Instruction: Generate impression based on findings.

Input: Back pain and radiculopathy. Compression fracture of L1. Patient had fall in 2015. Evaluate if compressing nerve roots. Also question of malignancy in the lumbar spine, for which postcontrast imaging requested. Five lumbar type vertebral bodies are presumed to be present. There is a compression fracture involving the L1 vertebral body with approximately 60% loss of height and grossly similar to prior chest CT dated 3/8/2016. There is mild degree of bone marrow edema as well as a small fluid containing cleft along the superior fractured endplate. There is mild osseous retropulsion which was also evident on prior CT. Remainder of the vertebral body heights in the lumbar spine are maintained. There is grade 1 anterolisthesis of L4 on L5. Alignment of the lumbar spine is otherwise maintained. Bone marrow signal is benign. No suspicious osseous lesions are appreciated. Conus terminates at the mid L2 level.Partially imaged thoracic spine on the sagittal images demonstrates a disc bulge at the T10-T11 level with mild to moderate spinal canal stenosis.Multilevel degenerative changes are seen, with individual levels as described below:T12-L1: Osseous retropulsion related to the compression fracture with moderate degree of spinal canal stenosis without frank compression of the distal cord at this level. There is mild to moderate degree of bilateral neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is mild narrowing of the spinal canal in its lateral aspects related to prominence of the epidural fat. Otherwise there is no significant spinal canal or neural foraminal stenosis. No significant disc disease.L3-L4: There is up to moderate degree of spinal canal stenosis, primarily involving the lateral aspects of the spinal canal related to prominence of the epidural fat. There is no significant disc disease. Neural foramina are patent. L4-L5: There is severe spinal canal stenosis at this level related to anterolisthesis, advanced bilateral facet arthropathy, and ligamentum flavum thickening. There is mild bilateral neural foraminal stenosis. Moderate disc height loss with fatty endplate marrow signal changes.L5-S1: There is moderate to severe disc height loss with fatty endplate marrow signal changes. Otherwise no significant disc bulge. Mild facet arthropathy. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Multilevel degenerative changes in the lumbar spine, worst at the L4-L5 level where there is severe spinal canal stenosis. Additional levels as detailed above.2. L1 compression fracture with approximately 60% height loss appears similar to prior CT from 3/8/2016. There is residual marrow signal edema. There is osseous retropulsion with associated moderate degree of spinal canal stenosis as well as mild to moderate degree of bilateral neural foraminal stenosis at the T12-L1 level.3. No suspicious lesions within the spine to suggest neoplasm.4. Grade 1 degenerative spondylolisthesis at L4-L5.


Instruction: Generate impression based on findings.

Input: 42-year-old male with history of bladder cancer status post radical cystectomy with orthotopic neobladder. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No evidence of hydronephrosis..RETROPERITONEUM, LYMPH NODES: Mildly prominent lymph nodes adjacent to the left renal vein are unchanged. No evidence of lymphadenopathy.BOWEL, MESENTERY: No bowel dilatation or bowel wall thickening to suggest small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy and neobladder reconstruction.LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Again noted is the rind of enhancing prevertebral soft tissue at L1-L4 level is not significantly changed. There is T2 signal abnormality and enhancement at L1 inferior endplate, L2 superior and inferior endplates, and L4 vertebral body near the disc spaces.OTHER: No significant abnormality noted.

Output: 1.Interval increased prominence of heterogeneous signal abnormality and enhancement at L1/2, L2/3, and L3/4 with associated rind of enhancing prevertebral soft tissue. Differential considerations include chronic inflammatory/infectious etiology; neoplasm is considered less likely.2.No evidence of visceral organ metastases.


Instruction: Generate impression based on findings.

Input: Right base of skull mass. MRI: There is an unchanged lesion with high T2 and low T1 signal involving the right petrous apex and basiclivus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged T2 hyperintense foci within the cerebral white matter and foci of susceptibility effect that may represent chronic microhemorrhages. There is also unchanged encephalomalacia with hemosiderin lining in the medial left temporal lobe. There is a partially-empty sella. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is an unchanged left MCA bifurcation aneurysm measuring approximately 3 x 2 mm and a right PCOM aneurysm measuring approximately 3 x 2 mm. There are no new cerebral aneurysms or significant steno-occlusive lesions.

Output: 1. Unchanged lesion within the right petrous apex and basiclivus for which the differential diagnosis includes trapped secretions and less likely neoplasm, such as low grade chondrosarcoma. 2. Unchanged subcentimeter cerebral aneurysms.3. Unchanged probable microangiopathic white matter disease and hypertensive microhemorrhages, as well as left medial temporal lobe encephalomalacia.


Instruction: Generate impression based on findings.

Input: There is moderate motion artifact limiting evaluation. Given this limitation, there is no abnormal enhancement, acute infarct, mass effect, or cerebral edema. There are patchy periventricular and subcortical white matter T2 signal abnormalities which are nonspecific, likely representing advanced chronic microvascular ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is bilateral maxillary sinus mucosal thickening. The skull and extracranial soft tissues are unremarkable.

Output: 1.Moderately motion degraded exam with no acute infarct, abnormal enhancement or mass effect.2.Advanced chronic microvascular ischemic changes.


Instruction: Generate impression based on findings.

Input: 51 year old woman with history of cardiac sarcoid and new-onset heart block who presents for cardiac MRI to evaluate for progression of disease Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 26%, the LV end diastolic volume index is 155 ml/m2 (normal range: 65+/-11), the LVEDV is 272 ml (normal range 109+/-23), the LV end systolic volume index is 115 ml/m2 (normal range 18+/-5), the LVESV is 201 ml (normal range 31+/-10), the LV mass index is 78 g/m2 (normal range 67+/-11), and the LV mass is 137 g (normal range 114+/-24). There is global hypokinesis with regional variations. There is akinesis of the basal to mid anterior wall and severe hypokinesis of the basal to mid inferior walls. There is limited evaluation of gadolinium enhancement due to breathhold difficulties however there is likely extensive mid-myocardial late gadolinium enhancement in the entire base and mid anterior, septal, and inferior walls. No intracardiac thrombus.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 95 ml/m2 (normal range 69+/-14), the RVEDV is 166 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve posterior leaflet is tethered and there is at least moderate mitral regurgitation. The jet is eccentric and posteriorly directed. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a common origin of the left innominate and left common carotid artery. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is bilateral hilar and mediastinal lymphadenopathy. There are areas of high signal in the lungs that correlate with granulomas seen on prior chest CT. No evidence of fibrosis or pleural effusions.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function[LVEF 26%]2. The right ventricle is normal in size with normal systolic function [RVEF 58%]3. There is extensive mid-myocardial late gadolinium enhancement in the entire base and mid  anterior, septal, and inferior walls, similar to prior.  I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Metastatic cervical cancer. Evaluate for brain metastases. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable without abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No evidence of abnormal intracranial enhancement to suggest metastases.


Instruction: Generate impression based on findings.

Input: Diagnosis: Encounter for examination for normal comparison and control in clinical research programClinical question: Patient with metastatic gastric cancer. Please rule out brain mets prior to starting study. 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 mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter lesions of a mild degree are nonspecific. They are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: low back pain with left side radicular pain; sciatica 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. There is disk dessication and end plate reactive change present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild disk desiccation and facet hypertrophy present at this level.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.There is a small left renal cystic lesion along the superior aspect of the left kidney which is incompletely visualized on this exam. Most likely this represents a simple renal cyst.

Output: 1.There are mild degenerative changes present in the lumbar spine without significant compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 32-year-old female with hip pain. Pelvis: The right and left hip joints are symmetric and appear normal with no evidence of joint space narrowing or osteophyte formation. The sacroiliac joints are symmetric and appear normal. The visualized lumbosacral spine appears normal. The soft tissues are unremarkable.Right hip: No joint space narrowing or osteophyte formation is evident. The right hemipelvis and proximal femur demonstrate no significant abnormalities.

Output: No acute fracture or malalignment.


Instruction: Generate impression based on findings.

Input: Brain: There are no T2/FLAIR abnormalities. There is no abnormal signal in T1. There are no restriction or susceptibility abnormalities. Ventricular size is normal. There is no midline shift. There is no evidence of hemorrhage or mass effect. No structural abnormalities. The vascular flow voids are normal. Cervical spine: There is normal alignment or the vertebral bodies. There is no subluxation. There is no definite ligamentous STIR hyperintensity. The intervertebral disc spaces are preserved. No evidence of cord abnormal signal. The neural foramina are within normal limits. MRA neck: Dissection protocol was inadvertently not obtained. The right vertebral artery along the V2 segment is not well visualized due to venous contamination. Axial reformatted images suggest that the vessel is irregular and discontinuously narrowed, although the T2 flow void appears more uniform on MRI of the cervical spine. The axial T1-weighted images do not demonstrate any gross evidence of mural hematoma along the vertebral arteries. The dominant left vertebral body is within the normal limits. The common carotid arteries and the cervical carotid arteries are within normal limits.

Output: 1. Unremarkable MRI of the brain and of the cervical spine.2. The V2 segment of the right vertebral artery is questionably narrowed and irregular, although evaluation is limited due to venous contamination. Arterial dissection cannot be entirely excluded. If there is clinical suspicion for dissection, CTA of the neck may be obtained. Please note that dissection-specific sequences were inadvertently not obtained.Dr. Jason Choi was notified by Dr. Arie Franco on 11/8/2015 at 1:40 PM


Instruction: Generate impression based on findings.

Input: Clinical question: h/o neurocytoma; preop planning for resectionSigns and Symptoms: preop planning The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a midline mass present along the falx measuring 45x19mm axial dimensions. It contains foci of high signal on T1 centrally and is peripherally hypointense on T2 and T1. There is some associated signal hyperintensity within the cingulate sulcus.A focus of encephalomalacia is present along the left superior frontal gyrus.The patient is status post left frontal craniotomy.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Examination was performed for the purpose of stereotactic guidance during surgery. There is a midline mass present which has hemorrhagic components within it and is associated with adjacent siderosis within the cingulate sulcus.2.There is encephalomalacia along the left superior frontal gyrus.3.Patient status post left frontal craniotomy


Instruction: Generate impression based on findings.

Input: 55-year-old female with strong family history of breast cancer in mother diagnosed at 72 and sister with bilateral breast cancer. Personal history of a right breast fibroadenoma removed in 1989. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 39 years Female Reason: yearly surveillance of 5mm 7th nerve lesion History: loss of hearing left ear Provider Name: ISSAM A. AWAD ISSAM A. AWAD BRAINThe CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cysts.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.There is a 4 mm enlargement of the right geniculate ganglion does not appear to be different than the prior exam from 6/6/2015. The basilar artery is not tortuous and does not abut the trigeminal nerves. To the extent of visualization no significant arterial vascular structure abuts the trigeminal nerves. The left petrosal vein appears to be adjacent to the trigeminal nerve which is not unusual

Output: There is a 4 mm enlargement of the right geniculate ganglion does not appear to be different than the prior exam from 6/6/2015. This can be seen on the temporal bone CT. Is not well documented on this MRI exam. On the prior CT of the temporal bones it appears to break through the tegmen tympani. Please note that contrast-enhanced MRI exams or more sensitive in the detection of cranial nerve lesions compared to noncontrast MRI exams. The basilar artery does not abut the trigeminal nerves.


Instruction: Generate impression based on findings.

Input: Reason: left shoulder pain not responding to PT, please evaluate for pathology History: left shoulder pain ROTATOR CUFF: There is intermediate signal intensity along the bursal surface fibers of the supraspinatus at its insertion which may reflect tendinosis and/or fraying, but we see no fluid-filled tear. The supraspinatus muscle appears intact. There is perhaps minimal infraspinatus tendinosis as well, but we see no tear. The infraspinatus muscle appears intact. The subscapularis muscle and tendon appear intact. There is a small defect in the underlying humeral head which may be degenerative in etiology. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Minimal osteoarthritis affects the acromioclavicular joint. There is no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is intermediate signal intensity within the superior labrum, but we are uncertain if this represents prominent undercutting of the articular cartilage or a SLAP tear. This is not necessarily of any clinical significance.BICEPS TENDON: Two low signal intensity structures are noted within the bicipital groove. While it is possible this could represent a longitudinal split tear of the tendon of the long head of the biceps, we suspect that this is a normal variant accessory tendon, as the intra-articular portion of the tendon of the long head of the biceps appears normal. There is a small amount of fluid within the tendon sheath which is not necessarily of any clinical significance.ADDITIONAL

Output: 1. Very mild tendinosis and partial thickness bursal surface fraying of the rotator cuff as described above. We see no full-thickness rotator cuff tear.2. Minimal osteoarthritis of the acromioclavicular joint.3. Equivocal tear of the superior labrum and probable normal variant accessory biceps tendon. These findings are not necessarily of any clinical significance, but could be further evaluated with MR arthrography if clinically warranted.


Instruction: Generate impression based on findings.

Input: History of primary CNS lymphoma. There are postoperative findings in the right frontal region, with unchanged right superior frontal gyrus encephalomalacia anteriorly. There is also persistent patchy white matter T2 hyperintensity in the periventricular regions bilaterally. There is a chronic left inferior cerebellar hemisphere subcentimeter infarct. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intraparenchymal 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. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No evidence of intracranial tumor recurrence.


Instruction: Generate impression based on findings.

Input: 29 year-old female with left shoulder pain. ROTATOR CUFF: The rotator cuff musculature and tendons are within normal limits. SUPRASPINATUS OUTLET: There is trace fluid in the subacromial-subdeltoid bursa, however, we see no gadolinium within the bursa to suggest full-thickness tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal-appearing shoulder. No findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Dizziness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are nonspecific periventricular and subcortical white matter T2/FLAIR hyperintense foci which may be due to minimal small vessel ischemic disease. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Study on PSP. There is atrophy of the midbrain. There also appears to be mild atrophy of the cerebellar vermis. There are minimal confluent and punctate foci of T2 hyperintensity within the supratentorial white matter, which appears similar to the previous exam. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation.

Output: 1.Atrophy of the midbrain related to progressive supranuclear palsy. Please refer to the prior MRI for additional details.2.Nonspecific mild diffuse cerebral white matter abnormality may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The cerebellar tonsils remain somewhat low lying especially on the left although with normal configuration. There is stable left parieto-occipital plagiocephaly. The mucosal thickening within the paranasal sinuses is significantly improved since the previous study. There is persistent trace fluid in the mastoids.NECK

Output: 1. Continued stable post treatment changes relating to previous left parotid space rhabdomyosarcoma. No definite recurrent mass. 2. Stable appearance of nonspecific enlarged right level 2a lymph node.3. Essentially unremarkable contrast enhanced MRI brain. Interval significant improvement in paranasal sinus disease.


Instruction: Generate impression based on findings.

Input: Migraine without aura, not intractable, without status migrainosus [G43.009] / Headache [R51], Reason for Study: ^Reason: r/o structural lesion History: headache No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: 50-year-old female patient with history of desmoid tumor. Evaluate for progression. ABDOMEN:LIVER, BILIARY TRACT: Again seen are two mildly T2 hyperintense arterial enhancing lesions in segment 2 and segment 7 of the liver that do not significantly retain contrast on delayed imaging. The common bile duct is mildly enlarged and measures up to 7 mm in maximal diameter. There is no obvious mass lesion or obstructing cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No mass lesions seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mass abutting the inferior aspect of the pancreatic body currently measures 7.7 x 6.2 x 3.5 cm (axial series 12 image 61 and coronal series 9 image 32), previously 7.7 x 7.1 x 4.3 cm. This mass is again noted to encase and attenuate the SMV and SMA, which remain patent.BOWEL, MESENTERY: There are two broad-based ventral hernias in the central and right abdomen containing loops of bowel without evidence of complication.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Again seen are multiple uterine masses, which appear to be stable compared to prior examination. The majority of these masses have signal characteristics consistent with fibroids. However, again seen is a well-defined T2 intermediate signal intensity lesion in the right uterine fundus, which currently measures 4.5 x 3.3 cm (series 29 image 6), previously 5.5 x 3.9 cm.Bilateral ovarian cystic foci and a small amount of free fluid are again noted. A left ovarian cyst measures 4.1 cm in maximal dimension (series 29 image 22), previously 3.7 cm. Numerous nabothian cysts are again noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Minimal interval decrease in size of patient's known mesenteric-based desmoid tumor.2.Mild enlargement of the common bile duct without obvious mass lesion, cholelithiasis or pancreatic head lesion. ERCP can be obtained as clinically indicated.3.Indeterminate right fundal uterine mass has minimally decreased compared to prior examination. 4.Bilateral cystic foci in the ovaries are likely physiologic follicles.


Instruction: Generate impression based on findings.

Input: Adenoid cystic carcinoma of the right parotid gland (T4aN0), underwent right total parotidectomy and a right selective neck dissection with a rotational skin flap closure on 2/16/12. The patient experiences left facial numbness. There are partially imaged findings related to right parotidectomy without definite evidence of mass lesions in this region. There is unchanged nonspecific enhancement in the left petrous apex region. Otherwise, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The cavernous sinuses appear to be intact, albeit mildly asymmetric. There are a few scattered nonspecific foci of cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is persistent fluid signal within the right mastoid air cells. There is mild scattered paranasal sinus mucosal thickening. There are bilateral lens implants. There is a 14 mm wide right maxillary periapical cyst. There is an unchanged 8 mm diameter left parotid cystic lesion. There is diffuse T2 hyperintensity and enhancement in the left masticator muscles. There are left temporomandibular joint degenerative changes.

Output: 1. Stigmata of denervation effects in the left trigeminal nerve distribution.2. Unchanged subcentimeter cyst lesion in the left parotid gland without evidence of associated enhancing mass, although the images are not optimized for assessment of this region.3. Postoperative findings related to right parotidectomy without discernible evidence of tumor, although the images are not optimized for assessment of this region.4. Unchanged nonspecific enhancement in the left petrous apex region.5. Left temporomandibular joint degenerative changes.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with intracerebral hemorrhage, assess for etiology. Predominantly T1 isointense and T2 hypointense signal within the left thalamus is compatible with the known evolving late acute left thalamic hematoma. The thalamus is expanded and there is moderate edema in the surrounding parenchyma which tracks into the basal ganglia and parietal lobe as well as down into the midbrain. This hematoma results in fairly significant generalized mass-effect with midline shift to the right of up to 9 mm and effacement of the left quadrigeminal plate cistern. The midbrain is distorted as well. Allowing for differences in technique, the overall size of the hematoma is probably not increased.Also seen is partially T1 hyperintense and T2 hypointense material within the ventricular system compatible with intraventricular extension of hemorrhage. This hemorrhage is evident throughout the ventricular system with associated ventricular dilatation. Again, allowing for differences in technique, there has probably not been a significant change in ventricular size. T2 hyperintensity rimming the ventricles is compatible with transependymal CSF flow. A right frontal approach ventriculostomy is redemonstrated.Scattered areas of restricted diffusion are seen throughout the cerebral hemispheres. Many of these are associated with mild susceptibility, but some are not, and it does not seem likely that they could be accounted for entirely by blood induced artifact. In particular, some of them show a fairly vascular morphology, for example within the anterior left temporal lobe. The background brain demonstrate fairly extensive patchy periventricular T2 hyperintensity which may reflect chronic microvascular ischemic disease. Scattered foci of susceptibility are also seen, some but not all of which are probably chronic.On dedicated vascular images, no definite vascular lesion is seen in the vicinity of the left thalamus to account for the hemorrhage. The left PCA is displaced by mass effect, but it remains patent throughout. No definite high grade vascular stenosis is seen, though some degree of atherosclerotic irregularity is suspected within the cavernous ICAs. Flow related signal within the left sylvian MCA branches is uniformly reduced compared to the right, though this is felt to be an artifact of technique as normal signal recovers in all vessels at the same slice level. No aneurysms are detected within the limits of technique. A prominent right PCOM artery is seen. The ACOM artery and left PCOM arteries are not well seen.

Output: A large left thalamic hematoma with intraventricular extension is redemonstrated. There has been no significant interval change in the size of the hematoma, nor of the quantity of intraventricular blood or degree of ventricular dilatation. No definite vascular lesion is seen underlying the thalamic hematoma.Scattered areas of restricted diffusion are seen throughout the cerebral hemispheres, some of which are vascular in morphology and/or too large to be accounted for by minimal associated susceptibility. Given these findings, the possibility of an embolic phenomenon with secondary hemorrhage should be considered. Vasospasm and vasculitis would be additional but less likely etiologies.


Instruction: Generate impression based on findings.

Input: Thoracic spine: There is a low T1 signal, enhancing lesion involving the posterior elements of T6 with mild expansion of the left lamina and pedicle. There is no discernible compromise to spinal canal or neural foramen. The thoracic spine is in normal alignment. The vertebral body and disk heights are well maintained. There is overall heterogeneity of the bone marrow signal with multiple T1 and T2 hyperintense lesions, compatible with focal fatty marrow and/or intraosseous hemangiomas and what may represent radiation effects in the upper thoracic vertebrae. The spinal cord is of normal caliber and signal. There is no pathological enhancement of the spinal cord. There are minimal disc bulges at T10-11 and T11-12. There is no other significant disc bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. There is an enhancing lesion with low T1 signal in the posterior aspect of the left eighth rib. The left adrenal gland is enlarged, nodular and enhancing measuring up to 2.4 cm. There are partly imaged and incompletely characterized abnormalities in the right lung. Lumbar spine: The lumbar spine is in normal alignment. There is diffusely heterogeneous bone marrow signal multiple foci of T1 and T2 signal which may relate to intraosseous hemangiomas or focal fatty marrow. There is degenerative endplate marrow signal change at L4-5. There is no definite pathological enhancement. Interspinous process enhancement and edema at the L2-3 level are also likely degenerative in nature. The distal spinal cord and conus are within normal limits. There are mild disc bulges with central disc protrusions at L3-4 and L4-5, which along with bilateral facet arthropathy and ligamentum flavum thickening results in mild spinal canal and right neural foraminal stenoses. Mild disc bulges and bilateral facet arthropathy are present at the remaining levels without significant spinal canal or neural foraminal stenosis.

Output: 1. Metastatic lesions involving the posterior elements of T6, left posterior eighth rib, and left adrenal gland. 2. No significant spinal canal stenosis, neural foraminal narrowing or abnormal thoracic spinal cord signal.3. Lumbar degenerative changes predominantly at L3-4 and L4-5 with mild spinal canal and right neural foraminal stenoses at these levels.4. Partly imaged and incompletely characterized abnormalities in the right lung. Please refer to the prior chest CT report for details. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chiari decompression on 4/8/16: post-operative surveillance. There are postoperative findings related to Chiari decompression surgery with a small amount of fluid overlying the posterior fossa dura and C1 laminectomy bed. The cerebellar tonsils display rounded morphologies and there is intact cerebrospinal fluid flow across the neo-foramen magnum. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. At C3-4, there is facet hypertrophy, uncovertebral hypertrophy, and a small central disc protrusion, which results in narrowing of the left neural foramen. There is otherwise no significant spinal canal stenosis at this or the other cervical spine levels. The spinal cord displays normal signal and morphology.

Output: Postoperative findings related to Chiari decompression surgery with a small amount of fluid overlying the posterior fossa dura and C1 laminectomy bed and intact cerebrospinal fluid flow across the neo-foramen magnum.


Instruction: Generate impression based on findings.

Input: Evaluate for left breast implant rupture There is scattered fibroglandular tissuein the right breast.Mild parenchymal enhancement is noted in the right breast. Left silicone implant is intact. No evidence of rupture. No abnormal enhancement is seen in right breast and left reconstructed breast. 5 mm enhancing focus in the central right breast with a dark internal septations most likely represents a benign fibroadenoma. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Injury, unspecifiedClinical question: c-spine clearance, found down unresponsive at home.Signs and Symptoms: c-spine clearance, found down unresponsive at home.Clinical question: evaluate brain mass seen on HCT 10/22.Signs and Symptoms: eval for brain mass seen on CT 10/22. MRI brain:There is a 17x20 mm axial dimension ring enhancing mass present in the left parietal lobe subcortical white matter associated with a small focus of susceptibility effect and diffusion restriction. There is marked amount of vasogenic edema. There is mass effect associated with the vasogenic edema with compression of the right lateral ventricle and sulcal effacement There is a 9mm focus of contrast enhancement associated with susceptibility effect located in the posterior aspect of the left insular cortex.The ventricles are enlarged. There are periventricular confluent and patchy white matter T2 and FLAIR signal hyperintense lesions of a mild to moderate degree. There are patchy signal T2/FLAIR signal hyperintense foci in the brainstem.Normal vascular flow voids are present in the distal carotid arteries, the left vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery flow void is not readily appreciated.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. There is multilevel disk dessication present.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. There is a disk bulge and ligamentum flavum hypertrophy present at this level. There is mild spinal stenosis at this level. There are bilateral uncovertebral osteophytes at this level mildly narrowing the neural foramina at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge and ligamentum flavum hypertrophy present at this level. There are bilateral uncovertebral osteophytes at this level minimally narrowing the neural foramina at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level. There are small bilateral uncovertebral osteophytes at this level minimally narrowing the neural foramina 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 left vertebral artery flow void appears to be intact. The right vertebral artery appears smaller than the left. The right vertebral artery flow void is not readily appreciated.

Output: 1.There is a left parietal lobe ring enhancing mass present associated with minor hemorrhage and diffusion restriction. Differential considerations include infection (abscess) as well as neoplasia (metastasis or possibly primary brain tumor).2.There is a hemorrhagic lesion along the posterior aspect of the left insular cortex.3.Marked ventriculomegaly. The possibility of normal pressure hydrocephalus cannot be excluded. Alternatively this could represent communicating hydrocephalus. 4.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 5.Lesions in the brainstem are most likely vascular related.6.Findings raise the question of possible compromise (i.e. occlusive disease) to the right vertebral artery which is the non-dominant vertebral artery.7.There are degenerative changes present in the cervical spine without significant compromise to the spinal canal or exiting nerve roots. There is mild spinal stenosis at C3-4.


Instruction: Generate impression based on findings.

Input: 65 year old female with persistent back pain. The right sacroiliac joint is slightly wider than that on the left with slight irregularity and more sclerotic margins, as seen on the patient's CT examination from 2010. This may reflect the sequela of previous inflammation or be degenerative in etiology, but we see no enhancement on postcontrast sequences to suggest active sacroiliitis. Please note that this study was not protocoled for detailed evaluation of the lumbar spine. Severe degenerative disc disease affects the level of L4/L5 with signal abnormality and enhancement of the adjacent vertebrae and paravertebral soft tissues on the right. There is a diffuse disc bulge as well as ligamentum flavum hypertrophy with associated moderate spinal canal stenosis at this level. Mild degenerative disc disease affects the levels of L3/L4 and L5/S1. There is facet joint osteoarthritis at the levels of L4/L5 and L5/S1. There are also inflammatory changes in the paravertebral soft tissues at the level of L5/S1, right greater than left, with associated posterior synovial cyst formation.

Output: 1. Mild widening and articular surface irregularity along the inferior aspect of the right sacroiliac joint, which may represent previous inflammation or degenerative changes. We see no findings to suggest active sacroiliitis.2. Degenerative disc disease and facet joint osteoarthritis of the lower lumbar spine as described above.


Instruction: Generate impression based on findings.

Input: 85 year-old man with confusion and dysarthria. There is a left frontal area of encephalomalacia consistent with old ACA stroke. This finding was present on the prior study dated 2/15/2006. There are no CT findings of intracranial hemorrhage. There are no CT findings of acute stroke. However, if stroke is of clinical concern recommend MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Left frontal encephalomalacia consistent with old ACA stroke.2. No CT findings of intracranial hemorrhage or acute stroke. However, if stroke is a clinical concern recommend MRI.These findings were reported to Dr. Corning at 3:30 p.m. 08/11/2008.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with cervicalgia, history of C2 hypodensity on MRI, hot spot on PET. Degeneration of the left C2-3 facet joint is again seen with edema of the marrow, a small amount of fluid in the joint space, and associated enhancement of both the marrow and the adjacent soft tissues. On comparison with the prior MRI, the findings have not significantly changed. Elsewhere, no marrow edema, replacement or enhancement is seen. Slight reversal of the cervical lordosis is unchanged. Vertebral body heights are preserved. Relatively mild degenerative findings are again seen without significant interval change. Foraminal narrowing on the left at C2-3, on the right at C4-5, bilaterally at C5-6 and bilaterally at C6-7 is unchanged.

Output: Redemonstration of left C2-3 facet degeneration with evidence of associated edema and enhancement. Findings have not significantly changed from the prior MRI examination. No new lesions are seen.


Instruction: Generate impression based on findings.

Input: Assess medial and lateral meniscus. MENISCI: There is complex tearing of the posterior horn of the medial meniscus, with vertical and horizontal components. Signal characteristics and morphology of the lateral meniscus are within normal limits, without evidence of discrete tear.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the medial, lateral, and patellofemoral compartments is intact.LIGAMENTS: There is diffuse intrasubstance increased signal within the ACL, suggesting mucoid degeneration with evidence of ganglion formation. The PCL is intact. The collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Complex tear of the posterior horn of the medial meniscus.2.Mucoid degeneration and ganglion formation of the ACL.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of bronchus and lung, unspecified site [162.9], Reason for Study: ^Reason: hx of lung CA, eval brain mets History: weakness Variable size in numerous ring-enhancing lesions with the surrounding edema on bilateral hemisphere as well as posterior fossa including brainstem indicating metastatic lesions.On susceptibility imaging, each lesion shows various portion of susceptibility artifacts indicating intralesional hemorrhage or calcification.On sagittal image, there is about 7 mm tonsillar herniation indicating Chiari malformation.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Left-sided maxillary sinus shows retention cyst.There is no acute ischemic lesion.

Output: Multifocal various sized ring-enhancing lesions with the surrounding edema and possible internal hemorrhage or calcification indicating metastatic lesions as described above.


Instruction: Generate impression based on findings.

Input: Bilateral upper extremity numbness. Rule out stenosis. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a small disc osteophyte complex with right-sided uncovertebral hypertrophy and associated mild right-sided neural foraminal narrowing. No significant spinal canal or left neural foraminal stenosis.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Minimal degenerative changes in the cervical spine with mild right C3-C4 neural foraminal narrowing. There is otherwise no significant spinal canal or neural foraminal stenosis at any level or cord signal abnormality.


Instruction: Generate impression based on findings.

Input: 10-year-old female patient with history of Crohn's disease and fevers.EXAMINATION: MR enterography without and with IV contrast date ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: kidneys and uretersRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:There is persistent sigmoid and rectal wall thickening with enhancement and decreased peristalsis. No evidence of perirectal abscess or fistula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Persistent thickening of the sigmoid colon and rectum without perirectal abscess or fistula.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect, midline shift or suspicious intracranial enhancement. There is mild to moderate diffuse volume loss. There are mild periventricular and subcortical white matter T2 signal abnormalities which are nonspecific, likely representing chronic microvascular ischemic changes. The cerebellar tonsils remain above the foramen magnum. The flow voids at the skull base are intact. There is moderate opacity at the left mastoid air cells. There are degenerative changes in the visualized upper cervical spine with a proximally 4-mm anterolisthesis of C3 on C4.

Output: 1.No acute infarct. 2.Diffuse volume loss and mild chronic microvascular ischemic changes.3.Nonspecific opacification of the left mastoids. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 46 year old male with heart failure with reduced ejection fraction on Milrinone, history of alcohol abuse referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 17%, the LV end diastolic volume index is 230 ml/m2 (normal range: 74+/-15), the LVEDV is 573 ml (normal range 142+/-34), the LV end systolic volume index is 192 ml/m2 (normal range 25+/-9), the LVESV is 479 ml (normal range 47+/-19), the LV mass index is 65 g/m2 (normal range 85+/-15), and the LV mass is 162 g (normal range 164+/-36). The is global hypokinesis with regional variation. The apical to mid inferolateral wall is akinetic and thinned. There is predominantly transmural late gadolinium enhancement of the mid inferolateral wall that is consistent with prior myocardial infarction and the territory is not likely to be viable. There is additionally a mid-wall stripe of late gadolinium enhancement of the basal septum suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. Together, these findings suggest both an ischemic and non-ischemic etiology of the cardiomyopathy. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with severely reduced ejection fraction . The overall RV ejection fraction is 19%, the RV end diastolic volume index is 117 ml/m2 (normal range 82+/-16), the RVEDV is 291 ml (normal range 142+/-31), the RV end systolic volume index is 95 ml/m2 (normal range 31+/-9), and the RVESV is 237 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function (LVEF 17%). There is evidence of (1) a predominantly transmural myocardial infarction involving the basal to mid inferior and inferolateral walls and (2) a mid-wall stripe of fibrosis involving the basal interventricular septum. Together, these findings suggest a dual (ischemic and non-ischemic) etiology of the cardiomyopathy. 2. The right ventricle is mildly dilated with severely reduced ejection fraction (RVEF 19%)3. The territory affected by the myocardium is not likely to be viable. 4. There is at least moderate mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with right hemihypoesthesia and dysarthria. A band of restricted diffusion is seen beginning along the left putamen and extending superiorly toward the lateral ventricular margin. No other areas of restricted diffusion are seen.Scattered foci of parenchymal FLAIR hyperintensity are seen, a nonspecific finding. No evidence of significant generalized edema or mass effect is observed. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricles are normal in size and morphology.

Output: 1.Acute lenticulostriate infarct on the left spanning from the putamen to the lateral ventricular margin.2.Scattered nonspecific FLAIR hyperintense foci which may reflect chronic microvascular ischemic disease.3.No evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: 82-year-old female patient with nausea, anorexia, failure to thrive. Question of cholangitis, hepatic parenchymal infection following findings seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Redemonstration of patchy areas of peripheral T2 hyperintensity with diffusion abnormality within the anterior right and left hepatic lobes, similar to the most recent CT and subtly present on prior MRI; this likely represent cholangitis. No fluid collection or abscess is identified. The hepatic vasculature is patent. There is intra- and extrahepatic biliary ductal dilatation. While pneumobilia limits evaluation of the biliary system, there does appear to be a focus of signal void within fluid in the non-dependent portion of the common bile duct at the level of the ampulla (image 33, series 6). This is suspected to represent a stone, possibly measuring up to 4 mm. SPLEEN: There is an accessory splenule.PANCREAS: The main pancreatic duct is non-dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are multiple bilateral renal cysts, some of which are complicated. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted.

Output: 1.Within limitations of pneumobilia affecting assessment of the biliary system, suspected stone within the common bile duct at the level of the ampulla. 2.Intra- and extrahepatic biliary ductal dilatation with peripheral regions of signal abnormality within the liver favored to represent cholangitis given patient's clinical course.Findings communicated via telephone to J. Abimansour at 1646 hrs on 9/8/2016.


Instruction: Generate impression based on findings.

Input: Female, 46 years old, with known right parietal cavernoma with DVA, clinical presentation of seizures. An 8 x 7 mm lesion is evident within the right parietal white matter demonstrating bubbly internal T2 bright signal and a rim of susceptibility. Associated with this lesion, there is a small developmental venous anomaly which drains to the right thalamostriate system.A small developmental venous anomaly is evident within the posterior left frontal white matter. No other definite pathologic or anomalous enhancement is seen. Mild susceptibility effect is evident within the posterior aspect of the right superior frontal sulcus and along the right calcarine fissure.A prominent perivascular space is evident along the right anterior commissure. No other areas of significant parenchymal signal abnormality are detected. No abnormal extra-axial collections are noted. The ventricular system is within normal limits for size and morphology. Incidental note is made of bilateral choroid plexus cysts.

Output: 1.A lesion in the right parietal white matter is seen compatible with a cerebral cavernous malformation with associated developmental venous anomaly.2.A small developmental venous anomaly is also evident within the left posterior frontal white matter.3.Hemosiderin staining along the posterior aspect of the right superior frontal sulcus, and along the right calcarine fissure, would suggest the sequelae of a prior hemorrhagic event.


Instruction: Generate impression based on findings.

Input: History of multiple sclerosis: pain and numbness. There appears to be faint T2 hyperintensity in the mid thoracic spinal cord, with perhaps mild volume loss. 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 or neural foraminal stenosis. However, there is an unchanged T2 hyperintense lesion in the right S2-3 neural foramen that measures 15 mm in width. There is also a punctate perineural cyst in the incompletely images right C6-7 neural foramen. The paravertebral soft tissues are unremarkable.

Output: 1. Apparent faint T2 hyperintensity in the mid thoracic spinal cord, with perhaps mild volume loss may represent a chronic demyelinating lesion. 2. Am unchanged T2 hyperintense lesion in the right S2-3 neural foramen is incompletely characterized without intravenous contrast, but likely represents a perineural cyst.


Instruction: Generate impression based on findings.

Input: 69-year-old female. Chronic low back pain. Rule out degenerative disk disease, facet arthropathy. Nonenhanced CT of lumbar spine:CT examination of the lumbar spine cannot evaluate for herniation of disk material. If acute herniated disk is suspected an MRI examination should be performed.A bony density of vertebral column is unremarkable. Minimal grade 1 antral listhesis at L4 -- L5 is noted and the alignment the vertebral column is otherwise unremarkable.Advanced degenerative disk disease at L1 -- L2 with vacuum phenomenon and to a lesser degree degenerative disk disease throughout the rest of lumbar spine is noted.T12 -- L1.Mild degenerative disk disease and hypertrophic changes of posterior elements. No central spinal stenosis or neural foramina compromise.L1 -- L2.Advanced degenerative disk disease and vacuum phenomena. Hypertrophic changes of the articulating facets more pronounced on the left with vacuum reading the left facet complex is present. No detectable central spinal stenosis. I suspect compromise of the neural foramina secondary to asymmetric hypertrophic changes of posterior elements.L2 -- L3.Mild degenerative disk disease and shallow broad-based bulge of disk material. No central spinal stenosis. Hypertrophic changes of posterior elements appears slightly more prominent on the left with resultant mild left neural foramina compromise. No central spinal stenosis.L3 -- L4. Mild degenerative disk disease and hypertrophy changes of posterior elements which appears a slightly more pronounced on the right. No central spinal stenosis. No definitive neural foramina compromise.L4 -- L5.Mild to moderate degenerative disk disease. Minimal grade 1 grade anterolisthesis.Moderate to advanced hypertrophic changes of posterior elements which is more prominent on the left and with vacuum from. There is no central spinal stenosis. No definitive neural foramina compromise.L5 -- S1.Mild to moderate degenerative disk disease with loss of disk height and vacuum phenomenon. Extensive hypertrophic changes of posterior elements on the right and minimally on. No central spinal stenosis. Mild broad-based bulge of disk material. Possible mild compromise of bilateral neural foramina.

Output: 1.Degenerative disk disease and hypertrophic changes of posterior elements throughout the lumbar spine as detailed.2.Discrepancy in the degree of hypertrophic changes of posterior elements between the two sides at multiple levels as detailed. No detectable scoliosis is present.3.No central spinal stenosis at any level.4.Mild neural foramina compromise as detailed per level above.5.This examination cannot evaluate for herniated disk is clinically questioned. If concern for herniated disk exist an MRI is recommended.


Instruction: Generate impression based on findings.

Input: 45-year-old male patient with left knee pain. Evaluate for medial meniscus tear with Baker's cyst. MENISCI: There is a defect and tear through the posterior horn of the medial meniscus with both a vertical and horizontal component (sagittal T2 series 9 images 25 through 28) along the superior articular surface. The anterior horn of the medial meniscus and the lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: There is a partial-thickness cleft in the cartilage of the medial patellar facet. There is no focal chondral defect in the medial or lateral compartments.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex are intact. The patellar retinacula are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Tear through the posterior horn of the medial meniscus with both vertical and horizontal components.2.Partial-thickness cartilage cleft in the medial patellar facet.


Instruction: Generate impression based on findings.

Input: 56 year old man with metastatic renal cell cancer. Concern for new intracranial metastatic lesion. Examination is suboptimal due to extensive motion artifact. There is however noted a very large necrotic tumor in the right frontal lobe measuring approximately 34 mm by 38 mm in transaxial dimension measured on axial image 17. There is approximately 10.3 mm midline shift at the level of the septum pellucidum. This finding is consistent with a metastatic lesion. In addition a focal area of low attenuation in the left posterior parietal is noted which demonstrates no evidence of enhancement. This finding may represent an old stroke. This examination is otherwise unremarkable for an iny additional metastatic lesions. Note however should be made that due to suboptimal quality of the exam secondary to motion artifacts and repeat exam or an MRI is recommended to exclude the possibility of additional metastatic lesions. No evidence of hemorrhage or hydrocephalus is detected.

Output: Large necrotic right frontal lobe tumor believed to represent metastatic lesion from patient's known renal cell cancer. Please see above comments.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Incidental note is made of a benign Thornwaldt cyst in the midline nasopharynx.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. Incidental note is made of a tiny fenestration of basilar artery immediately past the vertebral artery confluence.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.

Output: 1.There is no evidence of intracranial hemorrhage, mass, or acute infarct. 2.Minimal chronic small vessel ischemic disease.3.No flow-limiting stenosis involving the intracranial or neck arteries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Intra-vs. extra-articular fluid collection. Evaluate fluid collection seen on CT in subscapularis. There is a collection anterior to the subscapularis muscle with intermediate T1 signal, high T2 signal, and rim enhancement with central low signal on post-contrast imaging which is compatible with an infected fluid collection. This collection tracts along the subscapularis muscle to its insertion on the humeral head and communicates with the subdeltoid bursa. The collection measures at least 1.5 cm in depth and 4.5 cm in the transverse dimension, however, a portion of the collection is not included in the field of view. Additionally, there is a large joint effusion.Bone marrow signal is within normal limits.Mild osteoarthritis affects the acromioclavicular joint. Glenohumeral joint alignment is within normal limits. Glenohumeral joint articular cartilage is intact. There are subchondral cysts within the humeral head which are likely degenerative. No rotator cuff tear is identified.

Output: Extra-articular infected fluid collection anterior to the subscapularis muscle is likely in the subcoracoid bursa with extension into the subacromial/subdeltoid bursa.


Instruction: Generate impression based on findings.

Input: Female 35 years old Reason: Elevated bilirubin in acute pancreatitis/ on TPN. Evaluate biliary system History: Elevated bilirubin in acute pancreatitis/ on TPN. Evaluate biliary system ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No focal hepatic lesions on the noncontrast exam. Patent vessel flow voids are seen in the main portal vein.Biliary tree is normal in caliber. No significant intrahepatic ductal dilatation. Common bile duct measures 7 mm. No definite evidence of choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is edematous compatible with acute pancreatitis. There is mild pancreatic ductal dilatation and slight sidebranch dilatation.Small foci of T2 hyperintense lesions in the pancreas likely represent either small intrapancreatic pseudocysts or dilated side branches.There is a fluid pocket between the pancreatic tail and the stomach measuring 5.2 x 2.4 cm on image 25/series 401 and may represent a pseudocyst.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small left pleural effusion.

Output: 1.No biliary ductal dilatation as clinically questioned. No evidence of choledocholithiasis.2.Findings of pancreatitis with a probable developing pseudocyst adjacent to the tail of the pancreas.


Instruction: Generate impression based on findings.

Input: Female, 48 years old, with new severe headaches. Evaluate for intracranial mass. A single punctate focus of FLAIR hyperintensity is seen within the left centrum semiovale, unchanged. No other significant parenchymal signal abnormality, edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra axial fluid and the ventricles are normal in size and morphology. Minimal prominence of the central canal of the spinal cord in the upper cervical region is unchanged and likely within the limits of normal variation.

Output: No significant interval change and no findings which would account for the patient's headaches.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with transient ischemic attack. Brain MRI:No restricted diffusion is seen. There is no evidence parenchymal edema or mass effect. No findings to suggest intracranial hemorrhage or any abnormal extra axial fluid collection are detected. The ventricular system is normal in size and morphology. Again seen is crowding at the level of the foramen magnum with cerebellar tonsillar ectopia, right side more than left, similar to prior.Brain MRA:No significant intracranial vascular stenosis or occlusion is observed. No aneurysm or vascular malformation is detected.Neck MRA:Mild mural irregularity at the carotid bifurcations is seen which could reflect either mild atherosclerotic disease or imaging artifact (to which noncontrast neck MRA images are particularly susceptible). Otherwise, no significant stenosis is detected by NASCET criteria within the carotid or vertebral vasculature.C-spine MRI:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is seen. The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No epidural process is suspected.C2-3: Unremarkable. C3-4: Mild facet hypertrophy. Left uncovertebral hypertrophy with slight left foraminal osteophytic spurring. Moderate left foraminal narrowing. No significant interval changes.C4-5: Unremarkable. C5-6: Mild facet hypertrophy. Mild uncovertebral hypertrophy. No significant spinal canal or foraminal stenosis. No significant interval changes.C6-7: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation with a small central extrusion. No significant generalized spinal canal stenosis. Mild left foraminal narrowing. No significant interval changes.C7-T1: Mild facet hypertrophy. Mild posterior disc-osteophyte complex formation with a small central disc protrusion which appears similar to prior. No significant spinal canal or foraminal stenosis. No significant interval changes.

Output: 1.No evidence of acute ischemia or any other significant intracranial abnormality. Cerebellar tonsillar ectopia is unchanged.2.No significant vascular abnormality on either the brain or neck MRA. Mild irregularity at the carotid bifurcations may represent imaging artifact or perhaps mild atherosclerotic disease.3.Mild degenerative disc disease is again seen without significant interval change and with no areas of high-grade spinal canal stenosis. The spinal cord is unremarkable.


Instruction: Generate impression based on findings.

Input: 43 year old female patient with pain in the recto-vaginal space. PELVIS:UTERUS, ADNEXA: A cystic lesion within the right adnexa measuring 2.0 x 2.8 cm likely represents a physiologic cyst in a premenopausal female. An ill-defined intermediate signal, non-enhancing round structure within the myometrium in the body of the uterus measuring 1.5 x 1.5 cm likely represents a fibroid. There is borderline thickening of the junctional zone, measuring up to 11 mm, with poor distinction of the myometrial/endometrial junction. There is arcuate morphology of the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No mass or fluid collection is noted within the rectovaginal space.

Output: 1. Findings highly suspicious of adenomyosis; correlate with prior ultrasound.2. Uterine fibroid and probable physiologic right adnexal cyst.


Instruction: Generate impression based on findings.

Input: Bacteremia and back pain. There is degenerative spondylosis in the lower lumbar spine, including a disc extrusion at L5-S1 that is slightly eccentric to the left and severely narrows the spinal canal. In conjunction with facet hypertrophy, there is only mild narrowing of the bilateral neural foramina at L5-S1. In addition, mild high T2 signal and enhancement in the inferior L5 vertebral body, which is likely related to degenerative disease. There is a small disc protrusion with annular fissuring at L4-5 with slight spinal canal narrowing, but no neural foramen stenosis. There is a focus of high T1 and T2 signal with mild enhancement in the C2 vertebral body, which likely represents a hemangioma. Aside from intravertebral disc herniations in the lower thoracic and lumbar spine, the vertebral body heights are preserved. The vertebral column alignment is anatomic. There is a prominent retroperitoneal lymph node that measures up to 35 mm anterior to the L5 vertebral body. Enhancement of the surrounding prevertebral soft tissues may be treatment-related. Areas of pulmonary consolidation are better delineated on the body CT.

Output: 1. Degenerative spondylosis in the lower lumbar spine, with a disc extrusion at L5-S1 that severely narrows the spinal canal. 2. No evidence of infectious discitis-osteomyelitis or abscess in the spine.3. A prominent retroperitoneal lymph node likely represents metastatic disease.


Instruction: Generate impression based on findings.

Input: History of vaginal cancer. Perineal pain and bleeding. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Partially distended urinary bladder.LYMPH NODES: Small left obturator lymph node measuring less than 1 cm in short-axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Soft tissue mass centered in the left deep pelvis dorsolateral to the urethra which the mass encases at least 180 degrees (series 501/16) and displaces anterolaterally towards the left (series 501/15). The lesion invades the proximal vagina circumferentially. The lesion extends across the midline between the urethra and vagina towards the right. The lesion has a broad-based abutment with the right levator ani muscle which it displaces leftward (series 501/19) and invades the left levator ani musculature (series 501/19). Additionally there is a fingerlike projection abutting the internal rectal sphincter at several levels (series 501/18-19).The mass extends caudally into the labia, left greater than right. The lesion abuts the cortex of the left inferior pubic ramus. The lesion measures up to 5.1 x 3.5 cm in axial dimension and extends 5.7 cm in the craniocaudal dimension (series 601/27).Heterogeneous mottled bone marrow signal intensity is nonspecific.OTHER: No significant abnormality noted.

Output: Distal vaginal mass with local invasion, including involvement of the external anal sphincter and suspected internal anal sphincter involvement, as described above.Small pelvic lymph node is non-specific.


Instruction: Generate impression based on findings.

Input: History of metastatic adenocarcinoma of uncertain primary. Restaging exam. ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in signal and morphology. Subcentimeter focus of increased T2 signal in the right lobe likely a benign cyst. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is upper limit of normal in size.PANCREAS: Subcentimeter T2 bright focus in the pancreatic body may reflect a small sidebranch IPMN. Main pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post transverse colectomy with right lower quadrant diverting colostomy and left lower quadrant mucocutaneous fistula. No obstruction. Redemonstration of rectal wall thickening and enhancement with perirectal and presacral edema.BONES, SOFT TISSUES: Heterogeneous marrow signal in the pelvis and proximal femurs felt to reflect recurrent red marrow.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy.BLADDER: No significant abnormality noted.BOWEL, MESENTERY: Redemonstrated rectal wall thickening and enhancement with perirectal and presacral edema. The edema extends to and involves multiple tethered loops of adjacent small bowel. This is stable to questionably increased when compared to prior.BONES, SOFT TISSUES: Diffusely heterogeneous signal likely reflecting red marrow reconstitution.OTHER: Right lung basilar nodule (series 6 image 6) is not significantly changed from prior, accounting for differences in imaging technique.

Output: 1.No specific evidence of recurrent or metastatic disease.2.Findings compatible with colitis/proctitis as described above. This appears similar to perhaps slightly increased when compared to prior. If the patient has a history of radiation to the pelvis, this may reflect posttreatment changes.


Instruction: Generate impression based on findings.

Input: The last well-formed disk space is referred to as L5-S1. There is a well-circumscribed heterogeneous T1 and high T2 signal lesion in the right iliac bone measuring 12 x 8 mm with an apparent tract extending to the inner cortex of the iliac bone toward the right SI joint space, better visualized on earlier CTs. On prior CT, it has a sclerotic margin and appears to have benign features. It is stable dating back to 11/22/2009. There is normal alignment of the spine with normal osseous marrow signal and vertebral body heights. There is dessication of L4-5 and L5-S1 disks with mild loss of height at L4-5 and moderate loss of height at L5-S1 disks. The conus shows normal signal and caliber, terminating at L1-2.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: No disk herniation or spinal stenosis.L3-4: Minimal disk bulge, mild posterior epidural fat prominence and mild bilateral facet arthropathy causing no significant spinal canal or neural foraminal stenosis.L4-5: Mild disk bulge, facet arthropathy causing no significant spinal canal or neural foraminal stenosis.L5-S1: No spinal stenosis or disk herniation.

Output: Mild multilevel spondylotic changes with no significant spinal stenosis at any level in the lumbar spine.


Instruction: Generate impression based on findings.

Input: A 55 year old male with history of hypertension, smoker, family history of coronary artery disease, large B cell lymphoma after chemotherapy (including doxorubicin), superior vena cava syndrome. An echocardiography before chemotherapy showed mild left ventricular systolic dysfunction without significant change after the treatment. Referred to stress cardiac MRI for further evaluation.MEDICATIONS: esomeprazole, melatonin, metoprolol, pyridoxine. First Pass PerfusionDuring hyperemia, a perfusion defect is demonstrated by the apical and mid septum. 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 normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 60 ml/m2 (normal range: 74+/-15), the LVEDV is 133 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 50 ml (normal range 47+/-19), the LV mass index is 25 g/m2, and the LV mass is 56 g. There are no regional wall motion abnormalities present. . No thrombus is present.No iron overload was seen.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 67 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 68 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 trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. Perfusion defect/ "ischemia" is present during hyperemia within the mid to apical septum.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 62%).4. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 48 years old, with right lower extremity weakness and spasticity. Postsurgical changes from a right temporal craniotomy are seen. There is a fluid-filled cavity involving the right inferior and middle temporal gyri with minimal surrounding T2 hyperintensity and no associated edema. A slitlike extension of this cavity extends upward into the external capsule. Nodular and streaky areas of susceptibility are seen within or around the cavity likely representing chronic hemosiderin staining.Elsewhere in the brain, no significant parenchymal signal abnormality is seen. Diffusion-weighted images are within normal limits. No evidence of edema or mass effect is detected. No findings to suggest acute intracranial hemorrhage are noted. The ventricular system is within normal limits allowing for some mild ex vacuo dilatation of the right atrium and temporal horn. There may be mild crowding of structures at the level of the foramen magnum, though this is equivocal and can be artifactual or exaggerated by positioning.Marrow signal characteristics are within normal limits except for postoperative changes as above. Mucosal thickening or a mucous retention cyst is seen within the right maxillary sinus.

Output: 1.Sequelae of right temporal craniotomy with a resection cavity and/or encephalomalacia involving the right middle and inferior temporal gyri.2.Elsewhere no significant brain parenchymal signal abnormality is seen. No acute intracranial process is suspected.


Instruction: Generate impression based on findings.

Input: 72 year-old female with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. A moderate amount of diffuse hypodensity within a periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: The medial meniscus is intact. There is abnormal signal and morphology of the body and anterior horn of the lateral meniscus likely reflecting combination of postsurgical change and tearing. This appears similar to the exam dated 8/16/2012.ARTICULAR CARTILAGE AND BONE: There are new full-thickness cartilage defects within the medial compartment affecting both the femoral condyle and tibial plateau. The largest extent measures approximately 2.3 cm in the greatest AP dimension within the mid to posterior femoral condyle. There is associated underlying reactive marrow change which is also new from the prior exam. There is mild thinning of the articular cartilage of the lateral and patellofemoral compartments without discrete full-thickness defects.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: 1. Abnormal appearance of the body and anterior horn of the lateral meniscus likely reflects a combination of postsurgical change and tearing. Overall this appears similar to the prior exam.2. New large full-thickness defects of the articular cartilage of the medial compartment affecting both the femoral condyle and tibial plateau. The articular cartilage of the lateral patellofemoral compartments is thinned at otherwise intact.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with history of seizures and MS, on Tecfidera, with EEG findings localized to the left frontal lobe. Confluent periventricular T2 hyperintensity is seen with additional scattered foci affecting the basal ganglia, brainstem and posterior fossa. On comparison with the prior MRI examination from 2008, these findings have progressed slightly. No dominant or discrete lesions are seen in the left frontal lobe to account for EEG findings.No restricted diffusion, edema or mass effect is detected. No pathologic intracranial enhancement is observed. There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection. Generalized parenchymal volume loss is demonstrated slightly progressed from prior. The ventricular system is unremarkable.

Output: Extensive confluent patchy T2 hyperintense signal is seen within the cerebral hemispheres, brainstem and cerebellum compatible with the stated history of multiple sclerosis. These findings have progressed mildly from the prior examination. No dominant or discrete lesion is seen in the left frontal lobe to account for EEG findings.


Instruction: Generate impression based on findings.

Input: Evaluate for insulinoma. ABDOMEN:LIVER, BILIARY TRACT: Multiple biliary hamartomas are noted. No focal suspicious lesion within the limitations of a nonenhanced study. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: There is a mildly bulbous appearance of the pancreatic tail but no definite lesion on this limited nonenhanced study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are enlarged and the parenchyma is replaced with innumerable lesions most compatible with cysts, minimally complex cysts and complex lesions which cannot be adequately characterized without contrast. The largest on the right is a 7 cm superior pole region. The largest on the left is an 8.5 cm inferior pole lesion. These have internal complexity.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: Please note that the study is severely limited by lack of intravenous contrast which could not be administered given the patient's end-stage renal disease.1.Slightly bulbous appearance of the pancreatic tail without a definite lesion seen.2.Polycystic kidney disease with numerous lesions which cannot be adequately characterized without intravenous contrast. Some of the lesions have suspicious features.


Instruction: Generate impression based on findings.

Input: Limited range of motion ROTATOR CUFF: There is a complete tear of the supraspinatus tendon with approximately 3 cm of retraction. The tear extends posteriorly to involve the majority of the infraspinatus tendon which is similarly retracted. There is mild to moderate fatty atrophy of the supraspinatus muscle with moderate to severe fatty atrophy of the infraspinatus muscle. The teres minor tendon and muscle are normal. There is thickening and increased signal of the subscapularis tendon reflecting moderate tendinosis. A more focal area of increased signal intensity is seen at the insertion indicating partial undersurface tearing. There is minimal fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint. A small amount of subacromial subdeltoid fluid is noted, associated with the full-thickness tears described above.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding and there is minimal posterior translation of the humeral head with respect to the glenoid. Osteoarthritis affects the glenohumeral joint with small articular cartilage defects present. There is attenuation of the labrum reflecting degeneration and degenerative tearing. There is a small joint effusion with scattered foci of intermediate signal intensity likely reflecting mild synovitis.BICEPS TENDON: There is increased signal intensity and thickening of the long head of the biceps tendon along its transition from the rotator interval to the intertubercular groove which reflects tendinosis.

Output: Large rotator cuff tear with additional findings described above.


Instruction: Generate impression based on findings.

Input: 58-year-old female status post right lumpectomy 2006 for multifocal tubular cancer followed by radiation and tamoxifen presents with a palpable lump in the left breast for 4 months. History of sarcoidosis. Mammogram: Three standard views of both breasts and spot compression views of left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Radiopaque linear markers were placed on scars overlying the right breast and axilla. Stable architectural distortion and scarring are again noted in the right upper outer quadrant. Benign scattered calcifications in both breasts are stable. Several stable benign masses are again seen in the left breast. Triangular marker denoting palpable abnormality is identified in the left breast 4 o'clock position. A spot compression views a benign oval, partially circumscribed 11-mm mass is noted, mostly unchanged from prior mammograms.No new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Multiple surgical clips are projected over the right axilla. Ultrasound: Targeted left breast 4 o'clock position ultrasound corresponding to mammographic abnormality performed. There is an oval parallel oriented mass measuring 1.1 x 0.5 x 0.8 cm with a blood vessel traversing superior anterior to it. This most like represents a benign fibroadenoma and also most likely corresponds to the benign morphology mass seen on mammograms and MRI dating back to 2006.

Output: Palpable abnormality left breast 4 o'clock position most likely corresponds to benign fibroadenoma, with a mammographic and MRI correlate which is stable dating back to 2006. Annual diagnostic mammogram with left breast ultrasound is recommended. Findings and recommendations were discussed with the patient in detail.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: eval biceps, flexor tendons History: continued proximal anterior forearm and elbow pain after lifting heavy object not responsive to PT LIGAMENTS: Although this examination was not optimized for detailed evaluation of the intrinsic ligaments of the elbow, the ulnar collateral ligament, radial collateral ligament, and the lateral ulnar collateral ligament appear intact.TENDONS: There is partial-thickness tearing of the biceps tendon, at the level of its insertion on the bicipital tuberosity. There is minimal, if any, retraction of the proximal tendon fragment. Some of the fibers of the biceps tendon can be traced to their insertion and appear intact. There is thickening and intermediate signal intensity of the proximal tendon fragment indicating tendinosis. There is a moderate amount of fluid within the bicipitoradial bursa.The brachialis tendon appears intact. There is minimal thickening and intermediate signal intensity of the triceps tendon indicating minimal tendinosis. The common extensor tendon appears intact. There is thickening and intermediate signal intensity within the common flexor tendon indicating minimal tendinosis.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. No full-thickness articular cartilage defects are seen. SURROUNDING STRUCTURES: There is minimal increased signal abnormality within the medial head of the triceps muscle at the level of the myotendinous junction which may reflect a mild strain. The imaged musculature of the left elbow is otherwise unremarkable. There is nonspecific subcutaneous edema along the medial aspect of the elbowADDITIONAL

Output: Partial-thickness tear of the biceps tendon at the level of its insertion on the bicipital tuberosity as described. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Status post SRS for left cerebral vascular malformation in May 2015: surveillance. MRI: There is interval appearance of an irregularly rim-enhancing lesion measuring up to approximately 20 mm surrounding the site of the treated left temporo-occipital region arteriovenous malformation. There is increase in the extent of surrounding vasogenic edema. However, the anomalous vessels are less conspicuous. 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, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no discernible arterialized flow within the nidus of the arteriovenous malformation. There is no evidence of significant steno-occlusive lesions in the regular cerebral arteries. There is no evidence of aneurysms.

Output: Interval development of radiation necrosis at the site of the treated left temporo-occipital region arteriovenous malformation, with associated surrounding vasogenic edema. The nidus of the arteriovenous malformation appears to have thrombosed.


Instruction: Generate impression based on findings.

Input: 29 years Female (DOB:6/30/1986)Reason: 29 yo F with 1 month of acute onset headaches with prodromal dizziness/imbalance and +family hx of fatal cerebral aneurysm in 21 year old brother; please evaluate for vascular malformation/aneurysm or other abnormality History: see abovePROVIDER/ATTENDING NAME: RITA M. ROSSI-FOULKES RITA M. ROSSI-FOULKES MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 demonstrate a small mucous retention cyst in the right maxillary sinus. 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 left vertebral artery is larger than the right vertebral artery. It is extracranial origin of the left posterior inferior cerebellar artery

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute ischemic cerebral infarction4.MRI of the brain and MRA of the brain are within normal


Instruction: Generate impression based on findings.

Input: Foot pain and swelling Again seen is mild soft tissue swelling overlying the dorsum of the foot which is improved significantly from the prior examination. There is no abnormal marrow signal to suggest osteomyelitis or focal fluid collection to suggest abscess.Mildly increased signal is seen along the bases of the fourth and fifth metatarsals which may represent reactive change or stress injury. There is no discrete fracture line.

Output: Improving soft tissue edema without osteomyelitis or abscess.