Instruction: Generate impression based on findings.

Input: History of poorly differentiated sinonasal carcinoma SNUC treated with CRT. There are postoperative findings related to sinonasal tumor excisional biopsy with resection of the left ostiomeatal complex and left middle and superior turbinates. There is no evidence of measurable sinonasal region tumor. There is persistent mucosal and secretions that completely fill the left sphenoid sinus. There is also persistent moderate mucosal thickening in the left maxillary sinus and mild mucosal thickening within the right maxillary, right sphenoid, left frontal, and right ethmoid sinuses. The parotid glands are unremarkable. There is encephalomalacia in the inferior right cerebellar hemisphere. There are also scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There are bilateral lens implants.

Output: 1. Post-treatment findings in the sinonasal region with persistent diffuse mucosal inflammatory changes, but no convincing evidence of gross tumor recurrence. 2. Chronic right inferior cerebellar infarct.


Instruction: Generate impression based on findings.

Input: NSCLC brain metastases status post WBRT in 11/2014. There is interval decrease in size of multiple subcentimeter enhancing supratentorial and infratentorial lesions. For example, a right anterior frontal lobe lesion measures up to 4 mm, previously 8 mm and a left cerebellar hemisphere lesion measures up to 3 mm, previously 5 mm. There is also negligible residual vasogenic edema associated with the lesions. There is a punctate focus of susceptibility effect in a left precentral gyrus lesion, which may represent hemorrhage or calcification. In addition, the enhancing component within the pineal gland has decreased in size. There is minimal patchy cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is patchy fluid signal within the bilateral mastoid air cells.

Output: Interval decrease in size of multiple subcentimeter enhancing supratentorial and infratentorial metastases.


Instruction: Generate impression based on findings.

Input: Reason: Recurrent cervical cancer, MRI for interstitial brachy planning History: Recurrent cervical cancer, MRI for interstitial brachy planning PELVIS:UTERUS, ADNEXA: There is been interval placement of a brachytherapy applicator which extends to the vaginal cuff. This lies adjacent to a region of focal thickening along the right anterolateral aspect which measures up to 1.0 cm in thickness. Evaluation of recurrent tumor at the vaginal cuff is suboptimal due artifact from the adjacent applicator.BLADDER: Bladder contains air and a Foley catheter.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: Limited exam with recurrent tumor at the vaginal cuff. Study performed for brachytherapy planning.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is a a globular appearance with increased signal of the posterior horn of the medial meniscus. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is partial visualization of presumed bone infarctions in the distal femur. Mild thinning of the articular cartilage of both the medial and lateral compartments is seen without full-thickness defectLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Degenerative signal within the posterior horn of the medial meniscus with no evidence of meniscal tear within the medial or lateral meniscus.2. Mild cartilaginous thinning particularly of the medial compartment.


Instruction: Generate impression based on findings.

Input: Clinical question: 72-year-old male with lung, liver masses. Concern for malignancy. Signs and symptoms: Shortness of breath. Pre and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates a hemorrhagic ring-enhancing mass in the left anterior frontal lobe with diffuse surrounding vasogenic edema with resultant regional mass effect. Finding is highly suspected of a metastatic lesion measuring 8 x 9 mm in transaxial dimensions.There are 2 abutting ring-enhancing necrotic masses in the left posterior temporal-occipital region without vasogenic edema or mass effect with combined measurement of approximately 16 x 9 mm on sagittal post enhanced series. No convincing evidence of any additional metastatic lesion to brain parenchyma or the leptomeninges and no detectable calvarial or orbital metastatic lesions.A small developmental venous anomaly in the cingulate vagina resolving left parietal lobe is also noted on post enhanced images.Ventricular system and CSF spaces are within normal and the maintained midline.Unremarkable signal intensity of the paranasal sinuses, mastoid air cells and middle ear cavities.

Output: 1.Ring-enhancing metastatic lesion in the left frontal and two abutting ring-enhancing metastatic lesion in the left posterior temporal-occipital region as detailed/measured above.2.Small left parietal cingulate gyrus developmental venous anomaly.3.Unremarkable pre and post enhanced study otherwise.


Instruction: Generate impression based on findings.

Input: Clinical question: History of right sided brain tumor status post biopsy now planning for resection. Signs and symptoms: Preop planning for resection. Pre and post enhanced Stealth brain MRI:Examination is performed utilizing surgical planning/Stealth protocol and is not a complete diagnostic exam.Examination redemonstrate a large, irregular, enhancing and necrotic tumor in the right hemisphere with significant surrounding vasogenic edema, mass effect with mild deviation of midline to the left. There is no significant change other than subtle decreased midline shift.The tumor is very irregular in configuration which makes precise measurements difficult however it measures approximately 35 mm transverse axis and 61 mm in AP axis. It extends inferiorly into the left thalamus and basal ganglia and extends superiorly and posteriorly and reaches the cortex of the right posterior frontal-parietal lobe similar to prior study.

Output: Very large irregular, enhancing and necrotic right hemispheric mass with surrounding vasogenic edema and trace deviation of midline to the left as detailed.


Instruction: Generate impression based on findings.

Input: Status post fall from however board on May 24 with arm extended. Elbow pain. Assess for supracondylar fracture. I see no fracture. There is, however, elevation of the distal humeral fat pads indicating a joint effusion or hemarthrosis, and I cannot exclude an occult fracture. If further imaging evaluation is clinically warranted, MRI may be considered.

Output: Although no fracture is evident, elevation of the distal humeral fat pads indicates a joint effusion or hemarthrosis. If further imaging evaluation is clinically warranted, MRI may be considered to assess for an occult fracture.


Instruction: Generate impression based on findings.

Input: Reason: 7 months s/p Left knee arthroscopy, microfracture patella, trochlea and medial femoral condyle, continued pain evaluate for healing of microfracture History: left knee pain MENISCI: The lateral meniscus appears intact. There is deformity and increased signal abnormality within the posterior horn of the medial meniscus consistent with a complex tear which extends to involve the body of the meniscus, which is of indeterminate age. The anterior horn appears intactARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness articular cartilage signal abnormality along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus which may represent a combination of degeneration and postsurgical changes from prior chondroplasty/microfracture. There are partial-thickness articular cartilage clefts immediately adjacent to this signal abnormality (image 18; series 6).There is subjective thinning of the lateral tibiofemoral articular cartilage. There is moderate to severe articular cartilage degeneration affecting the patellofemoral compartment with a focal area of the median eminence of the patella being completely devoid of articular cartilage. There is a linear focus of increased and decreased signal abnormality within the femoral trochlea, centrally, indicating a full-thickness articular cartilage cleft. There is full-thickness articular cartilage signal abnormality along the medial facet of the patella which likely represents a combination of degeneration and postsurgical change from prior chondroplasty/microfracture. There is subchondral signal abnormality in the surrounding area.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus.2. Articular cartilage signal abnormality along the medial femoral condyle and medial facet of the patella as described above which likely represents a combination of degeneration as well as postsurgical change related to prior chondroplasty/microfracture as described above.


Instruction: Generate impression based on findings.

Input: 48-year-old female patient with right tibial pain, medial and lateral joint line tenderness. MENISCI: The posterior horn of the medial meniscus is attenuated compared to that seen on the prior study which may represent progression of attritional tearing or interval partial meniscectomy. The attenuated posterior horn appears separate from the root of the posterior horn compatible with a full-thickness radial tear. There is medial extrusion of the body of the medial meniscus that appears more prominent on the current compared to the prior study. The anterior horn appears relatively intact.Best seen on the coronal sequences is an obliquely oriented tear that appears to transect the body of the lateral meniscus. There is blunting of the free edge of the posterior meniscus which may reflect prior meniscectomy.ARTICULAR CARTILAGE AND BONE: Foci of subchondral osteonecrosis in the lateral and medial femoral condyles posteriorly appears similar to the prior study. There is a small cyst in the tibial plateau near the attachment of the posterior cruciate ligament that is new compared to the prior study.There is moderate to severe degeneration of the cartilage along the medial facet of the patella, appearing similar to the prior study. There has been progression of cartilage degeneration along the weightbearing portion of the medial femoral condyle. Cartilage degeneration/osteophyte formation along the lateral femoral condyle anterior to the meniscus appears similar to the prior study.LIGAMENTS: The patient has undergone an ACL reconstruction. The intra-articular portion is markedly thinned compatible with interval tearing. The posterior cruciate ligament is intact. The medial collateral ligament and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: There is thickening and increased signal intensity of the distal patellar tendon representing tendinosis with adjacent foci of metallic susceptibility artifact suggesting surgery at this site. There is a thin collection of heterogeneous signal intensity in the subcutaneous fat overlying the distal patellar tendon suggesting a bursitis.ADDITIONAL

Output: 1. Medial and lateral meniscal tears.2. Progression of osteoarthritis as described above.3. Progressive thinning of the anterior cruciate ligament graft indicating interval attritional tearing.4. Distal patellar tendinosis with findings suggestive of chronic overlying bursitis.5. Joint effusion and small Baker's cyst.


Instruction: Generate impression based on findings.

Input: extraosseous Ewing sarcoma of the right hand A marker was placed along the skin dorsal to the second/third metacarpal space. No underlying lesion or abnormal enhancement is identified. The bone marrow signal is normal throughout. No focal osseous lesion. The extensor and flexor tendons are intact. The structures of the carpal tunnel are normal in appearance.

Output: No evidence of recurrent disease.


Instruction: Generate impression based on findings.

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

Output: Successful fluoroscopic guided right hip arthrogram for MRI.


Instruction: Generate impression based on findings.

Input: Crohn's disease with stricturing involving the ileum and right 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: Dilated left upper pole calyx, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall enhancement, thickening, and stenosis involving the distal 7 cm of terminal ileum (series 16, image 53). There is enhancement and wall thickening involving a 3 cm segment of the ascending colon with associated stricturing (series 16, image 49). There are foci of nodular enhancement in the cecum and ileocecal valve most consistent with inflammatory polyps, unchanged. Additional nodular enhancement in the right lower quadrant (series 16, image 60) may represent a focus of granulation tissue. No evidence of abscess.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS: PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Acute on chronic inflammatory changes involving the terminal ileum and ascending colon similar to the prior exam.


Instruction: Generate impression based on findings.

Input: Lung cancer on treatment. There is no evidence of acute intracranial hemorrhage or infarct. There are scattered areas of T2 hyperintensity in the cerebral white matter, which are nonspecific. There are multiple unchanged punctate foci of susceptibility effect in the bilateral cerebral hemispheres. There is no evidence of acute infarction. There is diffuse cerebral and cerebellar volume loss. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There are bilateral lens implants. There are bilateral mastoid air cell effusions.

Output: Multiple unchanged punctate foci of susceptibility effect in the bilateral cerebral hemispheres appear to correspond to treated metastases.


Instruction: Generate impression based on findings.

Input: Right sided weakness. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right cerebellar developmental venous anomaly. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions in the left frontal sinus and bilateral maxillary sinus retention cysts. There is deficiency of the nasal turbinates and a defect in the anterior nasal septum. MRA: Focal loss of flow-related signal in the junction between the extracranial and intracranial portions of the right internal carotid artery may be artifactual. Otherwise, there is no evidence of significant steno-occlusive lesions or cerebral aneurysms.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Focal loss of flow-related signal in the junction between the extracranial and intracranial portions of the right internal carotid artery may be artifactual. Otherwise, no evidence of significant cerebrovascular steno-occlusive lesions.3. Deficiency of the nasal turbinates and a defect in the anterior nasal septum may be related to prior vasoconstrictive agent use or granulomatous disease.


Instruction: Generate impression based on findings.

Input: 44 year-old male. Left knee pain-more anterolateral knee pain with some posterior pain as well. MENISCI: The anterior horn and anterior half of the body of the lateral meniscus is diminutive with branching signal abnormality consistent with complex tearing. The posterior horn is spared. The medial meniscus is intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Diffuse articular cartilage thinning of the lateral tibiofemoral compartment with a near full thickness to full thickness defect at the posterior aspect of the femoral condyle. Medial tibiofemoral and patellofemoral compartment are intact without focal defects. Tricompartmental osteophytes. Small subchondral cyst in the tibia near the ACL insertion.LIGAMENTS: ACL, PCL, MCL, and LCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tearing of a diminutive anterior horn and body of the lateral meniscus.2. Cartilage degeneration in the lateral tibiofemoral compartment.3. Small Baker's cyst.


Instruction: Generate impression based on findings.

Input: History of left neck carcinoma. Question of pulmonary embolism. Complains of acute onset shortness of breath. Likely PE but also evaluate for possible mass effect on trachea.IMAGE ACQUISITIONS: CT neck soft tissues with contrast. On the uppermost image of the neck CT, the previously noted right parietal metastasis is again seen and measures 19 x 19 mm, minimally larger than the comparison brain MRI.There has been interval growth of the left neck mass . At the level of the vocal cords the airway appears narrowed although this is more likely due to a left vocal cord paralysis than direct mass effect. More inferiorly the trachea does appear slightly narrowed by mass effect. The mass measures 67 x 80 mm transaxially and 90 mm in the craniocaudad dimension. Note that the inferior margin of this mass extends into the superior mediastinum. Multiple new enhancing lymph nodes are seen in the left posterior neck, the two largest of these measure 11 mm in diameter. The right jugular vein is thrombosed. Within the isthmus of the thyroid there is a central low attenuation region which may represent a new thyroid metastasis.

Output: 1. Asymmetric narrowing at the level of the vocal cords more likely due to left vocal cord nerve paralysis. Inferior to this level there is slight narrowing of the trachea due to mass effect.2. Progression of disease in the neck with enlargement of the mass as well small small new pathologic lymph nodes, and likely new thyroid metastasis.3. Right parietal brain metastasis is incompletely visualized but appears slightly larger than the comparison MRI brain exam.4. Right internal jugular vein thrombosis.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity neurogenic claudication Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is development of narrowing of the lumbar spinal canal with superimposed mild degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy contribute to mild spinal canal stenosis. Minimal narrowing of the neural foramina.L3-L4: There is a left paracentral disc protrusion with effacement of the left lateral recess, new since prior MRI from 11/26/2013. There is also moderate degree of central spinal canal stenosis. There is facet arthropathy bilaterally with mild surrounding inflammatory changes in the left. There is moderate to severe left and moderate right neural foraminal stenosis. L4-L5: Small left paracentral annular fissure and minimal protrusion which is minimally more prominent in the interval. Mild effacement of the left lateral recess. Otherwise no significant central spinal canal stenosis. There is bilateral facet arthropathy. Mild bilateral neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits. Degenerative changes are evident at the bilateral sacroiliac joints.

Output: Developmental narrowing of the lumbar spinal canal with superimposed degenerative changes resulting in moderate central spinal canal stenosis at L3-L4 again seen. Compared to 11/26/2013, there is a new left paracentral disc protrusion at the L3-L4 level with severe effacement of the left lateral recess. There is also moderate to severe left and moderate right neural foraminal stenosis at the L3-L4 level. There is also mild spinal canal stenosis at L2-L3. Additional details as above.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified kidney, except renal pelvis [C64.9], Reason for Study: ^Reason: eval for residual History: s/p crani There is evidence of right fronto temporal craniotomy.Previously seen right middle cranial fossa mainly extra-axial mass has been totally removed. In addition, right anterior and mesial aspect of the temporal lobe shows wedge-shaped focal tissue loss with evidence of adjacent susceptibility artifacts indicating postoperative changes blood products. On gadolinium enhanced scan, there are linear ill-defined enhancements delineating the cortical margin of the right anterior temporal lobe where the extra axial mass abutted. In addition, there are focal more prominent enhancements at the area of tissue defects. These enhancement may represent postoperative changes but the possibility of small residual lesion cannot be completely excluded. Follow up examination is recommended. Scattered T2/FLAIR high signal intensity lesions on bilateral periventricular white matter indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening of frontal sinus.

Output: 1. Post right middle cranial fossa mainly extra axial mass resection status.2. Focal tissue defect at the anterior mesial aspect of the right temporal lobe indicate resection margin.3. Linear somewhat ill defined enhancement of resection margin with focal more prominent enhancement on the tissue defect area indicate possible postoperative reactive changes. However, possibility of residual lesion cannot be completely excluded.4. No evidence of acute ischemic lesion.5. Non specific small vessel ischemic disease.6. Ventricular system appears to be normal.


Instruction: Generate impression based on findings.

Input: 10-year-old male with a history of a right frontal lobe cystic lesion, surveillance examination. There is no evidence of intracranial hemorrhage or acute infarct. There is redemonstration of a cystic mass in the right frontal lobe which demonstrates CSF signal intensity. The mass is unchanged measuring up to 25 mm with mild localized mass effect. There is no abnormal intracranial enhancement. There is a stable punctate focus of T2 hyperintensity within the right frontal deep white matter. 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. No significant change in right frontal lobe cystic mass, which may reflect a benign neuroglial cyst.2. Stable nonspecific punctate focus of T2 hyperintensity within the right frontal deep white matter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 46-year-old BRCA mutation carrier presents for MRI screening study IRB13073B. History of bilateral breast cancer status post right lumpectomy in 2003 for invasive ductal carcinoma and left lumpectomy in May 2012 for invasive ductal carcinoma. Patient received radiation and chemotherapy. Patient had a negative breast MRI on December 18, 2014. History of breast cancer in two sisters, maternal grandmother, maternal aunt and cousin. History of ovarian cancer in mother. No current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Right breast: Stable deformity and scarring in the right upper outer quadrant at site of lumpectomy. Diffuse skin thickening is consistent with radiation changes. No new enhancing masses or foci. Left breast: Postsurgical and postradiation changes with deformity and diffuse skin thickening. Interval further decrease in size of the left breast seroma. Stable nonenhancing low T2 signal mass at the 12:00 position of the left breast and left upper outer quadrant fibroadenolipoma.No new areas of enhancement. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 30-year-old male with history of foreign body versus soft tissue calcification. MRI of the right foot was performed without contrast enhancement. A marker is placed along the plantar aspect of the fifth metatarsal head along the area of the patient's pain. In this region there is mild reticulation of the subcutaneous soft tissues consistent with edema. However, the small radiopaque foreign body seen on prior radiographs cannot be clearly visualized on MRI. There is no discrete fluid collection in this region. Marrow signal of the adjacent fifth metatarsal appears within normal limits. The remainder of the foot appears normal.

Output: The small foreign body seen on prior radiographs cannot be clearly identified on MRI. There is mild subcutaneous edema surrounding the fifth metatarsal head along the area of the patient's pain, without discrete fluid collection or bone marrow signal abnormality. If further imaging evaluation is warranted, targeted ultrasound may be considered.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild cerebellar volume loss greater than expected for age. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The hippocampi are symmetric and normal in appearance. There is no evidence of structural abnormality. The major cerebral flow voids are intact. There are small maxillary sinus retention cysts and minimal fluid within the left mastoid air cells and possibly within the right middle ear cavity.

Output: 1.No evidence for mass, structural abnormality, or mesial temporal sclerosis.2.Nonspecific minimal fluid within left mastoid air cells, and possibly within the right middle ear cavity.


Instruction: Generate impression based on findings.

Input: Ms. Orendorff is a 59 year old female with a personal history of left breast lumpectomy in 09/2010 for IDC and an MR-guided biopsy in 9/2010 for reactive changes/columnar cell change. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes of the left lateral breast, compatible with history of left breast lumpectomy. Susceptibility artifact from biopsy marker clip is seen in the left central breast, far posterior depth, from prior benign MRI guided biopsy. There is no abnormal enhancement seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: Stable postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of unspecified site of unspecified female breast. Dorsalgia, unspecifiedClinical question: Stage 4 Breast Cancer; Increased Back Pain; Tenderness on Palpation.Signs and Symptoms: Stage 4 Breast Cancer; Increased Back Pain; Tenderness on Palpation. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. There are multiple marrow replacing lesions present in the lumbar spine which demonstrate sclerosis on recent abdominal CT imaging. There is approximately 30% loss of vertebral body height of L2 which is similar to the CT exam from 10/30/2015. There is no resultant compromise to the spinal canal or exiting nerve roots appreciated. There is no associated soft tissue extension appreciated on this exam. There are associated contrast enhancement with these lesions. There is involvement of predominantly vertebral bodies but also some of the posterior elements.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multiple sclerotic lesions throughout the lumbar spine compatible with sclerotic metastases which are associated with a compression fracture of L2. There is no compromise to the spinal canal or exiting nerve roots resulting from this at this time. There is a CT of the abdomen from 10/30/2015 which demonstrates these lesions as well and there is no obvious progression since that time.2.There are some mild degenerative changes present in the lumbar spine.


Instruction: Generate impression based on findings.

Input: 57 year old woman with worsening shortness of breath following pulmonary vein isolation procedure. Referred to rule out pulmonary vein stenosis. 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 55 ml/m2 (normal range: 65+/-11), the LVEDV is 113 ml (normal range 109+/-23), the LV end systolic volume index is 19 ml/m2 (normal range 18+/-5), the LVESV is 74 ml (normal range 31+/-10), the LV mass index is 41 g/m2 (normal range 67+/-11), and the LV mass is 85 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.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 47 ml/m2 (normal range 69+/-14), the RVEDV is 97 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 43 ml (normal range 35+/-13). AtriaThe left atrium is mildly dilated. The LA volume is 96 ml.The right atrium is mildly dilated. An atrial septal defect closure device is noted.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. There is no evidence of pulmonary vein stenosis.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC is normal in size and drain normally into the right atrium. The IVC is dilated. Coronary sinus is aneurysmal (16mm) in its mid portion.PericardiumThere is no obvious pericardial disease. Trace pericardial effusion. 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. Normal LV size and systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 56%).3. Mild biatrial dilation with evidence of an atrial septal closure device.4. Normal pulmonary vein anatomy without evidence of stenosis.5. Mid portion of coronary sinus is aneurysmal 6. Dilated IVC7. Trivial pericardial effusion.


Instruction: Generate impression based on findings.

Input: 71 years, Female, ataxia with new facial weakness. Per chart, history of SCA-8. There is moderate degree of volume loss involving the cerebellar vermis, particularly the superior aspect, and to a mild degree involving the bilateral cerebellar hemispheres. This finding is not significantly changed since prior. There is also mild supratentorial parenchymal volume loss which is perhaps slightly prominent for age, but not significantly changed since 10/24/2009. No significant volume loss involving the brainstem is evident. No significant signal abnormality involving the brainstem, cerebellum, or basal ganglia is evident. Incidentally noted is a punctate focus of enhancement and susceptibility involving the pons compatible with a tiny capillary telangiectasia. This finding is similar to prior allowing for slight differences in technique. No suspicious enhancement or masses along the visualized intracranial course of the cranial nerves, including the trigeminal nerves. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. No hydrocephalus. No extra-axial collections. Multiple foci of T2/FLAIR hyperintensity are again seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. No suspicious parenchymal or meningeal enhancement. Major flow-voids are preserved. Calvarium and remainder of the extracranial soft tissues are unremarkable.

Output: 1. Moderate degree of volume loss involving the cerebellar vermis and to a milder degree involving the cerebellar hemispheres, which is nonspecific but compatible with known diagnosis of spinocerebellar ataxia. There is also mild supratentorial parenchymal volume loss which is slightly prominent for age. These findings are not significantly changed since prior study from 10/24/2009. There are also mild chronic small vessel ischemic changes which were also seen before.2. Otherwise no evidence of acute ischemia, hemorrhage, intracranial mass, or mass effect. No suspicious enhancing lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: Metastatic thyroid cancer to bone, brain and lung. Pre-chemotherapy. Signs and symptoms: metastatic thyroid cancer. Enhanced CT of soft tissues of neck:Limited view of intracranial content demonstrates small enhancing metastatic lesion in the left frontal lobe measuring 7-mm times 10-mm. This could be further evaluated on dedicated CT of brain.Images through the skull base demonstrate a lytic lesion in the clivus with no change since prior exam. This lesion has a sclerotic rim. This is believed to represent postoperative changes of the sphenoid sinus with packing material.Cavernous sinuses and bilateral Petrus bones remain within normal limits.Images through the neck and demonstrate no evidence of a mass or pathologic adenopathy. No evidence of residual enhancing thyroid tissue. The esophagus appears dilated and contains air. This may represent reflux. Trachea appears ectatic.CT of brain with enhancement: Lytic changes of clivus with a sclerotic rim and internal calcific fragments remains stable since prior CT of head and neck study and MRI of brain. This lesion believed to represent non-pneumatized sphenoid sinus or may be result of prior surgical inflammation (transphenoidal hypophysectomy) and with packing of the sinus. There is no interval change since prior exams and there is no abnormal enhancement of this finding on MRI examination. Please correlate with patient's past history.Images through the posterior fossa demonstrate a well demarcated low-attenuation within the vermis with no enhancement at the site of previously noted metastatic lesion. Surrounding vasogenic edema still is present. The finding may represent post treated metastatic lesion. This lesion measures approximately 16.2 mm in transverse axis and 14.4-mm in AP axis. This is a smaller than prior measurements of the enhancing mass in this location which measured 21 mm times 18-mm.At enhancing tumor measuring approximately 9 mm times 7-mm in the inferior left frontal lobe with surrounding vasogenic edema is again identified. This mass on prior MRI examination measured 5-mm x 4.5-mm. there is no evidence of any new additional metastatic lesions to the brain or leptomeninges.Calvarium is intact. 65 cc of Omnipaque 350 was utilized for the above studies.

Output: 1.Stable CT of soft tissues of neck with no evidence of recurrence of tumor or pathologic adenopathy in neck.2.Minimally larger left inferior frontal metastatic focus with surrounding vasogenic edema. This lesion measures 7 mm times 9-mm on current exam.3.Patient is known enhancing metastatic lesion in the vermis demonstrates no enhancement on the current exam and measures smaller than prior exam.4.No evidence of new additional metastatic lesion to the brain or calvarium.


Instruction: Generate impression based on findings.

Input: Female, 52 years old. Pain. ROTATOR CUFF: There is a partial-thickness bursal surface tear of the posterior supraspinatus tendon near the myotendinous junction. The tear extends for approximately 6 mm in AP dimension and involves just over 50% of the tendon thickness, with less than 1 cm retraction of the torn fibers. There is also a very small partial-thickness articular surface tear of the supraspinatus tendon near its insertion. There is a background of mild to moderate supraspinatus tendinopathy. The supraspinatus muscle shows mild to moderate atrophy. There is mild infraspinatus tendinopathy. Otherwise, the infraspinatus and teres minor tendons and muscles are intact. There is mild subscapularis tendinopathy without discrete tear identified.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint with a focus of marrow signal abnormality at the base of the coracoid process with extension toward the superior glenoid and adjacent small cysts..GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum is suboptimally evaluated on nonarthrographic images, but there is abnormal signal and morphology of both the superior and inferior aspects of the labrum, compatible with degenerative tearing.BICEPS TENDON: The tendon of the long head of biceps is normal in position and morphology. ADDITIONAL

Output: 1.Partial thickness tear of the supraspinatus tendon on a background of rotator cuff tendinopathy as above.2.Glenohumeral joint osteoarthritis with extensive labral degeneration.


Instruction: Generate impression based on findings.

Input: Brain: In addition to the previously demonstrated focus of susceptibility effect in the medulla, there are now numerous, on the order of 50, new intraparenchymal foci of infratentorial and supratentorial susceptibility effect. There is no evidence of acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. The calvarium is intact. Neck: There are secretions in the posterior nasopharynx, but no evidence of measurable nasopharyngeal mass. The skull base appears to be intact. There is no significant upper cervical lymphadenopathy. The salivary glands appear unchanged. The major cervical flow voids are grossly intact. There is a posterior small disc osteophyte complex at C5-6.

Output: 1. Post-treatment findings in the nasopharyngeal region without evidence of measurable locoregional tumor.2. In addition to the previously demonstrated focus of susceptibility effect in the medulla, there are now numerous new intraparenchymal foci of infratentorial and supratentorial susceptibility effect, which could represent microhemorrhages, perhaps related to embolic disease versus less likely atypical metastases.


Instruction: Generate impression based on findings.

Input: History of mycosis fungoides with CNS involvement now s/p 2 cycles of Cytarabine/Etoposide in need of reimaging. CERVICAL SPINE: There is no evidence of mass lesions or abnormal enhancement in the cervical spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is multilevel degenerative cervical spondylosis, with a disc-osteophyte complex at C3-4 that abuts the spinal cord and results in mild bilateral neural foraminal narrowing. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.THORACIC SPINE: There is mild residual enhancement of the thoracic nerve roots and cauda equina, although significantly improved since the prior examination. The thoracic spine is in normal alignment. The vertebral body and disc heights are preserved. There is no abnormal marrow signal abnormality. There are is a small disc bulge at the T1-T2 level, small right paracentral disc protrusion at the T2-3 level, a tiny central disc protrusion at the T5-6 level, but there is no significant spinal canal stenosis or neural foraminal narrowing. There are additional degenerative changes involving the T6-7 posterior T11-12, with variable disc height loss and Schmorl's nodes but no significant spinal canal or neural foraminal stenosis at these levels either. LUMBAR SPINE: There is mild residual enhancement of the thoracic nerve roots and cauda equina, although significantly improved since prior examination. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are small disc bulges at L3-4 and L5-S1, with at most mild bilateral neural foraminal stenosis at L5-S1 and no significant spinal canal stenosis at any level in the lumbar spine.

Output: Mild residual enhancement of the thoracic nerve roots and cauda equina related to lymphoma, although significantly improved since September 2016.


Instruction: Generate impression based on findings.

Input: Anesthesia of skin [R20.0], Reason for Study: ^Reason: evaluate for history of previous stroke given TIA symptoms History: facial numbness There are numerous scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter. There is no evidence for diffusion restriction to suggest acute ischemia. No intracranial hemorrhage is identified. No midline shift or mass effect is appreciated. There is no evidence for hydrocephalus. The flow-voids of the major intracranial vessels are grossly unremarkable.

Output: 1. There are numerous scattered foci of T2/FLAIR hyperintensity the periventricular and subcortical white matter which are nonspecific however likely related to chronic microvascular ischemic change.2. No evidence for acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Left temporal meningioma resection: surveillance. There are postoperative findings related to left temporal convexity meningioma resection. There is unchanged confluent white matter T2 hyperintensity adjacent to the left anterior temporal resection margin and unchanged dural-based enhancing soft tissue along the anterior left middle cranial fossa, which measures up to 5 mm in thickness. There are unchanged mild scattered nonspecific punctate and confluent areas of cerebral white matter T2 hyperintensity. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is unchanged mild prominence of the right cerebellomedullary cistern, which may be related to an arachnoid cyst. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Postoperative findings related to left temporal convexity meningioma resection with unchanged dural-based enhancing soft tissue along the anterior left middle cranial fossa, which measures up to 5 mm in thickness.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 37 seconds

Output: Successful right hip arthrogram injection. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on findings.

Input: Ms. Constantino is a 33 year old female with a personal history of left breast mastectomy in 2015 for multifocal IDC. BRCA2 carrier. She presents for MRI screening evaluation. RIGHT BREAST:There is heterogeneous amount of fibroglandular tissue in the right breast. Mild to moderate background parenchymal enhancement is noted. There is no abnormal enhancement seen in the right breast.LEFT BREAST:Patient is status post left breast mastectomy. There is no abnormal enhancement seen in the left chest wall.AXILLA:No abnormal axillary lymph nodes are identified in either axillary region. Surgical clips are seen in the left axilla.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: History of meningioma, preoperative planning for resection. Examination is obtained for operative planning and intraoperative navigation. There is a large avidly enhancing mass along the right frontal convexity measuring proximately 8.5 x 7.5 x 4.3 cm. Mass is also seen extending along the anterior falx with relatively small component to the left of the midline. There is surrounding edema with downward mass effect on the right greater than left lateral ventricles and the corpus callosum. Mass effect also results in leftward midline shift of 1.5 centimeters at the level of the cingulate gyrus. No uncal herniation. The anterior and mid superior sagittal sinus are severely attenuated. Bilateral distal anterior cerebral artery branches are leftward displaced. No hydrocephalus.There is thickening of the right frontal calvarium compatible with hyper ostosis. There is mild associated enhancement of the right frontal calvarium including the overlying scalp. No frank osseous destruction is seen.

Output: 1. Examination for operative planning demonstrating large right-sided meningioma extending along the the right frontal convexity and the anterior falx. 2. Severe attenuation of the anterior mid aspect of the superior sagittal sinus. There is downward mass effect and 15 -mm leftward midline shift. 3. Sclerosis and thickening of the right frontal calvarium which is likely reactive. There is mild associated enhancement of the calvarium and overlying scalp raising a small possibility of calvarial invasion. No osseous destruction is seen.


Instruction: Generate impression based on findings.

Input: Low back and bilateral leg pain, greater to right leg. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of lumbar lordosis. Alignment is otherwise maintained. Multilevel degenerative changes are again seen including severe disc height loss of L4-L5 and to a lesser degree L3-L4 and L5-S1 levels. Compared to prior, there appears to be slight worsening of the L3-L4 height loss with increased endplate marrow signal changes. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described by level below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge with small right foraminal disc protrusion. There is no significant spinal canal or neural foraminal stenosis.L3-L4: Mild progression of disc height loss and endplate changes as described above. Mild facet arthropathy and ligamentum flavum thickening. There is mild disc bulge. There is mild neural foraminal narrowing, left relatively worse than right but without clear impingement. Minimal spinal canal narrowing as before.L4-L5: Severe loss of disc height as before. Mild facet arthropathy and ligamentum flavum thickening. There is a mild disc bulge, eccentric to the left. There is no significant spinal canal narrowing. Disc bulge contacts the left L4 nerve root. There is mild to moderate narrowing of the neural foramina, left worse than right. There is also mild encroachment of the right lateral recess.L5-S1: Mild disc height loss and disc bulge with mild facet arthropathy and ligamentum flavum thickening. Suggestion of increased vacuum phenomena or mineralization in the disc compared to prior. No spinal canal stenosis. There is moderate right neural foraminal stenosis where there may be impingement of the right L5 nerve root, similar to prior. There is mild left neural foraminal narrowing.

Output: Multilevel degenerative changes in the lumbar spine appear minimally progressed since prior MRI from 3/19/2015. There is no significant spinal canal stenosis at any level. There is up to moderate right L5-S1 neural foraminal stenosis where there may be impingement of the right L5 nerve root. Left-sided neural foraminal stenosis is relatively worse at the L4-L5 level.


Instruction: Generate impression based on findings.

Input: 67 year old male with history of AL amyloidosis and kidney involvement, eval for cardiac involvement Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 72%. The LVEDV is 116 ml (normal range 142+/-34), the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVESV is 32 ml (normal range 47+/-19) and the LV end systolic volume index is 18 ml/m2 (normal range 25+/-9). The LV mass is 138 g (normal range 164+/-36) and the LV mass index is 78 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. The native T1 myocardial relaxation time is mildly elevated at around [1080-1180]ms. These values are suggestive of [possible]underlying diffuse fibrosis or infiltration.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 59%. The RVEDV is 103 ml (normal range 142+/-31), RV end diastolic volume index is 58 ml/m2 (normal range 82+/-16), the RVESV is 43 ml (normal range 54+/-17), and the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is normal in size and function. The overall LV ejection fraction is 72%.2. Right ventricle is normal in size and function. The overall RV ejection fraction is 59%.3. The native T1 myocardial relaxation time is mildly elevated at around [1180]ms. These values are suggestive of [possible]underlying diffuse fibrosis or infiltration.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: enlargement of his lateral and third ventricles in the setting of aqueduct stenosis, caused by a small glioma History: yearly follow up, new headaches. There is again seen a subtle nonenhancing exophytic T2 hyperintense lesion in the left periaqueductal region measuring 5 mm which is similar in appearance to prior exams. Dilatation of the lateral and third ventricles is slightly increased. Minimal periventricular T2 hyperintensity is unchanged. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement, although please note that thin section 3-D T1 post contrast images were inadvertently not obtained. 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.Subcentimeter lesion in the left periaqueductal region is unchanged. Future follow-up should include thin section postcontrast images for a complete evaluation, as well as thin section T2-weighted imaging with the area of the lesion. This could be achieved with a "midline tumor" protocol.2.Aqueduct narrowing with associated obstructive hydrocephalus, subtly increased from the prior exam.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with history of grade 3/4 tumor. Signs and symptoms: Surveillance scan. Pre and post enhanced brain MRI:Examination redemonstrate large irregular hemorrhagic, necrotic and enhancing right hemispheric tumor extensively involving the left mid to posterior temporal and with superior extension into the right parietal lobe and medially into the right thalamus and right basal ganglia. The very large and irregular shape of the tumor makes precise comparison difficult, however within this limitation there is interval increased size of tumor is more apparent in the right basal ganglia and thalamus. Also compared to prior exam the enhancement of the tumor appears to be more solid in appearance. Mild ex vacuo dilatation of right lateral ventricle remains similar to prior exam and there is no evidence of midline shift.There is no detectable new foci of parenchymal signal abnormality or enhancement since prior study. The CSF spaces remain patent. The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are within normal and the normal pattern of enhancement.

Output: 1.Interval progression of patient's known right hemispheric GBM as detailed above.2.Stable size of ventricular system and with maintained midline.3.No detectable new foci of signal abnormality or abnormal enhancement beyond the above detailed tumor.


Instruction: Generate impression based on findings.

Input: Reason: T12 compression fracture History: point tenderness Unenhanced MRI of the thoracic spine:The radiology technologist in the MRI suite noted that patient was unable to lie flat and patient was placed within the gantry and while they head and neck were significant in the off center and superiorly in position. This results in significantly degraded images.The quality of the images are also deteriorated order to severe scoliosis of upper thoracic spine.Examination demonstrates as was noted on prior CT and mild compression fracture of superior endplate of T12 vertebrae and with resultant very minimal expansion of compressed vertebrae into spinal canal. There is no central spinal stenosis. There is mild compromise of the left neural foramina at this level due to degenerative changes. The signal intensity of the cord and its caliber is entirely within normal throughout the thoracic spine.Increased signal intensity on stir sequence within the vertebral body of T12 may indicated below. There is no detectable epidural or paraspinal soft tissue associated abnormality.Signal intensity of the rest of the vertebral bodies and posterior elements of thoracic spine are unremarkable.Without contrast region of metastatic disease cannot be ruled out.Again incidental note is made of bilateral pleural effusion. There is also revisualization of a low signal intensity mass along the superior aspect of the right kidney measuring approximately 70 mm in transaxial dimension. This finding may represent a tumor or a complex cyst of right kidney. A smaller cyst within the left kidney is identified which measures approximately 30 mm in transaxial dimension.Nonenhanced MRI of the cervical spine:Severely compromised exam due to above-described reasons. The alignment the vertebral column is unremarkable. Advanced degenerative disk disease is present. The signal intensity and caliber of the cord is grossly within normal. No definitive significant central spinal stenosis. There is however effacement of subarachnoid space at multiple levels due to bulging disks anteriorly and buckling of hypertrophy of ligamentum flavum posteriorly. Multi-level neural foramina compromise to the degenerative changes. Neural foramina cannot be assessed due to poor quality study.Nonenhanced MRI of thoracic spine:The signal intensity in the alignment of the lumbosacral spine is unremarkable. Mild degenerative disk disease throughout the lumbar spine. No central spinal stenosis at any level. No neural foramina compromise at any level. Axial T1-weighted images demonstrate fatty filum terminalis with slight thickening of the filum extending from L2 -- L3 intervertebral disk level inferiorly to S1.

Output: 1.MRI of cervical spine demonstrates degenerative changes of cervical spine with multilevel neural foramina compromise. Normal signal intensity and the alignment of the vertebral column. Normal signal intensity and caliber of the cord. Unremarkable signal intensity of vertebral column.2.MRI of thoracic spine demonstrates mild compression fracture of superior endplate of T12 with a numeral of the remaining body of T12 and minimal bulge of the compressed vertebra into the spinal canal however with no resultant central spinal stenosis. There is mild compromise of the left neural foramina at this level secondary to degenerative changes. Scoliosis of upper thoracic spine and resultant degenerative changes of the disk at the level of maximum scoliosis. Normal signal intensity and caliber of thoracic cord.3.MRI of thoracic spine is essentially unremarkable for bony abnormality, central spinal stenosis or neural foramina compromise. Fatty filum terminalis with thickening of the filum extends from L2 -- 3 disk space to S1 level.4.Tumor or a complex cyst measuring approximately 70 mm in transaxial dimension arising from the superior pole of right kidney as detailed above.5.Bilateral pleural effusion as described.Fatty filum terminal as detailed above.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease. Unknown phenotype, but a colonoscopy showed a normal colon and the terminal ileum was normal, nevertheless, a CT scan from an OSH showed inflammation in the small bowel. We need to assess his proximal ileum and jejunum. 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: Previously seen inflammatory wall thickening of the terminal ileum and right colon on OSH CT has resolved. No evidence of active or chronic inflammatory bowel disease. No fistulae, abscess, or sinus tracts are identified.Large amount of stool in the colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval resolution of the right colon and terminal ileum inflammatory wall thickening. Unremarkable appearance of the bowel with no evidence of inflammation. Large stool burden.


Instruction: Generate impression based on findings.

Input: History of subcutaneous pericolitis like T-cell lymphoma, diplopia. There is diffuse thickening of subgaleal soft tissue which shows diffuse enhancement on frontal area which extends cross the forehead reaching to the level of bilateral upper eyelids. The left high parietal scalp show localized loss of subgaleal fat layer which shows diffuse enhancement. This lesion may also represent similar lesion but not presented with mass like swelling.Underlying skull shows normal fatty marrow signal intensity.These scalp lesions may represent known subcutaneous lymphoma involvement. However, differential diagnosis include associated infectious process or trauma related swelling.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is no abnormal enhancement either.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Left maxillary sinus opacification.

Output: 1. Diffuse swelling and enhancement of the frontal subgaleal soft tissue which extends toward bilateral upper eyelids indicating possible known subcutaneous lymphoma involvement. Differential diagnosis include infectious or inflammatory process or trauma related swelling.2. Loss of fat signal intensity of the left high parietal scalp with enhancement, this could represent similar underlying lesion but not presented with mass like lesion.3. No acute ischemic or hemorrhagic lesion in brain parenchyme. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 17 year old female status post head trauma. Evaluate for change. There is no evidence of intracranial mass or edema. A small focus of high density presumably represents an extra-axial fluid collection adjacent to the frontoparietal cortex, (images 12 and 13), unchanged. Focus of soft tissue density overlying the left parietal occiput likely represents a hematoma without underlying fracture.These focal findings suspicious for a small subdural hematoma would be better evaluated with an MRI.Low-density focal widening of the right lateral sylvian fissure may represent an arachnoid cyst (image 7).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: 1. Unchanged, small focus of hyperdensity, as described above, may represent a subdural hematoma which would be better evaluated with MRI.2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Brain metastases. Presurgical planning stealth enhanced CT of brain. Enhanced MRI of brain:50 cc of Omnipaque is administered for this exam.Stealth post infused CT of brain for surgical planning is performed.Examination identifies a left inferior frontal lobe ring enhancing tumor likely a metastatic lesion measuring 7.7 x 7.6-mm in size on axial image 101 surrounding vasogenic edema is again identified. This lesion measures minimally smaller than MRI exam and this is believed to be secondary to difference in technique between the two studies. A second enhancing lesion overlapping the interhemispheric cortex of left frontal lobe with no necrosis however with subtle surrounding vasogenic edema. This lesion measures approximately 8.5 times 5-mm in size. Not significantly different from prior exam.This is study also demonstrate a third lesion in the right posterior temporal -- occipital junction measuring 7.4 times 8-mm in size on axial image 77.

Output: 1.Examination demonstrates previously noted two metastatic foci in the left frontal lobe similar to what was noted on prior exam.2.A third metastatic focus in the right posterior temporal -- occipital junction measuring 7.4 times 8-mm in size on axial image 77. 3.The new third metastatic lesion was not identified on prior post infused MRI images.


Instruction: Generate impression based on findings.

Input: 40-year-old male patient with history of liver lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There is no intra or extrahepatic biliary ductal dilatation. Redemonstration of multiple hypointense lesions within the right hepatic lobe, which are best seen on postcontrast imaging. There is no associated arterial enhancement, restricted diffusion, or T2-weighted signal abnormality. There is the suggestion of signal loss on out of phase imaging of some lesions. A reference lesion within segment six of the liver measures approximately 1.4 x 1.3 cm, previously 1.3 x 1.2 cm (image 42, series 1603). No new lesions are identified.The portal and hepatic veins are prominent in size, but patent.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: Susceptibility artifact related to a median sternotomy.OTHER: No significant abnormality noted.

Output: Relatively stable appearance of multiple non-specific hypointense lesions within the liver.


Instruction: Generate impression based on findings.

Input: Male, 24 years old. Evaluate for left knee synovitis. History: Recurrent left knee swelling on SSA. Has CRP 37 in the past - now negative. Joint swells with any exercise. MENISCI: The menisci appear normal without evidence of tear.ARTICULAR CARTILAGE AND BONE: There is edema-type signal within the posterior aspect of the medial tibial condyle in the vicinity of the attachments of the posterior capsule and semimembranosus which appears slightly more extensive on the current study compared to the prior. There is also a small focus of subchondral signal abnormality within the tibial plateau beneath the posterior horn of the medial meniscus which was not present on prior study and may represent a small erosion (series 4, image 29). There is a tiny defect of the overlying articular cartilage at this site.There is also a small focus of edema-type signal within the anterolateral aspect of the lateral tibial plateau which is new from prior study. There is mild subarticular edema on either side of the tibiofibular joint with possible small erosion of the fibular head (series 6, image 7). There is also edema within the lateral aspect of the patella at the retinaculum attachment which is more extensive than that seen on prior study.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanisms is intact.ADDITIONAL

Output: Large joint effusion with synovitis which appears to have progressed when compared with the prior study. Foci of bone marrow edema have also progressed with new small erosions. These findings suggest inflammatory arthritis.


Instruction: Generate impression based on findings.

Input: Clinical question: History of craniotomy for meningioma. Evaluate for recurrence or residual. Signs and symptoms: None. 3 months postop surveillance. Pre- and post enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrates postoperative changes of a large left frontal temporal craniotomy. Mild epidural thickening and enhancement under the craniotomy flap is an expected postoperative change. Minimal dural thickening and enhancement beyond the craniectomy flap on the left is also within expected postoperative changes.There is interval resolution of vasogenic edema and mass effect in left temporal lobe as result of resection of tumor. Small focus of FLAIR hyperintensity in the left anterior temporal tip without mass effect and likely representing gliosis is remaining. This finding measures approximately 30 mm in transaxial dimensions. On post enhanced images there is a thick irregular band enhancement along the left greater wing of sphenoid measuring at least 26 mm in transverse axis and 16 mm in AP axis (thickness). This finding demonstrate mixed signal intensity on T2 and FLAIR series. The appearance is suggestive of epidural thickening and enhancement however considering presence of tumor at this site on prior exam possibility of residual tumor cannot be excluded and further follow-up is recommended.

Output: 1.Postoperative changes of a large left anterior temporal and frontal craniotomy as detailed above.2.Interval resolution of vasogenic edema and mass effect in left temporal lobe due to removal of meningioma.3.A thick irregular band of enhancement along the greater wing of the sphenoid on the left measuring at 26 mm in transverse and 16 mm in thickness although could represent postsurgical change possibility of residual tumor/meningioma cannot be entirely excluded. Further follow-up is needed. 4.Residual focus of gliosis/encephalomalacia in the left anterior temporal tip is noted.


Instruction: Generate impression based on findings.

Input: Lumbar back pain Five lumbar type vertebral bodies are presumed to be present. S1 appears to demonstrate transitional anatomy with lumbarization on the right, which can be better visualized with radiographs or CT. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is disc desiccation with dorsal annular fissure and tiny central protrusion. There is no significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are within normal limits. There is an approximately 1 cm cystic lesion involving the subcutaneous tissues of the back on the left at the L2-L3 level, which may represent a sebaceous cyst.

Output: Mild degenerative changes at the L5-S1 level with dorsal annular fissure and small central disc protrusion. There is no significant spinal canal stenosis or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 49 year-old female with left thigh cramping, evaluate for muscle injury The musculature of the thigh appears normal. There is mild edema and enhancement along the lateral aspect of the greater trochanter. Although this exam was not protocoled for detailed evaluation of the gluteal tendons, the gluteal minimus tendon appears mildly thickened and there is surrounding signal abnormality, suggesting tendinosis or perhaps partial thickness tearing; the current clinical significance of this finding is uncertain, however.Chronic osteonecrosis affects the left and right femoral heads, appearing similar to the prior exam. There is no associated edema, subchondral fracture or subchondral collapse. A small focus of fluid signal intensity along the posteromedial distal femur may represent a small ganglion. Mild osteoarthritis affects both hips.

Output: No specific finding to account for the patient's left thigh cramping. Other findings as above.


Instruction: Generate impression based on findings.

Input: 30 year-old female with nausea, vomiting, and abdominal distention. 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: Simple cyst in the interpolar region of the right kidney.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.PELVIS:UTERUS, ADNEXA: Multiple subcentimeter foci of fluid signal intensity are identified within the adnexa bilaterally, consistent with follicles. There is a 2.6 cm focus of fluid signal intensity in the left adnexa which may represent a physiologic cyst. A nabothian cyst is seen.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: No significant abnormality noted.

Output: No findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: History of rectal cancer. Epic note dated 5/20/2016 speaks of a rectosigmoid cancer 12 cm from the anal vertex presenting with obstruction with transverse loop colostomy and chemotherapy. PELVIS:UTERUS, ADNEXA: Anteverted uterus. The endometrium/endometrial canal is normal in thickness. The inner myometrium/junctional zone is poorly delineated but is normal in thickness. The parametrial soft tissues are unremarkable. The adnexa are atrophic and poorly visualized. See discussion below regarding vaginal fistula. BLADDER: Partially distended urinary bladder without a focal abnormality.LYMPH NODES: Enhancing 8 x 8 mm lymph node in the posterior right external iliac chain (series 1 301/6 22). Additional punctate pelvic lymph nodes are not pathologically enlarged.BOWEL, MESENTERY: There is mild diffuse thickening of the rectum. At the level of the upper rectum/rectosigmoid junction there is focal narrowing, mural irregularity and mild perirectal fat spiculation which likely corresponds to the patient's known rectosigmoid/upper rectal cancer measuring approximately 1.6 x 1.6 cm (series 1301/563). This is adjacent to the presacral fluid collection with a presumed poorly delineated fistulous communication (series 701/55). BONES, SOFT TISSUES: Thick walled presacral fluid collection measuring 2.4 x 1.9 cm with a fistula tract extending caudally along the right mesorectal fat/fascia where it communicates with the right vaginal fornix. The collection abuts the rectosigmoid junction with the colon which appears tethered narrowed and spiculated. Communication with the large bowel is suspected. There is no upstream colonic dilatation to suggest underlying bowel obstruction.OTHER: No significant abnormality noted.

Output: 1.Posttreatment changes of the upper rectum/rectosigmoid junction with a 1.6 x 1.6 cm region of mild enhancement and perirectal fat spiculation, compatible with residual tumor. 8 x 8 mm right external iliac enhancing lymph node.2.An adjacent presacral fluid 2.4 x 1.9 cm collection is compatible with an abscess with a fistulous communication with the right vaginal fornix and likely the adjacent rectosigmoid colon.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out tumor or acute abnormalities. Signs and symptoms: Facial pain. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrate normal anatomical morphology and signal intensity of brain parenchyma on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement on post enhanced series.Calvarium and orbits are unremarkable and without evidence of abnormal enhancement.Pre-and post enhanced IAC MRI:Bilateral internal auditory canals demonstrate normal symmetrical bilateral size and morphology and without detectable abnormal enhancement. The signal intensity and morphology of the visualized inner ear structures are unremarkable. There is no detectable signal abnormality or enhancement of the facial nerves.The signal intensity of bilateral mastoid air cells and middle ear cavities are beginning normal and without abnormal enhancement.The signal intensity and morphology of bilateral neurovascular bundles across the cerebellopontine angles and within the internal auditory canals is within normal and without abnormal enhancement. Pons and bilateral cerebellopontine angles demonstrate normal signal intensity and without abnormal enhancement. Bilateral Meckel's caves and trigeminal nerves demonstrate normal signal intensity and without abnormal enhancement.There is no detectable abnormal enhancement of the cranial nerves.

Output: 1.Unremarkable pre-and post enhanced brain MRI.2.Unremarkable pre-and post enhanced MRI of IACs.


Instruction: Generate impression based on findings.

Input: 67-year-old female with the history of multiple pancreatic cysts, please evaluate for changes and/or abnormality ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. No intrahepatic biliary ductal dilatation. Gallbladder appears unremarkable.  Common bile duct demonstrates a normal morphology, anatomy and measures up to 4 mm SPLEEN: No significant abnormality noted.PANCREAS: Numerous sidebranch type IPMNs are seen throughout the pancreas. Index lesion which likely represents two adjacent IPMNs in the uncinate process of the pancreasmeasures 1.8 x 1.2 cm (image 34, series 3), previously 1.8 x 1 cm. There is been interval increase in size of one of the side branch IPMN in the body of the pancreas that measures 1.3 x 1.2 cm (image 24, series 3, series 5 image 33), previously measured 7 x 7 mm. The remaining other smaller lesions are unchanged. The main pancreatic duct is normal in caliber. There is no postcontrast enhancement of these lesions.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left partial nephrectomy changes. No focal lesions noted. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Unchanged, fluid signal intensity lesion noted adjacent to the distal esophagus likelyrepresents a foregut duplication cyst. Moderate sized hiatal hernia, unchanged. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Numerous sidebranch type IPMNs with no interval change in size of the index lesion in the uncinate process however interval increase in size of one of the IPMN in the body of the pancreas from 7 x 7 mm to 1.3 x 1.2 cm. No abnormal enhancement noted in any of these lesions.2. Left partial nephrectomy changes.


Instruction: Generate impression based on findings.

Input: Intracranial hemorrhage. BRAIN MRI:Again seen is an intraparenchymal hematoma in the left frontal lobe centered at the left frontal operculum measuring approximately 5.0 x 3.4 x 3.7 cm. There is mild surrounding edema with local mass effect. Hematocrit effect is noted within the hematoma which may related to coagulopathy. Small foci of T1 hyperintensity are noted without definite enhancement. There is mild increase in surrounding vascularity which is likely reactive. No other foci of chronic hemorrhage. There is partial effacement of the left lateral ventricle. No significant midline shift. No uncal herniation. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. Dural venous sinuses are patent.Sella and orbits are grossly within normal limits. There is minimal fluid in the left mastoid air cells. Paranasal sinuses and mastoid cells are otherwise clear. There is lytic T1 hyperintense lesion involving the left frontal calvarium which likely represents a hemangioma. There is a 11 x 9 mm lytic lesion involving the right parietal calvarium with mild intracranial extension into the extra-axial space, best seen on coronal post gad series 1402 image 126/190 and foci of calcifications. Small scattered arachnoid granulations are seen. Bone marrow signal is benign.MRA HEAD: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. Anterior and bilateral posterior communicating arteries are present. No evidence of aneurysms or vascular malformations.

Output: 1. Lobulated intraparenchymal hematoma centered at the left frontal operculum as seen on recent CT. No associated abnormal enhancement or other enhancing intraprenchymal lesions to suggest malignancy. No other foci of hemorrhage. Given the size of the hematoma, however, small underlying lesion can not entirely be excluded and follow-up can be obtained as clinically indicated.2. No associated aneurysm or malformation.3. 11x9 mm enhancing, lytic right parietal calvarial lesion with intracranial extension into the extra-axial space and calcifications. Finding is favored to represent a benign etiology such as hemangioma or meningioma and can be further assessed on follow-up studies.


Instruction: Generate impression based on findings.

Input: Pain. Question of abductor tear. ACETABULAR LABRUM: The labrum appears grossly intact, however, MR arthrogram is more sensitive for the detection of labral pathology.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. The articular cartilage appears intact.SOFT TISSUES: There is mild focal edema within the obturator externus, inferior gemellus, and quadratus femoris muscles in the region of the ischial tuberosity. Otherwise, the musculature appears within normal limits. The tendons of the gluteus medius, gluteus minimus, and piriformis are intact. ADDITIONAL

Output: Mild edema in the obturator externus, inferior gemellus, and quadratus femoris.


Instruction: Generate impression based on findings.

Input: Right foot pain TENDONS: The Achilles tendon, flexor tendons, and extensor tendons are intact.LIGAMENTS: The superomedial portion of the spring ligament appears slightly thickened but is otherwise intact. The inferoplantar longitudinal and medioplantar oblique portions of the ligament are not well seen on the axial images however these components are occasionally not well visualized on MRI. What is suspected to be the inferoplantar longitudinal component is noted on the sagittal sequences and what is thought to be the medioplantar oblique component is suggested on the oblique coronal sequences. The tibiospring component of the deltoid ligament appears intact as does the posterior tibiotalar component. The anterior talofibular ligament appears thickened but is likely intact. The calcaneofibular and posterior talofibular ligaments are intact. The distal tibiofibular complex appears intact. The plantar fascia and ligaments of the sinus tarsi appear intact.ARTICULAR SURFACES AND BONE: Mild osteoarthritis affects the talonavicular joint with subchondral cysts noted in the head of the talus. There is mild osteoarthritis of the midfoot articulations with mild degenerative signal abnormalities noted within the cuneiforms. There is no fracture or osteochondral defect. ADDITIONAL

Output: 1. Slight thickening of the superomedial component of the spring ligament which might reflect prior sprain but there is no discrete tear. 2. Mild osteoarthritis of the midfoot.3. Mild nonspecific subcutaneous edema surrounding the ankle.


Instruction: Generate impression based on findings.

Input: Status post L5-S1 left microdiscectomy one year ago Examination is mildly motion degraded. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 to 2 anterolisthesis of L4 on L5 similar to prior. There is also trace retrolisthesis of L3 on L4 and L4 on L5. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: Dorsal annular fissure with minimal central disc extrusion. There is ligamentum flavum thickening and facet arthropathy, relatively worse on the left. There is minimal central canal narrowing. There is mild left neural foraminal stenosis. No significant right neural foraminal narrowing.L4-L5: Grade 1/2 anterolisthesis similar to prior with disc uncovering. There is partial effacement of the lateral recesses with minimal central canal stenosis. Mild bilateral neural foraminal narrowing. Advanced bilateral facet arthropathy.L5-S1: Interval microdiscectomy with previously seen left-sided disc extrusion no longer evident. No evidence of recurrent disc herniation. There is minimal low T1 signal likely related to scar tissue in the left lateral and dorsal epidural space. Advanced facet arthropathy, left worse in right, with minimal left neural foraminal stenosis. No significant central canal narrowing or right neural foraminal stenosis.Small right renal cyst.

Output: 1. Compared to 9/9/2014, interval postsurgical changes related to left-sided microdiscectomy at L5-S1. No evidence of recurrent disc herniation.2. Degenerative changes at additional levels including degenerative spondylolisthesis at L4-L5 similar to prior. Advanced facet arthropathy is present at L4-L5 and L5-S1.3. Minimal central canal narrowing at L3-L4 and L4-L5. There is also mild neural foraminal narrowing at multiple levels as above. No high-grade spinal canal or foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Reason: ligament tear? History: reduced ROM, effusion, knee pain with walking after ski trip MENISCI: The lateral meniscus appears intact. There is increased signal abnormality within the posterior horn of the medial meniscus which extends to the tibial articular surface indicating an oblique tear.ARTICULAR CARTILAGE AND BONE: There is increased signal abnormality within the lateral femoral condyle and lateral aspect of the tibial plateau indicating bone contusions. There are also bone contusions within the medial femoral condyle and posterior aspect of the medial tibial plateau. There is decreased linear signal abnormality and bone marrow edema in the proximal fibula at the level of the insertion of the conjoined tendon, indicating a small nondisplaced avulsion fracture, best seen on image 27 of series 601. There is a subchondral impaction fracture in the lateral femoral condyle indicating a lateral notch sign. There is also linear decreased signal abnormality within the lateral aspect of the lateral tibial plateau which may represent a small nondisplaced subchondral fracture (image 19; series 601). There is superficial fraying of the articular cartilage along the medial facet of the patella. There is linear decreased signal abnormality along the medial facet of the patella likely representing a full-thickness articular cartilage cleft best seen on image 15 of series 401.LIGAMENTS: There is disruption of the ACL through its mid substance fibers. The PCL appears intact. There is increased signal abnormality and thickening of the MCL indicating a sprain. Other than the aforementioned small avulsion fracture of the fibula at the insertion of the conjoined tendon, the LCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Disruption of the ACL through its mid substance fibers.2. Impaction fracture of the lateral femoral condyle with probable small nondisplaced subchondral fracture of the lateral tibial plateau.3. Small nondisplaced avulsion fracture of the fibula at the level of the insertion of the conjoined tendon.4. Oblique tear of the posterior horn of the medial meniscus.5. Full-thickness articular cartilage cleft along the medial facet of the patella.6. Moderate size joint effusion.7. MCL sprain and other findings as described above.


Instruction: Generate impression based on findings.

Input: One year follow up for cavernous malformations. There are innumerable cavernous malformations throughout the supratentorial and infratentorial brain. Subcentimeter lesions in the left middle cerebellar peduncle and in the right superior cerebellar hemisphere appear to be slightly larger, but there is no evidence of acute hemorrhage or associated edema. The other lesions appear to be essentially unchanged. There is no convincing evidence of associated developmental venous anomalies. The ventricles and basal cisterns are unchanged in size and configuration, without midline shift. There is no evidence of acute infarct. The paranasal sinuses, mastoid air cells, and orbits are unremarkable.

Output: Innumerable supratentorial and infratentorial cavernous malformations, with slight interval increase in size of subcentimeter lesions in the posterior fossa, but no evidence of acute hemorrhage or associated edema.


Instruction: Generate impression based on findings.

Input: 56 year-old the female with lumbago There is straightening of the lumbar alignment. A intraosseous hemangioma is noted in the L1 vertebral body. There is no evidence of compression fracture or joint subluxation.T11-12, T12-L1: There is no central canal or neural foramen stenosis.L1-2, L2-3: There is no central canal or neural foramen stenosis.L3-4: There is diffuse disk bulge and bilateral mild facet degenerative change. There is no central canal or neural foramen stenosis. L4-5: Vacuum phenomena in L4-5 intervertebral disk. There is diffuse disk bulge. A large soft tissue density lesion is noted along the dorsal side of the L5 vertebral body, causing compression to the thecal sac and left side exiting nerve root. It is measuring 17 x 8 x 24mm. No associated bone destruction. On sagittal images, it is contiguous with the L4/5 intervertebral disk (image 31 series 80269). However, other etiology such as meningioma can not be completely excluded given relative poor soft tissue contrast on CT images. A MRI study may help further evaluate. L5-S1: there is no central canal or neural foramen compromise.

Output: 1. L4/5 canal soft tissue density lesion, most likely extruded disk with inferior migration. However, other etiology such as meningioma can not be completely excluded given relative poor soft tissue contrast on CT images. A MRI study may help further evaluate. It causes central canal stenosis and nerve root impingement on the left.2. Mild degenerative disk disease in the lumbar spine. See details above.


Instruction: Generate impression based on findings.

Input: 71 years Male (DOB:9/27/1944)Reason: Pt with hx of brain metastasis; parkinsonism, tremor History: see abovePROVIDER/ATTENDING NAME: TAO XIE TAO XIE The patient status post right parietal lobe surgery and right-sided craniotomy. There is a CSF cavity within the brain parenchyma at the surgical site no abnormal enhancing focus is identified at the surgical site. There is surrounding T2 and FLAIR signal hyperintensity. Compared to prior exam there is no significant change in the appearance of the surgical site. There is susceptibility effect at the surgical margins 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 is a mild degree of punctate foci of signal loss and susceptibility in the periventricular white matterThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.Status post right parietal lobe surgery. There is no evidence for tumor recurrence on the current exam.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Some periventricular and to lesser subcortical microhemorrhages are present which are nonspecific.


Instruction: Generate impression based on findings.

Input: Male 11 years old with right knee pain. Evaluate for physeal fracture. MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is mild edema in the posterior medial femoral condyle and medial tibial plateau and associated mild soft tissue edema. The marrow signal in the patella is normal. No fracture or articular cartilage defect is present.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Bone contusions in the medial femoral condyle and medial tibial plateau with associated soft tissue edema and moderate knee joint effusion.


Instruction: Generate impression based on findings.

Input: Clinical question: History of brain metastases status post radiation without confirmation of diagnosis; Stealth sequence - 1 mm cuts no fiducial. Signs and symptoms: Preop planning. Pre-and post-enhanced Stealth brain MRI:The examination is severely limited secondary to fairly extensive streak artifacts from patient's halo. Previously known tumor in the right thalamus and right cerebral peduncle is only partially visualized and appears as a ring enhancing mass. It measures approximately 18 X 15 -mm in size and is only partially visualized. No convincing evidence of any additional abnormal enhancing lesions.No acute new finding since prior study.

Output: Pre-and post-enhanced surgical planning stealth head CT partially re-demonstrates a necrotic rim enhancing mass in the right thalamus/right cerebral peduncle measuring 18 x15-mm in size.


Instruction: Generate impression based on findings.

Input: Reason: question of hydrocephalus vs. NPH History: ataxia, vertigo, lightheadedness There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered periventricular T2 hyperintensities which are nonspecific. The lateral ventricles are mildly enlarged. The third is slightly prominent. The fourth ventricle appears small with apparent slight crowding of the posterior fossa. The cerebral aqueduct is not optimally visualized. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1.No acute infarct.2.Lateral ventricles are mildly enlarged and there is mild prominence of the third ventricle, which is nonspecific. However the fourth ventricle does appear small with crowding of the posterior fossa, with suboptimal visualization of the cerebral aqueduct. Given the small fourth ventricle, normal pressure hydrocephalus is felt to be less likely. A CSF flow study may be helpful for further characterization.