Instruction: Generate impression based on findings.

Input: Left foot anterior calf numbness and left foot drop. Evaluate for lumbar disc disease or myeloma lesion. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There are mild degenerative changes including multilevel disc desiccation but without significant height loss. Additional details 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: Mild disc bulge and mild facet arthropathy contribute to mild bilateral neural foraminal narrowing, left relatively greater than right. No significant spinal canal stenosis.L4-L5: Mild disc bulge and mild facet arthropathy. There is mild to moderate right and minimal left neural foraminal narrowing. No significant spinal canal stenosis. L5-S1: No significant disc disease. There is moderate degree of facet arthropathy bilaterally, left worse than right. No significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are within normal limits. Multiple cysts in the kidneys are again seen.

Output: 1. No suspicious lesions to suggest multiple myeloma.2. Mild multilevel degenerative changes in the lumbar spine as detailed above. No significant spinal canal stenosis at any level. Neural foraminal stenosis is relatively worse at the right L4-L5 level where there is mild to moderate stenosis. There is also multilevel facet arthropathy, worst at the L5-S1 level.


Instruction: Generate impression based on findings.

Input: Evaluate for steno-occlusive disease, etiology of TIA: episode of aphasia and amnesia. Brain MRI: There is no evidence of intracranial hemorrhage or acute infarct. There two punctate fat signal intensity lesions in the midline of the posterior suprasellar cistern and interpeduncular cistern. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a small left maxillary sinus retention cyst. There is fluid within the pneumatized left petrous apex. Brain MRA: The vertebrobasilar system is relatively diminutive diffusely. Otherwise, there is no evidence of significant steno-occlusive lesions or saccular aneurysms.Neck MRA: There is a two vessel arch. There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of intracranial hemorrhage or acute infarct. 2. The vertebrobasilar system is relatively diminutive diffusely, but without focal steno-occlusive lesions.3. No evidence of significant steno-occlusive lesions in the major neck arteries.4. Two punctate lipid-containing lesions in the midline of the posterior suprasellar cistern and interpeduncular cistern are compatible with a lipomas or dermoids. 5. Left petrous apex effusion.


Instruction: Generate impression based on findings.

Input: Female, 12 years old, with tuberous sclerosis and seizures, status post fall/concussion, with negative CTA. Numerous scattered areas of cortical and subcortical T2 hyperintensity are demonstrated in both cerebral hemispheres, some with associated radial migration lines. These lesions have not significantly changed.Several subcentimeter enhancing foci are seen along the ependymal surface of the lateral ventricles without significant interval change. The largest measures only about 5 mm and is situated at the level of the right foramen of Monro.No significant generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. A cavum septum pellucidum is noted incidentally. Ventricular size and morphology are within normal limits.

Output: 1.Stigmata of tuberous sclerosis are seen including cortical tubers and subependymal nodules without significant interval change.2.No evidence to suggest any posttraumatic abnormality of the brain.


Instruction: Generate impression based on findings.

Input: 70 year old female with right hip pain despite therapy Limited study due to an unaugmented arthrographic technique and the absence of significant fluid in the joint. ACETABULAR LABRUM: Provided the limitation of a nonarthrographic technique study, no labral tear is evident. The labrum appears intact.ARTICULAR CARTILAGE AND BONE: Mild osteoarthritis affects the right hip. Minimal osteoarthritis affects the left hip on large field of view sequences.SOFT TISSUES: Normal muscle bulk without fatty atrophy or additional abnormality.ADDITIONAL

Output: Mild osteoarthritis of the right hip. No evidence of labral tear within the confines of a nonarthrographic study.


Instruction: Generate impression based on findings.

Input: Repeat evaluation of pituitary: multiple myeloma with possible pituitary abnormality on MR. There is a persistent mild heterogeneous enhancement of the pituitary. Otherwise, there no evidence of a discrete pituitary mass or enlargement of the gland. The pituitary infundibulum is intact. The optic apparatus and cavernous sinuses are intact.

Output: Persistent nonspecific mild heterogeneous appearance of the pituitary.


Instruction: Generate impression based on findings.

Input: 36-year-old female presents with a palpable volar wrist mass. There is a subcentimeter multilobulated homogeneously T2 hyperintense lesion abutting the ulnar aspect of the distal radius and the carpal tendons. The lesion is difficult to discern on T1-weighted imaging, however, there is no abnormal pathologic enhancement. The remainder of the osseous structures, musculature, and tendons are unremarkable.

Output: Nonenhancing left wrist mass is most consistent with a ganglion cyst.


Instruction: Generate impression based on findings.

Input: Reason: eval for Tendonitis; arthritis; joint inflammation History: decreased ROM elbow joint; pain; swelling LIGAMENTS: The ulnar collateral ligament appears intact. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact within the limitations of a non arthrogram study.TENDONS: There is increased signal abnormality within the common extensor tendon at the level of its origin from the lateral epicondyle indicating moderate tendinosis. Additionally, there is linear fluid signal abnormality within the common extensor tendon indicating a partial thickness tear (image 15; series 601). Some of the fibers of the common extensor tendon can be traced to the level of their origin on the epicondyle. There is no significant retraction. The biceps tendon appears intact. The brachialis tendon appears intact. There is intermediate signal intensity within the triceps at the level of its insertion on the olecranon indicating a mild tendinosis. The tendon itself appears intact.ARTICULAR SURFACES AND BONE: There is a moderate amount of fluid within the elbow joint with some foci of low signal intensity internally suggesting a synovitis. Note is made of multiple foci of low signal abnormality within the joint with the largest situated along the medial aspect of the olecranon, measuring 6 mm in the transverse dimension (image 22; series 501) consistent with loose bodies. There is an additional loose body identified within the ulnotrochlear articulation (image 14; series 1001). There is osteophyte formation indicating mild to moderate osteoarthritis of the elbow . There is full-thickness articular cartilage degeneration along the lateral aspect of the trochlea with underlying degenerative subchondral signal abnormality. There is partial-thickness articular cartilage degeneration along the medial aspect of the radial head.SURROUNDING STRUCTURES: The imaged musculature of the elbow is normal in appearance. There is perhaps minimal increased signal abnormality surrounding the ulnar nerve as it courses through the cubital tunnel which is nonspecific but may represent a very mild neuritis.ADDITIONAL

Output: 1. Partial thickness tearing and tendinosis of the common extensor tendon without significant retraction as described above.2. Moderate-sized elbow joint effusion with multiple loose bodies as well as findings suggestive of a synovitis as described above.3. Osteoarthritis of the elbow. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Spinal stenosis. Signs and Symptoms: lumbar canal stenosis. Nonenhanced lumbar MRI:There is advanced degenerative changes throughout lumbar spine. The signal pattern of the lumbar spine is compatible with DDD.T12-L1 demonstrate moderate disc disease and loss of disc height, mild facet and ligamentum flavum hypertrophy and without spinal stenosis or neural foraminal stenosis.L1-L2 demonstrate advanced dis disease and loss of disc height, mild right lateral recess compromise and unremarkable otherwise.L2-L3 demonstrate advanced dis disease and complete loss of dis height, mild grade 1 anterolisthesis, asymmetric right facet hypertrophy with moderate right neural foraminal and severe right lateral recess compromise.L3-L4 demonstrate advanced disc disease, complete loss of disc height, grade 1 anterolisthesis, asymmetric (R>L) facet degenerative changes with resultant moderate to severe left neural foraminal compromise and no central spinal stenosis. L4-L5 demonstrate moderate disc disease and loss of disc height, mild bilateral (L>R) facet and ligamentum flavum hypertrophy with resultant severe left neural foraminal and lateral recess compromise and no spinal stenosis. L5-S1 demonstrate mild disc disease and moderate left and mild right facet hypertrophic changes with resultant moderate left neural foraminal compromise. There is also a tiny synovial cyst arising from the left facet and projecting into the left lateral recess at this level. No spinal stenosis. There are multiple bilateral CSF signal intensity Tarlov cysts along the sacral neural foramen with bony remodeling.Lowermost visualized thoracic spine is unremarkable.

Output: 1.Advanced degenerative changes of the lumbar spine without spinal stenosis.2.Multi level neural foraminal compromise as detailed per level above.3.Multiple bilateral Tarlov cysts of the sacral spine and a tiny synovial cyst on the left at L5-S1 as mentioned.


Instruction: Generate impression based on findings.

Input: 17-year-old male with history of tibial OCD lesion. MENISCI: There is tearing and fraying through the free edge of the body of the lateral meniscus (image 24 series 6). The medial meniscus is small, however it is intact.ARTICULAR CARTILAGE AND BONE: Again seen is a heterogeneous lesion containing small cysts in the lateral tibial plateau extending to the articular surface with a maximal axial dimensions of 1.3 x 1.2 cm (image 23 of series 3). There is been mild subchondral collapse in the interim with a full-thickness osteochondral cleft measuring 4mm in depth(image 23 of series 6). There is mild adjacent edema signal abnormality. There is increased signal abnormality within the overlying cartilage of the lateral tibial plateau.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: There is a vertically oriented short segment partial-thickness tear through the distal patellar tendon with maximal mediolateral thickness of 3 mm. Patella alta again noted. Insall-Salvati ratio measures approximately 1.5. The tibial tubercle trochlear groove distance appears normal, however the femoral trochlea appears slightly shallow. Mild lateral subluxation of the patella in relation to the trochlear groove.ADDITIONAL

Output: 1. OCD lesion of the lateral tibial plateau with mild subchondral collapse which has progressed from prior. Increased signal within the articular cartilage likely indicates early degeneration.2. Free edge tear of the body of the lateral meniscus.3. Chronic partial thickness patellar tendon tear and patella alta.4. Mild lateral subluxation of the patella and shallow femoral trochlea.


Instruction: Generate impression based on findings.

Input: 54 years Female (DOB:2/19/1962)Reason: evaluate for structural lesions or hematoma History: car accident 2 weeks ago, still with headachesPROVIDER/ATTENDING NAME: THOMAS J KELLY CHRIS V ALBANIS MRI brain: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 right 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 is diminutive intracranially.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal. There is loss of disc space height, disk desiccation and endplate osteophytes at this level associated with the right lateral recess disc protrusion which encroaches on the nerve roots within the right neural foramen. There is mild narrowing of the left neural foramen at this level. There is partial effacement of spinal fluid ventral to the spinal cord at this level. There is mild ligamentum flavum hypertrophy present.At C5-6 there is no significant compromise to the spinal canal. There is loss of disc space height, disk desiccation and endplate osteophytes at this level associated with the right lateral recess disc protrusion which encroaches on the nerve roots within the right neural foramen. There is partial effacement of spinal fluid ventral to the spinal cord at this level. There is mild ligamentum flavum hypertrophy present.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is mild disc bulge present this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The left vertebral artery is much smaller than the right vertebral artery diameter.

Output: 1.No intracranial mass lesion or hematoma is appreciated.2.Intracranial portion of the left vertebral artery is not readily identified. Most likely this is related to hypoplasia. If there is concern for vertebral artery dissection or occlusive disease, an MR angiogram of the head and neck with dissection protocol may be helpful.3.There are degenerative changes present cervical spine with some encroachment of the right-sided exiting nerve roots at C4-5 and C5-6.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, history of breast cancer with brain metastasis, status post resection and radiotherapy. The hemosiderin stained left frontal lobe resection cavity has decreased in size. Mild T2 hyperintensity surrounding cavity is unchanged. Minimal thin enhancement along the resection cavity margins has decreased relative to the prior examination and is likely postoperative.No new areas of concerning parenchymal signal abnormality or enhancement are detected. No new edema or mass effect is detected. Developmental venous anomalies are evident in the right frontal lobe and left parietal lobe. The ventricular system is stable and normal in size.

Output: Continued evolution of postoperative findings are seen in the left frontal lobe. No evidence to suggest residual or recurrent tumor is seen, and no new intracranial lesions are detected.


Instruction: Generate impression based on findings.

Input: Female 59 years old; Reason: knee pain and instability MENISCI: There is fragmentation of the posterior horn of the lateral meniscus, with lateral extrusion of the body of the lateral meniscus. Increase signal within the anterior horn of the lateral meniscus likely represents degeneration. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the knee with foci of full thickness cartilage loss in the lateral tibiofemoral compartment and patellofemoral compartment. The lateral facet of the patella and lateral facet of the femoral trochlea are nearly devoid of cartilage. Reactive bone marrow changes and subchondral cyst formation are present in the lateral and midline tibial plateau, lateral femoral trochlea, and throughout the patella. There is mild cartilage degeneration in the medial tibiofemoral compartment, without fluid-filled defects. Tricompartmental osteophytes are present. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Severe osteoarthritic changes, with areas of full thickness cartilage loss, as described above.2. Fragmentation of the posterior horn of the lateral meniscus, with lateral extrusion of the body of the lateral meniscus.


Instruction: Generate impression based on findings.

Input: Further evaluation of cerebellar lesion. History of medulloblastoma. Status post resection in April 2007 followed by chemotherapy and radiation treatment (which was reported). Presented with three-week history of worsening headache, nausea and vomiting. CT scan of the head from outside institution shows right cerebellar mass. BRAIN: A lobulated, septated mass has developed in the lateral aspect of the right cerebellar hemisphere, at the site of previous tumor resection. The mass measures axially 3.9 cm x 3.6 cm and craniocaudally 2.4 cm. The mass is partly solid and partly cystic, with the largest cystic component being in the superior medial aspect of the mass along its interface with the cerebellar parenchyma, measuring up to 2.4 cm. The solid component shows heterogeneous contrast enhancement and diffusion restriction, reflecting dense hypercellularity. There is vasogenic edema in the right cerebellar hemisphere extending along the right-sided cerebellar peduncles. In addition to deforming the right cerebellar hemisphere and causing downward herniation of the right cerebellar tonsil 8 mm below the level of the foramen magnum, the mass also deforms the brainstem and partially effaces the fourth ventricle and its outflow tracts without obstructive hydrocephalus. The mass, along its superior part, abuts the junction between the right transverse and sigmoid sinuses without definite invasion. There is mild dural thickening and enhancement subjacent to the right retrosigmoid craniotomy but this is nonspecific and can be postoperative.There is no other contrast-enhancing or space-occupying brain lesion. There is no acute infarct. There is no sizable intracranial hemorrhage. A few, tiny foci of susceptibility effect in the occipital and frontal lobes may reflect mineralizing angiography from previous radiation treatment. Supratentorially, the ventricles and other CSF-containing spaces are normal in size and there is no midline shift. The major intracranial vascular flow voids are preserved.There is mild mucosal thickening in the left sphenoid and right maxillary sinuses. There are small cystic lesions involving the left ear pinna without associated inflammatory change, which were not present on the previous examination. Please correlate with possible history of ear piercing and physical examination.WHOLE SPINE:Cervical: There is reversal of the normal cervical lordosis along with desiccation of the upper and mid cervical discs. There is also a mild leftward convex curvature. There is no significant spinal canal or neural foraminal stenosis. The cervical spinal cord is unremarkable. There is no abnormal intrathecal contrast enhancement. Thoracic: Alignment is anatomic. The vertebral bodies and discs are preserved in height. The spinal canal is preserved. The thoracic spinal cord is unremarkable. There is no abnormal intrathecal contrast enhancement.Lumbar: Off note, there are 6 lumbar-type vertebrae and the last well-formed disc is at S1-S2. Alignment is anatomic accounting for straightening which may relate to patient position. The vertebral bodies and discs are preserved in height. The spinal canal is preserved. The conus medullaris tip lies at L1-L2 level. The conus medullaris is unremarkable. There is no abnormal intrathecal contrast enhancement.

Output: 1.Large heterogenous lateral right cerebellar mass along the previous resection cavity margin, most likely represents medulloblastoma recurrence. This shows strong resemblance in composition and signal characteristics to the original tumor from the pretreatment examination from April 3, 2007.2.The associated mass-effect compresses the fourth ventricle and causes secondary Chiari malformation but there is no obstructive hydrocephalus. 3.There is no intracranial metastasis, otherwise. A few, tiny foci of susceptibility effect in the cerebrum may reflect mineralizing angiopathy from previous radiation treatment.4.No spinal drop metastasis. Please note transitional spinal anatomy as above, and if surgery is to be contemplated, correlation with imaging of the entire spine is recommended.


Instruction: Generate impression based on findings.

Input: Reason: hx of subcentimeter lesion in head of pancreas, recommended repeat imaging in 12 to 18 months to evaluate for size change History: hx ofsubcentimeter lesion in head of pancreas, recommended repeat imaging in 12 to 18 months to evaluate for size change ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. Couple T2 subcentimeter hyperintense lesions are too small to characterize, favor cysts or hemangiomas.SPLEEN: No significant abnormality noted.PANCREAS: Small T2 hyperintense lesion in the head of the pancreas previously measured 0.9 x 0.7 cm. Today, this lesion measures the same (4:40) with no suspicious enhancement or component.A few other T2 hyperintense foci also likely represent side branch IPMNs, grossly stable.ADRENAL GLANDS: Left adrenal gland hyperplasia.KIDNEYS, URETERS: Small amount of perinephric fluid, likely chronic. Couple subcentimeter hypointensities best seen on postcontrast phases are too small accurately characterize but appear to have vague T2 hyperintense signal, likely small cysts. RETROPERITONEUM, LYMPH NODES: Stable infrarenal aortic aneurysm measuring up to 3 cm (15:145)BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable subcentimeter lesion in the head of the pancreas favoring a side branch IPMN with no suspicious features. Other foci of T2 hyperintensities also likely represent side branch IPMNs as above.2.Hepatic steatosis.3.Stable infrarenal aortic aneurysm.


Instruction: Generate impression based on findings.

Input: Male 23 years old with left shoulder pain. ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted. Trace fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Linear increased signal intensity partially separates the posterior glenoid labrum from the underlying glenoid. This starts at the 7 o'clock position and extends to the 10 o'clock position and is suspicious for a partial thickness tear but the clinical significance is uncertain. Furthermore, there is low signal intensity situated between the anteroinferior aspect of the glenoid and the humeral head which appears continuous with the capsular structures of the axillary recess and may represent redundant or displaced capsule between the humeral head and glenoid (series 5, image 11). There is also increased signal intensity within the adjacent inferior labrum and we cannot exclude the possibility of additional tearing. Given the limitations of this non-arthrographic study the anterior and superior labrum appear normal. The glenohumeral joint alignment is normal. There is no joint effusion. The articular cartilage appears normal. BICEPS TENDON: The tendon of the long head of biceps is normal.

Output: 1. Findings suggestive of incomplete tear of the posterior labrum of questionable clinical significance.2. Possible redundant and/or displaced capsular structures of the axillary recess between the humeral head and glenoid labrum, perhaps associated with adjacent inferior labral tearing. This can be further evaluated with MR arthrography if clinically warranted.


Instruction: Generate impression based on findings.

Input: Acute right knee pain for seven days. History of right knee surgery for meniscal tear (done in Netherlands), now with right knee "inside the knee" and medially. Exam today though is unremarkable other than clicking and sensation of instability on exam. MENISCI: There is abrupt truncation of the posterior horn of the lateral meniscus that may either reflect a radial tear or partial meniscectomy. There is also, however, branching signal abnormality within the body of the lateral meniscus, including curvilinear fluid signal intensity extending to the femoral articular surface, indicating a complex tear. The anterior horn of the lateral meniscus appears intact.There is abnormal, predominantly horizontally-oriented signal abnormality within the posterior horn and body of the medial meniscus extending to the femoral articular surface, indicating a tear. The tear also extends through the periphery of the meniscus and decompresses into a small heterogeneous parameniscal cyst. The anterior horn of the medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a full-thickness defect of the articular cartilage of the lateral tibial plateau beneath the truncated posterior horn of the lateral meniscus with mild degenerative signal abnormality in the underlying subchondral bone. There is osteophyte formation along the medial femoral condyle anterior to the meniscus with loss of overlying cartilage. There is also surface fraying and multiple clefts/fissures affecting the articular cartilage of the patella and femoral trochlea.LIGAMENTS: The cruciate and collateral ligaments are intact EXTENSOR MECHANISM: The extensor mechanism is intactADDITIONAL

Output: 1.Medial and lateral meniscal tears as described above. Abrupt truncation of the posterior horn of the lateral meniscus may either reflect additional tearing or changes following partial meniscectomy.2.Articular cartilage defects/degeneration as above.


Instruction: Generate impression based on findings.

Input: Headache(784.0) [784.0] / Subarachnoid hemorrhage [430], Reason for Study: ^Reason: evaluate for SAH, angio today consistent w/ vasospasm RCVS vs. Vasculitis History: recurrent thunderclap headache, beading on angiogram There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The left lateral orbital gyrus is prominent and appears to be connected to the left inferior frontal lobe pars orbitalis. However, there is no evidence of abnormal gray matter and the thickness of gray matter on this region appears to be normal indicating normal variation. 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: No evidence of acute ischemic or hemorrhagic lesion.No evidence of intra and extra axial mass lesion.Normal variation of left lateral orbital gyrus connection to the left inferior frontal gyrus pars orbitalis.


Instruction: Generate impression based on findings.

Input: 54 years Female (DOB:5/3/1961)Reason: hx of RA and CNS vasculitis, a/w right sided weakness and pain History: see abovePROVIDER/ATTENDING NAME: LEAH C ANDERSON CELESTE C THOMAS MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This has progressed since 2012 and 2014 and demonstrates minimal progression since 2015.There are multiple punctate T2 and FLAIR hyperintense lesions in the basal ganglia, thalami and brainstem as well as internal capsules. Additional such lesions are present in the cerebellar hemispheres. There are there is a focus of encephalomalacia in the inferior aspect of the right cerebellar hemisphere. There is no other focus of encephalomalacia along the superior aspect of the left cerebellar hemisphere. The pons is small. These lesions have not significantly changed since 2012.There is a punctate focus of signal hypointensity on susceptibility weighted imaging located adjacent to the operculum and the medial aspect of the right inferior frontal gyrus subcortical white matter. Another such lesion is present adjacent along the right superior frontal gyrus subcortical white matter along the deeper portions of the right superior frontal sulcus. In isolation these are of unknown clinical significance.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial mass lesion is appreciated No edema is identified within the brain parenchyma. No abnormal areas of enhancement are identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.The parotid ducts are dilated. There appears to be accessory parotid gland tissue lateral to the right masticator space.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 and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. The left A1 segment is larger than the right A1 segment. The posterior communicating arteries are medium-sized. MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. The left common carotid artery originates from the innominate artery. On the basis of NASCET criteria there is no significant stenosis at the left carotid bifurcation. There is 55% stenosis at the origin of the RICA. This has progressed since the prior exam from June 2015. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is a moderate degree of ischemic type lesions in the cerebellar hemispheres, brainstem, basal ganglia and thalami in the chronic stage. These have not substantially changed since October 2012.2.There is no evidence for acute ischemic cerebral infarction.3.There is 55% stenosis at the origin of the right internal carotid artery. This has progressed since previous exams.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. They are most likely vascular related. There is mild progression since October 2012.


Instruction: Generate impression based on findings.

Input: Back pain, leg burning and pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is trace retrolisthesis of L2 on L3, L3 on L4, and L4 and L5. The conus medullaris is normal in position.Multilevel degenerative changes are seen with disc desiccation at the L2-L3, L3-L4, and L4-L5 levels. There is also asymmetric prominence of the epidural fat involving the right lateral aspect of the spinal canal in the upper and mid lumbar spine which is of doubtful clinical significance. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, eccentric to the right. No spinal canal or neural foraminal stenosis. Mild facet arthropathy with small facet effusions.L3-L4: Mild disc bulge with small right foraminal disc protrusion. Facet arthropathy with bilateral facet effusions. There is no significant spinal canal stenosis. There is mild right neural foraminal stenosis with contact and posterior displacement of right L3 nerve root. Spinal canal and left neural foramen are patent. L4-L5: Mild disc bulge and moderate bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis, left greater than right, which may be effecting the L4 nerve roots.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Mild to moderate degenerative changes in the lumbar spine as described above. There is no significant spinal canal stenosis at any level. There is neural foraminal narrowing at the right L3-L4 and bilateral L4-L5 levels as above.2. Mild multilevel facet arthropathy, which may also be contributing to patient's back pain.


Instruction: Generate impression based on findings.

Input: Male; 78 years old. Reason: low risk prostate cancer, please evaluate. History: low risk prostate cancer PELVIS:PROSTATE:Prostate Size: 5 x 6.4 x 6.7 cm.Peripheral Zone: Scattered areas of T1 hyperintensity bilaterally due to hemorrhage. Small focus of increased enhancement measuring up to 6 mm (series 1601/2412) in the right mid gland peripheral zone, suspicious for prostate cancer.Central Gland: Heterogeneous with markedly enlarged transition zone.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Small focus of increased enhancement in the right mid gland peripheral zone, suspicious for prostate cancer. No evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: New right L5 radiculopathy, assess S1 screw. Right lower extremity weakness and pain. Five lumbar type vertebral bodies are again presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the upper to mid L2 level. There is fibrofatty infiltration of the filum terminale, measuring less than 2 mm in thickness.Again seen are postoperative changes of L5-S1 interbody fusion via left transforaminal approach. Left L5-S1 facetectomy with foraminal decompression again seen. Hardware appears in grossly unchanged position and was better assessed on recent CT from 7/11/2016. No foraminal or extraforaminal nerve root impingement is seen associated with the S1 screw as questioned. There is mild edema involving the L5-S1 disc space which may be on a postoperative basis. No surrounding inflammatory changes or fluid collections are seen to suggest infection.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: Disc desiccation with small central protrusion. No spinal canal or neural foraminal stenosis.L4-L5: Disc desiccation with small right central protrusion. No spinal canal or neural foraminal stenosis.L5-S1: Postoperative changes as described above. Spinal canal is decompressed. Left neural foramen is also surgically decompressed. There is enhancing scar tissue involving the left neural foramen without significant nerve root impingement within the limits of susceptibility artifact. There is mild to moderate right-sided neural foraminal stenosis with disc height loss and eccentric rightward disc bulge with calcification and endplate osteophyte, which are better seen on recent CT.

Output: 1. Postoperative changes of L5-S1 fusion again seen. Hardware was better assessed on recent CT, but there is no nerve root impingement associated with the S1 screw as questioned. There is mild to moderate degree of right-sided L5-S1 neural foraminal stenosis on a chronic degenerative basis related to partial calcified disc bulge and endplate osteophyte. Remainder of the neural foramina are patent.2. Fibrofatty infiltration of the filum terminale incidentally noted, with normal conus position.


Instruction: Generate impression based on findings.

Input: Enlarged right ventricle and right atrium. Mildly increase TR. Left VentricleThe left ventricle is normal in size. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVEDV is 199 ml (normal range 142+/-34), the LV end systolic volume index is 57 ml/m2 (normal range 25+/-9), the LVESV is 97 ml (normal range 47+/-19), the LV mass index is N/A g/m2 (normal range 85+/-15), and the LV mass is 69 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. The LA volume is N/A ml.Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 171 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 87 ml (normal range 54+/-17). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.AORTA FLOW QUANTITATION: Stroke volume in ml: 95.1Forward flow volume in ml: 96.4Backward flow volume in ml: 1.27Regurgitant factor in %: 1.3Pulmonary ArteryThe main pulmonary artery is normal in size. PULMONARY ARTERY MEASUREMENTS:MAIN: 22.5 mmRIGHT: 13 mmLEFT: 18 mmPULMONARY ARTERIES FLOW QUANTITATION:Main pulmonary arteries flow quantitation values are as follows:Stroke volume in ml: 71Forward flow volume in ml: 75.3Backward flow volume in ml: 4.33Regurgitant factor in %: 5.7Right pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 55Forward flow volume in ml: 55.8Backward flow volume in ml: 0.82Regurgitant factor in %: 1.5Left pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 31Forward flow volume in ml: 32.8Backward flow volume in ml: 1.76Regurgitant factor in %: 5.4Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.Extracardiac FindingsPartial view of the extracardiac mediastinum structures, lungs, soft tissues and bones of the chest and solid organs aren't hollow viscus of abdomen are of normal characteristics

Output: 1. No evidence of right atrium or ventricle hypertrophy.2. Normal cardiac viability.


Instruction: Generate impression based on findings.

Input: History of renal transplant complicated by postoperative MI and perforated diverticulitis status post Hartman's now with rising LFTs. ABDOMEN: The study is slightly limited by respiratory motion.LIVER, BILIARY TRACT: Contracted gallbladder containing gallstones. Numerous small stones in the distal cystic duct and within the common bile duct. No significant upstream biliary ductal dilatation.No suspicious liver lesion. Evaluation of the vasculature is limited respiratory motion. The main portal vein is grossly patent.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is atrophic with mild loss of intrinsic T1-weighted signal intensity. Peripancreatic inflammatory fluid and smaller collections are noted. The largest extends along the ventral aspect of the pancreatic body cranially measuring up to 4.0 x 2.9 cm in maximal cross-section and demonstrating T2 hyperintense fluid signal intensity.Note is made of pancreatic divisum. No significant pancreatic ductal dilatation. The parenchyma enhances homogeneously without evidence of parenchymal necrosis or hemorrhage. No evidence of arterial pseudoaneurysm formation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate bilateral pleural effusions.

Output: 1.Contracted gallbladder with numerous gallstones. Choledocholithiasis without upstream significant biliary ductal dilatation.2.Stigmata of pancreatitis including peripancreatic inflammatory fluid and small fluid collections. Pancreas divisum.3. Moderate bilateral pleural effusions.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Rule out intracranial hemorrhage. Signs and symptoms: Altered mental status and headaches. Heavy large vessel intracranial vascular calcification of vertebral arteries and carotids are noted. Large area of vasogenic edema in the right temporal lobe with extension into right parietal is noted. There is associated mass effect and midline shift to approximately 7 mm. no evidence of hemorrhage is detected. Cortical sulci, ventricular system and all CSF cisterns remain within normal. Follow-up exam but a dedicated MRI examination is highly recommended. This finding is concerning for malignancy or possibly an infectious process.

Output: Significant right-sided vasogenic edema with associated mass effect as detailed. Follow-up exam with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: 24-year-old female for follow-up status post right frontal/right orbital mass resection. Postoperative changes related to right frontal craniotomy and right orbitotomy are noted. There is been interval gross total resection of the intracranial portion of the large right frontal extra-axial mass. A moderate amount extra-axial fluid and a small amount of air are present over the right anterior frontal convexity and extending to the right orbit. Small area of restricted diffusion in the right inferior frontal lobe and anterior insular cortex is compatible with cytotoxic edema. There is a minimal amount of enhancement along the medial aspect of the resection cavity, favored to be related to postoperative change. No discrete nodular or masslike enhancement is present intracranially. There has been interval improvement of the mass effect on the adjacent right frontal lobe with reexpansion of the anterior horn of the right lateral ventricle. Hyperintense T2/FLAIR signal in the adjacent right frontal lobe is again seen compatible with edema and/or gliosis..The portion of the mass in the superior right orbit has at least mostly been resected. Susceptibility artifact related to the hardware implant limits assessment of residual tumor in the orbit. There are focal areas of peripheral enhancement in the superior lateral aspect of the right orbit, which may be related to postoperative changes or perhaps small amount of residual tumor and can be correlated with extent of resection. Attention on follow-up suggested. There has also been improvement of the mass effect on the right globe and improved but persistent marked right proptosis. No hydrocephalus. Major flow-voids are preserved.

Output: 1. Gross total resection of the intracranial portion of the previously demonstrated right frontal mass with minimal enhancement along the medial aspect of the resection cavity favored to represent postoperative change. No discrete nodular or masslike intracranial enhancement to definitively suggest residual intracranial tumor.2. There is at least near total resection of the superior orbital component of the tumor with susceptibility artifact limiting precise evaluation. Please see comment above.


Instruction: Generate impression based on findings.

Input: 74 year-old woman with fall. There is no evidence of intracranial hemorrhage, mass or edema. There are atherosclerotic changes of the internal carotid and vertebral arteries. There are moderate, periventricular regions of hypoattenuation consistent with age-indeterminate, small vessel ischemic disease. If stroke remains a clinical concern, recommend MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is mucosal thickening in the visualized portion of the maxillary sinuses bilaterally. The mastoid air cells are normally pneumatized.

Output: No CT findings of acute intracranial process. If stroke remains a clinical concern, recommend MRI.


Instruction: Generate impression based on findings.

Input: Fatigue and diarrhea. Found to have CMV viremia, C. Difficile colitis and CNS nocardia. Repeat imaging due to immunocompromise status per transplant cardiology. There is an enhancing lesion within the splenium of the corpus callosum measuring 1.8 x 1.6 x 2.4 cm, unchanged. Within the corpus callosum, adjacent to this lesion, there is restricted diffusion, also unchanged. There is adjacent T2 hyperintensity extending into the periventricular white matter of the occipital horns of the lateral ventricles. There is ill-defined enhancement within the right superior aspect of the pons, unchanged from prior. There are multiple foci of T2 hyperintensity within the subcortical and periventricular white matter, which are nonspecific but probably secondary to chronic microvascular ischemic disease. There are multiple foci of susceptibility within the bilateral cerebral hemispheres consistent with microhemorrhages, which are unchanged since the prior study. An empty sella is incidentally noted. There is sulcal and ventricular prominence, compatible with mild generalized parenchymal volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.An enhancing lesion within the splenium of the corpus callosum is unchanged in size, with adjacent restricted diffusion within the corpus callosum and periventricular vasogenic edema.2.Unchanged periventricular and subcortical T2 hyperintensities, compatible with mild to moderate microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Ms. Crook is a 62-year-old female with recent diagnosis of right breast cancer. She presents today for MR imaging evaluation. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the right upper outer breast, there is an irregular enhancing mass with associated biopsy marker clip measuring approximately 2.1 x 2.0 x 2.2 cm (AP x ML x SI), compatible with biopsy-proven malignancy. However, extending anteriorly and inferiorly from this malignancy is extensive clumped nonmass enhancement. Total span of abnormal enhancement (index malignancy + NME) measures approximately 9.0 x 3.2 x 5.6 cm. The nonmass enhancement extends into the right nipple. In the left breast, a few foci of enhancement are identified, none of which appear more suspicious than the rest. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Extensive abnormal enhancement seen in the right upper outer breast, measuring up to 9.0 cm in total span. The posterior extent is biopsy proven to be malignant. If confirmation of anterior disease is desired, then an US-guided biopsy can be performed; given that additional hypoechoic lesions (likely corresponding to the MR detected NME) were seen on recent ultrasound from 4/5/2016. (2) No MR evidence of enhancement in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: History of medullary thyroid cancer. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. There is a subcentimeter hepatic cyst. Stable probable small hemangioma in the posterior hepatic segment (series 11/27).No suspicious liver lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder with small gallstones without acute inflammation.SPLEEN: Splenic cyst. Nonspecific low T2 non-enhancing lesion, compatible with calcified granuloma as seen on CT.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable right adrenal lipid-rich adenoma. KIDNEYS, URETERS: Stable left superior pole minimally complex cyst with thin internal septations but no suspicious enhancement. Additional subcentimeter probable cysts.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: Stable examination without specific evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: There are findings related to L3 compression deformity and vertebroplasty with unchanged 40% height loss. There is decreased but persistent enhancement and resolved edema at this level. Overall, the spine bone marrow is patchy diffusely but unchanged. There are unchanged enhancing lesions at L2, L4, and L5 as well as two lesions at T11 and T12 that were not definitely present previously, however the prior exam was significantly motion degraded.The vertebral column alignment is within normal limits. The imaged spinal cord displays normal signal and morphology. There are multiple bilateral renal cysts.T12-L1: There is a mild disc bulge as well as mild facet arthropathy and ligamentum flavum thickening without significant spinal canal or neural foramen stenosis.L1-L2: There is a mild disc bulge as well as mild facet arthropathy and ligament flavum thickening without significant spinal canal or neural foramen stenosis.L2-L3: There is a mild disc bulge as well as mild bilateral facet arthropathy and ligamentum flavum thickening. These findings result in mild spinal canal stenosis but no significant neural foramen stenosis.L3-L4: There is a mild disc bulge as well as mild bilateral facet arthropathy and ligamentum flavum thickening. There is no significant spinal canal or neural foramen stenosis.L4-L5: There is a mild disc bulge asymmetric to the right as well as mild bilateral facet arthropathy and ligamentum flavum thickening. There is mild bilateral neural foramen narrowing and no significant spinal canal stenosis.L5-S1: There is no significant spinal canal, or neural foraminal narrowing.

Output: 1.Post-treatment findings related to L3 compression deformity and vertebroplasty with unchanged 40% height loss. No new compression fractures. 2.Unchanged diffusely patchy bone marrow may represent a combination of tumor and treatment effect.3.Unchanged enhancing lesions at L2, L4, and L5 as well as two lesions at T11 and T12 that were not definitely present previously, however the prior exam was significantly motion degraded.4.Unchanged mild lumbar spine degenerative changes with at most mild spinal canal stenosis at L2-L3 and mild bilateral neural foramen narrowing at L4-L5.


Instruction: Generate impression based on findings.

Input: Pancreatitis and ductal dilatation on CT. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. The common bile duct measures up to 6 mm and tapers smoothly at the ampulla. No filling defect or intrahepatic ductal dilatation. No discrete mass lesion.The liver is normal in morphology, signal intensity and size. Several liver cysts are noted.SPLEEN: Small splenule along the inferior margin of the spleen.PANCREAS: There is mild edema of the pancreatic parenchyma and peripancreatic fluid, compatible with acute pancreatitis. The pancreas demonstrates homogeneous postcontrast enhancement without evidence of necrosis. No loculated fluid collection. No evidence of venous thrombus or arterial pseudoaneurysm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several right renal cysts. No hydronephrosis or suspicious renal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is minimal fluid tracking along the right and left paracolic gutter, minimal perihepatic and perisplenic fluid. Minimal prominence of the proximal jejunal loops near areas of inflammation may represent focal ileus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of acute interstitial pancreatitis without complication such as fluid collection, arterial or venous complication, or pancreatic necrosis. Inflammatory fluid tracks along the retroperitoneal recesses. Focal ileus of the left upper quadrant small bowel loops.2.No biliary ductal dilatation or choledocholithiasis.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, with worsening altered mental status, word finding difficulty, dyskinesia and tremor in the severely immunosuppressed patient. No restricted diffusion is seen. No evidence of significant parenchymal edema or mass effect is detected. There are a few scattered small nonspecific foci of T2 hyperintensity in the brain. Numerous foci of susceptibility are, however, detected throughout the brain ranging in size from punctate to several millimeters. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.

Output: 1.No findings are seen to suggest infection, edema or any other definite acute process.2.Note is made of numerous scattered foci of susceptibility in the brain. These could represent sites of chronic microhemorrhage, amyloid angiopathy, or even sequelae of remote trauma. Correlation with clinical history and cerebrovascular risk factors may be helpful.


Instruction: Generate impression based on findings.

Input: 71-year-old female with shoulder pain. Evaluate for cuff tear. ROTATOR CUFF: There is a partial thickness undersurface tear of the anterior fibers of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring approximately 6 mm in the AP dimension without significant retraction. Additionally, more posteriorly there is a partial-thickness undersurface tear of the supraspinatus measuring approximately 12 mm in the AP dimension, involving approximately 50% of the tendon width, which extends posteriorly to involve the anterior fibers of the infraspinatus tendon without significant retraction. Supraspinatus tendon appears thickened with associated intermediate signal abnormality consistent with moderate tendinosis. The supraspinatus and infraspinatus muscles appear intact. The teres minor muscle and tendon appear intact. There is a small interstitial tear of the subscapularis tendon at the level of the myotendinous junction. The subscapularis muscle appears intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is heterogeneity and increased signal abnormality within the anterior and posterior superior glenoid labrum suggesting degenerative tearing. There is near full-thickness to full-thickness articular cartilage degeneration along the glenoid with associated subchondral cyst formation. There are subchondral cysts within the humeral head. There is osteophyte formation about the glenohumeral and acromioclavicular joints.BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of the biceps which may represent fluid extension to the glenohumeral joint. ADDITIONAL

Output: 1. Partial-thickness tearing of the rotator cuff without evidence of a full-thickness tear.2. Moderate degenerative changes affecting the glenohumeral joint.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 66-year-old woman with coarse hepatic echotexture and possible mass in the dome of the liver seen on recent ultrasound. ABDOMEN:LIVER, BILIARY TRACT: In segment 8 of the liver (601/36), there is an 83 x 73 mm multilobulated lesion. This lesion is markedly T2 hyperintense. Additionally, there is peripheral nodular enhancement of this lesion on the delayed postcontrast images (1504/84). This lesion appears hyperechoic on comparison ultrasound.Additional, smaller lesions with similar imaging characteristics are noted in the right lobe and measure up to 2 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cysts noted. Left kidney appears normal.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Significant dielectric artifact from the distended stomach. The remaining, partially visualized small bowel and colon otherwise appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small-moderate bilateral pleural effusions noted.

Output: 1.Significantly limited study due to failure of fat saturation and dielectric artifact from a markedly distended stomach. The perfusion sequences are nondiagnostic. 2.Large lesion in segment 8 of the liver with smaller similar lesions scattered throughout the right lobe. Due to the aforementioned limitations, imaging findings are suggestive but not entirely diagnostic of hemangiomata. 3.Follow up MR imaging can be considered in 3-6 months or the perfusion sequences can be repeated at no additional cost to the patient.


Instruction: Generate impression based on findings.

Input: 45-year-old male with right-sided weakness. Evaluate for bleed, ischemia. Ill-defined area of low attenuation in the pons is new since prior study. The more well-defined focus of low attenuation in the right middle cerebellar peduncle was also not seen on prior study. Further evaluation with MRI is recommended if clinically warranted.Chronic infarct in the posterior limb of the left internal capsule involving the corona radiata is again seen. Nonspecific calcification in the pons has been seen since prior study from November 2009.There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Ill-defined low attenuation in the pons is new since prior study. More well-defined focus of low attenuation in the right middle cerebellar peduncle was also not seen on prior study. Recommend evaluation with MRI if clinically needed.2. Old infarct in posterior limb of left internal capsule. No acute hemorrhage.


Instruction: Generate impression based on findings.

Input: Reason: Chiari malformation status post decompression. VP shunt, Syrinx. Weakness, headaches, difficulty walking , increase in syrinx size on recent MRI , repeat in 3 months History: expanding syrinx, shunt, chiari , worsening symptoms Again seen are postsurgical changes of prior Chiari decompression with suboccipital craniectomy and resection of the posterior arch of C1. Left cerebellar encephalomalacia is partially visualized and present previously. Fourth ventricular stent partially visualized.There is no significant change in extensive cervical syrinx with septations compared to 4/30/2015. For example at the C1 level, syrinx measures 17 x 13 mm similar to prior. Inferiorly syrinx extends to the C7 level similar to prior with additional T2 hyperintensity extending down to the T1 level appearing slightly less prominent in the interval.Abnormal T2 signal in the thoracic cord bilaterally is again seen from T6 to T7 and appears similar on the sagittal sequences. Axial T2 sequence of the thoracic cord were not obtained as patient could not tolerate further imaging. There is mild prominence of the central canal slightly more inferiorly from T7 to T8 which also appears similar to prior based on the sagittal sequences. Again noted is mild deformity of the thoracic cord with asymmetric flattening of the left ventrolateral aspect of the cord at the T5 level better appreciated on prior axial thoracic images.Mild multilevel degenerative changes are again seen in the cervical spine. Schmorl's nodes with mild depression of the superior endplates involving the thoracic spine are also again noted involving the superior endplates at T7, T8, T9, and T10. Alignment is maintained. Bone marrow signal is benign.

Output: Compared to 4/30/2015 there is overall no significant change in size or extent of large cervical syrinx extending from the cervicomedullary junction to the C7 level. Adjacent T2 signal abnormality extending more inferiorly from C7 to the T1 level however appears slightly decreased than before. Additional T2 signal abnormality involving the mid thoracic cord from T6 to T7 is also unchanged based on the sagittal sequences with patient not being able to tolerate further axial thoracic imaging. Contour deformity of the mid thoracic cord also remains unchanged which may be related to adhesions in the thecal sac from remote inflammation or surgical manipulation. No new cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Cystic left tracheoesophageal groove lesion may represent a branchial cleft seen on CT: dysphagia, pressure sensation. There is a T2 hyperintense tubular mass adjacent to the left aspect of the cervical esophagus that extends from the level of the C6 to T1 vertebral body levels, measuring 17 AP x 18 RL x 45 SI mm. There is a crenulated pattern of enhancement within the mass, suggestive of digestive track mucosa, and central non-enhancement. In addition, following the administration of oral contrast the center of the mass also enhances, although this may potentially be due to delayed centripetal intravenous contrast enhancement. The trachea and prevertebral space appear to be intact. The mass also appears to be separated from the thyroid gland. There appears to be a mildly prominent, but subcentimeter, right tracheoesophageal groove lymph node, which is nonspecific. There are small posterior disc-osteophytes at C4-5 and C5-6 without spinal cord impingement. The imaged salivary gland are unremarkable.

Output: A left paraesophageal mass measuring up to 45 mm may represent an esophogeal diverticulum or enteric duplication cyst with associated mucosal inflammation, although an underlying neoplastic component is a potential consideration. A vascular malformation or brachial cleft cyst with superimposed inflammation are alternative possibilities, perhaps.


Instruction: Generate impression based on findings.

Input: Clinical question: 60-year-old female with metastatic cancer with known metastases to T12-L5, left pelvis, evaluate for any nerve. Signs and symptoms: As above. Pre and post enhanced thoracolumbar MRI:Examination demonstrates metastatic lesion extensively involving vertebral body of T2, left pedicle and left superior articulating facet with enhancement. There is ventral epidural extraosseous spread of tumor and with partial extension into the left neural foramen at this level. No evidence of fracture, spinal stenosis and no detectable cord signal abnormality.There is a small focus of metastatic disease involving the superior aspect of body of T11 with enhancement without fracture or extraosseous spread of tumor.Large osseous metastatic lesion involves the vertebral body of T12 without evidence of extension into the pedicles or the posterior elements and without detectable fracture or extraosseous spread of tumor.There is an enhancing metastatic lesion involving nearly entire L1 vertebral body with approximately 50% compression deformity of the vertebrae. There is extension of tumor into the right pedicle. There is no evidence of a spinal stenosis or neural foraminal compromise at this level.Large enhancing metastatic lesion involving the vertebral body of L4 without fracture or malalignment and without spinal canal or neural foraminal compromise.Large enhancing metastatic lesion involves the vertebral body of L5 and without fracture or malalignment and no evidence of epidural spread of tumor.The signal intensity and caliber of thoracic cord, conus and cauda equina is within normal and without evidence of leptomeningeal enhancement.Shallow ventral disc protrusion with enhancement at C5-T6 and T7-T8 levels are noted and best appreciated on sagittal post enhanced series.A large right thoracic mass abuts the spine however without convincing evidence of extension into the neural foraminal or the spinal canal at any level.

Output: 1.Multiple enhancing osseous metastatic lesions involving vertebral bodies of thoracic and lumbar spine.2.There is approximately 50% compression deformity of metastatic L1 vertebral body as detailed.3.There is mild ventral epidural and left neural foraminal extension of tumor from metastatic disease at T2 level as detailed.4.No convincing evidence of intracanalicular or neural foraminal spread of tumor at any other level.5.Normal signal intensity and caliber of the cord and without detectable cord or left meningeal enhancement.6.Very large right thoracic mass abuts the thoracic spine at multiple levels however without detectable spread of tumor into the neural foramina or spinal canal.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of bronchus and lung. There has been overall decrease in size of multiple brain metastases since January 2015. For example, the dominant left temporal lobe lesion measures up to 22 x 20 mm, previously 25 x 24 mm and a right cerebellar lesion measures 9 x 9 mm, previously 11 x 12 mm. However, a left superior frontal gyrus lesion that measures up to 4 mm is not significantly changed. There has also been slight interval decrease in the associated vasogenic edema and midline shift, now measuring up to 7 mm, previously 9 mm. There is persistent partial effacement of the left lateral and third ventricles, but no evidence of hydrocephalus. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Overall decrease in size of the multiple brain metastases since January 2015.


Instruction: Generate impression based on findings.

Input: Clinical question: History of buccal mucosal cancer. Status post chemo. Evaluate for response. Signs and symptoms: None Enhanced CT of soft tissues of neck:This examination is severely limited due to patient's cervical fusion (fixating rods and multi-level transpedicular screws), significant kyphosis and extensive metallic dental filling. Extensive areas of the study is completely obscured by streak artifact from the metal and poor quality exam due to inability of patient to lie flat within the scanner.Within the significant restriction no definitive evidence of any new masses or pathologic adenopathy is noted. Very extensive postoperative changes of neck is again noted. Examination again demonstrates very heavy calcification of bilateral carotid bifurcations. Significant artifacts obscures the detail for assessment of vascular stenosis. Grade 1 anterolisthesis of C3 on C4 and and minimal retrolisthesis of C5 on C6 is again identified.Enhanced MRI of brain:There is no evidence of abnormal enhancement of brain parenchymal or leptomeninges. Findings suggestive of advanced small vessel disease of indeterminate age are again identified.Calvarium is intact.Complete opacification of left mastoid air cells and partially of the left middle ear cavity with no detectable bony changes is again identified. Limited view of paranasal sinuses are unremarkable. Right mastoid air cells and middle ear cavity are unremarkable.70 cc of Omnipaque 350 was administered per above studies.

Output: 1.Severely limited CT examination of soft tissues of neck due to above described causes. Examination however grossly remains similar to prior study and with no evidence of tumor or pathologic adenopathy.2.Negative CT of brain and calvarium for metastatic disease. Extensive small muscle disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 50-year-old woman with history of uterine fibroids and ovarian masses. PELVIS:UTERUS, ADNEXA: There are multiple, predominantly T1 and T2 hypointense subserosal and intramural masses within the uterus. The largest of these is a subserosal mass in the body of the right uterus (series 501, image 21) measuring 64 x 55 mm. The endometrial canal is distorted but otherwise normal.There are bilateral adnexal collections which are nonenhancing but homogenously T1 isointense and T2 hypointense. On the left, the largest collection measures 56 x 47 mm (series 1201, image 30).BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted in the rectosigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple subserosal and intramural fibroids.2.Bilateral adnexal endometriomas.


Instruction: Generate impression based on findings.

Input: TIA, migraines with odynophagia, persistent headaches (following a recent fall), and eye pain. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is degenerative spondylosis of the upper cervical spine with reversal of the usual lordosis.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with history of pituitary lesion, noted to be hypermetabolic on the prior PET scan. A mildly T2 hyperintense, mildly hypoenhancing lesion within the left aspect of the sella turcica is redemonstrated showing no significant interval change in size. The lesion measures up to 10 mm in diameter. No significant encroachment upon the suprasellar cistern is seen. The pituitary stalk deviates slightly towards the right. The cavernous sinuses and visualized optic apparatus are unremarkable. Mild paranasal sinus inflammation is seen.

Output: Stable lesion within the left sella turcica which could represent an adenoma.


Instruction: Generate impression based on findings.

Input: History of thymic cancer. Post therapy scan 6 -- 26 -- 08 showed left uptake in thyroid bed. Left submandibular uptake (node versus salivary gland).? Faint uptake in the right lung base. Please evaluate (A) is submandibular area uptake a node versus salivary gland. (B.) are there any lung metastases. (C) rule out other Mets. CT of soft tissues of the neck:Images through the skull base including cavernous sinuses remain within normal limits. Paranasal sinuses and mastoid air cells are also unremarkable.The parotid glands remain within normal limits in morphology and pattern of enhancement.The signal intensity and morphology of the left submandibular gland is within normal limits.In the left submandibular region there is no evidence of new finding since prior MRI examination of 8 -- 30 -- 2008. Either an accessory salivary gland or a small node (however with a fatty hilar region) is noted. This remains identical to what was noted on prior MRI. The submandibular gland on the left remains within normal limits with no abnormal enhancement. The left submandibular gland however appears larger than the right side which is also a finding that was noted on prior MRI examination. The mandibles remains within normal limits and there is no evidence of any dental abnormality to account for increased uptake.Images at the level of the thyroid bed failed to demonstrate any residual enhancing thyroid tissue. Metallic clips bilaterally in the thyroid bed however obscure the detail. There is no evidence of any pathologic adenopathy in the neck.Limited images through the apices of the lungs are unremarkable. Limited images of mediastinum are unremarkable.Extensive postoperative changes of anterior fusion of the cervical spine is noted and there is however no evidence of any destructive bony lesion.

Output: No evidence of a mass or pathologic adenopathy. Please review detailed report above.


Instruction: Generate impression based on findings.

Input: 18 year-old male with pain, multiple injuries There is thickening of the common flexor tendon, which likely represents a combination of tendinosis and scarring, with increased signal intensity at its origin which I suspect reflects chronic partial-thickness tearing or a prior full-thickness tear that has subsequently scarred down to the bone. The common flexor tendon is inseparable from the underlying anterior bundle of the ulnar collateral ligament, which we suspect is due to scarring. The majority of the ulnar collateral ligament is separated from the distal humerus suggesting a near full-thickness tear, or perhaps a full-thickness tear with focal scarring to bone. The UCL is also partially separated from the coronoid process, indicating at least a partial thickness tear. The ligament itself appears thickened, likely representing a combination of scarring and degeneration.There are findings indicating chronic injury to the lateral supporting structures of the elbow as well, including thickening of the posterolateral capsule, which is inseparable from the common extensor tendon. This likely represents chronic scarring with heterotopic ossification seen on recent radiographs. The normal bilaminar appearance of the radial collateral ligament and common extensor tendon is not seen, likely due to prior injury and scarring. Anteriorly, the lateral collateral ligament appears thickened. The lateral ulnar collateral ligament is grossly intact. The radial head is slightly laterally subluxed relative to the capitellum. A small amount of fluid is within the lateral joint with a curvilinear structure extending from the capitellum that likely either represents a synovial plica or a fragment of torn ligament.The tendons of the biceps and brachialis appear normal. The triceps tendon appears normal. We see no atrophy or edema of the musculature. There are small osteophytes along the ulnohumeral articulation with mild degeneration of the adjacent articular cartilage, but we see no discrete fluid-filled articular cartilage defect. The bone marrow signal is within normal limits.The ulnar nerve become slightly thickened with increased signal intensity within the proximal cubital tunnel, which may represent a mild neuritis.

Output: Findings compatible with the stated history of multiple prior injuries including chronic tearing/scarring of the medial and lateral supporting structures of the elbow as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Low back pain and leg pain. Signs and symptoms: Low back pain and leg pain. Nonenhanced lumbar MRI:The alignment of vertebral column is anatomical.The signal intensity of vertebral column demonstrate changes related to degenerative disease and unremarkable otherwise.T11-T12 demonstrate mild degenerative changes and unremarkable otherwise.T12-L1 demonstrate mild hypertrophic changes of posterior elements and unremarkable otherwise.L1-L2 demonstrate mild disc disease and mild asymmetric left-sided facet and ligamentum flavum hypertrophy. There is also asymmetric left-sided lateral and far lateral disc bulge. Constellation of above findings results in moderate to significant left neural foraminal compromise and mild central spinal stenosis. Tiny synovial cysts are noted projecting posterior and inferior to the left articulating facet.L2-L3 demonstrate moderate disc disease, loss of disc height and asymmetric mild to moderate left facet and ligamentum flavum hypertrophy. Constellation of findings results in mild spinal stenosis, moderate bilateral neural foraminal compromise.L3-L4 demonstrate advanced disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is a shallow broad-based right lateral and far lateral disc protrusion. Constellation of changes results in moderate central spinal stenosis and significant right and mild to moderate neural foraminal compromise.L4-L5 demonstrate advanced disc disease and loss of disc height and asymmetric moderate to significant right facet and ligamentum flavum hypertrophy and to a lesser degree on the left. Shallow broad-based bulging disc is also noted. There is resultant significant right and moderate left neural foraminal compromise and no central spinal stenosis.L5-S1 demonstrate mild disc disease and loss of height, moderate asymmetric right facet and ligamentum flavum hypertrophy and to a lesser degree on the left. There is no central spinal stenosis however moderate right neural foraminal compromise is present.Visualized SI joints are unremarkable.Paraspinal soft tissues are unremarkable.

Output: 1.Degenerative changes of lumbar spine with resultant moderate central spinal stenosis at L3-L4 and mild spinal stenosis at L1-L2 and L2-L3 levels.2.There are shallow broad-based disc protrusion and multilevel neural foraminal compromise (some significantly) as detailed per level above.


Instruction: Generate impression based on findings.

Input: 57-year-old male with history of elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.4 x 5.6 x 4.3 cmPeripheral Zone: In the left mid gland, there is a suspicious rounded 1.6 x 1.2 cm focus (axial series 1001 image 17) that shows decreased signal intensity on T2 and ADC. This lesion abuts the capsule and shows focal capsular distortion.Additional foci of low T2 signal intensity is seen in the bilateral apices (axial series 1001 image 10) without reliable hypointense signal on ADC.In the right anterior transitional zone, there is an ovoid 2.3 x 1.3 cm focus with indistinct margins and hypointense T2 and ADC signal, and corresponding contrast enhancement is also noted.Central Gland: Nodular appearance compatible with BPH.Seminal Vesicles: Extracapsular Extension: No convincing evidence.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: DJD of the bilateral hips.OTHER: No significant abnormality noted.

Output: 1.Rounded lesion in the left mid gland measuring 1.6 x 1.2 cm that abuts the capsule and shows capsular distortion is suspicious for malignancy.2.Ovoid lesion in right anterior transitional zone measuring 2.3 x 1.3 cm with indistinct margins and contrast enhancement is suspicious for an additional site of malignancy.3.Additional foci of indistinct low signal intensity in the bilateral apices without reliable decreased signal on ADC indeterminate.


Instruction: Generate impression based on findings.

Input: Prostate tumor. Prior biopsy. Elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.5 x 1.7 x 2.8 cmPeripheral Zone: 8 x 6 mm enhancing T2 hypointensity in the left mid gland with corresponding diffusion restriction is consistent with the patient's known prostate cancer, previously 9 x 6 mm. Central Gland: Heterogeneous without suspicious lesions.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. Subcentimeter bilateral external iliac lymph nodes, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Stable size and appearance of the patient's known prostate carcinoma.


Instruction: Generate impression based on findings.

Input: 27-year-old female with question of demyelination. Neck pain and left upper extremity weakness. MRI brain: Some sequences are limited by patient motion artifact. Allowing for this limitation, there is no specific evidence of demyelinating lesion, mass, infarct, or pathologic enhancement. The ventricles and sulci appear normal for age. There is a small right maxillary polyp, otherwise the paranasal sinuses and orbits appear unremarkable.MRI cervical spine: There is straightening of the normal cervical lordosis which may be in part positional. Vertebral body heights and disc spaces appear preserved. The cervical cord appears normal in morphology and signal. The cervicomedullary junction appears unremarkable. There is no evidence of neuroforaminal compromise or spinal canal stenosis. There is no pathologic enhancement on postcontrast images.

Output: 1. No evidence of acute or chronic demyelinating disease in the brain or cervical spine. No specific findings to account for the patient's symptoms.2. No abnormal signal in the cervical cord. No significant spinal canal or neural foraminal stenosis in the cervical spine. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Multiple sclerosisClinical question: MS; f/u progressionSigns and Symptoms: paresthesias The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a mild to moderate degree of periventricular and subcortical white matter lesions which are high signal on FLAIR and T2 MRI. Some of these lesions course to the corpus callosum. Many of these lesions are associated with T2 hypointensitiesNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate scattered opacities in the ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There are multiple periventricular white matter lesions present which were also present on the prior exam and have not changed. No new lesions are identified.


Instruction: Generate impression based on findings.

Input: Diagnosis: Slurred speechClinical question: Evaluate for strokeSigns and Symptoms: R-sided facial droop and slurred speech x15 mins, now resolved The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated within the brain parenchymaThere are punctate foci of T2 and FLAIR signal hyperintensity present within the thalami, basal ganglia and pons.There is a small focus of encephalomalacia along the inferior aspect of the left occipital lobe along the lingual gyrus.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Multiple lesions within the basal ganglia, thalami and brainstem which are suspected to represent old lacunar infarcts3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Headache. There is a 12 mm diameter enhancing, dural-based mass overlying the superior left parietal lobe. There is minimal masa effect upon the underlying brain parenchyma and no evidence of associated vasogenic edema. There is also a 10 mm diameter left paraclinoid enhancing, dural-based mass, which abuts the supraclinoid internal carotid artery. There is minimal masa effect upon the underlying brain parenchyma and no evidence of associated vasogenic edema. In addition, there is a plaque-like 4 mm thick enhancing, dural-based mass along the left frontal convexity, without significant mas effect upon the There is no evidence of intracranial hemorrhage or acute infarct. There is minimal diffuse, nonspecific, periventricular white matter T2 hyperintensity. There is mineralization in the bilateral basal ganglia. The ventricles are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. A 12 mm diameter mass overlying the superior left parietal lobe, a 10 mm diameter left paraclinoid mass, and a 4 mm thick mass along the left frontal convexity likely represent meningiomas.2. No evidence of intracranial hemorrhage or acute infarct.


Instruction: Generate impression based on findings.

Input: There is overall relative increased mean transit time diffusely throughout the left ACA and anterior MCA territories. There is slightly increased left cerebral blood volume on relative blood volume maps in this same region indicating compensatory relatively increased blood volume, except for the left inferior parietal lobule area which was previously infarcted. Finally there is a overall relative decreased cerebral blood flow involving the left ACA and MCA territories.Comparing the area of restricted diffusion seen on the MRI, constellation of MR perfusion findings are suggesting left ACA and MCA territorial hypoperfusion with incomplete compensatory status.

Output: Findings of diffusion-perfusion mismatch are seen on the left ACA and MCA territories. Specifically, the left ACA and MCA territories show relatively decreased perfusion with incomplete compensatory increase of relative blood volume.Findings were discussed with Dr. Satzer of neurosurgery at pager 2194 by Dr. Veronesi of neuroradiology.


Instruction: Generate impression based on findings.

Input: Reason: MR arthrogram right shoulder s/p right shoulder dislocation History: above ROTATOR CUFF: There is no evidence of rotator cuff tear. Contrast material remains within the joint space without communication to the subacromial/subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a partial thickness tear through the anteroinferior glenoid labrum without recent compatible with cartilaginous Bankart lesion.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Hill-Sachs and cartilaginous Bankart deformities of the right shoulder as above. The rotator cuff is intact.


Instruction: Generate impression based on findings.

Input: Left knee pain. MENISCI: The lateral meniscus appears intact. There is blunting of the body and posterior horn of the medial meniscus in a configuration compatible with prior meniscectomy. No discrete tears are identified within the medial meniscus.ARTICULAR CARTILAGE AND BONE: Tricompartmental osteophytes are present. There are areas of abnormally decreased T1 signal with associated mixed T2 signal within the medial femoral condyle as well as the medial tibial plateau in a pattern suggestive of microfracture procedure. There is full-thickness loss of cartilage throughout the medial tibiofemoral compartment, progressed from the prior examination. There is mild diffuse thinning of the cartilage of the lateral tibiofemoral as well as patellofemoral compartments without focal cartilaginous defects.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Degenerative osteoarthritic changes including full-thickness loss of cartilage throughout much of the medial tibiofemoral compartment, progressed from prior. Bone marrow signal changes in the medial tibiofemoral compartment suggestive of interval microfracture procedure.2.Postsurgical changes of medial meniscectomy without discrete meniscal tears.


Instruction: Generate impression based on findings.

Input: 67 years, Male, Reason: staging exam History: prostate cancer sp prostatectomy with rising PSA. PELVIS: MalePROSTATE, SEMINAL VESICLES: Status post prostatectomy. No evidence of recurrent tumor.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fluid attenuating collection along the right pelvic sidewall with a small septation measures 3.1 x 4.4 x 4.3 cm, likely a lymphocele. An additional smaller collection measuring 1 cm (801/28) also likely represents a lymphocele.

Output: 1.No evidence of local recurrence or lymphadenopathy.2.Lymphoceles along right pelvic sidewall.


Instruction: Generate impression based on findings.

Input: Clinical question: Response. Signs and symptoms: Right-sided weakness and aphasia. Unenhanced CT of brain:Examination demonstrates findings consistent with extensive small vessel disease and supratentorial brain parenchyma. Very subtle area of low attenuation of the cortex of the operculum of left temporal lobe and minimally within the insular cortex as was noted on prior MRI is identified. There is no definite interval change since prior exam. Calcification/possible clot of left MCA branch within the left sylvian fissure is again identified.There is no evidence of interval hemorrhage since prior exam. No definitive evidence of any new area of ischemic change.Ventricular system remains a stable cyst prior study.

Output: No definitive evidence of any new findings since prior study.


Instruction: Generate impression based on findings.

Input: Patient with lung mass. Evaluate for brain metastases. The ventricles and sulci are prominent, consistent with age-related volume loss. There is no pathological enhancement, midline shift or mass effect. There is no acute intracranial hemorrhage. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter and pons, consistent with moderate chronic small vessel ischemic changes. There is an area of encephalomalacia in the left superior frontal gyrus, likely from chronic infarct. There are multiple scattered foci of susceptibility artifact within the supratentorial compartment, consistent with hemosiderin deposition. There is no extraaxial fluid collection. There are small mucous retention cysts within the bilateral maxillary sinuses. There is partial opacification of the right ethmoid air cells. The remaining visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is pannus surrounding the odontoid process.

Output: 1. No abnormal parenchymal enhancement to suggest intracranial metastases. 2. Moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 71-year-old female patient with right shoulder pain. Question of rotator cuff tear. The exam is limited due to the patient's large body habitus and claustrophobia resulting in images that are degraded by motion artifact.ROTATOR CUFF: There is increased signal intensity within the anterior fibers of the supraspinatus tendon likely representing a full-thickness insertional tear measuring 1 cm in the AP dimension with minimal retraction. Increased signal intensity within the tendon more proximally indicates tendinosis. There is mild atrophy of the supraspinatus muscle. There are small foci of fluid signal intensity within the infraspinatus tendon along the myotendinous junction representing focal interstitial tears with equivocal extension to the bursal surface. There are also tiny interstitial undersurface tears of the infraspinatus tendon at its insertion, but we see no full-thickness tear. There is mild atrophy of the infraspinatus muscle. The teres minor muscle and tendon are intact. There is increased signal intensity in the subscapularis tendon indicating tendinosis with focal fluid signal intensity indicating interstitial tears as well as undersurface fraying. We see no full-thickness tear.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid in the subdeltoid/subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate osteoarthritis affects the glenohumeral joint. A small amount of fluid is noted in the joint, but no frank effusion. Evaluation of the labrum is limited due to motion artifact, however, there is increased signal intensity in the superior labrum indicating a tear. There is mild deformity of the anterior labrum likely representing degeneration.BICEPS TENDON: Increased signal intensity in the tendon of the long head of the biceps at its transition at the rotator cuff interval to the intertubercular groove indicates tendinosis. There also appears to be a longitudinal tear of the long head of the biceps tendon within the bicipital groove. Increased signal intensity within the bicipital groove on the fluid sensitive sequence suggests mild tenosynovitis.ADDITIONAL

Output: 1. Limited study due to patient body habitus and motion artifact showing rotator cuff tendinosis as well as a probable full-thickness tear of the anterior fibers of the supraspinatus tendon and partial thickness, largely intrasubstance, tears of the infraspinatus and subscapularis tendons.2. Osteoarthritis of the acromioclavicular and glenohumeral joints and other findings as described above.


Instruction: Generate impression based on findings.

Input: LOC and fall with head trauma; never had subsequent imaging; hx of bladder cancer. There is a subcentimeter area of high T1 and T2 signal in the right globus pallidus without restricted diffusion. There is a background of mild scattered cerebral and pontine white matter T2 hyperintensity in addition to prominent perivascular spaces. There is no evidence of mass or acute infarct. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. A subcentimeter area of high T1 and T2 signal in the right globus pallidus may represent a subacute lacunar infarct. Otherwise, a background of mild scattered cerebral and pontine white matter T2 hyperintensity may represent chronic small vessel ischemic disease.2. No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 65-year-old female with chronic low back pain. There is grade 1 anterolisthesis of L4 on L5. There is moderate to severe degenerative disc disease affects L4-5 and L5-S1 with associated vertebral body endplate changes. Mild degenerative changes affect the SI joints. At T12-L4, there is no significant spinal canal or neural foramen stenosis. At L4-L5, there is moderate to severe degenerative disc disease and vertebral body endplate changes, as well as moderate facet joint and ligamentum flavum hypertrophy, and a disc bulge with moderate bilateral neuroforaminal narrowing and severe spinal canal stenosis with buckling of the adjacent cauda equina nerve roots. At L5-S1, there is a disc bulge and facet hypertrophy with trace fluid in the right facet joint, with mild bilateral neuroforaminal narrowing, but no significant spinal canal stenosis. The vertebral body heights are intact. There are bilateral renal lesions that are incompletely imaged and characterized.

Output: 1. Grade 1 anterolisthesis of L4 and L5 and degenerative spondylosis with moderate bilateral neuroforaminal narrowing and severe spinal canal stenosis at this level.2. Bilateral renal lesions that are incompletely imaged and characterized, but may represent cysts. A renal ultrasound may be useful for further evaluation, if clinically warranted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.