Instruction: Generate impression based on findings.

Input: Female, 58 years old. Reason: lateral shoulder mass History: lateral shoulder mass Markers were placed along the lateral aspect of the shoulder, presumably denoting a palpable mass.There is a mass of predominantly fat signal intensity arising from the lateral fibers of the deltoid muscle and extending into the subcutaneous fat. Interdigitation of the deltoid muscle fibers within the fatty tissue suggests an intramuscular lipoma. The mass is approximately 3.7 x 3 cm in transverse dimension and approximately 8 cm in craniocaudal dimension. The mass is not included in its entirety on postcontrast images, but we see no enhancement in the visualized component of mass or other findings to suggest malignancy. We see no additional soft tissue masses.Please note that this study was not optimized to evaluate the rotator cuff or intrinsic structures of the shoulder. Within these limitations, the following observations can be made:Intermediate signal intensity within the supraspinatus tendon indicates tendinosis with defects along the bursal surface of the tendon distally indicating partial thickness tearing. The supraspinatus muscle is within normal limits.There is mild increased signal suggesting tendinosis of the infraspinatus tendon, but we see no discrete tear. The infraspinatus muscle appears normal.The teres minor tendon and muscle appear normal.There is thickening and increased signal in the subscapularis, indicating moderate tendinosis.Small cysts in the anterior aspect of the humeral head are likely secondary to the aforementioned rotator cuff abnormalities.Moderate osteoarthritis affects the acromioclavicular joint, and there is spurring of the anterior aspect of the acromion process.There is fluid within the subacromial/subdeltoid bursa, particularly anteriorly with peripheral enhancement indicating synovitis.Glenohumeral joint alignment is within normal limits. We see no joint effusion.Although we see no fluid signal intensity within the glenoid labrum, intermediate signal intensity within the superior labrum likely reflects degenerative tearing.Mildly increased signal intensity within the tendon of the long head of the biceps particularly at its transition between the rotator cuff interval and intertubercular groove suggests mild tendinosis.

Output: 1.Intramuscular lipoma affecting the lateral fibers of the deltoid as described above.2.Degenerative arthritic changes of the shoulder as described above including rotator cuff tendinosis and bursal surface partial thickness tearing of the supraspinatus tendon.


Instruction: Generate impression based on findings.

Input: 28 year old male with history of aortic coarctation repair at age 6, MRI done for evaluation of aorta and aortic valve Left VentricleThe left ventricle is normal size with normal systolic function. The overall LV ejection fraction is 67%. The LVEDV is 135 ml (normal range 142+/-34), the LV end diastolic volume index is 61 ml/m2 (normal range: 74+/-15), the LVESV is 45 ml (normal range 47+/-19) and the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9). The LV mass is 116 g (normal range 164+/-36) and the LV mass index is 52 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is a restrictive outlet VSD.Left AtriumThe left atrium is normal in size. PFO noted on first pass imaging.Right VentricleThe right ventricle is normal size with normal systolic function. The overall RV ejection fraction is 61%. The RVEDV is 152 ml (normal range 142+/-31), RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVESV is 59 ml (normal range 54+/-17), and the RV end systolic volume index is 27 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is at least mild eccentric AI. 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. Site of coarctation repair is visualized on cine images. Stroke volume pre-coarctation = 48 mL; stroke volume post coarctation = 46 mL. No evidence of collateral blood flow.Ao sinus of Valsalva 35 x 36 x 35 mmAo sinotubular junction 26 x 28 mmAscending aorta 26 x 25 mmPre-coarctation repair site 17 x 16 mmAt coarctation repair site 15 x 16 mmPost coarctation repair 16 x 18 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal size with normal systolic function. The overall LV ejection fraction is 67%. 2. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. There is a restrictive outlet VSD.4. The right ventricle is normal size with normal systolic function. The overall RV ejection fraction is 61%.5. PFO noted on first pass imaging.6. The aortic valve is trileaflet, opens widely and there is at least mild eccentric AI.7. Coarctation repair is seen on cine images. Aortic measurements as documented above. No pre-coarctation aneurysmal dilatation appreciated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Oligodendroglioma status post RT and now on PCV. There are post-treatment findings in the left temporal region with a persistent confluent, mildly expansile area of T2 hyperintensity and and susceptibility effect in the left temporal lobe with slightly increased patchy foci of enhancement, which may display corresponding slightly elevated perfusion. There is also an unchanged subcentimeter non-enhancing focus of T2 hyperintensity in the right superior cerebellar hemisphere. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Slight interval increase in the patchy foci of enhancement associated with treated left temporal lobe tumor,, which may represent incipient tumor progression.2. Unchanged nonspecific subcentimeter right cerebellar hemisphere lesion.


Instruction: Generate impression based on findings.

Input: 54-year-old man with history of right clear cell renal carcinoma status post resection 3/2016. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic cysts noted and unchanged. Cholelithiasis without evidence of cholecystitis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Splenule noted. Spleen appears normal.PANCREAS: Mild fatty atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Patient is status post partial right nephrectomy and surgical changes seen involving the inferior pole with susceptibility artifact. No evidence of enhancing tumor at this location. Subcentimeter renal cysts noted.RETROPERITONEUM, LYMPH NODES: There is a mildly prominent porta hepatis lymph node (5/18) which does not meet size criteria for lymphadenopathy. No additional lymphadenopathy noted.BOWEL, MESENTERY: Colonic diverticulosis, otherwise the partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: In the T8 and L1 vertebral bodies (8/13 and 19) there are T1 and T2 hyperintense round lesions which appear to enhance slightly on postcontrast imaging. The L1 lesion appears unchanged from the prior exam. The T8 lesion was not imaged on the prior exam, however these lesions are favored to represent benign hemangiomas.OTHER: No significant abnormality noted.

Output: Status post partial right nephrectomy without specific evidence of local recurrence or metastatic disease within the field-of-view.


Instruction: Generate impression based on findings.

Input: Left-sided weakness and slurred speech. Rule out ischemic stroke. Brain MRI without contrast:There is focal diffusion restriction along the posterior limb of the right internal capsule, correlating with the focal hypoattenuation on the companion CT scan. The remainder of the moderate to extensive cerebral white-matter abnormalities show no associated diffusion restriction. Milder but otherwise similar white-matter change is present in the brainstem and along the middle cerebellar peduncles. There is no susceptibility artifact to indicate intracranial hemorrhage. Predominantly central brain volume loss resulting in ventricular dilatation has not changed. There is no midline shift or brain herniation. Major intracranial vascular flow voids are preserved, reflecting gross patency.There is very minimal mucosal thickening in the maxillary and ethmoid sinuses. There are changes of previous bilateral cataract surgery. There is no destructive skull lesion.CRANIAL MRA WITHOUT CONTRAST:The intracranial internal carotid arteries show preserved flow-related signal and caliber. Similarly, the paired anterior and middle cerebral arteries and their major branches are preserved. The basilar artery is codominantly supplied by the vertebral arteries which also show preserved flow-related signal and caliber. The posterior cerebral arteries and their major branches are preserved as well. Of note, the right posterior communicating artery is well-developed. A smaller left posterior communicating artery is also present. Anterior communicating artery is also present. There is no aneurysm.NECK MRA WITH CONTRAST:The left common carotid artery arises from a common trunk with the right brachiocephalic artery, which is a common normal variation. The common carotid and the cervical internal carotid arteries show no significant stenosis. There is also no significant ostial narrowing. The vertebral arteries are slightly nonuniform in their caliber, most pronounced in the lower V2 segments, which is favored to be artifactual given high positioning of shoulders. There is no significant stenosis.

Output: 1.Focal diffusion restriction along the posterior limb of the right internal capsule is compatible with an acute ischemic stroke.2.The remainder of the moderate to extensive cerebral white-matter and right thalamic abnormalities are not diffusion restricted, reflecting chronicity of ischemic changes.3.Cranial and cervical MR angiography show no flow limiting stenosis.


Instruction: Generate impression based on findings.

Input: 84-year-old male with urothelial cancer, evaluate for progression in L3 lesion which was noted on CT scan. There is normal lordotic curvature of the lumbar spine with progressed now 6 mm of anterolisthesis of L4 on L5 and 3 mm of retrolisthesis of L5 on S1. The vertebral body heights are preserved. There is variable disc height loss most prominent at the L5-S1 level which was present in 2006. There has also been progression of the loss of disc height at the L2-L5 levels, especially at the L4-5 level. There are endplate degenerative changes noted at the L5-S1 level which were present in 2006.The lucent lesion seen in the inferior endplate of L3 on the most recent previous CT abdomen and pelvis demonstrates peripheral and surrounding STIR signal abnormality on the current MRI as well as internal T1/T2 isointense signal relative to the adjacent L3-4 disc. There has been no change in the size of the lesion compared to the CT abdomen and pelvis exam from 12/8/2015. The associated enhancement is felt to be reactive. The lesion was appreciable on the 2014 abdomen and pelvis CT, subtly present on the 2013 abdomen and pelvis CT, and is favored to represent a degenerative Schmorl's node rather than a metastatic lesion. Additional STIR signal abnormality within the marrow posteriorly along the L4-5 disk is thought to be degenerative in etiology. No other osseous lesions are identified. The spinal cord displays normal signal and morphology and terminates at the L1-L2 level. The paravertebral soft tissues are unremarkable. T2 hyperintense cystic lesions are again visualized within the liver parenchyma and the bilateral adrenal glands appear thickened, grossly unchanged. Also seen are two lesions in the right nephrectomy bed. The more posterior lesion has fat signal intensity and measures 1.3 x 1.6 cm (series 6, image 6). More anteriorly what was described on the CT as a nodule previously also demonstrates some dropout of signal with minimal central enhancement and measures 9 x 9 mm (series 6, image 6). These lesions are grossly unchanged compared to the most recent abdomen and pelvis.Degenerative changes are seen in the cervical spine as described below:T12-L1: Trace disc bulge without significant compromise to spinal canal or neural foramina.L1-L2: Trace disc bulge and some ligamentum flavum thickening without significant compromise to spinal canal or neural foramina.L2-L3: Small disc bulge with mild left greater than right facet arthropathy and ligamentum flavum thickening which causes moderate left neural foraminal narrowing. There is mild to moderate spinal canal stenosis.L3-L4: Small to moderate disc bulge with facet arthropathy and ligamentum flavum thickening which causes mild right and moderate left neural foraminal narrowing as well as moderate spinal canal stenosis.L4-L5: Uncovering of the disc with a superimposed disc bulge. Moderate to severe facet arthropathy and ligamentum flavum thickening which contributes to moderate to severe spinal canal stenosis. There is associated redundancy and thickening of the cauda equina nerve roots. Moderate-severe right and mild-moderate left neuroforaminal narrowing. The exiting right L4 nerve root is slightly thickened which likely is related to inflammatory changes. Lobulated areas of increased T2 signal abnormality on the right at the L5 level dorsal to the thecal sac could be tiny synovial cysts arising from the medial aspect of the right facet joint.L5-S1: Uncovering of the disc as well as a superimposed disc bulge which causes moderate bilateral neural foraminal stenosis. No spinal canal stenosis.

Output: 1.The L3 vertebral body lesion is felt to represent progression of a degenerative Schmorl's node rather than a metastatic lesion. Follow up cross-sectional imaging is recommended in 6 months to ensure definite stability, although prior body CT suggests subtle abnormality in this area dating back to 2013. No other osseous lesions identified.2.Progression of the multilevel degenerative changes most severe at the L4-5 level where there is up to moderate to severe right neuroforaminal and spinal canal stenosis. Slight progression of grade 1 anterolisthesis at this level.3.The exiting right L4 nerve root is slightly thickened which likely is related to inflammatory changes from impingement.4.Grossly stable appearance to the right nephrectomy bed lesions which at least partially contain fat.


Instruction: Generate impression based on findings.

Input: 59-year-old male with known pancreatic pseudocysts. Evaluate fistula. The review of medical records reveals recent MRI showing multiple pancreatic pseudocysts, one of which possibly communicates with the left renal vein. LUNG BASES: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: Scattered hypoattenuating lesions, some of which are likely benign cysts while others are too small to characterize.SPLEEN: Splenic vein thrombosis with perigastric collaterals.PANCREAS: Three pancreatic pseudocysts as seen on recent MRI, with the largest seen at the pancreatic tail measuring 2.4 x 4.5 cm. The pancreatic tail pseudocyst extends towards and abuts the left renal vein, which is thrombosed. No blood products are identified in the pancreatic cyst to suggest active communication.Dilated pancreatic duct was better visualized on prior MRI. Please refer to that report.Parenchymal calcifications are compatible chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Thrombosed left renal vein with stranding around the left kidney. No hydronephrosis. There is slight asymmetric delay in the corticomedullary differentiation of the left kidney, the venous drainage of which appears to be compensated via collaterals, suggesting that this is a chronic process. No evidence of fistula between the left renal vein and adjacent pancreatic pseudocyst.Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Patchy nodular sclerosis with areas of lucency are noted in the sacrum, appearing similar to prior studies. While this may represent an atypical form of Paget disease, further evaluation with MRI may be considered for further characterization.

Output: 1. Findings compatible with chronic pancreatitis with 3 pancreatic pseudocysts. The largest is in the pancreatic tail, which abuts left renal vein. However, there is no evidence of fistula at this location.2. Thrombosis of the left renal vein with slight asymmetric delay in the corticomedullary differentiation of the left kidney. Venous drainage of this kidney is compensated via collaterals, suggesting that this is a chronically evolving process.3. Patchy nodular sclerosis with areas of lucency in the sacrum. While this may represent an atypical form of Paget disease, further evaluation with MRI pelvis is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: Evaluate for osteomyelitisIMAGE ACQUISITIONS: CT- right hip, bilateral foot and ankle. Please note that the patient presented with a history of possible osteomyelitis with draining ulcers. An MRI with contrast was suggested to evaluate the right hip and bilateral foot and ankles. However, after conference with the primary service, our request for an MRI was modified and a CT with no enhancement was performed at the service's request.CT of the right hip shows a deep ulcer overlying the greater trochanter extending to the level of the bone with minimal cortical destruction and associated soft tissue gas. These findings are suspicious for osteomyelitis.CT of the right foot and ankle shows what appears to be a shallow soft tissue defect consistent with an ulcer overlying the medial and lateral malleoli. The underlying bony cortex appears intact. Vascular calcifications are noted. Degenerative changes affect the foot and ankle.CT of the left foot shows no ulceration, discrete abscesses or other radiographic findings to suggest osteomyelitis. Slight fat stranding about the foot is consistent with soft tissue edema. The patient is status post mid first metatarsal amputation with the osteotomy edge remaining intact.

Output: 1) Deep ulcer overlying the greater trochanter extending to the level of bone with minimal cortical destruction and associated soft tissue gas suspicious for osteomyelitis. 2) Shallow ulcers overlying the medial and lateral malleoli of the right foot with no evidence of cortical disruption.


Instruction: Generate impression based on findings.

Input: 49-year-old female patient with anterior spinal fusion hardware. There is an anterior plate with screws entering C6 and C7. We see no evidence of hardware complication. There is an intervertebral spacer at C6-C7. Surgical drain and cervical spine collar are noted.

Output: Orthopedic fixation of the lower cervical spine without evidence of complication.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. Loss of C5 and C6 marrow signal is consistent with sclerosis identified on prior CT. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.The right submandibular gland is absent and the left submandibular gland is enlarged, although normal in density most likely representing hypertrophy.Soft tissue and osseous changes are again noted from previous laminoplasty. There are no postoperative fluid collections.C2/3: Mild degenerative changes without resulting stenosis, unchanged.C3/4: Postsurgical laminoplasty, posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy (right greater left). There is no significant central stenosis. Moderate to severe left and moderate right neural foraminal stenosis is stable. C4/5: Postsurgical laminoplasty, posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is mild central central and moderate bilateral neural foraminal stenosis, stable. C5/6: Postsurgical laminoplasty, posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is no significant central stenosis. Moderate left and moderate to severe right neural foraminal stenosis, stable. C6/7: Postsurgical laminoplasty, posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is no significant central stenosis. Severe left and moderate to severe right neural foraminal stenosis, stable. C7/T1: Unremarkable and unchanged.

Output: 1.C3/4: Moderate to severe left and moderate right neural foraminal stenosis is stable. 2.C4/5: Mild central central and moderate bilateral neural foraminal stenosis, stable. 3.C5/6: Moderate left and moderate to severe right neural foraminal stenosis, stable. 4.C6/7: Severe left and moderate to severe right neural foraminal stenosis, stable.


Instruction: Generate impression based on findings.

Input: A 17 year old male with atypical chest pain who was referred to echocardiography which showed a suspected membranous ventricular septal defect and suspected non-compaction cardiomyopathy. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The ventricle is hypertrabeculated (at the level of the papillary muscles, in the short axis plane, the non-compacted to compacted ratio is >2.3; additionally, the myocardium at the mid to apical level has a wall thickness of approximately 4mm. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 114 ml/m2 (normal range: 74+/-15), the LVEDV is 187 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 95 ml (normal range 47+/-19), the LV mass index is 48 g/m2 (normal range 85+/-15), and the LV mass is 79 g (normal range 164+/-36). There is global mild hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracavitary thrombus.No obvious ventricular septal defect is visualized during this study. These finding support the diagnosis of left ventricular non-compaction. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is in the upper limit of normal with a low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 114 ml/m2 (normal range 82+/-16), the RVEDV is 186 ml (normal range 142+/-31), the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9), and the RVESV is 94 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a bovine 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 pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with mildly reduced systolic function, the LVEF is 49%. The ventricle is hypertrabeculated and the wall thickness is relatively thin at the mid to apical ventricular level. At the level of the papillary muscles, the diastolic non-compacted to compacted ratio is >2.3. In the appropriate setting, these findings support the diagnosis of left ventricular non-compaction. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. No left ventricular thrombus is noted. 4. No ventricular septal defect is identified on this examination. 5. The right ventricle is in the upper limit of normal with a low normal systolic function, the RVEF is 49%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 61-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 5.3 x 7.3 x 7.8 cm.Peripheral Zone: 6 mm round focus of low T2 signal with restricted diffusion in the right posteromedial mid gland, suspicious for prostate cancer (series 704/364).Central Gland: Heterogeneous with hyperplastic nodules, compatible with BPH. Cystic foci emanating exophytically from the base of the prostate gland are seen to connect to the central gland and are compatible with additional BPH nodules.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Focus suspicious for prostate cancer in the right mid gland without evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Reason: rule out posterior tibialis subluxation History: pain TENDONS: There is a small amount of fluid within the tendon sheath of the flexor hallucis longus, posterior tibialis, and flexor digitorum longus of questionable clinical significance. The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. The alignment is anatomic. ADDITIONAL

Output: No evidence of posterior tibialis tendon subluxation as clinically questioned. Nonspecific subcutaneous and soft tissue edema about the ankle as described above.


Instruction: Generate impression based on findings.

Input: Idiopathic pachymeningitis. There is diffuse mass-like dural thickening and enhancement along the posterior aspect of the clivus with extension into the upper cervical spinal canal at the level of the dens, measuring up to 12 mm in thickness, which is not significantly changed. There is also unchanged associated mass-effect upon the medulla. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchymal signal and pituitary gland appear unremarkable. 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.

Output: No significant interval change in the retroclival idiopathic pachymeningitis with extension into the upper cervical spinal canal and the associated mass-effect upon the medulla.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: brain metastasis from lung CA, followup scan History: occasional headaches There is no evidence of acute ischemic lesion on this scan.Multiple susceptibility lesions on bilateral hemispheres are again seen, no change since prior scan in terms of size and location. There is no evidence of new susceptibility lesion indicating acute hemorrhagic lesion on this scan.Underlying brain show patchy bilateral periventricular white matter high signal intensity lesions on FLAIR/T2 indicating non specific small vessel ischemic disease, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Bilateral mastoid air cells show opacifications, no change since prior scan.The paranasal sinuses are clear.

Output: No evidence of acute ischemic lesion.No evidence of new hemorrhagic lesion.No change of multiple susceptibility lesions since prior scan.No change of non specific small vessel ischemic disease since prior scan.Comment: Non contrast MRI is limited for detecting small metastatic lesion, thus, if clinically indicated, Gad enhanced MRI can be considered.


Instruction: Generate impression based on findings.

Input: Ms. Einsele is a 65 year old female with a personal history of right breast lumpectomy in 2002 for DCIS treated with radiation and hormonal therapy. Family history of breast cancer in mother, maternal aunt, maternal first cousin, and paternal aunt. Patient is BRCA2 mutation carrier. There is scattered fibroglandular tissuein both breasts.Mild parenchymal enhancement is noted bilaterally.Stable post-lumpectomy changes are present in the right inferior breast. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Hypotonia, brisk reflexes, child with autism spectrum disorder, intellectual disability, and ADHD. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The lateral ventricles appear to be dysmorphic and asymmetric. There is no midline shift or herniation. The brain parenchyma otherwise appears to be grossly unremarkable. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: There is a kyphotic alignment of the cervical spine, upper thoracic levoscoliosis, thoracolumbar dextroscoliosis, lower lumbar levoscoliosis, and minimal lumbar lordosis, but no spondylolisthesis. There is intervertebral disc herniation in the anterior portion of the superior endplate of L2 with surrounding degenerative bone marrow signal alterations. Otherwise, the vertebral body heights are preserved and the rest of the vertebral bone marrow signal is unremarkable. There is a central disc protrusion at C5-6 with high T2 signal that mildly indents the spinal cord. The rest of the spinal cord displays normal signal and morphology. The conus medullaris is located at the L2 level and there is no evidence of fibrofatty filum terminale or spinal tumors in general. The paravertebral soft tissues are unremarkable.

Output: 1. The lateral ventricles appear to be dysmorphic and asymmetric, which may be attributable to an underlying development anomaly.2. Kyphotic alignment of the cervical spine, upper thoracic levoscoliosis, thoracolumbar dextroscoliosis, lower lumbar levoscoliosis, and minimal lumbar lordosis, but no spondylolisthesis. 3. A central disc protrusion at C5-6 mildly indents the spinal cord.


Instruction: Generate impression based on findings.

Input: 67-year-old female with complex right renal cyst 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: Multiple T2 hyperintense nonenhancing renal cysts are noted in bilateral kidneys. In particular, the septated right inferior pole cyst measuring 6 cm in question has no nodularity or abnormal enhancement.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Thinly septated right inferior pole cyst measuring up to 6 cm without nodularity or abnormal enhancement. If Bosniak classification applied, consistent with Bosniak category 2.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer with brain mets treated with WBRT and SRS, now on Docetaxel now. There is a persistent punctate focus of susceptibility effect in the right postcentral gyrus, but no evidence of enhancing intracranial lesions. There is unchanged confluent white matter T2 hyperintensity in the bilateral cerebral hemispheres, which is likely treatment-related. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is persistent mild scattered paranasal sinus mucosal thickening and fluid signal within the bilateral mastoid air cells.

Output: Persistent punctate susceptibility effect in the right postcentral gyrus without evidence of residual enhancing metastases superimposed on a background of whole brain radiation effects.


Instruction: Generate impression based on findings.

Input: Reason: r/o occlusion stenosis History: concern for acute ischemia, aphasia, right side weakness. History of lupus and renal failure (Creatine of 3.0 eGFR =19) MRI of the brainThere is a focus of diffusion restriction involving the left inferior frontal gyrus, left insular cortex and adjacent centrum semiovale with patchy extension into the left middle frontal gyrus. This does not have significant FLAIR abnormality associated with it.There is a small focus of FLAIR abnormality without diffusion restriction in the subcortical white matter of the left frontal lobe which can be identified on the recent CT scanner as the area with cortical calcifications.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No acute intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is occlusion of the left MCA at the superior division. The left MCA inferior division is patent.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm.The anterior communicating artery is identified and is small. The posterior communicating arteries are readily identified and are small. The vertebral arteries are similar in size.

Output: 1.There is a focus of hyperacute infarction along the central portion of the superior division of the left MCA territory.2.A smaller focus of encephalomalacia due to ischemic injury in the left inferior frontal gyrus is associated with gyral calcifications.3.Occlusion of the superior division of the left MCA.4.Findings were discussed with Dr Goldenberg at the time of the exam. It was decided against intervention at this time.


Instruction: Generate impression based on findings.

Input: Unspecified epilepsy without mention of intractable epilepsyClinical question: patient with black out episodes, work up for seizure focusSigns and Symptoms: black out episodes The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple punctate foci of signal loss on susceptibility imaging present in the subcortical white matter of the occipital lobes, the left side of the corpus callosum and the subcortical white matter of the right frontal lobe as well as a periventricular white matter adjacent to the temporal horn of the right lateral ventricleNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a mild degree of the microhemorrhages present predominantly in the occipital and frontal lobe subcortical white matter but also in periventricular white matter. This is nonspecific.


Instruction: Generate impression based on findings.

Input: 37-year-old male patient with right hip pain after injury. Evaluate for labral tear. ACETABULAR LABRUM: There is separation of the anterior superior labrum from the underlying acetabulum indicating a tear from approximately the 2:00 to 3:00 position. Gadolinium extends through this tear into the paralabral soft tissues. Additionally, a thin band of intermediate signal intensity traverses the superior labrum at the 12:00 position, indicative of a tear. The posterior labrum appears intact.ARTICULAR CARTILAGE AND BONE: There is focal degeneration of the articular cartilage along the superolateral aspect of the femoral head. There is prominence of the anterior aspect of the femoral head neck junction, compatible with a cam deformity, with an alpha angle of approximately 60 degrees. The signal intensity of the bones of the right hip appears normal.SOFT TISSUES: The muscles of the right hip appear normal. The ligamentum teres appears intact. ADDITIONAL

Output: Right hip labral tears, cam deformity, and other findings as described above.


Instruction: Generate impression based on findings.

Input: New daily persistent headache (ndph) [G44.52], Reason for Study: ^Reason: Please examine re structural abnormality, especially of craniocervical junction History: New daily headache, wakes from sleep No evidence of acute ischemic or hemorrhagic lesion on the scan.There is about 5 mm downward herniation of bilateral cerebellar tonsil through the foramen magnum.There is no evidence of syrinx.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.CSF flow study through the foramen magnumBidirectional CSF flow was seen through the foramen magnum anterior to craniocervical junction and posterior to the cerebellar tonsil.

Output: 1. About 5mm downward herniation of bilateral cerebellar tonsil through the foramen magnum.2. No evidence of acute ischemic or hemorrhagic lesion. No mass lesion.3. Normal CSF flow study through the foramen magnum.


Instruction: Generate impression based on findings.

Input: Reason: HCC s/p TACE RFA, f/u History: cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Right hepatic lobe thermal ablation changes. Focal biliary dilatation inferior to the ablation cavity.Previously seen 0.9 x 0.8 cm lesion (12:223) in segment 5 medial to the prior ablation cavity now measures 1.2 x 1.0 cm (subtraction image series 101:38), and demonstrates faint arterial enhancement with definite washout.Subcentimeter stable segment 6 hepatic cyst.Unchanged left portal vein dilatation. Patent hepatic vasculature.Wedge-shaped enhancement in the periphery of the right hepatic lobe (arterial subtraction image series 100:26) without definitive washout or definite T2 signal likely represents a perfusional anomaly, but attention on subsequent imaging is suggested.SPLEEN: No significant abnormality noted.PANCREAS: 0.9 x 0.8 cm T2 hyperintense stable lesion in the uncinate processes the pancreas likely a side branch IPMN. No ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable mild prominence of retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.2 cm lesion suspicious for recurrent HCC near the ablation zone, further described above.


Instruction: Generate impression based on findings.

Input: 60-year-old male with history of elevated PSA, multiple negative biopsies. Evaluate for tumor or targetable lesions. 3-D reformats were generated on a separate workstation and reviewed. PELVIS:PROSTATE:Prostate Size: The prostate measures 6.4 cm in transverse, 4.5 cm in AP, and 5.6 cm in coronal call diameter.Peripheral Zone: Thin rim of peripheral zone tissue. Indeterminate T2 hypointense lesion of the right apex measuring 5 x 3 mm (series 801 image 14, series 301 image 76).Central Gland: Heterogenous multinodular enlarged central gland compatible with BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Indeterminate subcentimeter T2 hypointense lesion of the right apex.2. Enlarged central gland.


Instruction: Generate impression based on findings.

Input: Right shoulder pain The examination is slightly limited by motion artifact particularly on the coronal sequences.ROTATOR CUFF: There is a small focus of fluid signal intensity within the intrasubstance of the infraspinatus tendon suggesting the presence of an interstitial tear. This is best seen on series 4 image 8 and series 8 image 10. There is mild tendinosis of the supraspinatus tendon however there is no extravasation of gadolinium into the subacromial subdeltoid bursa to suggest the presence of a full-thickness rotator cuff tear.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a trace amount of fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum appears intact. Alignment of the glenohumeral joint is normal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. No evidence of labral tear.2. Mild interstitial tearing of the infraspinatus tendon and tendinopathy of the supraspinatus with no evidence of full-thickness rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Sinus symptoms: Lower extremity weakness, recent fall. Clinical question: Evaluate for fracture. Non-enhanced CT brain:There is no evidence of acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Findings consistent with small vessel disease of indeterminate age are noted.Calvarium is intact. Limited view of paranasal sinuses, mastoid air cells, middle ear cavities and orbits are unremarkable. No abnormality of the scalp is thickened.Nonenhanced CT of thoracic spine:Examination demonstrate a fracture along the horizontal plane bisecting the 10th vertebral body into superior and inferior halves fracture extends posteriorly and extends across the right pedicle and right pars inter-articularis. On the left fracture also extends across the left pedicle and left pars inter-articularis. There is also fracture of the spinous process of T10. There is evidence of slight retrolisthesis of the inferior half of T10 fracture vertebrae and lower thoracic spine in respect to the upper half of fracture T10 vertebrae. This subluxation result in mass effect and deformity of the cord both anteriorly and posteriorly and the AP diameter of the canal at this level measures 6-mm. axial images demonstrate bilateral pleural effusion which may represent hemorrhage. This finding is significantly more pronounced on the right. There is no definite evidence of paraspinal hemorrhage or edema or mass. Follow-up with an MRI is recommended for further assessment in particular of the cord.There is no definitive evidence of fracture at other levels. The alignment of the spine a bulb and below the fracture remains unremarkable.Heavy calcification of the interspinous ligament throughout the thoracic spine.Nonenhanced CT of lumbar spine:There is no evidence of fracture or subluxation. Extensive degenerative disk disease with large omental hypertrophic spurs and bulging disks results in multilevel height is suspected central spinal stenosis. These findings are more pronounced at L2 -- L3 and L4 -- L5 levels. I suspect multilevel neural foramina compromise also.

Output: 1.Negative CT of brain for post traumatic findings. Small vessel disease of indeterminate age.2.A linear fracture in horizontal plane bisects the T10 vertebral body in superior and inferior halves. The fracture extends to bilateral T10 pedicles and bilateral pars inter-articularis and spinous process.3.There is slight retrolisthesis of the lower T10 vertebral body in respect to the upper. There is resultant 6 mm central spinal stenosis.4.Extensive degenerative changes of thoracic spine and heavy calcification of interspinous ligament5.no evidence of fracture or subluxation in the lumbar spine.6.Extensive degenerative disk disease with multi-level central spinal stenosis and lumbar spine. I suspect that multilevel neural foramina compromise.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, with aphasia and right-sided weakness. Mild diffusion hyperintense signal is seen within the left precentral gyrus and in the subjacent corona radiata. There is only mild corresponding ADC hypointensity. This area shows corresponding T2 hyperintensity and there is mild edema in the form of a slight deformation of the left lateral ventricular margin.No other definite acute ischemic lesions are seen. Fairly extensive patchy periventricular T2 hyperintensity is noted bilaterally but without mass effect. The pons is also involved to a lesser degree.No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collections is seen. The lateral ventricles are disproportionately prominent relative to the caliber of the sulci as noted on prior CTs. The fourth ventricle is within normal limits.

Output: 1.Findings compatible with an ischemic lesion of likely subacute timecourse involving the left precentral gyrus and subjacent corona radiata. Discussed with Dr. Dimaggio at 10:45AM on 12/11/15.2.Evidence of extensive prior small vessel and lacunar ischemic disease.3.Prominence of the lateral ventricles out of proportion to the caliber of the sulci is seen. This can reflect preferential central volume loss but similar findings can also be seen in normal pressure hydrocephalus.


Instruction: Generate impression based on findings.

Input: Again seen at T10-T11 is disc height loss, endplate erosive changes, and T2 hyperintensity involving the disc space and the adjacent T10 and T11 vertebral bodies. There is associated abnormal enhancement of the vertebral bodies and the T10-T11 disc. There is mild loss of height involving the T10 and T11 vertebral bodies similar to prior. Edema and enhancement extends into the posterior elements. Compared to prior, there is improvement in the T2 hyperintensity within the disc space and progressive loss of disc height. Mild focal kyphosis is noted at this level, similar to prior.There is disc bulge at the T10-T11 level which results in effacement of the ventral thecal sac and deformity of the thoracic cord at this level. There is enhancement involving the epidural space including the bilateral neural foramina as well as the paraspinous soft tissues at the T10-T11. Epidural tissue appears decreased in comparison with the noncontrast sequences; please note prior imaging was without contrast. No discrete epidural abscess however is appreciated on the current study. No discrete abscess involving the paraspinous soft tissues is appreciated. There is narrowing of the T10-T11 neural foramina bilaterally.Remainder of thoracic vertebral bodies are appropriate height and alignment. No significant spinal canal or neural foraminal stenosis is seen in the remainder of the thoracic spine. There are small bilateral pleural effusions.

Output: Please note prior imaging was obtained without gadolinium. Compared to 4/21/2015, there is interval improvement in T2 hyperintensity within the T10-T11 disc space and progression of disc height loss. Enhancement involving the T10 and T11 vertebral bodies and the T10-T11 disc space persists but may be compatible with treated infection. No findings to suggest worsening infection. No epidural abscess is seen on the current study.There is persistent moderate spinal canal stenosis at the T10-T11 level with mild deformity of the thoracic cord. No new cord signal abnormality. Mild loss of vertebral body heights at the T10 and T11 levels and focal kyphosis at these levels again noted.


Instruction: Generate impression based on findings.

Input: headaches, known brain tumor patient for planning surgical resection. Multiple fiducial markers were seen on scalp for the registration of surgical planning.Comparing to prior exam, the left cerebellar hemispheric lesion shows focal resection cavity with surrounding edema indicating post operative status.In addition, there is a new high signal intensity lesion (15mm x 10.5mm) on the left thalamus on T2 weighted image.The lesion does not show susceptibility artifacts on gradient echo images.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Postoperative status of the left cerebellar hemispheric lesion.2. New T2 high signal intensity lesion on the left thalamus measuring 15mm x 10.5mm.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There is a thin rim of cortically located diffusion weighted abnormality with associated FLAIR abnormality within the right occipital lobe. There is also subtle cortical T1 hyperintensity and susceptibility in this region suggesting laminar necrosis. There is also a small focus of mild restricted diffusion involving the superolateral cerebellar hemisphere, which likely represents an additional tiny acute/subacute infarct.Encephalomalacia is seen in the right frontal and parietal operculum, right insular cortex, inferior frontal lobe, left centrum semiovale, posterior limb of the left internal capsule, left occipital lobe and left cerebellum, indicating prior infarcts. There is evidence of additional small chronic infarcts involving the left pons and left medulla which were also present previously. There is unchanged moderate periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. There is no hydrocephalus, midline shift or herniation. There is opacification of the left maxillary sinus, left anterior ethmoid air cells and left frontal sinus which suggests left ostiomeatal unit obstruction.

Output: 1.Small subacute cortical infarct involving the right occipital lobe and a small acute to subacute right cerebellar infarct.2.Multiple chronic supra and infratentorial infarcts as described above.3.Moderate chronic small vessel ischemic disease.4.Opacification of the left maxillary sinus, left anterior ethmoid air cells and left frontal sinus which suggests left ostiomeatal unit obstruction.


Instruction: Generate impression based on findings.

Input: Female, 77 years old. Left proximal thigh mass, evaluate for interval change. A lobulated mass of predominantly fluid signal intensity along the anterior aspect of the thigh within the adductor brevis muscle measures approximately 4.4 x 4.8 x 5.5 cm (series 701, image 17; series 601, image 20), previously 3.9 x 4.0 x 5.6 cm. There is a thin rim of peripheral enhancement associated and several thin nonenhancing septations. A small benign-appearing inguinal lymph node along the anterolateral margin of the mass measures 5 mm in short axis, unchanged. There are no significant inflammatory changes in the surrounding soft tissues. No other lesions are identified within the soft tissues. The underlying osseous structures appear unremarkable, with normal cortical thickness and marrow signal. The imaged muscles are otherwise unremarkable.

Output: A 5 cm mass along the medial aspect of the left anterior thigh is stable to slightly increased in size compared to the prior study and compatible with myxoma as confirmed on prior biopsy.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.1 x 5 x 4.7 cm.Peripheral Zone: Large posterior lesion with low T2 signal, restricted diffusion, and increased enhancement extending from the base bilaterally to the right mid to apical prostate gland, compatible with prostate cancer and measuring up to 3.5 x 2.5 cm (series 403/404). Central Gland: Heterogeneous. There is invasion of the prostate cancer into the central gland.Seminal Vesicles: There is invasion of the prostate cancer into the bilateral seminal glands.Extracapsular Extension: There is mild extracapsular extension of the prostate cancer, e.g., inferiorly right aspect. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the pubic symphysis with a small amount of joint fluid seen.OTHER: No significant abnormality noted.

Output: Large prostate cancer with extracapsular extension and seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: Female, 24 years old, with history of melanoma and a left-sided brain lesion. fMRI is requested for surgical planning purposes. All tested language paradigms produced reliable language related cortical activation. Language is left dominant. Broca's area activity is seen as expected within the left inferior frontal gyrus (primarily the pars triangularis and pars opercularis). Wernicke's area activity is seen as expected along the posterior aspect of the left superior temporal gyrus and sulcus. Both Broca's and Wernicke's areas are well removed from the patient's left middle frontal gyrus lesion. Of note, however, there is evidence of secondary language related activity located anterior, medial and superior to the lesion.

Output: Successful fMRI for pre-surgical language mapping. Language is left dominant. Broca's and Wernicke's areas are well removed from the left middle frontal gyrus lesion. Evidence of secondary language related activity is seen in the vicinity of the lesion, as above.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:9/2/1959)Reason: Eval new focal weakness r/o myelopathy History: New R-sided weaknessPROVIDER/ATTENDING NAME: MICAH T PROCHASKA MICAH T PROCHASKA 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 identified 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.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is a left paramedian disk protrusion present associated with end plate osteophytes which encroaches on the nerve roots in the left lateral recess and exiting the left neural foramen at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There is a left paramedian disk protrusion present associated with end plate osteophytes which encroaches on the nerve roots in the left lateral recess at C6-7 ( left C7 nerve roots).


Instruction: Generate impression based on findings.

Input: Left arm lymphedema and new left shoulder pain, known breast cancer There is severe osteoarthritis of the glenohumeral joint with diffuse cartilage loss and bone-on-bone apposition of the humeral head and glenoid. There is abnormal signal intensity within the glenoid which is favored to represent subchondral sclerosis and cyst formation rather than metastatic disease. There is flattening of the superomedial surface of the humeral head thought to reflect chronic remodeling with additional degenerative marrow edema and cystic changes in the underlying humeral head. There is a moderate-sized joint effusion with synovial enhancement indicating synovitis.There is intermediate signal intensity within the distal fibers of the supraspinatus suggesting tendinosis but we see no full-thickness fluid-filled tear. There is mild atrophy of the supraspinatus muscle. Mild insertional tendinosis also affects the infraspinatus tendon but again there is no evidence of a full-thickness tear. The teres minor and subscapularis tendons and muscles are normal.A trace amount of fluid is present within the subacromial-subdeltoid bursa. The acromioclavicular joint is normal. There is fluid within the biceps tendon sheath likely reflecting extension from the glenohumeral joint with mild associated tenosynovial enhancement. Evaluation of the intra-articular portion of the tendon of the long head of the biceps is limited given the internally rotated position of the patient but it otherwise appears grossly intact.

Output: Severe glenohumeral joint osteoarthritis with other findings described above.


Instruction: Generate impression based on findings.

Input: There is normal alignment with straightening of the normal cervical lordosis. Cord signal is normal. There is multilevel moderate to severe decrease in intervertebral disc space and intervertebral disc desiccation.C2-C3: Negative.C3-C4: There is mild diffuse posterior disc-osteophyte complex. There is moderate central canal stenosis with moderate foraminal stenosis left more than the right. There is bilateral uncovertebral hypertrophy. There is slight indentation of the ventral cord.C4-C5: There is mild diffuse posterior disc-osteophyte complex. There is mild-moderate central canal stenosis with moderate-severe right foraminal stenosis and mild to moderate left foraminal stenosis. There is bilateral uncovertebral hypertrophy, right more than the left.C5-C6: Moderate posterior disc-osteophyte complex with bilateral uncovertebral hypertrophy. There is a moderate spinal canal stenosis. There is moderate to severe foraminal stenosis bilaterally. There is hypertrophy of the ligamentum flavum.C6-C7: There is diffuse posterior disc-osteophyte complex. There is a moderate uncovertebral hypertrophy. There is mild spinal canal stenosis. There is moderate to severe right foraminal stenosis and moderate left foraminal stenosis.C7-T1: There is mild posterior disc-osteophyte complex with no evidence of spinal stenosis. There is a moderate to severe right foraminal stenoses and moderate left foraminal stenosis. Prominent bilateral uncovertebral hypertrophy.T1-T2: Sagittal images suggest a diffuse posterior disc-osteophyte complex with right foraminal prominence. Moderate right greater than left foraminal narrowing is noted.Sagittal images of T2-T3 demonstrate a left foraminal disk protrusion and moderate right foraminal narrowing, while at T3-T4 and T4-T5, there are right foraminal posterior disc-osteophyte complexes with mild right foraminal narrowing.Note is made of retropharyngeal course of the distal common carotid arteries and the proximal internal carotid arteries. Also there is mild scattered paranasal sinuses mucosal thickening.

Output: Moderate degenerative changes of the cervical spine as described above. The worst spinal stenosis is of moderate degree at C3-C4. Scattered up to moderate-severe foraminal stenosis as detailed above.


Instruction: Generate impression based on findings.

Input: Oligoastrocytoma treated with chemotherapy and prior resection. The images are degraded by patient motion. There are postoperative findings related to left parietal craniotomy. There is unchanged confluent T2 hyperintensity surrounding the left parietal lobe resection cavity consistent. There is also unchanged scattered cerebral white matter T2 hyperintensity, particularly in the right peritrigonal region, which is nonspecific. There is no evidence of abnormal enhancement. The ventricles are stable in size and configuration. There is no acute territorial infarct. There is no significant midline shift or herniation. The major cerebral flow voids are grossly intact. The skull and extracranial soft tissues are unchanged.

Output: No evidence of tumor progression amidst post-treatment findings.


Instruction: Generate impression based on findings.

Input: Reason: evaluate nerve roots and for cord compression History: C1-C2 instability The patient has an os odontoideum. The patient is status post posterior fusion and laminectomies at C1 - C2.There is signal hyperintensity within the spinal cord at the C2 vertebral body level which to some degree was present on the prior exam.Compared to the previous exam the alignment between C1 and C2 has changed. The anterior arch of C1 as well as the os odontoideum have migrated posteriorly relative to the rest of the C2 vertebral body. There is no compromise of the cervical spinal cord at C1-2.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.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.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. The left vertebral artery is significantly larger than the right vertebral artery. The right vertebral artery appears to be hypoplastic and this finding was also present on the previous exam.

Output: 1.The patient has an os odontoideum. The patient has undergone posterior fusion at C1-2. Since the previous examination the alignment between C1 and C2 has changed. The anterior arch of C1 as well as the os and the 20 and are subluxed posteriorly relative to the C2 vertebral body. There is no associated compromise to the cervical spinal canal at this level however. Please note that extension/flexion plain film views may provide more insight on stability.2.There is signal change present within the cervical spinal cord at the the C1-2 level. To some degree this is previously present and may represent a cord myelomalacia. A superimposed new or injury cannot be excluded.3.Please note that this examination is rather limited due to some patient motion as well as the patient's inability to tolerate the exam terminating the exam early.4.Please refer to CT of the cervical spine for further comments.


Instruction: Generate impression based on findings.

Input: Shoulder pain Moderate osteoarthritis affects the glenohumeral and acromioclavicular joints. The acromiohumeral interval is maintained, although a recent MRI examination revealed a rotator cuff tear. Glenohumeral joint alignment is within normal limits. Surgical clips overlie the axilla. Mild degenerative arthritic changes affect the visualized thoracic spine.

Output: Osteoarthritis and other findings as above.


Instruction: Generate impression based on findings.

Input: Neurosarcoidosis. Brain: There are postoperative findings to right transfrontal biopsy. There is increased confluent subcortical white matter T2 hyperintensity in the right middle frontal gyrus and bilateral occipital lobe periventricular regions, but decreased white matter signal abnormality elsewhere in the brain. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are persistent diffusely prominent intramedullary veins in the bilateral cerebral hemispheres, but no abnormal leptomeningeal enhancement. There are also scattered areas of gyriform intrinsic T1 hyperintensity, particularly in the occipital lobes, which may represent cortical laminar necrosis. The ventricular system appears to be slightly dilated throughout. There is no midline shift or herniation. Pituitary: The pituitary and infundibulum are not enlarged and there is no evidence of intrasellar lesions. The cavernous sinuses and optic apparatus are intact.

Output: 1. Interval evolution of the cerebral white matter abnormality with some areas that are more greatly affected than before and other areas that have improved and no evidence of recurrent leptomeningeal disease.2. No evidence of recurrent pituitary or infundibular involvement.3. Mild dilatation of the ventricular system, which may be a sequela of neurosarcoidosis and/or treatment effects.4. Findings suggestive of scattered cortical laminar necrosis, but no evidence of acute infarction.


Instruction: Generate impression based on findings.

Input: Reason: R/o tumor, degeneration, herniated disc, fracture History: L4-L5 tenderness to palpation Five lumbar type vertebral bodies are presumed to be present. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is ligamentum flavum and facet hypertrophy but no significant compromise to spinal canal or neural foramina.L2-L3: There is mild disc bulge with right disc protrusion and minimal narrowing of both neuroforamina. Ligamentum flavum and facet hypertrophy is also noted. There is no significant compromise to the spinal canal.L3-L4: There is disc bulge with ligamentum flavum and facet hypertrophy resulting in moderate to severe narrowing of the left neuroforamen and mild to moderate narrowing of the right neuroforamen. There is mild narrowing of the spinal canal.L4-5: There is disc bulge with ligamentum flavum and facet hypertrophy resulting in moderate narrowing of both neuroforamina, left greater than right, and mild narrowing of the spinal canal. L5-S1: There is disc bulge and facet hypertrophy resulting in mild narrowing of the bilateral neuroforamina. No significant compromise to the spinal canal.

Output: Multilevel spondylotic changes affect the lumbar spine, most pronounced at L3-4 and L4-5. No evidence of fracture.


Instruction: Generate impression based on findings.

Input: History of Crohn's status post resection. Active disease on prior MR enterography. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic cysts. Otherwise the liver is normal in morphology, signal intensity and enhancement without a focal lesion or biliary ductal dilatation. Normally distended gallbladder. No extrahepatic biliary ductal dilatation.SPLEEN: Subcentimeter probable splenic cyst.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal subcentimeter cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a paucity of small bowel compatible with history of multiple resections. There is no abnormal bowel dilatation, wall thickening, postcontrast enhancement, or restricted diffusion. No fluid collections. Small mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of active disease.


Instruction: Generate impression based on findings.

Input: Reason: rotator cuff tendinopathy History: rotator cuff tendinopathy ROTATOR CUFF: There is a full-thickness tear through the anterior aspect of the supraspinatus without tendinous retraction (series #7/14). The supraspinatus muscle appears severely atrophic. The subscapularis muscle also appears atrophic but to a lesser degree and no discrete tear is identified. The infraspinatus and teres minor are intact without evidence of discrete tear.SUPRASPINATUS OUTLET: There is a nonfused os acromiale.GLENOHUMERAL JOINT AND GLENOID LABRUM: Degenerative changes affect the glenohumeral joint with multiple subchondral cysts in the humeral head and in the posterior glenoid. There is no evidence of labral tearing. A small joint effusion is present, extending into the subscapular recess.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Full-thickness tear through the anterior aspect of the supraspinatus without tendinous retraction.


Instruction: Generate impression based on findings.

Input: 25 year old with history of syncope and premature ventricular contractions presenting for cardiac assessment after syncopal episode. Left VentricleThe left ventricle is mildly enlarged with low normal LV systolic function. The overall LV ejection fraction is 54 %, the LV end diastolic volume index is 118 ml/m2 (normal range: 74+/-15), the LVEDV is 227 ml (normal range 142+/-34), the LV end systolic volume index is 56 ml/m2 (normal range 25+/-9), the LVESV is 105 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is is normal in size. Right VentricleThe right ventricle is in the upper limit of normal in size with normal systolic function. The overall RV ejection fraction is 51 %, the RV end diastolic volume index is 118 ml/m2 (normal range 82+/-16), the RVEDV is 108 ml (normal range 142+/-31), the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9), and the RVESV is 108 ml (normal range 54+/-17). No regional wall motion abnormalities are noted.Right AtriumThe right atrium is mildly enlarged.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 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. The left ventricle is mildly enlarged with low normal systolic function (LVEF 54%). 2. The right ventricle is in the upper limit of normal in size with normal systolic function (RVEF 51%). 3. There are no regional RV wall motion abnormalities.4. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.5. Based on this CMR, this does not meet any major MRI criteria for ARVC.


Instruction: Generate impression based on findings.

Input: Clinical question: Restaging lung cancer. Signs and symptoms: Staging lung cancer. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates several small foci of subcortical and periventricular FLAIR/T2 hyperintensity in bilateral cerebral hemispheres. Minimal similar signal changes in bilateral basal ganglia is also noted. Findings are nonspecific, nonhemorrhagic and demonstrate no enhancement. This appearance however in this age group is often result of microvascular ischemic changes.. Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise.The signal void of major intracranial arterial branches are identified.There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease.The signal intensity of intracranial venous sinuses are within normal and the normal pattern of enhancement.Calvarium demonstrate normal signal intensity and without abnormal enhancement. Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses remain well pneumatized. There is however a small focus of chronic mucosal thickening in the midline of inferior aspect of frontal sinuses.

Output: 1.No evidence of metastatic disease.2.Negative diffusion-weighted series and findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed.


Instruction: Generate impression based on findings.

Input: Male; 73 years old. Reason: recurrent renal cancer s/p surgery. needs disease reeval History: renal cancer ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Low T2 signal of the liver, suggestive of iron deposition. New enhancing nodule along the anterior peritoneum just anterior to the left hepatic lobe measuring 2.6 x 1.9 cm (series 21/39), suspicious for metastasis.SPLEEN: New rim-enhancing intrasplenic lesion measuring 2.9 x 2.2 cm (series 21/39), suspicious for metastasis.Increased size of rim-enhancing posterior perisplenic lesion currently measuring 1.6 x 2.3 cm (series 21/61), previously 0.9 x 1.3 cm.There is also increased size of enhancing lateral perisplenic nodule (series 21/46).PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Increased size of enhancing nodule in the superior aspect of the left nephrectomy bed currently measuring 2.7 x 1.9 cm (series 21/59), previously 1.6 x 1 cm.KIDNEYS, URETERS: Status post left nephrectomy. Stable amorphous soft tissue in the left nephrectomy bed currently measuring up to 3.2 x 2.1 cm (series 21/66), previously 3.2 x 2.1 cm on prior study from 2/12/15 and 11/21/14 (when it was reported to measure 2.2 x 2.1 cm in error); this tissue likely represent postsurgical scarring given its stability.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval postsurgical changes from left colectomy with new right lower quadrant colostomy. Increased left lateral body wall rim enhancing lesion located in the superior left paracolic gutter currently measuring up to 4.5 x 3.1 cm (series 21/82), previously 2.9 x 2.4 cm; this lesion may be mildly invading adjacent small bowel loops.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple enhancing metastases in the upper abdomen are new or increased since prior study.


Instruction: Generate impression based on findings.

Input: Encounter for examination for normal comparison and control in clinical research program [Z00.6], Reason for Study: ^Reason: metastatic breast cancer - baseline screening for a clinical trial History: none There are multiple intra axial nodules demonstrating various degree of enhancement. The location of lesions include; right precentral gyrus (7mm), left superior temporal gyrus posterior aspect (9.8mm), left precuneus around the left parieto-occipital fissure (11mm), and left occipital lobe (14mm).There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Bilateral Staphylomas. There is no signal intensity of lens indicating post cataract surgery.

Output: Multifocal intra axial lesions indicating metastasis as described above. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 45-year-old female. Uterine fibroids, dysmenorrhea, menorrhagia. PELVIS:UTERUS, ADNEXA: Enlarged uterus with multiple submucosal, intramural, and subserosal T2 hypointense masses consistent with fibroids. These fibroids vary in size with the largest in the left posterior uterine fundus, measuring 4.5 x 3.3 cm. Post contrast sequences show that these fibroids show significant vascularity, most with 80% or greater enhancement. The endometrial cavity is 2 mm in thickness and appears normal in signal intensity. Small Nabothian cyst. No adnexal masses. Ovaries are normal in appearance.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free pelvic fluid, likely physiologic in a premenopausal woman.

Output: Multiple uterine fibroids, majority of which show significant vascularity.


Instruction: Generate impression based on findings.

Input: Female 51 years old Reason: eval ACL, meniscus History: knee pain MENISCI: Medial and lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: T2 hyperintense bone marrow edema involving the lateral femoral condyle, the medial femoral condyle and the lateral tibial plateau, as well as a small area in the posterior medial tibial plateau. There is generalized thinning of the patellar articular cartilage.LIGAMENTS: MCL is partially torn. The ACL, LCL and PCL are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Partial tear of the MCL. Bone contusions involving the femoral condyles and the tibial plateau.


Instruction: Generate impression based on findings.

Input: Male, 24 years old, with neck pain and history of neck injury. Assess for cord contusion. The cervical lordosis is slightly reversed but alignment is otherwise unremarkable. Vertebral body height and morphology are normal. No evidence of marrow edema is seen. No worrisome marrow replacement is detected.The paraspinal soft tissues are unremarkable. In particular, the ligaments of the craniocervical junction are intact.The visualized spinal cord demonstrates normal morphology throughout and is free of pathologic signal abnormality.The intervertebral discs are preserved. No significant facet arthropathy is suspected. The spinal canal and neural foramina are patent.

Output: 1.No evidence of spinal cord contusion or other cord abnormality.2.No evidence of significant injury to the osseous structures of the cervical spine or the ligamentous attachments.3.No significant degenerative disc disease is seen. The spinal canal and neural foramina are patent.


Instruction: Generate impression based on findings.

Input: Personal history of right breast DCIS status post lumpectomy. Left breast tenderness. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally, less than on the prior study.No suspicious enhancement is seen in either breast. In the posterior depth of the right inner breast, there has been interval resolution of a postsurgical seroma. Multiple bilateral benign high T2 signal cysts are again noted, a few with benign thin peripheral rim enhancement. The benign morphology 6 mm left inner breast mass is stable. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 59 years, Female, primary CNS lymphoma, status post cycle 1 induction chemotherapy. There are bilateral frontal burr holes related to biopsies. There are subacute blood products in the left frontal lobe which have decreased since prior CT from 9/15/2016. There is intrinsic T1 shortening and mild residual enhancement in the left frontal lobe, which is markedly decreased when compared to prior MRI from 9/12/2016. T2/FLAIR hyperintensity related to vasogenic edema in the left frontal lobe is also significantly improved. Residual enhancement is most evident involving the left anterior cingulate gyrus. Associated mass effect has also significantly improved with reexpansion of the lateral ventricles.T1 shortening with questionable enhancement and surrounding T2 hyperintensity involving the right thalamus and right frontal lobe are again seen with much larger lesions in these locations evident on earlier MRI from 5/1/2016. No new enhancement or new intracranial mass is seen to suggest disease progression. There is moderate degree of T2/FLAIR hyperintensity in the pons similar to prior MRI from 9/12/2016 and is nonspecific; finding reflect chronic small vessel ischemic disease, posttreatment change, or prior osmotic demyelination.No evidence of acute ischemia. No significant intracranial mass effect, midline shift, or herniation. No hydrocephalus. No extra-axial collections. Major flow-voids are preserved. Moderate opacification of the left-sided mastoid air cells is again seen.

Output: Marked interval decrease in size of enhancing mass in the left frontal lobe consistent with treatment response. There is mild residual enhancement in the left frontal lobe along the left anterior cingulate gyrus, which is best seen on the post gadolinium 3-D T1 sequence. Questionable, minimal enhancement is present in the right frontal lobe and right thalamus at the sites of much larger masses seen on earlier MRI study from 5/1/2016. No new or enlarging lesions compared to 9/12/2016.


Instruction: Generate impression based on findings.

Input: 63-year-old female. Left hip pain, on chronic prednisone. Evaluate for AVN. ACETABULAR LABRUM: Limited evaluation of the labrum without intra-articular gadolinium. There is intermediate signal intensity in the anterior superior labrum consistent with degeneration.ARTICULAR CARTILAGE AND BONE: Serpiginous T1 hypointense line with confluent central T1/T2 hypointensity involving nearly the entire subchondral bone of the left femoral head consistent with avascular necrosis. There is associated articular surface collapse indicating it is advanced. There is edema type signal in the bone from the neck to the intertrochanteric region, likely secondary to the above described avascular necrosis.There is also early avascular necrosis affecting the right femoral head with serpiginous T1 hypointensity and central fat signal intensity. It involves approximately 25% of the articular surface without associated subchondral collapse.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Bilateral femoral head avascular necrosis, advanced on the left with articular collapse.


Instruction: Generate impression based on findings.

Input: Sudden left ear hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is mild fluid within the right mastoid air cells. The left mastoid air cells and middle ears appear unremarkable.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: Female 13 years old with a history of mediastinal lymphangioma. Evaluate for changes in size and character. Exam is limited by motion artifact.LUNGS AND PLEURA: Stable size and appearance of nonspecific T2 hyperintense lesion along the left lung pleura (series 601, image 37). This may represent an intrapulmonary lymph node.MEDIASTINUM AND HILA: The T2 hyperintense anterior mediastinal lesion with T2 hypointense septations measures 3.6 x 1.8 cm (series 601, image 25), previously 3.8 x 1.8 cm. It does not enhance and is unchanged in appearance compared to the prior exam.CHEST WALL: Mild thoracolumbar scoliosis appears similar to prior exams.UPPER ABDOMEN: The nonenhancing, T2 hyperintense lesion in the superior aspect of the spleen measures 3.5 x 3.0 cm (series 601, image 48), previously 3.3 x 3.0 cm.

Output: 1.Mediastinal lymphangioma is not significantly changed in size or appearance.2.Stable size and appearance of the splenic lesion which also likely represents lymphangioma.


Instruction: Generate impression based on findings.

Input: 54-year-old female history of cardiac arrest and altered mental status. Evaluate for anoxic injury. There is symmetric diffusion restriction demonstrated in bilateral corpus striatum, thalami, posterior parietal and occipital lobes, as well as the pre and post central gyri compatible with hypoxic ischemic injury. There is subtle associated increased T2 signal abnormality especially in the basal ganglia and thalami. There is mild effacement of bilateral occipital sulci. No evidence of intracranial hemorrhage. There is no significant midline shift. Normal vascular flow voids are present within the intracranial vessels. There is a moderate amount of fluid in bilateral maxillary sinuses and mastoid air cells. The orbits are unremarkable.

Output: Findings compatible with acute hypoxic ischemic injury.


Instruction: Generate impression based on findings.

Input: Female, 37 years old, with right sided pain and sciatica. Spinal alignment is within normal limits. Vertebral body heights are maintained. Bone marrow signal intensity is within normal limits. The visualized spinal cord and conus demonstrate normal signal intensity and morphology. The conus tip terminates at the L1 level which is normal. Fatty infiltration of the filum terminale is seen with the filum measuring up to 2 mm in thickness. No epidural abnormalities are suspected.The intervertebral disk spaces are preserved. Additional level specific findings are as follows:L1-2 to L3-4: Unremarkable. L4-5: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a right foraminal annular fissure. Mild generalized spinal canal stenosis without nerve impingement. Mild bilateral neuroforaminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis.

Output: 1.Mild disc degeneration at L4-5 with a disc bulge and right foraminal annular fissure. Mild canal stenosis is seen without nerve root impingement. 2.Facet arthropathy is evident at L4-5 and L5-S1.3.Incidental note is made of fatty infiltration of the filum terminale. This can be an asymptomatic incidental finding in the absence of symptoms of tethered cord.


Instruction: Generate impression based on findings.

Input: 77-year-old female patient with right lower extremity ulcer and x-ray suggestive of osteomyelitis. There is edema-like signal in the subcutaneous tissues of the medial lower leg. There is a shallow ulcer adjacent to the medial distal tibia that does not extend to the deep tissues or medial compartment musculature. The underlying osseous structures are normal in signal.

Output: Shallow soft tissue ulcer and soft tissue edema in the medial distal lower leg without evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Spinal stenosis. Signs and symptoms: Spinal stenosis. Nonenhanced lumbar MRI:The signal intensity in the anatomical alignment of the vertebral column is unremarkable.T11-T12 demonstrate mild degenerative changes and unremarkable otherwise.T12-L1 demonstrate mild degenerative disease and unremarkable otherwise.L1-L2 demonstrate mild degenerative disease and unremarkable otherwise.L2-L3 demonstrate mild disc disease and mild asymmetric left-sided facet and mild bilateral mental problem hypertrophic changes without spinal stenosis or neural foraminal compromise.L3-L4 demonstrate mild disc disease, mild bilateral ligamentum flavum hypertrophy and mild asymmetric left-sided facet hypertrophic changes. No spinal stenosis. There is moderate left neural foraminal compromise secondary to asymmetric left facet hypertrophy changes. Patent right neural foramen.L4-L5 demonstrate moderate disc disease and loss of disc height, shallow broad-based bulging disc, mild left ligamentum flavum hypertrophy and the moderate left and mild right facet hypertrophic changes. There is evidence of laminectomy at this level with resultant expansion of thecal sac and no central spinal stenosis. There is however significant bilateral neural foraminal compromise primarily secondary to hypertrophic changes of posterior elements.5-S1 demonstrate postoperative changes of bilateral laminectomy and without evidence of central spinal stenosis. There is advanced disc disease with near complete loss of disc height and mild degenerative changes of posterior elements. No evidence of neural foraminal.The paraspinal soft tissues are unremarkable.

Output: 1.There is no evidence of central spinal stenosis at any level as is questioned clinically.2.Postoperative laminectomy changes at L4-L5 and L5-S1 levels.3.Significant bilateral neural foraminal compromise at L4-L5.


Instruction: Generate impression based on findings.

Input: 13-year-old male with neurofibromatosis. Periorbital neurofibroma causing ptosis. Please provide craniofacial protocol. There is redemonstration of a soft tissue mass located along the right eyelid along the extraconal space on the right side along the superior and temporal aspect of the right orbit which goes as far back as the posterior aspect of the right eye. It does extends into the expected location of the right lacrimal gland. This known to represent a plexiform neurofibroma based on clinical history. This is stable in overall morphology and extent compared to the MRI from 8/15/09. There is associated enophthalmus and inferior displacement of the eye on the right side.There is opacification of the right maxillary sinus. the right maxillary sinus is smaller than its left counterpart and almost completely involuted. Mastoid air cells and middle ears are clear.

Output: 1.Findings consistent with plexiform neurofibroma involving the right eyelid with extending into the right lacrimal fossa and adjacent extraconal space with no intraconal extension. There is associated enophthalmus and inferior displacement of the eye on the right side. In part this displacement and enophthalmos may also be related to right maxillary sinus atelectasis (silent sinus syndrome).2.Small opacified right maxillary sinus consistent with hypoplasia of the right maxillary sinus. Please correlate with clinical history for silent sinus syndrome or prior trauma.


Instruction: Generate impression based on findings.

Input: Hand and wrist pain x1 month. There is a positive ulnar variance and there is a cyst on ulnar side of the lunate. These findings can be associated with ulnar impaction syndrome in the correct clinical context. This can be confirmed with an MRI of the wrist.No fracture or dislocations.

Output: Positive ulnar variance and cyst formation in the lunate suggestive of ulnar impaction syndrome. Further evaluation with an MRI should be considered.


Instruction: Generate impression based on findings.

Input: 75-year-old female with right leg pain for 8 months Two skin markers were placed over the anterolateral aspect of the mid leg. There is no underlying focal abnormality in the soft tissues or bone. The bone marrow signal is within normal limits throughout. There is diffuse muscular atrophy. No abnormal enhancement is noted within the soft tissues or bone. No fracture or malalignment.

Output: Diffuse muscle atrophy without specific abnormality identified to account for the patient's leg pain.


Instruction: Generate impression based on findings.

Input: Metastatic ovarian cancer s/p SRS to multiple lesions: no symptoms. There are postoperative findings related to right frontal craniotomy for resection of a right frontal lobe metastases. There is no persistent confluent T2 hyperintensity surrounding the resection cavity, but no evidence of enhancing tumor in this region. There is an unchanged enhancing lesion in the right peritrigonal white matter that measures up to 6 mm in width, with associated vasogenic edema. There is interval resolution of the enhancing lesions in the left periventricular frontal lobe white matter and right cerebellar hemisphere. There is no evidence of acute intracranial hemorrhage or infarction. There is no midline shift. The major cerebral flow voids are intact. The orbits are unremarkable.

Output: 1. Recent postoperative findings with a right frontal lobe without evidence of recurrent tumor in this region.2. Unchanged subcentimeter right peritrigonal metastasis.3. Interval resolution of a left periventricular frontal lobe and right cerebellar metastases.


Instruction: Generate impression based on findings.

Input: 61 years Female (DOB:4/23/1955)Reason: brain mets History: nonePROVIDER/ATTENDING NAME: PHILIP C HOFFMAN PHILIP C HOFFMAN The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of partial empty sella.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This was also present on the prior exam and has not changed significantlyThere are punctate foci of signal loss and susceptibility weighted imaging within the periventricular white matter and within the subcortical white matter. Approximately 6 or 7 such lesions identified. These are unchanged compared to the previous exam.Incidental note is made of a developmental venous anomaly in the left cerebellar hemisphere.There is a 4 mm focal enhancement in the right postcentral gyrus which is barely visible on the prior exam 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 some mild mucosal thickening. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.

Output: 1.There is a lesion in the right postcentral gyrus measuring 4 mm in size is suspected to represent a new metastasis.2.There is no evidence for acute cerebral ischemic infarction3.There is diffuse periventricular white matter signal change present which is most likely treatment related.


Instruction: Generate impression based on findings.

Input: Headaches and history of mesothelioma. There appears to be a punctate focus of enhancement at the grey-white matter junction of the anterior left middle frontal gyrus. There is no evidence of intracranial hemorrhage or acute infarct. There is minimal scattered nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid within the bilateral mastoid air cells.

Output: A punctate focus of enhancement at the grey-white matter junction of the anterior left middle frontal gyrus may represent a metastases, focally prominent vasculature, or artifact. Close interval follow up may be useful for further elucidation.