment as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 70 year-old woman with IPMN ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Accounting for differences in technique stable size and appearance of cystic lesion located in pancreatic body. Lesion measures 6 mm on image 26 series 8, previously measured 6 mm. The lesion appears to communicate with the main pancreatic duct, see image 52 series 4. Please note that evaluation suboptimal without IV contrast. No definite lesional wall nodularity seen on this noncontrast study.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: Accounting for differences in technique, stable sidebranch IPMN in pancreatic body.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, pain and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right elbow was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using a 25-gauge needle.Under fluoroscopic guidance, 22 gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 6 cc's 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 the 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: 45 seconds.

Output: Successful fluoroscopic-guided right elbow arthrogram.


Instruction: Generate impression based on findings.

Input: A 62 year old female with history of coronary artery disease, s/p non-ST elevation myocardial infarction (2009) and coronary arterial bypass graft (SVG to OM 1/2/3 and LIMA to LAD), ischemic cardiomyopathy with a left ventricular systolic function of 42% (by cardiac MRI of 4/30/2015), hypertension, COPD, diabetes, mild chronic kidney disease, peripheral arterial disease, Hodgkin's lymphoma s/p chemotherapy. Referred to stress cardiac MRI for further evaluation. MEDICATIONS: amiodarone, aspirin, atorvastatin, furosemide, gabapentin, insulin, metoprolol, ranolazine, sitagliptin, spiriva, spironolactone. First Pass PerfusionDuring hyperemia, there is an extensive, severe perfusion defect that involves the entire left ventricle, except the basal to mid lateral wall. Viability/ Myocardial ScarThere are two myocardial infarctions each of which have both transmural and non-transmural components to them. They involve the (1) mid anterolateral, inferolateral, and inferior walls and (2) apical anterior, lateral, inferior, and septal walls. The segments affected by these myocardial infarctions have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and likely to be viable.Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 32%, the LV end diastolic volume index is 96 ml/m2 (normal range: 65+/-11), the LVEDV is 171 ml (normal range 109+/-23), the LV end systolic volume index is 65 ml/m2 (normal range 18+/-5), the LVESV is 116 ml (normal range 31+/-10), the LV mass index is 70 g/m2, and the LV mass is 124 g. There is global hypokinesis with regional variation. No intracavitary thrombus was noted.Left AtriumThe left atrium is mildly dilated (106 ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 51 ml (normal range 35+/-13). 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 trivial 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 "pseudo-bovine" pattern (normal variant). 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 pericardial effusion.Extracardiac FindingsSternal wires were noted. Previously noted hepatic angioma or cyst is seen again.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. Extensive, severe myocardial ischemia associated with significant amount of myocardial viability. 2. Two large myocardial infarctions, as described above, are noted. 3. The left ventricle is mildly dilated with moderately reduced systolic function (LVEF 32%). 4. Normal RV size and systolic function (RVEF 55%).5. Mild LA dilation.When compared to the prior study from 4/30/2015, the LVEF has worsened. Stress testing was not performed on the prior study. 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 BRCA positive female status post right breast lumpectomy in 1994 for DCIS and left breast lumpectomy in 2008 for IDC followed by radiation and chemotherapy treatment. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is stable post-surgical volume loss and scarring in each breasts. 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: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Ms. Spearson is a 49 year old female with a family history of breast cancer in her mother, diagnosed at the age of 49. Personal history of left breast excisional biopsy in 2009 for benign papilloma. Breast cancer screening MRI to be performed on study irb 13073b There is extreme amount of fibroglandular tissue in both breasts. Multiple small cysts are present in both breasts.Moderate parenchymal enhancement is noted bilaterally.Again seen are stable multiple bilateral enhancing masses and foci, including two reference mid 10 o'clock and anterior 4 o'clock left breast enhancing lesions. 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: Female, 38 years old, with altered mental status and history of neurosarcoid. Assess for active neurosarcoid lesions. Evidence of prior right frontal approach biopsy is again seen. Ill-defined, predominantly subcortical T2 hyperintensity without mass effect is redemonstrated in the right upper lobe showing no significant interval change. Mild periventricular T2 hyperintense rimming and scattered additional small foci of T2 hyperintensity are also unchanged.No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Hemosiderin staining is evident in the right frontal lobe likely related to prior biopsy. Smudgy susceptibility effect which may reflect hemosiderin staining is also seen scattered through the cerebral hemispheres, particularly in the occipital lobes, without interval change. Note is made of prominent transmedullary veins.On postcontrast imaging, diffuse fine leptomeningeal enhancement is seen involving both cerebral hemispheres symmetrically. These findings have become more conspicuous when compared to the prior examination. The pituitary infundibulum also enhances somewhat more conspicuously than what is typically seen.No restricted diffusion is evident. No significant generalized mass effect is noted. The ventricles remain mildly prominent but similar in caliber to the prior examination.

Output: 1.Diffuse leptomeningeal enhancement has become more prominent when compared to the prior examination. This could represent a neurosarcoid flare.2.Signal abnormality in the right frontal lobe status post prior biopsy, and scattered additional areas of parenchymal signal abnormality, are not significantly changed and may represent sites of prior neurosarcoid involvement.


Instruction: Generate impression based on findings.

Input: Evaluate for labral tear. Evaluate for proximal biceps tear. ROTATOR CUFF: No evidence is seen of a full-thickness rotator cuff tear. The gadolinium remains in the glenohumeral joint. There is some thickening and intermediate signal within the supraspinatus consistent with tendinopathySUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a SLAP tear (superior labrum anterior posterior).BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Supraspinatus tendinopathy. SLAP tear of the labrum


Instruction: Generate impression based on findings.

Input: 54-year-old male with pain. Evaluate for meniscus tear/medial chondromalacia. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is mild focal degeneration of the articular cartilage of the lateral facet of the femoral trochlea superiorly. There is mild fraying of the articular cartilage of the patella centrally. The remainder of the articular cartilage is unremarkable. The bone marrow signal intensity is within normal limits.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Minimal degeneration of the articular cartilage of the patellofemoral joint, but we see no meniscal tear.


Instruction: Generate impression based on findings.

Input: Right ataxia. There are T2 hyperintense lesions within the left midbrain, pons, bilateral basal ganglia, as well as the bilateral cerebral hemisphere white matter, predominantly in a periventricular distribution. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. There are secretions in the right sphenoid sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Bilateral basal ganglia and thalamic and right pons chronic lacunar infarcts and a background of chronic cerebral white matter small vessel ischemic disease, but no evidence of acute infarction.2. Findings suggestive of acute right sphenoid sinusitis.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: Minimal fraying of the lateral meniscus without additional internal abnormality or evidence of meniscal tears, bilaterally.ARTICULAR CARTILAGE AND BONE: Red marrow changes observed in the femoral metaphysis without additional abnormality, specifically cartilage in osseous structures are intactLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Minimal fraying of the lateral meniscus along the inner edge without additional acute abnormalities observed.


Instruction: Generate impression based on findings.

Input: Sudden onset seizures. There is a non-enhancing focus of susceptibility effect in the left anterior frontal lobe, within the deep white matter of the superior frontal gyrus, that measures up to 7 mm. There is no appreciable associated vasogenic edema. There is also an enhancing lesion with serpiginous susceptibility effect involving the lingual sulcus centered the anteromedial left occipital lobe that measures up to 20 mm. In addition, there is a focus of brush-like enhancement and susceptibility effect in the right pons that measures up to 3 mm. There is no evidence of acute intracranial hemorrhage or acute cerebral 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is a subcentimeter cystic lesion along the lateral aspect of the left temporomandibular joint, which likely represents a synovial cyst.

Output: 1. Subcentimeter lesion in the left frontal lobe likely represents a cavernous malformation, without evidence of acute hemorrhage.2. An enhancing lesion involving the left lingual sulcus, centered in the anterior occipital lobe, may also represent a type of vascular malformation. A dedicated MRA or CTA may be useful for further evaluation.3. A punctate enhancing lesion in the right pons is compatible with a capillary telangiectasia.4. Outside imaging is not available on the PACS for comparison at this time.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for etiology of seizures History: as above. Study limited by patient motion.There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The hippocampi are symmetric without abnormal signal or enhancement. No heterotopic gray matter. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Study limited by patient motion. Given this caveat, there are no findings to explain the patient's seizures.


Instruction: Generate impression based on findings.

Input: 34 year old female. Left knee pain. Evaluate for chondromalacia patella versus meniscus tear. Status post left knee surgery 2001. MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Metal artifact from tibial screws somewhat limits evaluation. Bone marrow signal intensity is unremarkable within this limitation. Small focal areas of high signal intensity in the medial patellar facet articular cartilage with associated moderate thinning consistent with chondromalacia; no full thickness defect. Tibiofemoral articular cartilage is normal in thickness without a focal defect.LIGAMENTS: ACL, PCL, MCL, and LCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Chondromalacia of the medial patellar facet without a full thickness defect.2. No evidence of a meniscal tear or ligamentous injury.


Instruction: Generate impression based on findings.

Input: Cervical radiculopathy. There is degenerative spondylosis at C2-3 and C4 through C7. In particular, there is a posterior disc-osteophyte complex with marked disc space narrowing at C6-7 that nearly abuts the spinal cord and results in approximately moderate bilateral neural foraminal narrowing. There may also be mild right neural foraminal stenosis at C2-3 and C5-6. There is reversal of the usual cervical lordosis. The vertebral body are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal. The paravertebral soft tissues are unremarkable.

Output: Degenerative spondylosis at C2-3 and C4 through C7. In particular, there is a posterior disc-osteophyte complex at C6-7 that nearly abuts the spinal cord and results in approximately moderate bilateral neural foraminal narrowing.


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.he 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: 51 seconds

Output: Successful fluoroscopic guided left hip arthrogram for MRI.


Instruction: Generate impression based on findings.

Input: Female 48 years old Reason: 48 yo with right ascending colon cancer. Liver lesions on Ct Scan. Need MRI to evaluate liver lesions History: Melena ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Within segment 6 of the liver there is a T2 hyperintense lesion that does not show central enhancement or peripheral enhancement. It measures 10 x 10 mm. No restricted diffusion within the lesion. There are similar smaller foci within the right hepatic lobe. The imaging features most compatible with either a cyst.Biliary tree is without diagnostic abnormality.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.Right hepatic lobe lesion with imaging features compatible with a hepatic cyst.


Instruction: Generate impression based on findings.

Input: 43 year old female with abnormal EF of echo, MRI done for further evaluation. Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 57%. The LVEDV is 134 ml (normal range 109+/-23), LV end diastolic volume index is 73 ml/m2 (normal range: 65+/-11), LVESV is 58 ml (normal range 31+/-10), and LV end systolic volume index is 32 ml/m2 (normal range 18+/-5). There are no regional wall motion abnormalities present. There is a small focus of LV late gadolinium enhancement at the inferoseptal RV insertion point of unclear significance.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch 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 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. Left ventricle is normal in size and function. The overall LV ejection fraction is 57%.2. Right ventricle is normal in size and function. The overall RV ejection fraction is 51%.3. There is a small focus of LV late gadolinium enhancement at the inferoseptal RV insertion point of unclear significance. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.