Instruction: Generate impression based on findings.

Input: 74 year old man with paroxysmal AF, referred for MRI prior to AF ablation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 161 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 68 ml (normal range 47+/-19). There is mild concentric LVH. There are no regional wall motion abnormalities present. There is focal small area of delayed enhancement in the mid level lateral wall mid-myocardium of unclear significance. It does not have the appearance of myocardial infarct.Left AtriumThe left atrium volume is 166ml. 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 68 ml/m2 (normal range 82+/-16), the RVEDV is 150 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace 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 "pseudo-bovine" brachiocephalic branching pattern. The aortic root is mildly dilated (41mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.RUPV: 22x23mmRLPV: 22x22mmLUPV: 13x17mm LLPV: 12x19mmPulmonary 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 57%.2. There is focal small area of delayed enhancement in the mid level lateral wall mid-myocardium of unclear significance. It does not have the appearance of myocardial infarct.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%.4. The left atrium volume is 166ml. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Back pain for 3 months: tingling in finger tips. There is a partially imaged mass in the posterior fossa with marked compression of the brainstem. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Partially imaged mass in the posterior fossa with marked compression of the brainstem. Dedicated brain MRI with contrast is recommended for further evaluation.2. No evidence of cervical spine lesions.


Instruction: Generate impression based on findings.

Input: 46-year-old female with mass, seizure, preoperative evaluation Redemonstrated is an extra-axial mass in the lateral right middle cranial fossa which is mildly T2-hypointense, intensely and heterogeneously enhancing, with a wide base over the medial squamosal and anterior petrous portions of the right temporal bone as well as part of the right greater wing of the sphenoid with associated hyperostosis. It again measures 3.9 cm x 2.1 cm x 2.0 cm and is associated with dural thickening extending along the free edge of the right tentorium (dural tail).It is associated with vasogenic edema in the anterior right temporal lobe reaching into the external capsule with mild mass-effect on the right lateral ventricle and sylvian fissure. There is mild leftward midline shift and minimal right uncal herniation, unchanged better demonstrated is a small developmental venous anomaly within the pons. Fiducials are in place.

Output: Redemonstrated is an extra-axial mass in the lateral right middle cranial fossa most likely represents a meningioma. There is associated moderate degree of vasogenic edema with mild leftward midline shift and minimal right uncal herniation, unchanged.


Instruction: Generate impression based on findings.

Input: Pain in right knee status post PCL rupture. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is a full-thickness defect of the articular cartilage of the anterior medial condyle of the femur with mild progression. There is a small amount of internal signal of the lateral facet of the patella, indicating chondromalacia, similar to the prior study.LIGAMENTS: The collateral ligaments and the ACL appear intact. The previously observed suspected strain of the PCL has resolved on today's exam. PCL appears continuous without surrounding edema. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: Interval resolution of PCL disruption and articular cartilage degeneration of the medial condyle of the femur with chondromalacia of the patella.


Instruction: Generate impression based on findings.

Input: 74 years Female (DOB:4/14/1942)Reason: eval for abnormality/ disc hern. History: c/o ataxia, LBP and right hip pain. LE weaknessPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature. There is fusion of the C3-4 and C6-7 vertebral bodies. There are some mild signal hyperintensity on T2 STIR imaging within the C4 and C5 vertebral bodies.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is some disc desiccation at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are some ventral osteophytes present this level which effaces spinal fluid ventral to the spinal cord. The spinal cord is mildly deformed at this level. There is osseous fusion across the C3-4 disc.At C4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate osteophytes and uncovertebral osteophytes as well as ligamentum flavum hypertrophy. The spinal fluid ventral and posterior the spinal cord is effaced and there is flattening of the spinal cord. There is severe spinal stenosis at this level. There is narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots bilaterally at this level.At C5-6 there is loss of disc space height, disc desiccation and a left paramedian broad-based disc protrusion associated with effacement of the spinal fluid ventral and posterior the spinal cord and some mild flattening the spinal cord. There is some hypertrophy of the ligamentum flavum at this level. Overall there is moderate to severe spinal stenosis at this level. There is narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots bilaterally at this level. Encroachment of exiting nerve roots appears to be worse on the left versus the right sideAt C6-7 the disc space is obliterated and there is fusion of the C6 and C7 vertebral bodies. There are some left paramedian osteophyte formation which extends into the left neural foramen at this level. It is associated with encroachment of left-sided exiting nerve roots and encroachment of the left hemicord.At C7-T1 there is no significant compromise to the spinal canal . There is encroachment of the right-sided exiting nerve roots within the neural foramen at this level due to disc material.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall 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 mild ligamentum flavum hypertrophy at this level.At L4-5 there is a diffuse disc bulge associated with loss of disc space height and disc desiccation as well as some endplate osteophytes. There is ligamentum flavum hypertrophy at this level. There is effacement of the CSF surrounding the nerve roots at this level and effacement of the fat at the lateral recess bilaterally at this level. Overall there is moderate spinal stenosis at this level. There is narrowing of the neural foramina at this level which is slightly worse on the right versus the left side. There is some mild to moderate encroachment of the exiting nerve roots within the neural foramen at this level. There are some Schmorl's nodes at this level.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with some Schmorl's nodes. There is mild anterior subluxation of L3 on L4. There is bilateral facet hypertrophy at this level and ligamentum flavum hypertrophy. There is effacement of spinal fluid surrounding the nerve roots at this level. Overall there is moderate spinal stenosis at this level. There is encroachment of the exiting nerve roots within the neural foramina at this level as a result of disc material and facet hypertrophy. There are some endplate reactive changes present at this level especially on the right side where there is T2 STIR signal hyperintensity adjacent to the disc spacesAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is a Schmorl's node present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.In general, the right kidney appears smaller than the left kidney.

Output: 1.There are multilevel degenerative changes present in the cervical spine with severe spinal stenosis at C4-5 and moderate to severe spinal stenosis at C5-6 as well as encroachment of the left hemicord. There is encroachment of exiting nerve roots bilaterally at C4-5 and C5-6 and on the left side at C6-7. Endplate reactive changes appear to be more in the subacute phase at C5-62.There are degenerative changes present in the lumbar spine worse at L3-4 and L4-5. There is moderate spinal stenosis at each of these levels as well as a mild degree of anterior subluxation of L3 and L4. There is also encroachment of the exiting nerve roots bilaterally at L3-4 and to a lesser degree at L4-5. Endplate reactive changes appear to be more in the subacute phase at L3-4 eccentric towards the right.3.The right kidney appears to be smaller than the left kidney.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for lesions, assess hepatic vessel patency History: s/p combined liver/kidney transplant 2005, recurrent cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Status post liver transplant. The central portion of the liver demonstrates a somewhat reticular enhancement pattern suggestive of fibrosis. The liver intensity is mildly increased on in phase imaging suggesting iron deposition. No suspicious focal hepatic lesions are identified.The biliary anastomosis is patent without significant stenosis appearing similar to the prior study. The hepatic artery is patent. The portal vein is patent. The previously seen thrombus in the SMV has resolved. Hepatic veins are patent.SPLEEN: Borderline splenomegaly measuring 13 cm.PANCREAS: Pancreas is normal in morphology and signal intensity without a focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: End-stage left native kidney. Partially visualized left iliac fossa transplant kidney appears atrophic with moderate hydronephrosis. Partially visualized right iliac fossa transplant kidney grossly without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a small duodenal diverticulum anterior to the second portion of the duodenum (series 7, image 27) which was shown to contain air on prior CTs and currently appears to be filled with debris. The area lacks restricted diffusion. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post liver transplant without suspicious focal lesions. Hepatic fibrosis. Patent hepatic vasculature.2.Recanalization of previously seen SMV thrombus.


Instruction: Generate impression based on findings.

Input: 12-year-old male with visual changes and headaches. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. Cortical sulci, ventricular system and all CSF cisterns are within normal limits. Paucity of cortical sulci and small ventricular system although normal for patient's stated age it could also represent findings of pseudotumor cerebri.There is suggestion of some crowding at the level of foramen magnum which although may be due to slice positioning, possibility of slight ectopia of cerebellar tonsils cannot be ruled out. Multiple prior CT examination of this patient's back to 2004 were all reviewed. Similar findings are also noted on all prior studies. An MRI examination of brain is recommended for further and better evaluation to explain patient's repetitive visits for similar clinical symptoms.Bony density of calvarium, pneumatization of paranasal sinuses, middle ear cavities and mastoid air cells are within normal limits.

Output: Stable examination since prior studies. The common follow-up with an MRI examination. Please see above comments.


Instruction: Generate impression based on findings.

Input: 37-day-old female. Meningitis, GBS. Premature birth with gestational age of 31 weeks. Triplet gestation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There appears to be paucity of myelination in the perirolandic region. The brain parenchyma, brainstem, and cerebellum otherwise appear unremarkable. The pituitary gland also appears to be unremarkable. There is perhaps mild prominence of the subarachnoid spaced overlying the bilateral anterior temporal poles, but no evidence of abscess. 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, sand scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial abscess or infarct. 2. Apparently delayed myelination, even accounting for prematurity. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 78 years old, with cognitive decline. Assess for structural lesions. No evidence of restricted diffusion, parenchymal edema or mass effect is seen. Fairly extensive patchy periventricular and subcortical T2 hyperintense lesions are noted in both cerebral hemispheres and to a lesser degree in the brainstem. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles and sulci are mildly but proportionately prominent and are otherwise within normal limits.

Output: 1.No acute intracranial abnormality.2.No evidence of any significant structural lesion.3.Fairly extensive patchy white matter signal abnormality likely represents chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within the left maxillary sinus and right sphenoid sinus, otherwise the remaining paranasal sinuses and mastoid air cells are clear. Cervical spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There are no MRI findings of ligamentous injury.C2/3: UnremarkableC3/4: UnremarkableC4/5: Left uncinate hypertrophy causes mild left neural foraminal stenosis.C5/6: Minimal osteophyte disc complex without resulting stenosisC6/7: UnremarkableC7/T1: Unremarkable

Output: 1.Mucosal thickening is present within the left maxillary sinus and right sphenoid sinus, otherwise negative noncontrast brain MRI.2.C4/5: Mild left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 75-year-old male with lower back pain that is followed by increased stool frequency, evaluate for active small bowel inflammation from Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. There is once again mild irregularity of the central intrahepatic biliary ducts appearing similar to prior, though this examination is not tailored for examination of the bile ducts. There is cholelithiasis without specific evidence of cholecystitis.SPLEEN: Splenomegaly, measuring up to approximately 17 cm in the cranial caudal dimension.PANCREAS: The previously described multiloculated cystic lesion in the uncinate process of the pancreas (series 3, image 18) measures approximately 1.1 x 1.4 cm, previously 1.1 x 1.4 cm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference upper abdominal retroperitoneal lymph node (series 15, image 18) measures 3.9 x 1.3 cm, previously 3.9 x 1.3 cm. Other non and extrahepatic peritoneal lymph nodes appear similar to the prior examination.BOWEL, MESENTERY: There is increased fibrofatty proliferation involving the jejunum. Postsurgical changes of ileal resection are present. There is narrowing and decreased distensibility involving an approximately 10 cm segment of the distal neoterminal ileum without evidence of associated upstream obstruction. There is no associated bowel wall thickening, increased mucosal enhancement, or other signal abnormalities to suggest active inflammation.BONES, SOFT TISSUES: Degenerative changes affect the spine particularly the lower thoracic spine. Postsurgical changes are present in the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes of prior ileal resection.2.Non-flow limiting chronic stricturing of approximately 10 cm segment of presumed neoterminal ileum without evidence of active inflammation.3.Grossly stable appearance of the biliary tree compatible with history of sclerosing cholangitis. Cirrhotic liver. Splenomegaly.4.Grossly stable cystic lesion in the uncinate process of the pancreas which most likely represents an IPMN. 5.No significant interval change in retroperitoneal lymphadenopathy.6.Apparently new 1.7 cm sclerotic focus within the left ilium which may represent a benign bone island but would be better characterized on dedicated CT or MRI if clinically indicated.


Instruction: Generate impression based on findings.

Input: Reason: right knee instability History: right knee instability MENISCI: The patient has undergone partial meniscectomy of a previous discoid meniscus. We see no tear of the meniscus currently. The medial meniscus appears normal. ARTICULAR CARTILAGE AND BONE: A tiny focus of low signal intensity within the articular cartilage of the femoral trochlea centrally may represent focal degeneration but is of questionable clinical significance. We see no fluid-filled articular cartilage defects. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact.ADDITIONAL

Output: Surgical changes of partial lateral meniscectomy. We see no meniscal tear or findings to account for the patient’s knee instability. Other findings as above.


Instruction: Generate impression based on findings.

Input: Cogan's syndrome, vasculitis: sudden onset hearing loss. Internal Auditory Canals: 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.Brain: Some of the images are degraded by dental brace artifact. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There appears to be asymmetric prominence of the left pterygoid venous plexus.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. No evidence of cerebral infarction.


Instruction: Generate impression based on findings.

Input: Reason: R hip pain History: R hip pain ACETABULAR LABRUM: Small linear focus of contrast is seen within the anterior superior labrum, which is consistent with a small residual or recurrent tear. Additional degenerative and postoperative changes are also seen in the labrum.ARTICULAR CARTILAGE AND BONE: Abnormal signal intensity in the left femoral head appears similar to prior and likely represents avascular necrosis. There is no evidence of subchondral collapse. The bone marrow signal intensity is otherwise normal. Postoperative changes are seen at the femoral head/neck junction. Low signal intensity within the articular margin of the superior lateral acetabulum is again seen, appearing similar to prior and likely represents chronic degeneration.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Residual or recurrent tear of the anterior superior labrum and additional findings as above.


Instruction: Generate impression based on findings.

Input: Ex-25 5/6 week preemie, subglottic stenosis status post dilatation x 2, concern for vocal cord dysfunction. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. However, there appears to be delayed myelination, with the paucity of the expected degree of T1 hyperintensity in the anterior limbs of the internal capsules and posterior corpus callosum, for example. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The larynx was not imaged in this exam. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are areas of consolidation in the right lung, which may represent atelectasis.

Output: 1. Relative paucity of cerebral myelination likely related to prematurity, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Unremarkable cervical spine.3. The larynx was not imaged in this exam. Therefore, dedicated neck imaging may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for new stroke or mass lesion. Signs and symptoms: Transient episodes of vomiting and confusion with right hand tremor. Nonenhanced brain MRI:Diffusion weighted images demonstrate no evidence of an acute ischemic stroke.Examination demonstrate mild degree of chronic small vessel ischemic strokes involving the subcortical and periventricular white matter of the cerebral hemispheres and minimally of bilateral basal ganglia as well as pons. There is no convincing evidence of any appreciable significant change in the extent of disease since prior exam from 2014.Ventricular system remains within normal size and with maintained midline. Slight prominence of cortical sulci appears similar to prior exam.There is a well-demarcated extra axial T2 hypointense mass along the anterior aspect of the left middle cranial fossa highly suggestive of a small meningioma and without change since prior exam. On this exam there is no appreciable mass effect with this finding and the adjacent brain parenchyma in the streets no signal changes to suggest edema.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells, calvarium and soft tissues of the scalp.

Output: 1.No acute intracranial process.2.Findings of mild chronic nonhemorrhagic small vessel ischemic strokes without convincing evidence of change since prior exam from 2014.3.Small extra axial left anterior middle cranial fossa likely representing a meningioma without change since prior studies.


Instruction: Generate impression based on findings.

Input: 22-year-old male 2 years of medial knee pain with a sense of instability and occasional catching. MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage appears intact without evidence of near full-thickness or full-thickness articular cartilage defects. No bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Small amount of fluid within the joint but no large effusion or other findings to account for the patient's knee pain, instability, or catching.


Instruction: Generate impression based on findings.

Input: 36-year-old male with pain and locking of the left knee. Evaluate for meniscus tear. MENISCI: We see no meniscal tear.ARTICULAR CARTILAGE AND BONE: There is degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle measuring just over 1cm in diameter, with heterogeneous signal intensity and what appear to be full-thickness high signal intensity clefts traversing the cartilage as well as an underlying focus of subchondral edema-type signal. There also appears to be mild degeneration of the adjacent articular cartilage of the medial tibial plateau. There is superficial fraying of the articular cartilage of the medial facet of the patella with at least one near-full-thickness cleft. There is mild increased signal intensity of the articular cartilage of the lateral tibial plateau beneath the posterior horn of the lateral meniscus which may reflect early degeneration.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Degeneration of the articular cartilage along the medial femoral condyle and patella and other findings as described above. We see no meniscal tear.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 31 seconds

Output: Successful fluoroscopic left hip arthrogram injection.


Instruction: Generate impression based on findings.

Input: 16-year-old girl with history of posterior reversible encephalopathy syndrome and altered mental status. Cortical and subcortical areas of T2 hyperintensity from examination on 11/11/2016 have resolved. There are a few, residual foci of T2/FLAIR hyperintensity in the periventricular white matter, stable from 11/18/2016. There is no restricted diffusion to suggest acute ischemia. There is no intracranial hemorrhage. There is no intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. The major flow-voids are preserved. The orbits, paranasal sinuses, and calvarium are unremarkable.

Output: Stable examination with small areas of residual signal abnormality but no evidence of recurrent PRES.


Instruction: Generate impression based on findings.

Input: Altered gait and weakness, although diffuse. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. A slight disc bulge and bilateral facet hypertrophy, as well as ligamentum flavum thickening at L4-5 result in minimal to mild neural foraminal stenosis and perhaps slight spinal canal stenosis. There is also minimal disc bulging and facet hypertrophy at L3-4, without significant spinal canal or neural foraminal stenosis. There is no significant spinal canal or neural foraminal stenosis at the other lumbar spine levels otherwise. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: A slight disc bulge and bilateral facet hypertrophy, as well as ligamentum flavum thickening at L4-5 result in minimal to mild neural foraminal stenosis and perhaps slight spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified symptoms and signs involving the nervous systemClinical question: evaluate for cerebellar degeneration / atrophySigns and Symptoms: ataxia (trunk only), word finding difficulty, fatigue The CSF spaces are appropriate for the patient's stated age with no midline shift. Artifact somewhat obscures visualization of the lower medulla. No abnormal mass lesions are appreciated in the cerebellum.There is a developmental venous anomaly present in the left lower medulla.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.

Output: There is no evidence for cerebellar atrophy on this exam.


Instruction: Generate impression based on findings.

Input: 17 years, Female, with bilateral lower extremity pain and systemic symptoms concerning for rheumatologic process. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Borderline low-lying cerebellar tonsils are noted without clear evidence of Chiari I malformation. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI brain is within normal limits. Specifically, no evidence of inflammatory/rheumatologic process.


Instruction: Generate impression based on findings.

Input: Re-evaluate disease status following completion of immunotherapy: Stage IV melanoma. The right sinonasal mass has further decreased in size, measuring up to 2 mm in thickness, previously 4 mm, and displays less enhancement. There is minimal scattered paranasal sinus mucosal thickening. The lesion in the left lateral rectus muscle is also no longer discernible. The right orbit is unremarkable. There is no significant lymphadenopathy in the upper neck. The major salivary glands are unremarkable. The imaged portions of the brain parenchyma and pituitary gland appear unremarkable.

Output: 1. The right sinonasal metastasis has further decreased in size2. No measurable residual left lateral rectus muscle metastasis.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: The lateral meniscus is intact and unremarkable. The medial meniscus however demonstrates irregularity and abnormal signal along the apical aspect with marked fraying and mild globular signal within the central body. No discernible discrete focal tear extends discretely into the body or either horn.ARTICULAR CARTILAGE AND BONE: Mild to moderate diffuse thinning of the cartilage more pronounced in the patellofemoral surface. This latter area demonstrates additional focal defects and no regular surface greater along the lateral facet. Minimal underlying early degenerative changes. Marrow signal otherwise unremarkable. Mild associated degenerative osseous changes.LIGAMENTS: No abnormality noted, ligaments are intact and well-visualized. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Medial meniscal fraying with associated mild degeneration of the medial meniscal body as described. Small to moderate effusion and associated mild scattered degenerative changes


Instruction: Generate impression based on findings.

Input: Female, 28 years old. Left knee pain. Evaluate for patellar tendonitis. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is increased signal within the articular cartilage of the lateral facet of the patella indicating patellar cartilage edema and softening. There is no full-thickness tear or fissuring of the cartilage. The medial and lateral articular cartilage of the femur are intact. There is no bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The trochlea is shallow indicating trochlear dysplasia. The lateral trochlear inclination is abnormal. The tibial tuberosity to the trochlear groove distance is within normal limits measuring 1.5 cm. The patellar and quadriceps tendons are normal.ADDITIONAL

Output: Findings compatible with trochlear dysplasia.


Instruction: Generate impression based on findings.

Input: 65 years Female (DOB:6/8/1951)Reason: CSF leak with ventriculomegaly from pneumocephalus History: AMS, CSF leak, pneumocephalusPROVIDER/ATTENDING NAME: AGNIESZKA ANNA ARDELT AGNIESZKA ANNA ARDELT MRI of the brainThere is intracranial air present within the lateral ventricles as well as just anterior to the right temporal lobe. Interval extends into the right sphenoid sinus. There is a defect present along the lateral aspect of the right sphenoid sinus.There is a focus of encephalomalacia present along the right frontal lobe anteriorly which was also present on the prior exam.There is a 12 mm extra-axial mass adjacent to the left cerebellar hemisphere and of the left tentorial leaf as well as the left occipital bone. It is unchanged since prior exam.There are several 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There is a defect present along the lateral wall of the right sphenoid sinus which appears to represent a source for potential CSF leak. There is associated intracranial air (pneumocephalus) present.2.There is redemonstration of a small extra-axial lesion adjacent to the left cerebellar hemisphere which is stable since 2007.3.No evidence for intracranial aneurysm.4.No evidence for intracranial cerebrovascular occlusive disease5.Several Periventricular and subcortical white matter lesions are present which are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Male, 40 years old, with left-sided numbness. Evaluate for cord compression at C5-6. No evidence of cord compression is seen. Spinal alignment is anatomic. Vertebral body height and morphology are within normal. No evidence of marrow replacement or marrow edema is seen. No significant compromise of the spinal canal or neural foramina is detected.

Output: No evidence of cord compression.


Instruction: Generate impression based on findings.

Input: Male 59 years old Reason: evaluate for gluteus medius tear History: lateral hip pain. Evaluation of the bone and soft tissues of the hips is limited by metallic susceptibility artifact from bilateral total hip arthroplasties. There is also metallic susceptibility artifact anteriorly within the pelvis, perhaps due to components of a penile prosthesis.The main and lateral tendons of the left gluteus medius can be followed to their insertions on the greater trochanter. We see no gluteus medius tear. The gluteus minimus appears thinned. Its tendinous insertion is difficult to visualize due to the aforementioned metal artifact, but we suspect it is intact and we see no abnormal signal or edema in the vicinity of the tendon to suggest a tear. The visualized components of the gluteus maximus muscles are intact. There is moderate atrophy of the psoas muscle on the left. We see no specific findings to suggest complications of either hip prosthesis. Mild degenerative disk disease and facet joint osteoarthritis affect the lower lumbar spine and we suspect that there is narrowing of the spinal canal; this would be better assessed with a lumbar spine MRI if clinically warranted. The sacroiliac joints appear normal. The remaining musculature of the left hip is unremarkable. Grossly, the musculature of the right hip seen on the large field of view images is unremarkable, although the gluteus minimus muscle appear slightly atrophic.

Output: 1.Limited evaluation due to susceptibility metallic artifact from prostheses. Given this limitation, we see no muscle tears; specifically, the gluteus medius appears intact.2.Degenerative arthritic changes of the lower lumbar spine could be better assessed with dedicated lumbar spine MRI if clinically warranted.3.Atrophy of the left psoas muscle.


Instruction: Generate impression based on findings.

Input: 63-year-old male with history of IPMN ABDOMEN:LIVER, BILIARY TRACT: Diffuse decreased signal throughout the liver parenchyma. No suspicious liver lesions.SPLEEN: Diffuse decreased signal throughout the splenic parenchyma.PANCREAS: Markedly atrophic pancreas without main pancreatic ductal dilatation. MRCP images demonstrate subcentimeter cystic lesions likely representing sidebranch IPMNs, not significantly changed since the prior exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic kidneys with subcentimeter renal cortical cysts. Left pelvic renal transplant is partially imaged without hydronephrosis noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Stable appearing side branch IPMNs.2. Diffuse decreased signal in the liver and spleen consistent with iron deposition disease.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect, or cerebral edema. There are minimal foci of T2 hyperintensity in the cerebral white matter, which likely represent perivascular spaces. There is small area of encephalomalacia in the right superior frontal gyrus. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild bilateral maxillary sinus mucosal thickening. The orbits, skull, and extracranial soft tissues are otherwise unremarkable.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Chronic low back pain, L4-L5 degenerative disc disease on x-ray. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:Examination demonstrates uniformly smaller than expected caliber of the lowest visualized thoracic and lumbosacral spine which is believed to represent anatomical variation of congenital small canal/short pedicles.Visualized T10-T11 only on sagittal series demonstrates moderate disc disease and loss of disc height and mild hypertrophic changes of posterior elements which in combination with congenitally small caliber of the spinal canal results in central spinal stenosis and moderate bilateral neural foraminal compromise secondary to degenerative disease.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate moderate to advanced disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. There is a left lateral disc-osteophyte complex with subtle mass effect on the thecal sac and with resultant mild to moderate central spinal stenosis and moderate left neural foraminal compromise.L2-L3 demonstrate mild disc desiccation, mild bilateral ligamentum flavum hypertrophy and mild facet disease. Mild bilateral neural foraminal compromise and central spinal stenosis.L3-L4 demonstrate moderate disc disease and loss of disc height, mild bulging disc, moderate bilateral ligamentum flavum and facet hypertrophy (L>R). Mild bilateral facet effusion. Above findings in combination with congenitally small canal results in moderate central spinal stenosis, moderate left and moderate to severe right neural foraminal compromise.L4-L5 demonstrate moderate to advanced disc disease and loss of disc height, there is a large central and left lateral disc-osteophyte complex, moderate left and mild to moderate right facet and ligamentum flavum hypertrophy. Constellation of findings results in severe central spinal stenosis, significant left and moderate right neural foraminal compromise.L5-S1 demonstrate mild disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis however there is significant bilateral neural foraminal compromise primarily secondary to hypertrophic changes of posterior elements.

Output: 1.There is generalized smaller than expected caliber of the lower most visualized thoracic and thoracolumbar spine believed to represent a congenital anatomical variation.2.Mild to moderate degenerative changes at T10-T11 with resultant central spinal stenosis as detailed.3.Degenerative changes at L3-L4 and including a small left lateral disc-osteophyte complex results in central spinal stenosis.4.Degenerative changes at L3-L4 in combination with congenitally small canal with resultant moderate central spinal stenosis.5.Extensive degenerative changes at L4-L5 and including a large left lateral disc-osteophyte complex results in significant left lateral recess and significant central spinal stenosis.6.There is also evidence of multilevel neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: 83-year-old man with right frontal contusion and left frontal epidural hematoma. Question extension of hematoma. There are bilateral, fluid-density subdural CSF collections. These appear slightly enlarged from previous studies, although the previous exam is suboptimal. The crescent shaped lesion in the left pterion region is isodense to the brain parenchyma and consistent with a meningioma -- this could be better evaluated with MRI. The lesion measures 1.5 x 0.8 cm (series 1430 image 12).There are periventricular regions of hypoattenuation consistent with age-indeterminate, small vessel ischemic disease.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The right frontal scalp hematoma is decreased in size from the prior study.

Output: 1. Bilateral subdural CSF collections with slight increase in size from previous study.2. Left pterion lesion consistent with meningioma.3. No CT evidence of epidural hematoma as questioned on requisition.


Instruction: Generate impression based on findings.

Input: Ms. Finlay is a 62 year old female with a personal history of right breast biopsy in 2007 for LCIS and left breast biopsy in 2007 for ALH. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.Stable hepatic cysts.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Male 20 years old; Reason: eval for labral tear, +obrien + jerk, possible posterior instability History: Shoulder pain ROTATOR CUFF: There is minimally increased signal in the distal supraspinatus tendon, without thickening, possibly representing minimal tendinosis. The remainder of the rotator cuff appears normal.SUPRASPINATUS OUTLET: No significant abnormality noted. Acromioclavicular joint is normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. There is a deep cleft at the anterior-superior labrum, without definite evidence of an acute/subacute abnormality. The posterior labrum is normal.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Minimally increased signal in the distal supraspinatus tendon, without thickening, possibly representing minimal tendinosis. 2. Deep cleft at the anterior-superior labrum, without definite evidence of an acute/subacute abnormality. Correlation with physical examination findings may be helpful. 3. Normal appearance of the infraspinatus and posterior labrum, per clinical query.


Instruction: Generate impression based on findings.

Input: Lumbar radiculopathy, with now increasing left leg pain with numbness. History of recent right-sided L3-4 foraminotomy and microdiskectomy for lumbar radiculopathy, as well as minimally invasive left L5-S1 hemilaminotomy and diskectomy and bilateral laminectomy at L4-L5 in 2005. There are interval postoperative findings related to right L3 foraminotomy and microdiskectomy, with enhancement in the paraspinal tissues along the surgical approach and in the right L3-4 neural foramen, with improved patency of the right aspect of the spinal canal at this level. However, there is persistent mild disc bulge, left ligamentum flavum thickening, and bilateral facet joint hypertrophy with moderate narrowing of the right L3-4 neural foramen, beyond the effects of granulation tissue, and effacement of the left lateral recess at L3. There are remote postoperative findings at L4-5 and L5-S1 with a persistent disc bulge, bilateral ligamentum flavum thickening, and facet hypertrophy with associated mild bilateral L4-5 and right L5-S1 neural foramen stenosis, but severe left L5-S1 neural foramen stenosis, as well as moderate spinal canal stenosis at these levels. There is also trace retrolisthesis of L5 on S1. There is no significant spinal canal or neural foraminal stenosis in the upper lumbar spine. The vertebral body heights are preserved. Aside from degenerative bone marrow signal alterations at L5-S1, the vertebral bone marrow appears unremarkable. The imaged portions of the spinal cord are unremarkable.

Output: 1. Interval postoperative findings related to right L3 foraminotomy and microdiskectomy, with enhancement in the paraspinal tissues along the surgical approach and improved patency of the right aspect of the spinal canal at this level. However, there is persistent mild disc bulge, left ligamentum flavum thickening, and bilateral facet joint hypertrophy with moderate narrowing of the right L3-4 neural foramen and effacement of the left lateral recess at L3. 2. Remote postoperative findings at L4-5 and L5-S1 with a persistent disc bulge, bilateral ligamentum flavum thickening, and facet hypertrophy with associated mild bilateral L4-5 and right L5-S1 neural foramen stenosis, but severe left L5-S1 neural foramen stenosis, as well as moderate spinal canal stenosis at these levels.


Instruction: Generate impression based on findings.

Input: Right upper quadrant and epigastric pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size morphology and signal intensity. A few punctate probable benign hepatic cysts are noted. No focal suspicious lesion biliary ductal dilatation or vascular abnormality.SPLEEN: Normal in size without a focal abnormality.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: Normal MRCP without findings to account for the patient's right upper quadrant and epigastric pain.


Instruction: Generate impression based on findings.

Input: T8 -- T9 level mass. Possible vascular period recommended CTA for further evaluation. Examination demonstrates a dural based high density mass measuring approximately 22 mm in cranial cephalad access in 5-mm in AP access immediately anterior to the superior facet of T8 on the left. There is no evidence of increased vascularity to suggest arteriovenous malformation, dural aVF at this location. This lesion is primarily on the left side however a very small extension of the lesion across the midline to the right is noted. The finding is believed to represent a meningioma. A high density lesion on axial images is more suggestive of calcification rather than enhancement. Review of prior MRI examination demonstrates no abnormal edema of the cord. No definitive increased vascularity within the epidural dorsal fat pad is detected.3D reformatted images of the area of interest were also made.The lesion appears as a calcified intra dural lesion,likely a meningioma.

Output: Dural based intradural extra medullary high density (likely calcification and less likely enhancement) may represent an intracanalicular meningioma. No definitive evidence of increased vascularity to suggest vascular malformation and no evidence of edema of the cord on prior MRI examination from 4 -- 9 -- 2009 was noted.


Instruction: Generate impression based on findings.

Input: Female; 29 years old. Reason: Paraganglioma off therapy; assess for recurrence of disease ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Surgical clips from prior lymph node dissection. No lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Retroverted uterus. Small amount of endometrial fluid, likely physiologic. Small right ovarian simple cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild pelvic ascites, likely physiologic.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: 62-year-old male with left adrenal gland abnormality on recent CT. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Small, peripheral portal hepatic venous shunt is noted in the right hepatic lobe.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Multilobulated left adrenal gland mass measuring up to 5 x 3.1 x 5.6 cm (AP by transverse by craniocaudal, series 701/22 and series 801/13). The lesion is part cystic and part solid with the cystic components demonstrating thin rim enhancement. Evaluation for microscopic fat in the solid component is limited due to suboptimal in-and-out of phase images.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Compression deformities of T12 and L1 vertebral bodies, as detailed on MRI lumbar spine from 6/5/2015.BONES, SOFT TISSUES: Body wall anasarca.OTHER: Mild abdominal ascites.

Output: Partially cystic, partially solid left adrenal mass is incompletely characterized due to suboptimal in-and-out of phase images. The patient will return for repeat sequences at no additional charge.


Instruction: Generate impression based on findings.

Input: Tongue cancer 20 years ago and new dysarthria: evaluate for recurrence. Dental artifact obscures the anterior oral cavity. Otherwise, no measurable mass is apparent in the posterior tongue. The rest of the upper aerodigestive tract is unremarkable. There is also no significant lymphadenopathy in the neck based on size criteria or abnormal signal characteristics. The thyroid and salivary glands appear to be intact. There is extensive volume loss in the imaged portions of the brain. There are bilateral lens implants. There are secretions in the left sphenoid sinus. There is multilevel degenerative spondylosis of the cervical spine.

Output: 1. Dental artifact obscures the anterior oral cavity. Otherwise, no measurable mass is apparent in the posterior tongue. 2. No significant lymphadenopathy in the neck based on size criteria or abnormal signal characteristics.3. Extensive volume loss in the imaged portions of the brain. 4. Secretions in the left sphenoid sinus may be due to acute sinusitis.


Instruction: Generate impression based on findings.

Input: There appears to be an area blurring at grey-white matter interface in the left middle frontal gyrus. The hippocampi are unremarkable and there is no evidence of grey matter heterotopia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: An apparent area of blurring at grey-white matter interface in the left middle frontal gyrus may represent focal cortical dysplasia.


Instruction: Generate impression based on findings.

Input: 19 year old female patient with elevated LFT, bilirubin, conjugated and unconjugated. ABDOMEN:LIVER, BILIARY TRACT: There is no intra- or extrahepatic biliary ductal dilatation. A short segment narrowing in the proximal common bile duct on the thick slab images appears to communicate on rotation of imaging. Furthermore, there is no proximal dilatation. No suspicious hepatic lesion is identified. The hepatic vasculature is patent.SPLEEN: Mild splenomegaly.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: Trace bilateral pleural effusions.

Output: 1.Mild splenomegaly without acute abnormality otherwise to account for the patient's symptoms.2.Trace bilateral pleural effusions.


Instruction: Generate impression based on findings.

Input: Male, 38 years old, with history of thalamic pilocytic astrocytoma, grade 1, follow-up examination. Redemonstrated is a heterogeneous, partially calcified mass arising in the right posterior thalamus. As before, the lesion is exophytic and projects posteriorly into the right lateral ventricular atrium. The overall size of lesion has not significantly changed and continues to measure 34 x 25 mm. Patchy internal enhancement has become slightly larger and more confluent when compared to the immediate prior examination, though it appears similar to older exams.No new intracranial lesions are seen. No significant edema is detected. A punctate nonspecific focus of T2 hyperintensity is seen in the left inferior frontal juxtacortical white matter, unchanged. Apart from effacement of the right ventricular atrium, the ventricular system is stable and normal in size.

Output: There has been no significant interval change in size or imaging characteristics of a heterogeneous, exophytic right thalamic tumor.


Instruction: Generate impression based on findings.

Input: Ms. O'Hara is a 52 year old female with known left breast cancer. She presents for MRI evaluation as part of the I-SPY2 protocol. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left upper inner breast, there is revisualization of the biopsy proven malignancy now measuring 2.4 x 1.9 x 2.2 cm, previously measuring 3.7 x 2.8 x 3.0 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip continues to be seen within this mass.There is no additional abnormal enhancement seen in the remainder of the left breast or the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) Interval decrease in size of index malignancy of the left breast. (2) No MRI evidence for malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and right mastoid air cells are clear. Minimal inflammatory T2 hyperintensity is noted in left mastoid air cells. There is no abnormal enhancement within the brain. Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: Minimal inflammatory T2 hyperintensity is noted in left mastoid air cells. Otherwise negative MRI of the brain and internal auditory canals including gadolinium enhancement.


Instruction: Generate impression based on findings.

Input: 11-year-old female status post fall with effusion, TTP medial knee. MENISCI: The medial and lateral meniscus are normal.ARTICULAR CARTILAGE AND BONE: The articular cartilage is normal with no evidence of thinning or degeneration. Bone marrow signal intensity is normal.LIGAMENTS: The anterior cruciate and posterior cruciate ligaments are normal. The medial and lateral collateral ligaments are normal.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for radicular problems. History of endometrial cancer. History of focal RT. Signs and symptoms: Right lower extremity pain? Radicular. Pre-and post-enhanced lumbar MRI:There is normal anatomical alignment the vertebral column.There is uniform marrow signal changes at all entire visualized thoracolumbosacral spine consistent with a prior radiation therapy changes.Multilevel small Schmorl's nodes of no clinical significance is noted.Lower most visualized thoracic spine and thoracic cord is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable. L2 -- L3 demonstrate mild ligamentum flavum hypertrophy and unremarkable otherwise.L3 -- L4 demonstrate mild bilateral facet and ligamentum flavum hypertrophy and mild degenerative disk disease. Findings results in mild to moderate bilateral (left greater than right) neural foraminal compromise.L4 -- L5 demonstrate mild degenerative disk disease and moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No central spinal stenosis. Mild to moderate bilateral neural foraminal compromise. L5 -- S1 demonstrate mild degenerative disk disease and a tiny far left lateral annular fissure (sagittal T2, T2 stir image 13). This finding demonstrate expected enhancement. No spinal stenosis or neural foraminal compromise.Enhanced images demonstrate no additional foci of enhancement of the vertebral column, cord, conus or cauda equina.

Output: 1.No evidence of malignancy and this exam.2.Mild degenerative disk disease and mild to moderate hypertrophic changes of posterior elements without evidence of central spinal stenosis at any level.3.Tiny far left lateral annular fissure at L5 -- S1 on the left as detailed. Mild to moderate bilateral neural foraminal compromise at L3 -- L4 and L4 -- L5 levels secondary to degenerative changes as detailed.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for spinal stenosis. Signs and symptoms:Poor balance, history of cervical spine surgery. Nonenhanced cervical MRI:Examination demonstrates extensive degenerative disk disease at C4 -- C5 through C7 -- T1 levels and to a lesser degree at other levels. There is resultant mild S-shaped deformity of the cervical spinal.Foramen magnum is unremarkable.C2 -- C3 demonstrate asymmetric hypertrophic changes on the right with right facet hypertrophy changes resultant severe right neural foraminal compromise and unremarkable otherwise.C3 -- C4 demonstrate asymmetric significant right facet hypertrophic changes and asymmetric right-sided uncovertebral hypertrophy resulting in significant right neural foraminal compromise and unremarkable otherwise.C4 -- C5 demonstrate significant disk disease and loss of disk height, significant asymmetric right-sided uncovertebral osteophyte formation and mild asymmetric right facet complex hypertrophy. Constellation of changes at this level results in significant bilateral neural foraminal compromise and moderate central spinal stenosis. There is mass effect and flattening deformity of the ventral aspect of the cord on the right secondary to asymmetric right uncovertebral osteophyte formation. The signal intensity of the cord remains normal.C5 -- C6 demonstrate asymmetric (right greater than left) degenerative changes. Large right-sided uncovertebral osteophyte and to a lesser degree on the left results in mass effect and flattening deformity of the cord and and moderate central spinal stenosis. Significant right and moderate to significant left neural foraminal compromise at this level is also noted.C6 -- C7 demonstrate advanced disk disease with loss of disk height, mildly asymmetric (left greater than right) hypertrophic changes of facet is noted. There is mild central spinal stenosis and significant (left greater than right) neural foraminal compromise at this level.C7 -- T1 demonstrate advanced disk disease with near complete loss of disk height, mild hypertrophic changes of posterior elements, mild grade 1 anterolisthesis. Constellation of changes results in mild central spinal stenosis and moderate bilateral neural foraminal compromise.The signal intensity of the cervical and the upper most visualized thoracic cord to T3 level is within normal.

Output: 1.Nonenhanced MRI of cervical spine demonstrate advanced degenerative changes of disks and the posterior elements and asymmetric (right greater than left) fashion likely secondary to scoliosis as detailed.2.Changes results in central spinal stenosis of varying degree at C4 -- C5, C5 -- C6, C6 -- C7 and C7 -- T1 levels.3.There are also multi-level significant neural foraminal compromise as detailed per level above.4.Although there is flattening deformity of the cord at the levels of spinal stenosis, the signal intensity of the cord however remains within normal.


Instruction: Generate impression based on findings.

Input: Pancreatic lesion, history of chronic pancreatitis per electronic medical record ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. The hepatic and portal veins are patent. Status post cholecystectomy. Prominent common bile duct with a focal stenosis at the ampulla, likely benign.SPLEEN: No significant abnormality noted.PANCREAS: No evidence of pancreatic lesion. The main pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Prominent common bile duct with a focal stenosis at the ampulla, likely benign.2.No evidence of pancreatic lesion.


Instruction: Generate impression based on findings.

Input: Female, 11 years old, status post head injury, craniectomy. Brain:Right frontal scalp swelling is seen along with evidence of the recent craniectomy. The known right frontal bone fracture is not specifically visualized on MRI. Sequelae of prior left frontal ICP monitor are also seen.The right frontal parenchyma subjacent to the area of skull fracture demonstrates mild T2 and questionable mild restricted diffusion. Clear restricted diffusion is seen within the splenium of corpus callosum. There may also be a few additional punctate foci of restricted diffusion, for example along the right superior cerebellum.No evidence of significant generalized mass effect is seen. No abnormal extra-axial collections are detected. Several punctate foci of susceptibility are evident in the right frontal lobe compatible with microhemorrhage. The ventricular system is normal in size and morphology. The mastoid air cells are opacified.C-spine:Straightening of the cervical lordosis is likely positional. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural collections are observed. The prevertebral tissues are difficult to assess due to intubation. The posterior paraspinal musculature is edematous. In addition, there is edema along the inferior aspect of the nuchal ligament, as well as mild edema within some of the interspinous spaces. However, the ligaments of the craniocervical junction, the ALL, PLL and ligamenta flava all appear to be intact. The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is demonstrated.

Output: 1.Sequelae of right skull fracture and craniectomy are demonstrated.2.The frontal lobe parenchyma subjacent to the area of fracturing demonstrates edema with perhaps a minor component of cytotoxic edema. There is also evidence of subtle microhemorrhage. 3.Restricted diffusion is also seen in the splenium of corpus callosum which can indicate axonal shear injury. There may be a few additional foci of punctate restricted diffusion also indicating axonal injury.4.No evidence of injury to the spinal cord or the osseous cervical spine is seen. The posterior paraspinal musculature is edematous. In addition, there is edema suggesting strain or partial tearing along the inferior nuchal ligament and to a lesser degree within the interspinous spaces of the mid cervical spine.


Instruction: Generate impression based on findings.

Input: Male, 2 years old, with sensorineural hearing loss. The periventricular white matter in the cerebral hemispheres appears to be thinned relative to the typical normal appearance for this age group. Similar findings are seen on the prior outside MRI. A single small focus of FLAIR hyperintensity is noted within the right frontal operculum, and there may also be minimal FLAIR hyperintensity in the white matter surrounding the right frontal horn. No pathologic parenchymal or extra-axial enhancement is detected.Brain morphology is otherwise within normal limits. The corpus callosum is fully formed and intact. The extent of white matter myelination has progressed relative to the prior examination and is within acceptable limits for age. No edema or mass effect is seen. No restricted diffusion or evidence of intracranial hemorrhage is noted. The lateral ventricles are mildly prominent, left side more than right, which could be reflective of the above-mentioned white matter thinning.On dedicated imaging of the IACs, the fluid-filled structures of the inner ear are within normal limits. The cochlear nerves are present bilaterally. No pathologic IAC or CP angle enhancement is detected.

Output: 1.Findings suggestive of mild periventricular white matter thinning, not significantly changed from the prior outside examination. No acute intracranial abnormalities are detected.2.On dedicated IAC imaging, no specific abnormalities are detected. The cochlear nerves are present bilaterally.


Instruction: Generate impression based on findings.

Input: Pain after injury There is a tear of the midportion of the tendon of the medial head of the gastrocnemius which extends slightly superiorly however further distally, the tendon appears intact. There is a small associated hematoma and edema within the subcutaneous musculature. The remaining muscles and tendons are intact. The marrow signal of the tibia and fibula are normal.

Output: Tear of the midportion tendon of the medial head of the gastrocnemius although further distally, the tendon is intact. There is a small associated hematoma and subcutaneous edema. Remaining evaluation is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Metastatic renal cell cancer status post thoracolumbar surgery for tumor decompression and fusion. Evaluate for change to residual or recurrent tumor. Thoracic: Again seen are postsurgical changes of spinal fusion with thoracic hardware extending from T7 to T12 with bilateral paraspinous rods and bilateral pedicle screws at the T7, T8, T11, and T12 levels. There is evidence of decompressive laminectomies from T8 to T10. Postsurgical changes in the lumbar spine are described in the section below. Compared to 9/23/2015, there is no significant change in extensive marrow infiltration involving the T9 vertebral body with extension into the posterior elements as well as the ventral epidural space, with resulting complete effacement of the ventral thecal sac. Dorsal thecal sac is preserved without evidence of significant mass effect on the cord at this level. Again seen is moderate narrowing of the right T9-T10 neural foramen related to tumor and not significantly changed since prior. There has been interval increase in diffuse tumor infiltration at the T3 level. The T3 lesion previously measuring 4.9 x 2.7 cm now measures 5.2 x 6.4 cm in the AP and transverse dimensions (axial T2 image 23 or series 1001) and involves the left aspect of the vertebral body, pedicles, lamina, and transverse process and extends laterally along the left chest wall. Besides the increased vertebral involvement, there is also new epidural tumor effacing the left lateral aspect of the thecal sac and mild associated deformity of the cord. There is also development of moderate to severe neural foraminal stenosis involving the left T2-T3 and T3-T4 neural foramina. No new cord signal abnormality.Tumor infiltration involving the T10 vertebral body is not significantly changed. There is a small lesion involving the left T1 transverse process also similar to prior.Pathologic fracture with mild loss of height of the T9 vertebral body and mild osseous retropulsion is not significantly changed. Vertebral body heights and alignment are otherwise grossly preserved in the thoracic spine. Adrenal nodules and evidence of left nephrectomy again seen and better assessed on recent CT.Lumbar: Postsurgical changes in the thoracic spine continue into the lumbar spine with paraspinous rods and bilateral pedicle screws at the L2 and L3 levels. Partial corpectomy with graft placement again noted at the L1 level. Laminectomy at T12 and at L1 for spinal canal decompression also again seen.Tumor infiltration involving the residual L1 vertebral body is again seen. Susceptibility artifact limits evaluation however finding is not significantly changed. Mild compression fracture involving the L1 vertebral body is also not significantly changed. Elsewhere in the lumbar spine, no definite evidence of new or progressive marrow signal abnormality is seen. No findings to suggest epidural or leptomeningeal disease in the lumbar spine. Partially imaged pelvis demonstrates enlargement of bilateral iliac wing and right sacral lytic lesions. There appears to be increased tumor infiltration involving the neural foramina of the right S1 and S2 nerve roots.Aside from the mild compression fracture of L1, vertebral body heights are preserved. Alignment is grossly preserved aside from mild reversal of lordosis at the L3 level. There is mild to moderate narrowing of the right T12-L1 and L1-L2 neural foramen related to tumor. There is also mild narrowing of the left L4-L5 and right L5-S1 neural foramina on a degenerative basis.

Output: 1. Compared to 9/23/2015 there has been progression of metastatic disease, particularly at the T3 level where there is increased vertebral involvement and increased epidural tumor effacing the left lateral aspect of the thecal sac with mild associated deformity of the cord. No evidence of frank cord compression or cord signal abnormality. There is also increased tumor involving the left T2-T3 and T3-T4 neural foramina.2. Interval progression of tumor within the partially visualized right sacrum and bilateral iliac bones. There appears to be increased tumor infiltration surrounding the right S1 and S2 nerve roots in the neural foramina.3. Postsurgical changes related to spinal canal decompression and fusion are again seen. There remains effacement of the ventral thecal sac related to epidural tumor at the T9 level similar to prior. Spinal canal is surgically decompressed posteriorly at this level.4. Additional foci of tumor are not significantly changed. Mild pathologic fractures involving the T9 and L1 vertebral bodies are not significant changed. Please see details above.


Instruction: Generate impression based on findings.

Input: Clinical question: Has disc herniation changed. Signs and symptoms: Left lower extremity progressive, preop, symptoms changed. Nonenhanced lumbar MRI:The alignment of the vertebral column remains anatomical and stable since prior study.Examination at T 11-T12 through L2-L3 levels is unremarkable.L3-L4 demonstrate mild disc disease and loss of disc signal and height, mild bilateral facet and ligamentum problem hypertrophy without central spinal stenosis or neural foraminal compromise. There is a right para median linear T2 hyperintensity within the annulus of the disc consistent with an annular fissure. This finding is more conspicuous (axial T2 series 6 image 21 and sagittal T2, T2 STIR image 8) on current exam compared to prior study which is suggestive of interval worsening.L4-L5 demonstrate moderate disc disease and loss of disc height and signal intensity and moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet disease however. Bilateral facet effusion fairly similar to prior study.Previously noted large central broad-based disc protrusion demonstrate interval increase in size and mass effect on the thecal sac and spinal stenosis. On axial T2 series 6 image 15 disc protrusion measures approximately 19 mm at the base and 7 mm in height both feet interval increase since prior study measurement of 15 x 4 mm. Moderate central spinal stenosis with interval worsening and no neural foraminal compromise.L5-S1 is unremarkable other than mild degenerative changes.

Output: 1.Interval increased size of a central L4-L5 disc protrusion with increased mass effect and moderate central spinal stenosis without neural foraminal compromise.2.No spinal stenosis or neural foraminal compromise at any other level.3.More conspicuous right paramedian annular fissure at L3-L4 since prior study.


Instruction: Generate impression based on findings.

Input: Left leg pain and weakness and anosmia with history of stroke. Brain: There is cavitary encephalomalacia centered in the straight gyri bilaterally, right larger than left, as well as volume loss of the bilateral olfactory bulbs and tracks. There is also susceptibility effect along the margins of the encephalomalacic cavities, which likely represents chronic hemosiderin deposition. Furthermore, there is dural thickening and enhancement of the overlying dura in this region, which may be reactive in nature. There are subcentimeter foci of encephalomalacia in the pons and left thalamus and basal ganglia. There is unchanged extensive diffuse patchy and punctate T2 hyperintensity and scattered punctate foci of susceptibility effect in the cerebral and brainstem white matter. There is a background of mild diffuse cerebral volume loss. There is no evidence of acute infarction. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The skull and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening and secretions. There are also subcentimeter adenoid retention cysts.Orbits: There is a defect in the defect in the left lamina papyracea, with protrusion of orbital fat and deformity of the left medial rectus muscle. The bilateral globes and ocular adnexa otherwise appear to be intact. There is no evidence of intraorbital mass lesions or abnormal enhancement.

Output: 1. Encephalomalacia and hemosiderin deposition involving in the bilateral straight gyri, as well as the olfactory bulbs and tracks, right larger than left, which may represent the sequela of prior hemorrhagic contusions. 2. Extensive chronic small vessel ischemic disease and chronic lacunar infarcts, but no evidence of acute infarction. 3. A defect in the left lamina papyracea may represent a chronic fracture. The bilateral orbits otherwise appear unremarkable.


Instruction: Generate impression based on findings.

Input: History of liver transplant. GI bleed. Evaluate for pseudoaneurysm. ABDOMEN:LIVER, BILIARY TRACT: The patient is status post liver transplant. The liver is normal in morphology and size measuring 17 cm in craniocaudal dimension. Mild decrease in signal intensity on in phase imaging suggesting iron deposition. No intrahepatic or extrahepatic biliary ductal dilatation. The hepaticojejunostomy appears patent. Small volume perihepatic ascites.No suspicious liver lesion.As seen on the prior study the donor common hepatic artery originates from the anterior aorta superior to the celiac axis. The celiac axis demonstrates mild dilatation just distal to its ostium which is nonspecific and unchanged from prior studies. The pulmonary vein and hepatic veins are patent. No specific evidence of pseudoaneurysm. Small periportal lymph nodes are noted.SPLEEN: Mild splenomegaly measuring 16 cm in craniocaudal dimension. 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: Mild dilatation of the celiac artery just distal to its ostium is unchanged.Incompletely evaluated presumed small bowel bowel in the right hemiabdomen demonstrates mild hyperenhancement.BONES, SOFT TISSUES: Mild gynecomastia.OTHER: Moderate left and small right pleural effusion with adjacent compressive atelectasis. Right midlung mass lesion better evaluated on prior CTs.

Output: 1.No pseudoaneurysm is identified. A more sensitive evaluation would be a CT angiogram. Alternatively if the patient continues to have symptoms of GI bleeding a CT angiogram or nuclear medicine tagged RBC scan should be considered. 2.Dilatation of the celiac artery just distal to the ostium is unchanged.


Instruction: Generate impression based on findings.

Input: Hemangioma of intracranial structures [D18.02] / Headache [R51] / Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: yearly surveillance of ccm/aneurysm History: headaches Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Multifocal various sized susceptibility lesions throughout the brain including pons, midbrain, right frontal and left occipital lobes are again seen, unchanged.No evidence of associated surrounding edema indicating recent hemorrhages.No evidence of abnormal enhancement either.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 2mm sized right ACA proximal A2 segment. The size and configuration of the aneurysm appear to be stable since prior scan.Bilateral Pcom arteries and Acom artery are patent.There is no other intracranial arterial aneurysm seen.There is no evidence of intracranial arterial luminal stenosis.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of multiple susceptibility lesions in the brain.3. No change of 2mm sized right ACA A2 segment aneurysm since prior scan.


Instruction: Generate impression based on findings.

Input: Female 59 years old Reason: several weeks of left knee pain, Baker's cyst History: several weeks of left knee pain, Baker's cyst; minimal improvement with PT MENISCI: There is a complex tear of the medial meniscus at the junction of the posterior horn and body including a radial component which may be complete. The anterior horn appears intact. There is also a poorly defined abnormal signal intensity within the inner third of the posterior horn of the lateral meniscus extending to both the tibial and femoral articular surface likely representing additional degenerative tearing.ARTICULAR CARTILAGE AND BONE: There is tricompartmental osteoarthritis with full-thickness cartilage loss most severely affecting the patellofemoral and medial compartments with underlying subchondral cysts in the patella and femoral trochlea. There is tricompartmental osteophyte formation.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Osteoarthritis and Baker's cyst as described above.2.Tears of the medial and lateral meniscus and other findings as described above.


Instruction: Generate impression based on findings.

Input: 59-year-old male with dysarthria and imbalance. Evaluate for stroke. No evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia seen in the right frontal lobe. There are postsurgical changes within the right parietal region with abnormal FLAIR signal and evidence of old blood products involving the right parietal lobe. The diffusion hyperintensity in this region is likely artifactual related to the blood products. There is no evidence of mass. There is abnormal focus of FLAIR signal in the left occipital lobe which may also be related to prior infarct. There is additional mild-to-moderate scattered periventricular and subcortical white matter hypoattenuation which is nonspecific and likely related to chronic small vessel ischemic disease.There is mild prominence of the extra-axial CSF spaces along the bilateral cerebral convexities which is favored to be related to the patient's global parenchymal volume loss although small subdural effusions without mass effect remain a small possibility. 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.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct. 2.Post-surgical changes of a prior right parietal craniotomy with focus of right parietal lobe encephalomalacia with chronic blood products. 3.Right frontal lobe encephalomalacia and evidence of an additional probable small infarct involving the left occipital lobe.4.Scattered mild-moderate chronic likely small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 57-year-old male. Right shoulder pain. Follow up from x-ray. ROTATOR CUFF: Full-thickness rotator cuff tear of the supraspinatus at the musculotendinous junction with associated marked fatty atrophy of the muscle belly. There is proximal retraction measuring approximately 13 mm and the tear involves almost the complete AP dimension of the supraspinatus, spanning 18 mm.Mild tendinosis of the subscapularis and infraspinatus without a tear. No edema or atrophy of these muscles. SUPRASPINATUS OUTLET: Moderate AC joint osteoarthritis with capsular hypertrophy and osteophytes. GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenoid labrum is grossly intact. Moderate osteoarthritis of the glenohumeral joint with small osteophytes.BICEPS TENDON: Intact and situated in the bicipital groove. ADDITIONAL

Output: Full thickness supraspinatus tear at the musculotendinous junction with associated retraction and marked muscle fatty atrophy.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage. There has been an interval increase in size of the confluent patchy regions of T2 hyperintensity and T1 hypointensity throughout the supratentorial white matter. In addition, there are more prominent and confluent regions of decreased diffusion throughout the supratentorial cortex as well as the basal ganglia and thalami. The ventricles and sulci have slightly increased in prominence, likely due to global volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is fluid within the bilateral mastoid air cells.

Output: Finding most compatible with severe hypoxic ischemic injury with interval evolution since the prior exam.


Instruction: Generate impression based on findings.

Input: 10-year-old female patient with autoimmune thyroiditis.EXAMINATION: Sonogram thyroid 12/14/2016 RIGHT LOBE MEASUREMENTS: 1.8 x 5.2 x 1.4 cm.LEFT LOBE MEASUREMENTS: 2.0 x 5.5 x 1.2 cm.ISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Diffusely enlarged, heterogeneous, hypervascular without focal nodule.LEFT LOBE: Diffusely enlarged, heterogeneous, hypervascular without focal nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Enlarged, benign-appearing lymph nodes are noted bilaterally.OTHER: No significant abnormality noted.

Output: 1.Enlarged and heterogeneous thyroid gland without focal nodule is suggestive of thyroiditis, similar to prior examination.2.Enlarged benign appearing lymph nodes bilaterally.


Instruction: Generate impression based on findings.

Input: Presents with right upper quadrant pain. History of liver transplant and biliary stricture. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from a liver transplant. The gallbladder is absent.Subcentimeter segment II and V very hyperintense T2-weighted foci compatible with cysts.No suspicious liver lesion. Mild intra and extrahepatic biliary ductal dilatation with the common duct measuring 9 mm at the porta hepatis, increased from the prior study. There is a focal T2-band near the anastomotic site suspicious for a focal stricture, best seen on series 501, image 18. Distally the duct tapers smoothly to the level ampulla. No filling defect to suggest a mass.The hepatic artery, portal vein and hepatic veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: 8 x 8 mm cystic lesion in the head/uncinate process of the pancreas with lobular margins but no septations, or mural enhancing nodules, unchanged and likely a sidebranch IPMN. Additional relatively stable subcentimeter cystic foci in the pancreatic, body and numerous foci in the pancreatic tail are relatively stable in size and number.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable subcentimeter cyst in the superior pole of the left kidney. No hydroureteronephrosis or suspicious focal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild bilateral gynecomastia.OTHER: No significant abnormality noted.

Output: 1.Interval increase in intra and extra-hepatic biliary ductal dilatation with a focal T2-band near the level of the anastomosis suspicious for a focal stricture. 2.No significant interval change in the multiple subcentimeter pancreatic cystic foci most consistent with sidebranch IPMNs.


Instruction: Generate impression based on findings.

Input: 70 years, Male, lung adenocarcinoma. Staging. Multiple sequences are motion degraded which may limit detection of small metastatic foci. There is an 8 x 8 mm peripherally enhancing lesion in the left medial temporal lobe with mild surrounding edema suspicious for a small metastasis, axial post gadolinium reformatted image 71, series 1202. No intracranial mass effect or abnormal parenchymal or meningeal enhancement elsewhere to suggest additional metastasis. There is a small focus of susceptibility in the right occipital lobe abutting the right occipital horn compatible with chronic microhemorrhage. No findings to suggest recent infarct. Ventricles are normal in size. Major flow voids are preserved. There is mild mucosal thickening in the right maxillary sinus with a right maxillary sinus mucus retention cyst. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 8 x 8 mm peripherally enhancing lesion in the left medial temporal lobe highly suspicious for metastasis. No additional lesions are appreciated within the limits of a motion degraded study.


Instruction: Generate impression based on findings.

Input: right sided numbness, vertigo No evidence of acute ischemic or hemorrhagic lesion on this scan.Scattered high signal intensity lesions on FLAIR images on bilateral white matter indicate non specific small vessel disease. No change since prior exam.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Minimal non specific small vessel disease as described above.


Instruction: Generate impression based on findings.

Input: Diffuse osseous metastases involving the cervical, thoracic and lumbar spine, as well as the sacrum are again noted. There is no evidence of acute cord compression. Mild loss of height of the T12 and T7 vertebral bodies again noted.Moderate degenerative disease affects the lower cervical spine with disk osteophyte complexes, but there is no evidence of acute cord compression. Small disk bulges along the lower thoracic and lumbar spine without acute cord compression.

Output: 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. Diffuse osseous metastasis is again seen with no evidence of acute cord compression. Mild epidural extension of sacral metastasis is again seen.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Trouble swallowing and neck pain. There is no evidence of mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is minimal anterolisthesis of C4 upon C5. The vertebral and carotid artery flow voids appear to be intact. The imaged intracranial structures are unremarkable.

Output: No evidence of mass lesions in the neck.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for progression of spinal stenosis, worsened pain after fall one year ago. Signs and symptoms: Back pain radiating down lateral right thigh. Nonenhanced lumbar MRI:Lower most visualized thoracic spine and thoracic cord from T10 inferiorly is unremarkable and stable since prior exam.T12-L1 is unremarkable and stable since prior study.L1-L2 demonstrate mild disc desiccation and mild bilateral facet and ligamentum flavum hypertrophy. Findings at this level results in mild central spinal stenosis which has progressed since prior study. Mild bilateral neural foraminal compromise remains however very similar to prior exam.L2-L3 demonstrates advanced disc disease and loss of disc height with mild interval progression. Mild to moderate bilateral facet and ligamentum flavum hypertrophy is also noted without convincing evidence of change. Findings results in moderate to severe central spinal stenosis without significant change. There is a lateral and far lateral right-sided disc protrusion (axial T2 series 1001 image 18 and sagittal T2/T2 stair image 12). This finding results in compromise of right neural foramina and with mass effect and superior displacement of right L2 nerve root. Degenerative changes results in mild-to-moderate left neural foraminal compromise without significant change.L3-L4 demonstrate advanced disc disease and loss of disc height with mild interval progression. There is asymmetrical right-sided disc bulge or broad-based disc protrusion which results in compromise of the right neural foramina and mass effect on the right L3 nerve root. There is subtle interval progression of these findings since prior exam. Moderate to severe left neural foraminal compromise is again noted without appreciable change. Moderate central spinal stenosis with suggestion of slight interval progression since prior study at this level is also noted.L4-L5 demonstrate moderate disc disease and moderate bilateral ligamentum flavum hypertrophy with mild facet disease. No spinal stenosis however mild left neural foraminal compromise is present. There is subtle interval progression of disease.L5-S1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.The perispinal soft tissues remain unremarkable.

Output: 1.Extensive degenerative changes at L2-L3 with resultant moderate to severe central spinal stenosis without significant change. There is a new right-sided disc protrusion with further compromise of right neural foramina and mass effect on the right L2 nerve root.2.Extensive degenerative changes at L3-L4 with resultant central spinal stenosis and neural foraminal compromise with mild progression as detailed.3.Mild degenerative changes at L1-L2 with interval progression and new mild central spinal stenosis.4.Please review detailed report per level above.


Instruction: Generate impression based on findings.

Input: Male 81 years old Reason: stenosis? History: Right lower extremity radiculopathy The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. Probable T11 hemangioma is incidentally noted. Mild degenerative endplate signal change at L5-S1. Otherwise no focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact, with its tip at the L1-2 level.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 no significant compromise to spinal canal or neural foramina.L3-L4: Mild broad-based disc bulge. Moderate facet hypertrophy. Mild central spinal stenosis. No neural foraminal narrowing. L4-5: Moderate facet hypertrophy. Broad-based bulge with superimposed central protrusion, with severe central spinal stenosis. Mild bilateral foraminal narrowing.L5-S1: Moderate facet hypertrophy. Broad-based disc bulge with superimposed left paracentral disc protrusion, with mild central spinal stenosis. Effacement of the left lateral recess, with the S1 nerve root posteriorly displaced. Moderate left and mild right neural foraminal narrowing.

Output: Multilevel degenerative spondylosis, with central protrusion at L4-5 with severe central spinal stenosis, and other findings as above.