Instruction: Generate impression based on findings.

Input: Male, 46 years old, with history of recurrent/metastatic T4 N3 nasopharyngeal carcinoma status post chemotherapy. An enhancing lesion centered on the right cavernous sinus with extension into the middle cranial fossa continues to decrease in size. The lesion measures up to 22 x 8 mm in the axial plane, previously 25 x 20 mm. Mild treatment related alterations are demonstrated in the nasopharynx without any evidence to suggest recurrent tumor.The brain parenchyma itself is free of edema, mass effect and pathologic enhancement. No intracranial hemorrhage or any abnormal extra axial fluid collection is detected. Diffusion-weighted images are unremarkable. Ventricles are normal in size and morphology.

Output: 1.Continued interval decrease in the size of the lesion involving the right cavernous sinus and adjacent middle cranial fossa.2.Stable treatment related findings in the nasopharynx with no evidence to suggest recurrent tumor.3.The remainder of the brain is unremarkable.


Instruction: Generate impression based on findings.

Input: 54-year-old male with pain after twisting injury, evaluate for lateral meniscal tear Please note that due to a technologist error, sagittal T2 FS sequences were not obtainedMENISCI: There is blunting of the free edge of the posterior horn of the lateral meniscus which may reflect a prior partial meniscectomy, however fluid signal intensity is noted entering the free edge of the blunted posterior horn indicating a horizontal tear. There is lateral extrusion of the body of the lateral meniscus with intermediate signal intensity within the body extending to the tibial articular surface which may represent additional tearing or intrasubstance degeneration that pre-existed the meniscectomy. The anterior horn of the lateral meniscus is intact. There is a heterogeneous collection of near fluid signal intensity along the superior aspect of the extruded lateral meniscal body likely represents either a parameniscal cyst or focus of synovitis. The posterior horn of the medial meniscus appears slightly diminutive in size with blunting of the free edge and intrasubstance signal extending to the tibial articular surface, suggestive of fraying/degenerative tearing. The body and anterior horn of the medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full thickness degeneration of the articular cartilage along the posterior lateral femoral condyle as well as mild diffuse thinning within the remainder of the lateral compartment. Osteophytes are present along the anterior aspect of the medial femoral condyle with thinning of the overlying cartilage; otherwise the medial compartment cartilage is relatively spared. There is a full-thickness fissure within the articular cartilage along the inferior aspect of the trochlea. There is mild diffuse thinning of the articular cartilage of the patella.LIGAMENTS: The proximal ACL appears thinned, which may represent an old partial thickness tear; however there is no evidence of an acute tear. The PCL is intact. The proximal MCL appears thickened, which may represent old injury. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor tendon is intact.ADDITIONAL

Output: 1.Findings suggestive of prior arthroscopy and partial meniscectomy. There also appears to be a tear involving the free edge of the posterior horn of the lateral meniscus with additional possible meniscal tears as described above.2.Osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with multiple sclerosis. Multiple T2/FLAIR hyperintense lesions are again seen compatible with demyelinating disease involving the juxtacortical and periventricular white matter and to a lesser degree the brainstem and posterior fossa. Differences in technique between exams make accurate comparison difficult. However, it does appear that lesions have increased in size and number. For example, an enhancing lesion in the right frontal periventricular white matter (image 50 series 601) was not clearly present on the prior examination. In addition, ill-defined periventricular hyperintensity in the periatrial regions is diffusely more prominent than on prior. A number of enhancing lesions are seen which correlate to new areas of T2/FLAIR hyperintensity.Cerebral volume is grossly preserved. No evidence of edema or mass effect is detected. No abnormal extra-axial collections are seen. The ventricles remain normal in size and morphology.

Output: Interval progression of demyelinating lesions.


Instruction: Generate impression based on findings.

Input: Female, 17 years old, with headache, with suprasellar mass and to recent hemorrhages, assess for changes or recurrent bleeding. A uniformly T1 and T2 hyperintense lesion within the sella has decreased in size when compared to the prior examination. It now measures 6 mm in height, previously 8 mm. As before, the lesion itself does not enhance but there is normal enhancement of the native pituitary gland which appears to drape over this lesion. The pituitary stalk continues to sit at midline and enhances normally. No impingement of the optic apparatus is seen.A small focus of gray matter heterotopia along the right frontal horn is unchanged. Otherwise, assessment of the brain is unremarkable. No areas of edema or mass effect are seen. No pathologic parenchymal or extra-axial enhancement is observed. No acute hemorrhage is seen and there are no abnormal extra-axial collections. The ventricular system is normal in size and morphology. Paranasal sinus mucosal inflammation is seen.

Output: 1.Interval decrease in size of a T1/T2 hyperintense presumably cystic lesion within the sella. The differential diagnosis remains as Rathke cleft cyst or cystic adenoma with proteinaceous or hemorrhagic contents.2.Stable focus of gray matter heterotopia along the right frontal horn. Otherwise, unremarkable evaluation of the brain.


Instruction: Generate impression based on findings.

Input: 13 years, Female, anterior uveitis concerning for inflammation or neoplasm. Eye pain, conjunctival injection, blurry vision, floaters.. Brain: Brain parenchyma appears unremarkable for age. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. There is slight prominence of the pituitary gland which is likely within normal limits for patient's age. Mild scattered paranasal sinus opacification as seen on recent CT. Paranasal sinuses and mastoid cells are otherwise clear. Bone marrow signal and extracranial soft tissues are within normal limits. Small T2 hyperintense structures within the parotid glands probably represent small lymph nodes and within normal limits.Orbits: There is no discrete intraorbital mass is evident. Extraocular muscles appear within normal limits. No mass within the globes. There is subtle fullness and abnormal enhancement involving the optic nerve heads which may reflect papilledema although no associated distention of the optic nerve sheaths is evident. There is also subtle nonspecific enhancement surrounding the optic nerve sheaths, particularly on the right, which may represent optic perineuritis. No abnormal signal or enhancement within the optic nerves themselves is appreciated. Mild prominence of the lacrimal gland tissue, right greater than left, without focal lesions. Mild thickening of the preseptal soft tissues, right greater than left, which may represent edema. No significant fat stranding, fluid collections, or abscess.

Output: 1. Brain MRI appears within normal limits. Specifically, no intracranial mass or mass effect.2. No discrete mass within the orbits. There is fullness and enhancement at the level of the the optic nerve heads, which may reflect papilledema and can be correlated with examination. There is also abnormal enhancement surrounding the optic nerve sheaths, right greater than left. This finding is nonspecific but may reflect optic perineuritis or congestion related to inflammatory process.3. Borderline enlargement of the lacrimal glands, right greater than left, without focal lesions.4. Mild thickening of the preseptal soft tissues, right greater than left, which may represent edema. No fluid collections or abscess.


Instruction: Generate impression based on findings.

Input: 22-year-old female with altered mental status Redemonstrated is confluent bihemispheric periventricular white matter and centrum semiovale low attenuation indicating nonspecific small vessel ischemic disease, not significantly changed. The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses are clear. Redemonstrated is partial opacification of a dependent left mastoid air cell. Note is again made of vascular calcifications.

Output: 1.Redemonstrated is confluent bihemispheric periventricular white matter and centrum semiovale low attenuation indicating nonspecific small vessel ischemic disease, not significantly changed. Please note CT is insensitive for the detection of acute nonhemorrhagic ischemia and MRI can be considered for further evaluation if deemed clinically beneficial.2.No acute hemorrhage.


Instruction: Generate impression based on findings.

Input: Radicular pain, evaluate for possible nerve impingement in the lumbar spine Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign with T1 hyperintense lesion at L4 consistent with a hemangioma. Fatty endplate marrow signal changes are noted at L5-S1 on a degenerative basis. The conus medullaris is normal in position at the L1-L2 level.Multilevel degenerative changes are seen with disc desiccation throughout the lumbar spine. There is significant loss of disc height at L5-S1 and to a milder degree at the remaining levels. Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.L2-L3: Minimal disc bulge. No spinal canal stenosis. Minimal bilateral foraminal narrowing. Bilateral facet arthropathy.L3-L4: Mild disc bulge and facet arthropathy without spinal canal stenosis. There is mild right and moderate left neural foraminal stenosis. L4-L5: Mild disc bulge and moderate bilateral facet arthropathy without significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal narrowing.L5-S1: Mild disc bulge and bilateral facet arthropathy without significant spinal canal stenosis. There is no significant right neural foraminal narrowing. There is moderate left neural foraminal stenosis. Paraspinous soft tissues are within normal limits. Small right renal cyst incidentally noted.

Output: 1. Degenerative changes in the lumbar spine without significant spinal canal stenosis at any level. There is up to moderate left L3-L4 and left L5-S1 neural foraminal stenosis, which may be producing left L3 or L5 radiculopathy. Individual levels as above.2. Multilevel facet arthropathy, relatively worse at the L4-L5 and L5-S1 levels, and may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for disk disease. Signs and symptoms: Patient with back pain radiating to her left leg. Pre-and post-enhanced lumbar MRI:The signal intensity of vertebral column is unremarkable other than changes related to degenerative disease.The alignment vertebral column is abnormal and with evidence of mild grade 1 anterolisthesis at L5 -- S1 secondary to degenerative disease.Lower most visualized thoracic spine and thoracic cord from T10 inferiorly are unremarkable.T12 -- L1, and one that showed to, L2 -- L3 and L3 -- L4 levels are unremarkable for spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate mild ligamentum flavum and facet hypertrophy, slight widening of the bilateral facet spaces with fluid signal intensity suggestive of bilateral facet inflammatory changes or fluid/effusion. There is a small synovial cyst projecting posterior and inferior to the right articulating facet at this level (axial T2 series 5 image 27 and sagittal T2/T2 stir image 11). There is expected enhancement of hypertrophic changes of posterior elements on post enhanced images. There is no central spinal stenosis or neural foraminal compromise.L5 -- S1 demonstrate moderate to advanced disk disease and loss of disk height, moderate bilateral facet and to a lesser degree ligamentum flavum hypertrophy. There is slight widening of the facet space and with T2 hyperintensity of on the left with expected subtle enhancement similar to L4 -- L5 level. There is no central spinal stenosis however moderate to severe left neural foraminal compromise is present at this level.

Output: 1.Examination at T10 -- T11 to L3 -- L4 levels are unremarkable.2.At L4 -- L5 there is extensive degenerative changes of facets and ligamentum flavum and including widening of facet displacement T2 hyperintensity suggestive of inflammatory changes or facet fusion. There is expected enhancement of these changes as detailed above. There is no central spinal stenosis or neural foraminal compromise. A small synovial cyst projecting posterior to right articulating facet is also noted.3.At the L5 -- S1 there is moderate to advanced disk disease and degenerative changes of posterior elements without central spinal stenosis. There is however moderate to severe left neural foraminal compromise.4.Post enhanced images demonstrate expected enhancement of degenerative changes of posterior elements at the L4 -- L5 and L5 -- S1 levels and unremarkable otherwise.


Instruction: Generate impression based on findings.

Input: Please note that evaluation is slightly limited by motion artifact.  The lateral and third ventricles are moderately enlarged with abnormal contour and mild surrounding white matter T2 hyperintensities, compatible with periventricular leukomalacia. The 4th ventricle is normal in size. There is prominence of the CSF space adjacent to the right operculum, insula, and inferior frontal lobe, which may represent encephalomalacia from prior injury versus an arachnoid cyst. The sulci are otherwise unremarkable in morphology. The corpus callosum is thin, though fully formed. There is prominence of the CSF spaces anterior to the temporal tips and prominence of the suprasellar and prepontine cisterns. The brainstem is slender, though otherwise unremarkable. Bilateral choroid plexus cysts are noted. The cerebellar vermis is hypoplastic. The cerebellar tonsils are in normal position. There is prominence of the supravermian and retrocerebellar cisterns. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem, or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. SPINE

Output: 1. Findings compatible with periventricular leukomalacia. Prominence of the CSF space about the right frontal lobe and operculum may represent encephalomalacia from prior insult versus an arachnoid cyst. 2. Posterior fossa abnormalities, which probably largely reflect congenital developmental abnormalities. 3. No acute intracranial abnormality.4. Normal appearing spine and spinal cord. No evidence of tethered cord.


Instruction: Generate impression based on findings.

Input: Prostate cancer on surveillance Please note that evaluation is limited by extensive artifact on the ADC sequences.PELVIS:PROSTATE:Prostate Size: 3.0 x 6.0 x 3.3 cmPeripheral Zone: Heterogeneous with multiple subcentimeter foci of T2 hypointensity and enhancement suspicious for carcinoma, the most prominent of which is in the left apex. Specificity is limited by extensive artifact on ADC sequences. Central Gland: No significant abnormality notedSeminal Vesicles: No evidence of seminal vesicle involvement by tumor.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. No osseous lesions identified.OTHER: Fat-containing left inguinal hernia. Right inguinal hernia repair Prolene plug noted. Tarlov cysts noted.

Output: Multiple subcentimeter foci in the peripheral zone, most prominent of which is in the left apex, suspicious for carcinoma.


Instruction: Generate impression based on findings.

Input: MRI brain: This is a mildly motion degraded exam. There is no restricted diffusion. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There a few scattered foci of increased T2 signal in the periventricular and subcortical white matter which are nonspecific. There is mild prominence of superior cerebellar vermian sulci, which is of unknown clinical significance. There are no areas of pathological enhancement. 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. MR C-spine: This is loss of normal cervical lordosis. The cervical vertebral bodies and disc spaces are normal in height. The cervical spinal cord has normal signal characteristics and overall morphology. There is no pathological enhancement.At C2-3, there is no significant compromise to the spinal canal or neural foramina. At C3-4, there is is mild disc osteophyte complex and right uncovertebral hypertrophy, resulting in minimal narrowing of right neural foramen. No significant compromise to the spinal canal .At C4-5, there is uncovertebral hypertrophy. No significant compromise to the spinal canal or neural foramina.At C5-6, there is uncovertebral hypertrophy. In addition, there is a posterior osteophyte disc complex with superimposed central/right paracentral disc extrusion which extends about 3-4 mm cranially and 4 mm caudally, causing indentation on the ventral spinal cord resulting in impingement of the right ventral C6 nerve root. There is moderate spinal canal stenosis. There is minimal neuroforaminal narrowing, left more than right.At C6-7, there is no significant compromise to the spinal canal or neural foramina.At C7-T1, there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. There is slight asymmetric prominence of the right thyroid lobe with diffuse heterogenicity.MR thoracic spine: Some of the sequences are degraded secondary to lack of saturation bands. There is mild exaggeration of normal thoracic kyphosis along the upper thoracic spine. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.MRI lumbar spine: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. Paraspinous soft tissues are within normal limits. There is minimal fluid within the endometrium, likely physiological. There is also partial visualization of follicles in the ovaries.

Output: 1. No evidence of acute intracranial abnormality. 2 nonenhancing nonspecific scattered punctate foci of T2/FLAIR hyperintensity within the frontal lobe white matter.2. Mild volume loss of the superior cerebellar vermis suggestive of unknown clinical significance.3. Degenerative changes of the cervical spine most pronounced at C5-C6, with right central/paracentral disc extrusion resulting in indentation on the ventral cord and likely impingement of the right ventral C6 nerve root. There is moderate central spinal canal stenosis. Mild foraminal stenosis at C5-C6 and C3-C4 as described.4. Unremarkable MRI of the thoracic spine and lumbar spine.5. Mild asymmetric prominence and heterogeneity of the right thyroid lobe. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of brain, unspecified [D33.2], Reason for Study: ^Reason: hx residual / recurrent ganglioglioma. Yearly eval for growth History: yearly surveillance Previously shown fourth ventricle enhancing mass lesion is now measured about 20.4 mm x 15 mm on axial and 18.1 mm on coronal post gadolinium enhanced scan. Comparing to prior scan, there is interval increase in size of the lesion especially posterior left lateral aspect of the lesion.The measured size of the bilateral lateral ventricles, third ventricle and fourth ventricle appear to be enlarged since prior scan. For example, on coronal scan at the level of foramen of Monro, the maximum distance between the frontal horns of lateral ventricles was measured about 38.1 mm which was measured about 29.8 mm on prior scan.Post surgical changes of right cerebellar hemisphere and vermis appears to be stable since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Again redemonstration of thickening of the calvarium, no change since prior scan.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: Interval increase in size of enhancing fourth ventricle mass lesion since prior scan.Interval enlargement of ventricular system as described above.


Instruction: Generate impression based on findings.

Input: Paresthesia. There is a subcentimeter area of restricted diffusion and high T2 signal in the left thalamus with punctate foci of susceptibility effect. There are a few other foci of supratentorial and infratentorial susceptibility effect that scattered about, predominantly involving the deep grey matter. There is extensive cerebral white matter T2 hyperintensity without associated restricted diffusion. There are also more focal defects in the right corona radiata, right caudate, and right thalamus. There is a cavum septum pellucidum. The ventricles are otherwise unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Acute infarct in the left thalamus, superimposed upon probable hypertensive chronic microhemorrhages, chronic lacunar infarcts and extensive small vessel ischemic white matter disease.Discussed with Dr. Javed at 1:30 PM on 1/21/15.


Instruction: Generate impression based on findings.

Input: Not explain swelling left ankle, check for abscess A focal subcutaneous fluid collection is observed overlying the anterolateral ankle at the level of the distal fibular diaphysis and syndesmosis. This discrete heterogeneous fluid collection is surrounded by mild inflammatory changes does not demonstrate significant enhancement. Central decreased signal and internal septated appearance is most suggestive of possible subacute hematoma. For reference lesion axially measures 1.5 cm in greatest depth and approximately 5 (width) x 4.5 (craniocaudal length) cm. This abnormality underlies the patient placed marker and specifically a potential small sinus tract cannot entirely be excluded along the lateral aspect; please see the arrow.The underlying tendons are otherwise intact without focal abnormality. The osseous structures are also normal in appearance with unremarkable marrow signal.No additional abnormal fluid collections or soft tissue findings other than minimal inflammation and/or stranding in the immediate subcutaneous tissues. Please correlate with mild diffuse edema with opposite ankle

Output: A discrete multiseptated subcutaneous fluid collection in the anterolateral left ankle without superimposed focal findings to suggest infection and or acute process. Probable old hematoma. Please correlate patient history


Instruction: Generate impression based on findings.

Input: T2N1M0 SCC of the oral tongue restaging post treatment. There are interval post-treatment findings in the neck, including right neck dissection and radiation therapy, with diffuse swelling and enhancement in the treatment bed, but no evidence of residual measurable right oral cavity mass. There is no evidence of significant cervical lymphadenopathy based on size criteria. There is edema and enhancement of the right hypopharyngeal soft tissue with effacement of the right piriform sinus. The thyroid and remaining salivary glands are unremarkable. There is deformity of the left lamina papyracea, which may be post-traumatic. There is multilevel degenerative cervical spondylosis. The imaged intracranial structures and orbits are unremarkable. There is bilateral maxillary sinus mucosal thickening.

Output: 1. No residual measurable right oral cavity mass.2. No evidence of significant cervical lymphadenopathy.3. Edema and enhancement of the right hypopharyngeal soft tissue with effacement of the right piriform sinus is likely related to radiation effects.


Instruction: Generate impression based on findings.

Input: Male, 3 months old, ex-36 weeker, with Treacher-Collins syndrome and mandibulofacial dysostosis. Image quality is reduced by motion artifact on most sequences. Given this limitation, the gross morphology of the brain is within normal limits. No large structural abnormalities are suspected. No areas of parenchymal signal abnormality or restricted diffusion are seen.A subdural fluid collection is present along the left frontal lobe measuring up to 7 mm in thickness but causing little if any mass effect on the adjacent brain parenchyma. The collection follows CSF signal on all sequences other than the FLAIR sequence where it is hyperintense to CSF. No evidence of acute intracranial hemorrhage is seen. The ventricles are normal in size and morphology.The pituitary region is unremarkable. The corpus callosum is fully formed and intact. The cerebellar vermis and hemispheres are normally formed. The pattern of white matter myelination is appropriate for age.

Output: 1.A subdural collection is evident along the left frontal lobe causing little if any mass effect on the adjacent brain parenchyma. Given its signal characteristics, this collection could represent an old subdural hematoma or a proteinaceous subdural hygroma.2.The remainder of the examination is within normal limits.


Instruction: Generate impression based on findings.

Input: 59-year-old female with diplopia, rule out stroke. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Minimal right ethmoid mucosal thickening is seen. Bone marrow signal and extracranial soft tissues are within normal limits. There is an incidentally noted partially visualized cyst within the left longus colli muscle.

Output: No evidence of intracranial mass or acute infarct. No specific findings to explain patient symptomatolgy.


Instruction: Generate impression based on findings.

Input: Clinical question: Hepatic encephalopathy, now with acute mental status change, only responsive to pain. Signs and symptoms: Altered mental status. Very minimal blood adjacent to right frontal pressure monitor is again identified with no interval change. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus since prior study. No definitive evidence of edema or parenchymal air is detected. Cortical sulci, ventricular system and all CSF cisterns are stable since prior study. Extensive opacification of all paranasal sinuses with interval worsening since prior exam. The above findings could be related to instrumentation.Further evaluation with an MRI is recommended.

Output: No definitive evidence of any new finding since prior exam. Please see above comments.


Instruction: Generate impression based on findings.

Input: 48-year-old male with dysarthria, LUE/LLE weakness and diffuse hyperreflexia. Evaluate for stroke. Brain MRI:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal scattered T2/FLAIR hyperintensities which are nonspecific. There is no abnormal intracranial enhancement. There is mild diffuse volume loss. The 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.C-spine MRI:There is straightening of the cervical spine lordosis The vertebral body and disk heights are well-maintained. There is variable disc desiccation. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. There are small disc osteophyte complexes involving the C3-4 through C6-7 levels with a superimposed small central disc protrusion at C6-7. There is at most mild to moderate spinal canal stenosis with flattening of the right paramedian ventral cord at C3-C4 and minimal neuroforaminal narrowing at the C3-4 and C6-7 levels.

Output: 1.No evidence of acute infarct. 2.Minimal scattered chronic small vessel ischemic changes.3.Degenerative changes in the cervical spine with at most mild to moderate spinal canal stenosis and flattening of the right paramedian ventral cord at C3-C4 as well as minimal neuroforaminal narrowing at the C3-4 and C6-7 levels.


Instruction: Generate impression based on findings.

Input: 82-year-old male with gait decline. Reevaluate for CNS demyelination to explain a left Babinski reflex. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are is extensive periventricular and subcortical T2 hyperintensities, which are unchanged. There is mild diffuse volume loss. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild left maxillary sinus, left frontal and ethmoid air cell mucosal thickening. There is an underpneumatized right frontal sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there is an enhancing nodule that measures up to 8 mm, which appears to arise from the posterior aspect of the deep right parotid gland. There is a small left nasopharyngeal retention cyst.Cervical Spine: The exam is limited by motion. The spinal appears unremarkable. The bone marrow signal is within normal limits. The vertebral body heights are preserved. There is no spondylolisthesis. At C2 and C3, there is a mild disc bulge, but no significant compromise to the spinal canal or neural foramina. At C4-5, there is a disc osteophyte complex with facet and right greater than left uncovertebral hypertrophy, which causes severe right and moderate to severe left neuroforaminal narrowing. There is mild spinal canal stenosis at the C4-5 level. At C5-6, there is a disc osteophyte complex, as well as left greater than right facet and uncovertebral hypertrophy, which contributes to severe left and moderate to severe right neural foraminal narrowing. There is mild spinal canal stenosis at this level. At C6-7, there is a disc osteophyte complex, as well as facet and uncovertebral hypertrophy, which contribute to moderate bilateral neural foraminal narrowing. There is mild spinal canal stenosis at this level. At C7-T1, there is a small disc osteophyte complex, but no compromise to the spinal canal or neuroforamina. There are small disc bulges at the T1-T2 and T2-T3 levels without compromise to the spinal canal or neuroforamina at these levels. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct. 2.Extensive white matter lesions may represent chronic small vessel ischemic disease and/or demyelination.3.Multilevel degenerative spondylosis, which is most prominent at the C4-5 and C5-6 levels, where there is at most mild spinal canal stenosis and severe right C4-5 and severe left C5-6 neural foraminal narrowing.4. Nonspecific nodule that measures up to 8 mm, which appears to arise from the posterior aspect of the deep right parotid gland. 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, 4 years old, with history of generalized tonic-clonic seizure in 7/2016, recurrent on two other occasions and on current admission. No evidence of parenchymal edema, mass effect or restricted diffusion is seen. No structural defects are identified. Slight asymmetric prominence of the right temporal horn is seen. The mesial temporal structures are normally formed, symmetric and free of abnormal signal intensity. No evidence of intracranial hemorrhage or any abnormal extra-axial collection is seen. Ventricular size and morphology are otherwise within normal limits.

Output: Slight asymmetric prominence of the right temporal horn may represent a developmental variant. The mesial temporal structures are otherwise unremarkable. No specific findings are seen which would account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: 40-year-old female POD 2 status post tumor resection. There are postoperative changes of recent left parietal craniotomy with overlying skin staples. There are small amount of blood products in the resection bed. No evidence of residual tumor. Remainder of the brain is unremarkable. There are no areas of restricted diffusion to suggest infarction. No significant edema or new mass effect. No midline shift or downward herniation. The basal cisterns are intact and symmetric. Normal flow voids are identified in the cerebral vasculature. The paranasal sinuses, orbits, and mastoid air cells are clear.

Output: Expected postoperative changes of left parietal extra-axial tumor resection without evidence of residual tumor. No significant mass effect.


Instruction: Generate impression based on findings.

Input: 89-year-old female with history of endometrial tumor. Evaluate for tumor extent. PELVIS:UTERUS, ADNEXA: There is a T2 intermediate, enhancing cervical mass measuring approximately 2.2 x 1.5 (series 901, image 40) x 2.0 cm (series 1001, image 15). The mass appears to extend into the upper vagina as noted on the postcontrast images. No obvious extension into the endometrial canal; the endometrium is noted to be thin measuring 0.2 cm. Fat plane between the uterus and the rectum/sigmoid is preserved.BLADDER: No significant abnormality noted.LYMPH NODES: There are subcentimeter nonspecific bilateral common iliac and external iliac chain lymph nodes with the largest on the right measuring 1.3 x 0.8 cm (series 401, image 41).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially visualized degenerative changes involving lower lumbar spine. Moderate to severe degenerative changes at bilateral hip joints.OTHER: No significant abnormality noted.

Output: 1.Although given history of endometrial cancer, MR findings are of an enhancing endocervical canal mass with minimal probable extension into the upper vagina and questionably into the lower uterine segment endometrium. MR findings favor a cervical neoplasm.2.Nonspecific subcentimeter bilateral common iliac and external iliac lymph nodes.


Instruction: Generate impression based on findings.

Input: headache, left side weakness Brain MRIMotion artifacts degraded image quality.No evidence of acute ischemic or hemorrhagic lesion.Multifocal scattered high signal intensity lesions on FLAIR on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.The left maxillary sinus shows retention cyst.C Spine MRIThere is focal central disc protrusion (series= 601, image=21/39) which abuts thecal sac at the level of C45.Diffuse disc bulging which obliterates anterior epidural space at the level of C56 and broad based focal disc bulging (series = 601, image 13/39) at the level of C67 with minimal spinal canal stenosis at the level of C67.Minimal neural foraminal narrowing at the level of C56 especially on the right side.The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The paraspinal soft tissues are unremarkable.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel disease.3. Degenerative spondylosis on C spine, in particular intervertebral disc protrusion at the level of C45, diffuse disc bulging at the level of C56 and broad based focal disc bulging at the level of C67.


Instruction: Generate impression based on findings.

Input: Diagnosis: Syncope and collapse Syncope and collapseClinical question: evaluate for stroke vs. Seizure nidusSigns and Symptoms: as above MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense foci are present in the brainstem.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 mild mucosal thickening.. 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. There is multilevel disc desiccation presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina. There is some disc desiccation present at this level.At C3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with some uncovertebral osteophytes predominantly in the left side and ligamentum flavum hypertrophy. There is associated flattening of the spinal cord and effacement of spinal fluid ventral and posterior the spinal cord. There is cord T2 signal hyperintensity within the spinal cord at this level especially the left hemicord. There is encroachment of left-sided exiting nerve roots at this level due to disc material and osteophytes Overall there is severe spinal stenosis present associated with findings suggesting cord edema.At C4-5 there is loss of disc space height, disc desiccation as well as endplate uncovertebral osteophytes. The uncovertebral osteophytes and disc material is more prevalent on the left side where there is encroachment of the left-sided exiting nerve roots. There is also effacement of spinal fluid ventral and posterior the left hemicord at this level and partial effacement of spinal fluid ventral and posterior the right hemicord. There is hypertrophy of the ligamentum flavum present. Overall there is moderate spinal stenosis at this level. There is mild flattening of the spinal cord.At C5-6 there is loss of disc space height, disc desiccation as well as endplate and uncovertebral osteophytes associated with encroachment of the exiting nerve roots within the neural foramina bilaterally. There is hypertrophy of the ligamentum flavum present. There is also effacement of the spinal fluid ventral and posterior the spinal cord at this level. Overall there is moderate spinal stenosis at this level with mild cord flatteningAt C6-7 there is loss of disc space height, endplate and uncovertebral osteophytes as well as encroachment of the exiting nerve roots within the neural foramina bilaterally. There is partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild degree of spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal. Disc material extends into the neural foramina bilaterally at this level and is associated with some encroachment of the exiting nerve roots within the neural foramina bilaterally.The vertebral artery flow voids appear to be intact.There is enlargement of the left thyroid lobe with a heterogeneous lesion which is incompletely visualized on this exam.

Output: 1.There is severe spinal stenosis present at C3-4 associated with flattening the spinal cord and cord signal change suspicious for cord edema suspicious for spondylitic myelopathy. Please correlate with patient's clinical history for spondylitic myelopathy.2.There is a moderate degree of spinal stenosis present at C4-5 associated with mild cord flattening due to degenerative changes.3.There is a moderate degree of spinal stenosis at C5-6 associated with some mild/minimal cord flattening related to degenerative changes.4.There is encroachment of exiting nerve roots bilaterally at C5-6 and C6-7 as well as on the left-sided C3-4 and C4-5 due to degenerative changes.5.The left lobe of the thyroid gland appears enlarged and heterogeneous. This is not adequately imaged on this examination. Please correlate with patient's clinical history and symptoms.6.Periventricular and subcortical white matter lesions of a mild to moderate degree as well as some patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 7.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Abdominal pain and recent diagnosis of Crohn's 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 significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel wall thickening, enhancement, and associated narrowing involving a 10 cm segment of distal ileum (series 13, image 52, 56, and 60). Additionally, there is a separate 6 cm segment of mid ileum which is similarly affected (series 13, image 58). Angulation of several small bowel loops in the right lower quadrant. No evidence of fistula or abscess.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Acute on chronic changes in the mid and distal ileum as described above compatible with inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Pain and limited range of motion. Rule out rotator cuff tear. ROTATOR CUFF: There is increased signal intensity within the posterior fibers of the supraspinatus tendon indicating tendinosis that extends posteriorly to involve the anteriormost fibers of the infraspinatus tendon. There is perhaps mild bursal surface fraying as well. I see no full-thickness fluid-filled full-thickness tear. The supraspinatus muscle appears normal. There is perhaps mild atrophy of the infraspinatus muscle. The teres minor muscle and tendon appear normal. The subscapularis muscle and tendon appear normal.SUPRASPINATUS OUTLET: There is mild spurring of the anterior acromial process, but the acromioclavicular joint appears normal. There is a small amount of fluid in the subacromial bursa, of questionable clinical significance. The coracoacromial and coracohumeral ligaments appear intactGLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is a small amount of fluid within the glenohumeral joint but no frank effusion. Intermediate signal intensity within the superior labrum suggests a tear, of questionable clinical significance. The inferior labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears normal.

Output: 1. Rotator cuff tendinosis and perhaps bursal surface fraying but no full-thickness fluid-filled cuff tear is evident.2. Small amount of fluid in the subacromial bursa and probable superior labral tear of questionable current clinical significance.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma, history of resection. Evaluate change to residual tumor. There are postoperative findings related to transphenoidal surgery. There is no significant interval change in size of the lobulated enhancing left sellar and suprasellar mass, which measures approximately 15 AP x 10 RL x 13 SI mm. There is persistent mild mass effect upon the left lateral aspect of the optic apparatus, which otherwise demonstrates normal signal characteristics. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. The ventricles are stable in size and configuration. There is no midline shift or herniation.

Output: Persistent lobulated left sellar and suprasellar residual macroadenoma with persistent mild mass effect upon the left lateral aspect of the optic apparatus.


Instruction: Generate impression based on findings.

Input: 23 year old woman with double inlet left ventricle s/p Fontan, s/p coiling of innominate vein to pulmonary vein collateral vessel, and s/p SVT ablation referred for evaluation of hypoxia. Overall AnatomyDoublet inlet left ventricle s/p bidirectional Glenn shunt and Fontan procedure. There are side-by-side, malposed great vessels. The interatrial septum has been resected. The tricuspid and mitral valves both drain into the left ventricle. There is a hypoplastic right ventricle which communicates with the left ventricle via a large ventricular septal defect. The main pulmonary artery is ligated and forms a blind pouch. Systemic Venous Return (Fontan)A Glenn shunt connects the SVC to the right pulmonary artery. There is a lateral tunnel conduit connecting the IVC to the right pulmonary artery. There are no obstructions or stenoses in either the SVC or IVC. The IVC is dilated. The presence of a communication between the lateral tunnel conduit and right atrial appendage can not be excluded. The communication is suggested on the non-contrast MRA and first pass contrast imaging, but not on cine CMR or contrast enhanced MRA. Systemic Ventricle (i.e. Left Ventricle)The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 125 ml (normal range 109+/-23), the LV end systolic volume index is 35 ml/m2 (normal range 18+/-5), and the LVESV is 58 ml (normal range 31+/-10). Pulmonary Venous ReturnThere are four pulmonary veins which drain into the common atrium. There are no obvious obstructions of the pulmonary veins.Right VentricleThe right ventricle is hypoplastic.Common AtriumThe interatrial septum has been resected resulting in a common atrium. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely into the left ventricle and there is no significant mitral regurgitation.Tricuspid ValveThe tricuspid valve opens widely into the left ventricle and there is mild tricuspid regurgitation. Great VesselsThere are side-by-side, malposed great vessels. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no thoracic aortic aneurysm or thoracic aortic dissection. The main pulmonary artery is ligated and forms a blind pouch emptying into the right ventricle. There are no proximal stenoses of the left and right pulmonary arteries. The left pulmonary artery diameter is 11mm. The right pulmonary artery diameter is 16mm.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Double inlet left ventricle with hypoplastic right ventricle s/p tunneled Fontan2. No Fontan/ Glenn obstruction. Can not rule out small communication between intra-cardiac tunnel and right atrial appendage. 3. Normal left ventricular size and systolic function (LVEF 54%). 4. Main pulmonary artery is ligated and forms blind pouch.5. Dilated inferior vena cava.6. Left pulmonary artery is 2/3 of the size of right pulmonary artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Neurogenic claudication and lumbar stenosis/spondylolisthesis. There is 5 mm of anterolisthesis of L3 on L4 and minimal anterolisthesis of L5 on S1. The vertebral body heights are preserved. There is multilevel disc narrowing with signal desiccation, which is most prominent at L3-4, L4-5, and L5-S1. The vertebral bone marrow signal is unremarkable aside from degenerative endplate signal alterations. The conus terminates at the inferior L1 level. There is diffuse atrophy of the lower paraspinal muscles. At T9 though T12, posterior disc-osteophyte complexes result in indentation of the spinal cord, as well as bilateral neural foraminal stenosis. At L2-L3, there is minimal disc bulging and mild bilateral facet arthropathy and ligament flavum hypertrophy with mild right and moderate left neural foraminal stenosis, but no significant central stenosis. At L3-L4, there is moderate bilateral facet arthropathy, and ligamentum flavum hypertrophy causing severe central stenosis in conjunction with the anterolisthesis. There is also mild right and moderate left neural foraminal stenosis at this level. At L4-5, a central disc protrusion superimposed on disc bulging, as well as moderate bilateral facet arthropathy result in moderate to severe spinal canal stenosis and mild-to-moderate right and moderate left foraminal stenosis. At L5-S1, a central disc protrusion superimposed on disc bulging, as well as mild bilateral facet arthropathy result in mild right and severe bilateral neural foraminal stenosis and mild spinal stenosis.

Output: 1. Marked multilevel degenerative lumbar spondylosis with grade 1 anterolisthesis and moderate to severe spinal canal stenosis at L3-4 moderate to severe spinal canal stenosis, moderate to severe spinal canal stenosis at L4-5, as well as severe bilateral neural foraminal stenosis at L5-S1.2. Degenerative spondylosis in the imaged portions of the lower thoracic spine with indentation of the spinal cord by disc-osteophyte complexes.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Closed fracture of unspecified bone Backache, malaise and fatigueClinical question: severe pain from buttock to R leg. Hx of osteoporosis, lumbar spine compression fracture on x-raySigns and Symptoms: pain and weakness. Hx of myositis and osteoporosis Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. There is disc desiccation present. The sacroiliac joints are narrow and partially fused.There is a mild superior endplate compression present at L5. There is a CT of the abdomen from 2011 which suggests that this is been present since that time. There is T2 signal hyperintensity present along the superior aspect of the L5 vertebral body.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy present at this level and a minor disc bulge. At L4-5 there is bilateral facet hypertrophy associated with a disc bulge and effacement of fat at the lateral recesses. The fat surrounding the exiting nerve roots within the neural foramina is not effaced. Overall there is a mild degree of spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation and a mild left far lateral disc protrusion at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation with a mild disc bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.Cysts are present in the visualized portions of the kidneys which have also been identified on CT of the abdomen from 6/6/2011.There is significant fatty replacement present throughout the paravertebral musculature. This has been present on the prior abdomen CT from 2011

Output: 1.There are degenerative changes present in the lumbar spine with mild spinal stenosis at L4-5.2.There is a mild superior endplate compression present at L5 which has been present since 2011 at least, however, some associated signal changes suggest that there may be some current inflammatory change probably related to some exacerbation of the superior end plate compression.3.There is fatty replacement of much of the visualized paravertebral musculature. There is isolated fatty replacement of the some of the gluteal musculature. Please correlate to patient's clinical history. This is long standing. Differential considerations may include polymyositis, though it is non-specific.


Instruction: Generate impression based on findings.

Input: History of right breast IDC on recent biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Proven malignancy with biopsy clip is seen as an enhancing mass measuring 1.5 x 1.6 x 1.7 cm in the right outer breast near 9:00. Immediately lateral/anterior to the index mass is a 6 mm satellite. There are multiple additional masses medial to the index lesion in the far posterior breast as well as a 9 mm extent of anterior non-mass enhancement extending anterior to the additional masses. Three of these are adjacent masses, all measuring about 6 mm each, that are present near the pectoralis muscle in the central posterior depth. An additional 1.1 x 1.8 cm enhancing mass even further medial localizes to the anterior aspect of the pectoralis muscle itself. Inclusive of these findings, overall extent measures up to 6.2 x 3.5 cm. Within the right chest wall, there are two areas of enhancement that appear to lie within chest wall soft tissues probably in intercostal muscles. Though non-specific in appearance, their proximity to the primary tumor and the satellite lesions raises concern for additional tumor involvement. No abnormal enhancement is seen in the left breast. A few scattered foci and areas of edge parenchymal enhancement are not suspicious. No abnormal axillary lymph nodes are identified in either axillary region.Within a mid-upper thoracic vertebral body, there is a high T2 round area without clear enhancement. Statistically, this is probably a hemangioma, though other etiologies are possible.

Output: 1. Biopsy proven right breast cancer with multiple additional masses and non-mass enhancement in the breast. The overall extent of masses, inclusive of the mass suspicious for pectoralis involvement is up to 6.2 cm.2. Areas of enhancement in the pectoralis muscle and right chest wall are all suspicious for tumor involvement of muscles. 3. Non-specific high T2 signal lesion in the thoracic spine may be a hemangioma. Findings were discussed with Dr. Jaskowiak. Additional imaging work up will likely include bone scan and CT. PET may also be considered. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 60-year-old male with history of muscle weakness and the proximal right arm. Evaluate for muscle inflammation. Although this examination is not protocoled for detailed evaluation of the shoulder, there is a massive tear of the rotator cuff involving the supraspinatus and infraspinatus tendons with retraction of tendon fibers. There is also fatty atrophy of the supraspinatus and infraspinatus musculature. The humeral head is high riding. There is a glenohumeral joint effusion as well as enhancement of the synovium indicating a mild synovitis. Fluid also extends into the subacromial/subdeltoid bursa as well as the biceps tendon sheath. There also appears to be a small amount of fluid in the subcoracoid bursa suggesting a mild bursitis. Evaluation of the glenoid labrum and biceps tendon are limited on this study. There is moderate acromioclavicular joint osteoarthritis. Mild fluid signal intensity and enhancement along the proximal fibers of one of the anterolateral tendons of the deltoid muscle is nonspecific but may represent prior myotendinous strain, and there is mild edema-type signal in the adjacent muscle. The remainder of the deltoid appears normal, as does the remaining musculature of the arm. Marrow signal is within normal limits. Evaluation of the elbow is limited but there appears to be mild osteoarthritis.

Output: 1.Massive rotator cuff tear and arthropathy as described above.2.Abnormal myotendinous signal of the deltoid as described above may reflect prior strain.


Instruction: Generate impression based on findings.

Input: Right ptosis and diplopia. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered nonspecific cerebral white matter T2 hyperintense foci. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There is mild right maxillary sinus mucosal thickening.Orbits: There is no evidence of orbital mass lesions. The bilateral globes, optic nerves, extraocular muscles, lacrimal glands, and orbital fat are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of orbital mass lesions.


Instruction: Generate impression based on findings.

Input: Locoregional synovial sarcoma of spine (C2-T2) with cardiac extension; pulmonary relapse March 2016; surveillance imaging. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There is also a mild effusion within the left mastoid air cells.Spine: There are postoperative findings related to C2-T2 laminoplasty and tumor debulking. There is interval decrease in size of the enhancing left paraspinal tumor with encasement of the left vertebral artery at these levels, with invasion of each neural foramen and minimal extension into the intraspinal epidural space, measuring up to 20 mm in thickness at the C3-4 level, previously 25 mm. There is persistent patchy heterogeneous marrow replacement throughout the cervical spine and upper thoracic spine, but the vertebral body heights are preserved. There is a kyphotic curvature at the cervico-thoracic junction, but no spondylolisthesis. The spinal canal is narrowed from C3-C7, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. There is associated mild spinal cord flattening in this region, without spinal cord signal abnormality. The posterior paraspinal tissues are unchanged. There are nodules within the partially imaged right lung. There is a small right apical pneumothorax.

Output: 1. Slight interval decrease in size of the treated residual tumor along the 2. Persistent patchy heterogeneous marrow replacement throughout the cervical spine and upper thoracic spine, but the vertebral body heights are preserved. 3. The spinal canal is narrowed from C3-C7, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. 4. No evidence of intracranial metastases.5. Pulmonary metastases and small right apical pneumothorax. Please refer to the separate chest CT report for additional details.


Instruction: Generate impression based on findings.

Input: There is straightening of the normal lumbar lordosis. There is mild anterolisthesis of L3 on L4 of approximately 5 mm and minimal anterolisthesis of L5 on S1, which are likely on a degenerative basis. There is progression of mild to moderate loss of disc height throughout the lumbar spine with disc desiccation, especially at L2-L3. The vertebral body heights are well-maintained. The marrow signal is heterogeneous. There is no pathological enhancement. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. The partially imaged kidneys demonstrate bilateral renal cysts.T12-L1: Interval development of disc bulge with superimposed central disc extrusion with inferior migration of 7 mm. No significant spinal canal or foraminal stenosis.L1-L2: Progression of disc bulge with superimposed central disc extrusion and superior migration of 11 mm and mild bilateral facet degeneration. No significant spinal canal or foraminal stenosis. L2-L3: Progression of disc bulge with bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild right and moderate left neuroforaminal stenosis. No significant spinal canal stenosis.L3-L4: Unchanged mild anterolisthesis of L3 and L4 with pseudodisc bulge, advanced bilateral facet degeneration and thickening of the ligamentum flavum contributing to effacement of the lateral recesses, mild to moderate spinal canal stenosis and moderate bilateral neuroforaminal stenosis (left worse than right). There is enhancing epidural tissue at the L3 level effacing the right posterolateral thecal sac, which is likely related to granulation tissue.L4-L5: Slight progression of disc bulge, asymmetric to the right, with central disc protrusion and bilateral facet degeneration, contributing to mild bilateral foraminal stenosis and minimal spinal canal narrowing. There is slightly progressed effacement of the right lateral recess with possible impingement on the descending right L5 nerve root.L5-S1: Unchanged disc bulge with bilateral facet degeneration, contributing to moderate right greater than left foraminal stenosis. No significant spinal canal stenosis.

Output: 1. Moderate degenerative changes of the lumbar spine with progression of degenerative disc disease at the L1-L2, L2-L3 and L4-L5 levels with mild to moderate spinal canal stenosis at L3-L4. There is effacement of the right lateral recess at L4-5 slightly worse than prior which may be impinging on the traversing right L5 nerve root. There is also foraminal stenosis at multiple levels as detailed above.2. No suspicious lesions to suggest metastatic disease.


Instruction: Generate impression based on findings.

Input: Encounter for examination for normal comparison and control in clinical research program [Z00.6], Reason for Study: ^Reason: 66 y/o female to be evaluated for brain mets for participation in clinical trial History: none No evidence of acute ischemic or hemorrhagic lesion. There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 26 years Male (DOB:1/21/1990)Reason: Pain History: painPROVIDER/ATTENDING NAME: RODERICK H. BIRNIE RODERICK H. BIRNIE 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 a right paramedian disc protrusion present at this level which mildly encroaches on the nerve roots of the right lateral recess, however, there is some spinal fluid surrounding the nerve roots at the right lateral recess. There is a punctate T2 signal hyperintensity present along the annulus at the disc protrusion at this level. There is mild loss of disc space height and disc desiccation at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a small left paramedian broad-based disc protrusion present at this level. There is some encroachment of the nerve roots of the left lateral recess at this level, however, there is some spinal fluid surrounding the nerve roots at the left lateral recess. There is mild loss of disc space height and disc desiccation 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.

Output: 1.There is a left paramedian disc protrusion present at L4-5 and a right paramedian disc protrusion at L5-S1 with only mild encroachment of the nerve roots at the associated lateral recesses.


Instruction: Generate impression based on findings.

Input: 6th and 7th nerve palsy with headache. No evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal scattered high signal intensities on bilateral hemispheres on FLAIR images indicate minimal non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: No evidence of acute ischemic or hemorrhagic lesion on this scan.Minimal non specific small vessel disease.Normal brain MRV.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with right-sided weakness, known left hemispheric brain tumor with question of petechial hemorrhage. Significant interval expansion of a large tumor is evident spanning the left temporal and parietal lobes. Whereas previously, the lesion was largely solid and minimally enhancing, there is now a prominent central necrotic core and a thick irregular enhancing rim. The lesion inclusive of the enhancing portions measures up to 79 x 45 x 58 mm. Enhancing components of the lesion do correlate with elevated rCBV.Within the lesion core, strong susceptibility artifact is seen along with scattered small areas of T1 hyperintensity, all of which likely reflect the presence of intratumoral blood product. Outside of the tumor core, no definite or significant parenchymal hemorrhage is seen.T2 hyperintensity and mass effect within the parenchyma surrounding the lesion core have increased substantially. Signal abnormality now fills the left temporal lobe and also occupies a large portion of the left occipital and parietal lobes. Signal abnormality tracks through the white matter capsules and into the left cerebral peduncle and left thalamus. A midline shift of 12 mm to the right is seen with subfalcine herniation. Left uncal medialization is also noted. However, no significant transtentorial herniation is evident at this time.The left temporal horn appears to be dilated and likely entrapped. Effacement of the left ventricular atrium is seen. Both lateral ventricles are otherwise slightly more prominent than on the prior examination. A few additional scattered foci of white matter T2 hyperintensity are relatively unchanged.

Output: Since the prior MRI examination, the left temporoparietal lesion has significantly increased in size with development of a central necrotic core and a thick irregular rim of enhancement. A marked increase in surrounding signal abnormality and mass effect is also seen. Given the recent completion of RT/TMZ, the possibility that this may represent pseudoprogression could be entertained. However, blood volume mapping and the gross morphology of the lesion would favor tumor progression.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for myelomatous lesions. Signs and symptoms: Nonspecific bone pain. Pre and post enhanced cervical MRI:Cervical vertebral column and partially visualized skull base demonstrate no detectable bone marrow signal abnormality or enhancement to suggest myelomatous lesions as is clinically questioned. There is also no detectable abnormal enhancement of the cord or the leptomeninges.There is normal anatomical alignment of vertebral column. Explain foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild disc disease and mild bilateral ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise. There is a tiny right lateral annular fissure best appreciated on sagittal T2 and T2 STIR image 10.C4-C5 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Degenerative changes at this level results in mild central spinal stenosis without neural foraminal compromise.C5-C6 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in mild central spinal stenosis and significant bilateral neural foraminal compromise.C6-C7 demonstrate moderate to advanced disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy and a disc-osteophyte complex in the midline and extending to the right which results in flattening and posterior displacement of the cord on the right, moderate central spinal stenosis, moderate right and mild left neural foraminal compromise. Subtle T2 increased signal intensity of the cord on the right is suspected.C7-T1 demonstrates mild degenerative changes and unremarkable otherwise.Pre and post enhanced MRI of thoracic spine:Near anatomical morphology, signal intensity and alignment of vertebral column is within normal and without abnormal enhancement.Mild to moderate degenerative disc disease in the mid to lower thoracic spine is noted. There is however no evidence of central spinal stenosis or neural foraminal compromise at any level. The signal intensity and caliber of the cord remains within normal and without detectable abnormal enhancement.At T1-T2 level there is a small non-mass producing left paramedian disc extrusion with slight upward migration posterior to the body of T1. No spinal stenosis or neural foraminal compromise.Pre and post enhanced lumbar MRI:There is no signal abnormality or abnormal enhancement of the vertebral column to suggest myelomatous disease.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy, mild bilateral facet disease however with intravenous left facet effusion. There is a broad base left lateral and far lateral disc protrusion at this level. Constellation of changes results in significant left lateral recess and left neural foraminal compromise and moderate right neural foraminal compromise without central spinal stenosis.L4-L5 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and moderate right facet hypertrophy and right facet effusion. There is no spinal stenosis however moderate to severe right neural foraminal compromise is detected.L5-S1 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy, moderate right and mild left facet hypertrophy. No spinal stenosis however moderate to severe right and mild left neural foraminal compromise.

Output: 1.Pre- and post enhanced are of of cervical spine demonstrate no evidence of myelomatous lesions. Degenerative changes at C4-C5, C5-C6 and C6-C7 levels with resultant central spinal stenosis (worse at C6-C7) as detailed above. Multilevel neural foraminal compromise is also noted. Questionable T2 hyperintensity of the cord on the right at C6-C7 as detailed above.2.Pre and post enhancement MRI of thoracic spine demonstrate no evidence of myelomatous lesions. Mild degenerative changes and a tiny extruded disc at T1-T2 level as detailed above. No evidence of spinal canal or neural foraminal compromise at any level. No abnormal enhancement of the vertebral column, cord or the leptomeninges.3.Pre and post enhanced MRI of lumbar spine demonstrate no evidence of myelomatous disease. Degenerative changes at L3-L4, L4-L5 and L5-S1 levels and including facet effusion and disc protrusion as detailed. There is no evidence of central spinal stenosis however neural foraminal and lateral recess compromise (some significantly) are present as detailed per level above.


Instruction: Generate impression based on findings.

Input: 47-year-old male with elbow pain and extensor mass. Evaluate tendon tear. LIGAMENTS: The ulnar collateral ligament and radial collateral ligament appear intact within the limitations of this non arthrogram study. TENDONS: The biceps brachii muscle and tendon appear intact. There is mild increased signal abnormality and thickening of the brachialis tendon which may represent mild tendinosis. The brachialis muscle appears intact.There is fluid signal abnormality within the common extensor tendon at the level of its insertion on the lateral epicondyle consistent with a tear, which measures 8 mm in the AP dimension. Some of the fibers of the common extensor tendon can be traced to the level of its insertion on the lateral upper condyle of the humerus.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. SURROUNDING STRUCTURES: The remainder of the subcutaneous tissue and muscle is normal in appearance.ADDITIONAL

Output: 1. Tearing of the common extensor tendon as described above.2. Findings suggestive of a very mild olecranon bursitis.


Instruction: Generate impression based on findings.

Input: Reason: staging History: new prostate cancer GG 4+3=7From Epic: A prostate biopsy was performed and revealed a Gleason 3+4 =7. The positive findings left anterior apex 15% and left anterior base 5% of submitted tissue. Two previous prostate biopsies were performed in 2014 and 2015 and were benign PELVIS:PROSTATE:Prostate Size: 4.2 x 3.5 x 3.4 cmPeripheral Zone: There is a lesion in the peripheral zone at the left base which is ill-defined but exhibits low signal intensity on T2/ADC images measuring approximately 2.0 x 1.4 cm (501/7), suspicious for prostatic adenocarcinoma. Other smaller foci of increased T2 signal are indeterminant. Hemorrhage is present in the right mid gland peripheral zone.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion in the left base peripheral zone suspicious for prostatic adenocarcinoma. No evidence of seminal vesicle invasion or extracapsular extension.2.No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female 2 years old; Reason: Assess for fracture or abnormality. History: Patient with one-day history of soft tissue swelling over the right hypothenar eminence.VIEWS: Right wrist AP, lateral and oblique (3 views) 8/5/2016 at 0948 No fracture or malalignment is seen. If concern for soft tissue abnormality persists obtain an ultrasound or MRI.

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Migraines. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The cerebellar tonsils extend up to 4 mm inferior to the foramen magnum, but display rounded contours. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is left frontal sinus mucosal thickening.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or ventriculomegaly.2. The cerebellar tonsils are minimally low-lying and otherwise do not have features of Chiari type 1 malformation.3. Left frontal sinus mucosal inflammation.


Instruction: Generate impression based on findings.

Input: 70 year old female. History of HCC status post TACE/RFA. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Portal vein: Portal vein proximal to the TIPS is patent. Intraluminal portion of the distal TIPS is not well assessed due to artifact.Hepatic artery: PatentLow signal T1 and T2 wedge-shaped defect in segment 3 without enhancing component to indicate recurrence. No new suspicious hepatic mass.Cholelithiasis.SPLEEN: Splenomegaly measuring 14.5 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged. Some have intrinsic T1 hyperintensity consistent with hemorrhagic/proteinaceous cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multiple uterine masses seen only on the coronal images, most likely fibroids.

Output: Stable ablation changes in segment 3 without evidence of recurrent HCC.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with history of meningioma status post resection on 10/31/2013. Surveillance exam. A mildly hemosiderin stained resection bed is again seen spanning the left parietal and temporal lobes. No evidence of any nodular enhancement is seen within or around the resection bed to suggest residual or recurrent tumor. Encephalomalacia and associated confluent T2 hyperintensity within the parenchyma surrounding the resection bed has very slightly progressed. Elsewhere, no pathologic intracranial enhancement is seen. Patchy foci of white matter T2 hyperintensity in the cerebral hemispheres are not significantly changed and remain nonspecific. No new abnormal extra axial collections are detected. Ventricular size and morphology are unchanged.

Output: Sequelae of prior left-sided meningioma resection are seen. No evidence of residual or recurrent tumor is demonstrated. Encephalomalacia and T2 hyperintensity within the surrounding parenchyma has slightly progressed, but this is likely of no clinical significance.


Instruction: Generate impression based on findings.

Input: Low back pain with history of back surgery. Evaluate for discitis. Per EPIC: chronic low back pain s/p L4-S1 spinal fusion 11/20/15, DM II, HTN, and h/o of prostate cancer s/p radical prostatectomy and radiotherapy. There are postoperative findings related to posterior decompression and instrumented fusion from L4 through S1 with bilateral pedicle screws affixed to posterior contoured stabilization rods. A disc spacer is demonstrated within the L5-S1 intervertebral disc space. There is mild anterolisthesis of L5 on S1 with accentuation of the normal lumbar lordosis. There is irregularity involving the L5-S1 endplates with loss of vertebral body height and bone marrow edema and enhancement in the L5 and S1 vertebral bodies. There is also enhancement involving the soft tissues anterior to the vertebral bodies. In addition, there is a fluid collection that measures up to 15 mm anterior to the L5-S1 disc space. There is no evidence of epidural fluid collections. Assessment of this region is otherwise limited by metal hardware artifacts. There is multilevel degenerative disc spondylosis present. At L1-2, there is disc bulging resulting in mild effacement of the ventral thecal sac, without significant spinal or neural foraminal stenosis. At L2-3, there is a mild disc bulge causing mild spinal stenosis and mild bilateral neural foraminal narrowing. There are mild posterior facet degenerative changes as well. At L3-4, there is a mild disc bulge causing mild narrowing of the bilateral neural foramina, without evidence for spinal stenosis. At L4-5, there is susceptibility artifact from indwelling hardware limiting evaluation. There is loss of intervertebral disc space with a disc bulge. There is suggestion of at least mild to moderate bilateral neural foraminal narrowing at this level. There is diffuse fatty replacement of the sacral marrow likely related to prior radiation treatment. There imaged portions of the spinal cord are unremarkable. The left psoas muscle and bilateral posterior paraspinal muscles are atrophic.

Output: 1. Postoperative findings related to posterior fusion from L4 to S1 and placement of intervertebral disc spacer at L5-S1. The L5-S1 endplates appear irregular with mild anterolisthesis and loss of vertebral body height, as well as inflammation of the bone marrow, disc space and anterior paraspinal soft tissues, which likely represents discitis-osteomyelitis. A small fluid collection is present anterior the the L5-S1 disc space, but there is no evidence of epidural abscess.2. Multilevel degenerative spondylosis of the lumbar spine as described above.


Instruction: Generate impression based on findings.

Input: 37 year old male with history of HTN, frequent PVCs, and dizziness who presents for cardiac MRI to evaluate for right and left heart function, structure, and fibrosis. Left VentricleThe left ventricle is upper limits of normal in size with normal systolic function. The overall LV ejection fraction is 62 %, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 227 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 87 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 105 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is upper limits of normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 126 ml/m2 (normal range 82+/-16), the RVEDV is 155 ml (normal range 142+/-31), the RV end systolic volume index is 59 ml/m2 (normal range 31+/-9), and the RVESV is 119 ml (normal range 54+/-17). No micro or microaneurysms are present. No abnormal enhancement.Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch. The thoracic aorta 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.

Output: 1. The left ventricle is upper limits of normal in size with normal systolic function (LVEF 62%). 2. The right ventricle is upper limits of normal in size with normal systolic function (RVEF 54%).3. There is no MRI evidence of arrhythmogenic right ventricular cardiomyopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 57-year-old female with history of primary osteoarthritis involving multiple joints, evaluate osteoarthritis Right hip:Tiny osteophytes suggesting mild osteoarthritis.Left hip:Tiny osteophytes suggesting mild osteoarthritis. Rounded calcifications in the pelvis suggest uterine fibroids.Right knee:There is moderate osteoarthritis particularly affecting the patellofemoral joint. Tricompartmental osteophytes noted. An ossicle posterior to the medial aspect of the distal femur probably represents a loose body within the joint. There are small foci of gas within the joint which presumably reflect recent intervention, although we cannot exclude the possibility of septic arthritis.Left knee:Mild osteoarthritis affects the left knee with tiny osteophytes and a subchondral cyst in the patella. There is an approximately 4 cm rounded soft tissue opacity overlying the posterolateral aspect of the knee that may represent a cutaneous or subcutaneous mass. This can be further evaluated with MRI if clinically warranted.

Output: 1. Osteoarthritis of both knees and both hips as described above.2. Small foci of gas density in the right knee joint presumably reflect recent intervention, please note if there has not been recent intervention septic arthritis should be considered. 3. Posterolateral knee mass as described above which can be further evaluated with MRI if clinically indicated.


Instruction: Generate impression based on findings.

Input: Pain in right knee Moderate to severe degenerative changes are again observed extending in all 3 compartments but more pronounced in the patellofemoral compartment. Irregularity along the condylar surface suggests questionable underlying cartilaginous defects. Correlation with MRI may be indicatedDegenerative changes include narrowing, sclerosis and osteophytes. No significant for a small effusion may be observed

Output: Near severe osteoarthritic changes


Instruction: Generate impression based on findings.

Input: 64-year-old female with mesothelioma status post HIPEC (06/2016) ABDOMEN:LIVER, BILIARY TRACT: Slitlike T2 hyperintense focus with hypointense nodularity in the inferior right lobe of the liver is new since the prior exam. Perihepatic disease has been resected since the prior MR with residual disease studding the surface of the liver. Implant at the dome of the liver is increased in size since prior CT.Reference measurement on the lateral right lobe is provided. There is a subhepatic peritoneal mass that is slightly increased in size when compared to the prior examination.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland nodule is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Focus of peritoneal disease along the right abdominal wall. Nodules noted in the greater curvature of the stomach and gastrosplenic ligament are similar to the prior CT. Trace perisplenic fluid.BONES, SOFT TISSUES: Rightward curvature of the lumbar spine with degenerative changes centered at L3-L4.Right paralabral cyst anterior to the to the right hip joint, increased in size. Right paralabral cyst in the gluteus minimus is unchanged in size. 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: Reference right lower quadrant soft tissue implant is not significantly changed in size. The posterior pelvic soft tissue implant is slightly increased to stable in size since the prior examination. Soft tissue nodularity involving anterior peritoneal reflection on prior CT not as visible on current MRI, uncertain whether reflects decreased size or differences in technique/modality.BONES, SOFT TISSUES: Rightward curvature of the lumbar spine with degenerative changes centered at L3-L4.Right paralabral cyst anterior to the to the right hip joint, increased in size. Right paralabral cyst in the gluteus minimus is unchanged in size. Heterogenous enhancement in the proximal femoral diaphysis is not evaluated well and likely unchanged.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/1/2016 09:18:26)VENTRAL BODY WALL COMPLEX CYSTIC LESION: 7.5 x 1.3 cm (Image 45, Series 6); 9.3 x 1.5 cm on prior (8/9/2016) (Image 94, Series 3).POSTERIOR PELVIC SOFT TISSUE IMPLANT: 3.1 x 3.7 cm (Image 60, Series 18); 3.4 x 3.0 cm on prior (8/9/2016) (Image 127, Series 3).RIGHT LOWER QUADRANT SOFT TISSUE IMPLANT: 4.3 x 4.3 cm (Image 63, Series 18); 4.1 x 3.4 cm on prior (8/9/2016) (Image 127, Series 3).RIGHT SUBHEPATIC NODULE: 2.2 x 2.8 cm (Image 234, Series 10).

Output: Peritoneal/mesenteric and subcapsular metastatic foci as detailed above are stable to slightly increased in size when compared to the prior examinations. There are no definite new lesions identified, accounting for differences in technique and modality (comparison made to prior postoperative CT). Findings and images reviewed with Dr. Turaga.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Eval for demyelinating disease History: paresthesias MRI brain:There is redemonstration of punctate signal hyperintensities located in the pons which are stable compared to the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is right-sided facet hypertrophy present. This is unchanged compared to the prior examAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level associated with some disk materialAt C4-5 there are endplate and uncovertebral osteophytes present associated with a diffuse disk bulge and posterior ligamentous hypertrophy. There is associated effacement of spinal fluid ventral and posterior to the spinal cord. There are bilateral uncovertebral osteophytes present at this level associated disk material and narrowing the neural foramina bilaterally. Compared to the prior exam these findings at the this level have progressed. There are endplate reactive change is present at this level which may be subacute with some bright signal on T2 and dark signal on T1.At C5-6 there is loss of disk space height and disk desiccation, endplate and uncovertebral osteophytes with effacement of spinal fluid ventral and posterior to the left hemicord and encroachment of the exiting nerve roots left more than right. Overall this appears relatively stable compared to the prior exam.At C6-7 there is a loss of disk space height, disk desiccation and diffuse disk bulge associated with endplate and uncovertebral osteophytes and partial effacement of spinal fluid ventral and posterior to the spinal cord and encroachment of the left-sided exiting nerve roots within the neural foramen.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Pontine lesions are stable when compared to the prior exam in general the are suggestive of vascular related lesions, however, they are nonspecific and could relate to other cause such as vasculitis or demyelination.2.Since the prior exam degenerative changes at the C4-5 have progressed and now there is a moderate degree of spinal stenosis present at this level associated encroachment of the exiting nerve roots bilaterally.3.Since the prior exam degenerative changes at C5-6 and C6-7, where there is encroachment of left-sided exiting nerve roots and encroachment of the left hemicord at C5-6 and a mild to moderate degree of spinal stenosis C5-6, have remained relatively stable.


Instruction: Generate impression based on findings.

Input: 75 year old man with CABG x2, multiple PCI, ascending aortic repair and chronic type B dissection, referred for evaluation of viability. Left VentricleThe left ventricle is mildly dilated with moderate to severely reduced systolic function. The overall LV ejection fraction is 29%, the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVEDV is 230 ml (normal range 142+/-34), the LV end systolic volume index is 82 ml/m2 (normal range 25+/-9), the LVESV is 163 ml (normal range 47+/-19). There is apical akinesis with associated thinning. There is hypokinesis of the mid to apical anteroseptal and septal walls. There is akinesis of the mid to apical inferior wall. There is late gadolinium enhancement in the distal to apical septum and anteroseptum that appears transmural and consistent with prior infarct. This area is not likely to be viable. There is subendocardial LGE in the mid anteroseptum / septum that occupies about 50% of the myocardium and is consistent with prior infarct. This area has intermediate probability of viability. The remaining myocardium is viable.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 30%, the RV end diastolic volume index is 106 ml/m2 (normal range 82+/-16), the RVEDV is 212 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 149 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThere is systolic turbulence across the AV. The number of leaflets cannot be determined on this study. There is mild to moderate aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation. There is mild to moderate annular calcification. There is thickening of the anterior valve leaflet.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. There is evidence of aortic root/ascending aorta graft repair. The aortic root in normal in size. Distal to the repair anastomosis begins a type B thoracic aortic dissection. This appears similar to outside CT report description. The true lumen in the descending thoracic aorta is narrowed.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are moderate bilateral pleural effusions with atelectasis. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: The left ventricle is mildly dilated with moderate to severely reduced systolic function. The overall LV ejection fraction is 29%.There is apical akinesis with associated thinning. There is hypokinesis of the mid to apical anteroseptal and septal walls. There is akinesis of the mid to apical inferior wall. There is late gadolinium enhancement in the distal to apical septum and anteroseptum that appears transmural and consistent with prior infarct. This area is not likely to be viable. There is subendocardial LGE in the mid anteroseptum / septum that occupies about 50% of the myocardium and is consistent with prior infarct. This area has intermediate probability of viability. The remaining myocardium is viable.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.