Instruction: Generate impression based on findings.

Input: History of labral repair now with shoulder pain. ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact.SUPRASPINATUS OUTLET: No abnormal fluid or gadolinium is present within the subacromial/subdeltoid bursa. The acromioclavicular joint is within normal limits.GLENOHUMERAL JOINT AND GLENOID LABRUM: A suture anchor in the superior glenoid causes artifact and somewhat obscures the superior labrum. Otherwise, the labrum appears intact. The middle glenohumeral ligament is thickened and cordlike.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL

Output: 1.Suture anchor in superior glenoid which somewhat obscures superior labrum. Within this limitation, no labral tears are identified.2.Rotator cuff unremarkable.


Instruction: Generate impression based on findings.

Input: 37-year-old female with history of endoscopic repair of CSF leak an encephalocele repair. Rule out subdural hemorrhage. The area of low attenuation in the right frontal lobe is again seen. This could represent vasogenic edema, however, to exclude other etiologies, contrast enhanced CT or MRI should be performed. Previous area of high attenuation in the right frontal lobe is less conspicuous. There is no new additional evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Post-surgical changes with sinus opacity of the sphenoid, right ethmoid, and maxillary sinuses. Right-sided frontal sinuses are also opacified. The mastoid air cells are normally pneumatized.

Output: Area of low attenuation in the right frontal lobe could represent vasogenic edema, though other etiologies should be excluded on MRI or contrast enhanced CT.


Instruction: Generate impression based on findings.

Input: Worsening headaches over the past 2 month and change in behavior. History of traumatic brain injury (after bike accident) on November 19, 2015. There is a cavum septum pellucidum and cavum vergae with convex/bulging lateral walls. Brain parenchyma appears otherwise unremarkable. No evidence of intracranial mass or mass effect. No evidence of hemorrhage or traumatic encephalomalacia. No evidence of ischemia. No extra-axial collections. No abnormal parenchymal or meningeal enhancement. The major cerebral flow voids are intact. There is a small right maxillary mucus retention cyst. Calvarium and extracranial soft tissues are otherwise unremarkable.

Output: MRI of the brain is essentially within normal limits. There is a cavum septum pellucidum and cavum vergae with bulging lateral walls. Finding is usually a normal variant without clinical significance but has been associated with headaches. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to posterior fusion of C3-C6 with bilateral pedicular screws and laminectomies at the levels, new from prior exam. Hardware related susceptibility artifact limits evaluation of these levels. The spinal canal at the postoperative levels shows no significant canal stenosis. Abnormal T2 hyperintense signal abnormality in the cervical cord has significantly decreased from prior exam although persistent at the C3-4 level with mild focal cord expansion and mild enhancement within the cord. There is disk desiccation and loss of disk height at multiple levels in the cervical spine. Vertebral body heights are preserved. The osseous marrow signal is benign.There is ill-defined enhancement of the posterior paraspinal and subcutaneous soft tissues which is likely postsurgical. No definite pathologic enhancement is identified elsewhere.C2-3: No disk herniation or spinal stenosis.C3-4: Postsurgical changes, small disk osteophyte complex with no spinal stenosis. However, there is mild residual effacement of the right lateral aspect of the thecal sac still present without significant spinal stenosis. Hyperintense T2 cord signal abnormality and focal cord expansion with mild enhancement as described above.C4-5: Postsurgical changes, disk osteophyte complex with no spinal stenosis.C5-6: Postsurgical changes, disk osteophyte complex with no spinal stenosis.C6-7: Posterior changes, disk osteophyte complex with uncovertebral hypertrophy causing mild right neural foraminal stenosis.C7-T1: No disk herniation or spinal stenosis.T1-2: No disk herniation or spinal stenosis.T2-3 and T2-4 levels show no disk herniation or spinal stenosis on the sagittal images.

Output: Postoperative findings related to posterior fusion of C3-C6 and decompressive laminectomies with spinal canal stenosis no longer seen at the postoperative levels. Marked interval decrease in abnormal T2 cord signal with persistent signal abnormality and focal expansion of the cord at C3-4.


Instruction: Generate impression based on findings.

Input: Low back pain and radiculopathy. There is approximately 10 mm of anterolisthesis of L5 upon S1 with mild disc space narrowing, desiccation, and adjacent endplate bone marrow signal alterations. There is associated facet arthropathy with mild left and severe right L5-S1 neural foramen stenosis. However, there is no significant spinal canal stenosis. The spinal cord and cauda equina nerve roots are intact. The conus medullaris is situated at the L1 vertebral body level. The paravertebral soft tissues are unremarkable.

Output: Approximately 10 mm of anterolisthesis of L5 upon S1 associated with degenerative spondylosis resulting in mild left and severe right L5-S1 neural foramen stenosis.


Instruction: Generate impression based on findings.

Input: 38-year-old woman presents with foot pain. History of infection following percutaneous pinning of a navicular fracture. Evaluate for plantar abscess. There is a band of nonenhancing signal abnormality extending through the dorsal soft tissues of the forefoot and midfoot which upon discussion with Dr. Toolan likely represents a surgical incision approximating the tract of a removed percutaneous pin. This incision extends through the soft tissues to the dorsal aspect of the base of the second metatarsal, the middle cuneiform and the navicular. There is signal abnormality and enhancement of these bones compatible with osteomyelitis as well as signal abnormality due to a comminuted fracture of the navicular. There is dorsal subluxation of the 2 larger navicular fragments relative to the head of the talus. There is a tubular focus of signal abnormality extending vertically through the medial cuneiform which represents a surgically created tract per discussion with Dr. Toolan.A second bandlike collection of nonenhancing signal abnormality is noted along the base of the first metatarsal and medial cuneiform representing a second incision along a prior pin tract.There is diffuse enhancement of the soft tissue surrounding the midfoot as well as enhancement of the articulations of the midfoot indicating inflammation. This enhancement extends proximally along the medial and lateral aspect of the hindfoot and distally to surround the bases of the first through fourth metatarsals. Although we see no discrete soft tissue abscess, there is fluid within the calcaneocuboid joint with small pockets of rim-enhancing fluid extending from the joint laterally and medially as well as a small amount of rim-enhancing fluid tracking inferiorly along the anterior plantar surface of the calcaneus. Given the degree of adjacent enhancement, this is concerning for septic arthritis that likely extends dorsally and anteriorly along the margins of the cuneiforms and fractured navicular.In addition to the signal abnormality in the aforementioned bones there is also abnormal signal within the head, neck and body of the talus, anterior tuberosity lateral marrow of the calcaneus, the cuboid, the lateral cuneiform, the medial cuneiform, and the bases of the third and fourth metatarsals. We suspect that this abnormal signal reflects osteomyelitis to at least some extent, although it could in part be due to long-standing neuropathic arthropathy. Bone marrow signal intensity of the phalanges appears normal.There is also a small amount of fluid within the tibiotalar joint with enhancing synovium which is nonspecific but we cannot exclude septic arthritis. There is also enhancement of tissue between the tip of the distal fibula and the lateral margin of the calcaneus just proximal to the calcaneofibular ligament indicating inflammation. There is enhancement of the tenosynovium of the peroneal tendons though see no frank fluid within the peroneal tendon sheaths. There is also mild enhancement of the tenosynovium of the medial tendons. There is minimal fluid within the flexor hallucis longus tendon sheath posterior to the distal tibia which may simply reflect extension of fluid from the ankle joint.There is also small amount of fluid within the subtalar joint. There is little if any enhancement of the joint following contrast administration and therefore we suspect this is noninfected.There is generalized atrophy of the musculature of the foot.There is diffuse reticulation of the subcutaneous fat of the dorsum of the foot with enhancement and thickening of the overlying skin suggesting cellulitis.

Output: 1. Bone and soft tissue infection of the foot as described above. Fluid in the calcaneocuboid joint is concerning for septic arthritis which we suspect propagates through the midfoot to the fractured and displaced navicular. A small amount of fluid and enhancement in the tibiotalar joint is nonspecific but we cannot exclude the possibility of infection. Other findings as above.


Instruction: Generate impression based on findings.

Input: Female, 15 years old, history of Chiari decompression, surveillance imaging. Evaluate flow. Again seen are postsurgical changes of Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1. The CSF space at the level of the foramen magnum remains preserved. The cerebellar tonsils show a normal rounded morphology. As before they descend to the level of the basion.A syrinx is redemonstrated within the spinal cord beginning at approximately T7 and extending to the conus. Syrinx measures up to 2.7 x 3.1 mm in the axial plane at the T8 level similar to prior. There has been no significant change in craniocaudal extent. Mild prominence of the central canal is again also seen from T7 up to T3 similar to prior. No new cord signal abnormality.Cervical and thoracic alignment is anatomic. Vertebral body morphology is normal. No concerning bone marrow signal abnormality is seen. No spinal canal or neural foraminal stenosis.

Output: 1.Status post Chiari decompression with continued patency of the CSF spaces at the level of the foramen magnum and preserved biphasic CSF flow. 2. Stable small thoracic syrinx. No new cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Reason: erosive t-n disease: synovitis History: pain and swelling follow up mri TENDONS: There is mild increased signal intensity within the posterior tibialis tendon, on the short TE sequences, as it courses posterior to the medial malleolus suggesting a mild tendinosis. There is spurring of the adjacent medial malleolus and more proximally, there is a small amount of fluid within the tendon sheath that is not necessarily of any clinical significance. The flexor digitorum longus and flexor hallucis longus appear intact. The peroneal tendons appear intact. The anterior tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: Moderate osteoarthritic changes affecting the talonavicular joint are again seen perhaps secondary to an underlying chronic inflammatory arthritis. There are focal subchondral lesions within the navicular and talus which may represent degenerative cysts or chronic erosions, but these appear similar to the prior study. We see no evidence of disease progression at the talonavicular joint and the edema within the navicular seen on the prior examination has resolved. There is a small amount of fluid noted within the dorsal recess of the talonavicular joint appearing similar to the prior study. There are arthritic changes along the subtalar joint appearing similar to the prior study, including cysts and/or chronic erosions along the medial facet. There is edema within the sustentaculum tali of the calcaneus which has decreased slightly when compared to the prior study. There is mild edema within the lateral aspect of the body of the talus which is new when compared to the prior study but nonspecific. There are also small poorly defined foci of signal abnormality, best seen on the STIR sequences, within the tibial plafond, the calcaneus near the calcaneocuboid and subtalar articulations, the lateral cuneiform, as well as within the anterior and posterior portions of the cuboid. The etiology and significance of these foci is uncertain. They could represent small islands of red marrow not evident on the prior study or perhaps reflect altered biomechanics. Their proximity to the joints also raises the possibility of small subchondral cysts, but they do not appear to disrupt the articular surface and therefore erosions are considered unlikely. Incompletely imaged on this study is mild edema within the proximal diaphysis of the fourth metatarsal. This is nonspecific but could represent stress reaction in the correct clinical context.

Output: 1. Osteoarthritic changes of the talonavicular and subtalar joints may be due to an underlying chronic inflammatory arthritis. We see no evidence of disease progression at these joints. The edema within the navicular and sustentaculum tali of the calcaneus has decreased when compared to the prior study.2. There is mild edema type signal within the lateral aspect of the body of the talus which is nonspecific, but is new when compared to the prior study.3. Small foci of signal abnormality, best seen on the STIR sequences, within the tibial plafond, lateral cuneiform, calcaneus, and cuboid are likewise nonspecific and may represent altered biomechanics or small islands of reconverted red marrow. They do not appear to disrupt the articular surface and therefore erosions are considered unlikely.4. Mild nonspecific edema within the proximal diaphysis of the fourth metatarsal is incompletely imaged on this study and could conceivably represent stress reaction in the correct clinical context.


Instruction: Generate impression based on findings.

Input: 55-year-old male with worsening bilateral upper and lower neuropathy Many noncontrast sequences are degraded secondary to patient motion. Given this caveat:Cervical:Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning areas of marrow replacement or marrow edema are seen. There is no gross abnormal marrow enhancement.The visualized spinal cord shows normal signal intensity and caliber without gross abnormal enhancement. Mild degenerative changes in the cervical spine are again seen and are unchanged. Individual levels as below.C2-3: Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis. Facet hypertrophy. These findings are unchanged.C3-4: Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal stenosis. Mild facet arthropathy. These findings are unchanged.C4-5: No significant disk degeneration, spinal canal stenosis or neuroforaminal narrowing. Mild facet arthropathy. These findings are unchanged.C5-6: Mild disk height loss and osteophyte formation. No significant spinal canal or neuroforaminal stenosis. Mild facet arthropathy. These findings are unchanged.C6-7: There is loss of disk height, disk osteophyte complex and uncovertebral hypertrophy on the left with mild to moderate narrowing of the left neural foramen. There is partial effacement of the ventral thecal sac and minimal spinal canal stenosis. No significant right neural foraminal narrowing. There is mild facet arthropathy. These findings are unchanged.C7-T1: No significant disk degeneration, spinal canal or neuroforaminal stenosis. Mild facet arthropathy. These findings are unchanged.Thoracic:The thoracic spine is in normal alignment with a normal thoracic kyphosis. There are minimal degenerative changes; the vertebral body and disk heights are otherwise well maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. Paraspinous soft tissue structures in the thoracic spine are unremarkable.Cord signal is grossly unremarkable given motion degradation and there is no gross abnormal enhancement.

Output: 1.Due to claustrophobia, the study was terminated at the patient's request before acquisition of all contrast enhanced imaging could be performed. Because of this, only motion degraded sagittal postcontrast images were obtained.2.Many noncontrast sequences are degraded secondary to patient motion.3.No gross abnormal signal in the spinal cord or gross abnormal enhancement.4.No high-grade spinal canal or neural foramina stenosis in the cervical spine. There are mild degenerative changes with minimal spinal canal narrowing and mild to moderate left neural foraminal narrowing at the C6-C7 level. These findings are unchanged.5.No significant spinal canal or neural foraminal stenosis in the thoracic spine.


Instruction: Generate impression based on findings.

Input: Severe back pain post lumbar puncture. Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma is unremarkable. The pituitary appears flattened, perhaps secondary to intracranial hypertension, unchanged from prior. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and paranasal sinuses are grossly unremarkable. The cerebellar tonsils are normal in position. Patient is status post left parietal craniotomy. There is a nonspecific enhancing lesion within the right parietal calvarium measuring up to 7 mm, unchanged.

Output: No evidence of intracranial hemorrhage or acute infarct. Persistent flattening of the pituitary, perhaps secondary to known intracranial hypertension.


Instruction: Generate impression based on findings.

Input: Clinical question: History of Nocardia. Signs and symptoms: Fatigue. Pre- and post enhanced brain MRI:Examination demonstrates a well demarcated masslike lesion in the splenium of corpus callosal with intense uniform enhancement measuring at 18 x 16 x 22 mm. There is extensive associated vasogenic edema. The mass demonstrates multiple internal tiny foci of susceptibility.Additionally there are tiny foci of susceptibility and increased T2/FLAIR surrounding hyperintensity in the superior right aspect of pons which also demonstrate small ring enhancement however without any associated mass effect. Constellation of findings are greatest to represent intracranial manifestation of nocardia.Additionally there are multiple foci of susceptibility throughout bilateral cerebral hemispheres and to a lesser degree in the posterior fossa with a few of the larger lesions demonstrating ring enhancement as an example a lesion in the left frontal subcortical white matter measuring approximately 4 mm on axial post enhanced series 1001 image 19. These findings are also all highly suspected for nocardia infection.Ventricular system remain within normal size without deviation of midline and the cortical sulci remain patent. There are several small foci of FLAIR hyperintensity in the subcortical and periventricular white matter without enhancement and likely representing mild chronic small vessel ischemic strokes.Findings on this exam were discussed by phone with the referring clinical service Emily Escue # 2702 at the time of review of exam.

Output: 1.Negative diffusion weighted images.2.Extensive findings of intracranial manifestation of nocardia infection as detailed above. The largest lesion is in the splenium of corpus callosum measuring 18 x 16 x 22 mm. Multiple tiny additional lesions throughout bilateral cerebral hemispheres and minimally in the posterior fossa as detailed above.3.Mild findings of chronic small vessel ischemic strokes are noted. I


Instruction: Generate impression based on findings.

Input: Cirrhosis, evaluate for HCC ABDOMEN:LIVER, BILIARY TRACT: The liver has a cirrhotic morphology. 13 mm arterially enhancing lesion in segment VII without definitive washout on delayed phases. Trace ascites. CholelithiasisThe hepatic and portal veins are patent.SPLEEN: Splenomegaly with collateral vessels. 1 cm T2 hyperintense enhancing nodule in the spleen most consistent with a hemangioma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Segment VII arterially enhancing lesion without washout is slightly increased in size compared to the prior exam possibly due to technical factors, but does not meet the criteria for HCC. Continued surveillance is recommended.


Instruction: Generate impression based on findings.

Input: Low back pain For the purposes of numbering, the most inferior well-defined disc space is labelled L5-S1. Again seen is a severe compression fracture involving the L3 vertebral body with approximately 70% loss of height similar to prior. There is edema involving the L3 vertebral body, also similar to prior. Interval placement of cement/kyphoplasty at the L3 vertebral body is seen. No significant osseous retropulsion.Remainder of the vertebral body heights are normal. Alignment is grossly maintained in the lumbar spine. There are diminished posterior osseous elements from L3-L4 to the sacrum reflecting combination of prior laminectomies and dysplasia.The spinal cord remains low-lying with the distal neural tissue/conus extending to the L5 level. Septations/adhesions are again again noted in the thecal sac from the L5 to S1 levels similar to priorDegenerative changes are specified by the intervertebral level as follows and unchanged since 2/22/2016: T12-L1: No spinal canal or neural foraminal stenosis.L1-L2: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is minimal disc bulge. There is unchanged mild central canal stenosis and bilateral mild to moderate neural foraminal stenosis.L2-L3: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is diffuse disc bulge without significant change in moderate to severe spinal canal stenosis and moderate bilateral foraminal stenosis. L3-L4: There is bilateral facet hypertrophy and ligamentum flavum thickening. There is also mild disc bulge with unchanged mild spinal canal stenosis and mild bilateral foraminal stenosis, relatively worse on the right. L4-L5: There is bilateral facet hypertrophy. There is central disc protrusion. No significant spinal canal stenosis. There is unchanged mild bilateral foraminal narrowing, relatively worse on the left.L5-S1: There is bilateral facet hypertrophy without neuroforaminal narrowing or spinal stenosis.

Output: 1. Compared to 2/22/2016, there is no significant change in moderate to severe spinal canal stenosis at the L2-L3 level.2. No significant change in compression fracture with approximately 70% height loss of the L3 vertebral body with interval changes of vertebroplasty.3. Unchanged appearance of the low-lying conus which extends to the L5 level. Again seen is evidence of prior cord detetherings. 4. Degenerative changes at additional levels as detailed above.


Instruction: Generate impression based on findings.

Input: Neck pain and bilateral upper extremity numbness and tingling. Evaluate for cervical stenosis. Low back pain and radiculopathy. History of previous lumbar surgery. Evaluate for scar tissue. CERVICAL SPINE:There is reversal of the normal cervical lordosis, which may be in part positional. The vertebral bodies are preserved in height. There is degenerative marrow signal subjacent to the endplates at C5-C6 and C6-C7, where degenerative disc-osteophyte complexes cause mild-to-moderate spinal canal stenosis as described below. Small anterior osteophytes are also present at these levels. Accounting for that and a hemangioma in C3 vertebral body, there is no significant marrow abnormality. The cervical spinal cord is normal in signal and shape. Included posterior fossa structures and upper thoracic spinal cord are unremarkable as well.C2-C3: There is no spinal canal or neural foraminal stenosis.C3-C4: Minimal disc-osteophyte complex barely indents the ventral thecal sac. Uncovertebral and facet arthropathy cause moderate right and mild left neural foraminal stenoses.C4-C5 and C5-C6: Disc-osteophyte complex causes mild central/left paracentral spinal canal stenosis. Facet and uncovertebral arthropathy causes moderate left C5-C6 and mild right C5-C6 and mild left C4-C5 neuroforaminal stenoses.C6-C7: The disc-osteophyte complex on this level causes mild-to-moderate spinal canal stenosis. Facet and uncovertebral arthropathy causes mild neuroforaminal stenoses.C7-T1: There is no spinal canal or neural foraminal stenosis.The internal carotid arteries show medial, retro-/parapharyngeal course, which is a normal variation. A partially empty sella is probably an incidental finding.LUMBAR SPINE:There are 5 lumbar-type, nonrib-bearing vertebrae. The last well-formed disc is at L5-S1.Sagittal alignment is notable for minimal degenerative anterior subluxation of L4 on L5 and L5 relative to S1, associated with desiccation of the respective discs. The vertebral bodies are preserved in height. There is degenerative marrow signal subjacent to the endplates at L5-S1. The spinal canal is narrowed at L5-S1 as described below. The tip of the conus medullaris lies at the lower L1 level. The conus medullaris and the included caudal part of the spinal cord show normal signal and shape.There are changes of previous posterior decompressive surgeries at L4-L5 and L5-S1 levels, where there are changes of bilateral laminotomies at both levels. Contrast-enhancing tissue is present at the surgery site and extending into the posterior and lateral epidural spaces at both levels. At L4-L5, there has been resection of the thickened ligamenta flava with resolved central and paracentral spinal canal stenosis. Minimal disc bulge and uncovering remain unchanged. The contrast-enhancing scar tissue extends into the posteromedial inferior aspect of the neural foramina without displacing or encasing the nerve roots. Neural foraminal stenoses remain mild-to-moderate, worse on the right. At L5-S1, the thecal sac is congenitally small with superimposed minimal anterior subluxation of L5 on S1. Prior laminectomy and partial facetectomies. There is prominent scar tissue abutting the bilateral S1 nerve roots.L1-L2, L2-L3, L3-L4 and L4-L5: There is no significant disc herniation and there is no spinal canal or foraminal stenosis. There is mild facet arthropathy and mild-to-moderate ligamenta flava thickening, which are worse in the lower levels.There are mild degenerative changes at the sacroiliac joints. Tiny sclerotic focus in the right iliac bone may represent a bone island. T1-hypointense, T2-hyperintense, and contrast-enhancing lesions in the kidneys likely represent cysts.

Output: 1.Mid cervical degenerative disease results in mild-to-moderate C6-C7 and mild C4-C5 and C5-C6 spinal canal stenosis. No high-grade cervical spinal canal stenosis. Neural foraminal stenosis is moderate on the right at C3-C4 as well as on the left at C5-C6 and mild at other levels as described above.2.Resolved spinal canal stenosis at L4-L5 following posterior decompression as described above. Thecal sac remains diminutive at the L5-S1 level which is likely combination of congenital narrowing, epidural fat, minimal anterolisthesis, and epidural scar tissue. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 79 year old woman with dyspnea on exertion, referred for evaluation of underlying ischemia. MEDICATIONS: ASA, lipitor, lasix, HCTZ First Pass PerfusionDuring hyperemia, there is a subtle subendocardial perfusion defect involving about half of the wall thickness of the entire base and mid-ventricle. There is a small defect of moderate severity in the mid inferolateral wall. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 54 ml/m2 (normal range: 65+/-11), the LVEDV is 85 ml (normal range 109+/-23), the LV end systolic volume index is 18 ml/m2 (normal range 18+/-5), the LVESV is 28 ml (normal range 31+/-10), the LV mass index is 36 g/m2, and the LV mass is 57 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 99 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 44 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is increased linear signal in the right upper lung and a second pleural based abnormality in the mid lung. These findings were previously better visualized on the chest CT scan from 10/2015. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, there is a subtle subendocardial perfusion defect involving about half of the wall thickness of the entire base and mid-ventricle. There is a small defect of moderate severity in the mid inferolateral wall. I suspect these abnormalities are predominantly related to microvascular dysfunction rather than epicardial coronary artery disease. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 67%).4. Normal RV size and systolic function (RVEF 56%).5. Moderate tricuspid regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chronic lymphocytic leukemia. Immunocompromised. Question fungal sinusitis.. There is mucosal thickening in the left maxillary sinus and T1 hyperintense secretions, There is no edema or infiltration into the adjacent soft tissues, including the orbit and pterygopalatine fossa. The other paranasal sinuses are unremarkable. There is lobular T2 hyperintensity within the bilateral olfactory recesses. There is a well-defined T2 hyperintense lesion in the right side of the clivus that measures up to 22 mm with minimal peripheral contrast enhancement medially. Mild sigmoid-shaped deviation of the nasal septum is present. As discussed previously, there is an incomplete posterior arch of C1, which is a normal variant. There is unchanged anterior wedging of C6. The imaged portions of the brain are grossly unremarkable. Enlarged lymph nodes are present in the bilateral neck and parotid glands.

Output: 1.Mucosal thickening and nonspecific secretions in the left maxillary sinus without specific findings to suggest an invasive fungal sinusitis. 2. Mucosal thickening in the bilateral olfactory recesses may represent nasal polyposis.3. Unchanged nonspecific lesion in the right basiclivus. 4. Partially imaged enlarged upper cervicofacial lymph nodes likely related to leukemia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 49 year-old female with seizure today, question of new onset. Rule out mass. There is no evidence of intracranial hemorrhage, mass or edema. Hypodensity within the right frontal region including cortical and subcortical regions along the floor of the anterior cranial fossa consistent with encephalomalacia of unknown etiology. If clinically warranted, an MRI may be considered for further evaluation of this region.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The mastoid air cells are normally pneumatized. Limited view of the paranasal sinuses are normally pneumatized.

Output: 1. Low density within the right frontal region, of unknown etiology may be further evaluated with MRI if clinically warranted. 2. No acute abnormalities.


Instruction: Generate impression based on findings.

Input: Brain parenchyma appears within normal limits. There is no diffusion abnormality. There are no areas of abnormal signal or pathological enhancement. The ventricles and sulci are within normal limits. No hydrocephalus. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is mucosal thickening in the sphenoid sinuses. There is mild mucosal thickening in the bilateral mastoid air cells.MRI pituitary gland: Dedicated images through the sella demonstrate a T1 isointense and T2 mildly hyperintense lesion measuring approximately 8x 6 mm in axial dimension and 7 mm in craniocaudal dimension, involving the left aspect of the suprasellar cistern just above the pituitary gland. There is no significant enhancement associated with it. This lesion is just lateral to the infundibulum and abuts the left aspect of the chiasm/prechiasmatic optic nerve without mass effect. The pituitary gland demonstrates preserved T1 hyperintensity involving the neurohypophysis and homogeneous enhancement. No focal abnormal signal intensity or mass is seen within the pituitary gland. The pituitary stalk lies in the midline. The optic chiasm, cavernous sinuses appear unremarkable. There is diffuse opacification of the bilateral sphenoid sinuses, which is increased since prior study from October 20, 2015.

Output: 1. 8 x 6 mm nonenhancing lesion involving the left aspect of the suprasellar cistern just above the pituitary gland. Differential is broad and includes benign cystic lesion (such as suprasellar Rathke's cleft cyst or epidermoid cyst) or hamartoma; neoplastic lesion can not be entirely excluded although lack of enhancement makes this less likely. Would suggest continued follow-up. There is no appreciable mass effect on the optic chiasm.2. The brain parenchyma is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Total PSA of 6.12. No prior biopsy. PELVIS:PROSTATE:Prostate Size: 4.4 x 5.5 x 6.9 cmPeripheral Zone: Left apex 5 x 4 mm T2 weighted hypointense focus with restricted diffusion.Left mid gland 6 mm T2 hypointense focus with restricted diffusion and arterial enhancement.Central Gland: Anterior 8 x 7 mm T2 weighted hypointense focus with restricted diffusion and arterial enhancement.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Non-specific subcentimeter left obturator lymph node.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left and anterior apex and left mid gland foci, largest measuring 8 mm, may represent sites of prostate carcinoma and are amenable to MR guided biopsy.


Instruction: Generate impression based on findings.

Input: New daily persistent headache (ndph) [G44.52], Reason for Study: ^Reason: evaluate for mass History: new onset headache in older patient There is no evidence of acute ischemic or hemorrhagic lesion. There is no evidence of abnormal enhancement.Scattered FLAIR/T2 high signal intensity lesions are seen on bilateral subcortical white matter which are nonspecific.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of abnormal enhancement.3. Nonspecific subcortical white matter FLAIR/T2 high signal intensity lesions. Differential diagnosis include nonspecific small vessel ischemic disease. Other white matter diseases such as demyelinating disease is less likely. Clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: rule out intracranial abnormality. CVA.signs and symptoms: History of cancer with brain metastases and after mental status Nonenhanced head CT:There is evidence of a right temporal craniotomy with focus of encephalomalacia under the craniotomy flap in the right anterior temporal lobe. There is no evidence of edema, hemorrhage or mass effect with this finding. The high convexity right frontal lobe there is a mass measuring approximately 11.9 x 8.4-mm on axial image 23. There is extensive surrounding vasogenic edema with resultant effacement of adjacent cortical sulci. This finding is believed to represent a metastatic focus.There are several small foci of low-attenuation in the subcortical white matter of left hemisphere which are not suggestive of metastatic disease and may represent small vessel disease ischemic stroke of indeterminate age. Follow-up with an MRI for detection of possible additional metastatic foci is recommended.There is no evidence of hemorrhage, midline shift or hydrocephalus.

Output: 1.Metastatic lesion in high convexity right frontal lobe with possible minimal hemorrhage measuring 8.4 x 11.9-mm in size.2.Ill-defined patchy areas of subcortical invagination suspected to small vessel ischemic stroke of indeterminate age.3.Evidence of a prior right-sided anterior temporal partial lobectomy as detailed above.


Instruction: Generate impression based on findings.

Input: 47-year-old female with abdominal pain, fatigue. Evaluate small bowel for inflammation in patient with Crohn's colitis. ABDOMEN:LIVER, BILIARY TRACT: There are scattered subcentimeter hepatic cysts.SPLEEN: There are multiple splenic cysts.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst. There is a dilated right upper pole calyx.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a long segment of decompressed small bowel within the mid-abdomen which does not abnormally enhance or demonstrate restricted diffusion. This likely represents peristaltic bowel as it is not delineated on later timed sequences likely secondary to distension. No small bowel wall thickening, restricted diffusion, or abnormal enhancement is identified. The terminal ileum is unremarkable. No focal areas of bowel dilatation or evidence of small bowel obstruction. The colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abnormal intra-abdominal collection.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a long segment of decompressed small bowel within the mid-abdomen which does not abnormally enhance or demonstrate restricted diffusion. This likely represents peristaltic bowel as it is not delineated on later timed sequences. No small bowel wall thickening, restricted diffusion, or abnormal enhancement is identified. The terminal ileum is unremarkable. No focal areas of bowel dilatation or evidence of small bowel obstruction. The colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abnormal intrapelvic collection.

Output: 1. No specific findings of active or chronic inflammatory bowel disease.2. Hepatic, renal, and splenic cysts.


Instruction: Generate impression based on findings.

Input: Clinical question: stroke. Signs and symptoms: Facial droop. Nonenhanced head CT:There are is no detectable intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. If clinical concern for stroke persist recommend an MRI examination. CT is insensitive for detection of early strokes. Limited view of orbits, paranasal sinuses unremarkable. Calvarium is intact. Minimal bilateral opacification of mastoid air cells.

Output: Negative head CT.


Instruction: Generate impression based on findings.

Input: 67-year-old female with history of HCC status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.Segment 5 ablation cavity measures 3.3 x 3.1 cm, previously 3.5 x 3.2 cm (image 13 of series 7). Intrinsic high T1 signal noted in cavity. High signal suggested along superior aspect of cavity on subtraction arterial imaging most likely technical/secondary to changes in patient positioning. No abnormal nodular or intralesional enhancement seen otherwise. Presumed segment 8 hemangioma measures 3.4 x 2.8 cm, previously 3.6 x 2.0 cm (image 17 series 7). Suggestion of rounded signal abnormality in hepatic segment 2 felt to be artifactual in etiology. SPLEEN: Splenic varices.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal cysts withRETROPERITONEUM, 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 exam without definitive evidence of disease recurrence or new sites of disease as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There are post treatment findings within the right neck including T2 hyperintensity within the right neck soft tissues, including in the region of the inferior portions of the right brachial plexus, but without discernible abnormal enhancement of the nerve roots. In addition, there is diffuse T2 hyperintensity and diminished bulk of the right trapezius muscle. There also appears to be mild compensatory hypertrophy of the right levator scapula. There are several subcentimeter neural foramen perineural cysts in the cervical spine at multiple levels, but no evidence of significant neural foramen or spinal canal stenosis. There is no evidence of mass lesions along the right brachial plexus or significant lymphadenopathy in the neck. Likewise, there is no evidence of mass lesions in the tongue base. However, there is a left thyroid nodule that measures up to approximately 10 mm. The imaged intracranial structures are grossly unremarkable.

Output: 1. Post-treatment findings within the right neck with denervation injury of the right trapezius muscle and possibly mild inferior right brachial neuritis, but no evidence of mass lesions in the region of the right brachial plexus or tongue base.2. Several subcentimeter perineural cysts in the cervical spine at multiple levels, but no evidence of significant neural foramen or spinal canal stenosis. 3. A nonspecific left thyroid nodule measures up to approximately 10 mm. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 52-year-old female with pain and weakness ROTATOR CUFF: Metallic susceptibility artifact within the posterior humeral head and adjacent soft tissues likely reflects prior rotator cuff repair. We see no full thickness rotator cuff tear. The supraspinatus tendon can be traced to its insertion on the greater tuberosity. The tendon is thinned, in part due to undersurface tearing with delamination and retraction of undersurface fibers to the level of the top of the humeral head. The undersurface tear measures approximately 1 cm in AP dimension. There is also tearing along the bursal surface fibers of the supraspinous tendon. Overall, the tearing involves greater than 50% of the tendon thickness. More proximally the tendon appears thickened and of slightly heterogeneous signal, compatible with tendinosis. There appears to be mild fatty atrophy of the supraspinatus muscle along the myotendinous junction, but the muscle appears otherwise normal. There may be mild tendinosis of the infraspinatus tendon, which otherwise is within normal limits. The teres minor tendon appears intact, although increased signal intensity within the muscle could reflect mild subacute denervation atrophy, appearing similar to the prior exam. The subscapularis muscle and tendon appear normal.SUPRASPINATUS OUTLET: There is mild osteoarthritis affecting the acromioclavicular joint. There is perhaps trace fluid in the subacromial-subdeltoid bursa, but no frank bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: No joint effusion. The superior labrum appears slightly blunted, which may reflect chronic fraying or degenerative tearing. There is no fluid-filled labral tear.BICEPS TENDON: The biceps tendon appears thin, but intact.

Output: 1. Postoperative changes of rotator cuff repair with thinning of the supraspinatus tendon, likely due to articular and bursal surface tearing, as well as additional findings as described above. No full-thickness rotator cuff tear is identified.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: evaluate for potential underlying lesion History: intraparenchymal hemorrhage. Interval development of left frontal acute/subacute ICH measured about 54.9 mm (AP) x 32.8mm(RL) x 53.6mm (CC) with surrounding edema and mass effects. Comparing to prior CT scan, the size and extent of mass effect including minimal midline shift toward right side appears to be stable.Previously recognized scattered susceptibility lesions on the left frontal lobe and periventricular white matter are again seen, unchanged.There is no evidence of acute ischemic lesion.Patchy FLAIR high signal intensity lesions on periventricular white matter is nonspecific, unchanged since prior scan.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Left frontal ICH with surrounding edema and mass effects as described above. No significant interval change since prior CT scan.2. No evidence of acute ischemic lesion.3. Non specific periventricular white matter FLAIR high signal intensity.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for small bowel inflammation, rule out Crohn's diease History: abdominal pain, diarrhea ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter right hepatic hyperintensity, most likely a cyst.. Mild hepatomegaly measuring 19.9 cm in craniocaudal dimension.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: No evidence of inflammatory bowel disease or other findings to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female 36 years old Reason: 36 y.o female with a h/o of Crohn's disease with current flare. Please eval for extent of disease. History: N/V, diarrhea ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Suboptimal evaluation of the small bowel due to poor distention. Within this limitation, there is wall thickening and hyperenhancement of the terminal ileum for a 18 cm segment. This includes the ileocecal valve. There is a linear connection between 2 loops of distal ileum in the right mid abdomen suspicious for a interloop fistula. There is also and inflamed loop of bowel in the left upper abdomen most likely representing a portion of proximal ileum that is suboptimally evaluated due to poor distention.There is thickening and hyperenhancement of the descending colon from the level of the splenic flexure to the rectum compatible with active inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Active inflammation involving the terminal ileum with findings suspicious for an interloop fistula.2.Additional areas of inflammation likely involving the proximal ileum suboptimally evaluated due to poor bowel distention.3.Active inflammation involving the descending colon.


Instruction: Generate impression based on findings.

Input: Lumbago with sciatica, right side [M54.41], Reason for Study: ^Reason: shooting pain down R later thigh to R lat foot past back surgery History: up For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Previously seen central to left disc extrusion at the level of L5S1 appears to be lessen in terms of the degree of protrusion. However, small low signal intensity lesion which likely represent the disc material is seen on the left side lateral recess. Redemonstration of the prior L3 and L4 bilateral total laminectomies with screws and rods as well as spacers L34 and L45 intervertebral disc spaces.The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. The signal intensity of vertebral bodies are within normal limits. L12: broad based central to left disc protrusion abutting thecal sac, no change since prior scan.L23: No discrete herniation, canal stenosis, or neural foraminal narrowing. Mild disk desiccation. No change since prior scan.L34: No disk herniation, canal stenosis, or neural foraminal narrowing. No change since prior scan.L45: No disk herniation, canal stenosis, or neural foraminal narrowing.L5S1: Small low signal intensity lesion on the left lateral recess but not directly compressing the left side nerve root or evidence of thecal sac compression. This could represent possible residual disc material or postoperative changes.

Output: 1. Interval decreased extent of the L5S1 disc extrusion as described above with remained small low signal intensity lesion likely represent residual disc material vs postoperative changes.2. No evidence of new disc herniation or neural foraminal stenosis.3. No change of postoperative status of L3,L4 bilateral total laminectomies since prior scan.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for fungal infection in brain. Signs and symptoms: Immunocompromise, AML. Pre and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrate normal anatomic cord morphology of the brain and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Examination also fail to demonstrate any abnormal enhancement of brain parenchyma, the meninges, calvarium or the orbits.Signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal and with normal pattern of enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series. Explain all paranasal sinuses are visualized and demonstrate normal pneumatization. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: Negative pre and post enhanced brain MRI exam as detailed.


Instruction: Generate impression based on findings.

Input: Right skull base mass. There is an enhancing dural-based mass in the right cavernous sinus region that measures up to 25 mm. There are multiple punctate foci of restricted diffusion in the bilateral cerebral hemispheres superimposed upon scattered T2 hyperintense cerebral white matter foci without restricted diffusion. There is a small area of encephalomalacia in the left paramedian pons. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. A dural-based mass in the right cavernous sinus region likely represents a meningioma.2. Multiple punctate early subacute infarcts involving the bilateral cerebral hemispheres in a pattern most suggestive of a watershed distribution superimposed upon probable chronic small vessel white matter disease and a left pons chronic infarct.


Instruction: Generate impression based on findings.

Input: 39-year-old female with a personal history of new diagnosis of DCIS in her left breast presents for MRI breast staging. She does has a family history of breast cancer and prostate cancer in her father. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:Susceptibility artifact from the biopsy clip is identified in the right breast, approximately 9:00 position, posterior depth, located medial to the biopsy cavity, as noted on post biopsy mammograms. Mild patchy enhancement around the biopsy clip and along the biopsy trajectory likely represents the postprocedure inflammatory change. Extending anteriorly from the biopsy clip are multiple enhancing foci scattered in the upper outer right breast. The total AP extent of the enhancing foci measures approximately 6 cm. The location of these foci correlates with the calcifications in the right upper outer breast on the mammogram. No additional suspicious enhancement is identified elsewhere in the right breast.LEFT BREAST:No abnormal enhancement is seen in the left breast. AXILLAE:No abnormal axillary lymph nodes are identified in either axillary region.

Output: Multiple enhancing foci in the RIGHT upper outer breast extending anteriorly from the biopsy-proven DCIS correlate with the mammographic calcifications. Given the MRI and mammographic correlation, stereotactic biopsy of an anterior cluster of calcification is suggested to evaluate the extent of the disease.No MRI evidence for malignancy in the LEFT breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Increased knee pain following motor vehicle accident last month, CT scan at outside hospital showed internal derangement. MENISCI: Abnormal signal intensity within the posterior horn of the lateral meniscus extending to the femoral surface as well as blunting of the posterior horn of the lateral meniscus is compatible with a complex tear. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Signal abnormality compatible with bone marrow edema is present within the posterior aspect of the lateral femoral condyle as well as within the lateral aspect of the tibial plateau. No discrete fractures are identified. Osteoarthritic degenerative changes affect the knee including tricompartmental osteophyte formation and subchondral sclerosis. There is a full-thickness cartilage defect involving the lateral tibial condyle underlying the posterior horn of the lateral meniscus which measures approximately 12 x 12 mm (7/9). Full-thickness cartilage loss is also present along the posterior aspect of the lateral femoral condyle. There is an additional near full-thickness focus of cartilage thinning involving the weightbearing portion of the medial femoral condyle (4/21). There is near full-thickness cartilage loss involving the medial facet of the patella as well as the patellar apex with mild underlying reactive bone marrow edema. There is also near full-thickness cartilage thinning involving the femoral trochlea particularly the lateral aspect.LIGAMENTS: The cruciate ligaments appear intact. The collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1.Bone marrow edema within the lateral femoral condyle and tibial plateau compatible with contusions.2.Complex tear of the posterior horn of the lateral meniscus.3.Severe arthritic degenerative changes including foci of full-thickness cartilage loss.4.Large popliteal cyst.


Instruction: Generate impression based on findings.

Input: 46 year old female, with a history of cervical cancer s/p LEEP, DLBC lymphoma on chemotherapy EPOCH-R, was noted with severe RV dilatation on echocardiogram. She is referred for cardiac MRI for further evaluate RV function. Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 88 ml/m2 (normal range: 65+/-11), the LVEDV is 181 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 75 ml (normal range 31+/-10), the LV mass index is 58 g/m2 (normal range 67+/-11), and the LV mass is 119 g (normal range 114+/-24). No LV hypertrophy was noted. Basal anterior interventricular septum is measured as 11 mm. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No intracardiac thrombus.Left AtriumThe left atrium is moderately to severely enlarged (46 mm). Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 109 ml/m2 (normal range 69+/-14), the RVEDV is 226 ml (normal range 110+/-24), the RV end systolic volume index is 59 ml/m2 (normal range 22+/-8), and the RVESV is 122 ml (normal range 35+/-13). No aneurysm or enhancement.Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is aortic regurgitation, visually estimated to be trace.Mitral ValveThe mitral valve opens widely and there is mitral regurgitation with the jet directed posteriorly.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe valve opens normally. Dedicated valvular imaging was not performed. However, tricuspid regurgitation is present. The jet is eccentric and is directed anteriorly toward right AV groove. AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated (47 mm). Proximal left pulmonary artery is measured at 28 mm and proximal right pulmonary artery is measured at 33 mm. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsLeft scapular mass reduced in size with residual thoracic lymphadenopathy. For reference, there is a left axillary lymph node which is 22 mm short axis. Left supraclavicular lymph node is 15mm. The osseous structures of the left shoulder girdle, including the scapula, are not well visualized. Previous right axillary lymphadenopathy is not visualized. Right port catheter terminates at the superior cavoatrial junction.

Output: 1. The left ventricle is normal in size and function. 2. The right ventricle is severely dilated with mildly reduced systolic function. 3. The main pulmonary artery is severely dilated, suggestive of pulmonary artery hypertension.4. Left scapular mass reduced in size with residual thoracic lymphadenopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology and the conus terminates at L2. The paravertebral soft tissues are unremarkable without evidence of a dermal sinus tract. There is no evidence of filar thickening or fibrofatty infiltration and there is normal anterior translation of the conus upon prone positioning.

Output: No evidence of tethered cord.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified disturbances of skin sensationClinical question: rule out right thalamic infarctionSigns and Symptoms: numbness, tingling The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities in the left mastoid air cells. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. There is no evidence for cerebral infarction to account for the reported numbness and tingling.


Instruction: Generate impression based on findings.

Input: Male, 51 years old, pain and paresthesias in the arms. Alignment is anatomic. Vertebral body height and morphology are normal. Marrow signal characteristics are within normal limits. There is mild edema within the left C3-4 facet complex and in the right C4-5 facet complex.C2-3: Unremarkable. C3-4: Left facet hypertrophy. Left paracentral disk osteophyte complex with effacement of the left ventral thecal sac and slight flattening of the left aspect of the cord. No convincing cord signal abnormality is seen. Moderate right and severe left foraminal narrowing. C4-5: Mild facet hypertrophy. Mild broad disk osteophyte complex. Minimal narrowing of the spinal canal. Moderate bilateral foraminal narrowing. C5-6: Unremarkable. C6-7: Minimal disk osteophyte complex formation. No spinal canal or foraminal stenosis. C7-T1: Unremarkable.

Output: 1. A left paracentral disk osteophyte complex at C3-4 causes effacement of the left ventral thecal sac and slight impingement on the left aspect of the cord.2. At C3-4, there is severe left and moderate right foraminal narrowing. At C4-5, there is moderate bilateral foraminal narrowing.3. Mild edematous facet arthropathy is seen on the left at C3-4 and on the right at C4-5.


Instruction: Generate impression based on findings.

Input: Female, 14 years old, with history of high-grade glioma status post craniotomy, chemotherapy and radiotherapy, with prior bevacizumab treatment. Findings are again seen compatible with prior left parietal craniotomy and tumor resection. The resection bed remains mildly hemosiderin stained with gyriform intrinsic T1 hyperintensity similar to prior. T2 hyperintensity around the cavity likely representing gliosis and encephalomalacia is unchanged. No definite enhancement is seen within the operative region.Ill-defined T2 hyperintensity has progressed within the left frontal lobe, also tracking inferiorly into the insula and posteriorly along the roof of the lateral ventricle and involving the corpus callosum. Numerous punctate foci of susceptibility are seen within this region which are increased in number from the prior examination. On postcontrast imaging there is progressive punctate and lacelike enhancement corresponding to this abnormal tissue as well. Subtle progressive pinching of the left frontal horn is seen indicating a slight increase in mass effect.Ill-defined T2 hyperintensity has also progressed in the right cerebral hemisphere, again involving predominantly the frontal lobe but with involvement extending posteriorly and inferiorly along the basal ganglia and insula, into the operculum and along the body of the lateral ventricle. The frontal lobe signal abnormality is associated with nonterritorial ill-defined restricted diffusion which is new from prior. On postcontrast imaging, new smudgy enhancement is seen along the right cingulate gyrus.Punctate foci of susceptibility have become more numerous in the right cerebral hemisphere. In addition, a 4 mm focus of intrinsic T1 hyperintensity in the right posterior cingulate gyrus, and a punctate focus along the right superior frontal sulcus, both associated with susceptibility, could represent relatively more recent blood product. The ventricles are not dilated and are otherwise similar in size and morphology to the prior exam. No midline shift or brain herniation is suspected. A mucous retention cyst is noted in the right maxillary sinus.

Output: Progressive signal abnormality and enhancement is seen in both cerebral hemispheres with new ill-defined nonterritorial restricted diffusion in the right frontal lobe. Significant progression of microhemorrhage is also seen in both hemispheres.It is possible that some degree of treatment effect may underlie the changes described above. However, the morphology and the distribution of the abnormality, including involvement of the peripheral right cerebral hemisphere which likely received relatively low radiation exposure, are more concerning for progressive tumor. The findings are suggestive of a gliomatosis-type pattern of spread.


Instruction: Generate impression based on findings.

Input: 25 years year-old Female. Per EMR: recent urinary retention, initially after endometrial ablation, then worsened after lumbar puncture. Evaluate for demyelinating disease.INDICATIONS: Reason: Eval for demyelinating disease History: urinary retention and paresthesias. Brain: Examination is limited to sequences per demyelinating disease protocol. No FLAIR hyperintense lesion is seen in the brain parenchyma to suggest demyelinating disease. Brain parenchyma appears grossly unremarkable. No intracranial mass or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small right maxillary retention cyst. The orbits, skull, and scalp soft tissues are grossly unremarkable.Cervical spine: There is no cord signal abnormality to suggest demyelinating disease. The craniovertebral junction appears within normal limits. There is mild loss of usual lordosis of the cervical spine, which could be secondary to positioning. Alignment is otherwise maintained. The cervical vertebral bodies and disc spaces are appropriate in height. There is no significant spinal canal or neural foraminal stenosis at any level. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: No evidence of demyelinating disease in the brain or cervical cord.


Instruction: Generate impression based on findings.

Input: 62-year-old male with a newly a history of pancreas cancer. EUS showed a pancreatic cyst, with some atypia. ABDOMEN:LIVER, BILIARY TRACT: No evidence of intra-or extrahepatic biliary ductal dilation. No focal mass lesions are identified. No gallstones or choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is atrophic suggestive of chronic pancreatitis. Note is made of multiple subcentimeter foci of fluid signal intensity in the head, body, and tail of the pancreas. There is a 6 mm cystic lesion in the tail of the pancreas. An additional cystic lesion in the body of the pancreas measures 5 mm. These findings may represent side branch IPMN versus cyst. There is no definitive communication with the main pancreatic duct. The main pancreatic duct is normal in size and appearance. There are no focal solid mass lesions or strictures identified. There is a normal response to secretin augmentation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple cystic lesions in the pancreas, with reference measurements provided above. Differential considerations include side branch IPMNs or cysts. No stricture or focal solid mass lesions are identified. 2.Findings suggestive of chronic pancreatitis.


Instruction: Generate impression based on findings.

Input: Ms. Fellner is a 55 year old female with a strong family history of breast cancer and BRCA2 positive. Family history of breast cancer in her sister at age 35 and in her paternal aunt at age 45. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: BRAIN: T2 hyperintensity within the right frontal and parietal subcortical and deep white matter centered around the central sulcus without significant change from prior study. There is mild associated T2 hyperintensity of the corticospinal tracts extending into the internal capsule posterior limb. There is no associated mass effect, susceptibility effect, diffusion restriction, or enhancement. There is no interval intracranial hemorrhage or acute ischemia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. SPINE: Stable appearing T2 hyperintensity extending the length of the spinal cord but most prominent in the cervical region without enhancement. Previously seen 3-mm rounded focus of intramedullary enhancement within the conus at the L1 level is not seen on this study. The vertebral column alignment is anatomical. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. There is persistent bladder distention.

Output: Redemonstration of large confluent focus of signal abnormality involving the right frontal and parietal white matter as well as signal abnormality throughout the spinal cord, without significant change from prior study. Persistent bladder distention.


Instruction: Generate impression based on findings.

Input: Breast cancer and brain metastases. There are postoperative findings related to left suboccipital craniotomy. There is a heterogeneous mass in the treatment bed with evidence of intratumoral hemorrhage, which measures up to approximately 35 mm. There is extensive surrounding vasogenic edema. There is associated partial effacement of the fourth ventricle and unchanged mild prominence of the supratentorial ventricles. There are subcentimeter lesions in the left gyrus rectus, left inferior frontal gyrus, right Heschl's gyrus, and medial right occipital lobe. There are skin fiducial markers.

Output: Preoperative MRI shows a dominant left cerebellar hemisphere tumor on the treatment bed and several subcentimeter supratentorial lesions.


Instruction: Generate impression based on findings.

Input: 87-year-old female with history of memory loss. There is extensive periventricular and subcortical white matter increased T2 signal abnormality. There is no evidence of acute ischemic infarction. There is a subcentimeter focus of susceptibility effect within the right precuneus. There is diffuse cerebral volume loss with perhaps slightly more pronounced involvement of the bilateral medial temporal lobes. 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. Diffuse cerebral volume loss with perhaps slightly more pronounced involvement of the bilateral medial temporal lobes, which may suggest Alzheimer's disease.2. Extensive cerebral white matter is nonspecific, but may be the sequela of chronic small vessel ischemic disease.3. Nonspecific subcentimeter focus of chronic microhemorrhage or calcification within the right parietal lobe.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 42 years Female (DOB:2/5/1974)Reason: MS, f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED There is redemonstration of a a few punctate periventricular and subcortical white matter lesions which are a symmetrically more in the left versus the right hemisphere. They are hyperintense on FLAIR and T2 MRI and are not readily identified on T1-weighted imaging. They are predominantly subcortical in location. These were also present on the prior exam and do not appear to be significantly different. Approximately 15 lesions appreciated which appear to be stable.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are periventricular and and predominantly subcortical white matter lesions present of mild degree which are stable compared to the prior exam these are nonspecific. The possibility that they're related to demyelination cannot be excluded.


Instruction: Generate impression based on findings.

Input: Possible spasmodic dysphonia: rule out central cause. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild, scattered, nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Neck: There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There are bilateral upper thoracic spine neural foraminal perineural cysts. There is bilateral upper lung bronchiectasis, enhancement, and cavities compatible with mycetomas.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of mass lesions in the neck.3. Bilateral upper lung bronchiectasis, fibrosis, and cavities related to mycetomas.


Instruction: Generate impression based on findings.

Input: Malignant poorly differentiated neuroendocrine carcinoma, any siteClinical question: 60 y/o pt with newly diagnose lung neuroendocrine CA; please eval for metsSigns and Symptoms: see aboveComments: Pt has difficulty breathing when laying flat and will need breathing treatment prior to going down. Please page 4937 with MRI time to coordinate. | The CSF spaces are appropriate for the patient's stated age with no midline shift. Exam is degraded due to patient motionThere is a small lesion which is bright on diffusion-weighted imaging and dark on the ADC map present in the right cerebellar tonsilTo the extent of visualization possible given only the limited imaging available 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.To the extent of visualization possible given only the limited imaging available the visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Examination is limited due to patient motion and the patient inability to continue with the exam. If clinically appropriate when the patient is able to and perhaps with the added benefit of sedation additional imaging may be possible.2.Along the right cerebellar tonsil there is a small lesion which is not well-defined on the available pulse sequences. Additional imaging may be of benefit to further evaluate this


Instruction: Generate impression based on findings.

Input: Clinical question: Right lumbosacral pain for more than 3 months. Signs and symptoms: Right lumbosacral pain for more than 3 months, numbness to the knee, no weakness. Nonenhanced lumbar MRI:The signal intensity and alignment of vertebral column is unremarkable.In the lower most visualized thoracic spine and thoracic cord is unremarkable.T12-L1, L1-L2, L2-L3 and L3-L4 levels demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild disc disease, shallow broad-based bulging disc, mild bilateral ligamentum flavum and facet hypertrophic changes. There is mild mass effect on the thecal sac secondary to above changes however without convincing evidence of a spinal stenosis and no neural foraminal compromise.L5-S1 demonstrate moderate disc disease and loss of disc height moderate right and mild left facet and ligamentum flavum hypertrophy. No central spinal stenosis however mild right neural foraminal compromise is noted.No detectable. Spinal soft tissue abnormalities.

Output: 1.Degenerative changes of the lumbar spine as detailed per level above.2.There is no convincing evidence of central spinal stenosis at any level.3.L5-S1 demonstrate moderate disc disease and hypertrophic changes of posterior elements with resultant mild right neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Clinical question: 74 year old female with metastatic breast cancer with involvement of prevertebral and paravertebral tissues in the cervical spine. Status post RT. Evaluate for change. Compared to prior exam from 6 -- 15 -- 11. Enhanced CT of soft tissues of neck:40 cc of Omnipaque 350 was given for this study. Multidetector helical CT of entire soft tissues of neck are acquired. Coronal and sagittal 2-D reformatted images are also acquired.Examination demonstrates a soft tissue mass in the right carotid space at the level of the skull base and C1 level. The mass surrounds the right transverse process of C1 and is inseparable from right vertebral artery at C1 level. There are diffuse lytic changes in the C1 vertebrae as well as lateral mass of C2 on the right. There is subtle mass effect and anterior displacement of the right internal carotid artery secondary to tumor. The tumor also reaches the right styloid fragment. The right internal jugular is compressed by the mass however remains patent. When compared with prior exam there is subtle interval decrease in the bulk of the tumor and apparently less mass effect on the carotid. There is no definitive extension of tumor into the spinal canal on this exam. On prior study there was a slight widening of the right epidural space likely secondary to tumor at C1 level. The very irregular shape of tumor makes precise measurement difficult however on axial image 22 at C1 level the extra osseous component of tumor measures 22 x 27.5-mm. And coronal post infused reformatted image 40 cranial cephalad axis of tumor measures 22-mm. A previous reported right-sided lymph node at the level of two also demonstrate interval decrease in its size. This node measures 6.6-mm in size compared to prior measurements of 11.8 times 8.6-mm. Or there is no evidence of any new lymphadenopathy. The vasculature of the neck remains intact. Limited images through the apices of the lungs demonstrate apical scarring and without definitive evidence of metastases. No appreciable interval change since prior exam. Please review dedicated report of CT of chest performed the same date as this study. Possible small metastatic lesions in C5 and C7 best appreciated on sagittal reformatted bone density image 22. These findings were present on prior study. If further evaluation of spine metastatic lesions are desired dedicated pre-and post enhanced MRI of cervical spine is recommended.

Output: 1.Interval significant decrease in the size of tumor at C1 and C2 right paraspinal region. Lytic metastatic lesions in C1 and C2 may be the source of this right-sided paraspinal soft tissue mass. Interval necrosis and decrease in the size of right-sided level 2 lymph node. No evidence of new lymphadenopathy.2.Residual tumor at C1 -- C2 level on current exam measures 22 x 27 x 40 mm.3.suspected small intra-osseus lytic metastatic lesions at C5 and C7. Questionable other lytic changes in the cervical spine. If further evaluation is desired dedicated pre-and post enhanced MRI of spine is recommended.


Instruction: Generate impression based on findings.

Input: Left shoulder pain and weakness Motion overall mildly limits sensitivityROTATOR CUFF: Supraspinatus appears diminished and torn involving the subacromial component towards its detachment. Full-thickness tear is observed involving the posterior aspect with intact fibers observed anteriorly. Associated mild atrophy of the supraspinatus muscular body is also identified. Other than mild tendinosis of the infraspinatus and more moderate similar nonspecific changes in the teres minor, the remainder of the cuff and tendinous attachments are otherwise intact.SUPRASPINATUS OUTLET: Mild narrowing with a downward sloping acromion. Mild to moderate osteoarthritic changes of the AC joint and scattered throughout the shoulder are also again observed including narrowing, sclerosis, osteophytes and subchondral cysts.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum is not well visualized and demonstrates degenerative globular signal on the anterior aspect and superiorly. An associated SLAP tear is also suspected questionable, yet motion minimizes sensitivity. Small effusion.BICEPS TENDON: Biceps tendon appears grossly intact and properly positioned, however mild tendinosis in the horizontal segment cannot entirely be excluded. ADDITIONAL

Output: Full-thickness tear of the supraspinatus with associated mild additional changes, as described.


Instruction: Generate impression based on findings.

Input: Cervical pain (stenosis). Weakness. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and morphology. At C2-3, there is small anterior indentation of the thecal sac by definitive disc-osteophyte complex which also mildly deforms the spinal cord, but without abnormal signal. The neural foramina are preserved. At C3-4, a disc-osteophyte complex causes moderate size anterior indentation of the thecal sac deforming the underlying spinal cord. The neural foramina are preserved. At C4-5, a disc-osteophyte complex causes mild thecal sac indentation and minimal spinal cord deformity. Associated right-sided uncovertebral proliferative change causes mild narrowing of the neural foramen. At C5-6, there is slight indentation the thecal sac by disc-osteophyte complex results in mild canal narrowing but no cord deformity. The neural foramina are preserved. At C6-7, there is minimal anterior indentation of the thecal sac by disc-osteophyte complex. In addition, there is mild bilateral uncovertebral process hypertrophy, but no significant neural foraminal narrowing. At C7-T1, there is no significant spinal or foraminal narrowing. The vertebral artery flow voids appear to be intact. The paravertebral soft tissues are unremarkable.

Output: Relatively mild multilevel cervical degenerative disease that is most pronounced at C3-C4 level, with mild-to-moderate spinal narrowing. There is no spinal cord signal abnormality. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: NK/T-Cell Lymphoma s/p MUD PBSCT with CNS PTLD. There has been interval evolution of post-biopsy findings in the right precuneus region. There is interval decrease in size of the mass with diffuse intrinsic T1 hyperintensity and susceptibility and minimal patchy enhancement. The lesion now measures up to 28 mm in width, previously 36 mm. There is also decrease in the extent of the surrounding confluent white matter T2 hyperintensity. There is slightly decreased effacement of the trigone of the right lateral ventricle. There is no midline shift or herniation. There is persistent pansinus inflammation and secretions.

Output: 1. Interval decrease in size of the biopsied right parietal lobe PTLD lesion and associated edema.2. Persistent pansinusitis.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:9/22/1961)Reason: New onset headaches and vertigo/imbalance in patient with known ischemic disease and HIV, eval for stroke/structural cause History: Headache, vertigo/imbalancePROVIDER/ATTENDING NAME: SANDRA LYNN ROSE SANDRA LYNN ROSE The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.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: Right lower extremity radicular pain, history of lumbar microdiscectomy. Evaluate for disc herniation at L4-L5 and L5-S1. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of lumbar lordosis. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Small disc bulge at T11-T12. Degenerative changes are seen in the lumbar spine with disc desiccation and height loss at L4-L5 and L5-S1.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L5-S1: Minimal disc bulge. No spinal canal or neural foraminal stenosis.Postoperative changes are seen related to prior microdiscectomy with laminotomy at the left L4-L5 level. No significant scar formation within the spinal canal. No imaging findings to suggest arachnoiditis. No evidence of fluid collections. Partially imaged 3 x 2 cm cystic structure in the right adnexa may represent a small ovarian cyst.

Output: Evidence of prior L4-L5 microdiscectomy without convincing evidence of recurrent disc herniation. Minimal disc bulges are seen at L4-L5 and L5-S1 without significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for cervical stenosis or foraminal stenosis. Signs and symptoms: LUE paresthesia and hyperreflexia. Nonenhanced cervical spine MRI:The alignment of the vertebral column is anatomical.There is uniform generalized small caliber of the cervical spinal canal which is believed to represent a congenital anatomic variation of the short pedicle.Foramen Magnum is unremarkable.C2 -- C3 is unremarkable.C3 the C4 is unremarkable.C4--C5 demonstrate mild degenerative changes with result in mild to moderate right neural foraminal compromise however without spinal stenosis or neural foraminal compromise. There is a tiny linear T2/T2 stir hyperintensity within the fundus of the disk in the midline and to the right consistent with a tiny annular fissure. This finding is best appreciated on sagittal T2 stir images 7 and 8 and axial T2 series 6 on image 21. C5 -- C6 demonstrate mild disk disease and loss of disk height. There is a tiny focus of T2 hyperintensity laterally on the right (sagittal T2 stir series 3 image 5 and axial T2 series 6 image 27) suspicious for small disk extrusion or annular fissure. There is moderate bilateral neural foraminal compromise secondary to degenerative changes. Mild degenerative changes at this level in combination with congenitally small canal results in mild central spinal stenosis at this level.C6 -- C7 demonstrate a small left lateral disk protrusion (sagittal T2 stir image 8 and axial T2 series 6 images 30 and 31). There is moderate left and mild right neural foramina compromise without central spinal stenosis.C7 -- T1 is unremarkable.Unremarkable signal intensity and caliber of cervical and uppermost visualized thoracic cord.

Output: 1.There is uniformly smaller caliber of the cervical spinal canal which represent a congenital anatomical variation.2.Mild degenerative changes at C5 -- C6 in combination with congenitally small canal results in central spinal stenosis only at this level.3.Tiny disk extrusion or annular fissure on the right at C5 -- C6 is noted.4.Shallow broad-based disk protrusion on the left at C6 -- C7 with moderate left neuroforaminal compromise.5.Multi-level neural foraminal compromise as detailed per level above.6.Normal signal intensity and caliber of cervical cord.


Instruction: Generate impression based on findings.

Input: 55-year-old female with mandible infection, c/w CT images from 4/2015, history of recurrent tongue cancer. Per chart, history of recurrent oral tongue cancer status post right partial glossectomy and modified radical neck dissection in October 2009 followed by adjuvant chemoradiation. Recurrence in May 2013 status post chemotherapy completed in June 2013, with a recurrence status post right hemiglossectomy and left forearm free flap reconstruction in August 2013. Status post chemotherapy and re-irradiation for third recurrence into the root of the tongue extending submucosally into the left base of the tongue extending up the left pharyngeal wall and the left posterolateral tongue. Completed Abraxane and chemoradiation in November 2014, base of tongue biopsy 1/14/15 negative for recurrence. Metal artifact from the patient's surgical hardware related to prior mandibulotomy limits adequate evaluation of the surrounding structures. The mandible cannot be fully assessed especially in the areas of prior infection due to metal artifact. Patient is also status post right hemiglossectomy and neck dissection with flap reconstruction. Using the hyoid bone as a landmark, when compared with prior CT study the previously noted areas of hypodensity along the posterior aspect of the left tongue base demonstrate heterogeneous diffuse enhancement on the current study, which are somewhat nonspecific and limited by metal artifact. However, there is no focal mass lesion identified and enhancing tissue is confluent with adjacent soft tissues. There is increased thickening of the adjacent mucosal surfaces which may reflect post treatment changes. There are scattered prominent mediastinal lymph nodes which are not pathologic by size criteria and were noted on the previous CT. The diffusion weighted images are essentially nondiagnostic due to metal artifact.Within the visceral space the thyroid gland appears within normal limits.The airway appears patent.There is trace fluid in the mastoid air cells bilaterally. There is asymmetric pneumatization of the left petrous apex now containing a small amount of fluid.The parotid and the submandibular glands appear unremarkable.Patient is status post tracheostomy.When correlating with prior CT, there are confluent areas of mineralization posterior to the vertebral bodies of C4-C6 compatible with ossification of the posterior longitudinal ligament. There is associated up to moderate spinal canal stenosis most prominent at C5/C6 with deformity of the spinal cord at this level. There is bilateral moderate-severe foraminal stenosis at C5/6.

Output: 1.There is no definite focal mass lesion. However when compared to prior CT, the previously noted areas of hypodensity along the posterior margin of the left tongue base now demonstrate diffuse heterogeneous enhancement which is nonspecific and may represent posttreatment changes. Correlation with PET study is recommended to exclude tumor recurrence.2.No cervical lymphadenopathy. Stable scattered prominent mediastinal lymph nodes.3.Ossification of the posterior longitudinal ligament with associated moderate spinal canal stenosis most prominent at C5/C6 with deformity of the spinal cord at this level. There is bilateral moderate-severe foraminal stenosis at C5/6.