Instruction: Generate impression based on findings.

Input: Other cerebral palsy [G80.8] / Unspecified convulsions [R56.9], Reason for Study: ^Reason: eval brain structure interval changes History: focal epilepsy No evidence of acute ischemic or hemorrhagic lesion.There is encephalomalacia on the left parietal lobe as well as posterior aspect of the precentral gyrus with internal susceptibility artifacts indicating prior ischemic infarct with hemorrhagic transformation.The left lateral ventricle shows ex vacuo changes.Left posterior aspect of the thalamus shows gliotic changes with focal lacunar infarct.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.

Output: 1. Left mainly parietal and part of frontal lobe, left MCA territory encephalomalacia with internal susceptibility artifacts indicating chronic ischemic infarction with hemorrhagic transformation.2. No evidence of acute ischemic or hemorrhagic lesion.3. Focal gliotic changes and lacunar infarct on the left thalamus.


Instruction: Generate impression based on findings.

Input: Male 62 years old Reason: hx of prostate cancer, evaluate for disease, interested in focal laser therapy History: see above PELVIS:PROSTATE:Prostate Size: 4.5 by 3.3 by 4.1-cmPeripheral Zone: Peripheral zone of the prostate is heterogeneous, however, no definitive focal lesion is seen on MRI. Patient's known prostate cancer foci could not be seen.Central Gland: Heterogeneous secondary to benign prostatic hyperplasia. Prominent bilateral central zone.Seminal Vesicles: Unremarkable.Extracapsular Extension: Not applicableBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Patient's known prostate cancer foci could not be visualized on MR examination.


Instruction: Generate impression based on findings.

Input: Right nasolabial fold shallowing, with possible parkinsonism. There is mild asymmetric prominence of the susceptibility effect in the medial substantia nigra on the right side. The substantia nigra otherwise appears to be gross intact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, aside from minimal nonspecific periventricular white matter T2 hyperintensity. The right lateral ventricle is slightly larger than the left, which can be an anatomic variant and there is no evidence of ventriculomegaly otherwise. 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 acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Male 18 years old; Reason: Evaluate for labral tear History: shoulder pain during throwing ROTATOR CUFF: No significant abnormality noted. The rotator cuff muscles and tendons are appear normal. The injected intra-articular contrast remains within the joint capsule and does not communicate with the subacromial or subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a SLAP tear present. The glenohumeral joint alignment is normal. Degenerative appearing cysts are present in the posterolateral humeral head. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Glenoid labrum SLAP tear2. Degenerative appearing cysts in the posterolateral humeral head.


Instruction: Generate impression based on findings.

Input: 67 year old male with hepatitis C and alcoholic cirrhosis referred for CMR as part of liver transplant evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 74 ml/m2 (normal range: 74+/-15), the LVEDV is 147 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 52 ml (normal range 47+/-19), the LV mass index is 28 g/m2 (normal range 85+/-15), and the LV mass is 56 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement present to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native pre-contrast myocardial T1 relaxation time = 973 ms which is normal. No evidence of myocardial iron overload. Hemodynamics:Based on cine imaging, the cardiac output is 6.32L/min and cardiac index is 3.2L/min/m2.Base on velocity encoded imaging, the cardiac output is 4.13L/min and cardiac index is 2.07L/min/m2.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 89 ml/m2 (normal range 82+/-16), the RVEDV is 177 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The aortic valve is trileaflet. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The ascending aorta is mildly dilated (41mm). Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 2. The right ventricle is normal in size and systolic function (RVEF 58%).3. Cardiac output and cardiac index are reduced but without evidence of any associated structure heart disease. 4. Mild ascending aorta dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of central nervous system lymphoma status post chemotherapy and radiation. There are chronic findings related to right transfrontal biopsy. There is no evidence of abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged punctate foci of encephalomalacia in the right cerebellar hemisphere, which likely represent chronic infarcts. There are unchanged nonspecific patchy areas of T2 hyperintensity in the cerebral hemisphere white matter. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is a persistent left maxillary sinus retention cyst. There is also persistent minimal fluid and mucosal enhancement in the bilateral mastoid air cells.

Output: Stable post-treatment findings without evidence of intracranial central nervous system lymphoma recurrence.


Instruction: Generate impression based on findings.

Input: Possible iron overload seen in liver on prior cardiac MRI ABDOMEN:LIVER, BILIARY TRACT: There is diffusely low T2 signal involving the hepatic parenchyma.SPLEEN: No significant abnormality noted.PANCREAS: Possible mildly decreased signal. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left inferior pole cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small T2 hyperintense foci at the level of multiple bilateral lower lumbar neural foramina suggestive of perineural cysts.

Output: Diffusely low T2 signal affecting the hepatic parenchyma is incompletely evaluated on this limited exam.


Instruction: Generate impression based on findings.

Input: Female 28 years old Reason: eval for sacral fracture History: tailbone pain for months hurts to sit BONE MARROW:There is an abundance of red marrow in the lower lumbar spine.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: No evidence of sacral fracture. No specific findings to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: Reason: myositis History: weakness. Interval resolution of edema signal intensity within the musculature bilaterally. Severe muscle fatty atrophy of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles bilaterally. The supraspinatus, infraspinatus, teres minor, and subscapularis tendons are intact. The remainder of the soft tissue structures are within normal limits. Bone marrow signal intensity is within normal limits.

Output: Interval resolution of muscle edema. Severe fatty muscle atrophy of the rotator cuff muscles.


Instruction: Generate impression based on findings.

Input: New weakness and paresthesia. History of left ventricular thrombus. BRAIN MRI:The wedge-shaped subcortical/cortical biparietal T2-hyperintense lesions that probably represent previous ischemia/infarct remain unchanged. The associated foci of susceptibility effect remain unchanged, reflecting hemosiderin staining or mineral deposition. The scattered T2 hyperintense foci of signal intensity in the cerebral white-matter, predominantly frontoparietal, remain unchanged and are nonspecific. There is no diffusion restriction or new intracranial hemorrhage. There is no mass-effect or midline shift. The ventricles and the other CSF-containing spaces are mildly enlarged, reflecting mild underlying brain volume loss.Minimal mucosal thickening in the paranasal sinuses and right mastoid air cells is nonspecific. There is no gross orbital abnormality.CRANIAL MRA:There is no significant steno-occlusive lesion of the major intracranial arteries or aneurysm. The basilar artery and the V4 segments of the vertebral arteries are slightly smaller than expected which might be developmental (especially given the lack of calcification on the CT scan from February 5, 2016 and the relatively large posterior communicating arteries). This is unchanged since the previous examination.

Output: 1.No acute brain infarct or new intracranial hemorrhage. Biparietal small chronic infarcts with hemosiderin staining or mineral deposition remain unchanged. Mild-to-moderate, for age, cerebral nonspecific white-matter lesions are most suggestive of chronic microvascular ischemia.2.Cranial MR angiography shows no significant arterial stenosis.


Instruction: Generate impression based on findings.

Input: Female, 39 years old, with vertigo. A single 2 mm focus of T2 hyperintensity within the white matter of the right superior frontal gyrus is unchanged. No other parenchymal lesions are seen. No evidence of edema, mass effect or restricted diffusion is demonstrated. No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles remain normal in size and morphology.

Output: A single nonspecific focus of signal abnormality within the right superior frontal gyrus is unchanged. No other significant intracranial findings are detected.


Instruction: Generate impression based on findings.

Input: 79 year old woman with history of hypertension, CVA transferred from outside hospital status post fall now with right facial droop and question of right hemineglect. There is a hypoattenuating region in the left parietal lobe. This is consistent with late subacute versus chronic infarct in the left MCA distribution. Recommend MRI to better define acuity of infarct. No CT findings of intracranial hemorrhage, mass effect, or midline shift.There are periventricular hypoattenuating regions consistent with age-indeterminate, small vessel ischemic disease.The ventricles and basal cisterns are normal in size and configuration. Cavum septum pellucidum, a nonpathologic finding, noted.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Late subacute versus chronic infarct in left MCA distribution. Recommend MRI to better define acuity of infarct. These findings were communicated with the ordering physician at the time of interpretation.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with worsening dysarthria and left-sided weakness. A band of restricted diffusion is seen within the right hemi-pons. No other areas of restricted diffusion are noted. Moderately extensive patchy periventricular T2 hyperintensity is demonstrated. No areas of significant parenchymal edema or mass effect is detected. No evidence of acute intracranial hemorrhage is seen. Scattered foci of susceptibility are noted primarily within the thalami and to a lesser degree elsewhere in the cerebral hemispheres which likely represent chronic microhemorrhage. No abnormal extra-axial collections are detected. The ventricles are normal in size and morphology.

Output: 1.Acute infarct in the right pons.2.Chronic moderately advanced small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 32-year-old female with pain and history of Crohn's disease, status post ileocecectomy in 2002. Recent scope reveals Crohn's disease at the anastomosis with narrowing. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening of the neoterminal ileum and proximal ascending colon with surrounding fat stranding and wall enhancement compatible with active disease. Associated dilated distal ileal loops proximal to the narrowed neoterminal ileum are also noted, and surrounding fibrofatty proliferation is evident. There are at least 2 fistulous connections to the inferior small bowel loops (coronal series 3 images 20, 22). No drainable fluid collection. A few areas of segmental wall thickening involving the proximal transverse colon shows no surrounding inflammatory change or wall enhancement and likely represent peristaltic contractions (coronal series 3 image 23).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Unremarkable uterus. Small left adnexal cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings compatible with active disease of the neoterminal ileum and adjacent ascending colon as described above with proximal bowel dilation of the ileum. At least 2 fistulous connections to the inferior adjacent dilated ileal bowel loops are noted.


Instruction: Generate impression based on findings.

Input: Lupus cerebritis, hemorrhagic stroke: headache. There are postoperative findings related to right anterior frontal lobe biopsy with an unchanged small area of high T2 signal and susceptibility effect in the surgical cavity. There is also an unchanged small area of susceptibility effect in the left inferior frontal sulcus. The rest of the brain appears to be unremarkable. There is no evidence of acute infarct. There is no abnormal intracranial enhancement. There is an unchanged subcentimeter pineal cyst. 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: 1. Stable postoperative findings related to right anterior frontal lobe biopsy and prior hemorrhage, as well as an unchanged small area of chronic hemorrhage in the left inferior frontal sulcus. 2. No evidence of acute infarction.


Instruction: Generate impression based on findings.

Input: 10month female with posterior midline neck mass, ultrasound suggests lipoma versus lymphovascular malformation. There is a fairly well-defined avidly enhancing T2 hyperintense mass that contains multiple prominent flow voids within the subcutaneous tissues of the superior right posterior neck. The mass measures up to approximately 4 cm. There is no significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The imaged portions of the intracranial structures and orbits are also unremarkable. The osseous structures are intact. There is left tympanomastoid fluid signal.

Output: 1. Findings suggestive of an infantile hemangioma in the subcutaneous tissues of the superior right posterior neck that measures up to approximately 4 cm.2. Left tympanomastoid fluid may represent effusions, perhaps in the setting of otomastoiditis.


Instruction: Generate impression based on findings.

Input: Suspected long syrinx with back pain: evaluate for tethered cord. The previously demonstrated small caliber thoracic syrinx is no longer discernible. The conus medullaris tip lies at the L1 level. There is no evidence of fibrofatty filum terminale. The vertebral column alignment is within normal limits. Aside from a small intravertebral disc herniation in the superior T9 endplate, the vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. The previously demonstrated small caliber thoracic syrinx is no longer discernible.2. The conus medullaris is not low-lying.


Instruction: Generate impression based on findings.

Input: A 59 year old male with personal history of tonsil carcinoma, s/p chemotherapy, dysphagia and recurrent aspirations, hypothyroidism, with progressive dyspnea and newly diagnosed heart failure with severely reduced systolic function and positive troponin. Referred to cardiac MRI for further evaluation MEDICATIONS: aspirin, atorvastatin, furosemide, levothyroxine, lisinopril, metoprolol First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is mid-myocardial stripe of late gadolinium enhancement noted in the septum. This finding is atypical for prior myocardial infarction but suggests the presence of replacement fibrosis and is commonly described in non-ischemic cardiomyopathy. There is additionally a very small amount of non-transmural subendocardial late gadolinium enhancement involving the mid inferolateral wall, this finding could represent a small myocardial infarction. The segment with this small myocardial infarction has an intermediate probability of viability. The native myocardial T1 times are moderately increased (1100-1150ms), which suggest the presence of interstitial fibrosis. No evidence of cardiac amyloidosis or myocardial iron overload. Left VentricleThe left ventricle is severely dilated with moderately to severely reduced systolic function. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 139 ml/m2 (normal range: 74+/-15), the LVEDV is 290 ml (normal range 142+/-34), the LV end systolic volume index is 96 ml/m2 (normal range 25+/-9), the LVESV is 200 ml (normal range 47+/-19), the LV mass index is 72 g/m2, and the LV mass is 150 g. There is severe global hypokinesis with regional variation and desynchrony.Left AtriumThe left atrium is severely dilated (161ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 216 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 100 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely, there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsModerate bilateral pleural effusions and bilateral intersitial lung infiltrates. 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: Cardiac MRI study is most consistent with diagnosis of non-ischemic cardiomyopathy with a very small concomitant myocardial infarction. 1. No perfusion defects/ "ischemia" present during hyperemia. 2. There is mid-myocardial stripe of late gadolinium enhancement noted in the septum. This finding is atypical for prior myocardial infarction but suggests the presence of fibrosis, inflammation, or infiltration and is commonly described in non-ischemic cardiomyopathy. There is additionally a very small amount of non-transmural subendocardial late gadolinium enhancement involving the mid inferolateral wall, this finding could represent a small myocardial infarction. The segment with this small myocardial infarction has an intermediate probability of viability. 3. The left ventricle is severely dilated with moderate to severely reduced systolic function (LVEF 31%). 4. The right ventricle is normal in size with normal systolic function (RVEF 54%).5. Severe biatrial dilation. 6. There is mild mitral and tricuspid regurgitation.7. There is a small pericardial effusion.8. See extracardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Preoperative planning for brain tumor. History of a left temporal AVM treated with radiation. There is a heterogeneous left supratentorial and infratentorial lesion with associated cystic compartments, some of which contain fluid-fluid levels suggestive of hemorrhage. There is also surrounding vasogenic edema in the left cerebellar hemisphere. There is marked effacement of the fourth ventricle and dilatation of the third and fourth ventricles, which have increased in size slightly. There is also marked mass effect upon the brainstem. There is also a similar contiguous heterogeneous lesion within the left temporal and occipital lobes with surrounding vasogenic edema. There is no herniation. There are skin-based fiducial markers.

Output: Presurgical planning MRI shows a complex mass in the left cerebellar hemisphere with associated obstructive hydrocephalus and a similar complex mass in the left temporo-occipital region. These lesions may represent radiation necrosis and perhaps vascular malformations with associated hemorrhage.


Instruction: Generate impression based on findings.

Input: Female, 75 years old. Reason: eval mass on dorsal forearm History: mass The soft tissue structures of the forearm appear normal, without solid mass lesion, discrete fluid collection, or focus of abnormal enhancement identified. The visualized muscles and tendons appear normal. The underlying osseous structures are unremarkable, with normal cortical thickness and marrow signal.

Output: No mass lesion or other focal abnormality on MR to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Male, 50 years old, with neck pain, feeling unable to support head. Spinal alignment is anatomic. Vertebral body morphology is normal. No concerning marrow replacement or significant marrow edema is seen. The spinal cord shows normal signal intensity and morphology throughout. Please note that some images are degraded by motion artifact, but within this limitation, the following level specific findings are made:C2-3: Minimal thickening of the PLL. No significant spinal canal stenosis or neuroforaminal narrowing.C3-4: Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Mild right foraminal narrowing.C4-5: Minimal central disk protrusion. No significant spinal canal or neuroforaminal stenosis. C5-6: Unremarkable. C6-7: Posterior disk osteophyte formation with a right paracentral disk protrusion. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. C7-T1: Unremarkable. The paraspinal soft tissues are unremarkable. The musculature of the neck as visualized is within normal limits. The ligamentous structures at the craniocervical junction are intact.

Output: Mild degenerative disk findings as detailed above without high-grade spinal canal or neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: Arachnoid cyst status post cyst fenestration in June 2015. There has been interval clearance of the blood products within the fenestrated arachnoid cyst located in the midline of the superior posterior fossa. In addition, the cyst has deceased in size, now measuring up to approximately 10 mm, previously approximately 20 mm, and there is no residual mass effect upon the tectum. There is no evidence of acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are bilateral maxillary sinus retention cysts.

Output: Interval evolution of postoperative findings related to posterior fossa arachnoid cyst fenestration with interval clearance of associated hemorrhage and decrease in size of the cyst.


Instruction: Generate impression based on findings.

Input: Recurrent nasopharyngeal cancer, EBV+, treated with and radiation therapy and chemotherapy. Neck: There are post-treatment findings in the right nasopharynx with mild right asymmetric pharyngeal mucosal space thickening without measurable residual mass, although assessment is limited by the lack of intravenous contrast. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unchanged. There is cervical spondylosis with at least moderate spinal canal stenosis at C5 and C6 with possible associated high T2 signal in the spinal cord. There are several cervical neural foramina subcentimeter perineural cysts. There are degenerative changes in the right temporomandibular joint with an associated effusion.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is persistent fluid signal within the bilateral mastoid air cells. There are maxillary sinus retention cysts and scattered paranasal sinus mucosal thickening. The skull and extracranial soft tissues are otherwise unremarkable.

Output: 1. Post-treatment findings in the right nasopharynx without measurable residual mass, although assessment is limited by the lack of intravenous contrast. 2. No evidence of intracranial tumor, although assessment is limited by the lack of intravenous contrast. 3. Degenerative spondylosis of the cervical spine with spinal canal stenosis at C5 and C6 and possible associated myelomalacia, although the sequences are not optimized for assessment of the spinal cord.


Instruction: Generate impression based on findings.

Input: Diagnosis: LumbagoClinical question: ro disc herniationSigns and Symptoms: above, pseudoscoliosis Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disc space height at this level associated with small endplate osteophytes and a diffuse disc bulge. There is some associated discogenic sclerosis present at this level. There is vacuum disc phenomenon present at this level. There is associated enhancement of the L5-S1 disc and T2 signal hyperintensity.At L4-5 there is a diffuse disc bulge present associated with bilateral ligamentum flavum hypertrophy and effacement of the fat at the lateral recesses bilaterally. There is some facet hypertrophy present on the right side at this level. There is triangulation of the thecal sac and overall a moderate degree of spinal stenosis present at this level. There is partial effacement of the fat surrounding the exiting nerve roots within the neural foramina at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.The uterus appears fairly large and associated with multiple heterogeneous signal intensity lesions.

Output: 1.There are degenerative changes present in the lumbar spine worse at L4-5 where there is a moderate degree of spinal stenosis related to disc bulge and ligamentum flavum hypertrophy.2.Enhancement of the L5-S1 disc is a likely inflammatory in nature. This could very well be related to degenerative disc disease in an acute phase. Early discitis may have a similar appearance. Please correlate with the patient's clinical symptoms and signs.3.Findings are compatible with uterine fibroids.


Instruction: Generate impression based on findings.

Input: Reason: MRI of right calcaneus to assess for brodie abscess- correlate with prior MRI and XR. Focal signal abnormality extending from the apophysis to the right calcaneus, best visualized on image 9 of series 9, demonstrating mild enhancement representing osteomyelitis. The more focal area of signal loss more inferiorly within this area seen on the same image is compatible with a sequestrum, new as compared to the prior MRI from 10/14/2016. No additional osteolytic lesions are noted within the ankle and calcaneus.

Output: Signal abnormality extending from the apophysis to the posterior inferior calcaneus with adjacent osteolytic changes, demonstrating mild enhancement representing osteomyelitis with a sequestrum. These findings are new from prior exam and were discussed with Dr. Bielski at 5:00 PM on 11/8/2016.


Instruction: Generate impression based on findings.

Input: Left hand numbness and weakness. Brain MRI: There are areas of encephalomalacia in the left cerebellar hemisphere. There is also mild scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is nodularity along the lateral margins of the lateral ventricles with signal characteristics similar to that of cerebral cortex, left more than right. There is no midline shift or herniation. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a right lens implant.Brain MRA: There is diffuse narrowing of the basilar artery. The vertebral arteries and anterior circulation are otherwise grossly patent, although the right vertebral distal to the PICA original is hypoplastic. There are prominent bilateral PCOM arteries. There is no evidence of cerebral aneurysms.Neck MRA: The bilateral cervical vertebral arteries are not readily apparent throughout much of the V1 and V2 segments. There is otherwise no evidence of significant steno-occlusive lesions of the right cervical vertebral artery or carotid arteries.

Output: 1. Chronic left cerebellar hemisphere infarcts and mild probable chronic small vessel ischemic disease, but no evidence of acute infract.2. No evidence of intracranial metastases.3. Nodularity along the lateral margins of the lateral ventricles is suggestive of subependymal nodular heterotopia.4. Diffuse narrowing of the basilar artery and apparent steno-occlusive disease of the bilateral cervical vertebral arteries. A CTA of the neck may be useful for further characterization, if clinically warranted.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for choledocholithiasis History: reported CBD stone with unsuccessful removal during ERCP 1 wk here with AMS, abnormal LFTs ABDOMEN:LIVER, BILIARY TRACT: Small perihepatic and pericholecystic fluid. Dilated common bile duct measuring up to 1.3 cm. Tiny stones in the dilated common bile duct (series 4 image 38). No focal hepatic lesion is identified.SPLEEN: Small T2 hyperintense lesion in the spleen, presumably cyst. Splenule adjacent to the splenic tip.PANCREAS: There is fat stranding around the pancreatic head, compatible with pancreatitis, which may be postprocedural due to recent ERCP or stone related. Distal pancreatic duct is narrowed approximately 9 mm proximal to the ampulla insertion, which may be related to parenchymal edema. There is adjacent duodenal wall thickening, likely reactive.Multiple small IPMNs in the pancreatic head/proximal body. Accessory duct noted, an anatomic variant.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst and right T2 hyperintense lesion, too small to characterize. There may be bifurcation of the left renal vein with circumaortic morphology.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral small pleural effusions with adjacent atelectasis.

Output: 1.Dilated common bile duct with tiny stones. 2.Mild proximal pancreatic duct narrowing and pancreatitis of the pancreatic head, which may be postprocedural given recent ERCP or related to stone.3.Findings discussed with Megan Meiklejohn, PA.


Instruction: Generate impression based on findings.

Input: 43-year-old male with right knee pain. Evaluate for right knee mass. Markers were placed along the anterior surface of the knee. Deep to the marker is a mass within the subcutaneous fat anterior to the patella and proximal patellar tendon that measures 4 cm x 2 cm in transverse dimension and 4 cm in craniocaudal dimension. It is predominantly of fluid signal intensity with small internal septations on T2-weighted images. There is peripheral rim enhancement on postcontrast sequences. Edema extends both superiorly and inferiorly from the mass within the anterior subcutaneous fat. The extensor mechanism itself appears normal.There is a small multilobular mass with internal septations posterior to the distal femoral metaphysis which shows no apparent enhancement and likely represents a ganglion. MENISCI: There is increased signal intensity along the undersurface of the peripheral fibers of the posterior horn of the body of the medial meniscus. While it is conceivable that this could represent a shallow undersurface tear of the vascularized periphery of the meniscus, it may simply represent signal averaging with normal juxtameniscal tissue and is not necessarily of any current clinical significance. The remainder of the medial meniscus appears normal. The lateral meniscus appears normal.ARTICULAR CARTILAGE AND BONE: The articular cartilage and bone appear normal. LIGAMENTS: The cruciate and collateral ligaments appear intact. ADDITIONAL

Output: Prepatellar bursitis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Neoadjuvant therapy completed. History of sarcoma. There is a mass which appears to be centered within the right proximal vastus lateralis muscle. This mass measures approximately 11.7 x 8.1 x 5.2 cm (craniocaudal x transverse x AP dimension). The mass has intermediate T1 signal, heterogeneous T2 signal, and significant enhancement on post-contrast imaging with internal areas of low signal compatible with necrosis. The inferior 2 cm of the mass is predominately cystic with multiple septations. This mass appears similar in size and signal characteristics to the prior MRI. The mass does not appear to involve the underlying bone. The vastus intermedius and rectus femoris muscles are displaced medially. There is an abundance of red marrow in the femurs.

Output: Large mass centered within the right vastus lateralis muscle compatible with provided history of sarcoma.


Instruction: Generate impression based on findings.

Input: Reason: pt with asymmetric enhancement of the prostate as seen on CT History: hx of melanoma PELVIS:PROSTATE:Prostate Size: 4.9 x 3.3 x 3.6 cmPeripheral Zone: A 1 cm T2 hypointense lesion is seen in the left prostate base. There is no diffusion restriction or abnormal enhancement in this area.Central Gland: No significant abnormalities noted.Seminal Vesicles: No significant abnormalities noted.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Nonspecific T2 hypointense lesion in the left prostate base, no corresponding diffusion restriction or abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Headache [R51] / Other specified joint disorders, unspecified ankle and foot [M25.879], Reason for Study: ^Reason: eval for posterior column abnormalities History: chronic daily headache, lack of proprioception There is subtle height loss with associated osteophytes at C5 especially on the anterior aspect and subtle enhancement indicate possible chronic compression fracture related changes. There is focal central protrusion of disc at the level of C34 which abuts thecal sac.Broad based disc bulge is seen at the level of C56. Spinal cord signal intensity appears to be normal.There is normal cervical lordosis. The cranial-cervical junction is normal.

Output: 1. Subtle high signal intensity with some enhancement of C5, likely represent chronic trauma related compression fracture.2. Disc protrusion at the level of C34 and bulging at C56.3. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 71 years Male (DOB:7/13/1945)Reason: a study on PSP, PI Dr Tao Xie History: as abovePROVIDER/ATTENDING NAME: TAO XIE TAO XIE There is redemonstration of some and brain atrophy. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Midbrain atrophy2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type I Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on this scan.About 6 mm sized high signal intensity lesion on the right globus pallidus is again seen (best seen on T2 coronal scan), the size and signal intensity do not show any significant interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no 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.C-spine:There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. Cervical soft tissue appear to be thickened bilaterally from C2 to C8 with various degrees, this finding does not show any interval change since prior exam on May 23 2014 Cervical spine MRI.There are multifocal various sized lesions (the maximum diameter of the largest one is about 28mm, previously it was 27mm) are found throughout the soft tissue neck, comparing to prior scan, there is no significant interval changes of the numbers, size and MR characteristics since prior scan.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of right globus pallidus lesion likely represent hamartoma in terms of size and MR characteristics since prior scan.3. No change of multilevel various degreed cervical nerve root thickenings and multiple soft tissue neck lesions (likely represent neurofibromas) since prior scan. (The right lower neck lesion shows 28mm which was 27mm, but could be related to different scan technique or measurement)


Instruction: Generate impression based on findings.

Input: Preoperative evaluation for pituitary pneumatized. Limited images provided for preoperative planning.There is redemonstration of a predominant solid enhancing sellar and suprasellar mass. There may be a small cystic component of the lesion along its superior aspect. The lesion impinges upon the right optic apparatus. This lesion appears grossly similar to the prior examination.

Output: Redemonstrated sellar and suprasellar mass, similar to prior examination.


Instruction: Generate impression based on findings.

Input: Compression deformities are as follows:1.Minimal compression deformity at T7 is noted, unchanged compared to 3/1/2014, thus is chronic.2.T10 compression has progressed when compared to 3/1/2014 (not included in the field-of-view on 5/20/2015), now moderate in extent. This includes some residual marrow edema isolated to the anterior aspects of the vertebral body, thus this is most likely subacute. There are no retropulsed fragments.3.There has been significant interval near complete collapse of T11 when compared to 5/20/2015 with approximate 7 mm retropulsion of fragments which impacts and deforms the anterior cord surface, without resulting intrinsic cord signal. CSF is maintained posteriorly, thus there is no cord compression. This osseous deformity also encroaches bilateral neural foramina at T10/11 and T11/12. Marrow edema is present, and these findings are consistent with an acute compression fracture.4.Chronic moderate compression fracture T12 is unchanged compared to 5/20/2015, thus chronic.Marrow heterogeneity identified and discussed for previous lumbar spine MRI is again present within the thoracic spine.T1/2 demonstrates a small left paramedian disc protrusion without cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates a tiny right paramedian disc protrusion without cord encroachment. T7/8 demonstrates a tiny right paramedian disc protrusion without cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 and T11/12 discussed above.T12/L1 demonstrates no significant disc bulge or cord encroachment. The spinal cord is without focal atrophy, edema, or myelomalacia. There are no masses.

Output: 1.T10 compression has progressed when compared to 3/1/2014, now moderate in extent. This includes some residual marrow edema isolated to the anterior aspects of the vertebral body, thus this is most likely subacute. There are no retropulsed fragments.2.There has been significant interval near complete collapse of T11 when compared to 5/20/2015 with approximate 7 mm retropulsion of fragments which impacts and deforms the anterior cord surface, without resulting intrinsic cord signal. CSF is maintained posteriorly, thus there is no cord compression. This osseous deformity also encroaches bilateral neural foramina at T10/11 and T11/12. Marrow edema is present, and these findings are consistent with an acute compression fracture.3.Marrow heterogeneity identified and discussed for previous lumbar spine MRI is again present within the thoracic spine.


Instruction: Generate impression based on findings.

Input: Ankle pain, Crohn's disease TENDONS: No significant abnormality noted.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Ill-defined increased signal and enhancement within the posterolateral soft tissues approximately 4 cm superior to the ankle joint. This finding is nonspecific in nature but may reflect soft tissue inflammation or early phlegmonous change. The signal intensity and appearance of the remaining ankle structures is otherwise normal.


Instruction: Generate impression based on findings.

Input: The last well-formed disk space is referred to as L5-S1. There is normal alignment of the lumbar spine. The vertebral body heights are preserved. There is disk desiccation at multiple levels of the lumbar spine with mild loss of disk height. The osseous marrow signal is benign. The conus terminates at T12-L1 and shows normal caliber and signal characteristics.T12-L1: Mild disk bulge without significant central spinal canal or neural foraminal stenosis.L1-2: No disk herniation, central spinal canal or neural foraminal stenosis.L2-3: Diffuse disk bulge with right paracentral/foraminal protrusion, and mild facet arthropathy causing minimal right neural foraminal stenosis and no significant central spinal canal stenosis. Disk material encroaches upon the right subarticular zone without significant stenosis.L3-4: Mild diffuse disk bulge and mild facet arthropathy causing no significant spinal canal or neural foraminal stenosis.L4-5: Diffuse disk bulge asymmetric to the right with right foraminal protrusion and annular fissure, mild bilateral facet arthropathy causing mild right neural foraminal stenosis. Disk material encroaches upon the bilateral subarticular zones without stenosis. No significant spinal canal or left neural foramina stenosis.L5-S1: Diffuse disk bulge asymmetric to the left and mild bilateral facet arthropathy causing minimal left neural foraminal stenosis. No significant spinal canal or right neural foraminal stenosis.There are bilateral small renal cysts.

Output: Mild multilevel lumbar degenerative changes with no significant spinal canal stenosis and minimal neural foraminal narrowing as detailed above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 22 year-old female with left lower quadrant abdominal pain. Four days postpartum. Evaluate for TOA, diverticulitis with septic thrombophlebitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: The uterus is enlarged and contains numerous air bubbles within the uterine cavity compatible with history of recent postpartum status. There is a uniloculated left ovarian cyst which measured 5.4 x 7.5 cm. Inferior to the cyst there is a smaller fluid collection in the left adnexa which may represent a fluid filled dilated fallopian tube. This may be evaluated further with transvaginal ultrasound and/or MRI. The findings are nonspecific, but can be seen with tubo-ovarian abscess or hydrosalpinx. There may be fluid in the right fallopian tube as well. Multiple small cervical cysts. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Postpartum uterus. Large left ovarian cyst. Questionable fluid filled left fallopian tube may be further evaluated with transvaginal ultrasound and/or MRI, if indicated.


Instruction: Generate impression based on findings.

Input: 35 year old BRCA 1 positive female with history of right mastectomy for breast cancer in 2015, followed by chemotherapy and radiation therapy. Status post right mastectomy.There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or right mastectomy bed. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 71 y/o man with CAD with known chronic total occlusion to the right coronary artery. He presents for evaluation of left ventricular systolic function and myocardial viability. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function . The overall LV ejection fraction is 53%, the LV end diastolic volume index is 75 ml/m2 (normal range: 74+/-15), the LVEDV is 155 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 73 ml (normal range 47+/-19). There is inferior and inferolateral hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 142 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 62 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlarged.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aortic size is 3.9 cm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function (LVEF 53%). There is inferior and inferolateral hypokinesis. There is LV dyssynergy.2. There is no late gadolinium enhancement which suggest complete viability in the hypocontractile segments.3. The right ventricle is normal in size and systolic function (RVEF 56%).


Instruction: Generate impression based on findings.

Input: 37-year-old female with pelvic pain, recent CT demonstrating possible fistulous connection between the small bowel and sigmoid colon. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Tethering of the sigmoid colon and rectum to the level of the apex of the vaginal cuff. No fluid track is seen to suggest fistulous connection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. T1 hyperintense lesion in the mid transvaginal cough may reflect post surgical blood product. Tissue adjacent to the vaginal cuff is favored to reflect ovarian tissue.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Tethering of the rectum, sigmoid colon, and probable ovarian tissue at the level of the apex of the vaginal cuff. No definite evidence of a fistulous connection is present. Findings favor adhesive disease.


Instruction: Generate impression based on findings.

Input: 76-year-old male with low back pain and bilateral lower leg pain worsened by ambulation. The bony density and the alignment the vertebral column in the lumbosacral region remains within normal limits.Incidental note is made of heavy calcification of the abdominal aorta.Mild degenerative disk disease and hypertrophic changes of posterior elements for patient's age is noted. No definitive evidence of central spinal stenosis or neural frontal compromise on this non-infused CT of the lumber spine is detected. Considering provided clinical data further follow-up with an MRI would be significantly more useful.

Output: 1.Mild degenerative changes of lumber spine with no definite evidence of neuroforamina compromise or central spinal stenosis.2.Normal density and the alignment of the vertebral column.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: seizures History: seizures Post right hippocampal laser ablation status.Ablation site susceptibility lesions indicating procedure related blood products with minimal FLAIR high signal intensity indicating surrounding edema are again seen, unchanged.Metallic artifacts on the right temporal area, unchanged.The left hippocampal FLAIR/T2 high signal intensity lesion, unchanged in terms of its size and extent since 3/25/2016. No evidence of acute ischemic or hemorrhagic lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Unchanged right hippocampal post LASER ablation status since prior scan.2. Unchanged left hippocampal FLAIR/T2 high signal intensity lesion since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion.4. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Right PCA territorial stroke based on CT scan. There is right occipital lobe, and right posterior inferior thalami restricted diffusion lesions indicating acute ischemic infarctions on the right PCA territory. There is no evidence of hemorrhagic transformation.There are focal encephalomalacia on bilateral inferior parietal lobules (left side lesion is larger than that of right side) indicating chronic ischemic lesion.There focal high signal intensity lesions on bilateral frontal lobes on FLAIR images which imply chronic lacune infarctions.The ventricles, sulci and cisterns are symmetric and unremarkable. 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate subtle irregularities of intracranial arteries. Especially the right MCA M1 segment shows about 30% of luminal stenosis. Other arteries demonstrated luminal irregularities but no evidence of luminal stenosis more than 30%. Vertebrobasilar system also shows luminal irregularities but no luminal stenosis.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate significant artifacts especially on arterial phase on bilateral common carotid artery region. Bilateral common carotid arteries were visualized on venous phase without showing any evidence of luminal stenosis.The vertebral artery origins do not show any evidence of luminal stenosis although demonstrated irregularities.

Output: 1. Acute ischemic infarctions on the right PCA territory without evidence of hemorrhagic transformation.2. Multifocal various degreed luminal irregularities on both intracranial and extracranial arterial system indicating atherosclerotic changes. However, there is no significant (more than 50%) luminal stenosis on arterial system.


Instruction: Generate impression based on findings.

Input: 60-year-old female BRCA1 positive with family history of breast and ovarian cancer. MRI high risk screening study IR 13073B There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 62-year-old male with IR drain, perihepatic abscess, evaluate for bilious drainage ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilation with narrowing at the level of the anastomosis. Thick walled multiloculated fluid collection in the right upper quadrant lateral to the hepaticojejunostomy measures 2.5 x 4.4 x 4.0 cm (series 501, image 12; series 401, image 15). A percutaneous pigtail catheter courses within the anterior portion of this collection, which is no longer measurable. Along the medial aspect of the larger, persisting posterior collection there is a tract of increased signal on the MRCP images extending superiorly towards the porta hepatis (series 801, image 79, 83, 93). On comparison CT, there is air in this region, which is likely outside the biliary tract. The combination of these findings is suspicious for possible fistulous communication between the biliary tree and perihepatic fluid collection. SPLEEN: Splenomegaly and varices.PANCREAS: Fatty involution of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left-sided renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Multiloculated perihepatic abscess with a tract of high signal extending superiorly towards the porta hepatis, where extraluminal air is noted on the comparison CT. This combination of findings is suspicious for possible fistulous communication between the biliary tree and perihepatic collection. If further imaging clarification would be helpful, a contrast enhanced MR scan utilizing Eovist which is excreted in the biliary tract, could determine whether a communication exists between the biliary tract and this collection.2.Pigtail drainage catheter within the anterior portion of the multiloculated perihepatic collection, which is no longer measurable. Posterior component persists without apparent drainage.


Instruction: Generate impression based on findings.

Input: Hypoxic brain injury. Delivered at 39.4 weeks gestation via emergent C-section secondary to cord prolapse. Intubated at ~7 minutes of age secondary to irregular respirations. Started on cooling protocol on 8/12/2015. There appears to be a punctate focus of T2 hyperintensity and what appears to be slightly restricted diffusion in the left globus pallidus. Otherwise, there is intact T1 hyperintense signal within the posterior limbs of the internal capsules bilaterally. The cortical ribbon also appears to be intact throughout. There is a hyperintense signal in the posterior pituitary gland, which is normal in neonates. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage. There is mild swelling of the left scalp.

Output: A punctate focus of T2 hyperintensity and apparent slightly restricted diffusion in the left globus pallidus may represent stigmata of hypoxia ischemic injury.


Instruction: Generate impression based on findings.

Input: 45-year-old female patient with history of fibroid uterus. PELVIS:UTERUS, ADNEXA: Bulky, fibroid uterus measures up to 10.2 cm in long axis. Largest fibroid along the left fundus measures 3.9 x 4.1 cm in axial dimension (series 501 image 39). The majority of the fibroids are intralumenal and the larger fibroids enhance heterogenously. The junctional zone is within normal limits for age.There is a cyst in the left adnexa with dependent decreased T2 signal and homogeneous T1 hyperintense signal that measures 4.6 x 2.7 cm (series 501 image 31). There is an additional cyst that measures 2.2 x 2.2 cm (series 501 image 36) with decreased T2 signal in the dependent portion of the cyst and homogeneous T1 hyperintense signal. Both cysts have thin walls without internal enhancement.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: 1.Bulky fibroid uterus.2.Two cysts in the left adnexa suspicious for endometriomas given signal characteristics including apparent T2 shading and presuming that one of the lesions visualized correlates to the 2.9 cm lesion reported on prior pelvic sonography and so suggesting that lesion persists after several weeks (favoring an endometrioma over a hemorrhagic cyst, the latter would be expected to demonstrate interval involution). Lesions may be followed up with pelvic ultrasound to differentiate from hemorrhagic cysts.


Instruction: Generate impression based on findings.

Input: 86-year-old female with mental status change and fall. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensities in the periventricular and subcortical white matter distribution consistent with small vessel disease age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Multiple punctate hypodensities consistent with old lacunar infarcts. Large white matter hypodensity in the distribution of the right posterior cerebral artery consistent with prior stroke.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered


Instruction: Generate impression based on findings.

Input: Ms. Luna-Yassin is a 38 year old female with multifocal left breast cancer with metastatic left axillary lymph node. She presents today for MRI evaluation while on neoadjuvant therapy to assess treatment response. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Left breast - In the left lower outer breast, the known index malignancy now measures approximately 1.6 x 1.0 x 1.0 cm (AP x ML x SI) previously measuring approximately 2.2 x 1.9 x 2.0 cm. The biopsy marker clip is present anteromedial to this mass. Extending anteromedially from the index malignancy are two additional enhancing foci, one of which has been biopsy-proven to be a satellite lesion. The total span of abnormal enhancement (index malignancy + enhancing satellite lesions) measures approximately 5.7 x 1.4 x 1.7 cm and 5.9 cm in the AP oblique dimension, previously measuring approximately 4.9 cm in the AP dimension. The two biopsy marker clips (one at the index malignancy and one at the satellite lesion) measures approximately 2.4 cm in the AP dimension. Right breast - There is a new rim-enhancing lesion identified in the right inferior breast measuring approximately 1.4 x 0.9 x 0.8 cm. This enhancing mass is associated with internal high T1 signal intensity, likely representing benign fat necrosis. Axillae - The known metastatic left axillary lymph node with associated biopsy marker clip now measures approximately 1.7 cm in maximal dimension, previously measuring 2.0 cm. There are no abnormal lymph nodes identified in the right axilla.

Output: (1) Overall interval decrease in size of known multifocal left breast malignancy. Residual abnormal enhancement (index malignancy + satellite lesions) continues to measure up to 5.9 cm in the AP dimension, greater than the distance between the two biopsy marker clips (one at the index malignancy and one at the satellite lesion) of approximately 2.4 cm. (2) Slight interval decrease in size of metastatic left axillary lymph node.(3) New rim-enhancing lesion in the right inferior breast, with imaging features suggestive of benign fat necrosis. Recommend correlation with an MR-directed ultrasound and/or mammogram. If no correlate is identified, then a short term 6 month MRI is recommended to confirm stability of this finding. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for bleed, mass effect. Signs and symptoms: Mental status changes Non-enhanced MRI of brain:No evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns as well as gray -- white matter differentiation is unremarkable.Calvarium, mastoid air cells, middle ear cavities and limited view of paranasal sinuses are negative.

Output: Negative nonenhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: Concern for osteomyelitis Evaluation of the clavicles is limited due to obscuration by overlying ribs. Within the limits, there is no gross bony erosion identified. There is moderate osteoarthritis of the acromioclavicular joint and shoulders bilaterally.

Output: No gross bony erosion of the clavicles within the limitations of the exam.


Instruction: Generate impression based on findings.

Input: 31-year-old female complains of aphasia for two hours yesterday. Patient is postpartum two weeks. Rule out dissection. CT of brain without infusion.No definitive evidence of any area of edema, mass effect, midline shift, hydrocephalus or hemorrhage is detected. Follow-up with an MRI is recommended.The cortical sulci, ventricular system and all CSF cisterns are essentially normal for patient stated age.The bony density of calvarium, pneumatization of paranasal sinuses and mastoid air cells are also unremarkable.CTA of the cervical region:Right carotid system.The origin of right common carotid artery is normal. The entire course of right common carotid artery, right carotid bifurcation, right internal carotid artery and right external carotid artery remain within normal limits.Left carotid system:The origin of left common carotid artery and entire course of the left common carotid artery remains normal.There is an abrupt sharp reduction in the caliber of the internal carotid artery from its origin distally which is believed to represent a dissection. There is a very narrow string of flow in an interrupted pattern is noted through the cervical region. This extends from the origin of left internal carotid artery to the skull base. The left internal carotid artery across the skull base has a small lumen however remains patent. The small lumen of the left internal carotid artery across the skull base may be due to diminished flow and not dissection.CTA of vertebral basilar system.A dominant normal appearing right vertebral artery in the cervical and across the skull base is noted.A smaller left vertebral artery which appears normal from its origin through the skull base.CTA of intracranial circulation:The supraclinoid portion of both internal carotid arteries are patent. There is also normal visualization of bilateral middle and anterior cerebral arteries. The left internal carotid artery immediately below the left anterior clinoid demonstrates reduction in its caliber.CTA of vertebral basilar system demonstrate patent bilateral vertebral arteries across the skull base with no pathology. There is also normal visualization of basilar artery and all of its branches with no pathology.On source images there is evidence of a patent anterior communicating artery and a small patent left posterior imaging artery.

Output: 1.No definitive evidence of pathology on CT examination of brain. Please follow-up with an MRI.2.Dissection of the left internal carotid artery at its origin which appears to extend superiorly to the skull base. A string of lumen of left internal carotid artery is noted in the cervical region which appears to have a interrupted segment immediately below the skull base.3.Unremarkable CTA of the cervical region of other vasculature.4.Essentially unremarkable CTA of intracranial circulation.5.Reduced caliber of left internal carotid artery across the skull base.


Instruction: Generate impression based on findings.

Input: 56-year-old female with history of multiple myeloma presents with weakness/incontinence, evaluate for cord compression. There is redemonstration of multilevel spondylotic changes involving the spine, most pronounced at C4-C5 where there is moderate central spinal canal stenosis and mild indentation of the of the spinal cord. There is no evidence of acute compression. There is no cord signal abnormality. The vertebral bodies are appropriate in the overall alignment and height. Partially imaged sacral plasmocytoma and T7 lesion without gross interval change since the prior examination. High T2 signal in the S2 vertebral body is unchanged.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. 2. Stable mild indentation of the spinal cord at C4-5 without evidence of acute cord compression.3. Grossly stable partially imaged sacral plasmocytoma and T7 lesion.


Instruction: Generate impression based on findings.

Input: Reason: elevated PSA eval for prostate cancer History: see aboveBiopsy 2/10/2014: left apex Gleason 6 adenocarcinoma.Biopsy 10/28/2013: left mid Gleason 6 adenocarcinoma. Left apex is 6 adenocarcinoma PELVIS:PROSTATE:Prostate Size: 5.4 x 4.1 x 4.6 cm.Peripheral Zone: Diffuse low T2 signal throughout the peripheral zone may reflect chronic prostatitis and limits sensitivity of prostate MRI.There is a T2 hypointense lesion in the left apex measuring 1.2 x 0.9 cm with intermediate ADC signal and early enhancement, similar to the prior exam. No new lesions are evident.Central Gland: BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter left external iliac nodes are stable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left apical lesion is stable and consistent with biopsy-proven adenocarcinoma. No new lesions are evident.


Instruction: Generate impression based on findings.

Input: Cerebral aneurysm, nonruptured [I67.1], Evaluate for significant stenosis. AMS There is been interval coiling of the previously identified aneurysmal sac extending from the left internal carotid artery ophthalmic segment. No residual aneurysm filling is identified. The bilateral internal carotid arteries, middle cerebral arteries, and anterior cerebral arteries are otherwise unremarkable. The vertebral basilar arteries and posterior cerebral arteries demonstrate normal caliber

Output: There has been interval coiling of left internal carotid artery para ophthalmic segment aneurysm. No residual aneurysm or steno-occlusive disease is identified.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago with sciatica, right side Muscle weakness (generalized)Clinical question: right side sciatica, severe with muscle weaknessSigns and Symptoms: as above Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There are some mild ligamentum flavum hypertrophy present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present associated with the loss of disc space height, disc desiccation and mild ligamentum flavum hypertrophy.At L3-4 there is no significant compromise to spinal canal. There is a broad-based right lateral disc protrusion present at this level which extends into the right neural foramen and mildly encroaches on the right-sided exiting nerve root within the neural foramen.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a Schmorl's present at this level. There is mild disc desiccation mild loss of disc space height and a mild disc bulge at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a cyst present in the left kidney along the inferior pole which measures 12 mm in diameter. This can also be identified on this CT exam from 1/13/2014 and has not changed.There is a large cystic lesion present along the right lobe of the liver. This can also be identified on this CT exam from 1/13/2014 and has not changed.

Output: 1.There is a right lateral disc protrusion present at L3-4 which mildly encroaches on the right-sided exiting nerve roots within the neural foramen. There are mild degenerative changes present in the lower lumbar spine without significant compromise to the spinal canal.2.Hepatic cysts and renal cyst are stable since the prior CT abdomen exam. Please refer to CT abdomen from 1/13/2014 for further comments.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with tingling and cervical radiculopathy on EMG. At most, there is a trace retrolisthesis of C5 relative to C6. Spinal alignment is otherwise anatomic.Degenerative endplate irregularity is evident at C5-6 and C6-7. Elsewhere, vertebral body morphology and marrow signal characteristics are unremarkable.Loss of disk height is seen at C5-6 and C6-7. Additional level specific findings are as follows:C2-3: Mild uncovertebral hypertrophy, left more than right. No significant spinal canal stenosis or neuroforaminal narrowing.C3-4: Mild uncovertebral hypertrophy. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.C4-5: Posterior disk osteophyte formation resulting in a mild generalized spinal canal stenosis with deformation of the left ventral cord. No cord signal abnormality is detected. Moderate bilateral foraminal narrowing. C5-6: Posterior disk osteophyte formation resulting in a severe spinal canal stenosis with generalized canal narrowing and cord deformation but with particular impingement of the left ventral cord. No cord signal abnormality. Moderate bilateral foraminal narrowing. C6-7: Posterior disk osteophyte formation resulting in a severe spinal canal stenosis with generalized cord deformation. No cord signal abnormality. Severe bilateral foraminal narrowing. C7-T1: Left facet hypertrophy causing mild left foraminal narrowing. No significant disk disease or spinal canal stenosis.

Output: 1. Multilevel cervical spondylosis resulting in mild spinal canal stenosis at C4-5 and severe stenoses at C5-6 and C6-7.2. Areas of predominantly left ventral cord impingement as above. No evidence of cord edema is seen.3. Scattered foraminal narrowing ranging from mild to severe.


Instruction: Generate impression based on findings.

Input: 21 year old woman with headache. There is no evidence of intracranial hemorrhage, mass or edema. There is possible Chiari malformation, however, head positioning is not ideal to evaluate for this abnormality. Recommend MRI.The ventricles and basal cisterns are normal in size and configuration.The foramen magnum appears slightly enlarged. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Possible Chiari malformation. Recommend evaluation with MRI.


Instruction: Generate impression based on findings.

Input: Sellar/suprasellar tumor surveillance. There is no significant interval change in the heterogeneous sellar and suprasellar mass with resultant mass effect and upon the optic apparatus. The mass also extends to the third ventricle and posteriorly into the interpeduncular cistern, with mass effect upon the mammillary bodies. The tumor measures up to nearly 35mm. There is no encasement of the internal jugular arteries. There is a partially imaged left maxillary sinus retention cyst.

Output: No significant interval change in the sellar and suprasellar mass with associated mass effect and upon the optic apparatus.


Instruction: Generate impression based on findings.

Input: Reason: Patient with R. ankle wound and drainage, please evaluate for osteomyelitis History: Leg pain There is diffuse subcutaneous edema throughout the ankle and extending distally along the dorsum of the foot. There is irregularity of the skin superficial to the lateral malleolus which may represent ulceration. There may also be ulceration of the skin anterior to the distal tibia. There is minimal increased signal intensity seen within the underlying lateral malleolus on the fluid sensitive sequences, but this likely represents reactive osteitis rather than osteomyelitis as the fat signal on the T1-weighted images is preserved. There is patchy increased signal intensity within the marrow of the talus, calcaneus, and medial cuneiform bones which may be degenerative in etiology and does not have the appearance of osteomyelitis. There is a small amount of fluid in the tibiotalar joint but no large effusion. There is also soft tissue edema deep within the ankle surrounding and within the distal flexor hallucis longus muscle. Although the edema becomes confluent, we see no focal fluid collection to confirm abscess. There is minimal fluid in the sheaths of the medial and lateral tendons but the tendons otherwise appear normal. There is also edema of the plantar musculature of the foot, which is nonspecific.

Output: Soft tissue swelling and ulceration without specific imaging features of osteomyelitis.


Instruction: Generate impression based on findings.

Input: MRI Orbits:There is no mass or evidence of mass effect within the orbits. There is no abnormal signal or mass involving the optic nerves or chiasm. Globes and extraocular muscles also appear unremarkable. No abnormal enhancement is appreciated.MRI Pituitary:Pituitary gland measures up to 8 mm in the craniocaudal dimension which is prominent for age. There is no suprasellar extension, mass effect on the optic chiasm or extension into the cavernous sinuses. There is normal T1 shortening of the neurohypophysis. Post gadolinium sequences of the sella are technically degraded. However no obvious lesion within the pituitary gland is appreciated.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. The vertebrobasilar system appears relatively small which is developmental. There is fetal origin of the bilateral PCAs. No evidence of aneurysms or vascular malformations.

Output: 1.No flow limiting stenosis or aneurysm involving the intracranial vasculature.2. Post gadolinium images of the orbit and sella are technically limited as patient had difficulty tolerating the study. The pituitary gland measures up to 8 mm in the craniocaudal dimension, which is prominent for age and while nonspecific may reflect pituitary hyperplasia. There is no clear evidence of a pituitary macroadenoma, mass effect on the chiasm, or cavernous sinus extension. If there is suspicion for microadenoma or a small orbital lesion, repeat post gadolinium sequences are suggested.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 pain MENISCI: There is a bucket-handle tear of the medial meniscus with displacement of meniscal tissue beneath the PCL and along the anterior horn of the medial meniscus. There is additional horizontal signal intensity within the truncated posterior horn of the medial meniscus reflecting additional tearing. The body of the medial meniscus is severely attenuated likely reflecting a combination of tearing/displacement and prior surgical change.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is focal near full-thickness to full-thickness degeneration of the articular cartilage of the lateral femoral trochlea with mild associated subchondral marrow signal abnormality. The remaining articular cartilage of the knee is otherwise intact. The remaining bone marrow signal is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is mild increased longitudinal signal within the lateral fibers of the quadriceps tendon which may reflect focal degeneration versus chronic tearing although this may not be of any current clinical significance. The patellar tendon is normal.ADDITIONAL

Output: Re-tear of the medial meniscus with displaced bucket-handle fragment as described above. Referral to the orthopedic surgery service is recommended.


Instruction: Generate impression based on findings.

Input: Male 51 years old Reason: Hepatomegaly, liver echogenic, likely reflecting underlying hepatic steatosis/parenchymal on ultrasound History: non, lfts elevated ABDOMEN:LIVER, BILIARY TRACT: Mild caudate hypertrophy and widening of the fissures. There is mild hepatic steatosis. No suspicious hepatic lesions. Hepatic and portal veins are patent. Gallbladder and biliary tree are without diagnostic abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Minimal hepatic steatosis. If further clinical suspicion exists, random needle biopsy is suggested for further evaluation of the hepatic parenchyma.


Instruction: Generate impression based on findings.

Input: 59 years Male (DOB: 6/25/1957)Reason: evaluate for inflammatory lesions or tumors History: new onset facial palsy and other focal deficitsPROVIDER NAME: JAMES R. BRORSON JAMES R. BRORSON MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There appears to be a 6 mm in the distal right vertebral artery just proximal to the origin of the right posterior inferior cerebellar artery.The visualized portions of the paranasal sinuses demonstrate partial opacification of the posterior ethmoid air cells and mucosal thickening in the right frontal sinus as well as a mucous retention cysts in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is a 2mm T2 hyperintense focus in the right hemicord at the C6 vertebral level.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is left-sided facet hypertrophy present at this level associated with mild narrowing of the left-sided neural foramen.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes at this level associated with narrowing of neural foramina. There are some mild endplate reactive changes present.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics. At the T5-6 level of the spinal cord is displaced anteriorly and mildly narrowed in its AP dimension, however no distinct lesion is identified associated with this. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.

Output: 1.There is mild displacement of the thoracic spinal cord anteriorly raising the question of a possible adhesion to the dura and herniation.2.Findings suggest a 6-7mm right vertebral artery aneurysm. A CT angiogram may help further evaluate this.3.A 2 mm lesion within the right hemicord at the C6 level is present. There is nonspecific and may relate to prior injury.


Instruction: Generate impression based on findings.

Input: Reason: R shoulder AC joint pain, calcific tendonitis History: R shoulder pain Suboptimal evaluation secondary to patient motion artifact.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 13 mm in the AP dimension. There is minimal (7 mm) retraction of the proximal tendon fragment. This tear extends posteriorly to involve the anterior fibers of the infraspinatus as well. Additionally, there is a small interstitial tear of the infraspinatus at the level of the myotendinous junction. There is fatty infiltration of the supraspinatus, infraspinatus and subscapularisSUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Moderate degenerative changes affect the acromioclavicular joint with prominent osteophyte formation along the inferior aspect of the acromion process.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal abnormality within the anterior inferior and superior labrum likely reflecting degeneration and degenerative tearing. There is a subcentimeter focus of fluid signal intensity along the superior and posterior aspect of the glenoid indicating a paralabral cyst likely related to a labral tear.BICEPS TENDON: The intra-articular portion of the long head of the biceps tendon is poorly visualized likely indicating a near full-thickness to full-thickness tear, although evaluation is limited secondary to patient motion artifact. The tendon of the long head of the biceps is also poorly visualized within the bicipital groove which may reflect proximal retraction beyond the caudal aspect of the examination.ADDITIONAL

Output: 1. Full-thickness tear of the supraspinatus with retraction as described above.2. Full-thickness tear of the long head of the biceps tendon with retraction as described above.3. Nonspecific right axillary lymphadenopathy.4. Degeneration/degenerative tearing of the glenoid labrum with paralabral cyst formation.5. Osteoarthritis of the shoulder with prominent osteophyte formation along the inferior aspect of the acromion process resulting in impression on the superior fibers of the supraspinatus.


Instruction: Generate impression based on findings.

Input: Status post plexiform neurofibroma decompression: 3 month postoperative evaluation. There are postoperative findings related to thoracotomy with excision of the left chest wall plexiform neurofibroma and lower cervical spinal canal plexiform neurofibroma debulking and laminoplasty. There is new kyphotic deformity of the cervicothoracic junction with associated spinal canal narrowing and slight indentation upon the spinal cord, which otherwise appears to maintain normal signal characteristics. Otherwise, there is no significant interval change in size of the residual transpatial tumor in the left neck and upper chest, with extension of tumor in to the left neural foramina from C5 to T5, as well as extension into the left spinal canal at C7-T1, resulting in mild spinal canal stenosis. There is an unchanged lesion in the right T6-7 neural foramen without extension into the spinal canal. There are several lesions in the posterior intercostal spaces at multiple levels, which may represent additional nerve sheath tumors.

Output: 1. Postoperative findings related to thoracotomy with excision of the left chest wall plexiform neurofibroma and lower cervical spinal canal plexiform neurofibroma debulking and laminoplasty, with new kyphotic deformity of the cervicothoracic junction with associated spinal canal narrowing and slight indentation upon the spinal cord, which is suggestive of instability.2. No significant interval change in size of the residual transpatial tumor in the left neck and upper chest, with extension of tumor in to the left neural foramina from C5 to T5, as well as extension into the left spinal canal at C7-T1, resulting in mild spinal canal stenosis. There is an unchanged lesion in the right T6-7 neural foramen without extension into the spinal canal. Please refer to the separate chest MRI report for additional details.3. Several lesions in the posterior intercostal spaces at multiple levels, which may represent additional nerve sheath tumors.Discussed with Dr. Frim at 12:55 PM on 9/16/15.


Instruction: Generate impression based on findings.

Input: Some images are degraded by motion artifact.Brain MRI: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. No abnormal enhancing lesion is identified. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute infarction. The paranasal sinuses and mastoid air cells are clear. There is left temporal lobe developmental venous anomaly, which is a normal variant. Bilateral prominent perivascular spaces are noted with focal prominence in the left periatrial white matter. Brain MRA: There is normal flow related enhancement of the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. There is central lack of flow related enhancement of the anterior communicating artery, which may be artifactual versus a tiny fenestration. Left A1 segment and bilateral P1 segments are hypoplastic, which are normal variants. No arterial narrowing, occlusions or aneurysms are identified. No arteriovenous malformations are identified.Brain MRV: There is normal venous flow demonstrated within the internal cerebral veins, straight sinus, superior sagittal sinus and within the bilateral transverse and sigmoid sinuses. No dural venous sinus thromboses or occlusions are identified.

Output: 1.No acute intracranial abnormality.2.No intracranial arterial narrowing, occlusion, or aneurysms are identified.3.No intracranial venous sinus thromboses or occlusions are identified.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is appropriate. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Lumbar spine MRI:Fat signal material abuts a low-lying conus at the level of L3/4, extending inferiorly through the lumbosacral junction, communicating with subcutaneous fat through a posterior dysraphism of S3, approaching the sacral hiatus. The remainder of the lumbar spine is unremarkable without pathologic enhancement.

Output: 1.Negative noncontrast brain MRI.2.Terminal lipoma with associated low-lying and tethered cord.


Instruction: Generate impression based on findings.

Input: Male 38 years old Reason: concern for osteomyelitis History: purulent drainage from left foot, hx of mid-left foot amputation Postsurgical changes of an amputation through the second third and fourth proximal metatarsals as well as apparent complete amputation of the first and fifth rays. Low T1 signal with corresponding T2 hyperintensity at the osteotomy sites of the remaining metatarsals is most consistent with osteomyelitis. Significant subcutaneous soft tissue edema is present throughout the remaining foot. There is also some marrow edema within the cuboid and calcaneus without corresponding low T1 signal. This likely represents reactive marrow edema. Small tibiotalar joint effusion is present. Remaining tendons appear intact.

Output: Findings most consistent with osteomyelitis of the osteotomy margins of the remaining metatarsals and other findings as above.


Instruction: Generate impression based on findings.

Input: 29-year-old male presents with acute left knee pain. MENISCI: Lobular intermediate signal with a more discrete linear component extending to the inferior articular surface in the posterior horn of the medial meniscus compatible with a tear. There is a small posterior parameniscal cyst. There is minimal extrusion of the menisci. No discrete tear involving the medial meniscus is identified.ARTICULAR CARTILAGE AND BONE: Bone marrow edema is noted in the lateral tibial plateau and lateral femoral condyle. There is some heterogeneity in the articular cartilage of the patellofemoral joint but no focal thickness tear is identified. There is however a focal cartilage defect with abnormal signal along the lateral aspect of the lateral condyle with underlying bone marrow edema.LIGAMENTS: Abnormal diffuse intermediate signal intensity throughout the anterior cruciate ligament with a full-thickness tear and proximal retraction of the ligament towards the origin. Abnormal appearance and signal of the MCL compatible with a severe sprain with suspicion for proximal tearing. High signal intensity through the lateral collateral ligament complex to a lesser degree is suggestive of a sprain.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Complete thickness tear of the ACL with associated tears of the lateral meniscus. Findings are also concerning for a high-grade MCL sprain with likely superimposed proximal tearing.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: meningitis History: meningismus There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no abnormal enhancement intracranially.There is, however, well circumscribed ovoid lesion on the right frontal bone. The lesion shows high signal intensity on T2, low signal intensity on T1 and shows homogenous enhancement. There is no associated soft tissue mass, nor periosteal reaction, both inner and outer table appear to be intact. Constellation of these findings suggest possible intra-osseous hemangioma. Differential diagnosis include dermoid, fibrous dysplasia, eosinophilic granuloma, metastasis, and multiple myeloma.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.No intracranial abnormal enhancement.Right frontal skull lesion most likely represent hemangioma with multiple differential diagnosis as described above.