Instruction: Generate impression based on findings.

Input: Brain: There is no discrete residual mass in the nasopharynx. There remains heterogeneous marrow signal involving the central skull base and ill-defined enhancement involving the bilateral pterygopalatine fossa and masticator spaces. There is diffuse opacification involving the bilateral anterior and posterior ethmoid air cells and to a lesser degree bilateral maxillary sinuses which is slightly improved in the interval and likely related to inflammatory mucosal thickening. There is diffuse opacification of the bilateral mastoid air cells which was present previously. There remains unchanged nonspecific patchy foci of T2 hyperintensity throughout the supratentorial white matter most likely representing mild chronic small vessel disease. Again seen is a small focus of cortical FLAIR hyperintensity and volume loss involving the left cingulate gyrus with foci of susceptibility which may be related to prior ischemic injury with hemorrhage and unchanged. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids remain intact. No abnormal parenchymal or meningeal enhancement in the brain.Orbits: Intraorbital extension of the tumor has resolved bilaterally when compared to the initial presentation MRI, and unchanged when compared to the more recent MRI. Bilateral globes and intraconal contents including optic nerves are unremarkable.

Output: Posttreatment changes related to nasopharyngeal cancer without definite evidence of residual tumor. There remains heterogeneous enhancement involving the central skull base as well as the pterygopalatine fossa without corresponding abnormal FDG uptake on prior PET/CT and compatible with treated tumor.


Instruction: Generate impression based on findings.

Input: CVA in 2011, evaluate for cervical spine lesions affecting motor tracts versus neuropathy vs myelopathy History: Persistent R sided weakness and hyperreflexia out of proportion to brain MRI findings. There is kyphotic deformity of the cervical spine, but no spondylolisthesis. There is multilevel degenerative spondylosis with small disc osteophyte complexes at C2-3 to C7-T1 with at most mild spinal canal narrowing, but up to severe neural foraminal narrowing at C3-4 through C6-7 bilaterally. There is high T2 signal in the spinal cord at the C4 level, mainly involving the grey matter, left more than right. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is encephalomalacia in the pons. The paravertebral soft tissues are unremarkable.

Output: 1. Kyphotic deformity of the cervical spine, but no spondylolisthesis.2. Multilevel degenerative spondylosis with small disc osteophyte complexes at C2-3 to C7-T1, with at most mild spinal canal narrowing, but up to severe neural foraminal narrowing at C3-4 through C6-7 bilaterally. 3. High T2 signal in the spinal cord at the C4 level may represent myelomalacia. 4. Chronic lacunar infarct in the pons.


Instruction: Generate impression based on findings.

Input: 44-year-old female status post surgical resection of a colloid cyst, now with mild memory impairment. There are unchanged postsurgical findings related to bifrontal craniotomy and resection of a colloid cyst via a transcallosal approach. There is new cortical gyriform high T2 signal and enhancement in the left temporal and occipital lobes and in the inferior left precentral gyrus. There is unchanged curvilinear increased T2 signal in the anterior right frontal lobe consistent with a prior ventriculostomy catheter tract. There is unchanged nonspecific thin confluent high T2 signal in the periventricular white matter along the bilateral lateral ventricles. There is no midline shift or herniation. There is unchanged asymmetry of the lateral ventricles and mild diffuse cerebral and cerebellar vermis volume loss. The orbits and paranasal sinuses are unremarkable.

Output: 1. Late subacute infarction affecting the left temporal and occipital lobes and left precentral gyrus consistent with prior infarction.2. Unchanged postoperative findings related to colloid cyst resection without evidence of residual or recurrent cyst.3. Mild diffuse cerebral and cerebellar vermis volume loss may be related to alcohol use. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 64-year-old with strong family history of breast cancer. No current complaints. History of bilateral cyst aspirations. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right upper outer central breast there is a new 5 mm focus of enhancement. Management of this focus was discussed for consensus by two attending breast radiologists. There are a few scattered stable foci and areas of normal edge parenchymal enhancement elsewhere, but none of these are suspicious in appearance. No abnormal axillary lymph nodes are identified in either axillary region.

Output: New focus of enhancement in the right central outer breast. This is relatively low suspicion, however, based on the patients very strong family history and the fact that this is a change compared to the old study, MRI guided biopsy is recommended. Based on the very small size, MRI directed ultrasound is felt to have a low probability of detection for this finding. The result was emailed to Joly Raju. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female 47 years old Reason: knee pain, possible MCL injury History: knee pain MENISCI: Medial and lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: Small focus of cartilage defect with underlying bone marrow edema in the posterior lateral femoral condyle. There is a focal partial-thickness defect in the cartilage of the medial patellar facet.LIGAMENTS: Abnormal increased signal in the MCL consistent with sprain/partial tear. The lateral collateral ligament complex is intact. The cruciate ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: MCL sprain/partial tear and other findings as above.


Instruction: Generate impression based on findings.

Input: There is multilevel degenerative spondylosis with a disc-osteophyte complex at C3-4 with mild right neural foraminal stenosis and mild spinal canal stenosis. In addition, there is a posterior disc-osteophyte complex with mild spinal canal narrowing and bilateral moderate neural foraminal stenosis. There is also a a disc-osteophyte complex at C6-7 with a superimposed right paracentral disc extrusion that encroaches upon the right neural foramen and mild indents the spinal cord. However, there is no abnormal spinal cord signal. The vertebral body and disc heights are preserved. There is no pathological enhancement.

Output: 1. Mild degenerative cervical spondylosis with a disc-osteophyte complex at C3-4 that results in mild right neural foraminal stenosis and mild spinal canal stenosis, a posterior disc-osteophyte complex with mild spinal canal narrowing and bilateral moderate neural foraminal stenosis, and at C6-7 with a disc-osteophyte complex superimposed right paracentral disc extrusion that encroaches into the right neural foramen and mild indents the spinal cord. 2. No evidence of cervical spine metastases.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with moderate intellectual disability and seizures since childhood with generalized tonic-clonic's and drop attacks and with generalized slow spike-and-wave on EEG. Scattered small foci of white matter T2 hyperintensity are seen without significant mass effect or edema. No restricted diffusion is evident. No pathologic parenchymal or extra-axial enhancement is detected.The mesial temporal lobes demonstrate symmetric morphology and signal characteristics. No structural abnormalities are detected here or elsewhere in the brain.There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology. The cerebellum is small relative to the posterior fossa suggesting cerebellar volume loss.

Output: 1.Scattered nonspecific foci of white matter signal abnormality.2.Volume loss of the cerebellum which may be secondary to long-term anticonvulsant therapy or other medications or toxic exposures.3.No additional structural abnormalities are seen to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Reason: progressive ataxia, please look for hot cross bun sign History: ataxia There is atrophy of the cerebellum and brainstem with a cross a cross bun sign.No abnormal enhancing lesions are identified within the brain parenchyma.A punctate T2 signal hyperintensity in the right external capsule is probably of little clinical significance.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrator minor opacity in the left sphenoid sinus and left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Atrophy of the posterior fossa structures are suspicious for SCA or MSA with cross bun sign as suspected.


Instruction: Generate impression based on findings.

Input: 66 year old male with prior MI and abnormal perfusion on nuclear imaging, assess for myocardial viabilityMEDICATIONS: Aspirin, carvedilol, HCTZ, rosuvastatin Viability/ Myocardial ScarThere is a non-transmural myocardial infarction involving the basal anterolateral wall, the basal and mid inferolateral wall, and the apical inferior wall. Based on late gadolinium enhancement, these segments have an intermediate probability of viability. However, after the administration of dobutamine, most of the segments demonstrate increased contractility suggesting that they are indeed viable. The remainder of the myocardium is free of myocardial infarction and viable. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 106 ml/m2 (normal range: 74+/-15), the LVEDV is 219 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 120 ml (normal range 47+/-19), the LV mass index is 80 g/m2, and the LV mass is 165 g. There is hypokinesis in the basal and mid inferolateral wall of the myocardium. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 196 ml (normal range 142+/-31), the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9), and the RVESV is 95 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a non-transmural myocardial infarction involving the basal anterolateral wall, the basal and mid inferolateral wall, and the apical inferior wall. Based on late gadolinium enhancement, these segments have an intermediate probability of viability. However, after the administration of dobutamine, most of the segments demonstrate increased contractility suggesting that they are indeed viable. The remainder of the myocardium is free of myocardial infarction and viable. 2. Mild left ventricular dilation with mildly reduced systolic function (LVEF 45%).3. Normal RV size and 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: 67 year old woman with history of LV dysfunction and eosinophilia, with previous cardiac biopsy suggestive of eosinophilic myocarditis. She was referred for cardiac MRI to evaluate for scar and active inflammation in view of recent steroid wean and intermittent symptoms of fatigue. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LVEDV is 152 ml (normal range 109+/-23), the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVESV is 75 ml (normal range 31+/-10), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LV mass is 85 g (normal range 114+/-24), and the LV mass index is 45 g/m2 (normal range 67+/-11). There is global mild hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RVEDV is 137 ml (normal range 110+/-24), the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVESV is 56 ml (normal range 35+/-13), and the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild 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 at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. Aortic sinus of valsalva measures 41 x 39 x 38 mm which is similar to the previous study.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 trivial pericardial effusion. On T2 STIR images there is prominence of the pericardial sac that could suggest evidence of pericardial inflammation. This prominence of the pericardial sac was also seen on previous study.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is no longer dilated but still shows mildly reduced systolic function (LV EF 50%). This has improved from previous LVEF 46%2. No late gadolinium enhancement to suggest an infiltrative, inflammatory or fibrotic process. 3. Normal size right ventricle with normal systolic function (EF 59%).4. There is trivial pericardial effusion. On T2 STIR images there is prominence of the pericardial sac that could suggest evidence of pericardial inflammation. This prominence of the pericardial sac was also seen on previous study.5. See aortic measurements above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Klippel-Feil syndrome and neck pain with syrinx, evaluate for change. Signs and symptoms: Yearly evaluation. Nonenhanced cervical MRI:There is revisualization of a stable few is right arch of C1 bone and with intravenous increased bony volume/hypertrophy similar to prior exam. There is mild dorsiflexion of the dens with resultant effacement of ventral subarachnoid space and mild mass effect and posterior displacement of the cervical medullary junction of the cord without central spinal stenosis or interval change since prior exam.The alignment of vertebral column and 8 signal intensity remains within normal and stable since prior study.Impression there is a uniform thin linear increased T2 signal intensity traversing the entire cervical cord and into the upper visualized thoracic cord identical to prior exam. Findings could represent central canal or less a nonexpansile syrinx. The caliber of the cord remains within normal for age and without detectable signal abnormality otherwise.There is no evidence of spinal canal or neural foraminal compromise at any level.Unremarkable paraspinal soft tissues.Nonenhanced thoracic MRI:Examination demonstrates normal signal intensity and alignment of vertebral column without detectable congenital anatomical anomaly.There is no evidence of a spinal canal or neural foraminal compromise.There is a mildly expansile syrinx of thoracic cord identical to prior exam and extending from C5-C6 disc level inferiorly to mid T9 level without evidence of interval change in extent or size since prior study. The finding measures maximum of 2.5 mm in transverse axis. The nonexpansile and segmental syrinx extends superiorly to the cervical cord and inferiorly to approximately T12 similar to prior exam.No detectable paraspinal abnormalities and unremarkable signal intensity of the cord otherwise.

Output: 1.No evidence of an acute or new finding since prior study.2.Revisualization of fusion of the right arch of C1 with the occipital bone.3.Revisualization of syrinx of cervical and thoracic cord measuring maximum of 2.5 mm in short segmental expanded thoracic component of syrinx and approximately 1 mm in the nonexpansile component of syrinx similar to prior exam.


Instruction: Generate impression based on findings.

Input: 38-year-old female with cervical cancer undergoing brachytherapy planning. PELVIS:UTERUS, ADNEXA: Stable size of known cervical mass measuring up to 5.7 x 3.6 cm, unchanged in size (series 601/43). The mass does demonstrate slight decrease in enhancement. Again seen are findings suspicious for uterine invasion and bilateral parametrial invasion as evidenced by ill-defined borders of the mass (e.g. 601/42). Again seen is abutment of the mass with the anterior aspect of the rectum with probable underlying rectal serosal invasion. Fibroid uterus. Subcentimeter Bartholin's gland cyst.A single loop of ileum is seen abutting the right adnexa.BLADDER: Small amount of air within the decompressed bladder, likely due to recent instrumentation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New mild lower abdominal ascites, most likely related to posttreatment change.

Output: No significant change in size of known cervical mass as detailed above.


Instruction: Generate impression based on findings.

Input: 33-year-old female patient with small retrorectal cyst detected on prior exam, patient is asymptomatic. Assess for interval growth. Lack of IV contrast limits evaluation.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a single septated T2 hyperintense lesion posterior to the rectum and anterior to the coccyx which measures 1.3 x 1.4 cm (image 33, series 10). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Single septated T2 hyperintense lesion posterior to the rectum presumably represents a cyst within limitations of a non-contrast study.


Instruction: Generate impression based on findings.

Input: 51 years, Female, Reason: h/o recurrent micropapillary borderline tumor of ovary, now with pain in left pelvis, r/o recurrence History: sharp pain in left pelvis, palpated mass at superior left vaginal cuff/left pelvic side wall. ABDOMEN:LIVER, BILIARY TRACT: Punctate T2 hyperintensity in the right hepatic lobe, likely a cyst (9/19).SPLEEN: Small splenule.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral subcentimeter renal cysts.RETROPERITONEUM, LYMPH NODES: Small scattered retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: There is a cystic lesion in the left adnexa which measures 3.7 x 2.7 x 5.1 cm and has nodular enhancing foci along the inferior aspect. This is increased in size from the prior ultrasound where it measured 1.5 x 1.4 x 1.2 cm.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly enlarged left inguinal node with restriction on diffusion weighted imaging measures 1.3 x 1.3 cm (17/33).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cystic lesion in the left adnexa with a nodular enhancing component is suspicious for recurrent borderline papillary serous tumor and is increased in size from the prior ultrasound.2.Mildly enlarged left inguinal lymph node also suspicious for recurrence/metastatic disease.


Instruction: Generate impression based on findings.

Input: Posterior fossa ependymoma, status post treatment, now with worsening ataxia, difficulty breathing. There are postoperative findings related to suboccipital craniotomy. There is no significant change in size of the somewhat infiltrative tumor with irregular peripheral enhancement in the right inferior fourth ventricle, cerebellopontine angle, right premedullary cistern, which measures up to approximately 5 cm. There is a right trans-cerebellar catheter that terminates within the tumor, along the medial aspect of a cystic space extrinsic to the tumor in the right cerebellopontine angle that measures up to 20 mm. There is associated mass effect upon the adjacent right cerebellar hemisphere, brainstem, and upper spinal cord. There is associated high signal diffusely within the cerebellum, right much more than left, pons, right middle cerebellar peduncle, and within the central portion of the upper spinal cord. There is a left transfrontal ventricular catheter that terminates in near the left foramen of Monro. The third and lateral ventricles nearly effaced. There is no midline shift or herniation. Although there is mass effect and perhaps encasement of the vertebrobasilar system, the flow voids are otherwise intact. There is no evidence of acute infarction or intracranial hemorrhage. There is persistent bilateral tympanomastoid fluid. There is diffuse paranasal sinus mucosal thickening.

Output: 1. Residual tumor in the posterior fossa with edema in the surrounding parenchyma is not significantly changed since March 2016.2. A cystic space extrinsic to the tumor in the right cerebellopontine angle is also not significantly changed since March 2016.3. The third and lateral ventricles are nearly effaced, with a left transfrontal ventricular shunt catheter in position.


Instruction: Generate impression based on findings.

Input: Right shoulder instability The examination is slightly limited by motion artifact.ROTATOR CUFF: There is slight increased signal intensity within the distal fibers of the supraspinatus may reflect mild tendinosis or articular surface fraying but there is no evidence of a rotator cuff tear. There is increased signal intensity within the insertional fibers of the subscapularis which is likely iatrogenic in nature related to the intra-articular injection. The caliber and signal intensity of the rotator cuff musculature is normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint but alignment is normal. Again seen is truncation and irregularity of the anterior and anterior superior labrum reflecting tearing. The posterior labrum is intact.BICEPS TENDON: Evaluation of the intra-articular portion of the biceps tendon reveals slightly increased signal intensity just prior to the insertion of the long head of the tendon onto the glenoid. This may reflect mild tendinosis or minimal extension of labral tearing into the biceps pulley but the extra-articular portion of the biceps is normal.ADDITIONAL

Output: .1. Tearing of the anterior and superior labrum with perhaps slight extension into the biceps pulley.2. Mild tendinosis of the supraspinatus tendon without evidence of a full-thickness rotator cuff tear. There is increased signal intensity within the insertional fibers of the subscapularis which is thought to be most likely iatrogenic in nature but correlation with physical exam findings is recommended to exclude a true subscapularis cuff tear.3. Moderate osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: Per chart, this is a 68 year-old African-American F with DM (on insulin), HTN, morbid obesity, depression, OA of knee and shoulder who presents with acute onset dizziness and imbalance since early AM on 6/18 that lasted for hours. Right upper extremity ataxia on neurologic exam. Assess for brainstem infarct, acute vertigo and cerebellar signs. There are two small foci of diffusion restriction in the left thalamus. The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter and pons, consistent with mild to moderate chronic small vessel ischemic changes. No extra-axial fluid collection is identified. There is opacification of a left posterior ethmoid air cell. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Two small foci of acute infarcts in the left thalamus. No evidence of acute intracranial hemorrhage or mass effect.2. Mild to moderate chronic small vessel ischemic changes. Urgent findings discussed with Dr. Buerki on 6/18/2015 at 3:15pm.


Instruction: Generate impression based on findings.

Input: assess sinuses, aspergillus: sinusitis. There are postoperative findings related to prior sinonasal debridement. However, there is diffuse pansinus mucosal enhancement and debris that displays low T2 and intermediate T1 signal. The enhancement along the walls of the sphenoid sinuses extend to the planum sphenoidale and anterior sella, where there are corresponding bony dehiscences that are more clearly depicted on CT. There are also dehiscences in the bilateral lamina papyracea and nasolacrimal ducts, with persistent enlargement of the left lacrimal sac, but no gross intraorbital extension, although the images are not optimized for the evaluation of the orbits. However, the left optic nerve canal is narrowed secondary to reactive thickening of the adjacent bone, which is also more clearly depicted on the prior CT. There is no evidence of intracranial abscess. There is no midline shift or herniation.

Output: 1. Postoperative findings related to prior sinonasal debridement with persistent extensive diffuse pansinus fungal disease.2. Inflammation along the walls of the sphenoid sinuses extend through bony dehiscences at the planum sphenoidale and anterior sella, which are more clearly depicted on CT. 3. Dehiscences in the bilateral lamina papyracea and nasolacrimal ducts, with persistent enlargement of the left lacrimal sac, but no gross intraorbital extension, although the images are not optimized for the evaluation of the orbits.4. The left optic nerve canal is significantly narrowed relative to the right secondary to reactive thickening of the adjacent bone, which is also more clearly depicted on the prior CT.


Instruction: Generate impression based on findings.

Input: Reason: Eval rotator cuff tendinopathy, r/o rotator cuff tear History: Acute on chronic L shoulder pain ROTATOR CUFF: There is bursal surface fraying of the supraspinatus approximately 2.5 cm proximal to its insertion on the greater tuberosity. Otherwise the supraspinatus muscle and tendon appear intact. There is intermediate signal intensity within the supraspinatus indicating mild tendinosis. The infraspinatus muscle and tendon appear intact. There is a tiny interstitial tear of the subscapularis at the level of its insertion. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is heterogeneity and intermediate signal intensity within the anterior inferior glenoid labrum indicating degeneration and tearing within the limitations of this non arthrogram study. The glenohumeral joint alignment is anatomic.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is a small amount of fluid within the tendon sheath which likely represents fluid extension from the joint. ADDITIONAL

Output: 1. Mild rotator cuff tendinosis. Minimal fraying of the supraspinatus. Tiny interstitial tear of the subscapularis.2. Degeneration and tearing of the inferior glenoid labrum as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: 12-year-old male. Arteriovenous malformation of cerebral vessels Arteriovenous malformation of cerebral vesselsClinical question: evaluate changes in AVMSigns and Symptoms: increased seizure frequency, h/o of AVM s/p embolization in 10/2015 MRI of the brainThe patient is status post left parietal craniotomy for AVM removal. There is metallic artifact present at the surgical site within the left occipital and parietal lobes. This may obscure visualization of local changes. There is T2 and FLAIR signal hyperintensity in the surgical bed.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the ethmoid air cells and sphenoid sinuses frontal sinuses and maxillary sinuses with air-fluid levels in the maxillary sinuses. Air-fluid levels were previously present in the maxillary sinuses as well.. The patient is status post intubation for the MRI. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. There is extracranial origin of the right posterior inferior cerebellar artery. There is infundibulum at the origin of the left posterior communicating artery. There is triplication of the anterior cerebral artery.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The right transverse sinus is larger than the left transverse sinus.

Output: 1.There is no convincing evidence for recurrence of arteriovenous malformation. Please note that conventional angiography is more sensitive in the detection of small residual components of arteriovenous malformation.2.Status post left parietal lobe surgery for removal of a arteriovenous malformation. Some surgical clips are present at the surgical site which may obscure a local visualization and creates some artifacts.3.No evidence for intracranial cerebrovascular occlusive disease or intracranial aneurysm. 4.There is no evidence for dural venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: There are dental braces which result in artifact, especially in DWI and SWI sequences.There are no T2/FLAIR abnormalities. Ventricular size is normal. There is no midline shift. No abnormalities are seen in the mesial temporal lobe. Basal cisterns are patent. There is no extra-axial fluid. There are no diffusion abnormalities within the visualized structures. There are no structural abnormalities. Visualized vascular flow voids are normal.

Output: Unremarkable MRI of the brain, within limitations of artifact from dental hardware.


Instruction: Generate impression based on findings.

Input: Female, 22 months old, with midline cleft lip and palate with mass in the line of the palatal cleft. A large deficiency is evident in the sphenoid and ethmoid portions of the anterior skull base. Through this deficiency, a CSF filled sac protrudes, continuing through a cleft palate to enter the oral cavity. This CSF filled sac appears to be contiguous with the third ventricle.A small portion of the inferior right frontal lobe herniates partially through the skull base defect. A vascular structure is evident originating at the left aspect of the herniating sac at the level of the nasal cavity, from which point it extends superiorly to join with the internal cerebral veins. The A1 segment of the left ACA also approaches and may slightly enter the defect.The sella turcica is not formed. It appears that the pituitary stalk is elongated and extends down into the defect. The pituitary gland itself appears to be adherent along the posterior wall of the sac, potentially extending as far down as the level of the oral cavity. Some quantity of hypothalamic tissue tracks along the walls of the third ventricle at least partly into the defect.The corpus callosum is absent with resulting colpocephaly. Mild disorganization of the gyri along the inferior frontal lobes is seen. Otherwise, the gyri are unremarkable. No evidence of restricted diffusion or any significant parenchymal signal abnormality is seen.The brainstem and cerebellar vermis are normally formed and intact. The cerebellar hemispheres are unremarkable. A normal variant cisterna magna is demonstrated.Fine bony details of the cleft lip and palate are better assessed on the separately dictated craniofacial CT.

Output: A sphenoethmoidal encephalocele is demonstrated with herniation of a CSF filled sac through the anterior skull base, continuing through a defect in the palate to enter the oral cavity. The CSF filled sac appears to be contiguous with the third ventricle.A very small quantity of the right inferior frontal lobe enters the skull base defect. More notable, however, is the fact that the pituitary gland appears to reside within the herniating sac, positioned along the posterior wall of the sac, potential extending all the way down to the oral cavity. A small amount of hypothalamic tissue may also enter the defect.At least one vascular structure, favored to represent a vein, traverses the encephalocele. The A1 segment of the left ACA approaches and may very minimally enter the defect as well.Brain parenchymal findings are seen compatible with agenesis of the corpus callosum.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of vertebral column [C41.2], Reason for Study: ^Reason: hx L3 chordoma with hx of resection. Eval for recurrence or abnormality History: surveillance imaging For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. External fixation with pedicular screws and rods from L1 to L5 with L3 colpectomy and instrument inserted at the level of L3.There are significant metallic artifacts from L1 to L5 instrumentations.There are diffuse enhancement on the L3 colpectomy area with mesial aspects of adjacent bilateral psoas muscles which most likely represent postop scar tissue. There is no definitive mass formation or abnormal enhancing soft tissues is seen.There is relatively well delineated lenticular shaped lesion on the L3 level posterior to spinal canal with some peripheral enhancement. The lesion shows high signal intensity on T2 and low signal intensity on T1 indicating fluid content. There is no evidence of mass effects against spinal canal.There is thin walled tubular lesion on the right side of the thoracoabdominal aorta. The lesion is about 22.8mm (AP) x 26.8mm (RL) x 55.3mm (CC). Comparing to prior scan especially Abdominal CT scan obtained on Jan 28 2015, the lesion is most likely representing evolving paraaortic retroperitoneal hematoma. Visualized spinal cord appears to be normal in signal intensity and conus medullaris terminates at L1 level. There is no other abnormal enhancement or lesion.Previously seen right renal cyst is again shown, no change since prior scan.

Output: 1. Post L3 colpectomy with external fixation from L1 to L5.2. No evidence of abnormal enhancement on this scan.3. Diffuse enhancement of L3 colpectomy area including mesial aspect of bilateral psoas muscles indicating post-surgical scar tissues. No definitive evidence of enhancing mass on operation site.4. Evolving retroperitoneal para aortic hematoma.5. Fluid collection which located posterior aspect of the spinal canal without showing any evidence of mass effects toward spinal canal with mild peripheral enhancement. Likely represent post surgical fluid collection.


Instruction: Generate impression based on findings.

Input: Reason: right ankle pain History: right ankle pain There is thickening of the Achilles tendon silhouette, consistent with tendinosis as seen on the prior MRI examination although we cannot exclude the possibility of a superimposed tear. Mild osteoarthritis affects the talonavicular joint. We see no fracture.

Output: Achilles tendinopathy as above. If there is clinical concern for a tear, repeat MRI be considered.


Instruction: Generate impression based on findings.

Input: Left knee pain, evaluate for chondral defect. Per Epic, history of partial medial meniscectomy. MENISCI: There is blunting of the free edge of the medial meniscus compatible with prior meniscectomy. The medial meniscus appears somewhat extruded laterally. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a 7 x 11 mm focus of abnormally decreased T1 signal and increased T2 signal along the lateral aspect of the medial femoral condyle (8/15) compatible with an osteochondral defect. A large segment of cartilage overlying this lesion appears to have delaminated for length of approximately 16 mm in AP dimension (6/10). The osseous component of the lesion lacks underlying linear T2 signal abnormality to suggest instability. Bone marrow edema and subchondral cyst formation is present within the medial femoral condyle adjacent to the osteochondral defect. The remaining cartilage of the knee appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1.Postsurgical changes to the medial meniscus.2.Osteochondral defect involving the lateral aspect of the medial femoral condyle with large segment of delaminated cartilage and without evidence of instability of the osseous component.


Instruction: Generate impression based on findings.

Input: 25 years, Female, headache. Also history of Legionnaire's disease. MRI BRAIN: There is extensive susceptibility effect involving multiple bilateral cortical veins as well as the superior sagittal sinus and bilateral transverse sinuses with areas of T1 hyperintensity consistent with venous thrombosis.There is no evidence of acute infarct. There are bilateral subdural fluid collections along the bilateral cerebral convexities as seen on recent CT with mild local mass effect, particularly along the right frontal convexity. Subdural fluid is also noted along the falx and tentorium. There is no midline shift or frank herniation, although there is mildly diminutive appearance of the ventricles and CSF cisterns which may be related to mild cerebral edema.No evidence of acute infarct. No intraparenchymal edema or hemorrhage. No parenchymal signal abnormality. There are minimal areas of apparent leptomeningeal enhancement such as at the left internal auditory canal which are nonspecific in this setting. No clear MRI evidence of intracranial infection.Paranasal sinuses and mastoid air cells are clear. Calvarium and intracranial soft tissues are grossly unremarkable.MRA HEAD: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. Patent anterior communicating and right posterior communicating artery. Left posterior communicating artery is not definitively seen which is normal variant.MRV HEAD: There is thrombosis involving the superior sagittal sinus as well as the proximal and mid aspects of the transverse sinus. The inferior sagittal sinus, very distal transverse sinuses, sigmoid sinuses, and visualized portions of the bilateral internal jugular veins appear patent. Internal cerebral veins, vein of Galen, basal veins of Rosenthal, and straight sinus are patent.

Output: 1. Extensive venous sinus thrombosis involving the entire superior sagittal sinus and majority of the bilateral transverse sinuses. The sigmoid sinuses and bilateral internal jugular veins are patent. There is also extensive thrombosis involving multiple cortical veins.2. There are bilateral subdural effusions which are nonspecific and are associated with mild local mass effect along the right frontal convexity. No findings to suggest empyema. There is mild dural enhancement which while may be related to the venous thrombosis, in association with the subdural effusions there is a possibility that this represents sequela of prior lumbar puncture. There are minimal apparent areas of leptomeningeal enhancement such as the left internal auditory canal which is nonspecific in the setting and may actually represent venous congestion. No definite MRI evidence of intracranial infection, but would suggest correlation with CSF analysis to better exclude infection.3. Suggestion of mildly diminished CSF spaces including the basilar cisterns and mildly diminished caliber of the ventricular system which may reflect mild cerebral edema. There is however no evidence of frank herniation.4. No evidence of parenchymal edema or parenchymal hemorrhage. Dr. Ali discussed findings with Dr. Thoburn at 1713 hrs on 8/3/2016.


Instruction: Generate impression based on findings.

Input: Reason: assess for osteomyelitis History: skin infection, elevated CRP, immunosuppressed Right femur:There is a small amount of fluid within the right hip without evidence of a large effusion. There is no bone marrow signal abnormality within the right femur to suggest osteomyelitis. There is diffuse nonspecific subcutaneous edema about the right hip and thigh. There is fatty atrophy of the musculature of the thigh most pronounced within the posterior compartment musculature. There is also enhancing increased signal abnormality within the hamstring musculature which is nonspecific but may reflect a myositis. Although the edema becomes confluent along the posterior and lateral aspect of the distal femur no focal encapsulated fluid collection is identified to suggest abscess formation. Note is made of a large knee joint effusion with thickened enhancing synovium indicating a synovitis.Right tibia/fibula:Severe osteoarthritis affects the right knee. Again seen is the right knee joint effusion with foci of internal debris and synovial enhancement on postcontrast sequences indicating a synovitis. There is a lobulated focus of fluid signal intensity within the proximal fibula likely representing a benign enchondroma, although this could be further evaluated with dedicated radiographs. There is nonspecific enhancing subcutaneous edema along the anterior and medial aspect of the leg. There is associated skin thickening most pronounced along the anterior aspect of the leg. There is soft tissue irregularity in this area which may represent ulceration. There is no bone marrow signal abnormality in the surrounding area to suggest osteomyelitis. There is diffuse fatty atrophy of the imaged musculature of the right leg. There is no focal fluid collection to suggest abscess formation. There is mild increased signal abnormality and fluid sensitive sequences within the anterior tibialis muscle which may reflect a myositis.

Output: 1. Extensive nonspecific enhancing subcutaneous edema about the thigh and leg as described above consistent with the stated history of a cellulitis. There is also signal abnormality within the hamstring musculature and anterior tibialis muscle which may reflect a myositis. There is no bone marrow signal abnormality to suggest osteomyelitis. There is no focal fluid collection to suggest abscess formation.2. Note is made of large bilateral knee joint effusions with thick enhancing synovium indicating a synovitis.3. Lobulated lesion within the proximal right fibula may represent a benign enchondroma, however, this could be further evaluated with dedicated radiographs if clinically warranted.4. Osteoarthritis of the knees and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: eval for sacroiliac infection History: as above Again seen is increased bone marrow signal abnormality about the left sacroiliac joint with associated erosion and deformity with minimal, if any, enhancement on postcontrast sequences. These findings may represent changes related to chronic osteomyelitis. However, the degree of enhancement and bone marrow signal abnormality on fluid sensitive sequences within the left iliac bone and left sacral wing appears decreased when compared to the prior examination. No additional bone marrow signal abnormality is identified. There is an apparent small focus of ossification within this erosion which could again conceivably represent a sequestration, although this was better seen on prior CT examinations. If the case, this site could conceivably serve as a nidus for continued infection which may be poorly demonstrated by imaging.Severe degenerative disc disease affects the imaged lower lumbar spine. Moderate osteoarthritis affects the hips. The imaged musculature of the pelvis is unremarkable. No focal fluid collection is identified to suggest abscess formation.

Output: Bone marrow signal abnormality and erosive changes about the left sacroiliac joint. While there is interval decrease in bone marrow signal abnormality in the surrounding area and enhancement, this remains suspicious for chronic infectious/inflammatory changes in the correct clinical context. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate edema, stroke, include sinuses. Signs and symptoms: Meningitis, CVAs Nonenhanced CT of brain:Multiple previously noted left hemispheric subacute cortical and left basal ganglial nonhemorrhagic strokes are again identified. There is no appreciable interval change. Mass-effect and effacement of cortical sulci is again identified. No change in the degree of mass effect.There is a very subtle area of low attenuation in the cingulate gyrus of the right posterior frontal which was not appreciated on prior CT study however it was present on prior MRI examination. There is also better visualization of a single small foci of low-attenuation in the right anterior limb of internal capsule which was also present on prior MRI however not on head CT.There is no evidence of interval hemorrhage or new ischemic stroke.CT of paranasal sinuses:There is fluid level within the dependent portion of bilateral maxillary sinuses. The ostiomeatal units of maxillary sinuses are patent. There is very extensive opacification of sphenoid sinus with mucosal thickening as well as fluid no. Extensive opacification of left posterior ethmoid air cells and to a lesser degree all the other ethmoid air cells. Frontal sinuses are pneumatized and no images of pathology. Presence of NG tube could explain presence of fluid within the sinuses.Images through nasal cavity demonstrate NG tube and some mucosal thickening. There is also partial opacification of bilateral mastoid air cells however with no opacification of the cavities.

Output: 1.Revisualization of multiple left hemispheric and few small right hemispheric ischemic strokes with no areas of hemorrhagic conversion and no evidence of new stroke. The mass-effect remains identical to prior study.2.Extensive because of thickening and fluid levels within paranasal sinuses could be result of patient's NG tube placement or sinusitis.3.The ostiomeatal units of maxillary sinuses are patent bilaterally.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with neurogenic bladder, pain and right hip pain. Evidence of posterior instrumented fusion is seen from L4 through S1. Posterior spinal canal decompression also been performed at least at L4-5.Spinal alignment is anatomic. Vertebral body heights are preserved. Apart from the L4 through S1 vertebral bodies, which demonstrate largely fatty marrow signal likely related to surgical fusion, the vertebral body marrow signal is unremarkable. No definite pathologic marrow enhancement is seen.The visualized spinal cord and conus are within normal limits allowing for motion artifact. Evaluation of the spinal canal is slightly degraded through the operative region at L4 and L5, but no significant intrathecal abnormality is detected. No definite pathologic enhancement of the spinal cord or nerve roots is detected.Level specific degenerative findings are as follows:T12-L1: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild spinal canal narrowing to which prominence of the dorsal epidural fat contributes. Moderate left and mild right foraminal narrowing. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Minimal bulging disk. Mild spinal canal narrowing to which prominence of the dorsal epidural fat contributes. Mild bilateral foraminal narrowing. L4-5: Hypertrophy of the residual facets. Partial fusion across the disk space with mild posterior osteophytic spurring asymmetric to the left. Partial left lateral recess effacement without significant generalized canal stenosis. Assessment of the neural foramina is complicated by metallic artifact, but moderate narrowing is suspected on the left. L5-S1: Facet hypertrophy. Disk space narrowing and minimal disk bulging. No significant canal stenosis. Assessment of the foramina is complicated by metallic artifact, but some degree of narrowing is suspected bilaterally. A left renal cystic lesion is identified incidentally.

Output: 1. Evidence of instrumented posterior spinal fusion from L4 through S1. The spinal canal has been decompressed posteriorly at least at L4-5.2. Relatively mild degenerative disk disease is seen at several levels. In combination with posterior element hypertrophy and prominence of the dorsal epidural fat, this contributes to mild spinal canal narrowing at L2-3 and L3-4.3. Moderate neuroforaminal narrowing is suspected on the left at L2-3 and L4-5.


Instruction: Generate impression based on findings.

Input: 18-year-old female with history of fall, knee pain, swelling, and instability. Evaluate for ACL tear. MENISCI: Increased linear signal in the posterior horn of the medial meniscus extending to the inferior articular surface compatible with meniscal tear. The lateral meniscus is normal in signal and morphology.ARTICULAR CARTILAGE AND BONE: Increased T2 signal within the lateral femoral condyle, posterior tibial plateau, and the fibular head compatible with contusions with probable underlying microtrabecular fractures.Again noted is a broad-based central exostosis of the anterior metadiaphysis of the femur consistent with an osteochondroma.LIGAMENTS: The anterior cruciate ligament demonstrates abnormal increased signal as well as abnormal morphology compatible with a tear; a few fibers appear intact at the origin.The posterior cruciate ligament is intact. Grade 1 sprain of the medial collateral ligament; otherwise, the collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Findings consistent with anterior cruciate ligament tear.2.Vertical tear of the posterior horn of the medial meniscus.3.Osseous contusions with probable microtrabecular fractures as detailed.4.Large knee joint effusion.5.Grade 1 sprain of the medial collateral ligament.6.Sessile osteochondroma of the distal metadiaphysis of the anterior femur.


Instruction: Generate impression based on findings.

Input: Reason: Concern for worsening metastatic disease History: Headache, history of metastatic breast CA status post WBRT The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of an enhancing lesion measuring 8 x 5 mm axial dimensions located in the left hand motor area of the precentral gyrus which previously measured 9x7mm. There is redemonstration of a couple punctate enhancing lesions in the right inferior parietal lobule which appears smaller on the current exam they currently measure 2 mm and previously measured 4 mm. One of these inferior parietal lobule lesions is associated with signal loss on susceptibility imaging which would suggest a microhemorrhage (this has not changed). There is redemonstration of a left temporal lobe lesion in the fusiform gyrus which previously measured 6 mm and now measures 3 mm. There is redemonstration of a right cerebellar lesion measuring 2 mm in size measuring about the same on the prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Multiple punctate lesions scattered in the brain parenchyma compatible with metastases - as detailed above - are smaller on the current exam when compared to the prior exam from December 2014.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with radiculopathy. Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are heterogeneous but there are no areas of suspicious focal marrow replacement. Edema is evident centered on the left L5-S1 facet joint and left L5 pedicle. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: Facet arthropathy. No spinal canal or foraminal stenosis. L2-3: Facet arthropathy. No spinal canal or foraminal stenosis. L3-4: Facet arthropathy and ligamentum flavum thickening. Minimal disc bulging. No spinal canal or foraminal stenosis. L4-5: Facet arthropathy and ligamentum flavum thickening. Minimal disc bulging. No spinal canal or foraminal stenosis. L5-S1: Facet arthropathy, particularly on the left with edema as above. Ligamentum flavum thickening. Minimal disc bulging. No spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.Severe degeneration of the left L5-S1 facet joint is seen with associated marrow edema. Nevertheless, this results in only a mild narrowing of the neural foramen.2.Elsewhere, only mild degenerative findings are seen. No significant disc herniation is detected. No spinal canal stenosis is observed.


Instruction: Generate impression based on findings.

Input: Female, 33 years old, with history of brainstem cavernoma, severe motor deficits after craniotomy. Six month follow-up. Evidence of left temporal craniectomy is again seen. Distortion and encephalomalacia within the adjacent left temporal parenchyma has become more prominent. However, no evidence of parenchymal edema is seen. Rather, there is ex vacuo dilatation of the left temporal and occipital horns. The parenchyma adjacent to the craniectomy site herniates mildly through the craniectomy defect.A partially resected cavernoma within the left dorsal brainstem at the junction of the midbrain and pons is redemonstrated. The lesion is stable to slightly smaller in size with some interval change in the pattern of internal T1 hyperintensity. No evidence of significant surrounding parenchymal edema is seen. No findings to suggest continued interval bleeding are noted.A small focus of encephalomalacia within the left dentate nucleus is unchanged from prior. Bilateral T2 hyperintensity and swelling of the inferior olivary nuclei is unchanged as well.No new intracranial lesions are seen. A small venous structure is redemonstrated running along the right aspect of the residual cavernoma. No other pathologic enhancing lesions are seen. The ventricular system is stable in size and morphology.

Output: 1.A partially resected left dorsal brainstem cavernoma is stable to slightly reduced in size. No evidence of interval bleeding is seen, and there is no edema in the surrounding parenchyma.2.Encephalomalacia has progressed at the left temporal craniectomy site.3.Findings compatible with hypertrophic olivary degeneration are unchanged.


Instruction: Generate impression based on findings.

Input: Headache and vision changes. Evaluate for radiation necrosis versus tumor recurrence. MRI Brain: There is no significant interval change in size of the irregular enhancement in the site of the previous resection cavity and along the surgical tract in the left occipital lobe. However, the intensity of enhancement is reduced. There is unchanged extensive associated T2/FLAIR hyperintensity surrounding the resection cavity, with predominantly white matter involvement. There is associated mass effect on the left lateral ventricular atrium. No midline shift. No additional enhancing lesions are noted.MR Spectroscopy: Single voxel spectroscopy was performed at several points within the enhancing lesion. These demonstrate reduction in all major metabolic peaks as well as the presence of some lactate, with the exception of one sampled voxel, where the choline peak is slightly larger than that seen in the other sampled areas. This is believed to be technical and related to the larger size of the voxel of that sample. Multivoxel spectroscopy shows overall decrease in metabolites through the area of enhancing tissue with the exception of one or two sampled areas, where there is a minimally elevated choline peak, still below that of creatine, versus normal appearing tissue.MR perfusion: There is decreased relative cerebral blood volume in the area of question in the left occipital lobe, inclusive of the enhancing tissue and the presumed edema.

Output: Conventional imaging demonstrates stable to slightly decreased size of an irregular enhancing lesion in the left occipital lobe. Perfusion imaging supports a benign process. Overall, spectroscopic evaluation is also most suggestive of a benign process. Close interval followup suggested.


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: Demyelination? Structural abnormality? History: R face numbness There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of L1. There is central focal protrusion of disc at the level of L5S1 which abuts thecal sac with disc dessication. Other level of discs do not show any evidence of disc herniation or degeneration.The paraspinal soft tissues and musculature are unremarkable.

Output: 1. Normal vertebral body and spinal cord on cervical, thoracic and lumbar level.2. Disc protrusion with dessication at the level of L5S1.


Instruction: Generate impression based on findings.

Input: Meningioma follow-up. There is no significant interval change in size of the dural-based enhancing mass along the planum sphenoidale, which measures 19 mm in height, 28 mm in width, and 20 mm in length. The tumor extends into the right optic canal and compresses the right optic nerve. There is associated mass effect upon the bilateral straight gyri with mild surrounding vasogenic edema. There is also associated dilatation of the sphenoid sinus. There are unchanged nonspecific scattered foci of T2 hyperintensity in the bilateral cerebral hemisphere white matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: No appreciable interval change in size of the planum sphenoidale meningioma with extension into the right optic canal and mild vasogenic edema in the adjacent brain parenchyma.


Instruction: Generate impression based on findings.

Input: 68 years, Male, Reason: history of small bowel cancer; Lynch syndrome History: history of small bowel cancer; Lynch syndrome. Interval small bowel resection with path showing adenocarcinoma. ABDOMEN:LUNG BASES: No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic lesions. Pancreatic duct appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post surgical changes the subtotal colectomy with ileocolonic anastomosis. No evidence of obstruction or inflammatory changes. No enhancing tissue to suggest tumor recurrence.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.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.Postsurgical changes without evidence of obstruction or tumor recurrence.2.No suspicious pancreatic lesions.


Instruction: Generate impression based on findings.

Input: There is redemonstration of postoperative changes in the left parietal lobe with foci of susceptibility within the resection cavity representing chronic blood products. Enhancement mass involving the left parietal resection cavity is decreased measuring 2.4 x 2.1 cm (14/103, previously 3.0 x 2.2 cm). There is extensive edema involving the left parietal lobe as well as the left temporal lobes similar to prior. Associated mass effect including effacement of the left lateral ventricle is minimally improved in the interval.There is redemonstration of an enhancing dural based lesion along the left lateral temporal lobe which is mildly decreased in size measuring 2.1 x 3.1 x 1.7 cm (14/181), previously 2.3 x 3.1 x 2.3 cm. The lesion exhibits mass effect with effacement of the frontal horn of the left lateral ventricle and mild 3 mm left to right midline shift, unchanged. A 7 mm enhancing lesion abutting the cortical surface of the left occipital lobe is less enhancing and slightly decreased in size since the previous study. Another left occipital lobe cortical based lesion is slightly increased in size (14/149) and measures 1.6 x 1.0 cm (previously 1.2 x 0.9 cm).There are no new enhancing lesions. The calcified subependymal nodules at the foramina of Monro are unchanged. There is no evidence of acute intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.

Output: 1. Again seen is evidence of metastatic disease in the brain. Compared to 7/29/2015 the enhancing mass involving the left parietal resection cavity demonstrates decrease in size. Dural-based left lateral temporal mass also demonstrates mild decrease in size. A 7 mm peripheral left occipital lesion inferior to the resection cavity also demonstrates slight decrease in size. There is however interval enlargement of a left occipital cortically based lesion from 12 x 9 mm to 16 x 10 mm. No new lesions.2. Vasogenic edema in the left parietal, occipital, and temporal lobes is similar to prior.3. Calcified subependymal nodules are unchanged and consistent with history of tuberous sclerosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Weakness after surgery, history of multiple sclerosis for 20 years. There are multiple supratentorial and infratentorial cerebral white matter T2 hyperintense lesions. Lesions in the bilateral superior frontal lobes appear to be more conspicuous. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: Multiple supratentorial and infratentorial cerebral white matter T2 hyperintense lesions are compatible with demyelinating disease, perhaps with superimposed chronic small vessel ischemic disease. Lesions in the bilateral superior frontal lobes appear to be more conspicuous. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Low back pain and right upper thigh pain. History of lumbar laminectomy. Evaluate for stenosis or disc herniation. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the L1-L2 level. There is fibrofatty infiltration of the filum terminale which measure up to 2 mm in diameter at the L5-S1 level.There are postsurgical changes of laminectomy at the L2-L4 levels. Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is disc desiccation with mild height loss. Mild disc bulge and mild bilateral facet arthropathy. There is associated effacement of the right lateral recess. There is mild right and minimal left neural foraminal stenosis. Central canal is surgically decompressed.L3-L4: Disc desiccation with mild height loss and mild bulge. Mild bilateral facet arthropathy. There is mild effacement of the lateral aspects of the spinal canal, which is otherwise surgically decompressed. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: There is vacuum disc phenomena with disc bulge, moderate bilateral facet arthropathy, and ligamentum flavum thickening which contribute to severe spinal canal stenosis just below the laminectomy. There is also moderate to severe bilateral, right greater than left, neural foraminal stenosis. L5-S1: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy. There is effacement of the lateral recesses. There is mild to moderate bilateral neural foraminal stenosis. There is also mild central canal stenosis. There are postsurgical changes in the posterior paraspinous soft tissues, which are otherwise unremarkable.

Output: 1. Postsurgical changes of prior laminectomy from L2 to L4 levels. There are multilevel degenerative changes, worst at the L4-L5 level, where there is severe spinal canal stenosis just below the laminectomy. There is also moderate to severe neural foraminal stenoses at this level, right greater than left. 2. Milder degenerative changes at additional levels as above.3. Fibrofatty infiltration of the filum terminale incidentally noted. Conus terminates in normal position at the L1-L2 level.


Instruction: Generate impression based on findings.

Input: Memory loss and pituitary adenoma. Brain: There is no evidence of intracranial hemorrhage or acute infarct. There are minimal scattered punctate foci of nonspecific T2 hyperintensity. The brain parenchyma otherwise appears 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, skull, and scalp soft tissues are grossly unremarkable. There is extensive bilateral maxillary and ethmoid sinusitis with sections.Pituitary: There is a T2 hyperintense lesion with delayed enhancement in the right anterior pituitary that measures up to 2 mm. The pituitary gland is otherwise not enlarged or atrophic. The pituitary stalk is intact. There is no mass effect upon the cavernous sinuses or optic apparatus.

Output: 1. A lesion in the right anterior pituitary that measures up to 2 mm may represent a microadenoma. 2. Minimal scattered punctate foci of nonspecific T2 hyperintensity. 3. Findings suggestive of acute sinuitis.


Instruction: Generate impression based on findings.

Input: 86 years Female (DOB:7/10/1929)Reason: eval for evolution of microhemorrhages History: hemorrhagic strokePROVIDER/ATTENDING NAME: FERNANDO D GOLDENBERG FERNANDO D GOLDENBERG No diffusion weighted abnormalities are appreciated.There is a small hemorrhagic focus in the right thalamus associated with surrounding signal hyperintensity of FLAIR. There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the available B0 images and available FLAIR images. This was also present on the prior exam.The exam is limited due to patient motion.

Output: 1.There is a small subacute right thalamic hemorrhage.2.Periventricular and subcortical white matter lesions as well as signal changes in the internal capsules, basal ganglia, brainstem and thalami are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. This was also present on the prior exam.3.No evidence for acute ischemic cerebral infarction. 4.Exam is limited due to the patient's inability to cooperate to complete the exam and due to motion artifact. As a result the evaluation is not as complete as most MRI exams and abnormalities may not be identified.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with back pain and right leg pain. History of fibrosarcoma along the left thigh. Evaluate for disc protrusion, tumor recurrence, abscess. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow signal abnormality or enhancement is observed. The distal spinal cord, conus and cauda equina are within normal limits. No pathologic intrathecal enhancement is seen. No epidural lesions are detected.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. No spinal canal or foraminal stenosis. L4-5: Facet hypertrophy and ligamentum flavum thickening. Loss of disc T2 signal with mild bulging and a small central disc protrusion. No significant spinal canal stenosis or nerve root impingement is seen. The neural foramina are not significantly compromised. L5-S1: Facet hypertrophy. Minimal disc bulging. No spinal canal or foraminal stenosis.

Output: 1.Disc degeneration is seen at L4-5 with loss of the normal disc T2 signal, slight disc bulging and a small central protrusion. However, no significant spinal canal stenosis or nerve root impingement is observed.2.No evidence of metastatic disease or spinal infection.


Instruction: Generate impression based on findings.

Input: Arnold-Chiari syndrome without spina bifida or hydrocephalus [Q07.00] / Insomnia, unspecified [G47.00], Reason for Study: ^Reason: Patient has history of chiari, r/o syrinx. PLEASE DO CINE FLOW History: headaches Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There is about 19 mm although not herniation of cerebellar tonsils consistent with Chiari I malformation with evidence of suboccipital craniectomy.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Small retention cyst on the right posterior ethmoid sinus.Complete Spine MRIThere is no evidence of syringomyelia.There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The conus medullaris terminates at the level of T12-L1.CSF flow study, through the foramen magnum.There is bidirectional CSF flow anterior aspect of upper cervical spine and brain stem through the foramen magnum.Bidirectional flow remained in the posterior aspect of cerebellar hemisphere and tonsil. These findings are unchanged since prior scan.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement. Ventricle size remains normal.2. Unchanged downward displacement of cerebellar tonsil with evidence of suboccipital craniectomy.3. No evidence of syringomyelia.4. Bidirectional CSF flow is demonstrated especially anterior aspect of brainstem and upper cervical spine through the foramen magnum as well as posterior aspect of the cerebellar tonsil and posterior aspect of the cerebellar hemisphere, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of bronchus and lung, unspecified siteClinical question: initial lung cancer stagingSigns and Symptoms: initial lung cancer staging The CSF spaces are appropriate for the patient's stated age with no midline shift. There are is a FLAIR and T2 and diffusion-weighted imaging signal hyperintense focus in the right choroid plexus and the smaller one in the left choroid plexus. Most likely these represent xanthogranulomas.There is a 34 x 23 mm axial dimension cystic lesion in the anterior aspect of the left middle cranial fossa associated with remodeling of the adjacent bone. It follows spinal fluid on all pulse sequences.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for brain metastasis appreciated. 2.Arachnoid cyst in the left middle cranial fossa.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 4.Choroid plexus lesions most likely represent xanthogranulomas.


Instruction: Generate impression based on findings.

Input: Reason: Outside Request: left shoulder pain; rotator cuff tear/impingement suspected History: ROTATOR CUFF: There is minimal increased signal abnormality within the distal supraspinatus indicating minimal tendinosis, essentially within normal limits. The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The teres minor muscle and tendon appear intact. There is superficial fraying of the articular surface fibers of the subscapularis at the level of its insertion on the lesser tuberosity. No full-thickness tear or retraction is evident. There is minimal fatty infiltration at the level of the myotendinous junction of the supraspinatus and infraspinatus.SUPRASPINATUS OUTLET: There is no fluid within the subacromial subdeltoid bursa. The acromioclavicular joint alignment is anatomic.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal abnormality within the anterior superior and inferior labrum indicating degeneration/degenerative tearing. No fluid-filled tear is evident within the limitations of this non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is a small amount of circumferential fluid within the tendon sheath likely representing fluid extension from the joint. ADDITIONAL

Output: Rotator cuff tendinosis tendinosis as well as superficial fraying of the subscapularis tendon without evidence of a full-thickness rotator cuff tear or retraction.


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: r/o stroke vs. Structural abnormality History: episodic R hemiplegia/hemisensory Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There is about 4mm downward location of cerebellar tonsil.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral Pcom arteries and Acom artery are patent. No aneurysm. No stenosis.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Normal brain and neck MRA


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial hemorrhage. Signs and symptoms: Intracranial hemorrhage. CT brain without infusion:Images through posterior fossa are unremarkable.Images through the supratentorial space demonstrate massive left frontal contusion with significant amount of hemorrhage. Two lesser degree extensive areas of contusion and hemorrhage in the right frontal lobe is also noted. Compared to prior suboptimal CT of brain there is a slight interval increase in the amount of hemorrhage in the right frontal lobe.Extensive bilateral anterior temporal lobe contusions are again identified. Slight increase in the hemorrhage in the left temporal lobe is suspected, however note should be made that the quality of the exam on the prior study is very poor due to extensive motion.Vasogenic edema surrounding all areas of the above described hemorrhage. Extensive subarachnoid hemorrhage is again identified. There is evidence of bilateral subdurals along the leaves of tentorium which is better appreciated on the current exam than prior. The subdurals extend dorsal to the occipital lobes (left greater than right). The thickest measurable portion of the larger left subdural measures only 3.7 mm on axial image 17. There is mass effect on the left frontal horn secondary to hematoma in the left frontal lobe. The degree of mass-effect remains identical to prior study. Residual blood within the bilateral dependent portion of the lateral ventricles remain similar to prior study. No change in the size of normal appearing ventricle or system.Calvarium is intact, mastoid air cells and middle ear cavities are unremarkable. Opacification of bilateral ethmoid air cells and otherwise well pneumatized paranasal sinuses.Images through orbits demonstrate severely enlarged superior ophthalmic veins which are abnormal and are concerning for increased flow secondary to carotid cavernous fistula. Recommend auscultation and bilateral orbit for detection of bruit and further evaluation with a dedicated MRI, MRA, MRV examination is recommended.

Output: 1.Extensive bifrontal and temporal contusion with surrounding vasogenic edema.2.Suggestion of slight increase in the amount of hemorrhage as detailed above.3.Extensive subarachnoid hemorrhage with no appreciable interval change.4.No appreciable interval increase in the degree of mass effect or size of ventricular system.5.Better visualization of blood in the subdural space overlapping bilateral tentorial leafs as detailed.6.Calvarium remains intact.7.Significantly enlarged and bilateral superior ophthalmic veins is concerning for a carotid cavernous fistula considering patient's history of trauma and extensive intracranial hemorrhage. Above findings were discussed with neural ICU fellow pager number 6228.


Instruction: Generate impression based on findings.

Input: Pancreatic cancer -- follow-up. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Infusion port in right anterior chest wall with tip of catheter in the distal superior vena cava unchanged..ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration liver again identified -- this obscures the ability to see lesions in the liver and if concern for metastatic disease in liver exists, ultrasound or MRI would be recommended. Pneumobilia seen from prior choledocho jejunostomy..SPLEEN: No significant abnormality noted.PANCREAS: Prior surgery status post Whipple procedure. Remaining pancreas appears normal and unchanged..ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Again noted are multiple small mesenteric lymph nodes along the root of the mesentery. The largest of these measures 1.0 x 2.3 cm (series 5 come image 108) with multiple smaller ones lower inferiorly. These are all unchanged and of uncertain significance. No new lesions are identified. The mild soft tissue cuffing along the posterior SMA remains unchanged with mild narrowing of the origin of the SMA better seen on prior exam and narrowing is less prominent on current examination. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Post hysterectomy without other abnormality..BLADDER: No significant abnormality noted.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. Status post Whipple procedure with stable exam and no significant change since prior examination. 2. Small lymph nodes at the root of mesentery appear unchanged and are of uncertain significance. 3. Diffuse fatty infiltration the liver -- this can obscure the presence of liver lesions and if concern exists for liver metastases, ultrasound or MR would be recommended.


Instruction: Generate impression based on findings.

Input: 67 year old female with coronary artery disease status post LAD stent who presents with atypical chest pain. MEDICATIONS: Aspirin, lisinopril, rosuvastatin, metformin First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is upper limits of normal size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 104 ml/m2 (normal range: 74+/-15), the LVEDV is 145 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 66 ml (normal range 47+/-19), the LV mass index is 54 g/m2, and the LV mass is 75 g. There are no regional wall motion abnormalities present. . Left AtriumThe left atrium is normal sized. Right VentricleThe right ventricle is normal size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 101 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 50 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 mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trivial pericardial effusionExtracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. The LV is upper limits of normal size and has normal systolic function (LVEF 55%).4. Normal RV size and systolic function (RVEF 50%).5. Mild to moderate mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 69 year old woman with history of dilated cardiomyopathy and COPD s/p PEA arrest who presents for cardiac MRI for further evaluation of patient's LV dysfunction Left VentricleThe left ventricle is moderately dilated and severely reduced in systolic function. The overall LV ejection fraction is 28%, the LV end diastolic volume index is 104 ml/m2 (normal range: 65+/-11), the LVEDV is 166 ml (normal range 109+/-23), the LV end systolic volume index is 75 ml/m2 (normal range 18+/-5), the LVESV is 121 ml (normal range 31+/-10), the LV mass index is 49 g/m2 (normal range 67+/-11), and the LV mass is 78 g (normal range 114+/-24). There is global hypokinesis with dyskinetic motion of the ventricular septum. There is a focal apical inferior region of transmural late gadolinium enhancement; this may be indicative of a possible cardioembolic event. In addition, there is septal late gadolinium enhancement that spares the endocardium, suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process and mostly likely represents old myocarditis.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 57 ml/m2 (normal range 69+/-14), the RVEDV is 91 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 49 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 ValveThere is thickening and restricted opening of the MV leaflets with mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are multiple masses in the liver which are most likely a hemangioma or cyst. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with severely reduced systolic function (28%). There is global hypokinesis with dyskinetic motion of the ventricular septum. 2. There is a focal apical inferior region of transmural late gadolinium enhancement; this may be indicative of a possible cardioembolic event. In addition, there is septal late gadolinium enhancement that spares the endocardium, suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with mildly reduced systolic function (46%).4. Moderate tricuspid regurgitation.


Instruction: Generate impression based on findings.

Input: Knee pain The examination is slightly limited secondary to motion artifact.MENISCI: There is abnormal signal intensity and morphology of the posterior horn and body of the medial meniscus (particularly of the undersurface) consistent with complex tearing.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the articular cartilage of the medial compartment but there is no full-thickness defect of either the medial or lateral compartment. There is fibrillation and irregularity of the articular cartilage of the patellar facet, particularly medially where there is a partial-thickness cleft identified. The articular cartilage of the femoral trochlea is intact. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tear of the medial meniscus.2. Mild to moderate articular cartilage loss of the patellar facet.3. Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Reason: rule out abnlity History: r quad and l calf atrophy 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. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a small central disk protrusion present at this level and the mild ligamentum flavum hypertrophy.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a small central disk protrusion present at this level and the mild ligamentum flavum hypertrophy.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.No compromise to lumbar spinal canal or neural foramina. No abnormal enhancing lesions are appreciated in the lumbar spine2.There are mild degenerative changes present in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with bilateral leg pain and numbness, walking with a cane which is new. A reversal of the cervical lordosis is seen, likely degenerative in etiology. A grade 1 anterolisthesis of L3 relative to L4 is also noted. Elsewhere, alignment is anatomic.With the exception of Schmorl's nodes at T11 and L4, vertebral body height is preserved. No concerning marrow replacement or marrow edema is detected.Multilevel cervical spondylosis is seen with disc osteophyte formation which does result in some degree of spinal canal narrowing, particularly at the C5-6 level. These findings have mildly progressed when compared to the prior examination.Multilevel degenerative findings are also seen in the lumbar spine with disc bulging and posterior element hypertrophy. There is resultant spinal canal narrowing at least at L3-4. The right L3-4 neural foramen is also significantly narrowed. Findings have progressed when compared to the prior examination.No evidence of any acute cord compression is seen.

Output: 1.No evidence of acute cord compression.2.Multilevel degenerative findings are seen in the cervical and lumbar spine which result in chronic narrowing of the spinal canal. If clinically warranted, these areas can be evaluated with non-emergent dedicated imaging.


Instruction: Generate impression based on findings.

Input: Somewhat motion limited exam. Limited sequences were obtained for stereotactic localization purposes with fiducials noted on the scalp. Redemonstrated are numerous intra-axial enhancing masses, with the largest in the left paramedian frontal parietal region measuring 2.3 x 2.6 cm, not significantly changed in size. There is heterogeneous signal again noted on T2-weighted images, with slight increased conspicuity likely relating to evolution of blood product compared to the prior exam. Previously, the superior right frontal lobe mass did not demonstrate significant susceptibility, with now evidence of prominent T2 hypointensity suggestive of new blood products. There is also associated mild localized mass effect with sulcal effacement in these areas without significant interval change. Redemonstrated is a heterogeneous peripherally solid and centrally cystic appearing mass in the expanded sella with suprasellar extension, which measures 1.8 x 2.0 cm. The blood-fluid level is slightly more pronounced and more symmetrically layered compared to the MRI from three days ago. The mass effect upon the overlying optic chiasm and gross partial encasement of the cavernous carotids without narrowing appears similar to the prior MRI exam.There is unchanged prominence of the ventricles and sulci, consistent with mild-moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift. There are stable scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific but may represent mild chronic small vessel ischemic changes. No extra-axial fluid collection is identified.

Output: 1.Multiple enhancing intra-axial masses with localized mass effect and vasogenic edema. There has been at least some evolution of the blood product in many of the masses, with interval development of blood products in the superior right frontal mass. This remains concerning primarily for metastatic disease.2.Redemonstration of an expansile partially solid and cystic versus necrotic mass centered in the expanded sella with significant suprasellar extension and mass effect upon the chiasm. Slight increased extent and symmetry of blood-fluid level within this mass which could indicate minimal additional hemorrhage. The differential includes a pituitary mass such as a macroadenoma, craniopharyngioma or superimposed metastatic disease.