Instruction: Generate impression based on findings.

Input: Headache 2 weeks ago. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal 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, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.MRA: There is a 1 to 2 mm outpouching at the origin of the right posterior communicating artery. Otherwise, there is no evidence of significant steno-occlusive lesions.

Output: 1. Minimal nonspecific cerebral white matter T2 hyperintensity. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute cerebral infarction.2. A 1 to 2 mm outpouching at the origin of the right posterior communicating artery likely represents a prominent infundibulum rather than a saccular aneurysm. Otherwise, no evidence of significant steno-occlusive lesions.


Instruction: Generate impression based on findings.

Input: MRI CARD WWO CNTRST, VIABLTY/SCAR IMAG.MORPH/FUNCT, 11/2/2016 12:49 PM Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 56%. The LVEDV is 73 ml (normal range 109+/-23), LV end diastolic volume index is 46 ml/m2 (normal range: 65+/-11), LVESV is 32 ml (normal range 31+/-10), and LV end systolic volume index is 21 ml/m2 (normal range 18+/-5). The LV mass index is 37 g/m2 (normal range 67+/-11). 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 mildly dilated. A large secundum atrial septal defect (18mm) is noted with evidence of continued left to right shunting on first pass contrast imaging. There is additionally an anomalous left superior pulmonary vein draining into the innominate vein. The remainder of the pulmonary veins drain normally into the left atrium. The Qp/Qs is 2.4.Right VentricleThe right ventricle is moderately dilated with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 114 ml/m2 (normal range 69+/-14), the RVEDV is 181 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 33 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there mild mitral regurgitation.Pulmonic ValveThe pulmonic valve is calcified and stenotic. There is turbulent flow thru the stenotic pulmonic valve with associated mild 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 ArteryThe main pulmonary artery is dilated (29x35mm). The left pulmonary artery is dilated (25x27mm). The right pulmonary artery is normal in size (16x17mm). Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and function (56%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is moderately dilated with normal systolic function (RVEF62%).3. The left atrium is mildly dilated. The right atrium is severely dilated.4. There is a large secundum type atrial septal defect and anomalous left upper pulmonary vein to innominate vein noted.5. There is pulmonic valve stenosis noted with associated dilation of the main and left pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 64-year-old male patient with left shoulder pain and concern for rotator cuff tear. Note that the examination is limited, as patient refused to continue and no sagittal T2 images were obtained. Also note that there are numerous foci of blooming metallic artifact about the shoulder joint.ROTATOR CUFF: Limited examination with a full thickness tear of the supraspinatus tendon at its insertion measuring approximately 3 mm in AP dimension. There is no associated retraction of the tendon, however, there is moderate atrophy of the supraspinatus muscle. Moderate tendinopathy affects the supraspinatus tendon at its insertion. The subscapularis, infraspinatus, and teres minor muscles and tendons appear within normal limits given this limited examination.SUPRASPINATUS OUTLET: There is increased T1 signal intensity within the rotator interval.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is irregularity of the anterior and posterior labrum, compatible with degenerative changes. There are numerous screws seen in the humeral head.BICEPS TENDON: The proximal biceps tendon is not well seen. The distal biceps tendon appears grossly within normal limits. ADDITIONAL

Output: 1.Limited examination due to patient's refusal to complete all sequences.2.Full-thickness tear of the supraspinatus tendon with moderate muscle atrophy and tendinopathy.3.Postsurgical changes in the humeral head.4.Irregularity of the anterior and posterior labrum, compatible with degenerative changes.5.Increased signal in the rotator interval and questionable thickening of the inferior glenohumeral ligament may represent adhesive capsulitis in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: Altered mental status. Therapeutic on coumadin. Evaluate for progression of septic emboli. There are multiple punctate foci of restricted diffusion with high T2 signal scattered throughout the cerebral and cerebellar white matter, involving watershed territories and subcortical white matter, which are decreased slightly in number from prior MRI. There are no new foci of restricted diffusion. There is a foci of susceptibility within the left corona radiata, new from prior, compatible with microhemorrhage. Additional focus of microhemorrhage within the left basal ganglia is unchanged. There is no evidence of mass. There is no midline shift or herniation. There is mild diffuse cerebral volume loss. The major cerebral flow voids are intact. Fluid is retained within the bilateral mastoid air cells, unchanged. The paranasal sinuses are otherwise clear. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1.Evaluation is limited due to motion degradation. Multiple punctate foci of cerebral and cerebellar acute ischemia bilaterally, decreased in number from prior studies, related to resolving embolic infarctions. New microhemorrhage within the left corona radiata, at site of prior infarct.2.Nonspecific bilateral tympanomastoid effusions.


Instruction: Generate impression based on findings.

Input: Chiari malformation decompression with syrinx, 3 month post op follow up. There are interval postoperative findings related to Chiari decompression surgery, with a intact cerebrospinal fluid flow across a widened neo-foramen magnum and decreased size of the long-segment cervicothoracic syrinx, which measures up to 5 mm in width, previously 7 mm. There is no evidence of pseudomeningocele. The vertebral column alignment is within normal limits, aside from a mildly retroflexed dens. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: Interval postoperative findings related to Chiari decompression surgery, with a intact cerebrospinal fluid flow across a widened neo-foramen magnum and decreased size of the long-segment cervicothoracic syrinx.


Instruction: Generate impression based on findings.

Input: Reason: 70 yo with bacteremia, h/o DDD with reported low back pain with onset of rigors. Please eval for any discitis/osteo History: had previous c/o low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L3 on L4. Alignment is otherwise maintained. Bone marrow signal is benign. Small scattered foci of T1 hyperintensity, relatively more prominent involving the posterior superior aspect of the L1 vertebral body, are compatible with hemangiomas or foci of fat. The conus medullaris is normal in position.Lack of contrast somewhat limits evaluation for infection. There is however no edema involving the disc or endplates to suggest discitis osteomyelitis. There are also no epidural or paraspinous fluid collections to suggest abscess.There is disc desiccation involving the discs throughout the lumbar spine, worst at the L5-S1 level where there is also moderate to severe loss of disc height with vacuum phenomena. Additional details regarding multilevel degenerative changes as described below: T12-L1: There is linear abnormal signal along the posterior aspect of the mid T12 to the mid L1 vertebral bodies likely representing a small right paracentral disc extrusion with cranial and caudal migration. There is no associated spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge and mild bilateral facet arthropathy without significant spinal canal stenosis. There is mild left neural foraminal stenosis. No significant right neural foraminal narrowing. There is small amount of fluid in the facet joints which is likely on a degenerative basis.L4-L5: There is disc bulge eccentric to the left, ligamentum flavum thickening, and bilateral facet arthropathy. There is mild effacement of the lateral recesses but no significant central spinal canal stenosis. There is mild left neural foraminal stenosis. No significant right neural foraminal narrowing. There is small amount of fluid in the facet joints which is likely on a degenerative basis.L5-S1: Moderate to severe disc height loss with disc bulge and a small central protrusion. There is no significant spinal canal stenosis. There is mild to moderate left neural foraminal stenosis and mild right neural foraminal stenosis.Paraspinous soft tissues demonstrate mild fatty atrophic changes involving the paraspinous musculature but are otherwise unremarkable.

Output: 1. There is no evidence of infection involving the lumbar spine within the mild limitations of noncontrast imaging.2. Mild to moderate degenerative changes in the lumbar spine as detailed above without significant spinal canal stenosis at any level. Please see additional details above.


Instruction: Generate impression based on findings.

Input: 54 years, Female, alcohol abuse and new altered mental status There are patchy areas and scattered foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. There is global parenchymal volume loss which is slightly advanced for patient's age. Few foci of susceptibility are seen involving the left greater than right basal ganglia which may related to mineralization. No hydrocephalus. No extra-axial collections. Major flow-voids are preserved. Minimal mucosal thickening is seen in the paranasal sinuses which are otherwise clear. There is also mild opacification of the bilateral mastoid air cells. There is diffuse heterogeneity of the bone marrow signal without discrete destructive osseous lesions evident.

Output: 1. No evidence of acute infarct, hemorrhage, or intracranial mass effect.2. Mild to moderate chronic small vessel ischemic changes. 3. Global parenchymal volume loss which appears slightly advanced for age.4. Diffuse heterogeneity of the bone marrow signal is nonspecific. No discrete destructive osseous lesion is evident.


Instruction: Generate impression based on findings.

Input: Male 34 years old; Reason: evaluate for sacroiliitis History: inflammatory back pain, uveitis, [+]HLA-B27 The sacroiliac joints appear normal, without enhancement or other findings suggestive of sacroiliitis. The visualized bone marrow is normal. Small amount of fluid is seen in the hip joints bilaterally, without definite evidence of synovitis. The soft tissues structures appear normal.

Output: No sacroiliitis or other findings to account for the patient's back pain.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disturbance of skin sensationClinical question: please do Dr Javed MS protocol on 3 Tesla MRI, compare to image in PAXSigns and Symptoms: numbness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a punctate T2 and T2 and FLAIR hyperintense lesion present in the right temporal lobe subcortical white matter which is unchanged since the prior exam. Additionally there are several more subcortical white matter lesions in the subcortical white matter of the frontal lobes which also present on the prior exam and are unchanged.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is straightening of the normal cervical curvature present with mild reversal centered at C5-6. Mild disc bulge present at C5-6.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. There is a minor disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are several subcortical white matter lesions present in the brain which are nonspecific and most likely of little clinical relevance given their number and stability.2.No cervical spinal cord lesions are appreciated to explain the patient's symptoms.3.There is a minor disc bulge present at C5-6 without significant compromise to spinal canal or exiting nerve roots


Instruction: Generate impression based on findings.

Input: Pain and tenderness to left lateral wrist There is soft tissue swelling about the wrist with no fracture. Alignment is within normal limits. The lunate appears slightly more dense than the remaining carpal bones but the significance of this is uncertain. If there is clinical concern for avascular necrosis, MRI can be considered for further evaluation.

Output: Soft tissue swelling of the left wrist without fracture. Slight increase in density of the lunate of unknown clinical significance, which can be further evaluated by MRI if there is clinical concern for avascular necrosis.


Instruction: Generate impression based on findings.

Input: Female, 3 months old, full term infant, with ventriculomegaly of the newborn, as well as hydronephrosis. Assess for ventricular size and for tethered cord. Brain:Numerous small, closely packed gyri are evident in the bilateral frontal lobes and along the perisylvian regions bilaterally. Deep parenchymal infolding is evident along the left sylvian fissure, and to a lesser degree along the right sylvian fissure.Due to the above findings, the overall cerebral morphology is dysmorphic. The lateral ventricles are enlarged, left side more than right, with a wavy external contour. The cerebral white matter is diffusely thinned. However, the stage of white matter myelination, where assessable, is appropriate for the gestational age.The corpus callosum is thinned but fully formed and intact. The pituitary region is unremarkable. The brainstem and cerebellum are normally formed and intact. No Chiari malformation is seen.No evidence of restricted diffusion is seen. No significant parenchymal edema or mass effect is observed. There is no evidence to suggest acute or chronic intracranial hemorrhage.Spine:A full complement of normally formed vertebral bodies is evident. No segmentation anomaly is seen. Spinal alignment is anatomic. Vertebral body signal characteristic are within normal limits.The visualized spinal cord demonstrates normal signal intensity and morphology. The conus tip terminates at the T12-L1 level. The nerve roots of the cauda equina disperse evenly through the thecal sac. Evidence of slight anterior motion of the conus and cauda equina is demonstrated on prone imaging. No findings to suggest a fatty filum terminale or any intraspinal fatty lesion is seen.Atelectasis is evident in the lung bases. Incidental note is pelvocaliectasis of the left kidney.

Output: 1.Findings are seen compatible with bilateral perisylvian and frontal lobe polymicrogyria. As a result, the brain is generally somewhat dysmorphic with enlarged ventricles and thinning of the cerebral white matter. No acute intracranial abnormalities are suspected.2.Unremarkable evaluation of the spine. No evidence of tethered cord.


Instruction: Generate impression based on findings.

Input: New onset seizures. There is prominence of the extra-axial CSF spaces which is within normal limits for this age group. No restricted diffusion to suggest acute ischemia. There is tiny focus of T2 hypointensity with susceptibility layering within the left occipital horn. The ventricles are within normal limits in size. Brain parenchyma is otherwise unremarkable for age. No intracranial mass or mass-effect. Sulcation and myelination are within normal limits for age. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There is opacification of the bilateral middle ear cavities and mastoid air cells which may be related to intubation.

Output: 1. No intracranial mass or mass effect. No structural lesions to suggest seizure focus.2. Minimal intraventricular blood products noted dependently in the left occipital horn, which could be acute or chronic. 3. Prominence of the extra-axial CSF spaces which can be normal in this age group.


Instruction: Generate impression based on findings.

Input: 65-year-old male with altered mental status and multiple myeloma not having achieved remission. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No definite intracranial mass or mass-effect. The CSF spaces are prominent in keeping with mild generalized parenchymal volume loss. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Mild mucosal thickening is present the frontal sinuses and scattered ethmoid air cells. Paranasal sinuses and mastoid cells are otherwise clear. The bone marrow signal throughout the calvarium, clivus, and upper cervical spine is heterogeneous, presumably related to patient's multiple myeloma. There is diffuse dural thickening, which is likely reactive. Multiple small subcutaneous lesions are seen in the scalp and face.

Output: 1. No evidence of definite intracranial disease, intracranial hemorrhage, or acute infarct.2. Heterogeneous bone marrow signal, compatible with diffuse myelomatous involvement.


Instruction: Generate impression based on findings.

Input: 64-year-old female history of metastatic breast cancer. Evaluate for brain metastasis. No evidence of intracranial metastatic disease. No intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement to definitely indicate metastatic disease.There are multiple small enhancing osseous lesions appreciated along the right aspect of the calvarium, appearing similar to the prior bone scan. There is no intracranial extension. Tiny foci of decreased signal within the right frontal lobe on susceptibility weighted imaging are consistent with microhemorrhage and are associated with surrounding FLAIR hyperintensity and faint enhancment. Possible adjacent developmental venous anomaly.There are no areas of restricted diffusion to suggest acute ischemic infarct. The ventricles and sulci are symmetric. The basal cisterns are intact. Flow-voids are visualized within the intracranial vessels. The paranasal sinuses, mastoid air cells, and orbits are unremarkable.

Output: 1. No definite intracranial metastatic disease.2. Foci of microhemorrhage and mild surrounding FLAIR hyperintensity and faint enhancement in the right frontal subcortical white matter is nonspecific and may represent subacute to chronic ischemia or other injury. Vascular etiology is also possibility with presence of an adjacent developmental venous anomaly. Hemorrhagic metastasis is much less likely but consider follow-up evaluation.3. Small osseous metastatic lesions involving the calvarium which were also present on prior bone scan.


Instruction: Generate impression based on findings.

Input: Resection of inverted papilloma. There are findings related to left sinonasal surgery, including partial maxillectomy and turbinectomy. There is interval decrease mucosal thickening in the left maxillary sinus and ethmoid cavity. However, there is persistent nodular lesion along the left aspect of the nasal septum measuring up to 9 mm in width. The lesion displays high T1 and low T2 signal centrally and low T1 and high T2 signal peripherally. There are small retention cysts in the right maxillary sinus. There is also mild scattered mucosal thickening in the left maxillary sinus and bilateral ethmoid air cells and frontoethmoid recesses. There is a defect in the left lamina papyracea. There is no evidence of intracranial mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: Findings related to prior left sinonasal surgery for resection of a inverted papilloma with a persistent nonspecific nodular lesion along the left aspect of the nasal septum measuring up to 9 mm in width. DIfferential considerations include residual treated tumor or organizing hematoma, for example. However, assessment is limited by the lack of intravenous contrast and the lack of dedicated thin-section images of the sinuses.


Instruction: Generate impression based on findings.

Input: Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: PRE-OP, craniotomy for cavernous malformation resection, CCD, please place neurosurgery resident to place fiducials History: Pre-op, cavernous malformation Multiple fiducial markers were seen for the preparation of stereotactic surgery.Redemonstration of left cerebellar hemispheric cavernous malformation with associated developmental venous anomaly. 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. The paranasal sinuses and mastoid air cells are clear.

Output: Redemonstration of left cerebellar cavernous malformation with associated developmental venous anomaly as described above. No change since prior scan.


Instruction: Generate impression based on findings.

Input: Male, 78 years old. Evaluate for osteomyelitis. Inflammation or infection at right foot with redness and pain. There is abnormal bone marrow signal in the base of the second metatarsal and the middle cuneiform with enhancement on postcontrast imaging concerning for osteomyelitis. The remainder of the bone marrow signal is unremarkable, including the calcaneus.There is fluid around the peroneus brevis and longus tendons which likely represents tenosynovitis. The Achilles tendon is unremarkable. The tibialis posterior, flexor digitorum longus, and flexor hallux longus tendons appear unremarkable. Along the plantar medial aspect, deep to the second metatarsal there is a homogeneous, multilobulated cystic collection with minimal thin rim enhancement measuring up to 1.8 cm (series 8, image 8) which likely represents a ganglion cyst.

Output: 1. Findings suspicious for osteomyelitis in the base of the second metatarsal and middle cuneiform.2. Multilobulated, cystic collection with minimal rim enhancement which likely represents a ganglion cyst.


Instruction: Generate impression based on findings.

Input: 49 years Female (DOB:10/11/1967)Reason: hx cervical foraminal stenosis s/p decompression 2014 Eval for stenosis or abnormality hx MS History: C/o Neck pain and Left arm painPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS The cervical vertebral bodies are appropriate in overall alignment and height. There are small T2 hyperintense lesions present within the cervical spinal cord including the left hemicord at C7, the right posterior lateral spinal cord at C3-4 and the central posterior aspect of the spinal cord at C2. There is no associated mass effect.There is some straightening of the normal cervical curvature present at this level.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 . There is loss of disc space height this desiccation, endplate osteophytes and diffuse disc bulge at this level associated with encroachment of the left-sided exiting nerve roots within the neural foramen.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 right vertebral artery is larger than the left vertebral artery.

Output: 1.There are multiple lesions in the cervical spinal cord which are concerning for demyelinating disorder. 2.There are degenerative changes present in the cervical spine associated with encroachment of left-sided exiting nerve roots at the C6-7 level.


Instruction: Generate impression based on findings.

Input: 68 years, Male, Reason: hx base of skull osteomyelitis and osteoradionecrosis, mastoiditis History: otorrhea, left otalgia, headache, neck stiffness. Again seen are areas of abnormal low T1 signal, enhancement, and erosive changes involving the skull base including the left occipital condyles and left greater than right C1 arch. Diffuse low T1 signal involving the clivus is also again seen. Findings are consistent with prior osteomyelitis/osteoradionecrosis. No new marrow signal abnormality compared to prior MRI from 12/9/2014. There are post-treatment findings in the left nasopharyngeal region with soft tissue deficiency involving the pharyngeal mucosal and left parapharyngeal spaces. No mass to suggest residual or recurrent tumor. There are small amount of secretions are noted within the posterior nasopharyngeal cavity layering dependently.There are postsurgical changes related to left mastoidectomy, with T2 hyperintensity and enhancement filling the surgical bed, which may represent graft material and/or granulation tissue. There is a peripherally enhancing fluid collection measuring up to 10 x 3 mm in the lateral aspect of the mastoidectomy cavity. Diffuse opacification of the left middle ear cavity and residual mastoid air cells also again seen.There is dehiscence involving the tegmen tympani and tegmen mastoideum as seen on recent CT. No adjacent epidural enhancement or fluid collections intracranially are appreciated.Examination of the brain demonstrates no evidence of acute ischemia, hemorrhage, intracranial mass, or mass effect. No abnormal extra-axial collections. No hydrocephalus. No abnormal parenchymal or meningeal enhancement. Few foci of susceptibility are noted involving the cerebellum bilaterally compatible with chronic microhemorrhages which appear new since prior MRI brain from 9/8/2014. There is also new focus of FLAIR hyperintensity involving the left posterior cerebellar hemisphere with foci of susceptibility compatible with hemorrhage.Moderate mucosal thickening involving the paranasal sinuses diffusely appear similar to prior. Dehiscence involving the sphenoid sinus floor is again seen which may be postsurgical versus related to prior infection.

Output: 1. Sequela of prior osteomyelitis/osteoradionecrosis with no significant change in extensive erosive changes involving the posterior skull base.2. Images of the brain demonstrate no abnormal parenchymal or meningeal enhancement to suggest intracranial extension of infection. No evidence of cerebritis, abscess, or empyema. Lumbar puncture can be considered if there is significant suspicion for meningitis.3. Focus of encephalomalacia with susceptibility involving the left posterior cerebellar hemisphere which is new since prior brain MRI from 9/8/2014 and suggests interval small hemorrhagic infarct. Few additional foci of susceptibility compatible with chronic microhemorrhages are seen bilaterally in the cerebellar hemisphere. Follow-up MRA neck can be considered if clinically indicated.4. Evidence of left-sided mastoidectomy as seen on recent CT from 11/2/2015 but new since prior MRI from 12/9/2014. There is diffuse T2 hyperintensity and enhancement involving the mastoidectomy bed which may represent granulation tissue and/or graft material and can be correlated with surgical history. There is however a focus of peripherally enhancing fluid collection measuring 10 x 3 mm in the lateral aspect of the mastoidectomy bed, which is nonspecific and may represent a small seroma, CSF collection, or abscess. Dehiscence involving the left tegmen tympani and tegmen mastoideum better seen on recent CT. Left middle ear cavity and residual mastoid air cells remain opacified.


Instruction: Generate impression based on findings.

Input: VHL disease and cocaine abuse evaluate for possible brain aneurysm. MRI: There are postoperative findings in the right posterior fossa, with confluent high T2 signal surrounding the right cerebellar hemisphere a mildly T2-FLAIR hyperintense cavity that measures up to 20 mm with a small mural nodule. There is scattered cerebral white matter T2 hyperintensity. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits are grossly unremarkable.MRA: There is no evidence of aneurysms or significant steno-occlusive lesions.

Output: 1. Postoperative findings in the right cerebellar hemisphere, with what likely represents a hemangioblastoma. Assessment is otherwise limited without intravenous contrast.2. Scattered cerebral white matter T2 hyperintensity may represent chronic small vessel ischemic disease, but no evidence of acute infarct.3. No evidence of cerebral aneurysms.


Instruction: Generate impression based on findings.

Input: Ms. Snow is a 45 year old female with a personal history of left breast lumpectomy in 2015 for IDC/DCIS treated with radiation therapy. Family history of breast cancer in maternal grandmother and maternal aunt. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Expected postsurgical changes are identified in the left breast and axilla. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Left hemifacial spasm preoperative planning. A vascular structure appears to slighty indent the left cranial nerve 7 and 8 complex, although the images are not optimized for detailed delineation of these structures. There is no evidence of intracranial mass. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are scalp fiducial markers.

Output: Preoperative planning MRI for microvascular decompression.


Instruction: Generate impression based on findings.

Input: Female, 66 years old, status post craniotomy for resection of meningioma. Evidence of repeat craniotomy at the high vertex is again seen. A resection cavity is present at the high convexity spanning the interhemispheric falx. The cavity contains a blood fluid level as expected for the immediate postoperative state.Tumor seen previously along the right aspect of the resection cavity has been significantly debulked. There is irregular enhancement along the right paramedian cavity which is nonspecific. Relatively thin enhancement along the left paramedian cavity is unchanged and favored to represent granulation tissue.Restricted diffusion is evident along the right resection cavity margin, particularly the floor of the cavity, which most likely represents postoperative sequelae. T2 hyperintensity compatible with vasogenic edema within both cerebral convexities shows no significant change from the prior examination.Evidence of prior left frontoparietal craniotomy is again seen with a stable resection cavity in the left middle frontal gyrus. A subcentimeter enhancing nodule along the left superior temporal gyrus is unchanged. Enhancement within the left squamous temporal bone is also unchanged.No new intracranial lesions are suspected. Ventricular size and morphology are unchanged.

Output: Findings are seen compatible with re-resection of tumor along the right paramedian high convexity. Irregular but relatively thin enhancement along the right sided surgical margin is nonspecific and could represent postoperative change. Continued follow-up will be necessary to exclude the possibility of residual tumor. Relatively thin enhancement along the left paramedian resection cavity is unchanged and favored to represent postoperative granulation from prior surgery.


Instruction: Generate impression based on findings.

Input: Lower back pain and mid back pain with herniated disks. Thoracic: Thoracic vertebral body heights are maintained. Alignment is maintained. No focal suspicious lesions within the marrow. Small focus of low T1 and low T2 signal at the dorsal T8 vertebral body may represent a sclerotic lesion such as bone island. Mild degenerative changes are seen in the thoracic spine. There is a small right paracentral disk protrusion at the T7-T8 level with mild ventral impression on the thoracic cord. No cord signal abnormality. Tiny left paracentral protrusion is seen at T8-T9 without spinal canal or neural foramina stenosis.There is otherwise no significant spinal canal or neural foramina stenosis.Lumbar:Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. Alignment is within normal limits. There is some diffuse low T1 marrow signal without focal destructive osseous lesions. The conus medullaris is normal in position.Minimal degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is disk desiccation and small central disk protrusion. No spinal canal or neural foraminal stenosis.Mild facet arthropathy in the lumbar spine. Paraspinous soft tissues are within normal limits.

Output: 1. Right paracentral disk protrusion at the T7-T8 level with mild impression on the right ventral aspect of the thoracic cord. No cord signal abnormality. No significant change since 10/20/2014.2. Minimal degenerative changes elsewhere in the thoracic and lumbar spine including small L5-S1 central disc protrusion without significant spinal canal or neural foramina stenosis.3. Diffuse low T1 marrow signal which is nonspecific and can be seen in conditions such as anemia, chronic illnesses, or less likely lymphoproliferative disorders.


Instruction: Generate impression based on findings.

Input: There is a 4 x 5 mm T2 hyperintense and T1 hypointense lesion within the location of the right geniculate ganglion corresponding to the abnormality on recent CT. The signal intensity is slightly brighter than CSF and there appears to be possibly dura or bone between the lesion and the intracranial compartment, although on CT the bone is very thinned at this level, and may be partially not visualized. Evaluation is limited without intravenous contrast.The internal auditory canals are symmetrical and normal in size. The left inner ear structures are unremarkable. There is a 1 cm T2 hyperintense cystic structure within the midline nasopharyngeal soft tissues most compatible with a Tornwaldt cyst. There is polypoid mucosal thickening within both maxillary sinuses. There is minimal fluid within the mastoid air cells bilaterally.

Output: 5 mm lesion within the expected location of the right geniculate ganglion corresponds to the abnormality seen on recent CT. While it is not fully evaluated without contrast, it is suspicious for a cystic facial nerve schwannoma as the normal geniculate ganglion and tympanic segment of the nerve are not visualized as they are on the contralateral side, with a meningocele felt less likely. Further characterization with a contrast exam is suggested.No evidence for IAC lesion on this limited non-contrast exam.


Instruction: Generate impression based on findings.

Input: Reason: 39yo with h/o renal txp (chronic steroids), recent admission for infected pseudocyst w/pancreatitis on IV antibiotics. now w/acute low back pain, +tenderness to touch. Eval for diskitis or compression fx, other pathology? History: low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.The patient's kidneys are not identified in their usual location. There is a CT of the abdomen which demonstrates a left-sided pelvic kidney

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.There is no convincing evidence for diskitis or osteomyelitis on the basis of this exam


Instruction: Generate impression based on findings.

Input: 70-year-old male with prostate cancer. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.8 cm in transverse, 4 cm in AP, and a 3.8 cm in critical diameter.Peripheral Zone: Dominant lesion noted in the right apex measuring 1.1 x 0.6 cm (axial series 401 image 9, series 501 image 139). This lesion likely extends to the mid gland. Small punctate T2 hypointense foci are also seen in the left apex.Central Gland: Heterogeneous enlarged transitional zone suggestive 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: Dominant lesion in the right apex measuring 1.1 x 0.6 cm. This lesion likely extends to the mid gland. Small punctate T2 hypointense foci also noted in the left apex.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Random TRUS Biopsy on 11/3/2014 was negative. PELVIS:PROSTATE:Prostate Size: 3.9 x 1.8 x 1.8 cmPeripheral Zone: No suspicious lesion identified.Central Gland: In the right anterior mid gland to apex is a 1.3 x 0.9 cm (series 801/12) poorly defined T2 weighted hypointense lesion with associated restricted diffusion.In the anterior mid gland is a 7 x 5 mm (series 801/12) poorly defined T2-weighted hypointense lesion with associated restricted diffusion.Seminal Vesicles: No evidence of seminal vesicle dilatation.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific right external iliac lymph node measuring 6 mm in short axis.BONES, SOFT TISSUES: Diverticulosis.

Output: Right and left apex lesions for which MR guided biopsy is recommended to exclude prostate cancer.


Instruction: Generate impression based on findings.

Input: Chiari malformation with cervical syrinx: new back/neck pain. There are postoperative findings related to Chiari decompression. The cerebellum is low-lying and appears adherent to the overlying dura posteriorly. There is increase in size of the cervical syrinx, with a cavity that measures up to 17 mm in width at the C2 and C3 levels. Inferior to the cavity, there is diffuse high T2 signal and swelling of the spinal cord from the C4 to C7 levels. The thoracic spinal cord is unremarkable. There is mild retroflexion of the dens. There is markedly impeded flow of cerebrospinal fluid across the neo-foramen magnum. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression. The cerebellum is low-lying and appears adherent to the overlying dura posteriorly, which may be due to adhesions. 2. Increase in size of the cervical syrinx since 2013, with a cavity that measures up to 17 mm in width at the C2 and C3 levels with what likely represents pre-syrinx from C4 to C7.


Instruction: Generate impression based on findings.

Input: Altered mental status. Examination is at least moderately limited by patient motion.There is no evidence of intracranial hemorrhage, mass, or acute infarct. Focal T2/FLAIR hyperintensity involving the right precentral gyrus remain unchanged in comparison with CT, and likely reflects gliosis. Scattered areas of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific but compatible with mild chronic small vessel ischemic disease. The ventricles and basal cisterns are mildly enlarged, reflecting underlying global parenchymal volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Mild mucosal thickening in the maxillary and anterior ethmoid sinuses is nonspecific.

Output: 1.Significantly limited examination due to patient motion. There is however no evidence of acute infarct. No intracranial mass effect.2.Focus of FLAIR hyperintensity involving the right lateral precentral gyrus is nonspecific but may represent gliosis from chronic infarct and unchanged since earliest available CT from 2/24/2016.3.Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are bilateral breast MRI performed at Franciscan Alliance.For comparison, screening mammogram dated 7/15/2016, right breast mammograms dated 8/24/2016 and 9/13/2016 and targeted right breast ultrasound dated 8/24/2016 and 9/13/2016 are available. Bilateral breast MRI: Axial T1, T2, STIR, dynamic contrast enhanced images and sagittal STIR sequences of both breasts were submitted for review.There is heterogeneous fibroglandular tissue. There is mild background parenchymal enhancement in both breasts.There is an 8 x 9 x 9 mm enhancing mass in the lower outer quadrant of the right breast, corresponding to the biopsied malignancy. Biopsy clip artifact is seen along the medial aspect of the mass. This mass demonstrates mixed enhancement kinetics with areas of rapid wash in and washout. Approximately 4 mm superoanterior to the index mass, there is a 7 x 4 x 7 mm enhancing mass with persistent enhancement kinetics, concerning for satellite lesion. When measured together, the masses span 1.7 x 0.9 x 2 cm. There are additional scattered enhancing foci in the right breast, which are likely benign.No suspicious enhancing focus or mass in the left breast. There are additional scattered enhancing foci in the right breast, which are likely benign.There are two abnormal right axillary lymph nodes, the largest measuring up to 1.4 x 1 x 1.2 cm. Biopsy clip artifact is seen adjacent to the more lateral node. No abnormal internal mammary or left axillary lymph nodes.

Output: 1. An 8 x 9 x 9 mm enhancing mass in the lower outer quadrant of the right breast, corresponding to known biopsied malignancy. An adjacent 7 mm mass is concerning for a satellite lesion.2. Two abnormal right axillary lymph nodes. The more lateral node was previously biopsied with pathology showing invasive ductal carcinoma3. No MR evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Motion limits evaluation of detail especially on dedicated IAC sequences. At least 3 new punctate foci of susceptibility are identified (series 1101 images 106, 137, 138), corresponding to cavernous malformations specifically in the deep white matter of the right frontal lobe and left frontal lobe. Overall, numerous previously seen supratentorial and infratentorial cavernous malformations are not significantly changed. There is no evidence of new FLAIR signal, edema, or mass-effect. Likewise there is unchanged dural based left frontal parafalcine enhancing lesion measuring up to 5 mm in width.No evidence of intracranial hemorrhage or acute infarct. Ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. There is persistent opacification of the right maxillary sinus. There is fluid within the mastoid air cells bilaterally.T2 signal within the inner ear structures is not well evaluated. Right internal auditory canal again demonstrates susceptibility effect and is no longer T1 hyperintense. This is favored to represent evolution of chronic blood products in the internal auditory canal. There is no abnormal enhancement appreciated. The cranial nerves within the canal are not well delineated.

Output: 1. At least 3 new supratentorial cavernous malformations within the left and right frontal lobes. Numerous supratentorial and infratentorial cavernous malformations are not significantly changed without suggestion of recent hemorrhage.2. T2 signal within the inner ear structures is not well evaluated secondary to artifact. However there is again susceptibility effect within the right internal auditory canal likely representing evolution of chronic blood products.3. Unchanged dural-based left parafalcine extra-axial enhancing lesion that measures up to 5 mm in width, which likely represents a meningioma.


Instruction: Generate impression based on findings.

Input: Male 30 years old with left shoulder pain. Evaluate for labral tear. ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact.SUPRASPINATUS OUTLET: There is edema within and along the capsule of the acromioclavicular joint and mild edema within the distal end of the clavicle. There is also slight irregularity of the distal clavicular margin. These findings may reflect a recent low-grade separation, stress reaction of the distal clavicle (posttraumatic osteolysis) or chronic osteoarthritic changes. Gadolinium deep to the anterior deltoid is likely iatrogenic. We see no additional fluid within the subdeltoid bursa to suggest rotator cuff tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is abnormal signal intensity traversing the posterior labrum superiorly indicating a tear with small adjacent paralabral cysts. The tear extends anteriorly to involve the superior labrum and also extends inferiorly to at least the 6:00 position. There is also partial thickness tearing of the anterior inferior labrum which may represent further extension of the aforementioned tear.BICEPS TENDON: The tendon of the long head of the biceps is intact. The coracohumeral and superior glenohumeral ligaments are poorly defined on this study and we cannot exclude tearing of these structures.

Output: 1.Extensive tearing of the glenoid labrum as described above.2.Edema within and along the capsule of the acromioclavicular joint as well as within the distal clavicle may represent a recent low-grade separation, stress reaction of the distal clavicle (posttraumatic osteolysis) or chronic osteoarthritic changes.3.Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female 61 years old Reason: r/o pancreatic cancer, pt is a carrier of BRCA-2 mutation History: newly diagnosed pre-diabetic, dilated CBD per outside U/S ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Within segment 6 of the liver there is a T2 hyperintense lesion that shows peripheral nodular enhancement and progressive central enhancement compatible with a hemangioma. No suspicious hepatic lesions. Hepatic and portal veins are patent.Patient is status post cholecystectomy. The common bile duct diameter increased since the CT dated 2/17/2014. The common bile duct at its proximal aspect measures 17 mm and measures 7 mm at the head of the pancreas. Its most distal portion in the ampulla is suboptimally imaged by MR.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology and signal. Pancreatic duct is mildly dilated measuring up to 3 mm. No discrete pancreatic mass is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval increase in the diameter of the common bile duct without a definite mass but the transitions point is about the level of the ampulla. Mild pancreatic duct dilatation without an evident pancreatic mass. This may be due to either a small mass (below imaging threshold) or benign ampullary stenosis. Further evaluation of the ampulla with EUS can be performed as clinically indicated.2.Right hepatic lobe hemangioma.


Instruction: Generate impression based on findings.

Input: 56-year-old female with severe pain and allodynia in the right foot. There is mild subcutaneous edema involving the ankle which extends along the dorsum of the foot, which is nonspecific. There is moderate fatty atrophy of the plantar musculature of the foot, which is also nonspecific. There is moderate atrophy of the visualized musculature of the leg. We see no masses or structural causes to explain the patient's right foot pain. Although this study was not protocoled for detailed evaluation of the tendons, we see no gross abnormalities of the tendons. There is a mild hallux valgus deformity. Mild osteoarthritis affects the first MTP joint. No joint effusion is evident.

Output: Nonspecific subcutaneous edema, mild to moderate diffuse skeletal muscle atrophy, hallux valgus deformity and mild osteoarthritis of the first MTP joint. Otherwise, there are no structural abnormalities to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Right knee pain. Evaluate meniscal tear. MENISCI: There is extensive degenerative tearing of the lateral meniscus. This includes attenuation, deformity and extrusion of the body of the lateral meniscus, attenuation and abnormal signal intensity of the anterior horn, and horizontally oriented signal abnormality within the posterior horn that extends to the tibial articular surface. There is increased signal intensity within the posterior horn of the medial meniscus indicating intrasubstance degeneration, which extends to the tibial articular surface suggesting a degenerative undersurface tear.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss along the lateral femoral condyle and medial tibial plateau with cyst formation and degenerative signal abnormality in the underlying subchondral bone. There is more focal near-full-thickness to full-thickness degeneration of the articular cartilage along the lateral aspect of the medial femoral condyle. There is edema-type signal within the posterior aspect of the medial femoral condyle as well as a cyst in the anterior aspect of the medial tibial plateau which I suspect are degenerative etiology as well. Moderate cartilage degeneration affects the patellofemoral joint. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Osteoarthritis as described above most severely affecting the lateral tibiofemoral compartment with extensive tearing of the lateral meniscus.2.Intrasubstance degeneration and degenerative undersurface tearing of the medial meniscus as above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Sciatica, right side Radiculopathy, site unspecifiedClinical question: assess for causes of radicular back painSigns and Symptoms: back pain with radiculopathy Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level.At L4-5 there is loss of disc space height, diffuse disc bulge and endplate reactive changes associated with facet and ligamentum flavum hypertrophy. The endplate reactive changes are high signal on T2 and low signal on T1. The endplates are irregular. The loss of disc space height appears to be worse than a plain film exam of 3/24/2015. There is crowding of the nerve roots within the thecal sac at this level with near effacement of the spinal fluid surrounding the nerve roots. Overall there is a moderate degree of spinal stenosis present at this level. There is effacement of the fat at the lateral recess bilaterally at this level. There is narrowing of the neural foramina at this level associated with encroachment of the exiting nerve roots within the neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge at this level. At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a Schmorl's node at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.The kidneys appear relatively small.

Output: 1.There are degenerative changes present in the lumbar spine which are worse at L4-5 where there is moderate spinal stenosis and bilateral neural foramen encroachment due to degenerative change. The degenerative changes appear to have progressed significantly since the prior CT of the abdomen from 9/9/2014. There are acute endplate reactive changes at this level which are likely inflammatory in nature. Please correlate with clinical history.2.The kidneys appear atrophic.


Instruction: Generate impression based on findings.

Input: There are multiple, approximately 10, nodular and peripherally-enhancing lesions at the grey-white matter interfaces. For example, the largest infratentorial lesion measures up to 7 mm in the left middle cerebellar peduncle and the largest supratentorial lesion measures up to 8 mm in the right inferior frontal gyrus. There is negligible edema associated with the lesions. There is no evidence of intracranial hemorrhage or acute infarct. There is a small developmental venous anomaly along the inferior and anterior aspect of the right thalamus. 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 and scalp soft tissues are grossly unremarkable. There are small mucous retention cysts in the bilateral maxillary sinuses.

Output: Multiple subcentimeter supratentorial and infratentorial lesions are compatible with intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Known brain metastases from lung cancer status post recent whole brain radiation. There are four supratentorial ring-enhancing mass lesions with surrounding vasogenic edema. The right parietal lobe tumor measures up to 42 mm, the right occipital lobe tumor measures up to 12 mm, the left temporal lobe tumor measures up to 8 mm, and the left superior frontal gyrus tumor measures up to 7 mm. There is susceptibility effect along the walls and layering within the right parietal lobe tumor. There is also a nonspecific punctate focus of enhancement in the right lateral pons. There is no evidence of acute infarct. There is effacement of the right lateral ventricle, but no evidence of hydrocephalus. There is trace midline shift to the left and perhaps minimal subfalcine herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple brain metastases, the largest of which measures up to 42 mm in the right parietal lobe and demonstrate intratumor hemorrhage.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, history of GBM of the temporal lobe status post resection and chemotherapy. Presenting with behavioral changes and confusion. Evidence of left anterior temporal resection is again seen. The surgical cavity is largely collapsed. Gyral thickening and T2 hyperintensity affecting the residual anterior temporal parenchyma, with extension to the left mesial temporal lobe, have not significantly changed from the prior examination. Likewise, curvilinear enhancement within the collapsed cavity shows no definite change in size or confirmation.No new intracranial lesions are seen. No evidence of new edema, mass effect, restricted diffusion or acute intracranial blood product is seen. The ventricles remain normal in size and morphology. Very mild ill-defined T2 hyperintensity within the left periatrial white matter is favored to represent a treatment related change.

Output: Findings are redemonstrated compatible with left anterior temporal resection. Thickened T2 hyperintense anterior temporal gyri as well as thickening which extends into the mesial temporal structures may represent residual tumor but these findings are unchanged when compared to prior examination. Nonspecific enhancement within the resection cavity is unchanged as well. No new lesions are detected.


Instruction: Generate impression based on findings.

Input: Enlarged orbital muscles: proptosis. Orbits: There is interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior rectus muscle. There is mild protosis bilaterally, right more than left, which appears to be attributable to diffuse prominence of the orbital fat. Otherwise, the bilateral globes, lacrimal glands, and optic nerves bilaterally are intact. There is no evidence of orbital mass lesions.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval decreased enlargement of the extraocular muscles, with mild residual prominence of the right superior rectus muscle. Mild protosis bilaterally, right more than left, appears to be attributable to diffuse prominence of the orbital fat.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 38-year-old female with history of bilateral breast implants and axillary pain. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Bilateral retroglandular silicone implants are intact. There is some asymmetry in their positioning, but no finding of rupture. A few radiating folds are noted. There is mild thin rim enhancement in the tissue surrounding the right implant, not concerning for malignancy, rather suggestive of mild inflammation. There are mildly prominent but largely symmetric nodes in each axilla, possibly reactive due to the implants.

Output: No MRI evidence for malignancy. Mildly prominent axillary lymph nodes are probably reactive. Enhancement around the right implant suggestive of mild reactive/inflammatory change. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 23 years, Female, Reason: h/o GVHD of the liver with persistent cholestasis. Evalaute liver and biliart tract History: same. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal MRCP


Instruction: Generate impression based on findings.

Input: Pain. Left knee: There is a small joint effusion, but the knee otherwise appears normal. Avascular necrosis of the distal femur seen on the recent MRI examination is not clearly evident on these radiographs.Right knee: The knee appears normal with no specific findings to account for the patient's pain.

Output: Small left knee joint effusion but otherwise no specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 60-year-old female felt a pop in the left calf yesterday when she was avoiding the car. Painful to walk now. Evaluate for calf muscle rupture. There is edema deep to the medial head of the gastrocnemius muscle and superficial to the soleus muscle with associated discontinuity of the muscle distally near the myotendinous junction and associated retraction of 1.5 cm. There is mild intramuscular edema within the medial head of the gastrocnemius muscle. There is small amount of blood products/fluid at the myotendinous junction (series 10, image 34). Findings are compatible with a full-thickness tear of the medial head of the gastrocnemius muscle. No muscle atrophy is noted. The plantaris and scoliosis muscles appear normal. The anterior compartment musculature appears normal. Bone marrow signal is normal.

Output: Findings compatible with complete rupture of the medial head of gastrocnemius at the myotendinous junction with with retraction of the muscle by about 1.5 cm. There is a small amount of blood products/fluid at the site of tear at the myotendinous junction.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for apologies. Signs and symptoms: BP, BLE pain/numbness. Non-enhanced thoracic MRI:The alignment of vertebral column is anatomical. The signal intensity of vertebral column is unremarkable with the exception of subtle changes secondary to degenerative disease.T1 -- T2, T2 -- T3 and T3 -- T4 levels are unremarkable thereT4 -- T5 demonstrate shallow right lateral disk protrusion with subtle effacement of the adjacent subarachnoid space however without spinal stenosis or neural foraminal compromise.T5 -- T6 is unremarkable.T6 -- T7 demonstrate mild degenerative disk disease and loss of disk height and a shallow immediate right paramedian tiny disk protrusion without spinal stenosis or neural foraminal compromise.T7 -- T8 demonstrate a large right paramedian disk protrusion. It measures approximately 10 mm at the base and 5.6 mm in height. Finding is best appreciated on sagittal T2 and T2 stir image 8 and axial T2 series 801 image 27.This finding results in effacement of the ventral subarachnoid space on the right and with very subtle flattening deformity of the cord. There is however no central spinal stenosis or neural foraminal compromise. The signal intensity of the cord remains normal.T8 -- T9 is unremarkable.T9 -- T10 is unremarkable.T10 -- T11 demonstrate no appreciable degenerative disk disease however mild bilateral symmetrical ligamentum flavum hypertrophy is noted. No spinal stenosis or neural foraminal compromise.T11 -- T12 demonstrate mild degenerative changes and unremarkable otherwise.T12 -- L1 is unremarkable.There is no detectable perispinal soft tissue abnormalities.

Output: 1.There is a right lateral disk protrusion at T7 -- T8 with resultant subtle flattening deformity of the cord. No central spinal stenosis or neural foraminal compromise and no detectable cord signal abnormality.2.Additional small disk protrusions at T4 -- T5 and T6 -- T7 levels without spinal stenosis or neural foraminal compromise as detailed.3.Mild to moderate ligamentum flavum hypertrophy of the lower thoracic spine as detailed.4.Normal signal intensity and caliber of thoracic cord.


Instruction: Generate impression based on findings.

Input: History of prostate cancer status post prostatectomy. 3+4 disease with left posterolateral extraprostatic extension. PELVIS:PROSTATE: Status post prostatectomy. In the superior left posterolateral aspect of the prostatectomy bed there is a 2.1 x 1.2 cm nodule demonstrating restricted diffusion and arterial enhancement suspicious for residual tumor.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 2.1 x 1.2 cm nodule in the superior left posterolateral prostatectomy bed demonstrating restricted diffusion and arterial enhancement is suspicious for residual tumor.


Instruction: Generate impression based on findings.

Input: 72 years, Male, metastatic lung cancer, brain metastases, status post SRS to right frontal lesion. There appears to be little contrast within the brain on the post gadolinium sequences although full dose was administered. As such this examination is limited. There is however a cystic appearing lesion in the left inferior frontal lobe measuring up to 15 x 13 mm in the craniocaudal and transverse dimensions, coronal T2 image 13, and approximately 13 mm in the AP dimension. There is surrounding edema and mild local mass effect.There is also a 7 mm lesion involving the left anterior frontal subcortical white matter. There are additional scattered foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter which are nonspecific but compatible with chronic small vessel ischemic and/or posttreatment-related changes. Note underlying small metastases cannot be excluded due to the relative lack of contrast. There is no midline shift or herniation. No hydrocephalus. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. This examination is limited due to insufficient contrast within the brain on the postcontrast sequences although full dose was administered. This may be related to partial contrast extravasation. Would suggest patient returning for repeat postcontrast imaging.2. There are least two left frontal lobe metastatic lesions, as described above. There is mild local mass effect without midline shift or herniation. There may be additional smaller lesions which cannot be appreciated without contrast. Prior study is not available for comparison.


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB:10/17/1946)Reason: 3T scanner; area of vascular ectasia History: Yearly surveillance; HHT, at risk for AVMs, microhemorrhagesPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 7-year-old male with a left axillary lymphangioma. Evaluate. CHEST:LUNGS AND PLEURA: Visualized lungs with no evidence of enhancing mass or focal pulmonary opacities. No pleural effusions.MEDIASTINUM AND HILA: Cardiothymic size is normal without evidence of a pericardial effusion.CHEST WALL: A T2 hyperintense lesion in the left axilla measures 7.8 x 4.1 (series 301, image 14) x 7.2 cm (sagittal series 801, image 18) (craniocaudal, transverse, AP) contains septations. The mass has many locules of varying sizes. No evidence of enhancement and specifically the septations do not enhance. The mass is deep to the pectoralis muscle and does not cross into the pleural space. The subclavian and axillary arteries and veins appear normal.

Output: Findings consistent with left axillary lymphangioma without extension into the pleural space.


Instruction: Generate impression based on findings.

Input: Previously noted abnormal marrow signal and slight osseous expansion involving the body of the sphenoid, planum sphenodale, anterior clinoids, lesser wings of the sphenoids (right greater than left), shows no significant interval change.. Again seen is expansion and patchy enhancement of the clivus, similar in size and morphology compared to prior exam. Two or three scattered nonspecific foci of T2/FLAIR hyperintensity are seen in the cerebral hemispheres, without significant interval change. There is no evidence of intracranial hemorrhage or acute infarct. Stable mild ventricular enlargement and low lying cerebellar tonsils. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No significant interval change of expansile bony lesions involving the clivus and sphenoid since prior exam, compatible with fibrous dysplasia.


Instruction: Generate impression based on findings.

Input: A patient with known left breast cancer submitted outside study for review. Submitted for review are breast MRI (3/18/15) performed at Northwestern Memorial Hospital. Breast MRI was performed with a protocol outlined in the outside radiology report.There is marked parenchymal enhancement in both breasts, significantly limiting the sensitivity and specificity of this study.There are innumerable cysts in both breasts. A proven malignancy is demonstrated as an enhancing mass at far posterior 3 o'clock position, measuring 29 x 20 x 32 mm (AP x LR x CC), in the left breast. There is a linear non-mass enhancement at anterior 10 o'clock position in the left breast, measuring 17 x 8 x 10 mm.In the right breast, there is an enhancing mass, measuring 8 x 8 x 10 mm, at far posterior 10 o'clock position.Axillary regions are not completely imaged in this study.

Output: Limited MRI study due to marked parenchymal enhancement.1. Known cancer in the left breast at far posterior 3 o'clock position.2. Linear non-mass enhancement at anterior 10 o'clock position in the left breast. MR guided biopsy may be considered.3. An enhancing mass in the right breast at posterior 10 o'clock position. MR directed ultrasound study is recommended. If no sonographic correlate is obtained, MR guided biopsy may be considered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: concern for rotator cuff tear History: pain. ROTATOR CUFF: Minimal increased signal intensity within the distal fibers of the supraspinatus tendon suggests very mild tendinosis, but we see no discrete tear. Mild edema type signal intensity within the underlying greater tuberosity is likely reactive in etiology. The supraspinatus muscle is within normal limits.Minimal increased signal intensity within the distal anterior fibers of the infraspinatus tendon suggests very mild tendinosis, but we see no discrete tear. The muscle is within normal limits.The teres minor tendon and muscle are normal.The subscapularis tendon and muscle are normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears slightly widened, which may reflect prior surgery or old trauma. There is a small amount of fluid within the subacromial/subdeltoid bursa, which may reflect a mild bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. No joint effusion. Although we see no fluid entering the glenoid labral substance, intermediate signal intensity within the superior labrum likely reflects degeneration or degenerative tearing. The inferior labrum is intact. The articular cartilage is intact.BICEPS TENDON: Given the limitations of a non-arthrographic study, the tendon of the long head of the biceps appears normal.

Output: 1.Very mild rotator cuff tendinosis but no rotator cuff tear is evident.2.Widened acromioclavicular joint may reflect prior surgery or old trauma. Small amount of fluid in the subacromial/subdeltoid bursa is of questionable significance, but could represent a mild bursitis.3.Mild intermediate signal intensity in the superior labrum may reflect degeneration or degenerative tearing.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Aphasia expressive. Nonenhanced brain MRI:No detectable acute intracranial process and in particular no evidence of acute ischemic stroke.Examination demonstrate diffuse nonspecific foci of flair hyperintensity only in the periventricular and subcortical white matter of cerebral hemispheres which considering patient's stated age of 84 most likely representing chronic nonhemorrhagic small vessel ischemic strokes of mild-to-moderate degree.There is also a small focus of cortical and subcortical encephalomalacia in the left frontal lobe consistent with a chronic nonhemorrhagic ischemic stroke. Images through posterior fossa demonstrate multiple tiny chronic cerebellar ischemic strokes in the distribution of Michael branches. Unremarkable signal intensity of brain parenchyma otherwise.The signal void of major intracranial arterial branches are identified.Incidental note is made of anatomical variation of partially empty sella.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells and calvarium.

Output: 1.No acute intracranial process.2.Mild to moderate chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter. Multiple small pica territory bilateral cerebellar chronic strokes.3.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (5/27/2015), images from stereotactic core needle biopsy of right breast and postprocedural right mammographic images (5/27/2015), breast MRI (6/6/15) performed at Northwestern Memorial Hospital. DIGITAL MAMMOGRAPHIC IMAGES (5/27/2015):The breast parenchyma is heterogeneously dense. There are two clusters of suspicious pleomorphic calcifications in the right breast. One is located at posterior 12:00 position, measuring 8 mm. The other is located at superior and far lateral aspect of the right breast. Those calcifications are linearly arranged, measuring 12 mm.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. IMAGES FROM STEREOTACTIC CORE NEEDLE BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (5/27/2015):Stereotactic core biopsy was performed for 2 sites of calcifications in the right breast. According to outside report, the calcifications at 12:00 was sampled by superior approach, and the calcifications at upper outer aspect was sampled by inferior approach. No specimen radiograph is submitted. Postprocedural right mammographic images show a dumbbell shaped clip at 12:00 position, 12 mm inferior to the biopsy site, and a x shaped clip at the biopsy site of far lateral superior aspect. No residual calcifications are identified at either site. Per outside radiology report, pathology for 12:00 lesion was DCIS grade 1-2 with ADH, and for far lateral superior site was focal ADH with benign findings.BREAST MRI (6/6/15): Imaging protocol is described in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, limiting the sensitivity of MRI.There are two clip artifacts in the right breast, at posterior 12:00 position and the posterior upper outer aspect. Within the limitations due to marked parenchymal enhancement, no suspicious enhancement superior to the 12:00 clip or around the upper outer clip is seen. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: Biopsy proven DCIS in the right posterior 12:00 and focal ADH at far lateral superior right breast. Marker clip was displaced 12 mm inferiorly at 12:00 lesion, and the clip at the upper outer lesion was located at the biopsy site. MRI did not show suspicious enhancement. Pathology slides should be reviewed at University of Chicago. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 79-year-old female with left upper quadrant and left lower quadrant pain ABDOMEN:LUNG BASES: Mild bronchiectasis and nonspecific, careful increased densities at the lung bases, not significantly changed from previous study.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Interval increase in the size of the previously described hypodense lesion in the neck of the pancreas. This lesion now measures 2.5 x 1.7 cm on image number 38, series number 3. Left of IV contrast limits optimal evaluation of this lesion. MRI is recommended for further evaluation.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lower pole punctate nonobstructing stone.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Right adnexal cystic lesion is unchanged measuring 4.2 x 4.2 cm on image number 112, series number 3. Left adnexal solid-appearing lesion measures 6.4 by 5 cm on image number 109, series number 3, slightly increased in size compared to previous CT.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Limited study lack of IV contrast. Right renal nonobstructing stone.Slight interval increase in the size of the cystic lesion in the head of the pancreas. MRI of the pancreas is recommended for further evaluation.Interval minimal increase in the size of the left adnexal solid lesion. Ultrasound may be helpful for further evaluation.


Instruction: Generate impression based on findings.

Input: Low back pain and numbness, saddle anesthesia, fecal incontinence, urinary retention/overflow incontinence. Evaluate for cord compression. Examination is obtained per screening adult cord compression spine MRI protocol. There are postsurgical changes of laminectomy and posterior spinal fusion from L4 to S1. There is no evidence of cord compression or compression of the cauda equina in the lumbar spine. The vertebral bodies are appropriate in height. Alignment is grossly maintained. Small disk bulges are seen throughout the lumbar spine without evidence of significant spinal canal stenosis. There is no compromise of the spinal cord. No evidence of high-grade stenosis within the lumbar spine. Examination is suboptimal for assessment of cord signal abnormality. There is apparent hyperintense STIR signal within the cervical cord which may be artifactual.Scattered foci of T1 hyperintensity in the spine are compatible with focal fat or hemangiomas. There is a T2 hyperintense focus involving the inferior aspect of the T9 vertebral body which is nonspecific.

Output: 1. No evidence of cord compression or compression of the cauda equina. 2. Apparent increased T2/STIR signal in the cervical spine may be artifactual. If there is clinical suspicion for cervical myelopathy, recommend dedicated cervical spine MRI.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol, details are not as evident on imaging as dedicated protocols of the spine. Dr. Ali discussed findings with Dr. Ahn on 1/7/2014.


Instruction: Generate impression based on findings.

Input: 19-year-old male with knee pain and popping after soccer injury 4 days ago. MENISCI: The medial and lateral menisci are intact without evidence of tear.ARTICULAR CARTILAGE AND BONE: Tricompartmental articular cartilage is intact. Bone contusions are noted in the lateral femoral condyle and posterior tibial plateau.LIGAMENTS: The anterior cruciate ligament is poorly defined and edematous, compatible with an acute tear. The posterior cruciate ligament is intact. The collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Anterior cruciate ligament tear without evidence of meniscal injury.2.Large joint effusion with decompression into a Baker's cyst.


Instruction: Generate impression based on findings.

Input: 50 -year-old male with metastatic melanoma with multiple brain metastases and intracranial hemorrhage. There is no significant interval change in the size of the left thalamic hematoma to the 2.8 x 2.1 x 3.7 cm (AP x TR x CC image 14; series 4) from 2.7 x 2.2 x 3.4 cm. The hematoma extends into the midbrain. There is no significant interval change in the amount of vasogenic edema in the surrounding area even allowing for technique differences: Edema and hematoma measure together 4.2 cm in diameter (15; series 4), previously 4.2 centimeters. There is mass effect on the superior cerebellar peduncle as well as the fourth ventricle. Additionally, there is distortion and rightward displacement of the third ventricle which is stable. There is no significant interval change in the previously described slight enlargement of the lateral ventricles bilaterally. The temporal horn of the left lateral ventricle measures 9 mm, previously 9 mm. There is narrowing of the basal cisterns which appears unchanged when compared to the previous study. There is no evidence of frank brain herniation. There is no evidence of extra-axial fluid collection. Multiple mass lesions within the cerebral hemispheres are noted, some of them hyperdense consistent with petechial hemorrhage or mineralization. Findings are consistent with known metastatic lesions and appear grossly stable. The area of dominant left frontal lobe and right cerebellar hypoattenuation also appear grossly similar to the recent brain MRI. No new parenchymal lesions or hematomas are noted. The visualized mastoid air cells and paranasal sinuses are clear. The visualized orbits are unremarkable.

Output: 1. No significant interval change in left thalamic hematoma with extension into the midbrain. No significant interval change in the amount of vasogenic edema in the surrounding area. Stable distortion of the third ventricle and stable enlargement of the lateral ventricles bilaterally without evidence of frank brain herniation. 2. Redemonstration of multiple metastatic intraparenchymal brain lesions better visualized on recent MRI examination. No evidence of new parenchymal lesions or sites of hemorrhage.


Instruction: Generate impression based on findings.

Input: 38-year-old male presents with ulceration and discoloration of the left third finger, evaluate for infection or bone necrosis. There appears to be loss of the soft tissue distal to the tuft of the distal phalanx of the middle finger. However, the distal phalanx maintains its normal predominantly fatty signal intensity on T1-weighted images and no definite edema or enhancement is seen within this bone on the fat-suppressed T2-weighted and postcontrast sequences. Increased signal intensity within the distal phalanx on certain fat suppressed images is favored to represent incomplete fat saturation. The middle and proximal phalanges of the middle finger appear normal as do the remaining visualized bones of the hand. On the single large field of view coronal T1-weighted sequence, there is abnormal low signal intensity within the lunate bone. This cannot be further characterized and may represent a cyst or avascular necrosis. It is not necessarily of any current clinical significance. There is mild subcutaneous edema dorsal to the proximal interphalangeal joint of the index finger.

Output: Loss of soft tissue along the tuft of the distal phalanx of the middle finger, but no evidence of osteomyelitis. Additional findings as described above.The above findings were communicated via a text-page to Michael Hawking (pager 1646) at 2:23 PM on 12/1/2016.


Instruction: Generate impression based on findings.

Input: 55-year-old male with left index finger ulcer. Radiograph shows index finger ulceration without osteolysis. Ring finger ulceration as provided by clinical service. Examination is degraded due to motion. Please not that the distal index finger is not included within the field-of-view on all sequences. Mild high T2 signal and enhancement at the distal aspect of the index finger only on seen on axial sequences, incompletely evaluated. No loculated fluid collection. The tendons demonstrate grossly normal signal provided the above-mentioned limitation.Mild to moderate degenerative disease affects the carpometacarpal and intercarpal joints.

Output: Please note that the distal index finger is not included in the field-of-view on all sequences and thus incompletely evaluated. Mild high T2 signal and enhancement at the distal aspect of the index finger only seen on axial sequences. Close follow-up is recommended.Findings discussed with Dr. Kyle Borque at 1130 on 11/22/15.


Instruction: Generate impression based on findings.

Input: 65-year-old female patient with pain. Question of rotator cuff tear. ROTATOR CUFF: No subscapularis tendon fibers are noted traversing the bicipital groove compatible with full thickness tearing. The infraspinatus and supraspinatus muscles appear atrophied. There is insertional tearing of either the superior fibers of the infraspinatus tendon or the inferior fibers of the supraspinatus tendon. There is full-thickness tearing of the anterior fibers of the supraspinatus tendon with approximately 2 cm of tendinous retraction.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is superior glenohumeral joint space narrowing. BICEPS TENDON: The long head of the biceps tendon is not visualized within the bicipital groove and is either torn or dislocated.ADDITIONAL

Output: 1. Full thickness tearing of the supraspinatus and subscapularis tendons with tendinous retraction and atrophy of the supraspinatus.2. Torn or dislocated long head of the biceps tendon.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: brain mets History: surveillance Redemonstration of suboccipital craniectomy with left cerebellar hemispheric metastatic lesion resection status. Multiple susceptibility lesions within the surgical field are again seen, unchanged.Craniectomy site pseudomeningocele is redemonstrated, unchanged in terms of its size and MR signal intensity.Somewhat irregular and linear enhancements along the resection margin are again seen, unchanged in terms of extent and MR signal characteristics since prior scan. Multifocal bihemispheric parenchymal enhancing nodules are again seen, unchanged since prior scan.No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post left suboccipital craniectomy with left cerebellar metastatic lesion resection status. Unchanged postoperative changes including surgical field products related susceptibility lesions and craniectomy site pseudomeningocele.2. No difference of left side resection site enhancements. No evidence of tumor recurrence or residual mass.3. Unchanged multiple enhancing metastatic nodules since prior scan. 4. No evidence of new ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Male, 16 years old, with a suprasellar cystic lesion status post fenestration, yearly follow-up exam. The left frontal approach ventricular catheter remains in stable position coursing inferiorly and medially through the left frontal horn, foramen of Monro, and third ventricle, traversing the ventriculocisternostomy to terminate within the cystic suprasellar space. This cystic space shows no significant interval change in size measuring 20 x 16 mm in the axial plane (image 12 series 601).The pituitary gland remains evident along the floor of the sella and is stable in size and morphology. No restricted diffusion, parenchymal signal abnormality, edema or new mass effect seen. No new abnormal extra-axial fluid collections are detected. The ventricular system is unchanged in size and configuration.

Output: 1.Stable positioning of the left frontal approach catheter.2.Stable size of the cystic suprasellar space


Instruction: Generate impression based on findings.

Input: 70 year old man with history of AML s/p chemotherapy and recent LV dysfunction, as well as atypical chest pain, referred for cardiac MRI with vasodilator stress testing.MEDICATIONS: Furosemide, lisinopril, rivaroxaban First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 103 ml (normal range 47+/-19), the LV mass index is 47 g/m2, and the LV mass is 109 g. There is extrinsic compression of the inferolateral wall by the diaphragm. Otherwise, there is global hypokinesis. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with low-normal systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 198 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 106 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a bovine brachiocephalic branching pattern. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (33mm at the level of the ascending aorta)Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. There is an SVC catheter present. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is left hemidiaphragm elevation. There is a chest wall Port-A-Cath. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and mildly reduced systolic function (LVEF 48%). Extrinsic compression on the lateral wall of the left ventricle by the elevated left hemidiaphragm.4. Normal RV size and low-normal systolic function (RVEF 47%).5. Severe left atrial dilation.6. Mild main pulmonary artery dilation.


Instruction: Generate impression based on findings.

Input: History of left shoulder instability, evaluate for labral tear ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There appears to be anterior superior sublabral foramen, normal anatomic variant (series 501 image 11). No definite labral tear is identified. Contrast remains within the glenohumeral joint without communication with subacromial and subdeltoid bursa.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Anterior superior sublabral foramen, normal anatomic variant. No labral or rotator cuff tear is identified.


Instruction: Generate impression based on findings.

Input: Portable tunnel syndrome with now repeat of symptoms. Pain. The median nerve is abnormally enlarged within the carpal tunnel, measuring nearly 30 sq mm at the level of the distal carpal row. Although there is loss of fat signal intensity within the carpal tunnel, I see no frank enhancement to indicate synovitis. Low signal intensity within the subcutaneous fat volar to the carpal tunnel may represent a surgical scar from prior carpal tunnel release. Bandlike low signal intensity extending from the hook of the hamate to the trapezium likely represents a combination of residual retinaculum and scarring and is bowed volarly. I see no mass within the carpal tunnel itself. A small (5 mm) collection of fluid signal intensity with minimal enhancement is situated between the volar lip of the distal radius and the overlying flexor pollicis longus tendon and likely represents a small ganglion, perhaps associated with the volar radiolunotriquetral ligament.The bones of the wrist appear normal. Minimal enhancement of the distal radioulnar joint may represent a very mild synovitis, but this is equivocal. A tiny focus of enhancement just distal to the membranous portion of the scapholunate ligament may represent focal synovitis or tiny ganglion, but is of questionable clinical significance. I otherwise see no specific findings to indicate a scapholunate or lunotriquetral ligament tear. Mild increased signal intensity within the medial fibers of the articular disc of the triangular fibrocartilage may reflect mild degeneration, but I see no fluid-filled tear. The tendons appear intact.

Output: Abnormal enlargement of the median nerve within the carpal tunnel and other findings as described above.