Instruction: Generate impression based on findings.

Input: 44 year-old female history of mass seen on prior ultrasound. ABDOMEN:LIVER, BILIARY TRACT: Segment 6 lesion correlating to prior ultrasound measuring 2.7 x 2.0 cm demonstrating mildly increased T2 and decreased T1 signal abnormality with rapid relatively diffuse contrast enhancement with iso to slightly hyperenhancement on delayed series. On hepatobiliary phase there is relatively decreased uptake within the lesion. There is a small amount of fat noted within the periphery as well as mild homogeneous restricted diffusion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Segment 6 lesion with imaging characteristics most compatible with a hepatic adenoma.


Instruction: Generate impression based on findings.

Input: Back pain with radiation to the left leg. The patient is noted to have transitional spinal anatomy and for the purposes of numbering, there are 6 lumbar type vertebral bodies. The last fully formed disc is designated as L6-S1.There is mild anterolisthesis of L5 on L6. The lumbar spine is otherwise in normal alignment with a normal lumbar lordosis. There is mild narrowing of the intervertebral discs at the L3-4, L4-5, and L5-6 levels, and likely developmental at L6-S1. The vertebral body heights are well-maintained. No focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact. There is scattered disc desiccation.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is minimal shallow left paracentral disc protrusion without significant compromise to spinal canal or neural foramina.L3-L4: There is mild disc bulge with mild narrowing of the spinal canal and bilateral neural foramina with thickening of the ligamentum flavum.L4-L5: There is moderate disc bulge with moderate narrowing of the spinal canal. There is also superimposed left neural foraminal disc extrusion which migrates cranially approximately 8 mm, resulting in severe left-sided neural foraminal stenosis. There is also a right paracentral sequestered disc fragment of differential signal from the parent disc, which measures 12 x 6 mm in the greatest axial dimension and 14 mm in the craniocaudal dimension. The fragment extends along the upper L5 vertebral body. This fragment appears to abut and minimally displace the descending right L5 nerve root. There is moderate right neural foraminal stenosis. Additionally, there is thickening of the ligamentum flavum and bilateral facet arthropathy.L5-6: There is mild anterolisthesis of L5 on L6 with uncovering of the disc at this level. There is moderate disc bulge with moderate narrowing of the spinal canal and mild bilateral neural foraminal stenosis. There is bilateral facet arthropathy, right greater than left. There is thickening of ligamentum flavum. There is a central annular fissure with shallow central disc protrusion.L6-S1: There is no significant compromise to spinal canal or neural foramina.

Output: 1. Transitional anatomy as detailed above. If surgery is to be contemplated, correlation with imaging of the entire spine is recommended. 2. Multilevel degenerative changes as detailed above with disc extrusion at the L4-5 level resulting in severe left neural foraminal stenosis which may be accounting for the patient's symptoms. Additional right paracentral sequestered fragment at this level which abuts the descending right L5 nerve root.3. Mild degenerative anterolisthesis of L5 on L6.


Instruction: Generate impression based on findings.

Input: 20-year-old male with pain and weakness. Evaluate for rotator cuff tear or biceps tendinitis. ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis muscle and tendon appear intact. There is mild to moderate fatty infiltration of the teres minor muscle. The teres minor tendon appears intact.SUPRASPINATUS OUTLET: There are small cysts within the distal end of clavicle with edema within the underlying bone marrow. There is mild edema within the soft tissue adjacent to the distal clavicle, but the acromioclavicular joint alignment is normal and the bone marrow signal intensity of the acromium is normal. There is trace fluid within the subdeltoid bursa which may not be of any clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. We see no effusion. Although we see no frank fluid within the superior labrum, there is branching intermediate signal intensity indicating a SLAP tear. This tear appears to extend into the superior aspect of the anterior labrum as well. There is also linear intermediate signal intensity partially traversing the posterior inferior labrum with what appears to be a tiny paralabral cyst.BICEPS TENDON: The tendon of the long head of the biceps appears normal.ADDITIONAL

Output: 1. Cyst formation within the distal clavicle with underlying edema could be degenerative in etiology or reflect a stress injury/chronic repetitive trauma (i.e., posttraumatic osteolysis of the distal clavicle).2. SLAP tear with findings suggestive of a nondisplaced posterior inferior labral tear as well.3. Small cysts in the posterior aspect of the humeral head are of questionable current clinical significance, but can be seen in patients with posterosuperior glenoid impingement.4. Mild to moderate fatty atrophy of the teres minor muscle without apparent etiology. The rotator cuff otherwise appears normal as does the biceps tendon.


Instruction: Generate impression based on findings.

Input: Female, 45 years old, with radiating neck pain. Straightening of the cervical lordosis is likely positional. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, edema or enhancement is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. No evidence of cord signal abnormality or pathologic spinal cord enhancement is seen. No epidural lesions are detected.C2-3: Left facet arthropathy. No significant spinal canal or foraminal stenosis. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Mild posterior disc-osteophyte complex formation with asymmetric focality towards the left foraminal zone. No significant spinal canal stenosis. Moderate left foraminal narrowing with questionable mild nerve root impingement. Mild right foraminal narrowing.C5-6: No spinal canal stenosis or neuroforaminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Relatively mild disc degeneration is seen, most notably at C4-5. There is no spinal canal stenosis at this level, but the left neural foramen is moderately narrowed with questionable nerve root impingement.


Instruction: Generate impression based on findings.

Input: Precocious puberty, headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild left maxillary sinus mucosal thickening.

Output: No evidence of intracranial structural abnormalities.


Instruction: Generate impression based on findings.

Input: Female; 49 years old. Reason: bile duct patency s/p OLT History: increased alk phos ABDOMEN:LUNG BASES: Small pleural effusions with adjacent bibasilar compressive subsegmental atelectasis, partially visualized.LIVER, BILIARY TRACT: Postsurgical changes of liver transplant. There is a single right upper quadrant surgical drain with tip overlying the hepatic dome. Decreased right hepatic lobe subcapsular hematoma with mild residual mixed T2 signal intensity debris-like material, most compatible with residual blood products. Mild perihepatic ascites, mildly increased at the hepatic dome. Previously seen heterogeneous signal in segment 7 has resolved. No focal hepatic lesions. New mild right intrahepatic bile duct dilation due to central right intrahepatic bile duct stricturing (series 1301/7). Mild narrowing of the common hepatic duct near Klatskin's (series 701/98). Patent choledochojejunostomy.Normal vascular flow voids of the portal vein and hepatic veins are present on T2 sequences. Limited evaluation of the hepatic artery flow void.SPLEEN: Splenomegaly. Peripheral heterogeneous signal in the spleen is concerning for splenic infarction similar to prior study.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter.BOWEL, MESENTERY: Increased body wall anasarca. Interval resolution of proximal small bowel dilation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of ascites.

Output: 1. New mild right intrahepatic bile duct dilation due to central right intrahepatic bile duct stricturing (series 1301/7). Mild narrowing of the common hepatic duct near Klatskin's (series 701/98). Patent choledochojejunostomy.2. Decreased right hepatic lobe subcapsular hematoma, though some residual blood products persists.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other alteration of consciousnessClinical question: Seizure protocol. 1 mm thin cut, coronal flairSigns and Symptoms: New onset seizure on August 23, 2015. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Male, 40 years old, history of anaplastic oligodendroglioma, WHO grade 3, status post RT, TMZ, and Avastin. Findings related to prior right frontal lobe tumor resection are again seen. The large right frontal resection cavity demonstrates no significant interval change in size and morphology. As before, the cavity communicates with the right lateral ventricle.Thick, T2 heterogeneous tissue along the posterior aspect of the resection cavity demonstrates no significant change from the prior examination. This tissue is diffusion restricting, and demonstrates patchy gyriform and speckled intrinsic T1 hyperintensity with little if any superimposed enhancement, also similar to prior.Ill-defined T2 hyperintensity spreading posteriorly from this thickened tissue has improved. Ill-defined T2 hyperintensity along the left frontal horn is unchanged. Left inferior frontal encephalomalacia is unchanged. Volume loss and minimal T2 hyperintensity within the right cerebral peduncle are unchanged. No new parenchymal lesions are seen. The ventricular system is stable in size and morphology.

Output: There has been no significant change in the size or distribution of thickened tissue along the posterior margin of the right frontal resection cavity. As on the prior examination, this tissue demonstrates diffusion restriction, intrinsic T1 hyperintensity and minimal if any enhancement compatible with post-antiangiogenic treatment effect. No new or growing lesions are seen.


Instruction: Generate impression based on findings.

Input: Pain, edema with medial ankle shift left and indistinct cortex to medial talus. Evaluate for Charcot versus septic ankle joint versus DJD. The posterior tibialis tendon is not visible posterior to the tip of the medial malleolus, indicating a complete rupture. More proximally, the tendon is markedly enlarged with increased intrasubstance signal extending to the tendinous surface indicating tendinosis and partial-thickness tearing. The distal segment of the torn tendon, extending from the tip of the medial malleolus to the navicular tuberosity, is enlarged and deformed, with increased signal intensity indicating severe tendinosis and partial-thickness tearing. There is enhancement of the soft tissues at the site of the tear extending both proximally and distally along the abnormal tendon, indicating inflammation. The adjacent flexor digitorum longus tendon appears intact, as does the flexor hallucis longus tendon. The peroneal tendons appear intact, as do the anterior tendons and the Achilles tendon.Mild osteoarthritis affects the tibiotalar joint with small subchondral cysts. There is a small amount of fluid within the joint, but no large effusion, and I see no findings to suggest a septic arthritis. A small amount of fluid within the subtalar joint is likewise within normal limits. Mild to moderate osteoarthritis affects the midfoot articulations, but I see no specific imaging features of neuropathic arthropathy. Small ossicles distal to the medial malleolus may reflect old trauma. Please note that this protocol was not optimized for evaluation of the ligaments of the ankle.

Output: 1. Complete rupture of the posterior tibialis tendon with severe tendinosis and additional partial thickness tearing of the tendon as described above.2. Osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Bilateral hip pain. Patient on steroids for treatment of lymphoma. Evaluate for evidence of osteonecrosis. Left Hip: There is serpentine, bandlike signal abnormality within the femoral head indicating osteonecrosis involving the entire weight-bearing surface of the femoral head (4-5 cm in diameter). There is moderate edema and enhancement within the subjacent femoral neck but currently we see no subchondral fracture or articular surface collapse. There is a small joint effusion with mild synovial enhancement which commonly accompanies osteonecrosis of the femoral head. Please note that the study is not protocoled for evaluation of the cartilage of the hip, but we see no gross labral deformity or hyaline cartilage defect.Right Hip: There is serpentine, bandlike signal abnormality within the femoral head indicating osteonecrosis involving the entire weight-bearing surface of the femoral head (4-5 cm in diameter). There is mild edema within the adjacent femoral neck but currently we see no subchondral fracture or articular surface collapse. There is a small joint effusion with mild synovial enhancement which commonly accompanies osteonecrosis of the femoral head. Please note that the study is not protocoled for evaluation of the cartilage of the hip, but we see no large articular cartilage defect. There appears to be a small ossicle in the anterior superior labrum, which may not be of any current clinical significance.The remaining bone marrow signal intensity is normal. The pubic symphysis and sacroiliac joints are normal in appearance. Moderate degenerative disk disease affects L4/L5. The visualized musculature is within normal limits.

Output: Bilateral femoral head osteonecrosis.


Instruction: Generate impression based on findings.

Input: There is a positive ulnar variance. Contrast opacified the radiocarpal joint in the expected fashion. I see no contrast extending into either the midcarpal joint or distal radioulnar joint. There is mild spurring along the sigmoid notch of the radius.. Please refer to the subsequent MRI report for further information.Exposure time: 1:52

Output: Successful injection of contrast into the radiocarpal joint. There is a positive ulnar variance, but I see no contrast entering the distal radioulnar joint to confirm a TFCC tear.


Instruction: Generate impression based on findings.

Input: 63 year old male with ischemic cardiomyopathy presenting for evaluation of viability and left ventricular systolic function. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 156 ml/m2 (normal range: 74+/-15), the LVEDV is 340 ml (normal range 142+/-34), the LV end systolic volume index is 114 ml/m2 (normal range 25+/-9), the LVESV is 249 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 139 g (normal range 164+/-36). There is significant transmural late gadolinium enhancement in a pattern consistent with myocardial infarction involving the left anterior descending and right coronary artery. These areas are not likely to be viable. The basal and mid lateral wall and part of the basal anterior, anterolateral walls are viable.No intracardiac thrombus.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 212 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 104 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve has bileaflet tethering, opens widely and there is at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is at least trivial pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated (31mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 27%2. There is extensive LGE consistent with previous infarct as described above. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of thyroid glandClinical question: r/o metsSigns and Symptoms: h/o thyroid cancer. PET scan suggested a likely benign lesion near L1, but could not rule out small metComments: 1. Has tooth implant. 2. Wears earrings. 3. Has had neck surgery (thyroidectomy and neck dissection) | Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine. Some foci of T1 signal hyperintensity are present at L1, L4 and L5 and could represent either focal fatty replacement or small hemangiomas.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There is no evidence for metastases to the lumbar spine.


Instruction: Generate impression based on findings.

Input: Reason: R shoulder rotator cuff tear History: R shoulder pain ROTATOR CUFF: There is a full-thickness tear of the anterior fibers of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 10 mm in the AP dimension. There is minimal retraction. There is interstitial tearing of the supraspinatus at the level of the myotendinous junction. There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis.There is mild fatty atrophy of the supraspinatus muscle. The infraspinatus muscle and tendon appear intact. The subscapularis muscle and tendon appear intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. There are foci of low signal intensity debris internally which may reflect a mild bursitis. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. No fluid-filled tear of the glenoid labrum is evident within the limitations of this non arthrogram study.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Rotator cuff tendinosis with full-thickness tearing of the supraspinatus and minimal retraction. Other findings as above.


Instruction: Generate impression based on findings.

Input: Clinical question : CVA. Signs and symptoms: Left-sided weakness Non-infused CT of brain:No definitive evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. No detectable cortical stroke. There is subtle high density of right middle cerebral artery in the horizontal portion of sylvian fissure and considering patient provided clinical data possibility of thrombus within the right middle cerebral artery should be considered.Follow-up with a CTA and MRI examination of brain is recommended. Small area of low-attenuation in the region of the left external capsule may represent an old lacunar infarct. This examination is otherwise unremarkable. The above findings were relayed to the referring service via Stat Consult communication system.

Output: 1.Subtle high density of right middle cerebral artery in the right sylvian fissure as described above. Considering patient's provided clinical data this may represent clot within the right MCA main trunk.2.Small lacunar infarct of left basal ganglia.3.No evidence of acute cortical stroke or hemorrhage.


Instruction: Generate impression based on findings.

Input: 55-year-old male with pain MENISCI: Limited evaluation of the menisci due to patient motion. There is abnormal signal within the anterior horn, body, and posterior horn of the medial meniscus, extending to the articular surface with meniscal tissue displaced laterally and anteriorly, likely representing a displaced flap or fragment. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: A focal full-thickness articular cartilage defect on the lateral tibial plateau measures approximately 1 cm in AP diameter, and 7 mm in transverse diameter. Subchondral cyst is noted beneath the medial tibial spine.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The patella tendon and quadriceps tendon are intact. There is mild prepatellar tendon soft tissue edema.ADDITIONAL

Output: Focal articular cartilage defect along the lateral tibial plateau and medial meniscal tear with displaced fragment as described above.


Instruction: Generate impression based on findings.

Input: Low back pain with possible spondylolysis at L5 on S1 with exaggerated lordosis and pain with extension. Examination is mild motion degraded. Five lumbar type vertebral bodies are presumed present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There are minimal disk bulges from L1-L2 to L4-L5. Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: No significant disk disease, spinal canal, or neural foramina stenosis. If there is high suspicion for pars defect, consider CT or oblique radiographs for further evaluation.


Instruction: Generate impression based on findings.

Input: There are many motion artifact that degrades the study. During the study the patient was confused and unable to cooperate. Interpretation is limited. Diffusion images demonstrates high signal in the left posterior limb of internal capsule nucleus that extends to the left cerebral peduncle with no convincing evidence of restricted diffusion in ADC map.There is increased T2/FLAIR signal with corresponding low signal in T1 seen in the right insular cortex extending to the lateral aspect of the precentral gyrus and to the right middle frontal gyrus, and the subcentral lobule, in the distribution of the superior division of the right cerebral artery.There is cortical-based T2/FLAIR high signal in the left occipital pole.There is no evidence of midline shift. Ventricular size is prominent, age related.There is mild to moderate prevascular T2/FLAIR lesions, age related. The sella appears empty.The right eyeball lens is thin. The paranasal sinuses are clear. Mastoid air cells are clear.

Output: 1.No convincing evidence of acute cerebral infarction. 2.There is evidence for old infarctions in the left occipital pole and in the distribution of the superior division of the right middle cerebral artery.


Instruction: Generate impression based on findings.

Input: Reason: mechanical fall, concern for rotator cuff tear History: pain, limited ROM ROTATOR CUFF: Note is made of a near full-thickness tear of the supraspinatus at the level of its insertion on the greater tuberosity extending from the articular surface involving greater than 50% of the tendon width. This tear extends proximally approximately 3 cm from the level of the insertion on the greater tuberosity. There is no significant retraction. There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is partial thickness insertional tearing of the infraspinatus at the level of the greater tuberosity. There is no significant retraction. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. The glenohumeral joint alignment is anatomic. There is branching linear signal abnormality traversing the anterior inferior glenoid labrum indicating a tear which extends through the articular cartilage along the anterior inferior glenoid. There is heterogeneity and intermediate signal intensity within the superior labrum indicating a combination of degeneration and degenerative tearing. There is subchondral cyst formation within the greater tuberosity.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. High-grade near full thickness insertional tearing of the supraspinatus tendon as well as partial thickness insertional tearing of the infraspinatus.2. Acromioclavicular and glenohumeral joint osteoarthritis.3. Degeneration and degenerative tearing of the glenoid labrum as described above. 4. Moderate to large glenohumeral joint effusion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Spinal stenosis, lumbar region [M48.06], Reason for Study: ^Reason: ?lumbar spinal stenosis History: radicular pain in a saddle distribution, decreased patellar reflexes For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: mild disc dessication, no neuroforaminal narrowing or spinal stenosis. L4-L5: mild disc dessication, diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: mild disc dessication, there is disc extrusion toward left side lateral recess and compressed nerve root. No evidence of spinal stenosis.

Output: 1. Disc extrusion at the level of L5S1 toward left side lateral recess as described above.2. Multilevel disc degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: Female, 14 years old, with autoimmune disease with new brain lesions, preoperative planning exam for brain biopsy. Multiple patchy ill-defined areas of parenchymal and brain surface enhancement are again seen involving the bilateral cerebral hemispheres and the cerebellum. These appear similar to the prior examination accounting for differences in technique. Several of the enhancing lesions, and particularly the dominant enhancing lesion in the right cerebellum, are associated with surrounding T2 hyperintensity. Also noted is an area of subcortical T2 hyperintensity and mild gyral volume loss without enhancement involving the left parietal lobe, again similar to prior.

Output: Redemonstration of multiple cerebral and cerebellar lesions, most of which enhance, which appear similar to the immediate prior examination.


Instruction: Generate impression based on findings.

Input: 36 years Female (DOB:4/28/1979)Reason: myoclonus History: action myoclonus, intubated X 7 days for statusPROVIDER/ATTENDING NAME: FERNANDO D GOLDENBERG THOMAS J KELLY MRI brain:There is mild dural enhancement and thickening adjacent to the right frontal and parietal lobes. There are a couple focal nonenhancing tubular lesions measuring which are dark on T2 imaging and bright on T1 weighted imaging. These are located adjacent to the dura but in the subarachnoid space and appear to adhere to the dura. One is located adjacent to the right frontal lobe and one is located adjacent to the right parietal lobe. There is some associated susceptibility effect with these lesions. Although suggests that this may represent subacute blood.There is a small developmental venous anomaly present along the left postcentral gyrus.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level associated with small uncovertebral osteophytes.At C4-5 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes at this level associated with disc material. There is narrowing of the neural foramina with bilateral moderate encroachment of the exiting nerve roots.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes at this level associated with disc material. There is narrowing of the neural foramina with mild encroachment of exiting nerve roots on the right and moderate encroachment of the exiting nerve roots on the left.At C6-7 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes at this level associated with disc material. There is narrowing of the neural foramina with mild encroachment of exiting nerve roots on the right and moderate encroachment of the exiting nerve roots on the left.At C7-T1 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes at this level associated with disc material. There is narrowing of the neural foramina with mild encroachment of exiting nerve roots on the left and moderate encroachment of the exiting nerve roots on the right.The vertebral artery flow voids appear to be intact.

Output: 1.There is some pachymeningeal thickening present on the right side which is a nonspecific finding. This could be reactive change to a separate pathology. Dural based on clock lesion may have a appearance like this but would be somewhat unusual.2.Adjacent to the pachymeningeal thickening there are tubular lesions. These could represent calcifications or cortical venous thrombi. A CT of the head and CT venogram may be helpful to sort this out.3.There are degenerative changes present in the cervical spine without compromise to the spinal cord. There is encroachment of exiting nerve roots bilaterally at C4-5, on the right at C6-7 and on the left at C5-6.


Instruction: Generate impression based on findings.

Input: Clinical question: History of metastatic colon cancer with brain metastases. Please evaluate for stereotactic radiosurgery planning. Signs and symptoms: Brain metastases. Pre-and post enhanced treatment planning brain MRI:Enhancing necrotic tumor in the right posterior lateral cerebellar measuring 20.7 x 18.0-mm with interval increased size since the prior study measurement of 13.5 x 10-mm with surrounding vasogenic edema and regional mass effect.A large irregular necrotic rim enhancing tumor in the left posterior temporal lobe measures nearly similar to prior exam at 32 x 31 mm compared to prior study measurement of 34 x 31mm. Extensive surrounding vasogenic edema and regional mass-effect is present.There is no evidence of any additional parenchymal or leptomeningeal enhancement to suggest metastatic disease. Calvarium also fail to demonstrate any abnormal enhancement. Ventricular system remains within normal size and it maintains midline.

Output: 1.Visualization of metastatic lesions in the right posterior cerebellum with evidence of interval increased size as measured above. A second larger necrotic tumor measures fairly similar to prior exam in the left posterior temporal lobe.2.No additional foci of parenchymal, leptomeningeal, calvarial or orbital metastases.3.No significant mass effect and or deviation of midline.4.Significant acute on chronic pansinusitis with interval worsening since prior exam.


Instruction: Generate impression based on findings.

Input: Right shoulder pain The examination is limited by motion artifact. Also note that the sagittal images are not obtained as the exam was terminated prior to completion.ROTATOR CUFF: There is a massive rotator cuff tear with full-thickness disruption and retraction of the supraspinatus and infraspinatus tendons proximal to the glenoid. Evaluation of the subscapularis and teres minor tendons is limited given motion artifact and the absence of sagittal sequences. There is marked fatty atrophy of the rotator cuff musculature.SUPRASPINATUS OUTLET: Fluid is present within the subacromial subdeltoid bursa. There is minimal osteoarthritis of the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Severe osteoarthritis affects the glenohumeral joint. The anterior labrum is not visualized secondary to chronic tearing.BICEPS TENDON: Evaluation of the biceps tendon is limited given the internally rotated positioning of the patient however the biceps appears intact within the intertubercular groove.ADDITIONAL

Output: 1. Massive rotator cuff tear with full-thickness disruption and retraction of the supraspinatus and infraspinatus tendons. There is marked fatty atrophy of the rotator cuff musculature.2. Severe osteoarthritis of the glenohumeral joint with a large joint effusion containing foci of low signal intensity which likely reflect a combination of synovitis and loose bodies.


Instruction: Generate impression based on findings.

Input: NF1 and optic glioma. BRAIN: There is an unchanged patchy area of T2 hyperintensity within left cerebellar hemisphere. There are also unchanged areas of T2 hyperintensity in bilateral parietal periventricular white matter, hypothalamus, and posterior right putamen. There is no associated abnormal enhancement. The pons and corpus callosum are unchanged. The optic chiasm is not enlarged. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The cerebral flow voids appear to be grossly intact. There are inflammatory changed within the left sphenoid sinus.ORBITS: There is unchanged enlargement of the intraorbital and perhaps the intracanalicular portions of the left optic nerve up to approximately 3 mm in width, with mild T2 hyperintensity and negligible enhancement. The right optic nerve appears to be normal. In addition, the globes, extraocular muscles, lacrimal glands, retrobulbar fat, and preseptal soft tissues are normal bilaterally.

Output: 1. Unchanged intracranial stigmata of neurofibromatosis type 1.2. No significant interval change in the small left optic nerve glioma.


Instruction: Generate impression based on findings.

Input: 63 year old female with breast cancer s/p chemotherapy, hx of atrial flutter s/p ablation. Referred for MRI for assessment of function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%. The LVEDV is 129 ml (normal range 109+/-23), LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), LVESV is 49 ml (normal range 31+/-10), and LV end systolic volume index is 27 ml/m2 (normal range 18+/-5). The LV mass is 53 g (normal range 114+/-24) and the LV mass index is 29 g/m2 (normal range 67+/-11). 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.The native T1 myocardial relaxation time is within normal range. There is no LV thrombus. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%. The RVEDV is 141 ml (normal range 110+/-24), the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVESV is 63 ml (normal range 35+/-13), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%.2.The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%. 3.There is no evidence of late gadolinium enhancement suggesting no fibrosis or inflammation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 69-year-old female with history of primary sclerosing cholangitis status post left liver lobectomy now with elevated alkaline phosphatase status post ERCP with balloon dilation ABDOMEN:LIVER, BILIARY TRACT: Status post left hepatic lobectomy. Difference in perfusion between the anterior (five, eight) and posterior (six, seven) segments of the right lobe of the liver with moderate intrahepatic biliary ductal dilation involving the anterior segments and mild intrahepatic biliary ductal dilatation involving the posterior segments, progressed since the prior exam. The ducts converge and terminate at an area of enhancement measuring 9 x 9 mm near the biliary enteric anastomosis.There is minimal peaking of the right intrahepatic biliary ducts consistent with the patient's history of primary sclerosing cholangitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a minimally complex renal cyst in the left kidney. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post Roux-en-Y with biliary enteric anastomosis, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Slight progression of intrahepatic biliary ductal dilatation with moderate intrahepatic biliary ductal dilatation involving the anterior segments and mild intrahepatic biliary ductal dilatation involving the posterior segments of the right lobe of liver. Ducts converge and terminate at an focal area of mass like enhancement measuring 9 x 9 mm near the biliary enteric anastomosis. Findings are may represent enhancement of a small mass at the level of the anastomosis versus inflammation related to the patient's underlying primary sclerosing cholangeitis resulting in thickened ductal walls. Further evaluation with ERCP may be considered.


Instruction: Generate impression based on findings.

Input: 25-year-old woman with a history of dermatomyositis, restrictive lung disease, pneumonia, hypothyroidism and tachycardia. Referred for cardiac MRI to assess for cardiac involvement of her dermatomyositis Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%. The LVEDV is 139 ml (normal range 109+/-23), LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), LVESV is 64 ml (normal range 31+/-10), and LV end systolic volume index is 36 ml/m2 (normal range 18+/-5). The LV mass is 77 g (normal range 114+/-24) and the LV mass index is 44 g/m2 (normal range 67+/-11). 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 however assessment of the base of the left ventricle was limited by breathing artifact. There is no LV thrombus. 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 52%, the RVEDV is 146 ml (normal range 110+/-24), the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVESV is 70 ml (normal range 35+/-13), and the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%.2.The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 75-year-old man with history of incontinence, evaluate for cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has grossly normal signal characteristics and overall morphology. There are mild, multilevel degenerative changes in the cervical spine without high-grade spinal stenosis. Additionally, there is a disc bulge with mild to moderate narrowing of the neural foramina at L4/L5. No high-grade stenosis involving the cauda equina.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.2.Mild, multilevel degenerative changes without high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine.3.Large thyroid goiter.


Instruction: Generate impression based on findings.

Input: 82-year-old female with spinal stenosis. Presented with severe back pain and positive blood cultures. Please evaluate for epidural abscess. Please note that while there are no specific findings to suggest an epidural abscess, this exam cannot exclude an epidural abscess. Instead an MR is recommended for further evaluation. The exam is significantly limited by patient motion artifact and large body habitus. Within these limitations, the following observations are made. The bones are diffusely osteopenic. The alignment of the thoracic spine is anatomic. The vertebral body heights are grossly maintained. Multilevel degenerative disk disease is seen. Anterior and posterior osteophyte formation is seen at multiple levels, however there is no significant bony compromise of the central canal. The paraspinal soft tissues are grossly unremarkable. LUMBAR SPINE

Output: 1. Limited exam due to patient motion artifact and large body habitus.2. This exam cannot exclude an epidural abscess. An MR is recommended for further evaluation.3. Multilevel degenerative disk disease with central canal compromise at multiple levels.


Instruction: Generate impression based on findings.

Input: Pain. Evaluate for Baker's cyst. MENISCI: Medial and lateral menisci are intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits without evidence of a contusion or fracture. Articular cartilage of the tibiofemoral and patellofemoral compartments is intact. LIGAMENTS: There is edema along the medial collateral ligament posteriorly but the ligament itself appears intact. The ACL, PCL, and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Findings compatible with rupture/leakage of a Baker's cyst.


Instruction: Generate impression based on findings.

Input: History of peripheral T-cell lymphoma. Left ring finger swelling. There is ill-defined soft tissue lesion surrounding the middle phalanx of the fourth digit extending to the PIP joint with intermediate T1 and increased T2 signal with enhancement on postcontrast imaging. There is destruction of the underlying middle phalanx with infiltration of enhancing soft tissue. Bone marrow signal adjacent to the areas of destruction is within normal limits. No additional areas of abnormal enhancement are noted in the left hand.

Output: Infiltrative, enhancing soft tissue lesion encasing the middle phalanx of the left ring finger with destruction of the underlying osseous structures is most consistent with a soft tissue metastasis given history of malignancy. Infection is still a possibility but considered less likely.


Instruction: Generate impression based on findings.

Input: Diagnosis: Low back painClinical question: severe low back painSigns and Symptoms: low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a broad-based left lateral recess disc protrusion at this level which mildly displaces the nerve roots at the left lateral recess.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is fluid within the uterus.

Output: There are some mild degenerative changes present lumbar spine with a broad-based disc protrusion at L5-S1 which very mildly displaces the nerve roots at the left lateral recess.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils are rounded in configuration and extend approximately 5 mm below the level of the foramen magnum. There is mild reversal of the normal cervical lordosis. There is anomalous morphology with butterfly configuration of the C3 vertebral body, and likely also involving C4 and C5 vertebral bodies. There is a rudimentary disc at the C6-C7 level with diminished anterior-posterior dimension of the C6 and C7 vertebrae as well as partial fusion of the right C6-C7 facet. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. There is no significant disk bulge, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: 1. Prone sequences are degraded by motion artifact. However, there is a fibrofatty filum terminale from L4 to L5/S1 with probable tethered cord. Please correlate clinically.2. Multiple segmentation anomalies and butterfly vertebrae within the cervical, thoracic and lumbar spine as described above. Partial fusion of the L1-L2 vertebral bodies with posterior angulation, contributing to effacement of the ventral thecal sac at this level.3. Low-lying cerebellar tonsils with rounded configuration, not meeting strict criteria for Chiari 1 malformation.


Instruction: Generate impression based on findings.

Input: 40 year-old female with history of ulnar cancer and rectovaginal fistula presenting with gas from vagina now concerning for rectovaginal fistula. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: 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: Mildly dilated proximal small bowel loops with relatively decompressed distal small bowel loops. There is a paraumbilical hernia containing small bowel segments and the hernia may be the cause of this mild partial small bowel obstruction. No evidence of perforation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Endometrial cavity is distended.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Infiltrative, soft tissue density around the rectum and in the bilateral ischiorectal fossa. There is a possible communication between the vagina and rectum on the right side. However MRI of the pelvis will be much better for depiction of the fistulous tract.

Output: Possible rectovaginal fistula on the right. MRI of the pelvis may be helpful for better depiction of the fistulous tract. Dilatation of the endometrial cavity. Perirectal inflammatory changes.Possible mild small bowel obstruction. The etiology is unknown but may be related to the periumbilical hernia containing small bowel segments.


Instruction: Generate impression based on findings.

Input: Right shoulder pain Exam is limited by motion artifact.ROTATOR CUFF: No significant abnormality noted. Tiny degenerative cysts are noted along the greater tuberosity.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the glenoid labrum is limited by lack of intra-articular contrast. Within these limits, there appears to be detachment of the anterior and superior labrum best appreciated on series 3 image 14/27. There is additional signal abnormality within the superior labrum which may relate to degenerative tearing. Abnormal signal intensity is also noted within the posterior labrum (series 4 image 15/27) with underlying cystic change in the glenoid. A trace amount of fluid is noted in the subcoracoid recess.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Abnormal signal of the labrum concerning for tear with possible detachment anteriorly.


Instruction: Generate impression based on findings.

Input: Reason: left knee pain, evaluate for medial meniscus tear, chondral damage History: left knee pain MENISCI: There is mild intrasubstance degeneration of the posterior horn of the medial meniscus along with very mild surface irregularity along the undersurface fibers near the free edge likely representing fraying, but we see no fluid-filled or unstable-appearing tear. There is intrasubstance degeneration of the body of the meniscus as well. The anterior horn appears intact. There is minimal intrasubstance degeneration of the lateral meniscus which otherwise appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness degeneration of the articular cartilage of the patella along the median eminence and medial facet with underlying degenerative subchondral signal abnormality. There is also perhaps mild thinning of the articular cartilage of the lateral facet of the patella and femoral trochlea. There is focal full-thickness degeneration of the articular cartilage of the lateral tibial plateau, posteriorly, with degenerative signal abnormality in the underlying subchondral bone. The medial compartment articular cartilage appears relatively preserved.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Cartilage degeneration particularly affecting the undersurface of the patella. The medial compartment cartilage appears relatively spared.2. Mild intrasubstance degeneration of the menisci and possible fraying of the posterior horn of the medial meniscus, but no fluid-filled or unstable tear is evident.3. Mild edema within the lateral head of the gastrocnemius may represent a strain.


Instruction: Generate impression based on findings.

Input: Reason: Left Knee instability, r/o ACL and or LCL tear History: knee instability MENISCI: The medial meniscus is unremarkable. The anterior horn and body of the lateral meniscus is unremarkable. There is an obliquely oriented vertical signal abnormality within the peripheral third of the posterior horn of the lateral meniscus which extends to the tibial articular surface and is continuous with the interface of the meniscus with the meniscofemoral ligament of Wrisberg. While we can't entire exclude the possibility of a meniscal tear, we suspect that it may simply represent a far lateral continuation of this normal variant interface.ARTICULAR CARTILAGE AND BONE: There is slight heterogeneity in the hyaline cartilage of the patella, suggesting mild degeneration, as well as slight heterogeneity of the articular cartilage of the lateral femoral trochlea, likely representing focal degeneration, with mild focal edema in the underlying bone. The articular cartilage in the tibiofemoral compartments is within normal limits.LIGAMENTS: The anterior cruciate and posterior cruciate ligaments are within normal limits. The medial and lateral collateral ligament complexes are unremarkable.EXTENSOR MECHANISM: There is mild thickening of the proximal patellar tendon with small ossicles as seen on prior radiographs, perhaps representing mild chronic tendinosis or sequela of Sinding-Larsen-Johansson syndrome. The Insall-Salvati ratio is within normal limits. The superior aspect of the medial femoral trochlea appears hypoplastic relative to the lateral aspect, suggesting dysplasia. Furthermore, the tibial tuberosity to trochlear groove distance is approximately 18 mm, which is borderline abnormal. There is slight lateral translation of the patella with respect to the center of the trochlea as well as edema within the superolateral aspect of Hoffa's fat pad, suggesting patellofemoral instability.ADDITIONAL

Output: 1.Findings indicative of patellofemoral instability as described above.2.No evidence of ACL or LCL tear.3.Linear signal abnormality in the posterior horn of the lateral meniscus is felt more likely to reflect a prominent interface with the ligament of Wrisberg rather than a true tear.


Instruction: Generate impression based on findings.

Input: Left pulsatile tinnitus, history of sinus surgery. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is an enlarged partially-empty sella. There is also mild asymmetric prominence of the left Meckel's cave. The partially-imaged left maxillary sinus is small and there are postoperative findings related to uncinectomy.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. An enlarged partially-empty sella is nonspecific, but can be a manifestation of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Bilateral leg stiffening, left greater than right, hyperreflexia left patellar, lumbar spine WNL. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There is a cavum septum pellucidum. There is otherwise no evidence of ventriculomegaly. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a left maxillary sinus retention cyst.

Output: 1. No evidence of demyelinating lesions or encephalitis.2. No evidence of Chiari malformation.3. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 16-year-old male with ankle pain x 4 months. TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. There is no defect within the anterior talofibular ligament (ATFL) or fluid surrounding the ligament. ARTICULAR SURFACES AND BONE: High STIR signal within the talus indicates a small amount of bone marrow edema. The osseous structures are otherwise unremarkable. ADDITIONAL

Output: Mild bone marrow edema within the talus without evidence of ligamentous or tendinous injury.


Instruction: Generate impression based on findings.

Input: Back pain with radiation to the left leg. The study is limited by patient motion. There is minimal posterior subluxation of L1 relative to L2. The vertebral bodies are preserved in height. Fat-containing lesions in L1, L2, and S2 may represent hemangiomas. There is mild T2 signal and height loss involving the L1-L2 through L4-L5 intervertebral discs, associated with mild degenerative marrow signal subjacent to the respective endplates. There are slight disc bulges at L1-2 through L3-4, but spinal canal is patent and there is no evidence of nerve root compression in the neural foramina. The tip of the conus medullaris is located at the lower L1 level and displays normal signal. There is no evidence of tumors. The paravertebral soft tissues are unremarkable.

Output: Mild multilevel degenerative lumbar spondylosis without evidence of nerve root compression.


Instruction: Generate impression based on findings.

Input: 76-year-old female with shoulder pain. Prior repair. Evaluate rotator cuff. ROTATOR CUFF: There is thickening and intermediate signal abnormality within the supraspinatus tendon indicating moderate tendinosis. There is a full-thickness tear of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring 6 mm in the AP dimension. There is no significant retraction. Fibers of the supraspinatus can be traced to the greater tuberosity. There is fatty atrophy of the supraspinatus.There is a small partial-thickness undersurface tear of the anterior fibers of the infraspinatus measuring approximately 4 mm in the AP dimension at the level of its insertion on the greater tuberosity. There is no significant retraction. There is also interstitial tearing of the infraspinatus tendon at the level of the myotendinous junction. The infraspinatus muscle appears intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes at the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal abnormality within the superior and posterior labrum likely reflecting degenerative tearing, within the limitations of this non arthrogram study. There is near full-thickness articular cartilage degeneration affecting the glenohumeral joint with subchondral signal abnormality within the humeral head and glenoid, likely degenerative in etiology. There is subchondral cyst formation in the humeral head.BICEPS TENDON: The tendon of the long head of the biceps is not visualized presumably reflecting postoperative change from prior biceps tenodesis. ADDITIONAL

Output: 1. Full-thickness tear of the rotator cuff as described above without significant retraction.2. Mild to moderate osteoarthritic changes of the glenohumeral joint.3. The long head of the biceps is not visualized presumably reflecting postoperative change from prior biceps tenodesis.


Instruction: Generate impression based on findings.

Input: VT Left VentricleThe left ventricle is normal size. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 72 ml/m2 (normal range: 65+/-11), the LVEDV is 125 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 58 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal . The overall RV ejection fraction is 55%, the RV end diastolic volume index is 80 ml/m2 (normal range 69+/-14), the RVEDV is 138 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 62 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.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 dilated. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings . 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. Normal LV size with lower normal LV systolic function.2. Normal RV systolic function, no evidence for ARVD.3. No evidence for delayed myocardial enhancement.


Instruction: Generate impression based on findings.

Input: Suspected viral mmeningitis. A lumbar puncture was done which revealed an elevated opening pressure. Brain MRI: There is a subcentimeter nodular lesion with susceptibility effect in the left corona radiata with an adjacent small development venous anomaly. There is no evidence of cerebral abscess or abnormal leptomeningeal enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is flattening of the pituitary gland. The ventricles and basal cisterns are normal in size. 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.Brain MRV: There is apparent focal constriction of the bilateral transverse sinuses. There is no evidence of cerebral venous sinus thrombosis.Orbits MRI: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. Small cavernous malformation in the left corona radiata with an adjacent small development venous anomaly.2. No evidence of cerebral abscess or abnormal leptomeningeal enhancement.3. No evidence of cerebral venous sinus thrombosis.4. No evidence of orbital lesions.5. Flattening of the pituitary gland and apparent focal constriction of the bilateral transverse sinuses can be manifestations of elevated intracranial pressure.


Instruction: Generate impression based on findings.

Input: 62-year-old male with history of cholangiocarcinoma, possibly metastatic. History of NSTEMI. Septic shock, concern for abscess. Hypotensive. LUNGS AND PLEURA: Intubated. Predominantly upper lobe emphysema. Mild reticular opacities in the lung bases. Linear opacity in the left lung base likely represents atelectasis or scarring. No pleural effusions. Several scattered micronodules are present, several of which are calcified and likely related to prior granulomatous disease. The largest noncalcified lung nodule measures 3 mm in the right upper lobe. There is new bilateral lower lobe consolidation and volume loss. MEDIASTINUM AND HILA: Calcified right hilar and mediastinal lymph nodes are likely due to prior granulomatous disease. Other small mediastinal and hilar lymph nodes are present, but no significantly enlarged mediastinal or hilar node. Aortic and coronary atherosclerotic calcifications are present. Cardiomegaly. The orientation of the heart within the thorax is abnormal with posterior displacement of the ventricles. The pericardium is seen at the level of the right AV groove, but elsewhere, pericardium is not clearly apparent. This raises the possibility of partial absence of the pericardium, which could explain the abnormal orientation of the heart. CHEST WALL: Degenerative changes affect the thoracic spine.ABDOMEN: LIVER, BILIARY TRACT: There is a poorly defined hepatic mass with intrahepatic biliary dilatation in the left lobe. Multiple new hypodensities have appeared throughout the liver since the prior MRI exam. The dominant left lobe mass in hepatic segment 2/3 is larger and now measures 7 x 7 cm, associated with intrahepatic biliary dilation in left lobe; findings most consistent with cholangiocarcinoma (series 4, image 79). The fat layer between this exophytic mass and the pancreas appears preserved. The mass occludes the left bile duct approximately 1 cm from confluence, however, the confluence itself appears unaffected. Left hepatic and portal veins are obliterated by mass. The middle hepatic vein passes immediately lateral to mass but appears unaffected. No extrahepatic biliary ductal dilation. New metastasis in the posterior inferior right hepatic lobe measures more than 4 cm in diameter (image 93 of series 4). The metastases have indistinct margins. The new smaller hepatic hypodensities have better defined borders and may represent metastases vs. septic emboli, although metastases are more likely. There is an accessory left hepatic artery arising from the left gastric artery. The left gastric artery arises directly from the aorta adjacent to the celiac trunk (series 17, image 57). SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic calcification, probably from prior pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: There is diffuse retroperitlymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New moderate ascites. IVC filter is in place. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Foley catheter in a decompressed urinary bladder. There is an reservoir for the patient's penile prosthesis in the expected position adjacent to the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A rectal tube is in expected position.BONES, SOFT TISSUES: Degenerative changes of the lumbosacral spine and pelvis.OTHER: Moderate ascites. Probable carcinomatosis of the mesentery.

Output: Findings consistent with left liver lobe cholangiocarcinoma. Dominant left lobe mass is larger since 10/12/2011, and multiple new hepatic hypodensities have appeared. New hepatic metastases. New moderate ascites. New bilateral lower lobe consolidation / volume loss.New diffuse omental density suggests carcinomatosis.


Instruction: Generate impression based on findings.

Input: Syncope. The study was initially protocoled along with MRA of the neck with contrast. However, the patient was unable to hold still for the examination despite premedication. Therefore, no contrast was given and the contrast-enhanced neck MRA was not performed. The study remains at least moderately limited by patient motion.Brain MRI: There is wedge shaped diffusion restriction involving the anterior-superior aspect of the left cerebellar hemisphere, associated with T2-hyperintense/T1-hypointense signal and mild swelling but no significant mass-effect on the fourth ventricle or other posterior fossa structures. This is compatible with an acute/early subacute infarct. There is T2-hyperintensity with volume loss in the left pons, compatible with encephalomalacia, most probably from previous infarct. There is moderate patchy T2-hyperintense signal in the cerebral white-matter as well, which probably represents chronic microvascular ischemia. There are multiple foci of susceptibility effect involving the right basal ganglia, compatible with punctate hemorrhages. There is no definite associated edema or T1 shortening. In fact, these are associated with mild but focal ex vacuo enlargement of the posterior body on the right lateral ventricle. Otherwise, there is moderate global brain volume loss resulting in expansion of the ventricles and other CSF-containing spaces. There is no midline shift or brain herniation. The sella is expanded and largely fluid-filled.The mastoid air cells are clear. There is trace mucosal thickening in the paranasal sinuses. There is no gross orbital abnormality. A small forehead lesion that is T1-hyperintense may represent a small sebaceous cyst.SusceptibilityCranial MRA:There is moderate irregularity and attenuation of flow-related signal in the right V4 segment, which probably reflects moderate atherosclerosis. The left vertebral artery and the basilar artery are patent but slightly irregular. Similarly, the other major intracranial vessels show irregularity likely related to atherosclerotic disease without large vessel occlusion. Note motion degradation limits assessment.

Output: 1.Examination moderately limited by motion.2.Acute/early subacute left cerebellar infarct, in the territory of the superior cerebellar artery.3.Chronic left pontine infarct and moderate cerebral chronic microvascular ischemia. Moderate brain volume loss.4.Punctate hemorrhages in the right cerebral hemisphere are likely chronic and may relate to hypertension.5.Diffuse moderate atherosclerosis of the intradural segment of the right vertebral artery. There is also atherosclerotic involvement of the other major intracranial vessels but no large vessel occlusion.


Instruction: Generate impression based on findings.

Input: Neck pain and radicular pain to the right upper extremity. There are stable postoperative findings related to anterior cervical fixation at C4-C6. At other cervical levels, vertebral body heights and bone marrow signal are preserved. There is mild straightening of the normal cervical lordosis. Otherwise, alignment is anatomic. There is diffuse congenital narrowing of the spinal canal and multilevel degenerative spondylosis, including multilevel disc bulges and moderate ligamentum flavum hypertrophy. In particular, at C2-C3, there is unchanged disc-osteophyte complex and ligamentum flavum and facet hypertrophy, resulting in moderate spinal canal stenosis with impingement upon the cord and bilateral neural foramen stenosis. At C3-C4, there is an unchanged slight disc-osteophyte complex and ligamentum flavum hypertrophy, resulting in mild spinal canal stenosis, but no significant neural foraminal stenosis. At C6-C7, there is an unchanged slight disc-osteophyte complex and ligamentum flavum hypertrophy, resulting in mild spinal canal stenosis and moderate bilateral neural foraminal stenosis. A C7-T1, there is unchanged trace posterior disc-osteophyte complex and left uncovertebral joint hypertrophy with unchanged mild left neural foraminal narrowing. The spinal cord appears to be unremarkable. The paraspinal soft tissues are unremarkable.

Output: 1. Unchanged diffuse congenital narrowing of the cervical spine with superimposed degenerative spondylosis, that is most pronounced at C2-3, where there is impingement upon the spinal cord and at C6-7, where there is moderate bilateral neural foraminal stenosis. 2. Stable postoperative findings related to anterior cervical fixation at C4-C6.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: MRI BRAINThere is mild ectopia of the left cerebellar tonsil which is somewhat pointed inferiorly and extends to about 2 mm below the foramen magnum. CINE phase contrast CSF flow imaging shows no significant flow through the posterior foramen magnum or around the cerebellar tonsils. Elsewhere, normal biphasic flow is seen.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection, hemorrhage, or restricted diffusion/acute ischemia. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No acute intracranial abnormality.2. Cerebellar tonsillar ectopia with no evidence of CSF flow through the posterior foramen magnum.


Instruction: Generate impression based on findings.

Input: 41 years Female (DOB: 3/3/1975)Reason: MS History: Lhermitte'sPROVIDER NAME: ANTHONY T. REDER ANTHONY T. REDER MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a diffuse disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.No abnormal lesions are identified within the brain parenchyma or the cervical spinal cord to suggest demyelination.2.There are mild degenerative changes present in the cervical spine


Instruction: Generate impression based on findings.

Input: Strong family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. A few stable foci are present, stable, and none suspicious in appearance. No abnormal axillary lymph nodes are identified in either axillary region.Small amount bilateral pleural fluid is present.

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


Instruction: Generate impression based on findings.

Input: Male, 27 years old. Left shoulder instability ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor muscles and tendons are normal in appearance. Contrast remains within the joint space.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a defect in the anterior labrum at approximately the 3:00 position. This likely represents a normal variant (sublabral foramen), but we cannot completely exclude a tear in this location.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: A defect in the anterior labrum likely represents a normal variant, but we cannot completely exclude a tear in this location. Otherwise normal MR appearance of the shoulder.


Instruction: Generate impression based on findings.

Input: Reason: 51F with history of bladder cancer s/p cystectomy with neobladder; surveillance imaging. ABDOMEN:LIVER, BILIARY TRACT: Unchanged subcentimeter hepatic cysts. No new suspicious lesions or pathologic enhancement. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left midpole subcentimeter renal cyst. Kidneys enhance homogeneously. No focal obstructing ureter mass.RETROPERITONEUM, LYMPH NODES: No abdominal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy and neobladder creation. No suspicious lesions to suggest recurrence.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Infectious endocarditis, large vegetation on mitral valve, rule out septic embolism. Transient altered mental status. Multiple foci of restricted diffusion are seen involving the bilateral cerebral hemispheres as well as infratentorially including the bilateral cerebellar hemispheres. The relatively largest area of restricted diffusion is seen within the left cerebellar hemisphere in the left superior cerebellar artery territory. There is corresponding T2/FLAIR hyperintensity. Additional scattered foci of FLAIR hyperintensity in the periventricular and subcortical white matter are compatible with chronic small vessel ischemic changes. Tiny focus of susceptibility is seen in the left frontal subcortical white matter compatible with chronic microhemorrhage and probably present on prior MRI although study with motion degraded.There is advanced supra-and infratentorial global parenchymal volume loss. There is prominence of the ventricular system with T2 hyperintensity involving the periventricular white matter which remains unchanged from 8/14/2014 and suggestive of transependymal flow.No intracranial mass or mass-effect. No midline shift or downward herniation. Major flow-voids are preserved. Empty sella incidentally noted. There is moderate opacification of the left middle ear cavity and mastoid air cells.

Output: 1. Multiple (greater than 10) scattered supratentorial and infratentorial foci of restricted diffusion consistent with acute infarcts. These involve the bilateral anterior and posterior circulations and compatible with embolic disease. Largest of the infarcts involves the left cerebellar hemisphere. Given history of infectious endocarditis, may consider follow up study for development of abscess as clinically indicated. No findings to suggest abscess on the current non-contrast study.2. Advanced global parenchymal volume loss.3. Prominence of the ventricular system, possibly disproportional to the degree of volume loss, which may suggest component of chronic communicating hydrocephalus. Finding however is unchanged since 8/12/2014.4. Tiny focus of chronic microhemorrage in the left frontal lobe, which was probably present on prior study although study was motion degraded. No acute infarct within the region to suggest hemorrhagic transformation. Dr. Ali discussed findings with Radovanovic at 1450 hrs on 2/6/2015.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact. There is no evidence of acute infarct. There is mild susceptibility effect along the tentorium. There are no areas of abnormal parenchymal signal and the myelination pattern is appropriate for age. The ventricles and basal cisterns are normal in size and configuration. The midline structures and craniocervical junction are intact. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable.

Output: 1. No evidence of acute ischemia.2. Mild susceptibility effect along the tentorium is most compatible with prominent tentorial veins without convincing evidence of significant subdural hemorrhage.


Instruction: Generate impression based on findings.

Input: Tiny cystic pituitary lesion on the previous brain MRI. For follow-up.. In the posterior aspect of the sella, there is a 6 mm T1 hyperintense, mildly lobulated, mildly heterogeneous soft tissue that is larger than the neurohypophysis is expected to be. This lesion shows no definite contrast enhancement and has not changed since the previous examination. Along the anterior aspect of this lesion, there is a thin nonenhancing focus which also remains unchanged. Remainder of the pituitary gland demonstrates normal homogeneous enhancement. No evidence of mass effect. Bilateral cavernous sinuses and optic chiasm are unremarkable.Limited assessment of the brain shows no intracranial hemorrhage, mass, or acute infarct. The ventricles and other CSF containing spaces are normal in size. Major intracranial arteries are patent. A 10 mm pineal cyst is unchanged.

Output: 1.Compared to 4/16/2014 there is unchanged appearance of the pituitary gland with subcentimeter T1 hyperintense lesion involving the posterior pituitary favored to represent a Rathke cleft cyst or pars intermedia cyst. No associated mass effect.2.Limited sequences obtained of the remainder of the brain are unremarkable without evidence of intracranial mass or mass effect.


Instruction: Generate impression based on findings.

Input: Clinical question: Surveillance scan of right frontal cerebrovascular anomaly, CCM protocol on 3T. signs and symptoms: New onset of seizure Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination redemonstrates a previously known right middle frontal gyrus developmental venous anomaly without evidence of an associated cavernous malformation. There is no evidence of interval change since prior exams.Unremarkable anatomical morphology and signal intensity of brain parenchyma otherwise on all MRI sequences.Unremarkable surgical cortex, cortical sulci, ventricular system and the CSF spaces. Normal visualization of signal void of major intracranial arterial branches.Normal signal intensity of intracranial venous sinuses and with normal pattern of enhancement.Unremarkable calvarium, soft tissues of the scalp, orbits and without abnormal enhancement.There is a small retention cyst in the left maxillary sinus stable since prior study are unremarkable paranasal sinuses otherwise.

Output: 1.Pre-and post-enhanced brain MRI demonstrates a right frontal developmental venous anomaly without interval change since prior study. Unremarkable pre-and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: History of inflammatory myositis versus steroid myopathy, now off of steroids. CK elevated. Evaluate for inflammatory myositis. Right thigh: There is mild generalized fatty atrophy of the musculature of the right thigh with relative sparing of the vastus intermedius muscle. There is relatively severe fatty atrophy of the gluteus maximus muscle distally. On the fat-suppressed T2-weighted sequences, there is mild increased signal intensity of the gracilis muscle within the proximal and mid thigh as well as mild increased signal intensity within the proximal adductor magnus muscle. There is also mild enhancement of the proximal adductor magnus muscle following gadolinium administration. There is increased signal intensity within the obturator internus and externus muscles on the fat-suppressed T2-weighted images with mild enhancement of these muscles following gadolinium administration; little, if any, fatty infiltration of these muscles is noted on the T1-weighted images. There is mild increased signal intensity on fat-suppressed T2-weighted images within the lateral fibers of the gluteus maximus muscle with mild enhancement following gadolinium administration. There is mild peritrochanteric edema and enhancement which may reflect mild inflammation, of questionable clinical significance. The right hip appears normal. There is a small right knee joint effusion with synovial enhancement indicating mild synovitis. Signal intensity of the femur is normal.Left thigh.: There is mild generalized fatty atrophy of the musculature of the left thigh with relative sparing of the vastus intermedius. There is relatively severe fatty atrophy of the gluteus maximus muscle distally. On the fat-suppressed T2-weighted sequences there is increased signal intensity of the mid gracilis muscle with minimal if any enhancement following intravenous gadolinium administration. There is also patchy increased signal intensity within the proximal adductor magnus muscle which perhaps enhances slightly following gadolinium administration. There is increased signal intensity within the proximal sartorius muscle on fat-suppressed T2-weighted images, with mild enhancement following gadolinium administration. There is mild increased signal intensity within the proximal rectus femoris muscle along the myotendinous junction on T2-weighted images, with mild patchy enhancement noted following gadolinium administration. Similar abnormal signal intensity and enhancement is noted focally within the vastus lateralis muscle. As on the right side, there is increased signal intensity within the lateral fibers of the gluteus maximus muscle on the fat-suppressed T2-weighted images with mild enhancement following gadolinium administration. There is also increased signal intensity within the obturator internus and externus muscles on the fat-suppressed T2-weighted images, with mild enhancement following gadolinium administration; there is little if any fatty atrophy of these muscles on the T1-weighted images. There is mild peritrochanteric edema and enhancement which may reflect mild inflammation, of questionable clinical significance. The left hip joint appears normal. There is a small to moderate-sized left knee joint effusion with synovial enhancement indicating a mild synovitis. The signal intensity of the left femur is normal.

Output: Relatively symmetric myositis pattern as described above, with mild diffuse fatty atrophy of the thigh musculature and relatively severe fatty atrophy of the distal gluteus maximus muscle bilaterally, along with scattered foci of mild muscle edema and enhancement as described above.


Instruction: Generate impression based on findings.

Input: 17 month old female. Rule out mass lesion for possible seizure No areas of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. No evidence of a mass is identified on this non-infused exam.The cortical sulci in the left anterior temporal tip appear minimally more pronounced compared to the right side. This finding may be secondary to slice positioning and angulation of the head within the scanner. Further follow-up with an MRI examination is recommended.The cortical sulci, ventricular system and all of the CSF cisterns are otherwise unremarkable.Calvarium, limited view of paranasal sinuses and mastoid air cells are also unremarkable.

Output: No definitive abnormality however please see above comments.


Instruction: Generate impression based on findings.

Input: 66-year-old male with neutropenic fever. E. coli sepsis. Complains of headaches. Please evaluate for bleed or sinus infection. CT of brain without confusion.Subtle area of edema in the high convexity right frontal lobe involving cortex and subcortical white matter is noted. Further evaluated with an infused MRI examination is recommended to exclude possibly to an infectious process. This finding is best identified on axial images 21 to 24. No hemorrhage is associated with this finding. The above finding may represent a cortical stroke however considering provided clinical data an infectious process cannot be ruled out and an MRI is recommended.CT of maxillofacial.Minimal chronic sinus disease of bilateral maxillary sinuses are identified. Very minimal bilateral chronic ethmoid disease is also suspected. No evidence of air fluid level is present. The osteomeatal units of the maxillary sinuses are patent.

Output: 1.Focal area of cortical and subcortical white matter edema in high convexity right frontal as detailed above. Further evaluation with an MRI is recommended.2.Minimal chronic inflammatory sinus disease as detailed.


Instruction: Generate impression based on findings.

Input: Abnormal seizure like movements: ex 36 weeker with infantile hypertonia and developmental delay: EEG with mild spikes and school difficulties. There is no evidence of intracranial hemorrhage, mass, heterotopia, hippocampal sclerosis, infarction, or edema. The right ventricle is slightly larger than the left, which can be a normal anatomic variant. Otherwise, the brain parenchyma appears unremarkable. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of potential seizure foci.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Thoracic disc disease, bilateral numbness to lower extremity. There are small posterior disc-osteophyte complexes at C5-6, C6-7, and C7-8, which do not impinge upon the spinal cord. The spinal cord signal characteristics are normal. There is no evidence of tumors in the thoracic spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. Small posterior disc-osteophyte complexes at C5-6, C6-7, and C7-8, which do not impinge upon the spinal cord. 2. No evidence of spinal cord lesions.3. No evidence of tumors in the thoracic spine.


Instruction: Generate impression based on findings.

Input: Paresthesia in all limbs and head. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive paranasal sinus mucosal thickening, enhancement, and secretions.

Output: 1. No evidence of intracranial demyelinating lesions or masses. 2. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Altered mental status, advanced HIV No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. There is diffuse global supratentorial and infratentorial parenchymal volume loss which is advanced for age. There is moderate degree of confluent T2/FLAIR hyperintensity in the bilateral periventricular and to a lesser degree subcortical white matter, which is nonspecific. Major flow-voids are preserved. Susceptibility-weighted sequence is severely motion degraded limiting evaluation for hemorrhage. No hydrocephalus. No extra-axial collections.There is moderate mucosal thickening involving the right maxillary sinus, right sphenoid sinus and right anterior and posterior ethmoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of acute infarct or intracranial mass effect. No findings to suggest abscess or empyema.2. There is confluent T2/FLAIR hyperintensity in the periventricular white matter as well as global parenchymal volume loss which is advanced for age. These findings while nonspecific can be seen with HIV encephalopathy. Advanced chronic small vessel ischemic disease, if there are vascular risk factors, may also be considered.3. Moderate paranasal sinus opacification on the right.