Instruction: Generate impression based on findings.

Input: 57-year-old female with history of persistent back pain. Lumbar spine alignment is within normal limits. Vertebral body heights are maintained. Bone marrow signal intensity is benign. The cord is unremarkable. The conus terminates at the level of T1.Multilevel degenerative disc disease is present as follows:T12-L1: There is a very small right paracentral disc protrusion. No significant neuroforaminal or spinal canal stenosis.L1-2: There is a mild disc bulge resulting in mild spinal canal stenosis. No significant neuroforaminal stenosis.L2-3: There is a mild disc bulge. There is no significant spinal canal stenosis. Mild left neuroforaminal stenosis.L3-4: There is a moderate disc bulge with a left paracentral disc protrusion which is new resulting in moderate spinal canal stenosis. There is moderate neuroforaminal narrowing on the left and mild on the right. Mild facet hypertrophy.L4-5: There is a moderate disc bulge. Mild facet hypertrophy. Mild bilateral neuroforaminal narrowing. No significant spinal canal stenosis. Mild facet hypertrophy.L5-S1: There is no significant disc disease. Mild right neuroforaminal stenosis. Mild facet hypertrophy. No significant spinal canal stenosis. There is a synovial cyst present along the posterior aspect of the L5 facet comlex extending into the paraspinal soft tissues which is larger.

Output: 1. New disc herniation at L3-4 resulting in moderate spinal canal stenosis and neuroforaminal narrowing as above.2. Enlarging synovial cyst posterior to the L5 facet complex extending into the paraspinal soft tissues.3. Progressive degenerative disc disease as above.


Instruction: Generate impression based on findings.

Input: History of prostate cancer.Additional history per electronic medical record:Gleason 7 (3+4) right apex. Gleason 6 (3+3) left mid. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.8 x 4.1 cm.Peripheral Zone: There is an area of low T2 and ADC signal with associated increased early enhancement within the left mid gland (series 401, image 12) measuring 8 x 9 mm suggestive of neoplasm.There is an area of low T2 and ADC signal with associated increased early enhancement within the right apex (series 501, image 151) measuring 7 x 9 mm suggestive of neoplasm.Central Gland: There is a focus of decreased T2 and ADC signal with associated increased early enhancement within the left anterior central gland (series 501, image 163) measuring 8 x 9 mm suggestive of neoplasm.Several well circumscribed nodules compatible with hyperplastic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No definite evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Areas of abnormal signal within the peripheral zone (left mid gland and right apex) as well as left anterior central gland suspicious for neoplasm.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified optic neuritisClinical question: evaluate for autoimmune processSigns and Symptoms: vision loss MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.MRI of the brain and orbits is within normal limits. There is no evidence for optic neuritis there are no stigmata of demyelinating disorder appreciated intracranially.2.No abnormal lesions are appreciated within the cervical spinal cord. There is no significant compromise to the cervical spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Meralgia paresthetica, right lower limb [G57.11], Reason for Study: ^Reason: lumbar herniated disc vs meralgia paretsthetica- persistent neuropathic pain over the right lateral thigh History: right lateral thigh pain 45 years Female (DOB:4/6/1971)Reason: lumbar herniated disc vs meralgia paretsthetica- persistent neuropathic pain over the right lateral thigh History: right lateral thigh painPROVIDER/ATTENDING NAME: MINDY ALYCE SCHWARTZ MINDY ALYCE SCHWARTZ For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: L1-2: no neuroforaminal narrowing or spinal stenosis. L2-3: Diffuse bulging of disc with focal annular tear is seen. No neuroforaminal narrowing or spinal stenosis. L3-4: Mild disc desiccation. Diffuse bulging of disc with bilateral ligamentum flavum thickening result minimal to mild spinal canal stenosis at this level.L4-5: Mild disc desiccation. There is broad-based disc protrusion toward left side far lateral direction which result left neural foraminal stenosis.L5-S1: Mild disc desiccation. There is broad-based disc protrusion toward the right neural foramen result in mild to dural foraminal stenosis at this level.

Output: 1. Disc protrusions are seen at the level of L4-5 (left side neural foraminal) and at the level of L5S1 (right side neural foraminal).2. Various degree disc degenerations are seen from L23 to L5S1 level.


Instruction: Generate impression based on findings.

Input: Pre op planning for surgical resection of brain tumor. There is a centrally low T2 and high T2 hemorrhagic lesion that measures up to 4.5 cm in the left frontal lobe. There is also a low T2 signal along margin of the right lateral ventricle body that measures up to approximately 15 mm. The ventricles and basal cisterns are unchanged in size and configuration. There is unchanged mild midline shift to the right. Skin fiducial markers are present.

Output: Treatment planing MRI for a left frontal lobe hemorrhagic lesion, which may represent a metastasis. A lesion along margin of the right lateral ventricle body may also represent a hemorrhagic metastasis.


Instruction: Generate impression based on findings.

Input: Newly diagnosed metastatic lung cancer. Evaluate T10 lesion, ?cord compression. Evaluate for other brain/spine mets. Limited noncontrast study. BRAIN: Evaluation for small intracranial metastases is limited on this noncontrast study. No discrete intracranial mass or mass effect is appreciated. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter and pons, which are nonspecific but likely representing chronic small vessel ischemic disease. There is focus of susceptibility effect at the inferior aspect of the right temporo-occipital lobe junction likely related to chronic hemorrhage. No evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. The patient is status post remote bilateral enucleation with a right eye prosthesis noted. There is fluid level in the bilateral maxillary sinuses. There is a 6 mm T2 hyperintense lesion at the left medial canthus of uncertain etiology.CERVICAL SPINE: No metastatic lesion is definitively appreciated although postcontrast sequences would be helpful. There is mild straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. There is mild to moderate loss of disc height involving the C4-C5 and C5-C6 levels with disc desiccation throughout the cervical spine. The spinal cord is of normal caliber and signal. C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Posterior disc osteophyte complex with central disc protrusion, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to moderate spinal canal and mild to moderate bilateral foraminal stenosis.C4-C5: Mild posterior disc osteophyte complex, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to mild to moderate spinal canal stenosis and mild to moderate bilateral foraminal stenosis.C5-C6: Posterior disc osteophyte complex, left uncinate hypertrophy, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to mild to moderate spinal canal stenosis and mild right and moderate left foraminal stenosis. C6-C7: Posterior disc osteophyte complex. No significant spinal canal or foraminal stenosis. C7-T1: No significant disc bulge, spinal canal or foraminal stenosis. THORACIC SPINE: There is evidence of metastatic disease with multiple foci of abnormal marrow signal including: posterior aspect of the left T9 vertebral body without retropulsion; expansile lesion involving the right aspect of the T10 vertebral body and posterior elements extending into the right posterior 10th rib, contributing to mild foraminal stenosis at the right T9-T10, moderate foraminal stenosis at T10-T11 and mild spinal canal stenosis at the T10 level; at least 3 small lesions within the T11 vertebral body, one of which is in the right pedicle; and a lesion at the left anterior aspect of the T12 vertebral body. The vertebral body heights are maintained without evidence of pathologic fracture. The spinal cord is of normal caliber and signal.There is no significant disc bulge, spinal canal or foraminal stenosis within the other levels of the thoracic spine. The thoracic spine is in normal alignment, with a normal thoracic kyphosis. LUMBAR SPINE: The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is abnormal marrow signal including: the posterior superior aspect of the L2 vertebral body and left pedicle with mild retropulsion, mild compression deformity and minimal left L1-L2 foraminal narrowing; superior endplate of L3; body of L4 and body and left pedicle of L5. Small lesions within the pelvis are also noted. The distal spinal cord and conus are within normal limits with the conus terminating at the L2 level.There is mild loss of disc height and disc desiccation of the lumbar spine with multilevel degenerative changes including mild disc bulges, thickening of the ligamentum flavum and facet arthropathy, but no significant spinal canal or foraminal stenosis within the other levels of the lumbar spine. OTHER: The partially imaged lungs demonstrate trace right and mild left pleural effusions, left lung mass, multiple bilateral pulmonary nodules, left hilar mass or lymphadenopathy and emphysematous changes. There is partially imaged pericardial effusion. There is nodular thickening of the partially imaged adrenal glands.

Output: 1. Noncontrast study limits evaluation for small intracranial metastases. Scattered punctate and confluent areas of abnormal T2 signal within the periventricular and subcortical white matter are nonspecific but compatible with chronic small vessel ischemic disease. No discrete intracranial mass or mass effect is appreciated. Postcontrast imaging can be obtained for more sensitive evaluation if clinically indicated. Focus of chronic hemorrhage at the right temporo-occipital lobe junction noted and nonspecific in etiology.2. Multiple foci of metastatic disease involving the axial skeleton as detailed above, most prominently involving the T10 vertebra and right posterior rib, contributing to mild foraminal stenosis at the right T9-T10, moderate foraminal stenosis at T10-T11 and mild spinal canal narrowing. No evidence of frank cord compression or cord signal abnormality.3. Pathologic compression fracture of the L2 vertebra with mild retropulsion but without significant spinal canal stenosis.4. Multilevel degenerative changes of the cervical and lumbar spine, most prominent at C3-C4 through C5-C6, contributing up to moderate spinal canal stenosis and variable multilevel foraminal stenosis as described.5. Partially imaged left lung mass, bilateral pulmonary nodules, left hilar mass or lymphadenopathy and emphysematous changes. Please refer to the separate chest, abdomen and pelvis CT report for additional details.6. Bilateral globe enucleation. A 6 mm T2 hyperintense lesion at the left medial canthus of uncertain etiology. Please correlate with physical exam.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 29 year-old female with infected OB incision. Question of endometritis. Abdominal pain in both lower quadrants. The examination is limited by the absence of oral contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Postpartum uterus with air in the fundus. No definite findings to suggest endometritis, but pelvic ultrasound or MRI examination may be more helpful, if clinically indicated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: There are midline surgical skin staples in the pelvis with subcutaneous fluid collection most likely due to a wound abscess which extend from axial image 103 -- 125/154 of series 3. The fluid collection is all superficial to the rectus sheath.

Output: Midline subcutaneous wound abscess in the pelvis does not extend beyond the rectus sheath. Small amount of air in postpartum uterus, probably post procedural.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for new infarct. History: Transient left face droop with persistent dysphagia. Known old right-sided strokes. There is an area of restricted diffusion and high T2 signal in the right basal ganglia and corona radiata that measures up to 20 mm. There is no evidence of gross hemorrhagic transformation. There is extensive encephalomalacia in the inferior right cerebellar hemisphere, a small areas of encephalomalacia in the inferior left cerebellar hemisphere, and defects in the bilateral corona radiata and centrum semiovale superimposed upon a background of confluent cerebral white matter T2 hyperintensity. There is diffuse cerebral volume loss. There is no midline shift or herniation. There is a right maxillary sinus retention cyst. There is a partially imaged, but large left parotid gland T2 hyperintense bosselated mass.

Output: 1. Acute infarct in the right basal ganglia and corona radiata superimposed upon a background of extensive chronic infarcts and small vessel ischemic disease.2. Partially imaged left parotid mass may represent a pleomorphic adenoma. Dedicated imaging of this region may be useful for further evaluation.Discussed with Dr. Reder at 3:20 PM on 1/15/15.


Instruction: Generate impression based on findings.

Input: Question new onset seizure. LD, ADHD. There is a suprasellar solid/cystic mass extending into the third ventricle and left frontal horn. The mass contains punctate areas of calcification. The mass extends posteriorly causing effacement of the midbrain and the quadrigeminal cistern. There is bony remodeling of the sella. This mass most likely represents a craniopharyngioma, and an MRI is recommended for further evaluation. There is mild leftward midline shift. No evidence of intracranial hemorrhage.The lateral ventricles are mildly dilated.An air-fluid level is present in the left sphenoid sinus. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Suprasellar solid/cystic mass as described above. This most likely represents a craniopharyngioma and an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 20 year-old female with a history of Chiari malformation without. MRI BRAIN:No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is pointed descent of the cerebellar of about 11 mm below the foramen magnum bilaterally. There is no associated platybasia. There is marked effacement of dorsal CSF space without any associated spinal cord signal changes. There is biphasic flow on phase contrast images across the foramen magnum though attenuated.Brain parenchyma is otherwise unremarkable for age.Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine:The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. However, signal loss within the C2-C3 disc is indicative of desiccation. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.

Output: 1. Chiari I malformation with pointed cerebellar tonsillar descent of 11 mm into the foramen magnum and effacement of the dorsal CSF space. Biphasic flow remains across the foramen magnum and no concerning associated spinal cord or cerebellar signal changes.2. Loss of signal within the C2-C3 disc is indicative of desiccation. The cervical spine is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: This exam is limited by patient motion, and patient's termination of the exam prior to completion, including lack of postcontrast sequences.BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.SPINE: There is mild straightening of the normal cervical and lumbar lordosis. The marrow signal is unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus terminating at T12. There are multiple pulmonary masses.

Output: 1.Within the limitations of this incomplete noncontrast exam, there is no evidence of neuro-axis metastases. 2.Multiple pulmonary metastases that were better assessed on the recent PET CT.


Instruction: Generate impression based on findings.

Input: 70-year-old female with weakness with internal rotation and shoulder pain. ROTATOR CUFF: There is thickening and increased signal abnormality of the supraspinatus consistent with moderate tendinosis. The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact. No full thickness rotator cuff tear is evident. SUPRASPINATUS OUTLET: No fluid is identified within the subacromial subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate degenerative changes affect the glenohumeral joint with subchondral cyst formation within the humeral head. Although this examination was not protocolled for evaluation of the glenoid labrum, there is heterogeneity and increased intermediate signal abnormality within the superior labrum suggesting degenerative tearing.BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of the biceps likely representing fluid extension from the glenohumeral joint. ADDITIONAL

Output: Degenerative changes of the glenohumeral joint and rotator cuff tendinosis without evidence of a full thickness rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 27 year old female patient with recurrent severe sepsis of uncertain source, perianal Crohn's disease status post seton drainage x 3. Unknown if all infectious sources have been drained. Evaluate for perianal/perirectal abscess, fistulae between pelvic organs, and other other infectious sources. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is wall thickening and enhancement of the rectosigmoid colon compatible with active inflammation. There colon proximal to this point is distended with stool. The terminal ileum is unremarkable. There is a suprasphinteric fistula extending from the 6 o'clock position of the rectum to the left ischioanal fossa which demonstrates complex branching and extends across midline to the right side. There is a small abscess/fluid collection measuring 1.9 x 0.7 cm (image 86, series 5) within the right ischioanal fossa just lateral to the puborectalis muscle. Furthermore, there is a more discrete abscess within the left ischioanal fossa measuring 1.4 x 1.1 cm (image 35, series 1602). At least two other perianal fistulae are identified on the right and left with setons in place.BONES, SOFT TISSUES: There is edema type signal within the posterior thorax and right thigh subcutaneous tissues. OTHER: There is no abnormal intra-abdominal fluid collection.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As described above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is no abnormal intra-pelvic fluid collection.

Output: 1.Complex, branching perianal fistulae with a left suprasphinteric fistula and at least two small bilateral perianal fistulae.2.Right ischioanal fluid collection and more discrete left ischioanal abscess. 3.Wall thickening and enhancement of the rectosigmoid colon compatible with active inflammation.


Instruction: Generate impression based on findings.

Input: Reason: stab wound of right upper arm at level of lower third of humerus with radial nerve palsy. R/O radial nerve laceration History: pain and wrist drop There is circumferential fluid within the tendon sheath of the long head of the biceps indicating a tenosynovitis. There is decreased linear signal abnormality traversing the subcutaneous tissue along the lateral and posterior aspect of the arm at the level of the mid to distal diaphysis of the humerus which likely represents scarring from prior injury/laceration. There is a skin marker in the overlying area presumably corresponding to the patient's area of prior injury. There is an 11 x 10 mm focus of increased signal abnormality on fluid sensitive sequences at the expected location of the radial nerve, interposed between the brachialis and medial head of the triceps musculature medial to the aforementioned scarring from prior injury which is nonspecific and may represent granulation tissue or perhaps a small seroma/hematoma, however, this is incompletely characterized on this noncontrast examination (image 10; series 6). The radial nerve is indistinct and poorly visualized and the surrounding area and may be disrupted. No bone marrow signal abnormality is identified. There is increased signal abnormality within the extensor musculature which likely represents subacute denervation injury (image 25; series 13). The imaged musculature of the right arm is otherwise unremarkable.

Output: 1. 11 mm nonspecific focus of increased signal abnormality at the expected location of the radial nerve at the level of the distal humeral diaphysis which is incompletely characterized but may represent granulation tissue or perhaps a small seroma/hematoma. The radial nerve is poorly visualized in the adjacent area and is likely disrupted. 2. Increased signal abnormality within the imaged extensor musculature is likely related to subacute denervation injury.


Instruction: Generate impression based on findings.

Input: 57-year-old male complaining of syncopal episode. Patient has history of CVA. Foci of hypoattenuation in the left cerebellar hemisphere compatible with known infarcts seen on MRI. Periventricular hypoattenuating foci are consistent with minimal ischemic small vessel disease, age indeterminate.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Abnormal focal finding on EEG and altered mental status. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are scattered patchy and punctate areas of high T2 signal in the cerebral white matter, without restricted diffusion. There are multiple punctate foci of susceptibility effect in the bilateral basal ganglia and thalami. The brainstem and cerebellum appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a T1 hypointense, enhancing area in the right parietal bone, which measures up to 25 mm.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2. Scattered patchy and punctate areas of high T2 signal in the cerebral white matter may represent chronic small vessel ischemic disease.3. Multiple punctate foci of susceptibility effect in the bilateral basal ganglia and thalami may represent chronic hypertensive microhemorrhages.4. Nonspecific enhancing area in the right parietal bone, which measures up to 25 mm. Differential considerations include an atypical hemangioma, venous lake, and metastatic disease, for example.


Instruction: Generate impression based on findings.

Input: There is no acute ischemia. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which may be nonspecific, but most consistent with moderate chronic small vessel ischemic changes. Otherwise the brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral ethmoid sinuses.

Output: 1. No evidence of acute infarct or intracranial mass.2. Moderate chronic small vessel disease.


Instruction: Generate impression based on findings.

Input: History of ascending aortic dilatation. CHEST:MEDIASTINUM AND HILA: The ascending aorta measures 4.2 x 4.1 cm (series 601/13) compared to approximately 40 x 40 mm previously. No dissection is evident and the aorta shows a normal appearing gradual transition.The aortic arch and descending thoracic aorta are unremarkable.The descending thoracic aorta demonstrates minimal mural nodularity compatible with atherosclerotic disease, with normal caliber and without other abnormalities.The main pulmonary artery measures at the upper limits of normal, measuring 30 mm in diameter.CHEST WALL: No significant abnormality noted

Output: Ascending thoracic aorta measures 4.2 x 4.1 cm in maximal cross-section, not significantly changed from 2010.


Instruction: Generate impression based on findings.

Input: Reason: s/p craniotomy History: ha Since the previous examination the patient has undergone frontal craniotomy for removal of a right frontal extra-axial mass. At the surgical bed there are blood products present in the subarachnoid space and gyral surface of the right lobe. There is T2/FLAIR signal hyperintensity within the adjacent right frontal lobe and to a lesser degree left frontal lobe. There is some diffusion restriction present along the right frontal lobe as well as the anterior aspect of the cingulate gyri in the body of the corpus callosum.There is a small right sided parafalcine lesion present adjacent to the right paracentral lobule measuring 30 x 10 mm axial dimensions. It is suspected to represent some residual neoplasm.There is a hemorrhagic lesion present in the right frontal subcortical white matter which was previously present but more conspicuous on current exam. It measures approximately 8 mm in diameter.There is soft tissue swelling along the scalp tissues at the site of surgery .There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. FLAIR and T2 hyperintensities are also present in the brain stem.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.Since the prior exam the patient has undergone resection of a extra-axial mass adjacent to the right frontal lobe. There is only a small residual right parafalcine component present adjacent to the right paracentral lobule. There are associated postoperative changes present with blood products in the surgical bed and swelling along the scalp tissues. There are also blood products in the adjacent extra-axial spaces at the surgical bed.2.Foci of diffusion restriction present along cingulate gyri, corpus callosum and right frontal lobe are present. The possibility that this is ischemia related cannot be excluded.3.There is remote traction of a small right frontal lobe hemorrhage.4.There are periventricular and subcortical white matter changes of a mild degree as well as minor brainstem lesions which are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are MRI dated 4/3/2015 performed at Vassar Brothers Medical Center in Poughkeepsie, NY. For comparison, prior mammograms and ultrasounds dating back to 1/26/2012 are available. MRI was performed without and with gadolinium-based contrast as per outside protocol. Incomplete images were uploaded. Patient will receive dedicated breast MRI today.

Output: As above.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact.BRAIN: There are two adjacent peripherally enhancing lesions within the right frontal lobe that measure 19 x 22 mm and 20 x 22 mm. There is extensive surrounding edema. Within the left frontal lobe there is a peripherally enhancing cystic mass that measures 40 x 41 mm with a enhancing nodule in the anterolateral portion that measures 26 x 12 mm. There is extensive surrounding edema that results in minimal rightward subfalcine herniation and partial effacement of the bilateral lateral ventricles. No uncal herniation.There is a punctate focus of susceptibility effect within the right parietal lobe as well as small foci within the lesions. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. SPINE: Motion degradation slightly limits evaluation. There is a new 21x8mm (axial plane) extramedullary mass within the right aspect of the spinal canal at the C4 level extending out of the right neural foramen and compressing the spinal cord; mass measures 22 mm in the craniocaudal dimensions. C5 osseous metastatic lesion again seen.At the level of T8 there is an intramedullary mass which measures 8 x 11 x 31 mm in the AP x transverse x craniocaudal dimensions. There is T2 hyperintensity within the spinal cord extending from the C3 through T11 levels. There is a new T1 hypointense and enhancing lesions within the T4 vertebral body. Previously seen small T2 vertebral body lesion now demonstrates T1 hyperintensity likely related to treatment. There is increased T1 hyperintensity involving the T3 vertebral body, also compatible with treatment. Small mild T1 hyperintense lesion involving the T8 vertebral body, may represent hemangioma. No associated compression fractures are dorsal epidural extension. Small left paracentral disk protrusions are again seen noted at the T6-7, T7-T8, and T8-T9 levels. There is a 8 x 5 mm new intradural enhancing lesion at the L5 level involving or adjacent to the descending right S1 nerve root, There is unchanged mild wedge compression deformity of the L1 vertebral body with heterogeneous signal and an interval decrease in edema and enhancement. No new osseous lesions in the lumbar spine.

Output: 1.Three large intracranial metastases with surrounding edema and minimal midline shift.2.New intramedullary spinal cord mass at the T8 level likely represents a metastasis. There is extensive edema throughout the spinal cord.3.New extramedullary spinal mass at the right C4 level extending into the right C4-5 neural foramen. There is resulting cord compression.4.New intradural enhancing lesion at the L5 level involving the traversing right S1 nerve root also compatible with metastasis.5.New osseous metastases at the T4 vertebral body without compression deformity. Pathologic compression fracture involving the L1 vertebral body again seen with interval decrease in edema and enhancement.Findings called to Dorota Havlin at 5:00pm on 1/12/15. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Low back pain There is moderate facet osteoarthritis of the lower lumbar spine with grade 1 anterolisthesis of L4. There is mild multilevel degenerative disc disease with relative sparing of L5-S1. The vertebral body heights are preserved.

Output: Facet joint osteoarthritis of the lumbar spine with other findings described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Initial staging. Signs and symptoms: Initial staging. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.In the periventricular and subcortical white matter of bilateral cerebral hemispheres there are few tiny foci of flair/T2 hyperintensity which are nonspecific and not enhancing. Proper clinical setting this finding could represent minimal chronic small vessel ischemic strokes.The anatomical morphology and the signal intensity of brain parenchyma is otherwise within normal all MRI sequences. Unremarkable C. cortex, cortical sulci, ventricular system, CSF spaces and brain margination. Post-enhanced images are negative for any abnormal parenchymal or leptomeningeal enhancement.Unremarkable images through the orbits and calvarium without abnormal enhancement.The signal intensity of paranasal sinuses and mastoid air cells are within normal.

Output: 1.Negative diffusion weighted images.2.Negative exam for metastatic disease.3.Few tiny foci of flair hyperintensity only in the subcortical and periventricular white matter which are nonspecific however in the proper clinical setting could represent minimal chronic small vessel ischemic strokes.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post craniotomy for resection of right parietal lesion. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination demonstrates a large focus of remaining vasogenic edema in high convexity right posterior frontal and parietal lobe abutting the right parietal surgical cavity. A surgical cavity containing serosanguineous fluid along the interhemispheric aspect of right parietal lobe measures at 25 x 16 mm in transaxial dimensions. There is T1 hyperintense signal intensity of surgical cavity secondary to expected postoperative blood which precludes precise assessment for detection of enhancing tumor. However within this limitation in this initial postoperative exam there is no convincing evidence of residual tumor at the surgical site however follow-up is needed to entirely exclude this possibility. Constellation of above findings results in effacement of adjacent cortical sulci and mass effect on the occipital horn and trigone of right lateral ventricle with trace leftward deviation of midline. There is however interval improvement of mass effect since preoperative study.Images through posterior fossa demonstrate a partially hemorrhagic solid mass in the left inferior cerebellar measuring at 20 mm in transverse and 18 mm in AP axis which is not significantly different since prior exam from 8-27-15. The mass demonstrates mild surrounding edema and mass effect without significant change since prior exam.No evidence of ventriculomegaly. CSF cisterns remain widely patent. Calvarium, orbits and paranasal sinuses are unremarkable.

Output: 1.Expected postoperative changes of left posterior parietal tumor resection as detailed. Expected postoperative T1 hyperintense contents of surgical cavity precludes precise assessment for detection of enhancement however within this limitation there is no convincing evidence of enhancing residual tumor. Further follow-up is needed.2.Stable partially hemorrhagic and enhancing left inferior cerebellar tumor, surrounding vasogenic edema and regional mass effect.3.Stable nondilated ventricular system and trace deviation of midline to the left with interval improvement since prior exam.


Instruction: Generate impression based on findings.

Input: Foot ulcer There has been amputation of the first ray at the tarsometatarsal joint. There is absence of the distal half of the second metatarsal presumably secondary to surgical resection as well. There is destruction of the head of the proximal phalanx and base of the middle phalanx of the second toe with associated edema and enhancement indicating osteomyelitis. There is surrounding soft tissue inflammation with what may be a tract extending from the PIP joint to the dorsal surface of the great toe. Furthermore, there is additional edema/enhancement within the distal phalanx of the second toe suspicious for osteomyelitis.There is deformity of the third metatarsal which is likely secondary to prior trauma and/or the sequela of old infection. There is a soft tissue defect overlying the distal phalanx of the third toe with abnormal signal intensity and enhancement of the underlying distal phalanx, suspicious for osteomyelitis. The marrow signal of the fourth ray appears normal with no evidence of osteomyelitis.There is a soft tissue defect or blister along the the fifth toe with minimal signal abnormality in the middle and distal phalanx. This signal abnormality is favored represent reactive osteitis as opposed to true osteomyelitis.There is diffuse soft tissue edema of the dorsal foot with mild increased signal intensity of the plantar musculature which may reflect subacute atrophy. There is no discrete fluid collection identified.

Output: 1. Osteomyelitis of the proximal, mid, and likely distal phalanges of the second toe.2. Probable osteomyelitis of the distal phalanx of the third toe.3. Soft tissue defect/blister of overlying the fifth toe with signal abnormalities in the distal and middle phalanges suggestive of reactive osteitis as opposed to true osteomyelitis.4. Additional findings described above.These findings were discussed with CNP M. Jacobs of the primary team at the time of dictation.


Instruction: Generate impression based on findings.

Input: 20-year-old male with pain. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is increased bone marrow signal abnormality within the lateral tibial plateau and lateral femoral condyle. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: Multiple lobulated foci of fluid signal abnormality along the posterior aspect of the proximal fibers of the ACL may represent ganglion formation versus mucoid degeneration. There is partial thickness tearing of the MCL.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Near full thickness tearing of the MCL with associated bone contusions affecting the lateral tibial plateau and lateral femoral condyle.2. Multiple lobulated foci of fluid signal abnormality along the posterior aspect of the proximal fibers of the ACL may represent ganglion formation. 3. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Male, 24 years old, history of testicular cancer with a thoracic metastasis. Findings are redemonstrated compatible with prior laminectomy and intraspinal tumor debulking from T9-10 through T11-12. The postoperative soft tissues are diffusely enhancing compatible with scarring/granulation, and there is 10 x 4 x 2 cm fluid collection within the subcutaneous operative bed. This collection does not reach to the dural margin, though at the T11-12 level, there is a discontiguous small locule of fluid immediately dorsal to the dura.Minimal ventral epidural thickening at T9, contiguous with enhancing disease in the vertebral body, is improved from prior. Likewise, minimal epidural thickening, contiguous with adjacent marrow space disease, at T11 is also improved. At no point in the operative region is there any large or bulky epidural disease, nor any significant spinal canal stenosis or cord compression.No evidence of epidural or marrow space disease is seen in the cervical or upper thoracic regions. Patchy enhancement within the T9 and T11 vertebral bodies is more focal and less uniform than on the prior study. The T11 vertebral body continues to show mild anterior wedging similar to prior.The lumbar spinal canal is congenitally narrow, but no evidence of significant epidural tumor is seen.Fairly diffuse enhancement persists within the L1 vertebral body and right pedicle with some heterogeneity centrally. The L4 vertebral body shows evidence of marrow replacement but no discrete enhancement. The L5 vertebral body shows a small region of enhancement on the right, although the entire vertebral body shows marrow replacement. The S1 vertebral body shows irregular but fairly diffuse enhancement. Patchy enhancement within the iliac wings is partially visualized.Since the prior examination, partially visualized pulmonary and mediastinal masses have significantly decreased in size.

Output: 1.Redemonstrated are findings related to surgical debulking of tumor from T9 through T12. The posterior soft tissue operative bed shows evidence of scarring/granulation, and there is a subcutaneous fluid collection which most likely represents a seroma.2.Only minimal ventral epidural thickening is seen at T9 and T11, contiguous with enhancing disease within the respective vertebral bodies. At no point is there any bulky epidural disease, significant canal stenosis or cord compression.3.Marrow space disease in the lower thoracic and lumbar spine has changed in imaging appearance, perhaps representing response to therapy. No evidence of new or progressive bony disease is seen.4.Partially visualized mediastinal and lung masses also seem to have decreased significantly in size.


Instruction: Generate impression based on findings.

Input: Chiari malformation status post surgery and schwannomatosis: worsening left leg pain with foot and calf numbness/tingling; new right leg pain. Brain: There is interval evolution of postoperative findings related to Chiari decompression. The cerebellar tonsils display unchanged configurations. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. Spine: There is further slight interval decrease in size of the cervical spinal cord syrinx. There is unchanged focus of high T2 signal and slight volume loss in the right hemicord at the C2-3 level, compatible with myelomalacia. There is unchanged multilevel spinal nerve root expansion with associated neural foramen widening throughout the cervical, thoracic, and lumbosacral spine. There is no associated spinal cord compression. The vertebral body heights are preserved. There is unchanged alignment of the vertebral column, with lack of thoracic kyphosis. There is a disc bulge at T12-L1. The vertebral bone marrow signal is unremarkable.

Output: 1. Interval evolution of postoperative findings related to Chiari decompression with further slight decrease in size of the cervical syrinx.2. Extensive schwannomatosis throughout the spine.


Instruction: Generate impression based on findings.

Input: Status post recent colloid cyst resection. There are recent postoperative findings related to transcallosal resection of a colloid cyst with a small amount of pneumocephalus and pneumoventricle, as well as mild swelling and diffuse susceptibility effect within the left lateral ventricle choroid plexus. In addition, there is a punctate focus of high T2 signal in the region of the left foramen of Monro with susceptibility effect in this region as well. The ventricles are otherwise unchanged in size. There is patchy T2 hyperintensity and restricted diffusion in the body of the corpus callosum and right cingulate gyrus along the surgical approach that measures up to 18 mm. There is otherwise unchanged mild cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no midline shift or herniation. There are postoperative findings related to rhinoplasty. There is hypertrophy of the right inferior turbinate.

Output: Recent postoperative findings related to colloid cyst resection with areas of acute ischemia along the surgical approach and a small amount of hemorrhage within the left lateral ventricle. A punctate focus of high T2 signal in the region of the left foramen of Monro is nonspecific, but may represent hemorrhage and/or a residual portion of the colloid cyst, although superimposed recent postoperative findings serve as confounding factors. Therefore, follow up via MRI would be useful.


Instruction: Generate impression based on findings.

Input: 62-year-old male with elevated PSA, enlarged prostate. Questioning abnormal PSA. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.4 cm in transverse, 4 cm in AP, and 4.8 cm in craniocaudal length.Peripheral Zone: In the mid gland left peripheral zone, there is a 17 x 12 mm ADC and T2 hypointense focus suspicious for a dominant lesion (series 301 image 42, series 403 image 224), and indistinctness of the hypointense capsule is concerning for extracapsular extension (series 301 image 42). Central Gland: Nodular changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: As above.BLADDER: Asymmetric thickening at the level of the left UVJ (series 601 image 64)LYMPH NODES: Nonspecific left external iliac lymph node measuring 1.3 x 0.4 cm (series 601 image 60).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant lesion in the left peripheral zone mid gland measuring 17 x 12 mm with suspected extracapsular extension (PI-RADS 5).2. Asymmetric thickening at the level of the left UVJ within the bladder, possibly mass, would be better characterized with direct visualization. No prior studies are available for comparison.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: History of left cerebellopontine angle meningioma resection: dizziness. There are postoperative findings related to retrosigmoid craniotomy for resection of a left cerebellopontine angle mass. There is a residual enhancing dural-based mass along the posterior aspect of the left petrous apex with underlying hyperostosis extension into the left internal auditory canal that measures up to 7 mm in thickness. There is minimal mass-effect upon the left pons. There is unchanged patchy T2 hyperintensity, enhancement, and susceptibility effect within the central pons, which may represent a telangiectasia. There are unchanged mildly The supratentorial structures are otherwise appears unremarkable and there is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Postoperative findings related to retrosigmoid craniotomy for resection of a left cerebellopontine angle mass with a residual enhancing dural-based mass along the posterior aspect of the left petrous apex with underlying hyperostosis extension into the left internal auditory canal that measures up to 7 mm in thickness, which is compatible with residual meningioma.


Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: evidence of obstruction, evaluation of possible focal mass seen on US History: elevated LFTs, echogenic focus in R lobe of liver, evidence of intra and extra hepatic duct dilation on ab US ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are at least 3 the small hypervascular lesions in the liver: The lesion in segment 4 measures 1.7 cm; lesion in segment 7 measures 11 mm; and smaller lesion in segment 2 measures under 1 cm. The lesions don't show washout on delayed phase of imaging.Additionally, in segment 7 of the liver there is a mildly T2 hyperintense lesion with some internal enhancement representing either a cyst with a septation or partially filling hemangioma.There is mild intra and extra hepatic biliary ductal dilatation. The CBD measures 9mm.No discrete mass is identified along the course of the common bile duct.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is normal in caliber. Pancreas is normal in morphology.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hypervascular hepatic lesions with imaging features compatible with flash filling hemangiomas.2.Mild internal/external biliary duct dilatation following cholecystectomy.


Instruction: Generate impression based on findings.

Input: 56 year old man with history of cardiomyopathy, PVCs, and possible ARVD is referred for reassessment. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 237 ml (normal range 142+/-34), the LV end systolic volume index is 70 ml/m2 (normal range 25+/-9), the LVESV is 149 ml (normal range 47+/-19), the LV mass index is 90 g/m2 (normal range 85+/-15), and the LV mass is 190 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is transmural late gadolinium enhancement of the basal inferior wall and transmural late gadolinium enhancement of the apical lateral wall. These findings suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Although on the current study, the pattern of LGE could be seen with prior myocardial infarction, on the prior study, which had better image quality, the LGE pattern was epicardial and not consistent with prior myocardial infarction.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. There is dyskinesis of the RV base and evidence of RV apical late gadolinium enhancement. The overall RV ejection fraction is 23%, the RV end diastolic volume index is 173 ml/m2 (normal range 82+/-16), the RVEDV is 366 ml (normal range 142+/-31), the RV end systolic volume index is 132 ml/m2 (normal range 31+/-9), and the RVESV is 280 ml (normal range 54+/-17). In the appropriate clinical setting, these findings support the diagnosis of arrhythmogenic right ventricular cardiomyopathy. Right AtriumThe right atrium is moderately dilated.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.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. When compared to the prior study both ventricles are larger and have a lower ejection fraction.2. Severe right ventricular dilation with severely reduced systolic function (RVEF 23%). There is dyskinesis of the RV base and evidence of RV apical late gadolinium enhancement. In the appropriate clinical setting, these findings support the diagnosis of arrhythmogenic right ventricular cardiomyopathy.3. Mild LV dilation with moderately reduced systolic function (LVEF 37%). There is global hypokinesis with regional variation. There is transmural late gadolinium enhancement of the basal inferior wall and transmural late gadolinium enhancement of the apical lateral wall. These findings suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Although on the current study, the pattern of LGE could be seen with prior myocardial infarction, on the prior study, which had better image quality, the LGE pattern was epicardial and not consistent with prior myocardial infarction.4. Moderate right atrial dilation.The findings of the LV and RV most likely represent the same process. ARVD can involve the LV as well as the RV. Also many LV cardiomyopathies can involve the RV and be mistaken for findings of ARVD.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 34-year-old female with known right breast cancer presents for MRI evaluation. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.A known cancer is demonstrated as an enhancing irregularly shaped mass at 9:30 position in the right breast, measuring 26 x 21 x 19 mm (AP x LR x CC), with a marker clip at posterior aspect.A benign intramammary lymph node is present at anterior 12:00 position in the right breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal cancer in the right breast.2. No MR evidence of malignancy in the left breast.3. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 15 year old female with amenorrhea.EXAMINATION: MR enterography without and with IV contrast 1/28/2015 The uterus measures approximately 2.1 x 1.7 x 3.9 cm, and fluid is present within the endometrial cavity, which measures approximately 1.3 x 1.1 cm. The uterine morphology, although somewhat diminutive is normal. The right ovary measures 2.6 x 2 .7 cm, and there is a 1.3 x 1.2 cm simple ovarian cyst. The left ovary measures 2.7 x 2.2 cm, with an associated 1.7 x 1.9 cm ovarian cyst.

Output: 1.Diminutive uterus, with fluid within the endometrial cavity as detailed above.2.Bilateral ovarian cysts.


Instruction: Generate impression based on findings.

Input: 53-year-old male with right knee pain. Mild to moderate osteoarthritis affects the knee. Please refer to recent MRI regarding cartilage degeneration. Several ossicles are noted posteriorly, likely representing loose bodies.

Output: Osteoarthritis of the right knee with loose bodies. Please refer to recent MRI for further information.


Instruction: Generate impression based on findings.

Input: 46 yo female with idiopathic scoliosis and cafe au lait macule. Evaluate for spinal cord abnormality. There is levocurvature of the upper thoracic spine with apex at the T3-4 level and dextrocurvature of the lower thoracic spine with apex at the T10-T11 level. No focal osseous lesions are appreciated. Bone marrow signal is benign with endplate marrow changes related to degenerative disease at the T10-T11 and T11-T12 level.Vertebral body heights are maintained without compression fractures. There is no abnormal signal or syrinx involving the thoracic cord although patient's body habitus makes evaluation difficult. There are prominent left lateral osteophytes in the lower thoracic spine. There is advanced left sided facet arthropathy at the T11-T12 level on the left and to a lesser degree at left T10-T11. There is mild impression on the left lateral aspect of the thoracic cord at T11-T12 related to ligamentum flavum thickening and advanced facet arthropathy. No significant spinal canal stenosis is otherwise appreciated. There is moderate narrowing of the left-sided neural foramina from T9-T10 to T11-T12.

Output: 1. Levocurvature of the upper thoracic spine with apex at the T3-4 level and dextrocurvature of the lower thoracic spine with apex at the T10-T11 level as seen on recent radiographs. 2. Associated degenerative changes particularly at the left T11-T12 level where there is significant left-sided facet arthropathy and ligamentum flavum thickening and mild impression on the left lateral aspect of the thoracic cord at this level. 3. No cord signal abnormality within the thoracic spine is appreciated. No high-grade stenosis. No other structural lesions are appreciated.


Instruction: Generate impression based on findings.

Input: Retro-orbital pain left greater than right. Postnasal drip. Bony density inferior exam is within normal limits. Small retention cysts within dependent portion of bilateral maxillary sinuses is noted. The ostiomeatal units of the maxillary sinuses are patent bilaterally. Small retention cyst within one of the right posterior ethmoid air cells. The rest of the paranasal sinuses are well pneumatized and unremarkable. Images through the orbit demonstrate normal appearing retro-orbital fat, extraocular musculature and optic nerves. Increased density in a linear fashion is noted overlapping the right upper quadrant of the right globe. There may be some increased density also within the right lacrimal gland. This finding may represent hemorrhage or heavy calcification. Please correlate with history and follow-up with an MRI examination.

Output: 1.Small retention cysts within the bilateral maxillary sinuses and right posterior ethmoid as detailed.2.Unremarkable suture paranasal sinuses otherwise.3.Patent bilateral ostiomeatal units the maxillary sinuses.4.Linear increased density overlapping the outer lateral quadrant of right globe which may represent calcification or blood product. Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Right breast pain. Patient is status post left lumpectomy and sentinel lymph node biopsy in November 20, 2011 for IDC grade 2, triple negative breast cancer. Patient is status post right excisional biopsy for ADH, which was upgraded to DCIS in July 2014. There is scattered fibroglandular tissue in both breasts. Post lumpectomy changes seen in both breast. Mild left breast skin thickening is compatible with post radiation change. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.Multiple high T2 signal lesions of various sizes in the liver are most likely cysts or hemangiomas.

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


Instruction: Generate impression based on findings.

Input: History of small cell lung cancer, with known brain metastases and seizure. There is an irregular peripherally-enhancing mass in the left anterior temporal pole that measures up to nearly 30 mm. There is extensive T2 hyperintensity and mild swelling throughout the left amygdala and hippocampus, with scattered punctate foci of faint enhancement. There is an enhancing nodule in the right fusiform gyrus that measures 8 mm in diameter, with surrounding confluent T2 hyperintensity. In addition, there is an enhancing lesion in the left occipital lobe that measures 6 mm in width, with surrounding confluent T2 hyperintensity. There is no evidence of acute intracranial hemorrhage or infarction. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left anterior maxillary alveolus cystic defect.

Output: Multiple brain metastases with associated vasogenic edema, the largest of which is located in the left anterior temporal pole. Diffuse swelling involving the amygdala and hippocampus with patchy foci of enhancement may be related to seizure activity associated with the metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out bleed. Signs and symptoms: Altered mental status Nonenhanced CT of brain:Examination demonstrates no evidence of acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Findings of advanced to small vessel disease with resultant underlying parenchymal volume loss is again identified. There is no definitive appreciable interval change since prior examination. If patient's clinical symptoms persist follow-up with an MRI is recommended.

Output: No interval change since prior exam. Findings consistent with advanced small vessel disease of indeterminate age with resultant parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: Male, 10 years old, history of ventriculomegaly, syrinx evaluate for changes. Brain: Redemonstrated is evidence of Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1. The cerebellum fills the surgically widened foramen magnum similar to prior resulting in persistent near complete effacement of the CSF spaces at this level. A mild retroflexion of the dens, prominence of the soft tissues and ligaments surrounding the dens contribute to this effacement. Mild dysplasia involving the skull base including the planum sphenoidale and clivus again noted.On cine-flow imaging, flow related signal is evident along the anterior aspect of the brainstem and through the cerebral aqueduct into the fourth ventricle. Diminished biphasic flow is demonstrated ventrally and dorsally at the foramen magnumThe lateral and third ventricles remain mildly enlarged but without significant interval change. Minimal T2/FLAIR hyperintensity along the ependymal surface compatible with mild transependymal flow. For reference, the trans-frontal diameter measured in the coronal plane is 55 mm, previously 55 mm.No new areas of parenchymal signal abnormality are seen including no evidence of restricted diffusion. No edema or mass effect is identified. There is no evidence of any significant intracranial hemorrhage.Cervical and thoracic spine:Redemonstrated is a large syrinx which begins in the cervical spinal cord at the C2-3 level where it shows evidence of septation, continuing inferiorly throughout the cord to the level of the conus at L1-2. At C6-C7 syrinx measures 10 x 14 mm in the AP and transverse dimension which is unchanged. At T7-T8, syrinx measures 10 x 10 mm in the AP and transverse dimension which is also unchanged. When compared to prior two studies, there is minimal increase in caliber at the C3-C4 level where it measures 3 x 7 mm previously 3 x 4 mm on 8/7/2014. Otherwise no change in the craniocaudal extent of the syrinx.No significant spinal canal or neuroforaminal stenosis is seen. There remains a small central disk protrusion at C6-7, unchanged.

Output: 1.Redemonstration of surgical findings status post Chiari decompression. As before, the cerebellum fills/prolapses into the surgically widened foramen magnum resulting in near complete effacement of the CSF spaces at this level. Cine-flow imaging is unchanged and demonstrates diminished biphasic ventral and dorsal CSF flow.2.Mild ventriculomegaly is unchanged. No other significant brain abnormalities are detected.3.Redemonstration of a large caliber syrinx involving nearly the entire spinal cord. There appears to be minimal increase in caliber of the syrinx in its most superior aspect at the C3-C4 level compared to 2/19/2015 and 8/7/2014. However there is overall no significant change in the maximal caliber and craniocaudal extent.


Instruction: Generate impression based on findings.

Input: Ms. Oden is a 61-year-old female with a personal history of left breast mastectomy in 2012 for ILC and right breast reduction mammoplasty in 2012. Treated with chemotherapy, Tamoxifen, and Arimidex. Family history of breast cancer in mother and maternal great grandmother. She has no current breast related complaints. Patient is status post left breast mastectomy. Minimal background parenchymal enhancement is noted in the right breast. Small seroma cavity is again identified in the left lateral chest wall.Scattered foci of enhancement are identified in the right breast, all of which are stable when compared back to multiple prior examinations. No abnormal enhancement is seen in the right breast or left chest wall. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Left leg weakness, increased severity There are degenerative changes in the cervical spine as seen on prior neck CT with prominent disc osteophyte complex at the C4-C5 level with associated moderate to severe spinal canal stenosis including mild flattening of the cord. Findings are better assessed on dedicated cervical spine imaging reported separately. There is also partial fusion involving the C6 and C7 vertebral bodies. No obvious cord signal abnormality.The vertebral bodies in the thoracic and lumbar spine are appropriate in the overall alignment and height. No evidence of high-grade spinal canal stenosis in the thoracic or lumbar spine.

Output: 1. Moderate to severe spinal canal stenosis at the C4-C5 level which is on a degenerative basis. Please see separate cervical spine MRI report for additional details.2. No findings to suggest acute cord compression. Due to the screening nature of this protocol, details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Ms. Brown is a 45-year-old woman with strong family history of breast cancer in mother, sister and grandmother. She presents today for MR imaging as part of her high risk screening protocol. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally.In the left central breast, mid depth, there is a lobulated enhancing mass identified measuring 0.9 x 1.0 cm. This corresponds to a benign morphology mass seen on multiple prior mammograms, with stability in appearance dating back to 2012. There is no abnormal enhancement seen in the right breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Stable benign enhancing mass of the left breast. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Generalized hyperhidrosis. Neutropenia. Acute myelogenous leukemia. Large external hemorrhoids. Evaluate for abscess. PELVIS:UTERUS, ADNEXA: The uterus is lobular in contour and contains multiple small intramural T2 hypointense hyaline fibroids. No abnormal enhancement is identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small volume of free fluid within the pelvis. Soft tissue is identified protruding from the rectum, which may represent a prolapsed rectum versus hemorrhoids.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted.

Output: 1.No abscess identified. Soft tissue protruding from rectum, may represent prolapsed rectum versus hemorrhoids.2.Small volume of free pelvic fluid and anasarca.


Instruction: Generate impression based on findings.

Input: There are numerous enhancing intracranial lesions predominantly near the gray-white matter junction suspicious for metastatic disease. Majority of these lesions demonstrate some hemorrhagic component similar to prior CT with surrounding vasogenic edema. The largest hemorrhagic lesion is centered in the right parietal lobe measuring 3.1 x 2.7 cm. Additionally, there is a lesion centered in the atrium of the right lateral ventricle measuring 1.9 x 1.7 cm. A calvarial lesion near the skull vertex with subgaleal and epidural extension measures 1.8 x 4.1 cm (cc by AP). This lesion also appears to invade the adjacent superior sagittal sinus. There is no diffusion restriction to suggest acute ischemia. There is mucosal thickening of the left maxillary sinus with an air-fluid level.

Output: 1. Numerous supratentorial and infratentorial enhancing lesions as well as a right intraventricular lesion are suspicious for metastatic disease. Majority of these lesions demonstrate at least some degree of hemorrhage.2. There is a calvarial lesion near the skull vertex with subgaleal and epidural extension as well as invasion of the adjacent superior sagittal sinus.3. Left maxillary sinus disease.


Instruction: Generate impression based on findings.

Input: Headache. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left sphenoid sinus retention cyst.Pituitary: The pituitary is not enlarged or atrophic. There is no evidence of pituitary or parasellar tumors. The infundibulum is situated in the midline. The cavernous sinuses and optic apparatus are intact.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. The pituitary gland is unremarkable.


Instruction: Generate impression based on findings.

Input: Reason: s/p injury to hand, evaluate index MCP joint, pain with extension History: pain Limited study as the patient refused to complete the examination per the technologist memo. Several sequences are also limited due to patient motion artifact. A marker was placed along the dorsal aspect of the second MCP joint. Given the aforementioned limitations, the underlying extensor tendon appears intact. We see no underlying bone or soft tissue injury affecting the MCP joint. There is a small sesamoid bone volar to the second metacarpal head. There is a small focus of signal abnormality within the lateral aspect of the second metacarpal head which may represent a small cyst. We see no frank synovitis. The remainder of the second metacarpal appears normal. The proximal and middle phalanges of the index finger appear normal. There is a fracture through the tuft of the distal phalanx as seen on recent radiographs.

Output: Limited study due to patient motion artifact and refusal to complete the examination which shows no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: New brain mass and hydrocephalus. Brain MRI:Redemonstrated is an heterogeneous complex cystic multiseptated appearing mass in the right lateral ventricle that measures 17 x 30 mm on axial view and 22 mm CC, unchanged. It abuts and possibly arises from the septum pellucidum. Tumor extends into and occupies the right half of the third ventricle. There appears to be minimal enhancement of the mass which is complicated by the small amount of adjacent hemorrhage. The right greater than left lateral ventricle and third ventricle enlargement is stable and there is subependymal T2 hyperintensity which suggest chronic CSF migration. The fourth ventricle and cerebral aqueduct are normal. Again seen is a left frontal approach EVD with distal tip adjacent to the wall of the body of the right lateral ventricle. Susceptibility abnormality is seen in the right lateral ventricle anteriorly and along the EVD tract, and near the right foramen of Monro along the inferior margin of the mass, which may be post-procedural blood product. There is some enhancement of the anterior horn of the right lateral ventricle which may be related to reaction to the blood products. The gray-white matter differentiation is preserved. There is no midline shift. There is mild scattered mucosal thickening in the paranasal sinuses.Spine MRI:CERVICAL SPINE

Output: 1.Redemonstration of a complex cystic enhancing mass involving the anterior horn and body of the right lateral ventricle with extension into the right foramen of Monroe and third ventricle. It is suspected that it may even extend towards the aqueduct of Sylvius. The differential includes choroid plexus tumor, astrocytoma, central neurocytoma or ependymoma/subependymoma.2.Stable ventriculomegaly involving the lateral ventricles and third ventricle.3.Unchanged EVD tip appearing along the wall of the body of the right lateral ventricle. Blood products are again along the EVD and near the tip which are likely post-procedural.4.No findings in the spine to indicate malignancy or metastasis.5.Mild disc bulge involving the L4-5 level and right greater than left L5-S1 disc bulge with a lateral disc protrusion which causes impression on the exiting right lateral S1 nerve root. No central canal stenosis.


Instruction: Generate impression based on findings.

Input: 55-year-old male with two weeks of fever, right upper extremity swelling, pain Replacing/insinuating between the fibers of the abductor pollicis brevis muscle is a collection of high T2 signal with peripheral rim enhancement measuring 4.5 x 1.3 cm (series 26, image 22). Adjacent to this collection is a second rim-enhancing fluid collection surrounding the flexor pollicis longus tendon and displacing the adductor pollicis brevis muscle dorsally, measuring 2.1 x 1.4 cm (series 26, image 21). Mild enhancement and edema type signal is noted within the adductor pollicis brevis muscle belly.A third rim-enhancing, lobulated fluid collection is noted in the first interdigital web space, along the medial and volar aspect of the adductor pollicis brevis muscle measuring 2.3 x 1.7 cm (series 26, image 16).Enlargement and signal abnormality of the flexor pollicis longus and fourth and fifth flexor digitorum superficialis tendons. Fluid tracks along the flexor compartment extending towards the carpal tunnel demonstrating peripheral enhancement. No significant abnormal bone marrow signal. Mild degenerative disease affects the carpometacarpal and partially visualized intercarpal joints.

Output: Multiple rim-enhancing fluid collections insinuating between the abductor pollicis brevis muscle fibers, surrounding the flexor pollicis longus tendon, and in the first interdigital web space as described above are suspicious for abscess. No convincing evidence of osteomyelitis. Other findings as above.Findings discussed with Dr. Kyle Borque at 1130 on 11/22/15.


Instruction: Generate impression based on findings.

Input: 35-year-old male rule out aneurysm. History of right frontal tumor resection. Rule out subarachnoid hemorrhage. Non-infused CT of brain.Examination demonstrates a large surgical cavity in the right frontal lobe representing site of previously resected tumor.Extensive vasogenic edema in the right hemisphere and to a lesser degree within the left cerebral hemisphere is noted. This is concerning for recurrence of tumor and a follow up exam with an MRI is recommended.No evidence of subarachnoid hemorrhage is detected. Slight high density within the sylvian fissure and interhemispheric fissure is secondary to low density of the adjacent brain parenchyma and not subarachnoid hemorrhage. MRV of intracranial sinuses.This examination is within normal limits and demonstrates normal augment renal venous sinuses.CTA of intracranial spiculation.CTA of the carotid system demonstrates patent bilateral internal carotid arteries across the skull base. There is good visualization of bilateral anterior and middle cerebral arteries with no evidence of pathology in particular no evidence of aneurysm.CTA of vertebral basilar system demonstrates patent bilateral intracranial components of the vertebral arteries with no pathology. Basilar artery and all of its branches are normal and demonstrate no pathology in particular no stenosis or aneurysm.

Output: 1.Increased edema surrounding the surgical cavity in the right hemisphere is highly concerning for recurrence of tumor and a follow up MRI with infusion is recommended.2.No evidence of subarachnoid hemorrhage on CT.3.Unremarkable MRV of intracranial venous sinuses.4.Unremarkable CTA of intracranial vasculature.


Instruction: Generate impression based on findings.

Input: 78 yo F with GBM s/p STR, evaluate for extent of disease for RT planning History: post-resection imaging There has been evolution of recent postoperative changes of right frontal craniotomy for near-total tumor resection. Lobulated enhancing tissue along the posterior/deep aspect of the resection cavity along the callosal genu and hypothalamus likely reflects residual tumor and appears slightly larger in the interval. There is more conspicuous interval increase in enhancement along the medial aspect of the resection cavity including the left paramedian frontal lobe as well as the right anterior inferior aspect of the basal ganglia, areas which demonstrated restricted diffusion on prior MRI related to postoperative ischemic injury. There is also increased volume loss in the left paramedian frontal lobe. Extent of T2 FLAIR hyperintensity representing vasogenic edema in the right frontal lobe is markedly improved.There is no midline shift or herniation. No hydrocephalus.

Output: Evolution of postsurgical changes related to near total tumor right frontal glioblastoma resection. Masslike enhancement along the deep, posterior aspect of the resection cavity likely reflects residual tumor and has mildly increased in size in the interval. Interval increase in enhancement involving the left paramedian frontal lobe and right anterior inferior basal ganglia is favored to represent evolution of postoperative ischemic injury.


Instruction: Generate impression based on findings.

Input: Alignment is normal. The marrow signal is benign. Mild chronic wedge deformity of C5 is again noted. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is no abnormal enhancement.C2/3: Mild posterior osteophyte disc complex and slight ligamentum flavum thickening. There is mild bilateral neural foraminal stenosis.C3/4: Posterior osteophyte disc complex, uncinate hypertrophy, and ligamentum flavum thickening. There is mild central, moderate to severe left neural foraminal, and mild right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex, uncinate hypertrophy, and ligamentum flavum thickening. There is mild central, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate left neural foraminal and severe right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and slight ligamentum flavum thickening. There are no significant stenoses.C7/T1: Posterior osteophyte disc complex and slight ligamentum flavum thickening. There are no significant stenoses.T1/2: Sagittal images suggest the presence of posterior osteophyte disc complex and facet hypertrophy encroaching the central canal and neural foramina.T2/3: Sagittal images suggest the presence of posterior osteophyte disc complex encroaching the central canal.

Output: 1.C2/3: Mild bilateral neural foraminal stenosis.2.C3/4: Mild central, moderate to severe left neural foraminal, and mild right neural foraminal stenosis.3.C4/5: Mild central, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.4.C5/6: Moderate left neural foraminal and severe right neural foraminal stenosis.5.T1/2: Sagittal images suggest the presence of posterior osteophyte disc complex and facet hypertrophy encroaching the central canal and neural foramina. T2/3: Sagittal images suggest the presence of posterior osteophyte disc complex encroaching the central canal. If the patient has symptoms referable to the thoracic spine, a dedicated thoracic MRI could better define these degenerative changes, if deemed clinically beneficial.


Instruction: Generate impression based on findings.

Input: Reason: R/o rotator cuff tear History: pain and weakness ROTATOR CUFF: There is complete rupture of the supraspinatus tendon at the level of its insertion on the greater tuberosity with approximately 3 cm of retraction of the proximal tendon fragment. There is extension of this tearing involve the anterior fibers of the infraspinatus. There is thickening and intermediate signal intensity within the infraspinatus and supraspinatus tendons indicating moderate tendinosis. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa confirming a full-thickness tear. Moderate osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. There is intermediate signal intensity within the superior labrum which may represent degeneration.BICEPS TENDON: There is thickening of the intra-articular portion of the tendon of the long head of the biceps indicating a mild tendinosis. The tendon itself appears intact. Tiny foci of decreased signal abnormality within the tendon sheath of the long head of the biceps may represent loose bodies or debris related to a tenosynovitis.ADDITIONAL

Output: 1. Complete tear of the supraspinatus with retraction. This tear extends to involve the anterior fibers of the infraspinatus. Tendinosis of the rotator cuff particularly involving the supraspinatus and infraspinatus tendons2. Osteoarthritis of the shoulder. 3. Mild tendinosis of the tendon of the long head of biceps and other findings as described above.


Instruction: Generate impression based on findings.

Input: History of traumatic brain injury with intracranial hemorrhage at age 4 presenting with abnormal gait and tremor. Evaluate for brain lesions or atrophy. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is thinning of the posterior body of the corpus callosum with relative sparing of the splenium. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter as well as T2 hyperintense signal along the periatrial white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. Cervical spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are minimal disc bulges throughout the cervical spine with no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Constellation of findings including thinning of the posterior body of the corpus callosum and signal abnormality of the periatrial white matter along the callosal fibers as well as scattered punctate lesions in the white matter throughout the cerebral hemispheres, could reflect sequela of prior chronic traumatic injury. Additional differential considerations include demyelinating, post inflammatory or vasculitic process among others.2. No significant spinal canal or neural foraminal stenosis of the cervical spine.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cardiac arrest, cause unspecifiedClinical question: s/p PEA arrest, assess brain parenchyma for hypoxic changesSigns and Symptoms: as above There is gyral T2 and FLAIR hyperintensity along small portions of the left posterior temporal lobe and left inferior parietal lobule associated with the blood products. There is a small amount of extra-axial blood present adjacent to the left and right parietal lobes and to a lesser degree right frontal lobe.A small focus of diffusion restriction is present along the left insular cortex.A punctate focus of diffusion weighted imaging signal hyperintensity without restriction is present in the left cerebellar hemisphere.At T2 and FLAIR hyperintense focus is present along the medial aspect of the left cerebellar hemisphere measuring 8 mm in diameter. This was not previously present.Punctate foci of T1 signal hyperintensity associated with susceptibility effect are present in the cerebellar hemispheres. There is also a punctate focus of signal loss on susceptibility imaging along the left lingual gyrus which was also present on the prior MRI exam and likely represents an old microhemorrhage. In isolation is of little clinical significance.There are 5-10 periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable compared to prior examNormal 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 some mucosal thickening in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Small hemorrhagic foci are present along the left inferior parietal lobule and left posterior temporal lobe. The cause is unknown based on this exam. One possibility is that this represents hemorrhagic conversion of prior infarction.2.A small focus of subacute infarction is present in the left insular cortex3.Small foci of extra-axial blood are present adjacent to the parietal lobes and right frontal lobe4.There are new microhemorrhages present in the cerebellar hemispheres one of which displays a small amount of adjacent cerebellar edema.5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 61-year-old female patient with history of BCRA mutation. Evaluate for pancreatic mass. ABDOMEN:LIVER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum noted. No suspicious pancreatic lesions seen. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense, nonenhancing lesions in the left kidney are too small to characterize and likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious pancreatic lesions or secondary signs of the lesion.2.Pancreatic divisum.


Instruction: Generate impression based on findings.

Input: Female 77 years old Reason: Evaluate for discitis/osteomyelitis History: ?discitis of L4 on CTA Multiple endplate deformities with mild loss of height of L3, L4 and L5 vertebral bodies. Endplate deformity of L5 is stable dating back to 5/31/2014. L3 is stable dating back to 3/2/2016. L4 endplate deformity is new as of 4/11/2016 CTA abdomen pelvis. There is edema signal involving the inferior endplate of L4 with Schmorl's node. There is also an L3 Schmorl's node. Overall these findings are compatible with multiple Schmorl's nodes/mild compression fractures. Edema signal and L4 is compatible with recent injury. There is associated enhancement of the endplate of L4. No suspicious enhancement is seen. There is no evidence of discitis/ostial myelitis. Abdominal aortic aneurysm is incompletely imaged, please refer to 4/11/2016 CT angiography abdomen and pelvis.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina. Small focal ectasia/perineural cyst involving the right L1 nerve root.L2-L3: Mild disc bulge. No neural foraminal or spinal canal stenosis.L3-L4: Mild disc bulge. Minimal neural foraminal narrowing. No spinal canal stenosis.L4-5: Moderate disc bulge. Moderate right and mild to moderate left neural foraminal narrowing. Mild central spinal stenosis. Partial effacement of the lateral recesses.L5-S1: There is no significant compromise to spinal canal or neural foramina.

Output: 1.Multiple endplate deformities of L3, L4 and L5 vertebral bodies consistent with mild compression fractures with Schmorl's nodes. L4 endplate deformity is recent given edema signal, as noted on CT.2.No evidence of discitis/osteomyelitis.3.Degenerative changes as described above worst at the L4-L5 level. Please see details above.


Instruction: Generate impression based on findings.

Input: Status post aneurysm coiling, communicating hydrocephalus, VP shunt placement. Examination limited by susceptibility related to extracranial portion of the shunt catheter. Right temporal-parietal approach ventriculostomy catheter tip terminates in the midline right lateral ventricle, unchanged. The ventricles appear mildly dilated, but unchanged from the prior study. Chronic hemosiderin staining of the surface of the brain likely represents the sequelae from prior subarachnoid hemorrhage. Extensive white matter T2 hyperintensity is not significantly changed and most consistent with chronic small vessel ischemic disease. There is chronic dural thickening. The paranasal sinuses and mastoid air cells are unremarkable . Findings are seen status post stent assisted aneurysm coiling in the communicating segment of the right ICA. Decreased signal within the stented portion of the distal ICA is likely artifactual and is unchanged. There is no evidence for recurrent aneurysm. No significant stenosis is evident in the anterior or posterior intracranial arterial circulations.

Output: 1. Status post stent assisted aneurysm coiling in the communicating segment of the right ICA. No evidence of recurrent aneurysm is seen.2. Moderate-severe chronic small vessel ischemic changes without evidence of acute ischemia / infarction.3. Right temporal-parietal approach ventriculostomy catheter with stable ventriclar size.


Instruction: Generate impression based on findings.

Input: 40 year-old female with HIV/AIDS and cervical cancer, status post radiotherapy. Presents with rectal bleeding. Evaluate for mass or inflammatory change. ABDOMEN:LUNG BASES: Small pleural-based nodules at the lung bases may be due to atelectasis or scar. No acute infiltrates or effusions.LIVER, BILIARY TRACT: Dilated gallbladder with cholelithiasis. Mild gallbladder wall thickening, possibly secondary to chronic cholecystitis. There is a benign hemangioma in the inferior right hepatic lobe, unchanged from the MRI examination.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is moderate left hydronephrosis and hydroureter with obstruction by infiltrative mass near the left ureterovesical junction, most likely a metastasis. The hydronephrosis is new since the MRI examination of 1/28/08.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse colorectal wall thickening, probably due to post-radiotherapy change. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: The uterus demonstrates heterogeneous contrast enhancement with loss of the normal fascial planes between the uterus and bladder most likely due to direct tumor invasion. The interface between the rectum and uterus/cervix is indistinct, probably due to post radiotherapy change. New 1 cm right sided intrauterine mass near the fundus at axial image 94/144 of series 3. BLADDER: Diffuse bladder wall thickening. Left sided 4 cm diameter intraluminal mass is stable since 1/28/08. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse rectosigmoid wall thickening, probably due to post-radiotherapy change. BONES, SOFT TISSUES: Of sclerosis at the pubic symphysis is most likely due to radiation osteonecrosis.OTHER: No significant abnormality noted

Output: Post-radiotherapy changes to pubic symphysis and rectosigmoid. Cervical mass invades bladder. New left hydronephrosis and hydroureter due to bladder mass and infiltrative changes at the UVJ.


Instruction: Generate impression based on findings.

Input: Female, 3 months old, ex 25 and 5/7 weeks preemie, history of spiking some EEG and poor head growth. Assess for periventricular leukomalacia. Within the limitations of motion artifact, the following observations are made.The degree of parenchymal gyration and the pattern of white matter myelination are appropriate for adjusted gestational age of approximately 0-1 month. The corpus callosum appears to be intact and fully formed. The pituitary region is probably within normal limits. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable.No evidence of any focal parenchymal signal abnormality is seen. No restricted diffusion or parenchymal edema is detected. No evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The left ventricular atrium is slightly larger than the right but without any additional evidence of parenchymal injury in this location.Findings compatible with a cleft palate are seen. The calvarium is otherwise unremarkable.

Output: 1. The appearance of the brain is appropriate for the adjusted gestational age.2. No definite evidence of periventricular leukomalacia or any other focal parenchymal lesion is seen. Slight asymmetric prominence of the left ventricular atrium relative to the right may simply represent a normal variation.3. Cleft palate.