Instruction: Generate impression based on findings.

Input: Female; 56 years old. Reason: Stem cell transplant patient with a recent CT showing a dome on her liver. Pt currently has a MSSA bacteremia. ABDOMEN:LIVER, BILIARY TRACT: Paradoxical loss of signal on in-and-out of phase images of the liver diffusely, suggestive of iron deposition.2.7 x 2.4 cm T2 hyperintense, T1 hypointense round segment 4a lesion with restricted diffusion. The degree of T2 hyperintensity is less than expected for simple fluid. The lesion demonstrates equivocal slight internal enhancement. Overall, the lesion is most suspicious for hepatic abscess, though solid lesion from tumor cannot be entirely excluded. Smaller, scattered hepatic cysts are similar to prior exams.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Old, healed right anterolateral rib fractures.OTHER: Patchy right lower lobe airspace opacities, similar to prior CT chest. Left axillary lymphadenopathy, partially visualized.

Output: 2.7 x 2.4 cm right hepatic lobe lesion most suspicious for hepatic abscess, though solid lesion from tumor cannot be entirely excluded.Findings discussed with Dr. Caponi at 10:35 a.m. on 4/27/15.


Instruction: Generate impression based on findings.

Input: Headache [R51] / Other symptoms and signs involving the musculoskeletal system [R29.898], Reason for Study: ^Reason: Evaluate for brain lesions or normal pressure hydrocephalus History: Recurrent bilateral leg weakness and headache. No evidence of acute ischemic or hemorrhagic lesion.About 8mm x 10mm sized pineal cyst, unchanged in its size and MR characteristics since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no other mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening on the right maxillary sinus and sphenoid sinus.

Output: Unchanged pineal gland cyst in terms of size and MR characteristics.Otherwise no remarkable finding.


Instruction: Generate impression based on findings.

Input: 43 year old with recent history of stereotactic biopsy of left breast calcifications, with a result of ADH, presents for research MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a segmental non-mass enhancement in the left breast at upper outer quadrant, measuring 30 x 29 x 44 mm (AP x LR x CC), corresponding to the area of amorphus calcifications.In the right breast, there is an enhancing lobulated mass measuring 10 x 7 x 15 mm at 12 o'clock position. No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Segmental non mass enhancement in the left upper outer quadrant, suggesting malignancy.2. Enhancing mass in the right 12 o'clock position, for which MR directed ultrasound is recommended. If no sonographic correlate is detected, MR guided biopsy should be considered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 24-year-old female with right foot pain along the metatarsal heads Ankle: There is a lobulated T2 bright, T1 dark fluid collection measuring approximately 1.8 x 0.8 cm with small tail extending posterior from the tibiotalar joint, consistent with a ganglion cyst. No enhancement is visualized on postcontrast images. Minimal fluid is noted within the tibiotalar joint. The ATFL and PTFL as well as the deltoid ligament complex are intact. The bones appear normal. A soft tissue marker is noted along the posterior aspect of the ankle.Foot: A soft tissue marker is noted along the plantar aspect of the second and third metatarsals without underlying abnormality identified. The bones and soft tissues appear within normal limits.

Output: Ganglion cyst posterior to the tibiotalar joint as described above.


Instruction: Generate impression based on findings.

Input: Male 64 years old Reason: eval for lymph node recurrence History: s/p transanal excision of T1 rectal cancer 2/2014 PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Two subcentimeter nodes in the left mesorectal fascia, unchanged compared to prior study. No new lymphadenopathy.BOWEL, MESENTERY: Scattered sigmoid colon diverticula. Non distention of the rectum. Within this limitation no mass lesion is evident. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of rectal mass. Two subcentimeter nodes in the left mesorectal fascia are unchanged compared to prior study. No new lymphadenopathy.


Instruction: Generate impression based on findings.

Input: History of hyperbilirubinemia, evaluate intrahepatic biliary ductal dilatation seen on abdominal ultrasound. ABDOMEN:LIVER, BILIARY TRACT: The hepatic parenchyma demonstrates normal signal intensity without focal lesions. There is scattered minimal intrahepatic biliary ductal dilatation. The common bile duct is normal in caliber measuring up to 5 mm. No biliary stones or strictures are identified. The gallbladder is unremarkable in appearance without cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal morphology, signal intensity, and enhancement. No focal pancreatic lesions are identified. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Minimal scattered intrahepatic biliary ductal dilatation without dominant stricture. No common bile duct dilatation.


Instruction: Generate impression based on findings.

Input: Female, 45 years old. Pain. F/u bone edema second metatarsal. There is bone marrow edema diffusely involving the navicular on STIR images, with slightly decreased T1 signal particularly along the anterior aspect of the bone, but no discrete fracture line is identified. The remainder of the bones of the ankle and midfoot show normal marrow signal. There is no specific abnormality in the region of the marker which is placed along the medial aspect of the first metatarsal head.There is mild nonspecific edema in the region of the flexor muscles plantar to the first and second metatarsals extending toward the forefoot. Otherwise, the soft tissues including the sinus tarsi show normal signal. There is a small ankle joint effusion.

Output: Abnormal bone marrow signal of the tarsal navicular without discrete fracture line identified. This is a nonspecific finding, which may reflect stress reaction/chronic injury or early avascular necrosis.


Instruction: Generate impression based on findings.

Input: T1N0 squamous cell carcinoma of the right oral tongue here for initial consultation. There may be minimal signal abnormality along the right alteral oral tongue related to tumor excision, but there is otherwise no discernible gross tumor in the oral tongue or other portions of the upper aerodigestive tract. The imaged cervical lymph nodes are not particularly enlarged. The major salivary glands and thyroid gland are unremarkable. There is an anterior disc-osteophyte complex at C5-6. The imaged portions of the orbits and intracranial structures are unremarkable.

Output: Findings attributable to right oral tongue tumor excision, but no evidence of gross residual or recurrent tumor. No evidence of significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Headache, retroorbital pain/pressure in right eye, diplopia, and decreased visual acuity. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. 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.Orbits: The bilateral globes and optic nerves are intact. The lacrimal glands, extraocular muscles, orbital fat, and vessels are unremarkable bilaterally. There is no evidence of intraorbital mass lesions.

Output: Unremarkable brain and orbits.


Instruction: Generate impression based on findings.

Input: Other intervertebral disc degeneration, lumbar region [M51.36], Reason for Study: ^Reason: radicular pain, back pain History: radicular pain, back pain. The lumbar lordosis is preserved. There is minimal retrolisthesis of L2 over L3 and mild anterolisthesis of L3 over L4, L4-L5, and L5 over S1. The vertebral body heights are maintained. Mild multilevel loss of intervertebral disc space is demonstrated. The conus terminates at L1. There is a small focus of T2 hyperintensity involving the spinal cord at T8-T9 level. Redundancy of the cauda equina is noted. There are multilevel degenerative changes of the lumbar spine as described below in detail. Of note, T8-T10 levels are only imaged in sagittal plane. T8-9: There is a disc bulge resulting in moderate central and mild bilateral neuroforaminal stenosis.T9-T10: There is a disc bulge with mild central and mild to moderate bilateral neuroforaminal stenosis, slightly worsened since prior examination.T10-T11: There is a disc bulge and small extrusion with superimposed hypertrophy of the ligamentum flavum resulting in mild spinal and mild to moderate bilateral neuroforaminal stenosis not significant changed from prior examination.T11-T12: Minimal disc protrusion, hypertrophic degenerative changes of the facets and ligamentum flavum without significant foraminal or central spinal stenosis.T12/L1: Facet disease and ligamentum flavum hypertrophy without significant central canal or neural foraminal stenosis.L1/2: Facet disease and ligamentum flavum hypertrophy without significant central canal or neural foraminal stenosis.L2/3: There is a disc bulge with hypertrophic degenerative changes of the posterior facet and ligamentum flavum resulting in moderate central and moderate bilateral neuroforaminal stenosis, not significantly changed since prior examination.L3/4: There is a disc bulge with advanced hypertrophic degenerative changes of the facets and ligamentum flavum resulting in severe spinal and bilateral neuroforaminal stenosis, slightly progressed since prior examination.L4/5: Disc bulge and hypertrophy of the facets and ligamentum flavum result in mild to moderate bilateral neuroforaminal and mild central spinal stenosis.L5/S1: Disc bulge with superimposed facet/ligamentous hypertrophic degenerative changes resulting in moderate left and mild to moderate right neuroforaminal stenosis.There are bilateral simple appearing renal cysts.

Output: 1. Multi-level marked degenerative disk disease as detailed above, most severe at L3-L4 and L4-L5, including spinal canal stenosis and neural foraminal stenosis. These findings are slightly progressed since 2012.2. Degenerative changes of the visualized lower thoracic spine included probable spinal cord impingement at T8-T9 where there is a small area of cord signal suggestive of myelomalacia or edema. Dedicated thoracic imaging can be obtained as clinically warranted.


Instruction: Generate impression based on findings.

Input: 38-year-old female with history of lumpectomy for right breast DCIS in 2015 presents for annual mammography. Patient received tamoxifen, but no radiation. No current breast related complaints. Three standard views and spot magnification views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography (BiRads Density Category D), unchanged in pattern and distribution. There are two linear scar markers overlying the right breast. There are postsurgical changes of the right breast, noting surgical clips. There is a rod-shaped biopsy clip in the upper outer posterior right breast. There are amorphous calcifications anterior and posterior to the clip, spanning approximately 25 mm. There are amorphous calcifications in the lower inner right breast at anterior-mid depth spanning approximately 1.5 cm.There is a 4 mm cluster of calcifications in the upper outer posterior left breast. More laterally, there is a second cluster of calcifications in the upper outer left breast at posterior depth, best seen on the CC view, measuring approximately 3 mm. There is a 1.8 cm partially circumscribed oval mass in the upper outer left breast adjacent to the calcifications, compatible with a cyst, better seen on breast MRI dated 8/18/2106.

Output: Postsurgical changes from right breast lumpectomy. Indeterminate calcifications in the upper outer right breast, lower inner right breast, and upper outer left breast. Comparison with prior imaging is recommended to evaluate for stability and/or interval changes.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison.


Instruction: Generate impression based on findings.

Input: 69-year-old with right breast 8 cm spanning DCIS (biopsy posteriorly), no biopsy performed of the anterior calcifications (which she declines). MRI performed to assess extent of disease prior to surgical spanning. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Right breast:Few subcentimeter cysts identified in the right breast. Few dilated fluid filled ducts are seen in the right retroareolar region.Clip artifact identified in the right upper-outer quadrant posterior depth at approximately 9:00 position. Extensive area of segmental clumped nonmass enhancement is seen from 9 to 2:00 position, extending anteriorly towards the nipple. Non mass enhancement is also seen extending in a discontinuous fashion medially and anteriorly. Total non mass enhancement measures 12 x 7.7 x 4.4 cm (AP X ML X CC). Distance of the nonmass enhancement from the nipple measures 8 mm. The nonmass enhancement especially in the medial anterior breast approximately 1 to 2:00 position appears more nodular and clumped, with rapid uptake and washout kinetics, cannot rule out microinvasion.Left breast:No abnormal enhancement is seen in left breast. Few benign morphology enhancing foci are noted in the left breast including a benign intramammary lymph node with a correlate on T2-weighted sequence and on the mammogram. A complicated septated cyst with peripheral rim enhancement is identified in the left breast 3:00 position measuring 19 x 19 x 16 mm (AP X ML X CC).No abnormal lymph nodes are identified in either axillary region.

Output: 1. Extensive nonmass enhancement in the right breast extending from 9 to 2:00 position, more than seen on the mammogram spanning 12 cm in maximum dimension. Areas of clumped nodular enhancement and suspicious kinetics in the medial anterior breast, cannot rule out microinvasion. If additional tissue sampling is needed at that site, MR directed ultrasound can be performed to find a correlate.Closest distance of the nonmass enhancement from the nipple measures approximately 8 mm.2. Complicated cyst and a benign intramammary lymph node in the left breast.3. No abnormality noted in the axillary regions.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: pseudotumor cerebri, chiari and shunt, yearly follow up Again seen is evidence of suboccipital craniectomy and resection of the posterior C1 arch for Chiari decompression. The shape and positioning of the cerebellar tonsils above the C1 level are unchanged from prior. CSF flow sequence is significantly degraded but there is suggestion of preserved flow ventrally and dorsally at the foramen magnum. There is also no significant crowding at the foramen magnum.Minimal nonspecific T2 hyperintensity along the body of the right lateral ventricle is unchanged. No other new or significant parenchymal lesions are seen. No evidence of acute ischemia or hemorrhage within the limits of susceptibility artifact relating to the shunt. No mass effect or edema is detected. The ventricular system is stable and normal in size. Shunt catheter terminates near the foramen magnum on the left as seen before.Major flow-voids are preserved. Tiny right maxillary sinus mucus retention cyst which was also present previously. Paranasal sinuses and mastoid air cells are grossly clear.

Output: Stable postoperative findings related to Chiari decompression. Stable size of ventricles. No new or acute intracranial abnormalities.


Instruction: Generate impression based on findings.

Input: A 57 year old male with atrial flutter and suspected hypertrophic cardiomyopathy by echocardiography referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with hyperdynamic performance. The mass is severely increased. There is excentric hypertrophy while the maximal thickness was noted at the infero- septum (24mm). The overall LV ejection fraction is 68%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 232 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 141 g/m2 (normal range 85+/-15), and the LV mass is 321 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is extensive late gadolinium enhancement involving the entire apex transmurally, and in a patchy pattern at the base and middle segments of all the walls (septum, lateral, inferolateral, inferior and anterior) but predominantly at the septum. The pattern is atypical for myocardial infarction and correlates with the diagnosis of hypertrophic cardiomyopathy. There is no iron overload. No findings supporting cardiac amyloidosis.No intracardiac thrombus.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with hyperdynamic performance. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 237 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 83 ml (normal range 54+/-17). The was is mildly thickened with enhancement.Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation. There is no stenosis. Accelerated flow was noted through the valve. There is no systolic anterior movement phenomenon.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. No systolic anterior motion of the anterior leaflet of the mitral valve.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. The left ventricle is normal in size with hyperdynamic contractility; the LVEF is 68%. The mass is severely increased with eccentric hypertrophy. Maximal thickness at the infero- septum (24mm). Extensive enhancement involving the entire apex transmurally, and in a patchy pattern at the base and middle segments of all the walls (septum, lateral, inferolateral, inferior and anterior) but predominantly at the septum. Enhancement is also noted at the RV insertion at septum. No SAM or MR. 2. The right ventricle is normal in size with hyperdynamic performance, the RVEF is 65%. Mild thickening with enhancement. These findings suggest hypertrophic cardiomyopathy with biventricular involvement.3. The nonstenotic, trileaflet aortic valve opens widely, mild aortic regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Seizures. There is T2 hyperintensity and volume loss involving the left hippocampus. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. There is no evidence of mass lesions. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with left medial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: Seizure. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are small areas of encephalomalacia in the right pons, right basal ganglia, and left thalamus. There are several scattered foci of cerebral white matter T2 hyperintensity bilaterally. There is bilateral basal ganglia mineralization. Otherwise, the hippocampi appear to be unremarkable and there is no evidence of heterotopia or hamartomas. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss, with superimposed ex vacuo dilatation of the right anterior lateral ventricle. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: Multiple chronic lacunar infarcts in the right pons, right basal ganglia, and left thalamus, superimposed upon mild chronic small vessel ischemic white matter disease, but no evidence of acute infarction or other evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: Clinical question: Intracranial pathology? Signs and symptoms: Weak upper extremity and thoracic dilatation. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column however with mild exaggeration of cervical lordosis.Unremarkable signal intensity of vertebral column other than mild changes secondary to degenerative disease.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord.There is no evidence of spinal canal compromise or stenosis at any level.Foramen magnum is unremarkable.C2-C3 demonstrate minimal degenerative changes and unremarkable otherwise.C3-C4 demonstrate moderate degenerative changes with resultant moderate bilateral neural foraminal compromise.C4-C5 demonstrate moderate degenerative changes with asymmetric right-sided facet hypertrophic changes. There is resultant significant right and mild left neural foraminal compromise.C5-C6 demonstrate moderate degenerative disease with asymmetrical right-sided facet hypertrophic changes resulting in significant right neural foraminal compromise.C6/C7 demonstrate mild disc disease and mild bilateral (right greater than left) facet hypertrophic changes without appreciable neural foraminal compromise.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord demonstrate mild degenerative changes and unremarkable otherwise.

Output: 1.Normal signal intensity and caliber of cervical and upper most visualized thoracic cord.2.No evidence of central spinal stenosis at any level.3.Multilevel primarily right-sided neural foraminal compromise (some significantly) as detailed per level above.


Instruction: Generate impression based on findings.

Input: 45 year old with proven right papilloma and enhancing focus in the left nipple on outside MRI (8/6/14) presents for diagnostic exam. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Two marker clips are present in the right retroareolar region. Scattered benign calcifications are noted in both breasts.No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. MR-directed ultrasound was performed for the left nipple. There is a circumscribed round isoechoic mass with mild blood flow, measuring 6 x 3 mm, corresponding to the MR findings. This is likely a papilloma. Because its size has not significantly changed since the outside MRI performed August 2014, ultrasound follow up is recommended.

Output: High probability benign mass in the left nipple. Follow-up ultrasound in 6 months is recommended.No mammographic evidence for malignancy.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with history of left temporal high-grade astrocytoma, postoperative MRI for radiation planning. An infiltrative T2 hyperintense mass is redemonstrated centered primarily on the left temporal lobe with extension into the occipital lobe, the left aspect of the splenium of the corpus callosum and superiorly into the parietal white matter. The lesion has increased in size from the prior examination, now measuring 94 mm in maximal dimension and 43 mm in width, previously 88 mm x 30 mm.On postcontrast images, the lesion again demonstrates vague cloudlike enhancement with a few superimposed nodular areas of enhancement. In general, the enhancement is less intense than on the prior examination which could be related to technique. However, it appears that some subtle cystic degeneration has occurred within the core of the lesion. The lesion also shows progressive internal susceptibility which may reflect petechial hemorrhage.The lesion induces mass effect in the form of atrial and temporal horn and sulcal effacement which is somewhat progressed from prior. No evidence of frank brain herniation is seen. Sequelae of stereotactic lesional biopsy are demonstrated.Elsewhere intracranially, a few scattered nonspecific foci of T2 hyperintensity are redemonstrated in the cerebral white matter. No convincing evidence of tumor is seen in the right cerebral hemisphere.

Output: Interval increase in size of a large infiltrative tumor centered on the left temporal lobe.


Instruction: Generate impression based on findings.

Input: 70-year-old female, unable to walk MENISCI: There is tearing of the inner margin of the medial meniscus underlying the osteochondral fracture. The lateral meniscus is grossly intact.ARTICULAR CARTILAGE AND BONE: A large osteochondral fracture involves the medial femoral condyle, measuring 1.3 cm in transverse dimension and 1.2 cm in AP dimension. There is fluid underlying the fracture fragment indicating instability. Extensive edema is present within the medial femoral condyle. There is focal full thickness fissuring of the underlying articular cartilage of the medial femoral condyle as well as within the medial tibial plateau. Mild thinning and degeneration of the articular cartilage of the patellofemoral cartilage and trochlea.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact. There is prepatellar soft tissue edema.ADDITIONAL

Output: 1. Findings consistent with spontaneous osteonecrosis of the medial femoral condyle likely secondary to insufficiency fracture as described above with associated tear of the medial meniscus and full-thickness defects of the adjacent articular cartilage. 3. Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Pain in right shoulder and right hand numbness. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is a right paracentral disc protrusion which effaces the ventral thecal sac and contacts the right ventral aspect of the cord. There is mild to moderate spinal canal stenosis involving the right aspect of the spinal canal at this level. Mild right neural foraminal narrowing. No significant left neural foraminal narrowing.C6-7: There is a right paracentral and foraminal disc extrusion which results in moderate to severe right foraminal stenosis. Left neural foramen is patent. There is mild to moderate spinal canal stenosis at this level. No cord signal abnormality.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Degenerative changes in the cervical spine at the C5-C6 and C6-C7 levels. There is a right paracentral C5-C6 disc protrusion with mild to moderate spinal canal stenosis involving the right aspect of the spinal canal at this level. There is also mild right neural foraminal narrowing at this level. At the C6-C7 level there is a disc extrusion which extends into the neural foramen and is associated with moderate to severe right-sided neural foraminal stenosis and suspected impingement of the right C7 nerve root. There is mild to moderate degree of spinal canal stenosis at this level. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Sudden left unilateral sensorineural hearing loss. 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.

Output: No evidence of retrocochlear or inner ear lesions, although the assessment is limited due to the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with low back pain, pain over L lateral thigh. Alignment is anatomic. Vertebral body morphology is within normal limits. Marrow signal characteristics are heterogeneous but benign. There is mild inferior endplate edema at T12The visualized spinal cord and conus are within normal limits. The cauda equina is unremarkable except as discussed below. T12-L1: Mild facet hypertrophy. Mild bulging disk. No significant spinal canal or foraminal stenosis. L1-2: Mild facet hypertrophy. Loss of disk T2 signal with mild bulging and a small superimposed right paracentral extrusion. Mild effacement of the right ventral thecal sac but no significant generalized spinal canal stenosis or neuroforaminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening with small facet effusions. Loss of disk height and T2 signal. Disk bulging. Moderate generalized spinal canal stenosis with some crowding of the cauda equina nerve roots. Moderate left and mild right foraminal narrowing. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening with facet effusions. Bulging disk asymmetric to the right. No significant generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. L4-5: Marked facet hypertrophy and ligamentum flavum thickening with large facet effusions and perhaps some small extracanalicular synovial cysts. Mild generalized spinal canal narrowing without significant nerve root crowding. Mild bilateral foraminal narrowing. L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk with a central annular fissure and protrusion. No significant spinal canal or neuroforaminal stenosis.

Output: 1. Multilevel spondylosis, most severely affecting the L2-3 level where disk bulging and posterior element hypertrophy result in any moderate spinal canal stenosis.2. Significant facet arthropathy is seen at L3-4 and L4-5.


Instruction: Generate impression based on findings.

Input: Left optic neuritis with scotoma. Orbits: The globes and optic nerves appears unremarkable. The ocular adnexa are intact. There is no evidence of mass lesions or abnormal intraorbital enhancement.Brain: There is a T2 hyperintense enhancing lesion in the right pituitary lobe that measures up to 6 mm. There is also a non-enhancing focus in the right lateral pituitary lobe that measures up to 4 mm. There is no mass effect upon the optic apparatus. There is no evidence of intracranial hemorrhage or acute infarct. There are a few punctate foci of T2 hyperintensity in the cerebral white matter, without associated 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.

Output: 1. An enhancing lesion in the right pituitary lobe that measures up to 6 mm may represent a microadenoma. A non-enhancing focus in the right lateral pituitary lobe that measures up to 4 mm may represent a cystic microadenoma.2. A few punctate foci of T2 hyperintensity in the cerebral white matter are nonspecific.3. The orbits are unremarkable.Discussed with Dr. Reder at 8:40 AM on 1/9/15.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (9/18/15) performed at Advocate Christ Medical Center. Breast MRI protocol is outlined in the outside radiology report.Per outside radiology report, there is a proven invasive ductal carcinoma grade 3 in the left breast, and a metastatic left axillary lymph node. No mammograms or ultrasound images are submitted for comparison.Submitted images could not be processed at our MRI workstation.There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.LEFT BREAST:An enhancing irregular mass, measuring 26 x 23 mm (AP x LR) is present at middle 3:00 position in the left breast, consistent with proven malignancy. A metallic artifact, presumably from a marker clip, is seen at the central portion within the mass. There are 2 additional masses at 6:00 position in the left breast; one at anterior measures 8 mm, and one at posterior measures 12 mm. Both masses are suspicious, showing a rim enhancement.There are multiple cysts throughout the breast.LEFT AXILLA:In the left axilla, there is an enlarged lymph node measuring 3 cm. Metallic artifact is seen at anterior medial aspect within this enlarged lymph node. Just inferior to this abnormal lymph node, there is another enlarged lymph node measuring 2 cm. There is a regional enhancement at left axilla/axillary tail, likely post-biopsy changes.RIGHT BREAST:There are multiple cysts throughout the breast.The largest cyst is located at anterior upper outer quadrant with proteinaceous fluid.The lateral aspect of the breast tissue shows relatively strong enhancement, likely background parenchymal enhancement. RIGHT AXILLA:No abnormal lymph nodes are identified.

Output: 1. Biopsy proven left breast cancer with metastatic left axillary lymph node. Two suspicious enhancing masses in the left breast at 6:00 position. If clinically indicated, MR directed ultrasound and possible biopsy can be performed for those 2 masses.2. Two enlarged lymph nodes in the left axilla, one of which is proven metastatic.3. Strong parenchymal enhancement in the right breast at lateral aspect. Six-month follow-up MRI is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Male, 48 years old, with multiple myeloma of the CNS. On limited visualization of the brain, a right frontal approach ventricular catheter is in place with its tip in the right frontal horn. There appears to be a small amount of enhancement along the catheter tract. Patchy enhancement is also seen along the left superior frontal sulcus which is difficult to compare to the immediate prior noncontrast examination. However, there was similar patchy enhancement in this area on the older study from 4/16. The previously demonstrated large nodule of enhancement seen in the posterior left frontal lobe does not appear to be present on the current study. Ventricular size remains within normal limits. Susceptibility effect and minimal enhancement in the pineal region may reflect treatment effect from the prior lesion in that location. The globes, optic nerves and extraocular muscles are within normal limits. No intraorbital masses are seen. No pathologic orbital enhancement is detected. Note is made of generalized paranasal sinus mucosal inflammation with fluid levels in the maxillary sinuses.

Output: 1.Please note that this examination only partially assesses the brain as it was ordered and protocoled as an MRI of the orbits.2.Mild enhancement along the right frontal catheter tract, and patchy enhancement along the left superior frontal sulcus, are nonspecific findings which could represent mild residual disease or treated disease.3.The previously seen large lesions in the left posterior frontal lobe and in the pineal region are not appreciated on this examination.


Instruction: Generate impression based on findings.

Input: Right sphenoid meningioma: headache. Brain: There is an enhancing dural based right paraclinoid mass that measures up to 27 mm, which is not significantly changed. The tumor abuts the right cisternal optic nerve and exerts mild mass effect upon the adjacent right medial temporal lobe. There is no evidence of intracranial hemorrhage or acute infarct. There are scattered cerebral white matter T2 hyperintense foci. 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. There are prominent arachnoid granulations in the bilateral greater wings of the sphenoid bones. There is mild scattered mucosal thickening in the paranasal sinuses.Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. No significant interval change in the right paraclinoid meningioma.2. Chronic small vessel ischemic white matter disease.


Instruction: Generate impression based on findings.

Input: 22-year-old male with history of primary sclerosing cholangitis ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Liver is normal in size. No evidence of steatosis. Gallbladder appears normal. Common bile duct is normal in size measuring 3 mm. There are a few areas of intrahepatic ductal narrowing with a beaded appearance. It is unclear whether this is progressed since prior exam due to differences in technique. No significant intrahepatic biliary ductal dilatation. No extrahepatic stricturing is evident.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right upper quadrant and ileostomy. No evidence of obstruction. Prominent jejunal loops measuring up to 2.9 cm may represent ileus related to recent surgery.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Beaded appearance of the proximal intrahepatic biliary ducts with areas of mild narrowing are suspicious for early primary sclerosing cholangitis. 2.No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Headache on the right side behind the eye for 1 week: also drooping right eyelid and pain in the eye when quickly looking down or down towards the nose. History of Brown syndrome OD 4 years ago. Orbits MRI: There is focal swelling, T2 hyperintensity, and hyperenhancement of the right superior rectus muscle posteriorly towards the orbital apex, measuring up to 6 mm in thickness, with mild compression of the optic nerve and proptosis. There is minimal, if any edema or enhancement in the adjacent orbital fat. The other right rectus muscles appear to be intact. The left orbit is unremarkable. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is susceptibility effect in the bilateral globi pallidi, which may represent mineralizing. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild ethmoid sinus mucosal thickening diffusely and moderate right sphenoid sinus mucosal thickening.Brain MRA: There is no evidence of significant steno-occlusive lesions or cerebral aneurysms.

Output: A lesion affecting the right superior rectus muscle may be infectious or inflammatory in nature and less likely neoplastic, given the relatively acute onset of symptoms. No evidence of associated vascular or intracranial lesions, within the limited of MRA. The paranasal sinus disease suggestive of sinusitis may be potentially related to the orbital lesion or it may be incidental.


Instruction: Generate impression based on findings.

Input: Lung cancer on chemotherapy now: dizziness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is also a punctate focus of T2 hyperintensity in the right basal ganglia. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There are small retention cysts in the left frontoethmoid recess and sinus. There are bilateral lens implants.

Output: 1. No evidence of intracranial metastases. 2. Probable chronic small vessel white matter ischemic disease and right basal ganglia lacunar infarct, but no evidence of acute infarcts.


Instruction: Generate impression based on findings.

Input: Kyphosis. Assess for spinal canal stenosis. There is straightening of the lumbar spine alignment in the sagittal plane. There are small central indentations along the inferior endplates of L1 and L5, but no significant overall vertebral body height loss. There is degenerative signal alteration subjacent to the endplates at multiple levels. There is also 1 cm diameter lesion involving the right side of the first sacral segment, which may represent a hemangioma. There is generalized lumbar disc T2 signal loss, as well as moderate height loss. There is suggestion of mild Baastrup disease at multiple levels. The tip of the conus medullaris is located at the lower L1 level. The conus displays normal morphology and signal. There is fatty infiltration of the posterior paraspinal muscles due to atrophy. Multiple well-circumscribed, homogeneously T2-hyperintense, T1-hypointense lesions involving the kidneys likely represent cysts, but there are not completely assessed.L1-L2: A disc bulge with a left paracentral broad-based protrusion results in narrowing of the left subarticular recess with posterior displacement of the traversing left L2 nerve roots. Mild facet arthropathy contribute to mild bilateral neural foraminal stenosis.L2-L3: A disc bulge is slightly eccentric to the right resulting in mild stenosis of the right subarticular recess and mild central spinal canal stenosis. Mild facet arthropathy contribute to mild-to-moderate bilateral neural foraminal stenosis. There is also a tiny perineural cyst in the left neural foramen.L3-L4: A disc bulge along with moderate facet arthropathy result in moderate spinal canal stenosis. There is also mild bilateral neural foraminal stenosis.L4-L5: A disc bulge along with facet arthropathy result in mild spinal canal stenosis and mild-to-moderate bilateral neural foraminal stenosis.L5-S1: A small central protrusion result in mild central spinal canal stenosis. Along with facet arthropathy, there is moderate-to-severe left and mild-to-moderate right foraminal stenoses.

Output: 1. Multilevel degenerative lumbar spondylosis, including moderate spinal canal narrowing at L3-L4 and moderate-to-severe left and mild-to-moderate right neural foraminal narrowing at L5-S1.2. Suggestion of mild Baastrup disease at multiple levels.3. Multiple probable bilateral renal cysts, which are otherwise incompletely characterized. A renal ultrasound may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 31 year old female with a history of pelvic soft tissue sarcoma status post resection on 8/22/2014 and radiation therapy on 1/9/15. Presents with improving low back pain radiating to the left leg. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The left piriformis muscle is uniformly enlarged with associated decreased signal abnormality, appearing less pronounced when compared to the prior study. Additionally, there is a focus of enhancement measuring 12 x 8 mm within the left piriformis muscle appearing similar to the prior study (102; series 1402). No additional foci of abnormal enhancement are identified. OTHER: No significant abnormality noted.

Output: 1.Focus of enhancement in the left piriformis muscle, suspicious for residual or recurrent disease. 2.There is enlargement and signal abnormality of the left piriformis muscle, which appears decreased in size when compared to the prior study. This is nonspecific and may represent post operative change although residual disease is not completely excluded and follow up examination is recommended.


Instruction: Generate impression based on findings.

Input: 61-year-old male with cirrhosis and abdominal pain. Please screen for HCC and possible source of generalized abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Status post cholecystectomy with stable mild prominence of the common bile duct measuring 5.8 mm in diameter. No suspicious lesions are identified. No evidence for washout. Patent vasculature.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable right upper pole renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Stable mildly enlarged periportal lymph nodes.BOWEL, MESENTERY: Small esophageal varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic morphology. No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Chiari surgery with pseudomeningocele: headache and neck pain. Brain: There are interval postoperative findings related suboccipital craniotomy. There is a persistent focus of nodular enhancement along the posterior aspect of the inferior medulla that measures up to 8 mm. There is a left transfrontal catheter that terminates in the atrium of the left lateral ventricle and a right transparietal catheter that terminates in the right anterior parafalcine region. The ventricles are unchanged in size and configuration. There is unchanged encephalomalacia in the right posterior frontal and parietal lobes. There is no evidence of acute infarction. There is colpocephaly with dysgenesis and thinning of the corpus callosum. There is unchanged beaking of the tectum and prominence of the mass intermedia. The fourth ventricle remains partially effaced, with paucity of choroid plexus tissue. There is mild distortion of the posterior cerebellum and medulla, which may be related to adhesion formation. The CSF flow study demonstrates biphasic flow anteriorly at the level of the foramen magnum, but relative paucity of flow posteriorly.Cervical Spine: There is mild prominence of the central canal at the level of the dens, measuring 1 to 2 mm in width. There are minimal posterior disc-osteophyte complexes at multiple levels without significant spinal canal stenosis. The vertebral column alignment is anatomic. The vertebral bone marrow signal is unremarkable. The vertebral body heights are intact.

Output: 1. Interval postoperative findings related to inferior cerebellar biopsy with a persistent subcentimeter lesion along the posterior aspect of the medulla, which likely represents ectopic choroid plexus.2. Unchanged intracranial stigmata of Chiari II malformation and the shunted ventricular system. 3. Minimal syringohydromyelia in the upper cervical spinal cord.4. Suggestion of arachnoid adhesion formation in the suboccipital surgical bed, but no evidence of pseudomeningocele.


Instruction: Generate impression based on findings.

Input: Reason: 74-year-old male with left knee pain medial, history of left knee surgery 25 years ago, evaluate for medial meniscus tear, chondral injury. History: Left knee pain MENISCI: The body and posterior horn of the lateral meniscus are markedly attenuated which may reflect prior subtotal meniscectomy, however, there is also fragmentation of the remainder of the posterior horn of the lateral meniscus indicating complex tearing. Only a thin rind of the periphery of the body of the lateral meniscus remains, which is extruded laterally from the joint. There is intrasubstance degeneration of the anterior horn of the lateral meniscus. There is globular intermediate signal intensity within the body and posterior horn of the medial meniscus that approaches the tibial articular surface likely representing intrasubstance degeneration/chondrocalcinosis and degenerative undersurface fraying/tearing. The anterior horn of the medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the lateral tibiofemoral compartment with the posterior half of the weightbearing portion of the compartment nearly devoid of articular cartilage, with associated small foci of degenerative subchondral marrow signal abnormality. The articular cartilage of the medial compartment appears relatively intact, although there is mild degeneration of the articular cartilage of the weightbearing portion of the medial femoral condyle. There is also superficial degeneration of the articular cartilage along the lateral facet of the patella. There is tricompartmental osteophyte formation including osteophytes along the inferior aspect of the femoral trochlea, centrally, with overlying cartilage loss. There are also small foci of edema-type signal along the periphery of the medial tibial plateau, likely degenerative in etiology.LIGAMENTS: A thin remnant of the anterior cruciate ligament remains which does not appear to attach to the femur consistent with a chronic tear. The PCL appears intact. The MCL appears intact. The LCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Attenuation and fragmentation of the lateral meniscus likely representing a combination of subtotal meniscectomy and complex tearing.2. Intrasubstance degeneration and undersurface degenerative tearing/fraying of the medial meniscus as described above.3. Articular cartilage degeneration most severely affecting the lateral tibiofemoral compartment.4. Chronic tear of the anterior cruciate ligament.5. Edema along the posteromedial aspect of the proximal tibia suggesting inflammation, perhaps representing a pes anserine bursitis.


Instruction: Generate impression based on findings.

Input: Left breast Paget's disease. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The skin of the left nipple and retroareolar region enhances and is thickened compatible with Paget's disease. Additionally, there is linear non-mass enhancement projecting posteriorly into the central retroareolar breast, extending 2.7 cm behind the nipple. No abnormal enhancement is seen in the right breast or elsewhere in the left breast. There are scattered enhancing foci with typically benign kinetic profiles. Some may represent small lymph nodes or fibroadenomas. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Findings compatible with left breast Paget's disease. 2.7 cm of abnormal linear enhancement extends behind the left nipple. No additional suspicious enhancement.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: History of pT4aN1 right conjunctival squamous cell carcinoma with recurrent disease, s/p CRT, eval response Again seen are postsurgical changes of right orbital exenteration, right parotidectomy, and right neck dissection. Previously seen enhancing nodule measuring 19 x 16 x 22 mm in the AP, transverse and craniocaudal dimensions along the superior aspect of the right zygomatic arch is no longer appreciated. Slightly more inferior to the zygomatic arch, previously seen enhancing nodule measuring 17 x 11 x 15 mm and extending along the surface of the right masseter muscle is no longer appreciated. Previously seen nodular area of enhancement measuring 15x10 mm in the pre-auricular region is no longer appreciated. There is more diffuse enhancement in the right parotid space and the soft tissues overlying the masseter muscle and adjacent to the zygomatic arch likely representing posttreatment change. No new enhancing nodule or mass is seen on the current study. Abnormal enhancement is again noted along the medial and posterior aspect of the right orbital exenteration site at the level of the optic canal and superior and inferior orbital fissures which may represent granulation tissue.Intracranially, there is no intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement is seen to suggest metastatic disease. There are multiple foci of T2/FLAIR hyperintensity in the supratentorial periventricular and subcortical white matter which are nonspecific but compatible with chronic small vessel ischemic disease. No evidence of acute infarct, hemorrhage, or extra-axial collections. No hydrocephalus.There is opacification of the right anterior ethmoid air cells and mild mucosal thickening in the right maxillary sinus which is likely inflammatory. Evaluation of the neck demonstrates no other masses or evidence of pathologic enhancement. There are scattered subcentimeter lymph nodes which are nonspecific. No pathologically enlarged or necrotic lymph nodes are seen. No suspicion osseous lesions are seen. Degenerative changes in the cervical spine with disc osteophyte complexes at C4-C5, C5-C6, and C6-C7 are again seen with associated mild narrowing of the spinal canal.

Output: 1. Previously seen enhancing nodules adjacent to the right zygomatic arch, right masseter muscle, and preauricular region are no longer appreciated and consistent with treatment response. No discrete measurable lesion is identified on the current study.2. Status post orbital exenteration and right parotidectomy. Enhancement involving the right parotid space, right masticator space, as well as nodular thickening along the medial and posterior aspect of the orbital exenteration remains unchanged and may represent posttreatment change.3. Status post right neck dissection. No suspicious cervical lymphadenopathy is appreciated.4. No intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Chronic atrial fibrillation [I48.2], Reason for Study: ^Reason: pls eval for mass lesion potentially causing hemorrhage History: cerebellar hemorrhage Left cerebellar hemispheric subacute ICH measured 15.5mm (AP) x 11mm (RL) x 12.3mm (CC) is again seen with minimal blood products on the anterior superior folia of the left cerebellum, unchanged since prior scan.There is no evidence of abnormal enhancement on this scan.Multifocal tissue losses seen on the right external capsule, bilateral caudate heads, left thalamus, and left external capsule are again seen, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable except subtle ex vacuo changes of the right lateral ventricle frontal horn. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Mucosal thickening of the left maxillary sinus is again seen, unchanged.

Output: Subacute hemorrhages involving left cerebellar hemisphere with some blood products on adjacent cerebellar folia as described above.No evidence of abnormal enhancement on this scan.


Instruction: Generate impression based on findings.

Input: 60-year-old female with myelopathy. Postop cervical x-ray. Interval postsurgical changes related to anterior cervical fusion with a plate and screw device affixing C3-C6 vertebral bodies and interbody bone graft at C3-C6. No evidence of hardware complication. There is grade 1 retrolisthesis of C3 on C4 mildly improved from prior study. Moderate degenerative disc disease at C2-C3 and C6-C7. Mild facet joint osteoarthritis similar to prior study.

Output: Postsurgical changes related to anterior cervical fusion and interbody fusion with no evidence of hardware complication. Degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: Left shoulder pain and weakness ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon which is complete with retraction to the level of the glenoid. This tear extends to involve most if not all of the infraspinatus tendon which is also retracted. There is mild to moderate atrophy of the supraspinatus musculature with severe atrophy of the infraspinatus musculature. The teres minor tendon and muscle are normal. There is thickening and increased signal of the subscapularis reflecting tendinosis. Superimposed upon this tendinosis is full-thickness tearing of the insertional superior fibers of the subscapularis. There is mild associated atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: There is moderate acromioclavicular arthrosis.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding which abuts the undersurface of the acromium. There is moderate glenohumeral osteoarthritis with cartilage loss and subchondral cystic changes noted. Degenerative changes of the anterior and superior labrum are noted. A small amount of fluid is present within the subdeltoid bursa. There is fat signal within the subscapularis recess which may reflect an area of focal lipomatous arborescens.BICEPS TENDON: Biceps tendon is not clearly seen within the superior portion of the bicipital groove which is likely the result of tearing. The tendon is seen further distally however a surface defect is present reflecting a partial tear.ADDITIONAL

Output: Large rotator cuff tear which includes complete full-thickness tears of the supra and infraspinatus tendons and partial tearing of the subscapularis tendon. Additional findings of the shoulder are described above.


Instruction: Generate impression based on findings.

Input: 28-year-old female with right knee pain. Evaluate for possible meniscal pathology. MENISCI: No evidence of meniscal tear.ARTICULAR CARTILAGE AND BONE: No significant thinning of the articular cartilage.LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Normal examination of the right knee.


Instruction: Generate impression based on findings.

Input: 48 year old female with a history of congenital pulmonary stenosis s/p PVR with pulmonic insufficiency and known pulmonary artery aneurysm. She is now referred for cardiac assessment and follow-up of pulmonary artery dimensions. Height: 170cmLeft VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is63%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 177 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 67 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 101g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 98 ml/m2 (normal range 69+/-14), the RVEDV is 228 ml (normal range 110+/-24), the RV end systolic volume index is 45 ml/m2 (normal range 22+/-8), and the RVESV is 105 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and visually there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. Pulmonic regurgitation appears at least moderate, but stable when compared to previous MRI. Tricuspid ValveThe tricuspid valve opens widely. Visually there is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no thoracic aortic aneurysm. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated. Measurements using 3D volumetric data demonstrate the following:Proximal main PA: 33x33mmDistal main PA: 45mmx43mmLeft PA (proximal): 35x44mmLeft PA (distal): 36x36mmRight PA: 34x33mmThese values are stable when compared to previously obtained measurements. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size and systolic function (LVEF 63%).2. Mildly dilated right ventricular size and normal systolic function (RVEF 54%).3. Moderate pulmonary valve regurgitation (visual estimate).4. Severely dilated right atrium.6. Pulmonary artery dilation which is severe, with measurements stable when compared to the previous MRI of 2014.


Instruction: Generate impression based on findings.

Input: History of C6-7 anterior cervical discectomy and fusion, evaluate alignment. Interval placement of anterior spinal fusion device with screws entering the C6 and C7 vertebral bodies with interbody bone graft at this level. The cervical spine remains in anatomic alignment. Degenerative disc disease affects the remainder of the cervical spine including loss of disc height and anterior osteophytes more fully characterized on recent MRI. Postsurgical changes are present within the soft tissues.

Output: C6-C7 anterior fusion in anatomic alignment.


Instruction: Generate impression based on findings.

Input: 28-year-old male with history of von Hippel-Lindau. History laminectomy for spinal hemangioblastoma. Has current cerebellar/spinal hemangioblastomas. Evaluate for growth and new lesions. BRAIN MRI: Compared to 1/3/2014, there is no significant change in size of left cerebellar enhancing lesion measuring 7 x 5 x 7 mm, previously measuring 6 x 5 x 7 mm. No evidence for restricted diffusion to suggest acute ischemia or infarction. The ventricles and sulci are symmetric and unremarkable. No hydrocephalus identified. No mass effect, midline shift, or basal cistern effacement. No intra-or extra-axial fluid collection identified. Proximal intracranial flow voids are identified.2 mm enhancing punctate lesion within the right posterior aspect of the medulla is better seen on the cervical spine MRI and unchanged (sagittal cervical postgad 8/15 and axial 3D postgad 8/80 series 4401). No other sites of abnormal intracranial enhancement identified. No evidence of gross endolymphatic sac abnormality.Orbital contents are unremarkable bilaterally. There is mild opacification of the anterior ethmoid air cells bilaterally, otherwise the paranasal sinuses and mastoid air cells are clear. MRI OF THE CERVICAL SPINE: There is mild straightening of the normal cervical lordosis. Laminectomies are identified from C3 to C6 and mild enhancement involving the posterior spinous paraspinous tissue consistent with postsurgical change. Unchanged linear enhancement along the posterior aspect of the cervical cord at the C4-C5 level which likely represents postsurgical change. Minimal T2 hyperintensity and possible minimal intramedullary enhancement within the cervical cord at the C4-C5 level is also unchanged.There is mild desiccation signal seen at C2 to C6 levels. No evidence of spinal stenoses or significant foraminal narrowing. No new or enlarging lesions are seen within the cervical cord.MRI OF THE THORACIC SPINE: The alignment and curvature of the thoracic spine are anatomic. There is preservation of the vertebral body heights. The intervertebral disks have normal signal intensity. The marrow signal is normal. No evidence of significant degenerative changes, disk herniation or spinal stenoses. The thoracic spinal cord is unremarkable. No evidence of pathological intradural or vertebral enhancement.The paraspinal soft tissues are unremarkable. Partially visualized intra-abdominal contents demonstrate multiple bilateral renal lesions. Some of these lesions are complex and indeterminate on this nontargeted examination. These are better seen on prior MR Abdomen Exam.MRI OF THE LUMBAR SPINE: The alignment and curvature of the lumbar spine are anatomic. There is preservation of the vertebral body heights. The intervertebral disks have normal signal intensity. The marrow signal is normal. There is no evidence of significant degenerative changes, disk herniation or spinal stenoses. The visualized distal spinal cord has normal signal intensity and morphology. The conus medullaris terminates at the inferior endplate level of T12. The cauda equina and filum terminale are unremarkable.No abnormal intradural or vertebral enhancement identified. The paraspinal soft tissues are within normal limits. The partially visualized intra-abdominal contents again demonstrates multiple complex and cystic renal lesions.

Output: 1. Compared to 1/3/2014, there is no significant change in small enhancing lesion involving the left posterior cerebellar hemisphere compatible with a hemangioblastoma. A second punctate lesion identified on the prior study along the right posterior aspect of the medulla is also unchanged. No new lesions or evidence of intracranial mass effect.2. Stable postoperative changes in the cervical spine. Linear enhancement along the posterior surface of the cord at C4-5 and minimal T2 hyperintensity and punctate enhancement within the cervical cord at C4-5 are all unchanged and compatible with postsurgical change. Comparison with preoperative MRI would be helpful. No new or enlarging lesions in the cervical, thoracic, or lumbar spine.3. Please refer to separate report for findings in the abdomen including enhancing renal lesions.


Instruction: Generate impression based on findings.

Input: 17 years, Male, Chiari malformation, do with CSF flow study. Brain: Minimal tonsillar ectopia is again seen with the right cerebellar tonsil relatively lower than the left, but without significant crowding at the foramen magnum. CSF flow sequence demonstrates preserved biphasic flow ventrally and dorsally at the foramen magnum. Remainder of the brain is unremarkable. No intracranial mass or mass effect. No parenchymal signal abnormality. No evidence of infarct or hemorrhage. Ventricles are normal in size. 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.Cervical Spine: The cervical spine is in normal alignment, aside from straightening which may be related to position. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. No evidence of syrinx.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.

Output: 1. Unchanged minimal cerebellar tonsillar ectopia without significant crowding at the foramen magnum and preservation of normal CSF biphasic flow. There is no clear imaging evidence of Chiari I malformation. Brain parenchyma is otherwise unremarkable.2. MRI cervical spine is unremarkable. Specifically, no evidence of syrinx.


Instruction: Generate impression based on findings.

Input: Seizures: absence and drop attacks. There is a mixed cystic and solid mass in the right temporal lobe that measures up to approximately 6 cm. An associated cystic component protrudes into the adjacent right lateral ventricle. There is remodelling of the overlying calvarium. There is no evidence of intracranial hemorrhage or acute infarct. There is medialization of the right uncus, but no midline shift. There is linear and branching susceptibility effect in the right cerebellar hemisphere, which likely represents a developmental venous anomaly. The major cerebral flow voids are otherwise intact. There are low T1 and high T2 signal spheroid lesions arising from the right lacrimal gland, which measure up to 10 mm in diameter. The paranasal sinuses and scalp soft tissues are grossly unremarkable.

Output: 1. A right temporal lobe mass with prominent cystic components likely represents a primary central nervous system neoplasm, such as a ganglioglioma, dysembryoplastic neuroepithelial tumor, or pleomorphic xanthoastrocytoma, for example. However, further characterization via MRI with contrast may be useful.2. Incompletely characterized right orbital lesions, which may represent lacrimal gland cysts. Further characterization with contrast may be useful.Discussed with Dr. CHALONGCHAI J. PHITSANUWONG at 1 PM on 7/31/15.


Instruction: Generate impression based on findings.

Input: Other cerebral infarction [I63.8], Reason for Study: ^Reason: Symptomatic basilar stenosis History: pontine infarct Brain MRIThere are scattered restricted diffusion lesions without evidence of blood products at the left side of mid pons indicating acute ischemic infarction without hemorrhagic conversion.There are multifocal bilateral small tissue losses suggesting lacunar infarctions involving left caudate head, bilateral basal ganglia and right periventricular white matter.There are scattered T2/FLAIR high signal intensity lesions on periventricular and centrum semiovale most likely represent non specific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal.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 long segment more than 50% luminal stenosis (about 18mm length) including focal near total occlusion of the distal basilar artery. The distal left vertebral artery is not shown.Bilateral ICAs, MCAs and ACAs appear to be normal. There is no evidence of intracranial arterial aneurysm.

Output: 1. Acute ischemic infarction involving left side of mid-pons without evidence of hemorrhagic conversion.3. Long segment basilar artery stenosis (more than 50% with about 18mm length) including near total occlusion of the distal basilar artery.


Instruction: Generate impression based on findings.

Input: History of labyrinthitis with dizziness, which feels like unsteadiness and worse when driving for the past 2-3 weeks.. 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.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. Dedicated temporal bone imaging may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: Brainstem lesion and post operative changes status post choroid plexus papilloma resection. There are postoperative findings related to suboccipital craniotomy. There is a persistent lobulated enhancing mass within the inferior portion of the fourth ventricle that measures up to 23 mm. There is confluent T2 hyperintensity in the posterior medulla, pons, and medial portions of the cerebellum, as well as scattered patchy areas of intrinsic T1 hyperintensity, enhancement, and susceptibility effect along the surgical approach and margins. There is a prior right transfrontal ventricular catheter track with surrounding T2 hyperintensity, susceptibility effect, and enhancement. There is a left transfrontal ventricular catheter that terminates in the third ventricle, slightly indenting the right thalamus. Artifact related to the surgical hardware otherwise obscures surrounding anatomy. There is no appreciable interval change in size of the ventricular system, which does not appear to be particularly dilated. There is a persistent left cerebral convexity extra-axial fluid collection that measures up to 3 mm in thickness associated with prominent smooth, diffuse dural enhancement. There is no evidence of acute cerebral infarction. There is a 6 mm wide arachnoid cyst anterior to the anterior temporal pole. There is a retention cyst in the left maxillary sinus. There is an apparent disconjugate gaze.

Output: 1. Postoperative findings in the posterior fossa with residual fourth ventricular choroid plexus tumor with probable vasogenic edema in the surrounding cerebellum and brainstem, as well as scattered areas of blood products, hemostatic material, and probable granulation tissue along the surgical approach, but no evidence of an acute territorial infarct.2. Unchanged appearance of the shunted ventricular system.3. Persistent left cerebral convexity extra-axial fluid collection that measures up to 3 mm in thickness associated with diffuse dural enhancement reaction.


Instruction: Generate impression based on findings.

Input: History: Left parietal intracranial hemorrhage follow-up Bilobed shape left frontal parietal hematoma is again seen. It appears slightly different on the current CT due to technique and angle of acquisition when compared to the recent brain MRI. Left high convexity frontal lobe hematoma, slightly ill defined and relatively hypodense, measuring about 2.2 x 1.9-cm. More inferiorly, the left frontal parietal lobe hematoma measures 2.3 x 2.4-cm. They are associated with large amount of adjacent edema. Trace amount of adjacent subarachnoid blood are also seen, unchanged. There are mild to moderate diffuse cerebral edema overall with paucity of extra axial space and sulci, effacement of basal cisterns, especially in the left. There is probable left-sided uncal herniation. No evidence of midline shift. The lateral ventricles are compressed. No hydrocephalus. Marked mucosal thickening with bubbly material seen in the sphenoid sinuses. Large right maxillary sinus retention cyst or polyp is present. Left inferior mastoid air cells opacification, left more than right. Minimal mucosal thickening seen in the ethmoid sinuses. Small right frontal sinus osteoma.

Output: 1. Left frontoparietal hematoma as described above with large amount of adjacent edema. Diffuse overall brain edema with paucity of extra-axial space and sulci, decrease in visualization of the left suprasellar cistern raising the possibility of left-sided uncal herniation. 2. Within limit of the comparison between current CT and prior MRI, there is no conclusive evidence of new separate intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: Pt with hx of migraines, but worsening and some change in character History: see above Brain MRINo evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.There is about 4 mm dominant displacement of right cerebellar tonsil through the foramen magnum.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Borderline cerebellar tonsillar dominant displacement through the foramen magnum.2. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.3. Normal brain MRA


Instruction: Generate impression based on findings.

Input: 57 year old female with a BRCA 1 mutation presents for screening MRI. Family history of breast cancer in her paternal grandmother at age 55, aunt at age 36 and cousin at age 48 There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.Enhancing skin lesion (8 mm) is present at posterior 5 o'clock position in the right breast. Clinical correlation is recommended.

Output: No MRI evidence for malignancy. Enhancing skin lesion is present at posterior 5 o'clock position in the right breast. Clinical correlation is recommended.BIRADS: 3 - Probably benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: History of right ear cholesteatoma and surgery in 2000 and 2013: right ear fullness, right tympanic membrane retraction. There are postoperative findings related to right mastoidectomy. There is fluid within the mastoid bowl and diffuse mucosal enhancement along the walls of the mastoid bowl. However, there is no corresponding restricted diffusion in this region. 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. There is scattered mucosal enhancement and fluid within the left mastoid air cells and middle ears also appear unremarkable. There is a retention cyst in the right sphenoid sinus.

Output: 1. Postoperative findings related to right mastoidectomy with associated effusion and perhaps inflammation, including granulation tissue perhaps, but no evidence of cholesteatoma.2. Findings suggestive of left otomastoiditis.


Instruction: Generate impression based on findings.

Input: Metastatic tonsil squamous cell carcinoma to the brain status post resection and post-operative SRS: surveillance MRI. There are post-treatment findings in the left temporal region without gross residual tumor in the treatment bed. However, there are several new punctate enhancing lesions in the right frontal lobe. Furthermore, there has been interval increase in size of the left occipital lobe and right precentral gyrus lesions, measuring 6, 9, and 15 mm, previously 5, 6, and 12 mm, respectively. There are punctate foci of restricted diffusion and high T2 signal in the left cerebellar hemisphere and left supramarginal gyrus region. There is an unchanged punctate focus of susceptibility effect in the right centrum semiovale. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Interval increase in size and development of new intracranial metastases. Otherwise, no evidence of residual tumor in the left temporal lobe treatment bed.2. Punctate foci of restricted diffusion in the left cerebellar hemisphere and left supramarginal gyrus region likely represent recent infarcts.


Instruction: Generate impression based on findings.

Input: MRI: Images are slightly limited by patient motion. There is no acute infarct, mass effect, or cerebral edema. There is mild and patchy white matter T2 signal abnormality adjacent to the atria of the lateral ventricles, unchanged. The ventricles and basal cisterns are prominent for age, related to global volume loss. There is no midline shift or herniation. There is minimal scattered ethmoid and sphenoid sinus mucosal thickening. The imaged marrow signal is diffusely low on T1, consistent with reactive marrow process in this patient with known sickle cell disease. There is no pathological enhancement.MRA: There is moderate motion degradation and artifact related to inflow limiting evaluation. Within these limitations, the intracranial circulation appears grossly intact. Area of mild narrowing of the right supraclinoid carotid artery and exam is not well visualized due to artifact. Given the degree of artifact present, this exam is not felt to be diagnostic for small aneurysms. There is prominence of the lenticulostriate arterial branches and better appreciated on prior exam, consistent with patient's known Moyamoya.

Output: No acute infarct. Limited MRA of the brain due to artifact related degradation with grossly intact intracranial circulation, with previously noted subtle abnormalities not as well appreciated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Knee mass Note that due to technologist error, no precontrast T1 fat sat images were obtained.Tendons and ligaments: The anterior cruciate ligament and the posterior cruciate ligaments are absent. There is no osseous contusion to suggest this is acute in nature. The medial and lateral collateral ligaments are intact. The quadriceps tendon and the patellar tendon are intact.Menisci: There is maceration of the posterior horn of the medial meniscus with abnormal signal also extending into the body and anterior horn. Increased linear signal is seen through the lateral meniscus representing degeneration although no discrete tear is appreciated. Joints:There is near full-thickness loss and diffuse thinning of the articular cartilage of the medial compartment with underlying subchondral cystic changes noted in the tibial plateau. There is diffuse thinning of the articular cartilage of the lateral compartment which is to a lesser degree than medially. Severe cartilaginous thinning of the patellofemoral articulation is also noted with areas of near full-thickness loss in the medial patellar facet and throughout the femoral trochlea.Joint effusion and soft tissues: There is a moderate-sized joint effusion and small popliteal cyst. Within the subcutaneous tissues anterior to the patellar tendon is a well-circumscribed ovoid lesion demonstrating high T2 signal and high/intermediate T1 signal. The mass measures approximately 1.3 x 1.7 x 1 cm in the greatest craniocaudal, transverse, and AP dimensions. Following contrast administration, there is no significant enhancement although there may be some thin enhancement peripherally. There is no joint space extension or invasion of surrounding structures.Osseous structures: No focal marrow replacing lesions are identified. There is no fracture.

Output: 1. Subcutaneous lesion anterior to the patellar tendon suggestive of a benign cystic lesion. Alternatively, this may represent small hematoma.2. Rupture of the ACL and PCL.3. Maceration and complex tearing of the medial meniscus.4. Varying degrees of articular cartilage loss and thinning which is most severe in the medial compartment.


Instruction: Generate impression based on findings.

Input: Bowel incontinence and right foot drop. The examination was initially requested with and without contrast. However, given the lack of intravenous access, it was changed to a noncontrast-enhanced examination.THORACIC SPINE:Multilevel cervical degenerative disc-osteophyte complexes mildly narrow the spinal canal and were present on the previous examination of February 2015.Thoracic spinal alignment is anatomic. The marrow is heterogeneous and less fatty than expected but shows no suspicious lesion on the fat-saturated sequences and is unchanged since February 2015. Vertebral body heights are preserved. There is multilevel disc desiccation but no significant disc bulge or herniation. The spinal canal is preserved. There is no neural foraminal stenosis also. The spinal cord is normal in signal and shape.The upper thoracic esophagus is slightly prominent which is nonspecific but may reflect esophagitis. There are small T2-hyperintense lesions in the liver which are not completely assessed but were present on the previous examination.LUMBAR SPINE:For the purpose of vertebral level numbering, there is partial lumbarization of S1 (the last well-formed disc is at S1-S2).There is new anterior subluxation at L4-L5 which along with other degenerative changes contribute to moderate spinal canal stenosis as described below. Otherwise, alignment is anatomic and the vertebral bodies are preserved in height. The marrow is heterogeneous and less fatty than expected but shows no suspicious lesion on the fat-saturated sequences and is unchanged since February 2015. Marrow edema-like signal involving the apposing parts of the spinous processes of L4 and L5 may reflect Baastrup disease. Lumbar disc desiccation relatively spares L1-L2 and L5-S1. There is moderate disc height loss at the subluxed L4-L5 level. The tip of the conus medullaris is at L2 level. The conus medullaris has normal shape and signal.T12-L1 and L1-L2: There is no significant spinal canal or neural foraminal stenosis. There is mild facet arthropathy at L1-L2.L2-L3: Minimal disc bulge is eccentric to the right and along with mild facet arthropathy results in minimal, if any, foraminal narrowing but no significant spinal canal stenosis.L3-L4: Minimal disc bulge causes no significant spinal canal or neural foraminal stenosis.L4-L5: The disc bulge and uncovering along with moderate-to-severe facet arthropathy (with minimal joint effusions) and moderate ligamentum flavum thickening result in moderate central spinal canal and mild-to-moderate neural foraminal stenoses. This has increased since the previous examination.L5-S1: Disc bulge along with moderate facet arthropathy and mild-to-moderate ligamentum flavum thickening result in mild bilateral neural foraminal but no significant spinal canal stenosis.S1-S2: There is no spinal canal or neural foraminal stenosis.

Output: 1.No spinal cord compression.2.No significant degenerative change or other abnormality of the thoracic spine.3.New, since February 2015, anterior subluxation and slightly increased degenerative disease at L4-L5 resulting in moderate central spinal canal and mild-to-moderate neural foraminal stenoses.4.Minimal edema-like signal involving the apposing parts of the spinous processes of L4 and L5 may reflect Baastrup disease. 5.Diffuse marrow abnormal signal is unchanged since February 2015 and may relate to HIV infection.6.Upper thoracic esophagus mucosa is slightly prominent which is nonspecific but may reflect esophagitis. Small T2-hyperintense lesions in the liver are not completely assessed but were present on the previous examination.7.Transitional lumbosacral anatomy. If surgery is to be contemplated, correlation with imaging of entire spine is recommended.


Instruction: Generate impression based on findings.

Input: Aphasia. Rule out acute stroke. While there is no acute infarct, the cerebral white-matter shows relatively mild T2/FLAIR hyperintensity in scattered deep/subcortical and confluent periventricular distribution. This is nonspecific but likely reflective of chronic microvascular ischemia. In addition, susceptibility-weighted imaging shows numerous tiny foci of hemosiderin staining predominantly in a subcortical distribution in both cerebral and both cerebellar hemispheres with less extensive central involvement of the deep gray nuclei. The largest of these involve the right precentral gyrus and measures 3 mm. None is associated with surrounding edema. There is moderate expansion of the ventricles, sulci and other CSF-containing spaces reflective of moderate underlying brain volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There has been bilateral eye lens replacement. There is mild ethmoid mucosal thickening and small maxillary retention cyst.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Numerous foci of susceptibility effect throughout the brain reflect microbleeds, predominantly in a peripheral distribution, which might be reflective of amyloid angiopathy. No sizable intracranial hemorrhage. 3.There are also changes of chronic microvascular ischemia in the cerebral white-matter in addition to moderate global parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: History of bilateral ventriculomegaly of Triplet C in the patient's current dichorionic-tri amniotic triplet gestation. 21 weeks gestational age. Images are tailored for evaluating the ventricles of fetus which is located in the maternal left pelvis. The other fetuses are only partially visualized on this exam. Within the limitations of significant fetal motion, there appears to be mild ventriculomegaly of fetus C with the ventricular atria measuring up to 12 mm on the left and 11 mm on the right. No other gross abnormalities are identified. The degree of cortical development appears appropriate for stated age.The known maternal complex adnexal cystic lesion is partially visualized.

Output: Mild ventriculomegaly in fetus C.


Instruction: Generate impression based on findings.

Input: 72-year-old male has intracranial mass with possible NPH. Memory difficulty and gait instability. Evaluate ventricular system and lesion if possible and Large extra-axial mass at the level of the left petroclinoid ligament, left cerebellopontine and prepontine cistern lesion consistent with a meningioma is redemonstrated. The lesion appears to extend into the left cavernous sinus. The density and size of lesion remains is stable since prior exam. Mass-effect on the pons is identical to prior study. Minimal difference in the appearance of tumor can be explained based on the slice angulation and positioning. Further evaluation with an MRI is recommended. No evidence of parenchymal edema adjacent to the tumor is identified. Images through posterior fossa demonstrate slight prominence of the lateral ventricles with no definitive interval change since prior exam.

Output: 1.Redemonstration of left petroclinoid ligament meningioma with no definitive evidence of change. Further evaluation with an MRI would be significantly more sensitive.2.Stable CT examination of brain with prominence of the supratentorial ventricular system.


Instruction: Generate impression based on findings.

Input: New confusion, dementia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered subcortical, deep, and periventricular cerebral white matter T2 hyperintensity. There is also patchy T2 hyperintensity in the pons. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. There may be a small right supraclinoid internal carotid artery outpouching. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. The white matter lesions are nonspecific, but may represent chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. 2. Possible small right supraclinoid internal carotid artery outpouching, which may represent an aneurysm versus volume averaging. Dedicated angiographic imaging may be useful.


Instruction: Generate impression based on findings.

Input: 38-year-old male with right upper weakness status post transoral resection of pituitary adenoma Restricted diffusion with matching ADC hypointensity, T1 hypointensity, and T2 hyperintensity is noted involving the leftward mid brain including the left cerebral peduncle. Changes from transsphenoidal surgery are again noted with residual pituitary mass containing central hemorrhagic products with upper bowing the optic apparatus, grossly unchanged from the recent postoperative pituitary MRI given the current brain acquisition technique. The ventricular system is unremarkable. There are no extra-axial fluid collections. Expected vascular flow voids are demonstrated.

Output: Acute to subacute ischemia involving the leftward mid-brain including the left cerebral peduncle. Results were discussed with the emergency room team caring for the patient on 8/5/2016 at 1:18 PM.


Instruction: Generate impression based on findings.

Input: History of ALL with neutropenic fever and fungal sinusitis presenting with headache. Evaluate for mass. Motion artifact and lack of intravenous contrast limits evaluation. There is no evidence of acute intraparenchymal hemorrhage, mass effect, or acute infarct. There is minimal extra-axial fluid along the bifrontal convexities which does not suppress on the FLAIR sequence raising possibility of subdural collection versus prominent subarachnoid space with artifact. No hydrocephalus. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is diffuse mucosal thickening of the paranasal sinuses, which is new compared to CT of 4/20/2015. Subtle T2/FLAIR hyperintense signal in the left periorbital soft tissues and retrobulbar fat is nonspecific. Subtle extension into the orbits is incompletely evaluated on this motion degraded and noncontrast study. There is partial opacification of the bilateral mastoid air cells.

Output: 1.Limited evaluation due to motion artifact and lack of intravenous contrast. No evidence of acute intraparenchymal hemorrhage, mass effect, or acute infarct. 2.Interval development of diffuse mucosal thickening of the paranasal sinuses, compared to CT dated 4/20/2015. There is possible abnormal FLAIR signal within the left orbit along the left medial orbital wall. There is also small extra-axial collection along the bilateral frontal convexities which is seen on the FLAIR sequence. Invasive fungal sinusitis with left orbital extension and possible intracranial extension cannot be excluded. Recommend performing MRI of brain with gadolinium and MRI of sinuses with gadolinium under sedation. Alternatively, maxillofacial CT with contrast can be considered.3.Nonspecific partial opacification of the bilateral mastoid air cells. Findings discussed with Dr. Watson on 5/3/2015 at 11:15 AM.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, 38 years old, with neurofibromatosis type I and seizure-like activity. Numerous small foci of periventricular and subcortical white matter T2 hyperintensity are seen without significant change from the prior exam. No mass effect or parenchymal edema is seen. No pathologic parenchymal or extra-axial enhancement is detected.There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.Although not a dedicated orbital examination, no abnormalities of the optic apparatus are suspected.Bone marrow signal characteristics are within normal limits. Several superficial enhancing lesions within the scalp are unchanged.

Output: 1.Numerous foci of white matter signal abnormality are seen without significant change from prior examination. These are nonspecific and may be related to patient's diagnosis of neurofibromatosis.2.No additional intracranial masslike lesions are seen. No other specific etiology for the patient's seizures is detected.3.Stable enhancing lesions in the scalp may represent neurofibromas.