Instruction: Generate impression based on findings.

Input: Male; 58 years old. Reason: hx of left flank pain History: see above Lack of intravenous contrast limits sensitivity for solid organ pathology.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: Subcentimeter T2 hyperintense lesions in both kidneys are too small to characterize but likely due to cysts. Ho hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Please see report from dedicated MRI lumbar spine performed concomitantly.OTHER: No significant abnormality noted.

Output: 1, No intra-abdominal or pelvic findings to explain the patient's symptoms.2. Please see report from dedicated MRI lumbar spine performed concomitantly.


Instruction: Generate impression based on findings.

Input: 57 year old woman with history of cardiac sarcoid, referred for evaluation of interval changes and risk stratification. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 130 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 45 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is a small patch of myocardial late gadolinium enhancement in the basal inferoseptal wall at the RV insertion point. The pattern is atypical for infarction and is likely to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. It appears unchanged compared to prior MRI in 2013. Additionally, there is no evidence of acute inflammation or edema on T1 and T2 imaging.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 71 ml/m2 (normal range 69+/-14), the RVEDV is 138 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 58 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve 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 psuedo-bovine brachiocephalic branching pattern (normal variant). 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 FindingsMinimal bilateral pleural effusions present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%.2. There is a small patch of mid myocardial late gadolinium enhancement in the basal inferoseptal wall at the RV insertion point. The pattern is atypical for infarction and is likely to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. It appears unchanged compared to prior MRI in 2013. Additionally, there is no evidence of acute inflammation or edema on T1 and T2 imaging.3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is redemonstration of numerous foci of T2/FLAIR hyperintensity within the supratentorial and infratentorial brain, including the brainstem. There is a large new lesion in involving the white matter adjacent to the posterior horn of the left lateral ventricle in the left parietal lobe measuring 2.0 x 1.7 cm. This lesion demonstrates discontinuous peripheral postcontrast enhancement. The previously identified lesion adjacent to the frontal horn of the left lateral ventricle appears decreased in size measuring 1.0 x 0.6 cm, previously 1.6 x 1.1 cm. A punctate lesion in the left middle cerebellar peduncle appears similar to prior examination. Numerous additional smaller lesions appear similar to prior examination, many with corresponding T1 hypointensity. The lesion identified in the right anterior medulla also appears similar to prior examination. No midline shift is appreciated. The basal cisterns are patent. No intra-axial or extra-axial fluid collections are visualized.

Output: 1. There is a new 2.0 cm T2 hyperintense white matter lesion involving the left parietal lobe with discontinuous peripheral enhancement consistent with active demyelination.2. The previously identified white matter lesion adjacent to the frontal horn of the left lateral ventricle appears decreased in size from prior examination consistent with expected evolution.3. Accounting for differences in technique, numerous additional foci of T2/FLAIR hyperintensity involving the supratentorial and infratentorial white matter appear grossly similar to prior examination and do not demonstrate postcontrast enhancement.


Instruction: Generate impression based on findings.

Input: 30 year old with history of idiopathic pulmonary arterial hypertension presenting for evaluation of possible ventricular septal defect seen on echocardiography. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%, the LV end diastolic volume index is 57 ml/m2 (normal range: 65+/-11), the LVEDV is 97 ml (normal range 109+/-23), the LV end systolic volume index is 20 ml/m2 (normal range 18+/-5), the LVESV is 35 ml (normal range 31+/-10), the LV mass index is 24 g/m2 (normal range 67+/-11), and the LV mass is 42 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.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with moderate to severe systolic dysfuction. The overall RV ejection fraction is 18%, the RV end diastolic volume index is 156 ml/m2 (normal range 69+/-14), the RVEDV is 266 ml (normal range 110+/-24), the RV end systolic volume index is 127 ml/m2 (normal range 22+/-8), and the RVESV is 217 ml (normal range 35+/-13). Right AtriumThe right atrium is severely enlarged. The coronary sinus is enlarged. 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 mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. The main PA size is 39 mm, the right PA size is 27 mm, and the left PA size is 23 mm.Venous AnatomyThe SVC and IVC drain normally into the right atrium. The IVC is dilated.ShuntsThere are multiple intracardiac or extracardiac shunts present. There is a small membranous VSD. There is a sinus venosus ASD comprised of 3 anomalous venous branches draining into the SVC. The pulmonary artery flow is 45 ml and the aortic flow is 46 ml. Qp:Qs = 0.98PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 64%2. The right ventricle is severely dilated with moderate to severe systolic dysfuction. The overall RV ejection fraction is 18%3. Sinus venosus ASD. Three anomalous veins draining into the SVC. Qp:Qs = 0.984. Small membranous VSD5. Severe dilatation of the main PA. Dilated branch PAs. Measurements above.6. Mild-moderate TR.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: Evaluate intramuscular NF lesions in left lower leg History: pain/evidence of intramuscular lesions at time of surgery Note is made of multiple round masses within the subcutaneous and soft tissues of the left leg consistent with the patient's known history of neurofibromatosis. The largest lesion is situated within the muscle belly of the medial gastrocnemius measuring approximately 2.1 x 1.7 cm (image 39; series 9), which was not definitely seen on the prior examination from 2009 and does not have the characteristic target sign on pre or post contrast imaging. While this may represent a neurofibroma, the possibility of a MPNST cannot be excluded. There are multiple additional masses involving the soleus and plantaris musculature as well as within the peroneal musculature consistent with patient's history of neurofibromatosis. There are also innumerable cutaneous and subcutaneous lesions consistent with the patient's history of neurofibromatosis. On the large field-of-view images, note is made of multiple enhancing foci of signal abnormality within the subcutaneous and soft tissues of the right leg also consistent with the patient's history of neurofibromatosis. Again seen is slight bowing of the tibia, unchanged. No bone marrow signal abnormality is identified.

Output: 2.1 cm mass within the medial head of the gastrocnemius as described above, new from the prior examination performed in 2009. While this may represent a neurofibroma, the possibility of a MPNST (malignant peripheral nerve sheath tumor) cannot be excluded. Multiple additional masses in the left leg as well as subcutaneous and cutaneous nodules, consistent with the patient's known history of neurofibromatosis.


Instruction: Generate impression based on findings.

Input: Reason: right heel pain History: right heel pain There are small posterior and plantar calcaneal spurs which are not necessarily of any clinical significance. There is no evidence of a stress fracture. Mild osteoarthritis affects the ankle and midfoot. The anterior margin of the Achilles tendon is slightly indistinct approximately 5 cm proximal to its insertion on the calcaneus. If there is clinical concern for an Achilles tendon tear, MRI could be considered.

Output: 1. Minimal osteoarthritis of the ankle and midfoot.2. Poor definition of the anterior margin of the Achilles tendon is of uncertain significance. If there is clinical concern for Achilles tendon tear, MRI could be considered.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, status post cardiac arrest. The choroid plexus within the right lateral ventricular atrium is enlarged relative to the left. The morphology of this tissue is frond-like without any notable cysts. The tissue demonstrates susceptibility effect which may reflect calcification or blood product.The lateral ventricles are not enlarged. The fourth ventricle is slightly prominent which may reflect mild vermian hypoplasia. No evidence of parenchymal edema is seen. No restricted diffusion is evident to suggest acute ischemia. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The mesial temporal structures are unremarkable.

Output: 1.No evidence of ischemic injury or any other acute intracranial abnormality.2.Asymmetric enlargement of the choroid plexus within the right lateral ventricular atrium is seen. This could represent a choroid plexus papilloma, less likely normal variant hypertrophy. No evidence of lateral ventricular enlargement is seen to suggest CSF overproduction. Further evaluation with postcontrast imaging should be considered.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with history of AVM status post SRS, yearly surveillance. An area of abnormal T2 hyperintensity measuring approximately 2 cm in diameter is again seen involving the left inferior parietal lobule. The abnormal vessels seen adjacent to this signal abnormality on the prior examination are not visualized on the present study due to lack of IV contrast. However, the morphology and size of the signal abnormality have not significantly changed from prior. On time-of-flight MRA images, and no definite abnormal vascularity is seen in the vicinity of this lesion.Cerebral morphology and signal characteristics are otherwise within normal limits. No evidence of significant edema or mass effect is seen. No restricted diffusion is noted. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. Ventricles are normal in size and morphology.MRA images demonstrate normal caliber and morphology of the intracranial vasculature. No areas of significant vascular stenosis or occlusion are seen. No aneurysms are detected within the limitations of technique.

Output: 1.Without the benefit of IV contrast, the previously demonstrated vascular tangle seen within the left inferior parietal lobule is not discretely visualized on today's exam.2.However, the associated parenchymal signal abnormality is seen and shows no significant interval change. No new intracranial lesions are detected.3.The MRA evaluation is within normal limits.


Instruction: Generate impression based on findings.

Input: 68 years Female (DOB:9/20/1948)Reason: r/o structural lesion` History: seizurePROVIDER/ATTENDING NAME: MAHESH PADMANABAN MAHESH PADMANABAN The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Incidental note is made of empty and expanded sella

Output: 1.Examination is degraded due to motion artifact which will obscure more subtle abnormalities.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Long history of ankylosing spondylitis. The vertebral bodies are preserved in height. There is no squaring of the vertebrae. The intervertebral discs are preserved in height and T2 signal, other than mild loss at L4-L5 along with slight disc bulging. There is no significant spinal or neural foramen stenosis. The spinal cord and conus medullaris show normal morphology and signal. The facet joints show no excessive fluid or gross erosive change. Only the upper portions of the sacroiliac joints is included and shows no edema, sclerosis, or fusion.

Output: 1. No specific findings to support the diagnosis of ankylosing spondylitis. However, this diagnosis can be subtle on MRI and is better assessed by radiographs.2. Mild L4-L5 degenerative disc disease but no significant spinal canal or neural foramen stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate STA to MCA bypass. MRI Brain: There is no restricted diffusion to suggest acute ischemia. There is extensive bihemispheric cerebral white matter T2 hyperintensity, left much greater than right, slightly progressed in the left anterior frontal and right anterior temporal lobes compared to 11/15/2015. There are otherwise multiple unchanged chronic lacunar infarcts involving the deep grey nuclei and surrounding white matter. The ventricles and sulci are diffusely prominent compatible with cerebral volume loss. There has been interval resolution of swelling and fluid in the scalp soft tissues overlying the bypass site. MRA Brain: There is a left-sided STA-MCA bypass, which is partially obscured by metal susceptibility effect. The portions not affected by the artifact otherwise appear to be intact. There is persistent paucity of flow-related enhancement of the majority the left internal carotid artery, with reconstitution at the distal supraclinoid portion. There is slightly decreased flow related signal in the left middle cerebral artery compared to the right, but no significant stenosis is apparent. There is irregularity of the cavernous and supraclinoid right internal carotid artery. There is an unchanged 2 mm outpouching of the right anterior communicating artery. There is also an unchanged 5 mm aneurysm along the right lateral cavernous internal carotid artery. There are unchanged multifocal stenosis affecting the distal vertebral, basilar artery, and posterior cerebral arteries.

Output: 1.Postoperative findings related to left STA to MCA bypass, which is incompletely characterized due to susceptibility artifact from adjacent surgical hardware. 2.Right supraclinoid internal carotid artery and anterior communicating artery aneurysms are unchanged.3. Progression of white matter chronic ischemic disease, but no acute infarction.4. Unchanged multiple chronic lacunar infarctions in the bilateral deep grey nuclei.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of right mastectomy in 2006 for ILC followed by radiation and chemotherapy and hormonal therapy presents for annual surveillance with breast MRI. Status post reconstruction with a TRAM flap. There is heterogeneous amount of fibroglandular tissue in the left breast. Status post right mastectomy with TRAM flap reconstruction.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or reconstructed right breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 31 year old presenting for evaluation of possible intracardiac shunt. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 88 ml/m2 (normal range: 65+/-11), the LVEDV is 199 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 74 ml (normal range 31+/-10), the LV mass index is 34 g/m2 (normal range 67+/-11), and the LV mass is 77 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.Left AtriumThe left atrium is normal in size. Aneurysmal inter-atrial septum which appears deviated toward s the right side.Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 96 ml/m2 (normal range 69+/-14), the RVEDV is 217 ml (normal range 110+/-24), the RV end systolic volume index is 49 ml/m2 (normal range 22+/-8), and the RVESV is 110 ml (normal range 35+/-13). 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 are normal in size and drain normally into the right atrium. Hepatic vein courses close to the IVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63% with normal wall motion and no LGE. 2. The right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%3. No hemodynamically significant intra-atrial or sinus venosus defect seen (Qp/Qs 0.94) on this study. Aneurysmal inter-atrial septum which appears deviated towards the right. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Concern for meningitis and brain metastases: fever, headache, altered mental status; note severely hypertensive since admission. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered areas of high T2 signal in the cerebral and pontine white matter. There is no definite abnormal intracranial enhancement, although the post-contrast images are particularly degraded by patient motion. 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: A punctate focus of apparent restricted diffusion in the right occipital lobe may represent a recent infarct superimposed upon a background of chronic small vessel ischemic disease. Otherwise, no evidence of intracranial metastases or abscess, although the images are generally degraded by patient motion.


Instruction: Generate impression based on findings.

Input: Knee pain and locking MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: No focal chondral defects or focal marrow edema.LIGAMENTS: The ACL and PCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No evidence of meniscal tear or chondral defects.


Instruction: Generate impression based on findings.

Input: There is a gyriform pattern of faint restricted diffusion in the left parietal and occipital lobes consistent with subacute infarction. There is an associated large area of T2/FLAIR hyperintensity involving the left parietal, occipital and posterior temporal lobes compatible with edema. There is associated susceptibility in this region related to petechial blood products.Additional scattered areas of susceptibility changes are noted in the bilateral cerebral hemispheres right more than left.There is a large area of encephalomalacia involving the right MCA territory as seen on prior CT, with ex vacuo dilatation of the right lateral ventricle. There is atrophy of the right cerebral peduncle related to wallarian degeneration. There is encephalomalacia involving the right inferior cerebellar hemisphere likely from prior ischemia, unchanged.There is a small infarct in the left posterior frontal lobe inferiorly at the junction of superior frontal gyrus and middle frontal gyrus, chronicity of which is uncertain.No herniation or midline shift. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening in the bilateral maxillary sinuses including retention cyst in the left maxillary sinus as well as mild mucosal thickening in the ethmoid sinuses. There is fluid within the nasopharynx and posterior nasal cavity likely related to recent intubation. There is right-sided craniotomy.BRAIN MRI

Output: 1.Faint gyriform pattern of restricted diffusion in the left parietal and occipital lobes compatible with subacute infarct. Associated large area of T2 signal abnormality likely represents edema related to the infarct.2. Focal infarct in the left frontal lobe of uncertain age but likely late subacute or chronic.3. Extensive chronicinfarct involving the right MCA territory as well as a chronic infarct in the right cerebellum.4. Periventricular and subcortical white matter T2 signal hyperintensities related to chronic small vessel ischemic changes.5. Paucity of distal branches of the right MCA beyond the bifurcation corresponding to the right MCA territory encephalomalacia, but otherwise no significant narrowing in the anterior or posterior circulation.6. No evidence of marrow signal changes or ligamentous injury to account for cervical spine trauma.7. Mild degenerative changes in the cervical spine mostly at C5-C6 with resultant moderate narrowing of left neural foramen. No evidence of central canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Reason: R/O Worsening of DZ History: Known DJD of L spine, acute chronic back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is disk dessication and a broad based central disk extrusion which is associated with partial effacement of the fat at the lateral recesses - left more than right. Disk material extrudes behind the superior endplate of S1. There is mild encroachment of the nerve roots at the left lateral recess. Compared to the prior CT lumbar spine this has not changed significantly.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is minor disk bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative disk changes present at L5-S1 with broad-based disk protrusion resulting in mild encroachment of the nerve roots at the lateral recesses- left more than right. Compared to the prior CT lumbar spine this has not changed significantly.


Instruction: Generate impression based on findings.

Input: Migraines. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter probable Thornwaldt cyst.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with altered mental status, evaluate for seizure versus stroke versus conversion. Diffusion-weighted images are within normal limits. No evidence of focal parenchymal signal abnormality, edema or mass effect is seen. No intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The posterior aspect of the septum pellucidum is deficient. The ventricular system is otherwise unremarkable.

Output: No specific findings are seen which would account for the patient's symptoms. Specifically, no evidence of acute ischemia or any seizure focus is seen.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: please do Dr Javed MS protocol compare to priorSigns and Symptoms: numbness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical white matter lesions present some of which are perpendicularly oriented to the lateral ventricles. Some extend to the calloso-cingulate junction and into the inferior aspect of the corpus callosum. Additional lesions are present in the brainstem, cerebellum and internal capsules. These lesions are hyperintense on FLAIR and T2 sequences and hypointense on T1 sequences. They are not associated with contrast enhancement.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Multiple white matter lesions are present throughout the brain as detailed above which have been stable since the prior exam and consistent with the clinical history of demyelinating disorder. There is no MRI evidence for acute plaque formation.


Instruction: Generate impression based on findings.

Input: Female; 63 years old. Reason: HCC screening History: cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No focal hepatic lesions suspicious for HCC. Main portal vein and its branches are patent. Cholelithiasis.SPLEEN: Mild splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace perihepatic and perisplenic ascites.

Output: Cirrhotic liver without focal hepatic lesion suspicious for HCC.


Instruction: Generate impression based on findings.

Input: Female, 17 years old, localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, not intractable, without status epilepticus. Previous imaging and EEGs at Lurie Children's Hospital. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No gray matter heterotopia or cortical dysplasia is evident. There are three or four very small nonspecific foci of T2/FLAIR hyperintensity in the subcortical white of the left cerebral hemisphere. Brain parenchymal signal is otherwise unremarkable. The mesial temporal lobe structures are symmetric and free of signal abnormality.Major flow-voids are preserved on T2 sequences. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No MRI findings to account for the patient's seizures. There are a few scattered foci of increased T2/FLAIR signal in the subcortical white matter of the left cerebral hemisphere, which are nonspecific. Correlation with prior outside imaging may be beneficial.


Instruction: Generate impression based on findings.

Input: Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: annual f/u after diagnosis of basilar aneurysm History: follow up Brain MRINo evidence of acute ischemic or hemorrhagic lesion the scan.A couple of scattered FLAIR/T2 high signal intensity lesions on bilateral cerebellar white matter, these are nonspecific lesions.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. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate previously identified focal bulge of distal basilar artery indicating possible aneurysm directing anterior and right lateral side is again seen. The luminal diameter of the lesion (about 6mm x 6.5mm) and its configuration do not show any significant interval change since prior scan.Otherwise normal bilateral ICAs, MCAs and ACAs. No other aneurysm is seen.No evidence of intracranial arterial luminal stenosis.

Output: 1. Non specific FLAIR/T2 high signal intensity lesions as described above.2. No evidence of acute ischemic or hemorrhagic lesion.3. Unchanged distal basilar artery possible aneurysm size and configuration since prior scan indicating its stability.


Instruction: Generate impression based on findings.

Input: 68-year-old female patient with diplopia. Diplopia secondary to CN 3 palsy OS thought related to DM. There is apparent mild T2 hyperintensity circumferentially along the bilateral inferior rectus muscles. Otherwise, the bilateral extraocular muscles are not particularly enlarged or atrophic. There are bilateral lens implants. The optic nerves are unremarkable bilaterally. There is no evidence of intraorbital mass lesions. The cisternal segments of the oculomotor nerves and cavernous sinuses are unremarkable. There are scattered foci T2 hyperintensity in the imaged portions of the cerebral white matter.

Output: 1. Apparent mild T2 hyperintensity circumferentially along the bilateral inferior rectus muscles is likely artifactual rather than related to early denervation effects or thyroid eye disease. However, assessment is limited due to the lack of intravenous contrast.2. Nonspecific scattered foci T2 hyperintensity in the imaged portions of the cerebral white matter may represent small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Anesthesia of skin [R20.0] / Paresthesia of skin [R20.2], Reason for Study: ^Reason: assess for stroke History: right arm and leg numbness and tingling Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. 2. Normal brain MRA, normal neck MRA


Instruction: Generate impression based on findings.

Input: 63-year-old male patient with new onset diabetes and family history of pancreatic cancer. Evaluate for pancreatic cancer. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion is identified. There is paradoxical loss of signal of the hepatic parenchyma on in and out of phase imaging compatible with iron deposition. No intra- or extrahepatic biliary ductal dilatation. SPLEEN: There is mild paradoxical loss of signal of the splenic parenchyma on in and out of phase imaging compatible with iron deposition.PANCREAS: No focal pancreatic lesion is identified. The main pancreatic duct is normal in diameter. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The left renal collecting system appears duplicated with prominence of the left lower moiety and to a lesser degree the left upper moiety. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious pancreatic lesion is identified.2.Signal changes within the liver and spleen compatible with iron deposition.3.Duplicated left renal collecting system with prominence of the left lower moiety.


Instruction: Generate impression based on findings.

Input: 50 years, Female, left hemibody pain. Brain parenchyma appears within normal limits for age. There is mild cerebral and cerebellar volume loss. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Brain MRI is within normal limits for age. Specifically, there is no significant abnormality involving the thalamus.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate brain metastases. Signs and symptoms: Evaluate brain metastases. Pre and post enhanced brain MRI:Examination demonstrates further interval improvement of metastatic lesions since prior study. Several of the previously noted tiny metastatic lesions in supratentorial space are no longer identified. The remaining 2 lesions measure smaller than prior exam. A remaining metastatic lesion along the medial aspect of left posterior temporal lobe measures at 1.6 mm in transaxial dimensions compared to prior study the measurement of 3.1. A tiny cortical-based left parieto-occipital fissure metastatic lesion measures at 2.2 mm compared to prior study the measurement of 3.4 mm. There is also interval decreased size of 2 tiny metastatic lesions in the posterior fossa on the right side. The remaining larger lesion measures approximately 6 mm in size compared to prior study measurement of 9 mm and the smaller in the measures approximately 2.5 mm in size compared to prior study remeasurement of 5.6 mm.None of the remaining lesions demonstrate any surrounding vasogenic edema or enhancement.Stable CSF signal intensity cyst in the pineal region.Diffuse and patchy foci of FLAIR hyperintensity in bilateral hemispheric white matter and pons are more conspicuous on current exam and suspected of post treatment/radiation change.

Output: 1.Interval further decrease in size of remaining metastatic lesions and some with interval complete resolution as detailed/measured above.2.More conspicuous patchy and confluent foci of FLAIR hyperintensity of bilateral hemispheric white matter and pons likely representing post treatment/radiation change.3.No intracranial edema, mass effect or ventriculomegaly.


Instruction: Generate impression based on findings.

Input: 64-year-old male with lateral hip pain. Evaluate for gluteus medius tear. BONE MARROW: No bone marrow signal abnormality is identified. No findings to suggest acute fracture or malalignment.SOFT TISSUES: Note is made of equivocal increased T2 signal abnormality within the left gluteus maximus muscle belly. No gluteus maximus muscle atrophy is identified. The gluteus maximus muscle bellies and tendons appear intact. The gluteus medius muscle bellies and tendons appear intact.JOINTS: No significant abnormality noted.ADDITIONAL

Output: Equivocal increased signal abnormality within the left gluteus maximus muscle belly is nonspecific but can be seen in denervation injuries. Further evaluation with a dedicated lumbar MRI examination could be considered. No evidence of gluteus medius injury, as clinically questioned.


Instruction: Generate impression based on findings.

Input: Reason: r/o osteomyelitis of calcaneus History: continued pain. Previously seen edema involving the calcaneus, anterior talus, and cuboid has decreased slightly compared to prior. No evidence of osteomyelitis.Focal abnormal signal within the inferior margin of the calcaneus corresponding to a lucency seen on prior CT has also decreased compared to prior.Previously seen patchy edema within the distal tibial epiphyseal cysts has resolved.No new areas of edema.Otherwise, the visualized bones and soft tissues are within normal limits.

Output: Interval decrease in nonspecific bone marrow edema involving the calcaneus, anterior talus, and cuboid. Interval resolution of edema involving the distal tibia. Findings again likely transient regional osteoporosis. No specific evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 52-year-old male patient with refractory hand pain. Evaluate for subclinical synovitis. There is mild synovitis adjacent to the second metacarpal head. A small collection of fluid signal intensity along the volar surface of the second metacarpal head may represent a small synovial cyst or ganglion. Mild osteoarthritis affects the first metacarpophalangeal joint with minimal synovitis and a small cyst or erosion in the first metacarpal head. The remaining metacarpophalangeal joints and interphalangeal joints appear normal.Enhancement along the volar aspect of the carpus likely represents synovitis, but is incompletely visualized on this hand study. Small enhancing foci in the capitate may represent cysts or erosions. The visualized tendons and remaining soft tissues appear normal.

Output: Mild synovitis of the first and second metacarpophalangeal joints and wrist with other findings as described above.


Instruction: Generate impression based on findings.

Input: 61 years Female (DOB:5/25/1955)Reason: eval for thoracic disc, bone spur. History: chest tightening- wrapping painPROVIDER/ATTENDING NAME: EDWIN RAMOS MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. The examination is mildly degraded due to patient motion artifact which may obscure more subtle abnormalities.T1 hyperintense foci are present at T7 and T5. These suppress on the STIR images. Most likely these represent vertebral body hemangiomas.

Output: 1.There is no compromise to the thoracic spinal canal or thoracic spinal cord. No abnormal lesions are appreciated within the thoracic spine.2.The examination is mildly degraded due to patient motion artifact which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 36 year old woman with recent of chest pain, intermittent first degree AV block, referred for cardiac MRI for further evaluation.MEDICATIONS: 75 mg Aminophyllin, 0.4 mg Regadenoson First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 84 ml/m2 (normal range: 65+/-11), the LVEDV is 165 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 53 ml (normal range 31+/-10), the LV mass index is 36 g/m2, and the LV mass is 70 g. There are no regional wall motion abnormalities present. No intracardiac thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 68%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 151 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 48 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a common origin of the innominate and left common carotid arteries.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 68%).4. Normal RV size and systolic function (RVEF 68%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 28 year old woman with SA node dysfunction, referred for evaluation of underlying fibrosis or inflammation. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 111 ml/m2 (normal range: 65+/-11), the LVEDV is 180 ml (normal range 109+/-23), the LV end systolic volume index is 49 ml/m2 (normal range 18+/-5), the LVESV is 80 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 70 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. There is no evidence of acute inflammation or edema on T1 or T2 imaging.Left AtriumThe left atrium is moderate to severely dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 114 ml/m2 (normal range 69+/-14), the RVEDV is 184 ml (normal range 110+/-24), the RV end systolic volume index is 56 ml/m2 (normal range 22+/-8), and the RVESV is 92 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild 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 are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 56%. There is no late gadolinium enhancement on long-axis images of the left ventricle to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 2. The right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%. Short axis late gadolinium enhancement images not uploaded to PACs. Will add addendum when these images are uploaded.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 58 year old female with insertional achilles pain. Evaluate for achilles tendinosis or calcaneal stress fracture. TENDONS: The extensor tendons appear intact. The flexor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized portions of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is increased signal abnormality within the tubercle of the calcaneus which may represent reactive osteitis. Stress reaction or contusion is considered less likely. No discrete fracture line is evident.ADDITIONAL

Output: Findings indicating plantar fasciitis and reactive osteitis of the calcaneus as described above.


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness, transient loss of consciousness with up going toes on the left. Many of the images are significantly degraded by patient motion. There is no gross evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pineal gland appear to be grossly unremarkable. There is an unchanged partially-empty sella. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The A1 segment of the left anterior cerebral artery flow void abuts the superior aspect of the left optic nerve. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Limited examination secondary to significant patient motion. Within this constraint, there is no gross evidence of acute infarction or mass lesions.2. Unchanged nonspecific partially-empty sella.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question of corner assess post op. Signs and symptoms: Status post right craniotomy. Nonenhanced head CT:Examination demonstrate expected postoperative changes of a large right-sided suboccipital craniectomy/repair. There is interval removal of previously noted large tumor in the right cerebellopontine angle. Subtle increased density within the right internal auditory canal is present on axial image 8 which may represent minimal residual tumor. Follow-up with an MRI is recommended. Widening of right cerebellopontine angle cistern is as result of prior tumor and postop change. Subtle deformity of the right cerebellum and right aspect of the pons is believed to be result of prior long-standing mass effect from tumor.There is also subtle deviation of the fourth ventricle across the midline to the left as was noted on preoperative study.There is no evidence of parenchymal hemorrhage or edema.Images through supratentorial space demonstrate no definitive evidence of abnormality.

Output: Expected postoperative changes of a large right suboccipital craniectomy and repair repair for removal of tumor.


Instruction: Generate impression based on findings.

Input: Intussusception seen on CT. Evaluate for bowel abnormality. Multiple liver lesions seen on CT. ABDOMEN:LIVER, BILIARY TRACT: There are several T2 hyperintense foci with imaging features compatible with benign hepatic cysts.At least 2 intermediately hyperintense T2-weighted foci in the liver have imaging features compatible with benign hemangioma. The largest is a segment 6 lesion measuring 2.2 x 1.6 cm (series 4/27).The 5 lesions which were seen on the recent CT which were hyperattenuating on portal phase imaging are homogeneously isointense to liver on T2 weighted imaging and are mildly T1 weighted hypointense. The arterial phase of the study is too early to evaluate arterial enhancement. On portal venous phase the lesions are homogeneously hyperintense to the liver parenchyma. The lesions demonstrate no significant intralesional fat. Hepatobiliary phase imaging suggests retention of contrast.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: The small bowel fold pattern is maintained. The proximal jejunum demonstrates moderate diffuse fold and wall thickening and hyperenhancement. No discrete mass is identified. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Nonspecific diffuse fold/wall thickening and hyperenhancement of the jejunum. No evidence of obstruction or focal mass lesion.2.Hepatic cysts and hemangiomata. Homogeneously enhancing liver lesions demonstrate retention of contrast on hepatobiliary phase imaging most suggestive of focal nodular hyperplasia.


Instruction: Generate impression based on findings.

Input: Evaluate for medial meniscal tear MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is marked thinning and irregularity of the articular cartilage of the medial femoral condyle and medial tibial plateau.. There is bone marrow edema associated with this cartilage loss.. The articular cartilage of the lateral joint is unremarkable.There is marked thinning of the articular cartilage of the medial facet of the patella.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Marked articular cartilage loss in the medial joint. No evidence of meniscal tear.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with question of visual field defect. Rule out acute cause. Signs and symptoms: Visual field deficit? Transient? Acute. Signs and symptoms: Visual field defect? Transient? No definitive evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain essentially within normal for patient stated age. Further evaluation with an MRI is recommended. Calvarium, paranasal sinuses and mastoid air cells are within normal limits.

Output: Negative CT of brain.


Instruction: Generate impression based on findings.

Input: 50 year old man with heart/kidney transplant on 10/22/15, referred for serial MRI as part screening for cardiac allograft rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. Normal LV wall thickness (9-10mm), which is stable compared to the last study. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 61 ml/m2 (normal range: 74+/-15), the is 136 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 44 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 103 g (normal range 164+/-36). 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. Quantitatively, the myocardial to skeletal T2-enhancement ratio is 1.66, which is in the normal range. The global relative enhancement is 1.89, which is in the normal range. This study was unable to calculate native T1 relaxation time. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 58 ml/m2 (normal range 82+/-16), the RVEDV is 128 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 55 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.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 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. Fibrin sheaths in the veins of the upper mediastinum, likely related to previous intravascular lines. PericardiumThere is a small pericardial effusion which is located over the basal portion of the heart and increased compared to the prior study. There is persistent but less notable T2-STIR signal of the pericardium associated with previously noted postoperative pericarditis. Extracardiac FindingsSternal wires are present. There is diffuse low signal of the liver and spleen, which was seen on the previous study. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%. This is unchanged compared to the previous exam.2. The myocardial to skeletal T2 ratio and global relative enhancement are normal. Wall thickness is stable. There is no late gadolinium enhancement. These findings speak against acute rejection. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%. This is unchanged compared to the previous exam. 4. Fibrin sheaths in the veins of the upper mediastinum. 5. Decreased T2-STIR signal and gadolinium enhancement of the pericardium but increase in amount of pericardial fluid.


Instruction: Generate impression based on findings.

Input: Auditory neuropathy on ABR: Sensorineural hearing loss. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of cochlear nerve deficiency, internal auditory canal lesions, or inner ear anomalies.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Intermittent vascular lesion on the left dorsum of tongue. Neck: There is no evidence of mass lesions or significant cervical lymphadenopathy. In particular, no tongue lesion is discernible. The thyroid and major salivary glands are unremarkable. The osseous structures are grossly intact. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. The reported tongue lesion is not discernible. 2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Possible spasmodic dysphonia: rule out central cause. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild, scattered, nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Neck: There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There are bilateral upper thoracic spine neural foraminal perineural cysts. There is bilateral upper lung bronchiectasis, enhancement, and cavities compatible with mycetomas.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of mass lesions in the neck.3. Bilateral upper lung bronchiectasis, fibrosis, and cavities related to mycetomas.


Instruction: Generate impression based on findings.

Input: Stage IV melanoma with two brain metastases, status post resection of a large left frontal lesion and SRS for a cerebellar lesion. Re-evaluate disease status following immunotherapy and hold due to elevated enzymes. There are postoperative findings related to left frontal craniotomy. There is a subcentimeter focus of susceptibility effect without associated enhancement in the left inferior frontal gyrus resection cavity. There is more prominent enhancement on the 3D T1 sequence associated with the right lateral cerebellar hemisphere lesion, but no significant interval change in size of the lesion, measuring up to 3 mm. Previously, the 3D post-contrast sequence was obtained earlier during the scan. There is no evidence of other intracranial mass lesions. There is no evidence of intracranial hemorrhage or acute infarct. 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. Post-treatment findings in the left frontal lobe metastasectomy without evidence of recurrent metastasis at this site. 2. Unchanged size, but more pronounced enhancement of the small right cerebellar metastasis, which may be due to differences in timing of the contrast material.3. No evidence of new intracranial metastases.


Instruction: Generate impression based on findings.

Input: History of breast cancer, on chemotherapy, now with right-sided headache and blurry vision. Evaluate for metastases. There is no evidence of intracranial hemorrhage, edema or midline shift. Though no mass effect is present, evaluation for metastatic lesions is limited by a lack of intravenous contrast. If there is a high suspicion for metastases, an MRI with contrast is recommended.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is opacification of a few ethmoid air cells. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality. No mass lesions are identified. If there is strong clinical concern for intracranial metastases, an MRI with contrast may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Male, 45 years old, with GBM, post RT evaluation. Postoperative findings are seen compatible with resection of a tumor at the left parietal-occipital junction. Extensive edema surrounding the tumor bed seen on the prior examinations has resolved. Only mild persistent T2 hyperintensity is present immediately surrounding the resection cavity. Several foci of enhancement are seen scattered along the margin of the resection cavity. The largest is found posteriorly and measures up to 8 mm. Brain parenchymal morphology and signal characteristics are otherwise unremarkable. No additional areas of tumor-like signal or enhancement are seen. The ventricles are normal in size and morphology.

Output: Findings are seen compatible with resection of a tumor from the left parietal-occipital junction. Edema seen on the prior examinations has resolved. Only minimal T2 signal abnormality remains immediately surrounding the resection cavity. Several small foci of enhancement along the cavity margin are nonspecific. Attention on subsequent exams will be required.


Instruction: Generate impression based on findings.

Input: 44 years Male (DOB:10/31/1971)Reason: follow up existing Pineal cyst found on the previous brain MRI. History: headachePROVIDER/ATTENDING NAME: JAMES X. TAO JAMES X. TAO The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The pineal gland measures approximately 8 x 10 mm sagittal dimensions and has a cystic appearance which is high signal on T2 and FLAIR. This is stable compared to prior exam.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.The patient's pineal cyst is stable compared to prior exam.2.No lesions are identified in the brain parenchyma to explain patient's seizures.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. They have not changed since prior exam.


Instruction: Generate impression based on findings.

Input: Altered mental status [780.97], Reason for Study: ^Reason: eval posterior fossa arachnoid cyst for e/o infection or mass effect in light of AMS History: AMS, hx of aspergillosis and sarcoid There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Scattered high signal intensity lesions on bilateral centrum semiovale on FLAIR imaging are nonspecific findings.There is localized lacunar infarct on the right supra marginal gyrus.Posterior fossa arachnoid cyst is again seen. The configuration of the boundary between the right side posterior fossa arachnoid cyst and right cerebellar hemisphere appear to be straight line instead of following the margin of right cerebellar hemisphere which may suggest possibility of mass effect of the arachnoid cyst against the right cerebellar hemisphere. However, the MR I clearly shows the normal definition of right the cerebellar sulci and folia without evidence of edema. Therefore, there is no definitive MR imaging evidence of mass effect of arachnoid cyst toward the right cerebellar hemisphere.The ventricles, sulci are symmetric and unremarkable. There is no mass, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal contrast enhancement. No evidence of infected arachnoid cyst.2. Posterior fossa arachnoid cyst is again seen without definitive MR imaging evidence of mass effect towards especially right cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: 16-year-old female with knee pain. MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: There is a bipartite patella and a contusion is present within the patellar accessory ossification center. The bones are otherwise intact. The articular cartilage is normal.LIGAMENTS: The medial retinaculum demonstrates a somewhat wavy contour with mild surrounding edema near its insertion on the patella, which suggests a partial tear. The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are normal. ADDITIONAL

Output: Probable partial tear of the medial retinaculum and contusion of the patellar accessory ossification center likely reflects a prior patellar dislocation. There is evidence of patellar instability given findings suggestive of patella alta and trochlear dysplasia. However, the patella is currently in anatomic alignment.


Instruction: Generate impression based on findings.

Input: Hemiplegic migraine, nosebleeds. There is no evidence of significant steno-occlusive lesions or cerebral aneurysms.

Output: No evidence of significant steno-occlusive lesions of the circle of major cerebral arteries. MRA is typically insensitive for the detection of small vessel vasculitis, however.


Instruction: Generate impression based on findings.

Input: Evaluate for ligament or tendon injury versus chronic tendinopathy of ankle after injury early 2015, left ankle. Pain for 5 months of right ankle, evaluate for chronic tendinopathy. RIGHT ANKLE:TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intactARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. No osteochondral defect is present. Mild osteoarthritis affects the midfoot.ADDITIONAL

Output: No evidence of ligamentous injury or tendinopathy. Degenerative changes and subcutaneous stranding, as above.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease at the TI. Evaluate extent of disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Acute inflammation involving the terminal ileum and the surrounding proximal small bowel loops as well as suspected involvement of the adjacent sigmoid colon. These bowel loops are angulated and drawn in centrally towards the distal ileum with signal characteristics consistent with acute inflammation. A fistulous communication between the distal ileum and sigmoid colon is not visualized but cannot be excluded.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:There is restricted diffusion involving the right basal ganglia extending from the right caudate body and extending inferiorly to the medial aspect of the putamen and including the posterior limb of the right internal capsule. There is corresponding T2/FLAIR hyperintensity. No associated susceptibility effect to suggest hemorrhage. No other focus of restricted diffusion. Remainder of the brain demonstrates several scattered foci of T2/FLAIR hyperintensity in the subcortical white matter which are nonspecific. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. Paranasal sinuses and mastoid air cells are clear. Calvarium and extracranial soft tissues are unremarkable.MRA BRAIN:The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA NECK:MRA of the neck without contrast is very technically limited but demonstrates no gross occlusion of the bilateral common carotid, internal carotid, or vertebral arteries.

Output: 1. Acute infarct involving the right basal ganglia including the right caudate body, medial putamen, and posterior limb of the internal capsule.2. Patent intracranial vasculature. 3. Very limited MRA neck without contrast demonstrates no obvious occlusion of the internal carotid, common carotid, or vertebral arteries in the neck. Dr. Syema Sheikh was notified on 10/2/2015 at 4:40 PM


Instruction: Generate impression based on findings.

Input: 59 year-old with biopsy-proven invasive carcinoma in the left upper outer breast. Additionally a stereotactic biopsy of the left breast at a central site showed ADH. On review of the prior studies, MRI 11/4/2015 and prior mammograms the small mass and area of previous calcifications/displaced clip are noted. Target ill defined mass is located in the left breast in the upper outer quadrant region located posteriorly at 2 o’clock. Also, target area of previous calcifications are located in the left breast in the central region located 5 cm lateral to the biopsy clip. The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was placed in an alphanumeric grid using lateral to medial approach for both lesions. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, two 9 cm Kopans needle was placed at both targets, one at a time. On orthogonal mammography, adequate positioning of the needles were confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. Spring wires were sequentially deployed. Repeat two view orthogonal mammograms reveal the spring wires to be in good position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. It was understood that the biopsy clip is 5 cm medial to the site of previous calcifications for the more anterior inferior wire. Dr. Schacht performed the procedure.Two sets of orthogonal digital specimen radiographs revealed the mass and spring wire to be within one specimen (IDC) and a spring wire to be in the 2nd specimen (ADH). The mass was relatively close to one margin on the IDC specimen and a small additional tissue sample was obtained.

Output: Successful needle localization of the left breast mass and site of prior calcifications.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 87 years Female (DOB:10/1/1929)Reason: stroke History: fallPROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY MRI of the brainThere is a focus of diffusion restriction present along the posterior aspect of the left paracentral lobule with a larger diffusion weighted abnormality associated with it. Other foci of signal hyperintensity and diffusion-weighted imaging left frontal lobe and right parietal lobe are associated with T2 shine through.There are multiple periventricular and subcortical white matter areas of confluent T2 and FLAIR signal hyperintensity associated with small foci of encephalomalacia in the right inferior parietal lobule, right postcentral gyrus left cuneus, right lingual gyrus , the left inferior frontal gyrus and the right orbital gyrus. The one in the right orbital gyrus, right postcentral gyrus and left inferior parietal lobule present on the prior exam the rest of developed since thenNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The right vertebral artery is larger than the left vertebral artery. There is extracranial origin of the left posterior inferior cerebellar artery present.

Output: 1.Findings suggest a subacute focus of infarction along the posterior aspect of the left paracentral lobule. 2.Multiple foci of encephalomalacia are scattered in both hemispheres of the brain which are suspicious for prior foci of infarction. Many of these are new since December 20123.There are extensive white matter signal changes throughout much of the brain which are nonspecific. It's possible that these are vascular related. These have significantly progressed since the prior exam from December 20124.No evidence for cerebrovascular occlusive disease.5.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: History of pharyngeal squamous cell carcinoma treated with chemoradiation therapy. T1N2b right hypopharyngeal squamous cell carcinoma diagnosed in 2/2013 s/p radical right neck dissection and adjuvant chemoradiation from 5/2013 to 7/2013. A right posterior neck recurrence occurred in 9/2013 and right posterior neck dissection was performed in 12/2013, which yielded well differentiated squamous cell carcinoma, with a second skin recurrence in right supraclavicular region treated via neck dissection, with positive margins, on 4/22/2014. Neck: There are postoperative findings related to right neck dissection without significant change in diffuse enhancement in the right lower neck subcutaneous tissues and paraspinal muscles. There is mild ill-defined diffuse hypopharyngeal swelling and enhancement, but no discernible measurable mass lesion or significant lymphadenopathy in the neck. The thyroid and major salivary glands appear unchanged. The right internal jugular vein appears to have been sacrificed. The other major cervical flow voids appear to be unchanged. The osseous structures are unchanged. There is minimal mucosal thickening within the paranasal sinuses, including a subcentimeter left maxillary mucous retention cyst. Brain: There is no intracranial mass or mass-effect. There is minimal persistent diffuse enhancement of the dura. However, there is no abnormal intraparenchymal enhancement to suggest metastatic disease. There is no evidence of acute ischemia. The ventricles are unchanged in size and configuration. Multiple nonspecific foci of T2 hyperintensity in the bilateral subcortical and periventricular white matter are unchanged. The skull appears unchanged.

Output: 1. No significant interval change in diffuse enhancement in the right lower neck subcutaneous tissues and paraspinal muscles, which is likely treatment-related. Otherwise, no discrete mass or significant lymphadenopathy is identified in the neck to suggest disease recurrence. 2. Nonspecific signal abnormality in the bilateral periventricular and subcortical white matter may represent chronic small vessel ischemic disease.3. No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Clinical question: Cortical IPH. Signs and symptoms: Confusion. Pre-and post-enhanced brain MRI:Diffusion weighted images demonstrate previously known small parenchymal hematoma in the left posterior temporal and unremarkable otherwise.Examination demonstrates an acute superficially located hematoma in the left posterior temporal lobe measuring at 12 times 17-mm in size and with minimal surrounding vasogenic edema and associated mass effect. There is no interval change since prior head CT exam.In addition the study demonstrates findings of moderate chronic nonhemorrhagic small vessel ischemic strokes in the subcortical and periventricular white matter of cerebral hemispheres, bilateral basal ganglia, left thalamus and minimally in the right pons.Post enhanced images are negative for any abnormal parenchymal or leptomeningeal enhancement and there is also no detectable enhancement of the left temporal hematoma or its surrounding parenchyma. The signal intensity of calvarium and soft tissues of the scalp remains in normal and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Negative diffusion weighted series.2.Left temporal small parenchymal hematoma measuring 12 x 17-mm and without abnormal enhancement. Nonhemorrhagic small vessel ischemic strokes of moderate degree.3.No detectable abnormal enhancement.4.Chronic


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several nonspecific punctate foci of increased T2/FLAIR signal within the supratentorial subcortical and periventricular white matter. There is also an ill-defined larger area of confluent increased T2/FLAIR signal in the right periatrial 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: Nonspecific punctate as well as confluent areas of white matter signal abnormality. Differential considerations include chronic small vessel ischemic changes, demyelinating disease, vasculitides, and other less likely etiologies. Recommend follow-up brain MRI without and with intravenous contrast in 3 months for further characterization and to assess interval change.


Instruction: Generate impression based on findings.

Input: Check for SLAP tear. Pain and clicking. Exam is limited in the absence of augmentation and an existing effusion.ROTATOR CUFF: Mild undersurface fraying of the supraspinatus with otherwise intact fibers. The remainder of the rotator cuff is otherwise intactSUPRASPINATUS OUTLET: Moderate osteoarthritic changes of the AC joint with more mild to moderate changes of the shoulder. This includes minimal narrowing, more pronounced osteophytes and subchondral cysts.GLENOHUMERAL JOINT AND GLENOID LABRUM: Specifically the labrum is grossly intact, however small diminished, specifically along the anterior aspect. Additionally abnormal signal underlying the superior component suggesting detachment is observed, however free fluid is not seen it could be absent given the lack of augmentation.Marrow signal is intact throughoutBICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild tendinosis of the supraspinatus with undersurface fraying as well as changes of the superior labrum suggesting probable SLAP tear difficult to confirm in the absence of an augmented exam.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 32-year-old female with pain, unspecified rotator cuff tear or rupture of right shoulder, not specified as traumatic. Evaluate rotator cuff for pre-operative planning, TSA. ROTATOR CUFF: There is generalized atrophy of the supraspinatus, infraspinatus, teres minor and subscapularis muscles. The tendons appear intact with no findings to suggest rotator cuff tear.SUPRASPINATUS OUTLET: High riding humeral head with no rotator cuff tear present.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is heterogeneous intermediate signalintensity within the glenohumeral joint likely pannus formation. As noted above, there is a high riding humeral head with no evidence of rotator cuff tear. There is no evidence of labral tear on this non-arthrogram study. BICEPS TENDON: The long head of the biceps tendon is difficult to follow throughout its course. ADDITIONAL

Output: High right humeral head with no evidence of rotator cuff tear. There is generalized atrophy of the rotator cuff musculature.


Instruction: Generate impression based on findings.

Input: Recent left side pterional craniotomy for debulking and fenestration of craniopharyngioma. There are postoperative findings related to left frontal and parietal craniotomy and more recently left pterional craniotomy with a small amount of hemorrhage deep to the craniotomy flap, in the suprasellar surgical bed and within the occipital horns of the lateral ventricles. There is also mild sulcal effacement in the left frontal lobe perhaps due to edema from retraction. The right frontal and right parietal craniotomy sites are unchanged. The left-sided cystic component of the suprasellar mass has decreased in size. However, the right-sided cystic component and more solid midline component are grossly unchanged compared to the MRI obtained just prior to the surgery. There is persistent mass effect upon the third ventricle. The lateral ventricles appear smaller than in May 2014, but are not significantly changed from the most recent exam. There is mild encephalomalacia in the bilateral anterior frontal lobes. There is no significant midline shift. There is scattered mild mucosal thickening and secretions in the bilateral maxillary and ethmoid sinuses. The orbits are unremarkable. There is an expected degree of left scalp swelling associated with the recent surgery.

Output: 1. Recent left pterional craniotomy with a small area of acute infarction in the left basal ganglia and a small amount of scattered postoperative hemorrhage.2. The left-sided cystic component of the suprasellar craniopharyngioma is smaller in size compared with the MRI obtained just before the surgery, while the remainder of the tumor has not significantly changed.3. The lateral ventricles appear smaller than in May 2014, but not significantly changed from the most recent exams.


Instruction: Generate impression based on findings.

Input: Right lower extremity radiculopathy, patient receiving lumbar epidural injections Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L2 on L3. There is grade 2 anterolisthesis and mild right lateral subluxation of L3 on L4. There is dextrocurvature with apex at L2-3. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: There is disk bulge, ligamentum flavum thickening, and facet arthropathy. There is loss of intravertebral disk space. There is moderate right and minimal left neural foraminal narrowing. No significant spinal canal narrowing.L2-L3: Anterolisthesis, severe loss of disk height, and disk bulge eccentric to the right. There is bilateral facet arthropathy and ligamentum flavum thickening. There is severe spinal canal stenosis. There is moderate bilateral neural foramina stenosis. L3-L4: Grade 2 anterolisthesis, severe loss of disk height, bilateral facet arthropathy and ligamentum flavum thickening. There is severe spinal canal stenosis and moderate right and moderate to severe left neural foramina stenosis.L4-L5: Disk desiccation with some loss of height. There is bilateral facet arthropathy and ligamentum flavum thickening. No significant spinal canal stenosis. There is minimal right and moderate to severe left neural foraminal stenosis.L5-S1: There is a disk bulge and mild facet arthropathy. No spinal canal stenosis. There is mild right foraminal narrowing. No spinal canal or left neural foraminal stenosis. There is contact of the disk bulge with the bilateral L5 nerve roots extra foraminally.There is atrophy involving the paraspinous musculature.

Output: 1. Multilevel degenerative changes in the lumbar spine as detailed above with grade 1 anterolisthesis of L2 on L3 and grade 2 anterolisthesis with mild right lateral subluxation of L3 on L4. There is dextrocurvature with apex at L2-3.2. Severe spinal canal stenosis at L2-L3 and L3-L4. 3. Multilevel neural foraminal narrowing and facet arthropathy as described above.


Instruction: Generate impression based on findings.

Input: The cervical cord is normal in signal and morphology without findings to suggest demyelinating plaques or cord edema. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disc space heights are preserved. The bone marrow signal is normal. There are mild degenerative changes with ligamentous flavum thickening and a disc osteophyte complex at C6-7 which results in minimal spinal canal stenosis and mild left neural foraminal narrowing. A posterior disc osteophyte complex at C5-6 results in minimal spinal canal stenosis at this level. Otherwise, the spinal canal and neural foramina are patent; however, evaluation of the neural foramina is suboptimal due to motion degradation. Paraspinous soft tissues are unremarkable.

Output: No abnormal signal within the cervical cord to suggest demyelinating disease.


Instruction: Generate impression based on findings.

Input: 29 year old with history of ALL, diabetes and VTE presenting from outside hospital with NSTEMI. Coronary angiography performed with no evidence of obstructive coronary disease. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the LVEDV is 112 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 47 ml (normal range 47+/-19), the LV mass index is 46 g/m2 (normal range 85+/-15), and the LV mass is 75 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is two very small areas of late gadolinium enhancement in the basal inferior wall and the mid inferior wall in a pattern that is atypical for myocardial infarction. There are additionally small patchy areas of mildly increased native myocardial T1 relaxation times. This pattern represents a mild underlying myocardial fibrosing, infiltrative, or inflammatory process. It is most suggestive of either a process such as vasculitis or mild myocarditis. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVEDV is 116 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve 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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular systolic size and function (LVEF65%).2. There are two very small focal areas of late gadolinium enhancement as described above. The finding could be due to either mild fibrosis, inflammation, or infiltration. The pattern of late gadolinium enhancement raises the possibility of vasculitis or myocarditis. The finding is atypical for prior myocardial infarction.3. Normal RV size and systolic function (RVEF52%).


Instruction: Generate impression based on findings.

Input: Recent MRI (8/28/15) showed non-mass enhancement in the right breast, for which MR directed ultrasound is recommended. History of right mastectomy for IDC and DCIS 8/2012 with implant placement. With physical exam, Thickening of the tissue is present at the site of enhancement on MRI. Focused ultrasound detects a hypoechoic lesion measuring 25 x 4 mm at 6:00 position in the right breast, corresponding to the MR findings. Increased blood flow is seen in this lesion.

Output: MR directed ultrasound detected a sonographic correlate with the MR enhancing lesion at 6:00 position in the right breast. Ultrasound guided biopsy is recommended. Results and recommendations were discussed with the patient. Results were discussed with Dr. Jaskowiak.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: PITUITARY: There is mild apparent hypoenhancement along the far left lateral aspect of the pituitary gland on series 1301 image 16, and not definitely present on the sagittal images. There is susceptibility artifact just inferior to this apparent abnormality likely due to sphenoid sinus are. Therefore, this apparent finding is felt to be artifactual.Contour and size of the pituitary gland are normal. There is no deviation of the pituitary stalk. The cavernous sinuses enhance symmetrically.BRAIN: There is no acute infarct, mass effect, or cerebral edema. There are a few punctate T2 signal abnormalities in the right matter adjacent of the left frontal horn (series 701 image 16), nonspecific, and of doubtful clinical significance. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are mucus retention cysts in the bilateral maxillary sinusitis, in the right sphenoid sinus. The skull and extracranial soft tissues are unremarkable.

Output: No definite pituitary lesion. No significant abnormalities in the brain.