Instruction: Generate impression based on findings.

Input: 82-year-old female with mass in the right neck on carotid. Question cyst versus solid mass versus carotid bulb Limited value examination due to lack of contrast infusion.Images through the basal brain demonstrates findings of old lacunar infarcts.The skull base is unremarkable. No definitive evidence of any pathologic adenopathy in the neck is detected. A mass with rim calcification within the left thyroid bed measuring approximately 27 x 26 .8-mm is noted. This is believed to represent goiter however possibility of other lesions cannot be entirely ruled out. Further evaluation with postinfusion exam, ultrasound or an MRI is recommended.Limited images through the apices of the lung are unremarkable. Bony density of area of exam is negative for any pathology.

Output: 1.Limited value examination due to lack of contrast infusion.2.Mass with rim calcification in the left lobe of thyroid as detailed above. 3.Notice of pathologic adenopathy.


Instruction: Generate impression based on findings.

Input: 35 year old woman with history of connective tissue disease, new LV dysfunction, referred for evaluation of underlying ischemia or infiltration.MEDICATIONS: prednisone First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is moderately dilated with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 108 ml/m2 (normal range: 65+/-11), the LVEDV is 174 ml (normal range 109+/-23), the LV end systolic volume index is 53 ml/m2 (normal range 18+/-5), the LVESV is 85 ml (normal range 31+/-10), the LV mass index is 32 g/m2, and the LV mass is 52 g. There are no regional wall motion abnormalities present. The native myocardial T1 relaxation time is 1054ms, which is within the normal range.Left AtriumThe left atrium is normal in size . Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 87 ml/m2 (normal range 69+/-14), the RVEDV is 140 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 57 ml (normal range 35+/-13). 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 mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is moderately dilated with low normal systolic function. The overall LV ejection fraction is 51% without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%5. Mild to moderate mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: CT scan of 11/12/15 recommended MRI of skull base/ sinus: Confirmed CSF rhinorrhea with question of cephalocele in right sphenoid and posterior ethmoid sinus. There is herniation of dysplastic brain parenchyma, adhesions, and cerebrospinal fluid into the right sphenoid sinus, posterior ethmoid sinus, and nasal cavity via a 7 mm wide defect in the right planum sphenoidale, which is compatible with an encephalocele. The encephalocele measures up to 3 cm in length. There is associated distortion and encephalomalacia of the right gyrus rectus. Fluid surrounding the encephalocele may represent leakage of cerebrospinal fluid. There are prominent arachnoid granulations in the floor of the middle cranial fossae bilaterally. There is also an enlarged partially-empty sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is a nonspecific focus of susceptibility effect in the left posterior fossa. 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 are grossly unremarkable. There is a retention cyst formation within the left maxillary sinus.

Output: 1. Encephalocele within the right sphenoid sinus and extending into the posterior ethmoid sinus and nasal cavity via a skull base defect with associated right gyrus rectus encephalomalacia. Fluid in the right sphenoid sinus may represent associated cerebrospinal fluid leakage.2. Prominent arachnoid granulations in the floor of the middle cranial fossae bilaterally and an enlarged partially-empty sella suggest underlying pseudotumor cerebri, which can also predispose to encephalocele formation and cerebrospinal fluid leakage.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, history of right parietal grade 3 oligodendroglioma status post resection, radiation and chemotherapy. Again seen are postsurgical changes of right parietal craniotomy for tumor resection. The resection cavity involving the inferior parietal lobule. There is surrounding T2/FLAIR hyperintensity, which remains unchanged, including signal abnormality extending into the posterior temporal lobe. No new T2/FLAIR hyperintensity, mass effect, or suspicious enhancement is appreciated. Intrinsic T1 hyperintensity and susceptibility effect are again seen and compatible with blood products and/or mineralization.There is a small developmental venous anomaly within the right thalamus. Mild ex vacuo dilatation of the right lateral ventricle is again seen. There is subcentimeter focus of susceptibility within the right paramedian midbrain which is more prominent than prior studies from 9/4/2015 and 3/9/2015. Remainder of the brain parenchyma is unremarkable without evidence of new infarct, hemorrhage, mass, or mass effect. No hydrocephalus. Aside from postsurgical changes, calvarium and extracranial soft tissues are unremarkable.

Output: 1. Posttreatment changes in the right temporoparietal lobes remain unchanged. No evidence of tumor progression.2. Gradual increasing size of focus of susceptibility/microhemorrhage within the right paramedian midbrain which may represent a small cavernous malformation, possibly related to prior radiation treatment although unclear if this area was within the radiation field. No surrounding edema.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal MRI of the knee.


Instruction: Generate impression based on findings.

Input: Multiple myeloma with new neck pain and known compression fractures, thoracic pain and tumor at T5- now bilateral rib pain radiating bilaterally from T5. Evaluate for disease or compression fracture progression. Cervical: Lack of contrast limits assessment for small lesions. There is diffuse infiltration involving the C5 vertebral body compatible with myelomatous involvement. There is subtle soft tissue thickening dorsal to the C5 vertebral body suspected to represent epidural tumor, and new since prior study from 4/14/2015. There is moderate spinal canal stenosis at this level which is predominantly on a degenerative basis including disc osteophyte complex and ligamentum flavum thickening. The moderate spinal canal stenosis at the C4-C5 and C5-C6 levels which is minimally worse given the now suspected thin epidural tissue. No cord signal abnormality is evident. There also appears to be mild to moderate C5-C6 neural foraminal stenosis, particularly on the right related to combination of degenerative disease/uncovertebral hypertrophy and epidural tumor.There are minimal degenerative changes elsewhere in the cervical spine without spinal canal or neural foraminal stenosis. No evidence of compression fractures in the cervical spine. Bone marrow signal heterogeneity including T1 hyperintensity involving the anterior aspect of the upper cervical vertebral bodies may represent sequela of prior treatment and similar to prior. No new cervical lesion is appreciated within the limits of noncontrast study.Thoracic:There are multiple compression fractures throughout the thoracic spine, essentially affecting all vertebral bodies aside from T4 and T12. There is severe compression fracture with approximately 70% loss of height involving the T6 vertebral body which appears slightly worse in the interval. Evidence of prior cement augmentation noted involving multiple thoracic vertebra. There is focal effacement of the ventral thecal sac at multiple levels including T8 and T10 which appears to be related to chronic cement extravasation. No high-grade spinal canal stenosis at any level or thoracic cord signal abnormality. Mild neural foraminal stenosis is present in multiple levels related to degenerative disease without high-grade neural foraminal stenosis at any level.There is exaggerated thoracic kyphosis with apex at the T6 level, similar to prior. Previously seen epidural tumor at the T6 level appears to have resolved. No new site of epidural disease is appreciated within the limits of noncontrast study.There is an approximately 16 mm lesion involving the T4 vertebral body which appears more discrete/larger than prior. Additional scattered small lesions seen previously are difficult to assess; no new large lesions are evident.There is diffuse osteopenia more evident on recent radiographs. Partially imaged lumbar spine also demonstrates a mild compression fracture of L1 and present previously without associated spinal canal stenosis.There is mild deformity involving the posterior medial aspects of the right 8th through 10th ribs likely related to remote fractures. Abnormal marrow signal involving multiple ribs consistent with myeloma.

Output: 1. Please note lack of intravenous contrast limits evaluation for small lesions including small foci of epidural tumor. Again seen is evidence of multiple myeloma affecting the cervical and thoracic spine. Compared to examination from 4/14/2015 there appears to be increased, thin soft tissue dorsal to the C5 vertebral body suspected to represent new epidural tumor. There is moderate spinal canal stenosis at this level, primarily on a degenerative basis but appears slightly worse in the interval secondary to the increased epidural tumor. No evidence of frank cord compression or cord signal abnormality.2. Previously seen epidural tumor at the T6 level is no longer appreciated. No new site of epidural disease in the thoracic spine within the limitations of noncontrast study.3. Increased size of lesion involving the T4 vertebral body without associated compression fracture or spinal canal stenosis.4. Multiple thoracic as well as L1 compression fractures, worst at the T6 level where there is approximately 70 % loss of height, which is slightly worse in the interval. Evidence of prior cement augmentation of T7-T10 evidence of chronic extravasation dorsally into the ventral epidural space appearing unchanged. No evidence of high-grade spinal canal stenosis in the thoracic spine or cord signal abnormality.5. Multiple osseous lesions elsewhere including the ribs and sternum are better appreciated on recent chest CT. Mild deformity involving the posterior medial right 8-10th thoracic ribs are compatible with remote fractures.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction. There is ventriculomegaly present out of proportion to sulcal width.There are patchy T2 and FLAIR signal hyperintensities along the pons and periventricular white matter. There is no focus of diffusion restriction present. Right there are small T2 hyperintense lesions in the cerebellum which are low signal on FLAIR. These probably represent enlarged periventricular spaces.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 left vertebral artery flow-void is very small.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. The eyeball lenses are thin.Examination is somewhat degraded by artifact related to patient motion. Many fast sequences were used in an attempt to reduce artifact at the expense of lower contrast resolution.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter changes of a mild degree as well as mild signal change in the pons are nonspecific. At this age they are most likely vascular related. 3.Some small cerebellar lesions may be related to prior microinfarcts but are nonspecific.4.There is generalized brain atrophy present.5.Examination is degraded by patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Right medial joint line pain. Evaluate for meniscus tear. MENISCI: There is a partial thickness radial tear of the posterior horn of the medial meniscus. There is also deformity of the posterior horn of the medial meniscus just medial to its root attachment which may reflect additional tearing and/or an adherent flap fragment of meniscal tissue from the aforementioned radial tear. There is also poorly defined increased signal intensity within the body of the medial meniscus suggesting intrasubstance degeneration that it appears to contact the tibial articular surface, perhaps reflecting undersurface fraying. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is superficial degeneration and fissuring of the articular cartilage of the patella particularly along the median eminence and medial facet. There is a small subchondral cyst within the femoral trochlea centrally with mild heterogeneity of the overlying articular cartilage likely reflecting focal degeneration. There is superficial degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle. Mild heterogeneity of signal intensity of the articular cartilage of the lateral compartment may reflect mild degeneration, but this is equivocal. The remaining bone marrow signal intensity is normal.LIGAMENTS: Cruciate and collateral ligaments are intact. There is a small bony excrescence arising from the medial epicondyle of distal femur at the proximal attachment of the medial collateral ligament perhaps representing old trauma. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1.Medial meniscal tear as described above.2.Cartilage degeneration as described above.3.Joint effusion.


Instruction: Generate impression based on findings.

Input: 35 years Female (DOB:10/18/1980)Reason: NEED T2 IMAGING ALONG WITH CONTRAST IMAGES STEALTH PROTOCOL. Preop planning for biopsy History: preop planningPROVIDER/ATTENDING NAME: BAKHTIAR YAMINI BAKHTIAR YAMINI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the T2 images.There are punctate foci of T2 hyperintensity in the brainstem and cerebellum as well as the thalami and basal ganglia.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Please note that this examination was performed for the purpose of stereotactic guidance during surgery. There are multiple subcortical and periventricular white matter lesions as well as lesions in the cerebellum and leptomeninges adjacent to the cerebellum which previously demonstrated contrast enhancement, however, these lesions currently no longer enhance but do demonstrate T2 signal hyperintensity. These are non-specific. One possibility is that these represent treated lesions.


Instruction: Generate impression based on findings.

Input: 75 years old, Female, Reason: 75 yo female with h/o thyroid nodules 2/2015. Needs repeat in 6-12 months to assess for growth or change. History: thyroid nodule RIGHT LOBE MEASUREMENTS: 4.9 x 1.4 x 1.4 cm, unchangedLEFT LOBE MEASUREMENTS: 4.9 x 1.6 x 1.5 cm, slightly smallerISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Subcentimeter isoechoic heterogeneous thyroid nodule with internal vascularity is unchanged and measures 4 mm in diameter. LEFT LOBE: Previously described two nodules in the left thyroid lobe are unchanged. The more superior nodule is solid and heterogeneous in appearance with internal vascularity measuring 1.2 x 0.9 x 1.4 cm. The inferior left thyroid nodule measures 1.1 x 0.6 x 0.9 cm and is spongiform appearance.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.

Output: Multiple small thyroid nodules are unchanged.


Instruction: Generate impression based on findings.

Input: Clinical question: Sepsis. Signs and symptoms: Altered mental status Nonenhanced head CT:Examination demonstrates no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Low attenuation of white matter of bilateral cerebral hemispheres are within normal for patient stated age of 12 days. Ventricular system remain within normal.Mastoid air cells and middle ear cavities are pneumatized and unremarkable. Calvarium is intact. If clinical concern persists an MRI is recommended.

Output: Negative nonenhanced CT of brain. If clinical concern persist recommend follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: Low back pain. Symptoms: Low back pain Nonenhanced lumbar MRI:The alignment of vertebral column is anatomical.T10-11, T11-T12, T12-L1 levels are unremarkable other than mild degenerative changes.L1-L2 demonstrate mild disc disease and loss of disc height, shallow broad-based bulging disc, mild bilateral ligamentum flavum and facet degenerative changes. No evidence of spinal stenosis however mild right neural foraminal compromise is detected.L2-L3 demonstrate moderate disc disease and loss of disc height, large disc/osteophyte (R>L) and moderate bilateral ligamentum flavum and facet hypertrophic changes. Constellation of changes results in mass effect and posterior displacement of thecal sac with moderate to severe central spinal stenosis. Degenerative changes also results in moderate bilateral (L>R) neural foraminal compromise and significant compromise of the lateral recesses bilaterally.L3-L4 demonstrate advanced disc disease and loss of disc height, moderate bilateral facet and ligamentum flavum hypertrophy, large right lateral osteophyte and a smaller on the left. Constellation of changes results in significant right neural foraminal compromise with no central spinal stenosis and mild to moderate left neural foraminal compromise.L5-S1 demonstrate advanced disc disease and loss of disc height, extensive facet and mild ligamentum flavum hypertrophy changes. There is suggestion of prior posterior bony fusion at this level. No central spinal stenosis however moderate left and mild right neural foraminal compromise is present.L5-S1 demonstrates advanced disc disease and significant loss of disc height, moderate asymmetric left-sided facet hypertrophy and mild on the right. There is suggestion of prior posterior approach surgery at this site and the bony fusion. No spinal stenosis however mild to moderate left neural foraminal compromise is noted.

Output: 1.Degenerative changes at L2-L3 and including a large disc-osteophyte results in moderate to severe central spinal stenosis and neural foraminal compromise as detailed.2.Extensive degenerative changes at other levels however without evidence of central spinal stenosis.3.There are multilevel neural foraminal compromise (some severely) as detailed per level above.4.Postoperative changes of prior laminectomy and bony fusion at L4 and L5 without residual central spinal stenosis as detailed.


Instruction: Generate impression based on findings.

Input: HIV on HAART with bilateral sensory disturbances in the hands and feet. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There is prominence of the retrocerebellar cerebrospinal fluid spaces. The ventricles and basal cisterns are otherwise 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.Cervical Spine: There is a large central disc extrusion that compresses the spinal cord at the C5-6 level. There is patchy high T2 signal and punctate enhancement within the spinal cord at this level. There is also a smaller central disc protrusion at the C4-5 level that slightly indents the spinal cord. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. A large disc extrusion compresses the spinal cord at the C5-6 level with associated spinal cord edema. A disc smaller central disc protrusion at the C4-5 level also slightly indents the spinal cord. 2. No evidence of intracranial hemorrhage, mass, or acute infarct. Discussed with Dr. Weyer at 3 PM on 3/12/16.


Instruction: Generate impression based on findings.

Input: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits, with the conus terminating at the L1-2 level.L1-2: Unremarkable. No significant spinal canal or neuroforaminal stenosis. No significant interval changes.L2-3: Unremarkable. No significant spinal canal or neuroforaminal stenosis. No significant interval changes.L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. Mild interval progression of findings.L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Mild right neural foraminal narrowing. Mild interval progression of findings.

Output: Mild scattered degenerative changes as detailed above, with mild right neural foraminal narrowing at L5-S1.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with intermittent headaches, history of pituitary adenoma. Evaluate for interval change. A T1 hyperintense lesion within the posterior pituitary is again seen with some interval reduction in size. The lesion now measures 7 x 8 x 5 mm and previously measured 8 x 11 x 9 mm. The anterior portion of the gland continues to appear normal. The pituitary stalk deviates very slightly to the left similar to prior. A cyst along the left medial temporal lobe, situated within the quadrigeminal plate cistern, appears to reflect an arachnoid cyst based on review of prior exams.

Output: 1.Mild interval decrease in size of a posterior pituitary lesion.2.Redemonstration of a probable arachnoid cyst along the left medial temporal lobe.


Instruction: Generate impression based on findings.

Input: 23 year old with history of sclerosing cholangitis. Follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: Again seen are multiple areas of biliary ductal stricturing and dilatation compatible with the diagnosis of sclerosing cholangitis. Overall the appearance is similar to the prior exam.Adjacent to the dilated ducts in the left lobe there is mildly increased T2 signal and restricted diffusion. No associated mass lesion is evident and this likely reflects periductal inflammation.No suspicious enhancing lesion. The hepatic vasculature is widely patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of sclerosing cholangitis as described appears similar to prior.2.No suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: Large complex left ovarian cyst. Presents for further characterization. PELVIS:UTERUS, ADNEXA: Anteverted retroflexed uterus. The endometrium is normal in thickness. The inner myometrium/junctional zone is thickened with an ill-defined inner/outer myometrial junction compatible with diffuse adenomyosis.There is a 7.8 x 6.8 cm left adnexal mass extending into the rectouterine pouch displacing the uterus anteriorly demonstrating hyperintensity on T1-weighted imaging sequences with hypointensity on T2-weighted imaging sequences compatible with an endometrioma.Otherwise the right adnexa and left ovary are unremarkable.Numerous cervical nabothian cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disc disease at L5-S1.OTHER: No significant abnormality noted.

Output: 1.7.8 cm left adnexal mass in the rectouterine pouch likely represents an endometrioma.2.Diffuse adenomyosis.


Instruction: Generate impression based on findings.

Input: Patient with positive valgus test, check for meniscal pathology. Pain MENISCI: Globular signal is observed throughout the posterior horn of the medial meniscus with a discrete radial tear extending to the posterior aspect. Lateral meniscus is otherwise unremarkable.ARTICULAR CARTILAGE AND BONE: Diffuse cartilaginous thinning with irregularity, most pronounced involving the condylar surface of the medial compartment. Relative sparing of the patellofemoral compartment however a moderate focal signal abnormality is observed in the medial aspect of the trochlear groove (image 23 series 601). Scattered subchondral cysts without additional superimposed acute marrow abnormalityLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Medial meniscal tear, as described2. Extensive cartilaginous loss and cystic changes, see above


Instruction: Generate impression based on findings.

Input: History of partial nephrectomy for papillary type 2 renal cell carcinoma. Also history of prostate cancer status post prostatectomy. ABDOMEN:LIVER, BILIARY TRACT: Small liver cyst is again noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes from a right partial nephrectomy including scarring as well as nodular areas of intrinsically increased T1 signal in the perinephric fat without associated enhancement to suggest neoplastic recurrence. There are several bilateral renal cysts the largest of which is on the left, appearing similar to prior. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lateral abdominal wall broad-based hernia containing small and large bowel without evidence of complication.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a partially visualized cystic structure within the left hemipelvis which was present on the CT from 4/27/2015 and is favored to reflect a lymphocele.

Output: Postoperative findings of partial nephrectomy without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: 20-year old female with history of left posterior knee pain. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is no bone marrow edema. There are a few scattered small foci of decreased signal intensity which may represent bone islands. The articular cartilage is unremarkable.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. There is mild edema in the subcutaneous fat anterior to the patella of questionable clinical significance.ADDITIONAL

Output: Mild edema-type signal abnormality within the soft tissues anterior to the patella and along the posteromedial aspect of the proximal tibia which is of questionable clinical significance. The bones and soft tissues of the knee are otherwise normal.


Instruction: Generate impression based on findings.

Input: Reason: back pain History: back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. Overall the pedicles are thickened short and the spinal canal is small.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disk bulge at this level as well as some mild facet ligamentum flavum hypertrophyAt L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge at this level associated with disk desiccation and facet and ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recess ease at this level and overall moderate degree of spinal stenosis. There is narrowing of the neural foramina bilaterally at this level. Compared to the 2007 exam there has been some interval progression of spinal stenosis.At L3-4 and the patient is status post left-sided hemilaminotomy. There is loss of disk space height, disk desiccation and diffuse disk bulge at this level associated with some ligamentum flavum hypertrophy. There is some effacement of the fat of the left lateral recess at this level and left hemi-canal . There is narrowing of the neural foramina bilaterally at this level. Overall the degree of encroachment knee left lateral recess is not changed substantially compared to 2007At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is redemonstration and no significant change of a T11-12 disk protrusion without significant compromise of the spinal canal.

Output: 1.Since the prior exam the patient has developed spinal stenosis at L4-5.2.There is a redemonstration of encroachment of the nerve roots at the left hemi-canal at L3-4. Differentiation of scar formation from encroachment due to disk material may be possible using a contrast enhanced exam.3.Congenitally narrow lumbar spinal canal.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [340], Reason for Study: ^Reason: eval for MS progression History: facial weakness There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There are, however, multiple high signal intensity lesions on FLAIR images which appear to be showing perpendicular against lateral ventricle. The lesions are seen on the right frontal lobe deep white matter, right corpus callosum body, right posterior parietal subcortical white matter, left side corpus callosum splenium, periventricular white matter on the left lateral ventricle occipital horn, and mesial aspect of the left superior temporal gyrus close to the posterior aspect of the left insular. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal high signal lesions on FLAIR which are consistent with multiple sclerosis lesions.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: History of bladder cancer status post cystectomy and ileal conduit. Surveillance examination. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Moderate diffuse pancreatic parenchymal atrophy. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Innumerable simple cystic lesions bilaterally. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No abdominal lymphadenopathy.BOWEL, MESENTERY: Postoperative changes from ileal conduit from aeration.BONES, SOFT TISSUES: No focal suspicious osseous lesion.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy and ileal conduit information.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small focus of enhancing subcutaneous tissue overlying the left rectus muscle (series 20 image 42) is not significant changed since 2013 and presumed postsurgical.OTHER: No significant abnormality noted.

Output: 1.Postoperative changes from cystoprostatectomy without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Examination is mildly motion limited. Cord signal is grossly unremarkable. Craniocervical junction is within normal limits. Vertebral body heights are normal. Alignment is normal. Bone marrow signal is benign. Mild degenerative changes are seen with multilevel disc desiccation. Individual levels as below:C2-C3: No spinal canal or neural foraminal compromise.C3-C4: No spinal canal or neural foraminal compromise.C4-C5 no spinal canal or neural foraminal compromise.C5-C6: Trace disc bulge with no spinal canal or neural foraminal compromise.C6-C7: Minimal disc bulging with no spinal canal or neural foraminal compromise.C7-T1: Trace disc bulging with no spinal canal or neural foraminal compromise.

Output: Minimal degenerative changes in the cervical spine. There is no significant spinal canal or neural foraminal stenosis at any level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with essential tremor. Multiple scattered foci of periventricular and subcortical T2 hyperintensity are seen. No evidence of edema or mass effect is detected. No abnormal extra-axial collections are observed. The ventricles and sulci are prominent compatible with underlying volume loss. Hemosiderin staining is seen within several right frontal sulci. No enhancing lesions are observed. Incidentally noted is a developmental venous anomaly which traverses the right genu of the corpus callosum.

Output: 1.Scattered foci of T2 hyperintensity are seen, a nonspecific finding which may reflect microvascular ischemic disease.2.Hemosiderin staining is seen along several right frontal sulci likely representing a prior hemorrhagic event.3.Mild parenchymal volume loss is noted.


Instruction: Generate impression based on findings.

Input: Impaired left L4 sensory deficits. Evaluate for impingement. There are 4 lumbar type vertebral bodies with a fifth transitional segment labeled L5 for the purposes of study. There is articulation of the bilateral transverse processes of L5 with the sacrum. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign with scattered foci of T1 hyperintensity compatible with focal fat or hemangiomas. The conus medullaris is normal in position.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. There is no significant spinal canal or neural foraminal stenosis at any level in the lumbar spine. Specifically, no evidence of L4 nerve impingement in the spinal canal or neural foramen.2. Transitional anatomy with partial sacralization of the L5 vertebral body incidentally noted.


Instruction: Generate impression based on findings.

Input: 52 years Male (DOB:1/24/1964)Reason: stroke History: acute R facial weakness/anesthesia, dysarthria; chronic imbalance, ?L hemiplegia, L spasticityPROVIDER/ATTENDING NAME: GREGG M HELLAND GREGG M HELLAND MRI of the brainA small focus of diffusion restriction is present along the posterior limb of the left internal capsule which extends into the left globus pallidus. This is associated with T2 and FLAIR signal hyperintensity. It measures approximately 12 x 7 mm axial dimensions.There is a T2 and FLAIR hyperintense punctate focus present in the left cerebral peduncle.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The visualized portions of the cervical spine appears to be central disc protrusion at C2-3 which partially effaces spinal fluid ventral to the spinal cord.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are small. The vertebral arteries are similar in size.

Output: 1.Findings are compatible with subacute lacunar infarct located in the left posterior limb of the internal capsule.2.There are several periventricular and subcortical white matter lesions which are nonspecific. They are most likely vascular related. 3.Findings are compatible with an old lacunar infarct involving the left cerebral peduncle.4.No evidence for cerebrovascular occlusive disease.5.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: 62-year-old male with right shoulder subcutaneous abscess after shoulder arthroscopy. Since the prior study the patient has undergone surgery with suture anchors in the humeral head and foci of metallic susceptibility artifact in the surrounding soft tissues. There is a skin defect along the superolateral aspect of the shoulder, perhaps representing a prior arthroscopy portal, with abnormal signal intensity extending from the defect through the subcutaneous fat and the lateral fibers of the deltoid into the subdeltoid bursa. There is rim-enhancing fluid within the subdeltoid bursa that communicates with a heterogeneous glenohumeral joint effusion via a full-thickness tear of the rotator cuff involving the infraspinatus and supraspinatus with surrounding enhancement indicating inflammation. These findings are concerning for septic arthritis/subdeltoid bursitis. There is erosion of the humeral head along the superolateral aspect with edema extending along one of the suture anchors. There is edema within the supraspinatus and infraspinatus muscles. There is retraction of much of the infraspinatus to the level of the glenohumeral joint with fluid extending into the fibers of the retracted tendon. There is a small interstitial tear of the subscapularis. Osteoarthritis affects the acromioclavicular joint but we see no findings to suggest infection of the joint. There is a tear of the superior labrum. The tendon of the long head of the biceps is not visualized within the rotator interval perhaps related to prior tenotomy. Enhancement within the bicipital groove may reflect a tenosynovitis. Mild edema is identified within the deltoid muscle.

Output: Findings suggestive of septic glenohumeral joint arthritis/subdeltoid bursitis and rotator cuff tear as described above. These findings were relayed to Dr. Eleswarapu via phone at 10:50 AM on 12/4/2015


Instruction: Generate impression based on findings.

Input: Female, 35 years old, with neurofibromatosis type I and pain. Cervical:Alignment is grossly anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected. Bilateral prominence of the C2 foraminal nerve roots is seen, with questionable prominence at additional levels.Mild degenerative disc disease is seen at C5-6 with a small central annular fissure. No significant spinal canal or foraminal stenosis is seen at any level.The thyroid gland contains multiple heterogeneous nodules. Numerous cutaneous neurofibromas are demonstrated.Brachial Plexus:As above, mild thickening of several of the cervical nerve roots is seen within the neural foramina. More distally, the brachial plexi are not clearly thickened and there are no obvious compressive lesions. No pathologic enhancement is observed.

Output: 1.At most, there may be mild thickening of several cervical nerve roots within the neural foramina.2.No intraspinal masses are seen. No spinal cord abnormalities are identified.3.The brachial plexi are not clearly affected by tumoral thickening or impingement.4.Multiple nonspecific thyroid nodules are seen.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [780.4], Reason for Study: ^Reason: Evaluate for posterior circulation lesions History: episodes of imbalance and running into walls which are PRIOR to feeling lightheaded Extensive but most likely confined to bilateral parieto-occipital deep white matter and periventricular white matter of bilateral lateral ventricle occipital horn area high signal intensity lesions on FLAIR images. These lesions do not show any evidence of restricted diffusion or hemorrhage. Subcortical u-fibers and Grey matter appear to be saved.There is no evidence of acute ischemic or hemorrhagic lesion on this scan. There are several scattered high signal intensity foci on FLAIR images on bilateral frontal white matter which are likely non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Extensive deep and periventricular white matter high signal intensity lesions on bilateral posterior parietal and occipital lobes. These lesions are not specific thus could represent inflammatory lesions including demyelinating disease, infectious process, vascular lesions or chronic ischemic lesions. Clinical correlations could be helpful. 2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Patient with right hip pain, noted to have a step-off on x-ray, concerning for degenerative joint disease versus fracture. The study is limited by an ability to optimally position the patient. ACETABULAR LABRUM: Given the limitations of a nonarthrogram study, the labrum appears grossly intact.ARTICULAR CARTILAGE AND BONE: There is no bone marrow signal abnormality to indicate acute fracture. Scattered osteophytes consistent with minimal osteoarthritic changes are noted in the right hip. Given the limitations of nonarthrogram study, the cartilage appears grossly intact. Small amount of fluid is noted within the joint, which is normal.SOFT TISSUES: The surrounding musculature are unremarkable. ADDITIONAL

Output: Minimal degenerative changes of the right hip without fracture or dislocation.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Midazolam and fentanyl were administered IV by the nurses during continuous hemodynamic monitoring. A localizing CT demonstrated a lesion within the left superior pubic ramus and acetabulum corresponding to the findings on the patient's recent MRI examination.A 13 gauge OnControl core biopsy needle was advanced under CT guidance into the aforementioned lesion within the left superior pubic ramus and left acetabulum. Three 13-gauge core needle biopsy specimens were obtained. Touch preparation slides were handed to cytopathology.The core biopsy specimens were hand carried to the Surgical Pathology labThe patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: CT-guided biopsy of a left superior pubic ramus/left acetabular lesion.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, with leg weakness, preoperative evaluation for surgical planning. T2 hyperintensity and gyral thickening is again seen involving the left paracentral lobule. On comparison with the prior examination, there has been some progression of this signal abnormality which extends further laterally into the left precentral gyrus. Sequelae of prior biopsy are noted including small cystic cavities along the biopsy trajectory and artifact related to the biopsy marker. Scattered foci of enhancement within the lesion are nonspecific and may be postoperative in nature. Incidental note is made of a developmental venous anomaly along the right marginal sulcus. No new lesions are detected. The ventricles are normal in size and morphology.

Output: Redemonstration of a lesion and/or lesional edema in the left paracentral lobule which has mildly expanded when compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Male 74 years old Reason: left knee pain and locking History: left knee pain. We have 4 views of the left knee. A vertically oriented deformity involving the lateral aspect of the patella may represent a bipartite patella or a healed nondisplaced fracture which was initially suspected on the MRI study from December 2010. Ossicles seen on the lateral view anterior to the distal femur are unchanged from the prior exam and may represent heterotopic ossification of the proximal quadriceps tendon or loose bodies in the suprapatellar pouch. There is mild osteoarthritis of the right knee with joint space narrowing of the medial compartment as seen on the frontal views, and is unchanged from prior exam.

Output: 1. Nonspecific curvilinear lucency may represent a bipartite patella or healed nondisplaced fracture as described above.2.Ossicles anterior to the distal femur may represent heterotopic ossification of the quadriceps tendon or loose bodies in the suprapatellar pouch.


Instruction: Generate impression based on findings.

Input: 32 year old male with history of asymptomatic left ventricular dysfunction thought to be secondary to chemotherapy for Stage IV neuroblastoma at the age of 4 (treated with chemotherapy, radiation and BMT). Left VentricleThe left ventricle is normal in size with mildly reduced left ventricular systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 63 ml/m2 (normal range: 74+/-15), the LVEDV is 107 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 53 ml (normal range 47+/-19), the LV mass index is 34 g/m2 (normal range 85+/-15), and the LV mass is 58 g (normal range 164+/-36). The left ventricular dysfunction is global with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 104 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 42 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size with mildly reduced systolic function (LVEF 51%). The systolic dysfunction is global and there is no evidence of late gadolinium enhancement to suggest scar or fibrosis. 2. Normal right ventricular size with normal systolic function (RVEF 60%).


Instruction: Generate impression based on findings.

Input: History of metastatic lung cancer with right hemiplegia. Evaluate for ischemia, structural lesion or metastasis. Brain: There is global parenchymal volume loss. There is no evidence of acute infarct, large intracranial mass, or mass effect. Again seen are scattered foci of susceptibility effect including the right frontal subcortical white matter, left inferior frontal lobe along the cortical surface, as well as in the left left paracentral lobule. Left inferior frontal focus corresponds to hyperdensity seen on CT likely representing calcification and less likely blood products given stability between 5/15 2015 and 5/20/2015. Remainder of the foci of susceptibility are compatible with chronic microhemorrhages or mineralization. There is mild associated FLAIR hyperintensity particularly with the left inferior frontal lesion which appears nodular. There are scattered foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is opacification of the left mastoid air cells.Cervical spine: Lack of contrast and motion degradation limiting evaluation for metastatic disease. There is minimal retrolisthesis of C5 on C6. At C5-6, there is disc bulge, mild loss of disc height and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild bilateral foraminal stenosis. There is abnormal marrow signal at the T1 and T2 vertebral bodies with involvement of the right-sided posterior elements of the T1-T3 vertebrae as well as the left T2 pedicle and T2 and T3 spinous processes. There is mild to moderate right foraminal stenosis at T1-T2 and T2-T3. The spinal cord displays normal signal and morphology. There is a small left pleural effusion. A nasoenteric tube is partially imaged.

Output: 1.No evidence of acute infarct. Please note lack of contrast limits evaluation for small metastatic lesions.2.Small foci of susceptibility effect described above in the right frontal lobe subcortical white matter and left paracentral lobule are compatible with chronic microhemorrhages or mineralization and possibly related to treated metastatic disease. Comparison with outside MRI studies would be helpful if available. There is an additional focus of susceptibility effect involving the cortical surface of the left inferior frontal gyrus which on MRI from 5/16/2015 appears to enhance although that examination is motion degraded. There is associated hyperdensity on recent CT which is favored to represent mineralization, perhaps due to treatment, or less likely minimal hemorrhage given stability between CT studies from 5/15/2015 and 5/20/2015. There is minimal associated nodularity and T2 signal compatible with mild edema or gliosis.3.Osseous metastases involving the T1-T3 vertebral bodies and posterior elements, contributing to mild to moderate right foraminal stenoses at T1-T2 and T2-T3.4.Degenerative changes of the cervical spine, most prominent prominent at C5-C6, with mild spinal canal stenosis and mild bilateral foraminal stenosis. No cord signal abnormality, high-grade spinal canal stenosis, or epidural tumor is appreciated within the limits of noncontrast study.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with brain tumor, functional mapping requested for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Of note, the foot movement paradigm elicited numerous areas of apparent cortical activation throughuot the hemispheres in addition to the expected sites which is of uncertain significance and potentially artifactual. Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. All paradigms show similar results. Language is left dominant. The putative Broca's area is identified in the left inferior frontal gyrus, primarily pars orbitalis. The putative Wernicke's area is identified along the posterior aspect of the left superior temporal sulcus.

Output: Successful functional MRI for sensorimotor and language cortical mapping.


Instruction: Generate impression based on findings.

Input: Pain radiating down left leg. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal compression deformity involving the right aspect of the superior L1 endplate. There is grade 1 anterolisthesis of L4 on L5, L3 on L4, and to a minimal degree L2 on L3. There is mild multilevel disc desiccation. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Mild disc bulge, eccentric to the right. There is mild right-sided neural foraminal stenosis. No spinal canal or left neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening and facet arthropathy. No spinal canal stenosis. Minimal narrowing of the bilateral neural foramina. L3-L4: Mild disc uncovering and bulge, ligamentum flavum thickening and moderate bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: Disc uncovering and disc bulge with small left foraminal disc extrusion. There is also ligamentum flavum thickening and moderate bilateral facet arthropathy. There is moderate left and mild right neural foraminal stenosis. There is no significant spinal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. Multiple left-sided renal cysts.

Output: 1. Multilevel degenerative changes throughout the lumbar spine. There is moderate left-sided neural foraminal stenosis at L4-L5 where there is suspected impingement of the left L4 nerve root.2. Additional details, including multilevel facet arthropathy with grade 1 anterolistheses, as above. No significant spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 80 year old woman with history of exertional angina, peripheral and carotid arterial disease, hypertension and atrial fibrillation who presents for evaluation of worsening of her chronic angina.MEDICATIONS: aspirin, felodipine, metoprolol, losartan, niacin, lasix, labetalol, omega 3 fatty acid First Pass PerfusionDuring hyperemia, there was a mild perfusion defect noted in the basal to mid inferoseptum and inferior wall. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with low-normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 136 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 71 g/m2, and the LV mass is 121 g. There are no regional wall motion abnormalities present. The native myocardial relaxation T1 time using endocardial mapping is 1110ms, which is mildly elevated and suggestive of a diffuse underlying fibrotic or infiltrative process. Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 67 ml/m2 (normal range 69+/-14), the RVEDV is 114 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly enlarged. Aortic ValveThe aortic valve opens widely and there is trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no 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. Mild perfusion defect in the basal to mid inferior wall and inferoseptum.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and low-normal systolic function (LVEF 52%).4. Normal RV size and systolic function (RVEF 57%).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 extent of tenosynovitis; s/p L hand debridement History: Same There is full thickness rupture of the flexor tendon apparatus of the index finger. The distal end of what we believe to be the superficial flexor tendon lies at the level of the second metacarpal neck. What we suspect is the torn proximal end of the deep flexor tendon appears to lie at the level of the distal radial diaphysis. The torn end of the distal tendon fragment is seen at the level of the proximal phalanx. Within the palm, between the torn tendon fragments, is a rim enhancing collection of fluid that appears to penetrate the volar skin surface. There is enhancement along the flexor tendon apparatus of the index finger, both proximal and distal to this fluid collection, indicating tenosynovitis, extending proximally into the carpal tunnel. From the carpal tunnel, enhancement extends distally along the entire flexor pollicis longus tendon, the entire flexor tendon apparatus of the middle finger, and to a lesser degree along the flexor tendons of the ring and fifth fingers, indicating tenosynovitis. There are multiple foci of signal void within the palmar soft tissues, extending into the index finger and also noted within the ring finger, which could represent foci of gas or metallic foreign bodies. The inflammation extends from the carpal tunnel into the anterior compartment of the forearm. There is a fluid collection in the mid forearm between the superficial and deep finger flexors, measuring just over 1cm in transverse dimension and approximately 3cm in longitudinal dimension, that likely represents an abscess. There is also intramuscular and intermuscular edema and enhancement of the volar compartment of the forearm, suggesting inflammation. However, there is edema within one of the forearm flexor muscles that we suspect is the flexor carpi radialis, with its tendon appearing to be disrupted at the level of the distal forearm. Once again, there are foci of signal void within the volar and radial soft tissues of the forearm that may reflect metallic foreign bodies or gas. There is also enhancement along the extensor tendons extending into the fingers (particularly the index, middle and ring fingers) indicating additional tenosynovitis with extension of inflammation proximally into the forearm. Although we see no focal fluid collections within the posterior compartment of the forearm, there is a small fluid collection within the subcutaneous tissues of the hand dorsal to the base of the third metacarpal, measuring approximately 1cm in diameter. There is also a subcentimeter fluid collection in the subcutaneous fat of the dorsomedial wrist. Once again, there are several foci of signal void within the dorsal soft tissues of the hand, wrist and forearm which may reflect metallic debris or gas. There is diffuse edema of much of the subcutaneous fat of the forearm. There is enhancement of the subcutaneous fat dorsal to the olecranon, extending distally through the medial subcutaneous fat of the forearm, compatible with cellulitis. There is diffuse synovitis of the wrist with carpal bone edema and erosions, indicating an inflammatory, likely infectious, arthritis.

Output: Extensive inflammatory changes of the hand, wrist and forearm as described above, including extensive tenosynovitis, inflammatory (probably septic) arthritis of the wrist, and tendon ruptures as described above. Furthermore, there are multiple foci of signal void within the soft tissues of the hand, wrist and forearm, but we cannot determine whether these represent small metal fragments or foci of gas. This could be further evaluated with radiographs. Findings were discussed by telephone with Dr. Foertsch of the Plastic Surgery service (at pager 4739) on 11/1/2016 10:09 AM.


Instruction: Generate impression based on findings.

Input: MRI brain:No evidence of restricted diffusion to suggest infarction. There are scattered foci of T2 hyperintensities in the periventricular and subcortical white matter without interval change. In addition, multiple chronic infarcts are redemonstrated in the bilateral cerebellum as well as bilateral posterior parietal lobes, unchanged from previous.No evidence of large intracranial hematoma. Ventricles are normal in size and configuration. No pathological enhancement is seen on postcontrast images.MRA brain:There may be some narrowing of the bilateral internal carotid arteries at the level of the anterior genu versus artifact. Otherwise internal carotid arteries show normal course and caliber. There is no definite high-grade luminal stenosis. The middle cerebral arteries are unremarkable. There is a hypoplastic right A1 segment. Only a single A2 segment is identified suggesting azygous configuration. There are prominent bilateral P-comm arteries. The basilar artery and PCAs are within normal limits. There is no evidence of flow-limiting stenosis or aneurysm.MRA neck: Please note that the origin of the great vessels are not well visualized due to technique. There is common origin of the brachiocephalic and left common carotid arteries. There is mild narrowing of the right carotid at the bifurcation, but without significant luminal stenosis. Again seen is a prominent internal maxillary artery arising from the right external carotid artery of uncertain clinical significance.The right vertebral artery is normal in course and caliber. The left vertebral artery is not seen on angiographic images, however, we do see a small V4 segment on the post contrast sequence. Non- visualization of most of the left vertebral artery may be related to hypoplasia versus proximal occlusion or severe narrowing.

Output: 1.No acute intracranial hemorrhage or acute infarction.2. Multiple scattered white matter T2 hyperintensities, which may be nonspecific, unchanged. Multiple chronic cerebellar as well as posterior parietal strokes are also unchanged.3. Again noted, the left vertebral artery is not definitely seen on angiographic images, however, there is demonstration of a small V4 segment on post contrast sequence. This appearance could reflect severe narrowing versus occlusion or a congenitally hypoplastic vessel. 4. Otherwise, no definite high-grade luminal stenosis is suspected in the anterior or posterior circulation. Redemonstration of Azygos configuration of ACA.


Instruction: Generate impression based on findings.

Input: 64-year-old male with history of ulnar osteomyelitis present with increased pain and swelling of the right wrist. Again seen is a lytic lesion of the distal ulna that is centered in the metaphysis and extends to the articular surface. A smaller lytic lesion present more proximally was seen on the prior radiograph from 10/27/2015, but is new compared to radiograph from 5/12/2015. Also again seen is cortical disruption and periosteal reaction along the ulnar aspect of the distal ulna with small lucencies in a permeative appearance extending to the mid-diaphysis, in a similar distribution as seen on the prior MRI. Soft tissue swelling is again noted. No definite radiographic evidence for osteomyelitis of the carpals or metacarpals to correspond to findings on MRI. No acute fractures are identified. Catheter is seen overlying the radius.

Output: Osteomyelitis of the distal ulna progressed since 5/12/2015 examination, but not significantly changed since 10/27/2015 examination.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with right chest and breast pain. Evaluate thoracic spine in preparation for spinal cord stimulator trial and implantation. Image quality is slightly limited by motion artifact. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The visualized spinal cord shows normal signal intensity and morphology throughout. The intervertebral discs are preserved. No significant bulge or herniation is seen. No compromise of the spinal canal or neural foramina is detected.

Output: Unremarkable evaluation of the thoracic spine.


Instruction: Generate impression based on findings.

Input: History of extraosseous Ewing's R, of the right hand. Surveillance, 24 months off therapy. A marker was placed along the dorsum of the hand overlying the space between the distal diaphyses of the second and third metacarpals. Small foci of signal abnormality deep and lateral to the marker likely represent postoperative changes. More diffuse increased signal intensity seen on the fat-saturated sequences in this vicinity likely simply represents artifact of incomplete fat saturation. I see no focal mass or abnormal enhancement to indicate tumor recurrence. The musculature of the hand appears normal. Bone marrow signal intensity is normal.

Output: No evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Altered mental status. MRI: There is diffuse cerebral and pontine white matter T2 hyperintensity and punctate foci of encephalomalacia in the bilateral basal ganglia without restricted diffusion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a retention cyst in the right maxillary sinus. There is unchanged anterior dislocation of the left mandibular condyle.MRA: There is no evidence of significant steno-occlusive lesions or saccular aneurysms.

Output: 1. Chronic small vessel ischemic white matter disease and chronic basal ganglia lacunar infarcts, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive lesions.


Instruction: Generate impression based on findings.

Input: 82 years, Male, stage III non-small cell lung cancer. No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. There is global parenchymal volume loss commensurate with patient's advanced age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There are bilateral lens implant. Paranasal sinuses and mastoid cells are grossly clear. No suspicious lesions in the calvarium.

Output: 1. No evidence of intracranial metastatic disease.2. Mild chronic small vessel ischemic changes and global parenchymal volume loss which is appropriate for patient's age.


Instruction: Generate impression based on findings.

Input: Reason: 55 yo with anal cancer with recent resection of hepatic met (involving diaphragm). Known tumor in anal/rectal area with suspected invasion of pelvic sidewall. Evaluate current status of disease History: met anal cancer ABDOMEN:LIVER, BILIARY TRACT: Status post resection of hepatic dome lesion seen on the prior study. No new hepatic lesions are evident. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate T2 hyperintensities in the right kidney are too small to characterize but likely represent small cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: T1 hyperintense lesion is unchanged, likely an endometrioma.There is increased tumor involvement along the right aspect of the vagina. In the mid to distal vagina, there is an area of narrowing (26/21, 25/39) with proximal fluid within the upper vagina and cervix. BLADDER: No significant abnormality noted.LYMPH NODES: Hypermetabolic lymph node on prior PET/CT is not within the field-of-view of either the abdomen or pelvis images.BOWEL, MESENTERY: There is near circumferential bowel wall thickening involving the anterior, right lateral and posterior aspects of the rectum and anal canal measuring approximately 10 cm in length extending from the anal verge proximally. Circumferential thickening of the rectum is unchanged measuring approximately 1 cm (25/30) in thickness, however there is increased soft tissue nodules along the right anterolateral aspect of the rectum in the mesorectal fat. The largest of these nodules measures 3.1 x 2.8 cm (25/37), previously 2.2 x 2.5 cm. These nodules extend beyond the mesorectal fascia on the right into the right ischioanal fossa (25/41). There is increased extension along the right aspect of the vagina to nearly the right labia.BONES, SOFT TISSUES: Increased T2 signal throughout the musculature of the pelvis it is likely related to radiation changes. Radiation changes are also evident within the sacrum.OTHER: No significant abnormality noted.

Output: 1.Rectal mass has increased in size with increased invasion into the vagina.2.Fluid in the upper vagina and cervix is likely due to obstruction.3.Resection of hepatic dome lesion. No new hepatic lesions are evident.4.Hypermetabolic lymph node seen on prior PET/CT is not within the field-of-view of either the abdomen or pelvis images.


Instruction: Generate impression based on findings.

Input: Female, 87 years old, with slurred speech. Image quality is degraded by motion artifact. Within this limitation, no restricted diffusion is seen. Minimal periventricular T2 hyperintensity is seen with a few scattered small foci of white matter hyperintensity. No edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra axial fluid collection is observed. There appears to be mild white matter volume loss along the left lateral ventricle which contributes to ex vacuo dilatation. Otherwise, the ventricular system is within normal limits.Within the limitations of MRA technique, no significant intracranial vascular compromise is identified. No aneurysm or vascular malformation is suspected. No significant stenosis is detected in the carotid vessels of the neck by NASCET criteria. There may be mild atherosclerotic narrowing in the proximal left ICA and the proximal right vertebral artery.

Output: 1.No evidence of acute ischemia is seen. There are findings which may be related to chronic microvascular ischemia, and mild chronic white matter volume loss along the left lateral ventricle.2.Findings related to mild atherosclerotic disease are seen with no significant vascular compromise detected in the head or neck.


Instruction: Generate impression based on findings.

Input: 21-year-old male. Pain at snuffbox, volar wrist. Evaluate for scaphoid fracture. Artifact from sideplate and screws affixing the distal ulna limits evaluation of adjacent structures.LIGAMENTS: Scapholunate and lunotriquetral ligaments are grossly intact. Subcentimeter fluid signal intensity focus at the dorsal margin of the scapholunate interval, likely a small ganglion cyst.TRIANGULAR FIBROCARTILAGE COMPLEX: Grossly intact.TENDONS: The visualized tendons are intact.BONES: No scaphoid fracture is evident.ADDITIONAL

Output: No evidence of a scaphoid fracture.


Instruction: Generate impression based on findings.

Input: Cyst and hydrocephalus: possible shunt malfunction. There is a catheter that enters via a right occipital burr hole and terminates in the anterior right lateral ventricle. There are thin septations within the dilated portion of the posterior right lateral ventricle, which has not significantly changed in size. The rest of the ventricular system is not particularly enlarged. There is confluent high T2 signal in the right frontal, parietal, and occipital white matter surrounding dilated right lateral ventricle, along with volume loss. There are also other scattered areas of periventricular and subcortical white matter T2 hyperattenuation. There is no evidence of acute infarction or intracranial hemorrhage. There are postoperative findings related to posterior fossa decompression with diminished flow of cerebrospinal fluid across the craniocervical junction. The cerebellum is not low-lying, however. There is an extra-axial catheter in the right frontoparietal convexity. There is no midline shift. The pituitary gland is normal in size. There is no abnormal intracranial enhancement. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.

Output: 1. Dilatation of posterior portion of the shunted right lateral ventricle with septations, which may represent adhesions with loculation or cyst formation and surrounding encephalomalacia and gliosis. The constellation of findings may be the result of remote insult, such as infection and perhaps ischemia. Other scattered areas of periventricular and subcortical white matter T2 hyperattenuation may represent chronic small vessel ischemic disease, but no evidence of acute infarct. 2. Postoperative findings related to posterior fossa decompression with diminished flow of cerebrospinal fluid across the craniocervical junction.


Instruction: Generate impression based on findings.

Input: Reason: characterize left wrist mass History: increasing in size left wrist mass, more proximal than typical ganglion There is a well-defined, nonenhancing lesion with multiple thin septa abutting the volar aspect of the distal radius, which measures 2.4 x 1.9 cm in its axial dimensions. The lesion is iso-intense to muscle on T1-weighted imaging and hyperintense on T2 weighted imaging. The bones, bone marrow, ligaments, and tendons are within normal limits.

Output: Lesion abutting the volar aspect of the distal radius is most consistent with a ganglion cyst.


Instruction: Generate impression based on findings.

Input: MRI: There is slight increase in size of the lesion in the right cerebellar hemisphere, measuring up to 18 mm with mild surrounding vasogenic edema, along with interval evolution of the signal characteristics in the lesion since July 2015. There is also no appreciable change in size of the 3 mm lesion in the right subinsular white matter. There are a few scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute infarction. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. There is a small defect in the right lamina papyracea. There is a right maxillary sinus retention cyst.MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.

Output: 1. Slight increase in size of the hemorrhagic right cerebellar metastasis since July 2015, but no significant interval change in the hemorrhagic right insular metastasis.2. No evidence of significant steno-occlusive lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: please do dr Javed protocol, MS progressionSigns and Symptoms: MS progression There is a T2 hyperintense focus present within the thoracic spinal cord at the T10-T11 level located along the midline and posterior aspect of the thoracic spinal cord. There is a questionable lesion within the thoracic spinal cord at the T8-9 level. There is no associated contrast enhancement with these lesions.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine. There is no associated mass effect or cord enlargement.

Output: A couple lesions are present within the distal thoracic spinal cord which are suspicious for demyelination.


Instruction: Generate impression based on findings.

Input: Reason: s/p resection of retroperitoneal sarcoma in 2009 and recurrence in 2010 - please eval for recurrence History: retroperitoneal sarcoma ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: 6 mm cystic focus in the pancreatic body (3/21) a similar to the prior exam. Main pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is a focal area of asymmetric fat anterior to the left kidney which is increased in size measuring 6.8 x 5.3 cm (8/25), previously 6.3 x 5.4 cm. A progressively enhancing component measures 2.7 x 1.6 cm (12/54). This region measured 2.5 x 1.4 cm on the prior exam and 1.7 x 1.0 cm on the exam from 6/5/2014.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Asymmetric fat adjacent to the left kidney is slightly increased in size with a slowly increasing enhancing component. Recurrent/residual tumor is suspected.2.Small cystic lesion pancreatic body is similar to the prior exam and may represent a sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: 32 year-old female with headache rule out masses. There is no evidence of intracranial hemorrhage, mass or edema. There is suspected crowding at the foramen magnum as there is lack of visualization of the subarachnoid space. This may be due to patient positioning for the exam or Chiari malformation. MRI is recommended for further evaluation of the intracranial structures at this level. There is no visualization of the sulci, however, the gray-white junction remains distinct. Ventricular volumes are small but this may be normal for the patient's age. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Suspected crowding at the foramen magnum may be due to patient positioning or Chiari malformation. Further evaluation with MRI is recommended to further define intracranial structures at this level. 2. Etiology of patient's headache may be due to pseudotumor cerebri, clinical correlation advised.


Instruction: Generate impression based on findings.

Input: Clinical question: Any fracture? Signs and symptoms: Worsening back pain. Nonenhanced thoracic MRI:The alignment of the vertebral column is anatomical.Examination demonstrates an approximately 8mm focus of T2/T2 stir hyperintensity beneath posterior left paramedian T6 vertebrae. Punctate size similar foci of hyperintensity is also noted in the right inferior articulating facet of T11 and T12 and a questionable in the right inferior articulating facet of T9 and 3 body of T8. A larger similar T2 hyperintensity focus is also noted in the proximal right T3 rib measuring at 13 mm size. Findings are highly suggestive of multiple myeloma.There is less than 50% compression deformity of T9 vertebrae without associated T2, T2 stir hyperintensity bone marrow signal changes and suggestive of a chronic fracture. There is however a small patchy foci of T2 hyperintensity within the compressed vertebrae suggestive of multiple myeloma. There is no evidence of malalignment. Very mild chronic compression deformity of the superior endplates of T8 and inferior endplate of T6 are also noted. There is mild exaggeration of thoracic kyphosis which is believed to be at least partially secondary to the above findings.The signal intensity and caliber of cord remains within normal. There is no evidence of neural foraminal or spinal canal compromise or stenosis at any level.Enhanced lumbar MRI:There is normal anatomic alignment of the vertebral column and without evidence of fracture. No evidence of spinal or neural foraminal compromise or stenosis at any level. Mild degenerative disease is noted.There are several small foci of T2/T2 stir hyperintensity involving vertebral bodies and posterior elements of vertebral column, multiple lesions in the sacrum and left iliac wing consistent with multiple myeloma. The largest lesion is along the inferior body of L2 and measuring at 8 x 22.5-mm on sagittal T2 stir. The largest lesion in the visualized sacrum is left and measures at 9 x 8-mm. A left posterior iliac wing lesion measures approximately 6 mm in transaxial dimension.

Output: 1.Nonenhanced MRI of thoracic spine demonstrate multiple small foci of T2/T2 stir hyperintensity in the vertebral bodies and the posterior elements and right T3 rib suggestive of multiple myeloma. There is less than 50% chronic compression fracture of T9 with associated patchy marrow signal changes representing multiple myeloma. Mildly exaggerated kyphosis of the thoracic spine. No spinal stenosis or neural foraminal compromise. Normal signal intensity and caliber of thoracic cord.2.Nonenhanced MRI of the lumbar spine demonstrate findings of multiple myeloma involving vertebral bodies and the posterior elements of vertebral column as well as sacrum and iliac wings as detailed/measured above. No fracture or malalignment. No spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis, type 1 (von Recklinghausen's disease). Please assess the margins of diffuse neurofibroma of occiput and upper neck which has grown significantly in past year. The extensive, infiltrative skin/subcutaneous mass involving the posterior aspect of the head/upper neck has not significantly changed in overall size though this is difficult to quantify. It is slightly smaller along its superior aspect (history of resection in 2015) while it has become slightly thicker and more nodular in the right retroauricular region. An underlying soft tissue nodule in the left suboccipital region has grown and now measures 13 mm in diameter (compared to 5 mm previously). This may represent a reactive lymph node but may also represent a localized neurofibroma. The underlying skull is intact.The brain shows no abnormality. The CSF-containing spaces, including the ventricles, are normal in size.The orbits are normal. Minimal mucosal thickening is present in the left maxillary and ethmoid sinuses without fluid, most likely of no significance. Mastoid air cells are clear.

Output: A large, diffuse neurofibroma involving the back of the hand and the upper neck has slightly grown in the right retroauricular region since 2007. There is no involvement of the underlying skull.


Instruction: Generate impression based on findings.

Input: 66-year-old female PSP study patient, re-scan for the FLAIR per protocol due to motion in previous one. Limited evaluation with FLAIR images only again show atrophy of the midbrain. There also appears to be mild atrophy of the cerebellar vermis. There are minimal confluent and punctate foci of FLAIR hyperintensity within the supratentorial white matter which appears similar to the previous exam. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: 1.Atrophy of the midbrain related to progressive supranuclear palsy. Please refer to the prior MRI for additional details.2.Nonspecific mild diffuse cerebral white matter abnormality may represent chronic small vessel ischemic disease.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, 39 years old. Reason: 39 yo M active runner with R leg pain - concern for torn hamstring. Pls aid in evaluation History: R leg pain The origins of the semimembranosus and conjoint tendons at the ischial tuberosity appear intact, without associated abnormal signal. The hamstring muscles also appear normal. The other visualized muscles and tendons appear normal. The visualized bones have normal marrow signal. The hip joint appears grossly normal on nondedicated images.

Output: No evidence of hamstring tendon or muscle injury. No other acute abnormality to compress the patient's pain.


Instruction: Generate impression based on findings.

Input: Liver lesion on CT concerning for hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: The liver is smooth in contour and normal in morphology. Within segment 8 there is a T2 hyperintense lesion which contains few thin septations, measuring 1.4 x 1.1 cm (series 501, image 33) and contains a vessel coursing through it. This lesion does not enhance with contrast administration, nor restrict diffusion. There is no fat identified within the lesion on out of phase imaging. No other lesion is identified. There is no intra or extrahepatic biliary ductal dilatation. The gallbladder is normal in appearance. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The uterus is partially imaged. The myometrium is thickened and contains numerous cystic spaces, compatible with adenomyosis. The endometrium is markedly dilated and contains heterogeneous enhancing components which are partially imaged , corresponding to suspected malignancy on recent CT January 9, 2016. Trace right pleural effusion.

Output: 1.Lesion within the hepatic dome identified on recent CT, probably a septated cyst.2.Partially imaged dilated endometrium containing heterogeneous enhancing components, suspicious for malignancy. Likely adenomyosis.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute compression of the thoracic cord or conus medullaris, or significant thoracic spinal canal stenosis. There is persistent high T2 signal abnormality within the T7 vertebral body extending to the left pedicle and the posterior elements of T11. The abnormal high T2 signal in the other thoracic vertebrae has subsided and the associated neural foraminal narrowing is no longer as apparent. The vertebral body heights are preserved. The previously demonstrated mass in the subcutaneous soft tissues superficial to the right paraspinous musculature is no longer apparent. There is mild multilevel degenerative spondylosis. The kidneys are markedly atrophic and contain numerous cysts bilaterally. There is a cyst in the right posteromedial aspect of the liver.

Output: 1.Signal abnormality related to the metastasis involving T7 and T11 persists, while the metastases in other thoracic vertebrae now less conspicuous, which is suggestive treatment response, although characterization of the actual tumor burden is limited due to lack of intravenous contrast. 2.The previously demonstrated mass that likely represented a metastasis in the subcutaneous soft tissues superficial to the right paraspinous musculature is no longer apparent.


Instruction: Generate impression based on findings.

Input: This exam is severely degraded by motion artifact despite sedation. BRAIN: There are postoperative findings related to right suboccipital craniectomy and right internal auditory canal surgery. There is a small focus of subjacent T1 and T2 hyperintensity within the right cerebellum that is likely post-operative in nature. There are a few additional scattered small foci of T2 hyperintensity within the supratentorial white matter that most likely represent chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants.IAC: This portion of the exam is limited due to lack of precontrast images. The original protocol was based on the order indication that stated "neurofibromatosis type I". The IAC portion of the exam was added by the interpreting radiologist due to EPIC review but after the injection of contrast. Within the right internal auditory canal there is a 6 x 7 mm focus of presumed moderate enhancement and T2 hypointensity. The labyrinthine structures are grossly unremarkable but not well evaluated on this exam.

Output: 1.Severely motion degraded exam.2.Postoperative findings related to right occipital craniectomy and right internal auditory canal surgery. Presumed moderate enhancement and T2 hypointensity within the right internal auditory canal is non-specific and likely representing scar/ granulation tissue however less likely possibility of a schwannoma cannot be entirely excluded. Comparison with prior outside imaging is recommended to assess for growth. Otherwise, follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with history of tongue cancer status post chemotherapy, last MRI concerning for toxicity due to 5-FU. A repeat MRI to assess for worsening or improvement. Diffusion restriction seen previously within the splenium of the corpus callosum and the bilateral thalami has resolved. No new areas of restricted diffusion are demonstrated.There is minimal residual FLAIR hyperintensity within the splenium at the site of the prior lesion. No definite residual signal abnormality is seen in the thalami. T2 hyperintensity within the pons has, however, become more coalescent and homogeneous.No evidence of intracranial hemorrhage or any large extra-axial fluid collection is seen. The previously suspected thin bilateral subdural effusions have improved with minimal residual fluid and/or dural thickening. The ventricular system is normal in size and morphology.

Output: Interval resolution of restricted diffusion is seen involving the splenium of the corpus callosum in the bilateral thalami. There is minimal residual FLAIR signal abnormality within the splenium. T2 hyperintense signal abnormality within the pons has become more coalescent and homogeneous.This pattern of abnormalities has been reported as a rare consequence of 5-FU exposure. Other potential considerations including an infectious encephalitis, metabolic derangement, or osmotic demyelination are probably less likely.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic lung cancer with previous resected right cerebellar metastases. Signs and symptoms: As above. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates interval increased size of a large necrotic rim enhancing tumor in the right para median cerebellum. On the current exam the tumor measures at least at 26 x 26 mm in transaxial dimensions compared to prior study measurement of 16.5 x 21.5 mm. On sagittal post enhanced series the tumor measures 22 x 26 mm compared to prior study measurement of 15 x 18 mm. There is extension of tumor into the vermis on the right. Surrounding vasogenic edema results in subtle mass effect on the fourth ventricle with anterior direction flattening. The fourth ventricle however remains patent.Although not a dedicated exam there is significant improvement of extensive region of enhancement with internal foci of hypoenhancement in the soft tissues of suboccipital region since prior exam. Recommend follow-up with dedicated pre- and post enhanced soft tissues of neck MRI for more complete assessment.There is no convincing evidence of any additional metastatic lesions on this degraded post enhanced images secondary to motion and extensive pulsation artifact.Ventricular system remains within normal size and with maintained midline without change.Calvarium is negative for metastatic lesions.Unremarkable images through the orbits and including axial fat sat post enhanced series.

Output: 1.Interval increased size of a right cerebellar enhancing/necrotic metastatic lesion measuring at 26 x 26 mm compared to prior study measurement of 16.5 x 21.5 mm. Mild increased surrounding edema and mass effect.2.Significant interval decreased enhancement of the limited visualized soft tissues of suboccipital region since prior study. Further follow-up with dedicated pre and post enhanced neck MRI is recommended for assessment of tumor.