Instruction: Generate impression based on findings.

Input: Relapsed neuroblastoma with headache. The lobulated heterogeneous mass along the floor of the left middle cranial fossa and infratemporal fossa with perineural extension into the left cavernous sinus through foramen ovale and rotundum has slightly increased in size, measuring up to approximately 4.5 cm, previously 4.0 cm. In addition, tumor along the left lateral extraconal space appears to have slightly increase in size, measuring up to 11 mm in thickness, previously 7 mm, with mass effect upon the left lateral rectus muscle and compression of the left optic nerve in the orbital apex. An extradural nodule adjacent to the lateral inferior left frontal lobe now measures up to 7 mm, previously 5 mm, and display central non-enhancement. There is also interval increase in size of the tumors along the bilateral mandibular condyles, measuring up to 22 mm in overall width on the right, previously 15 m, and 13 mm in overall width on the left, previously 11 mm. There is no evidence of intracranial hemorrhage or acute infarct. There is mild mega cisterna magna. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift. There is scattered paranasal sinus mucosal thickening and secretions. There is obstructed fluid within the left mastoid air cells.

Output: 1. Interval increase in size of tumor along the left lateral wall of the orbit with associated compression of the left optic nerve at the orbital apex.2. Slight interval increase in size of the mass along the floor of the left middle cranial fossa and infratemporal fossa with apparent perineural extension into the left cavernous sinus through foramen ovale and rotundum, as well as associated left Eustachian tube obstruction.3. A subcentimeter extradural lesion adjacent to the inferior left frontal lobe laterally has slightly increased in size and now appears to be partly necrotic.4. Interval increase in size of the tumors along the bilateral mandibular condyles.


Instruction: Generate impression based on findings.

Input: 59 year old male patient status post liver transplant in 1996 with elevated liver enzymes. ABDOMEN:LIVER, BILIARY TRACT: Post surgical changes of a liver transplant with hepaticojejunostomy. Suboptimal arterial timing, however, no suspicious hepatic lesion demonstrating washout is identified. There is stable minimal intrahepatic biliary ductal dilatation. No dominant stricture. Susceptibility artifact within the central biliary tree is likely due to air as seen on prior CT. The hepatic veins and portal veins are patent. Susceptibility artifact from a hepatic artery stent limits evaluation of the arterial vasculature.SPLEEN: There are perisplenic varices and borderline splenomegaly. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Post-surgical changes from a partial left nephrectomy or left lower pole scarring. Bilateral subcentimeter T2 hyperintensities are too small to characterize, but likely represent cysts. 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 hepatic lesion. No dominant stricture. No discrete biliary features to suggest PSC. 2. No significant biliary ductal dilatation with mild pneumobilia.


Instruction: Generate impression based on findings.

Input: 54-year-old female. Plantar fasciitis. Evaluate for a plantar tear. Evaluation of the fibula and surrounding soft tissues is limited due to metallic susceptibility artifact resulting from a distal fibular plate and screw device.TENDONS: Small amount of fluid within the medial tendons is unlikely to be of clinical significance. There is increased signal intensity within the peroneus brevis tendon as it courses posterior and beneath the fibular tip suggesting a longitudinal tear. There is a small amount of fluid within the peroneal tendon sheath at the level of the fibular tip, of questionable significance. The anterior tendons are normal.LIGAMENTS: The anterior talofibular ligament is not well visualized perhaps due to a chronic tear. The calcaneofibular ligament appears intact. The posterior talofibular ligament is slightly heterogeneous but we suspect is intact. The anterior and posterior tibiofibular ligaments are grossly intact. There is loss of the normal fatty striations of the deep fibers of the deltoid ligament along with small ossicles distal to the medial malleolus suggesting old trauma.ARTICULAR SURFACES AND BONE: There is thickening and increased signal intensity of the plantar fascia at its calcaneal attachment compatible with plantar fasciitis. We see no fluid signal intensity disrupting the fascia to indicate a tear. A small plantar calcaneal spur at the fascial attachment is seen with mild marrow edema, likely reactive. An os trigonum representing normal variant anatomy is noted with normal signal intensity. Tiny ankle and midfoot osteophytes compatible with mild osteoarthritis. Small amount of fluid in the tibiotalar and subtalar joints, of doubtful clinical significance. We see no osteochondral defect.

Output: 1. Plantar fasciitis with reactive mild edema in an adjacent calcaneal spur. We see no plantar fascial tear.2. Post-operative changes of distal fibular fixation.3. Ligamentous abnormalities, as described above, may be due to old trauma.4. Partial-thickness longitudinal tearing of the peroneus brevis of questionable current clinical significance.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: assess for new stroke History: left face, arm, \T\ leg weakness \T\ numbness, slurred speech, gait imbalance Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is, however, pontine atrophic changes with demonstration of so called hot cross bun sign on FLAIR/T2 images. There are also bilateral middle cerebellar peduncular atrophies (left greater than right) and encephalomalacia on the left cerebellar hemisphere which is corresponding to prior ischemic infarction.Above findings do not show any interval change since prior scan.The prepontine cistern is prominent due to pontine volume loss. Otherwise the ventricular systems is unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift. 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.No aneurysm. No significant intracranial arterial luminal stenosis.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of intracranial major vessel occlusion. No aneurysm.3. Atrophic changes of pons, bilateral cerebellar peduncles (left worse than right) and left cerebellar encephalomalacia with MR evidence of so called hot cross bun sign. Unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Clinical question: Hyperreflexia, neck pain, left-sided weakness. Signs and symptoms: As above. Nonenhanced cervical spine MRI:There is normal anatomical alignment of the vertebral column.Foramen magnum is unremarkable. Incidental note is made of foci of T2 hyperintensity within the pons distended. Previously known chronic lacunar infarcts.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative disease with resultant mild left neural foraminal compromise.C4-C5 demonstrate mild disc disease and mild to moderate bilateral facet and ligamentum flavum hypertrophy. There is a central shallow disc protrusion which is in contact and deforms the ventral aspect of the cord. There is resultant mild central spinal stenosis without detectable cord signal abnormality. Mild left neural foraminal compromise.C5-C6 demonstrate mild disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. No central spinal stenosis and mild left neural foraminal compromise.C6/C7 demonstrate mild disc disease and moderate asymmetric left-sided facet hypertrophic changes there is a shallow left sided disc-osteophyte complex with partial effacement of ventral subarachnoid space without spinal stenosis. Mild left neural foraminal compromise is noted.Normal signal intensity of the cervical and upper most visualized thoracic cord.

Output: 1.Degenerative disease and a small central disc protrusion at C4-C5 with resultant mild central spinal stenosis as detailed.2.Mild degenerative changes at other levels and including a tiny left paramedian disc-osteophyte complex at C6-C7 with resultant mild left neural foraminal compromise.3.No evidence of spinal stenosis at any other level. Please review above detailed report on neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: The pituitary gland measures up to 3 mm in height and is slightly heterogeneous. However, there is no evidence of a focal lesion within the pituitary gland. The pituitary stalk is intact and lies in the midline. The posterior pituitary bright spot is also intact. The suprasellar cistern, optic apparatus, and cavernous sinuses appear unremarkable.

Output: Mildly atrophic pituitary, without discernible pituitary lesion. 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: any evidence of a neurofibroma? History: woman with pain in left triceps who has neurofibromatosis type 1 Note is made of numerous cutaneous and subcutaneous foci of increased signal abnormality on fluid sensitive sequences which likely represent cutaneous neurofibromas. There is a 1.4 x 0.8 cm focus of increased signal intensity along the anterior aspect of the pectoralis major muscle which likely represents a neurofibroma. There is associated decrease signal abnormality centrally within this lesion. More inferiorly, within the medial head of the triceps is a 4.0 x 3.7 x 6.6 (AP x TR x CC) cm mass which demonstrates heterogeneous but predominantly increased signal intensity on fluid sensitive sequences with low signal intensity centrally, also likely representing an neurofibroma, although the possibility of a malignant peripheral nerve sheath tumor cannot be completely excluded. Note is made of prominent axillary lymph nodes which retain the normal fatty hilum. No bone marrow signal abnormality is identified. The imaged musculature of the left arm is otherwise normal in appearance

Output: Findings consistent with the patient's history of neurofibromatosis as described above. There is a 6.6 cm mass within the medial head of the triceps musculature that likely represents a neurofibroma, however, the possibility of a malignant peripheral nerve sheath tumor cannot be completely excluded by this examination.


Instruction: Generate impression based on findings.

Input: Outside hospital MRI presented for second opinion. ABDOMEN:LIVER, BILIARY TRACT: The study is limited due to lack of intravenous contrast.The common bile duct measures up to 7 mm with extrinsic narrowing at the level of the supra pancreatic lymphadenopathy (series 6/14). No significant intrahepatic biliary ductal dilatation.Better appreciated on the subsequent CT is a 3.2 x 2.3 mildly T2-weighted hyperintense lesion in the periphery of segment IVa/b.Periportal lymphadenopathy is also noted, see subsequent CT.SPLEEN: No significant abnormality noted.PANCREAS: Just cranial to the pancreatic head is a 3.3 x 2.3 cm masslesion/lymph node. The main pancreatic duct is normal in caliber. No significant pancreatic parenchymal atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Additional small subcentimeter upper abdominal and retroperitoneal lymph nodes also seen. Tiny right-sided juxtraphrenic lymph nodes present as well. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Outside MRI exam read:1.The mass lesion described as a pancreatic head mass is more compatible with peripancreatic lymphadenopathy as better characterized on the subsequent CT. 2.Incompletely characterized peripheral segment 4A/B lesion is better seen on subsequent CT.


Instruction: Generate impression based on findings.

Input: Ms. Matesi is a 60 year old female with a personal history of left breast mastectomy in 2012 for IDC/DCIS. Personal history of breast reconstruction with implant placement in 2016. Note that there was technical difficulty with this scan including inadequate fat suppression and patient motion artifact. There is scattered fibroglandular tissue in the right breast. Mild parenchymal enhancement is noted in the right breast. No abnormal enhancement is seen in the right breast. Status post left breast mastectomy with implant-based reconstruction. In the left reconstructed breast, there are two enhancing circumscribed masses identified. The first mass is located in the left upper inner location, 11:00 position, measuring approximately 0.6 x 1.4 x 0.7 cm (AP x ML x SI) and the second mass is located in the left upper outer location, 2:00 location, measuring approximately 0.6 x 0.6 cm (AP x SI). No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Two enhancing masses in the left reconstructed breast (11:00 and 2:00 position), which have a benign appearance, perhaps representing fat necrosis. An MR-directed ultrasound is recommended for further evaluation. If no sonographic correlate is identified, then a short term 6 month MRI follow-up may be recommended. (2) No MRI evidence for malignancy in the right breast. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: History of sickle cell disease and moyamoya. Visual disturbances (left blurriness/double vision) and left facial pain. Also, sinus tenderness.. The punctate and confluent frontoparietal white-matter T1-hyperintense, T1-hypointense signal has not changed. It remains more pronounced on the left. It is associated with facilitated diffusion and mild volume loss. The associated focal cortical loss and more pronounced volume loss around the left postcentral sulcus is also unchanged. There is no susceptibility artifact within the brain to reflect hemorrhage. There is no diffusion restriction to indicate acute or recent stroke. The focus of T2 hyperintensity in the left occipital periventricular white-matter is also unchanged.The left intracranial internal carotid artery remains markedly small as well as the left middle cerebral artery and its branches.The paranasal sinuses are clear for from mild posterior ethmoid mucosal thickening without fluid. The mastoid air cells and the middle ear cavities are clear as well.There is no skull destructive lesion. There are changes of previous left frontoparietal revascularization surgery in the calvarium and overlying scalp.

Output: 1.The signal abnormality involving the cerebrum, more pronounced in the left frontoparietal region, remain unchanged since February 2015. It is compatible with chronic ischemia/infarct.2.Severe narrowing of the left internal carotid artery as well as the left middle cerebral artery and its branches also remain unchanged and reflect the known sickle cell disease associated vasculopathy. 3.There is no acute/recent infarct or new brain abnormality.4.The paranasal sinuses are clear other than mild posterior ethmoid mucosal thickening without fluid.5.Left calvarial and scalp abnormalities are reflective of previous revascularization surgery.


Instruction: Generate impression based on findings.

Input: There are innumerable foci of bone marrow signal abnormality throughout the vertebral bodies which, in the thoracic spine, demonstrate enhancement and compatible with metastatic disease. Vertebral body heights and alignment are preserved. There is mild loss of height at L5 centrally which appears congenital based on recent CT. No pathologic compression fractures. There is relatively greater involvement of the T7 and T8 vertebral bodies as well as the T12 vertebral body where there is diffuse involvement. Posterior element involvement also seen at multiple levels.There is a 3 x 1 cm enhancing epidural mass at the T7 to T8 level posteriorly. This mass displaces the spinal cord anteriorly and flattens it. Mild T2 hyperintensity in the cord is suspected, best seen on the STIR sequence on the sagittal images of the thoracolumbar spine. Multiple liver cysts are noted, better seen on recent CT.

Output: 1.Enhancing epidural mass at the dorsal T7 to T8 level compatible with metastasis. There is anterior displacement and evidence of cord compression. Mild T2 hyperintensity within the cord is suspected.2.Diffuse osseous metastases throughout the spine and visualized pelvis. No pathologic compression fractures or additional levels of epidural tumor. Please note the cervical and lumbar spine was imaged per screening cord compression protocol and dedicated studies can be obtained if clinically indicated.


Instruction: Generate impression based on findings.

Input: Reason: history of renal transplant concern for infection, previous MRI with findings concerning for left clavicle osteomyelitis, please include this in views to evaluate for osteomyelitis. LUNGS AND PLEURA: Moderate to large bilateral pleural effusions, not significantly changed with adjacent compressive atelectasis. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal lymphadenopathy identified.CHEST WALL AND SOFT TISSUES: There is redemonstration of edema/fluid signal as well as increased enhancement within the fascial planes of the left upper chest wall surrounding the proximal and middle third of the left clavicle which is compatible with an inflammatory process such as cellulitis. There is also abnormal bone marrow signal, frank cortical disruption, and increased enhancement involving the proximal and to a lesser extent middle third of the left clavicle which is compatible with osteomyelitis which has progressed. This abnormal marrow signal extends to the sternoclavicular articulation with significant inflammatory change about the joint and cortical disruption of the sternum. No bony sequestrum or definite vascular involvement is visualized. T3 hemangioma.There is redemonstration of a nonspecific T2 hyperintense nodule in the subcutaneous soft tissues of the left upper back.UPPER ABDOMEN: PEG tube in place.

Output: 1.Findings compatible with increasing cellulitis and osteomyelitis of the proximal clavicle and adjacent sternum. There is involvement of the sternoclavicular articulation, concerning for septic arthritis.2.Large bilateral pleural effusions, grossly unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. There is suggestion of bilateral pars defects at L5 without spondylolisthesis.L1-L2: There is disc desiccation at L1-L2 with a Schmorl's node involving the inferior L1 endplate. No significant surrounding edema. No disc herniation. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Minimal degenerative changes including disc desiccation at L1-L2 with small Schmorl's node. There is also mild L5-S1 facet arthropathy. No significant spinal canal or neural foraminal stenosis at any level. 2. Likely pars defects at L5 without associated spondylolisthesis. This finding can be better visualized with oblique radiographs or CT if clinically indicated.


Instruction: Generate impression based on findings.

Input: 44 year old male with head and neck cancer. Status post chemo RT CT of the soft tissues of the neck.Images through the skull base are within normal limits.Images through the soft tissues of the neck demonstrate no definitive evidence of any masses or pathologic adenopathy. There is however slight fullness at the level of right posterior triangle which is contiguous with extensive areas of post operative change, surgical clips and effacement of fascial plane. I cannot entirely rule out possibly off a node within this region please correlate with clinical examination and if concern for lymphadenopathy in this location exist an MRI is recommended. Although no definitive evidence of lymph node can be detected on this exam.The bony density of the area of the study is negative for metastatic disease however extensive degenerative changes are noted.Limited images of the apices of the lung are negative for metastatic lesion. Please review dedicated report of CT of chest performed the same date.CT of brain with infusion.This examination is negative for metastatic lesion to the brain or the calvarium. This study is essentially within normal limits.

Output: 1.No definitive evidence of any masses or pathologic adenopathy.2.Unremarkable CT of brain with infusion.


Instruction: Generate impression based on findings.

Input: Right face arm and leg numbness. There is a focal restricted diffusion on the left medial aspect of the thalamus indicate acute ischemic infarct without evidence of hemorrhagic transformation.There is evidence of chronic hemorrhage on the left anterior aspect of basal ganglia probably adjacent to anteriorly of left internal capsule.There are multifocal variable sized tissue lordosis indicating chronic lacunar infarcts.In addition, multiple high signal intensities on FLAIR imaging on periventricular white matters indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Focal acute ischemic infarct, left mesial aspect of the thalamus without evidence of hemorrhagic transformation.Multifocal chronic lacunar infarct with nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 79 years Female (DOB:4/10/1937)Reason: Evaluate for lesion bulging into 4th ventricle History: pls see abovePROVIDER/ATTENDING NAME: FERNANDO D. GOLDENBERG FERNANDO D. GOLDENBERG There is diffusion restriction and T2 and FLAIR signal hyperintensity present along the right lentiform nuclei, right caudate nucleus, right insular cortex and a small portion of the right inferior frontal gyrus as well as part of the right hippocampus. Additional focus of diffusion restriction is present along the right precentral gyrus and adjacent posterior aspect of the right middle frontal gyrus. There are punctate foci of diffusion restriction along the right temporal, right occipital and right parietal lobe in the MCA and PCA distribution.There is a 12x8mm low signal ring associated with a popcorn like appearance centrally on T2 centered in the right tectal plate centered along the inferior colliculus associated with susceptibility effect.A small focus of susceptibility is present in the right basal ganglia along the posterior aspect of the putamen within infarcted tissue.Small focus of susceptibility is present in the right sylvian fissure.Punctate foci of signal loss on SWI are present in the brainstem including midbrain and pons. There is patchy contrast enhancement along the upper brainstem.Perfusion imaging is degraded by patient motion.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 have scattered opacities. The visualized portions of the orbits are intact. The visualized portions of the orbits are intact. The eyeball lenses are thin. There is a scleral band along the left eye.

Output: 1.Subacute infarctions along the right basal ganglia, and insular cortex in their entirety as well as small portions of the right precentral and middle frontal frontal gyrus and right hippocampus with punctate foci in the temporal and parietal lobes. There are small foci of hemorrhage in the right basal ganglia and surrounding the right MCA in the sylvian fissure.2.Cerebral cavernous malformation along the right tectal plate centered along the inferior colliculus.3.Microhemorrhages are present in the brainstem. One possibility is that there is a small DVA present which is obscured by motion artifact.4.Patchy enhancement in the brainstem is of uncertain significance.5.Perfusion imaging is degraded by patient motion.6.Post contrast imaging is degraded by patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 39 year old female referred for cardiac MRI for pre-operative evaluation prior to possible hysterectomy. Hx of possible ASD and VSD since birth. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%. The LVEDV is 111 ml (normal range 109+/-23), LV end diastolic volume index is 74 ml/m2 (normal range: 65+/-11), LVESV is 41 ml (normal range 31+/-10), and LV end systolic volume index is 27 ml/m2 (normal range 18+/-5). The LV mass is 50 g (normal range 114+/-24) and the LV mass index is 33 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. Suspect membranous VSD but direct images of VSD not possible on this study. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Inter-atrial communication noted. First pass images non-diagnostic.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RVEDV is 128 ml (normal range 110+/-24), the RV end diastolic volume index is 85 ml/m2 (normal range 69+/-14), the RVESV is 56 ml (normal range 35+/-13), and the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is not well seen, opens widely and there is no significant aortic regurgitation. Calculated aortic forward flow = 64 mL.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. Calculated pulmonary forward flow = 79 mL.Qp:Qs was calculated to be 1.25:1.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 normally into the right atrium. Prominent azygous vein which drains into the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsScoliosis was noted. 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 63%. 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.2.The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%3.Suspect membranous VSD but direct images of VSD not possible on this study. 4.Small atrial septal defect noted. 5.Qp:Qs = 1.25:1.6.See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient with breast cancer and dizziness. Evaluate for edema/bleed. There is no evidence of intracranial hemorrhage, edema, or midline shift. No definite evidence of metastatic involvement. However MRI is more sensitive for evaluation of metastases.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute findings.


Instruction: Generate impression based on findings.

Input: There is irregular thickened peripheral enhancement of the 2.6 x 2.2 cm lesion in the right temporoparietal region white matter. The rim of the lesion is T2 isointense and the central portion of this lesion demonstrates restricted diffusion. There is marked surrounding vasogenic edema with mass effect causing effacement of the right lateral and third ventricle with 9 mm leftward midline shift. The temporal horn of the right lateral ventricle is mildly dilated, suggesting early entrapment. Mild mass effect is present upon the right dorsal lateral aspect of the midbrain. No abnormal susceptibility artifact is present. No additional lesions are identified. No extra-axial fluid collection is evident.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. 2.6 cm right temporoparietal region lesion with a constellation of imaging features most likely representing abscess or neoplasia. Marked associated vasogenic edema and mass effect with stable 9 mm leftward midline shift.2. Limited additional sequences performed for STEALTH protocol.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other spondylosis with myelopathy, cervical region Spinal stenosis, lumbar regionClinical question: hx cervical myelopathy. Evaluate for progressionSigns and Symptoms: gait instability Cervical spine:The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is loss of disc space height, disc desiccation and a broad-based left lateral recess disc extrusion present with flattening of the spinal cord and effacement of spinal fluid ventral and posterior the spinal cord. There is narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots bilaterally at this level related to disc material. Overall there is moderate to severe spinal stenosis at this level. Compared to the prior exam from 1/21/2013 there is minimal progression.At C4-5 there is disc desiccation and a diffuse disc bulge associated with encroachment of the exiting nerve roots within the neural foramina bilaterally and effacement of spinal fluid ventral and posterior the spinal cord as well as posterior ligamentous hypertrophy. There is some flattening of the spinal cord present. Overall there is a moderate to severe degree of spinal stenosis at this level. Compared to the prior exam from 1/21/2013 there is not appear to be any significant progression.At C5-6 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with flattening of the spinal cord and bilateral encroachment of exiting nerve roots within the neural foramina. Overall there is a moderate to severe degree of spinal stenosis at this level. There is some cord signal hyperintensity present. Compared to the prior exam from 1/21/2013 there is not appear to be any significant progression.At C6-7 there is a diffuse disc bulge present associated with some partial effacement of spinal fluid ventral and posterior the spinal cord and encroachment of the exiting nerve roots bilaterally. Compared to the prior exam from 1/21/2013 there is not appear to be any significant progression.At C7-T1 there is a disc bulge present associated with encroachment of the exiting nerve roots within the right neural foramen. Compared to the prior exam from 1/21/2013 there is not appear to be any significant progression.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is a right paramedian broad-based disc protrusion present which mildly impresses on the nerve root at the right lateral recess. There is loss of disc space height and disc desiccation at this level.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with bilateral facet hypertrophy and partial effacement of the fat at the lateral recesses sees. There is a mild degree of spinal stenosis present at this level. There is effacement of the fat surrounding the exiting nerve roots within the neural foramina bilaterally with some compression of the exiting nerve roots.At L3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated bilateral facet and ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recess bilaterally at this level and crowding of the nerve roots within the thecal sac. There is a moderate to marked degree of spinal stenosis at this level which has mildly progressed since the 9/22/2014 exam. There is mild (1mm) anterior subluxation of L3 on L4.At L2-3 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with partial effacement of the fat at the lateral recesses bilaterally. There is narrowing of the neural foramina bilaterally with partial effacement of the fat surrounding the exiting nerve roots within the neural foramina. There is crowding of the nerve roots within the thecal sac at this level. Overall there is a moderate degree of spinal stenosis present at this level which has mildly progressed since the 9/22/2014 exam. At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present in the cervical spine with moderate to severe spinal stenosis at C3-4, C4-5, C5-6 as well as encroachment of the exiting nerve roots bilaterally at these levels as well as the right side at C7-T1. There is mild encroachment of exiting nerve roots at C6-7. Compared to the prior exam from 2013 does not appear to be significant progression.2.There are multilevel degenerative changes present in the lumbar spine with moderate spinal stenosis at L3-4 and L2-3 which has mildly progressed since the 9/22/2014 exam. There is encroachment of the exiting nerve roots bilaterally at L3-4 and L2-3.


Instruction: Generate impression based on findings.

Input: Ms. Findley is a 57 year old female with a known history of left breast malignancy currently being treated with neoadjuvant chemotherapy. She presents for MRI evaluation to assess for treatment response. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Susceptibility artifact is identified in the left upper outer breast, at site of biopsy proven malignancy. There is very faint enhancement seen associated with clip measuring approximately 0.7 x 0.7 x 1.0 cm (AP x ML x SI), previously measuring 2.0 x 1.9 x 2.9 cm.Biopsy clip artifact from prior benign biopsy is seen in the left upper outer breast with no associated abnormal enhancement. There is no abnormal enhancement seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Interval decrease in size of index malignancy in the left breast. If breast conservation therapy is desired, the small bar clip can be used as targeting for preoperative surgical guidance. (2) No MRI evidence of malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: muscle tear vs tumor History: mid-forearm pain with curling There is thickening, increased signal intensity, and enhancement of the distal biceps tendon at its insertion on the radius, indicating tendinosis and perhaps mild interstitial tearing. A small amount of fluid is also noted adjacent to the distal biceps tendon. The musculature of the forearm appears normal. The bone marrow signal intensity is normal without findings to suggest stress fracture. We see no mass to indicate tumor.

Output: Insertional tendinosis of the distal biceps tendon possibly with interstitial tearing but no other findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 33-year-old male with shoulder pain, concern for labral tear. ROTATOR CUFF: There is intermediate signal abnormality within the supraspinatus tendon indicating mild tendinosis. The supraspinatus tendon and muscle appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No intra-articular gadolinium is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Mild rotator cuff tendinosis without evidence of a labral tear.2. Subchondral cyst formation within the posterosuperior aspect of the humeral head which is nonspecific but can be seen in patients with internal impingement.


Instruction: Generate impression based on findings.

Input: Assess the gallbladder. Concern for acute cholecystitis. Right upper quadrant pain. ABDOMEN: The study was limited by the patient's inability to tolerate the examination. Not all of the standard sequences were obtained, including dedicated MRCP images. However, the images were obtained were diagnostic as follows:LIVER, BILIARY TRACT: The liver is normal in morphology size and signal intensity. No focal liver lesion is identified.The gallbladder is distended with pericholecystic fluid and inflammatory changes compatible with acute cholecystitis. There are punctate gallstones. There is a round filling defect in the mid common bile duct (series 5/25). The common bile duct is prominent measuring up to 8 mm with a filling defect at the level of the superior pancreatic head which may represent an additional stone and/or debris.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is normal in signal intensity without adjacent inflammatory changes. Normal caliber main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys bilaterally without hydroureteronephrosis.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: Cholelithiasis and findings suspicious for acute cholecystitis. Suspected choledocholithiasis with mild common bile duct dilatation.


Instruction: Generate impression based on findings.

Input: 66-year-old female with right knee pain. MENISCI: There is a radial tear of the posterior horn of the medial meniscus. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a full-thickness articular cartilage fissure along the lateral facet of the patella. There is subjective thinning of the articular cartilage of the lateral compartment as well as the medial compartment.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Radial tear of the medial meniscus as described above. 2. Articular cartilage fissure and degeneration as described above. 3. Small joint effusion and partially ruptured Baker's cyst. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Anesthesia of skin [R20.0], Reason for Study: ^Reason: numbness, please do dr javed MS protocol on 3T and compare to prior History: numbness There is no evidence of abnormal enhancement.A couple of high signal intensity on FLAIR/T2 especially on bilateral periventricular white matter is nonspecific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Nonspecific FLAIR/T2 high signal intensities on periventricular white matter.Otherwise unremarkable brain MRI.


Instruction: Generate impression based on findings.

Input: Thoracic vertebral body heights are maintained. There is dextrocurvature of the thoracic spine. T1 hyperintense lesion involving the T6 vertebral body is most consistent with hemangioma. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. Mild multilevel degenerative changes include small multilevel disc bulges, relatively more prominent at the T7-T8, T8-T9, and L1-2 levels. There is no significant associated spinal canal or neural foraminal stenosis. There is also mild multilevel facet arthropathy. Scattered perineural cysts are incidentally noted in the neural foramina, such as at left T4-T5 level, right T9-T10, and left T11-T12 levels. Left T11-T12 lesion measures approximately 9 x 14 mm presumably corresponding to the 9 mm lesion on CT.Mild degenerative changes are present in the cervical spine with small discussed by complex at the C4-C5 to C7-T1 levels with mild multilevel spinal canal stenoses.There is abnormal signal measuring approximately 2 cm in diameter in the right lower lobe which is not well assessed by MRI.

Output: 1. No suspicious lesions in the thoracic spine. A 9 x 14 left T11-T12 lesion of concern on outside CT is most consistent with an incidental perineural cyst and of doubtful clinical significance.2. Approximately 2 cm focus of abnormal signal in the right lower lobe may represent a lung nodule and can be correlated with outside chest CT.


Instruction: Generate impression based on findings.

Input: 53-year-old male with seizures, neck pain and right arm weakness. MRI HEAD: There is no restricted diffusion to suggest ischemia. Scattered periventricular and subcortical punctate T2/FLAIR hyperintense foci which do not demonstrate restricted diffusion consistent with chronic small vessel ischemic disease. There is prominence of sulci for patient's age suggestive of volume loss. No midline shift or mass effect. 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. Chronic fracture of the right lamina papyracea as seen on prior CT's. MRI CERVICAL SPINE: There is artifact related to spinal hardware including interbody fusion at C5-C6, laminectomy at C4-C7 with evidence of instrumented posterior fusion. There is slight accentuation of the normal cervical lordosis. The spinal cord is normal in signal intensity with no evidence of spinal cord compression. There is no marrow edema. At C1-C2 there is no evidence of significant neuroforaminal or spinal cord stenosis. There is a focal well-circumscribed high T1/T2 signal lesion which likely represents a benign hemangioma along the base of C2.At C2-C3 there is mild left neuroforaminal narrowing related to uncovertebral hypertrophy There is no significant neuroforaminal stenosis on the right. There is no spinal canal stenosis.At C3-C4 there is disc osteophyte formation and associated mild stenosis of the spinal canal. There is mild right and moderate left neuroforaminal narrowing.At C4-C5 there is disc osteophyte formation. There is mild right and left neuroforaminal narrowing. No significant spinal canal stenosis.At C5-C6 there is mild right and at least mild left neuroforaminal narrowing. There is no significant spinal canal stenosis. At C6-C7 there is no significant spinal canal or neuroforaminal narrowing.At C7-T1 there is no significant spinal canal or neuroforaminal narrowing.

Output: 1. Chronic small vessel ischemic disease with no focal intraparenchymal hemorrhage or mass lesion. Mild prominence of the sulci for patient's age suggestive of volume loss.2. Postoperative changes in the cervical spine with multilevel degenerative changes and associated neuroforaminal narrowing as described above. There is mild spinal canal stenosis at the C3-C4 level but no evidence of cord compression.


Instruction: Generate impression based on findings.

Input: Female 33 years old Reason: mass in right lobe, possible HCC seen on OSH CT/MRI. No previous liver disease. Please compare to OSH films (will be uploaded). History: same ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Within the right hepatic lobe, there is a focal mass in segment 7 measuring 3.5 x 2.6 cmThe lesion is minimally hypervascular current exam although it was more hypervascular on the prior study. There is washout of the lesion on delayed phase. On in and out of phase imaging, the lesion has fat signal.Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.3.5 cm right hepatic lobe lesion with imaging features most compatible with a hepatic adenoma.


Instruction: Generate impression based on findings.

Input: Worsening migraine, with new left sensory deficit. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Female, 22 years old, with weakness and paresthesias. Cervical spine: There are no enhancing lesions identified in the cervical spinal cord. There is no abnormal epidural or intrathecal enhancement. The cervical spine alignment remains anatomic. There is preservation of vertebral body heights. There is no abnormal enhancement of the bone marrow. The intervertebral disc heights are maintained. There is no evidence of significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.Thoracic spine: There are no enhancing lesions identified in the thoracic spinal cord. There is no abnormal epidural or intrathecal enhancement. The cervical spine alignment remains anatomic. There is preservation of vertebral body heights. There is no abnormal enhancement of the bone marrow. The intervertebral disc heights are maintained. There is no evidence of significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.Lumbar spine: There is a transitional lumbosacral segment with apparent partial sacralization of the L5 vertebra. The lumbar spine alignment is anatomic. There is preservation of the vertebral body heights. There is no abnormal marrow signal. The intervertebral disc heights and signal are maintained. There is normal morphology and signal of the distal spinal cord and conus medullaris. There is no abnormal intrathecal enhancement. There is no significant spinal canal or neural foraminal stenosis. The paravertebral soft tissues are unremarkable.

Output: No evidence of enhancing spinal cord lesions, spinal cord compression, or spine tumors.


Instruction: Generate impression based on findings.

Input: History of medulloblastoma, status post treatment: left upper extremity weakness. Brain: There are postoperative findings related to posterior fossa tumor resection and prior transfrontal ventricular shunting. There is extensive encephalomalacia in the cerebellum and scattered punctate foci of susceptibility effect in the cerebellum. However, there is no evidence of enhancing tumor. There is unchanged patchy T2 hyperintensity in the right frontal and occipital periventricular areas. There is a small right superior frontal gyrus developmental venous anomaly. There are punctate foci of susceptibility effect in the left amygdala and left parietal lobe white matter. There is no evidence of acute infarct. The ventricles are diffusely prominent, but unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fatty marrow in the skull base related to radiation therapy. There are bilateral lens implants. There are persistent secretions within the left maxillary sinus. Cervical Spine: There is fatty marrow within the vertebral bone marrow related to radiation therapy. There is no evidence of tumor in the cervical spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: Post-treatment findings related to fourth ventricular medulloblastoma resection and irradiation without evidence of recurrent tumor or drop metastases in the cervical spine.


Instruction: Generate impression based on findings.

Input: Female; 81 years old. Reason: radiation planning for treatment of cervical cancer History: cervical cancer PELVIS:UTERUS, ADNEXA: Large cervical mass with intermediate T2 signal, restricted diffusion, and contrast enhancement measuring up to 3.4 x 5.3 x 4.6 cm (AP by transverse by craniocaudal, series 1403/468 and series 701/27), compatible with cervical cancer. The mass is predominantly confined within the uterine serosa. However, there is focal area of loss of fat plane between the mass and the rectum, suspicious for mild rectal invasion (series 601/36). There is also mild extension of the tumor beyond the serosa toward the left pelvic sidewall seen inferiorly (series 601/37). Lastly, there appears to be mild inferior extension to involve the left lateral aspect of the upper vagina, where mild increased vaginal wall thickening and enhancement is seen (series 1403/398).Low T2 signal material below the mass in the endocervical and vaginal canals with intervening high T1 signal, most compatible with packing material and blood products. Uterine fibroid at the fundus measuring up to 4.3 x 4.2 cm (series 1403/513). Additional smaller myometrial fibroids are seen in the uterine body bilaterally.BLADDER: Foley catheter tip in bladder.LYMPH NODES: Bilateral pelvic sidewall lymphadenopathy, compatible with metastatic disease. For future reference, the largest lymph node measures 1.7 x 2.6 cm in the right pelvic sidewall (series 1403/478). A smaller, rounded left pelvic sidewall lymph node is seen on series 1403, image 498.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: Large left renal cyst extending into the superior pelvis, partially visualized.

Output: 1. Cervical cancer as detailed above with probable left pelvic sidewall and left upper vaginal involvement. Additionally, there is loss of the fat plane between the rectum, and underlying extension is not excluded, although not overtly seen.2. Bilateral pelvic sidewall metastatic lymphadenopathy, worse on the right.


Instruction: Generate impression based on findings.

Input: 74-year-old female with history of cecal mass on colonoscopy. Rule out metastatic disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Small hypodense lesions scattered in both the liver, largest measuring less than 1 cm. There are two small to accurate characterize but are more likely to be cysts. Further evaluation with MRI may be helpful for better characterization if clinically indicated.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Accent wall thickening involving the cecum consistent with patient's known history of carcinoma. 9 x 5 mm lymph node adjacent to the cecum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Multiple subcentimeter hypodense lesions scattered in both l lobes of the liver. Statistically they are more likely to represent cysts. MRI of the liver may be helpful in further characterization of these small lesions is clinically indicated. eccentric wall thickening of the cecum consistent with patient's known history of colonic carcinoma.


Instruction: Generate impression based on findings.

Input: Mass in forearm Note that a marker was placed along the volar aspect of the midforearm in the region of the patient's mass. There is an irregularly-marginated mass within the underlying subcutaneous fat of the volar forearm that contacts the underlying deep peripheral fascia of the anterior compartment musculature. This mass extends to the skin with the overlying skin appearing thickened. It measures approximately 3 x 1 cm in the transverse dimensions and just over 5 cm in the longitudinal dimension. The mass demonstrates irregular and spiculated margins and is slightly hyperintense to muscle on T1, hyperintense to muscle on T2, and shows diffuse enhancement following gadolinium administration. There is subcutaneous edema extending along the fascia both proximal and distal from the mass over the majority of the length of the forearm. The mass does not infiltrate the underlying musculature. The muscles of the forearm are normal in caliber and signal and the marrow signal of the radius and ulna is also normal. There is mild edema and enhancement of the subcutaneous fat posterior to the olecranon which may reflect mild inflammation.

Output: Irregularly-marginated mass within the volar subcutaneous fat of the forearm. While a specific histologic diagnosis cannot be ascertained, the location and characteristics are suggestive of nodular fasciitis. Referral to orthopedic oncology is recommended.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with left optic neuritis. Brain: There are numerous, primarily periventricular supratentorial and infratentorial white matter T2 hyperintense lesions, some of which demonstrate enhancement. There is no evidence of intracranial hemorrhage, mass, 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 skull and scalp soft tissues are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening.Orbits: There is diffuse enhancement and T2 hyperintensity of the left optic nerve orbital segment. There is no evidence of mass lesions and the rest of the left orbital contents are intact. The right orbital structures are unremarkable.

Output: 1. Numerous intracranial demyelinating lesions, some of which demonstrate enhancement, indicative of acute inflammation.2. Findings compatible with left optic neuritis.


Instruction: Generate impression based on findings.

Input: Left hip pain ACETABULAR LABRUM: There is abnormal signal intensity within the superior labrum best appreciated on series 11 images 13 through 15 suspicious for degenerative labral tearing. There is no evidence of gross labral detachment.ARTICULAR CARTILAGE AND BONE: Moderate osteoarthritis affects the left hip with small subchondral cystic changes along the superior acetabulum. Similar subchondral cystic changes are noted in the right superior acetabulum with additional moderate osteoarthritis affecting the right hip.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Left-sided labral tear without evidence of gross labral detachment. This may be in part degenerative in nature given that moderate osteoarthritis affects the hips.


Instruction: Generate impression based on findings.

Input: 28-year-old male status post labral repair, now with new injury and pain. ROTATOR CUFF: The tendons and muscles of the rotator cuff are intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There are postsurgical changes related to prior labral repair with at least four suture anchors within the anterior and posterior glenoid. Linear high signal is noted within the posterior labrum (series 2/9), and a re-tear of the glenoid labrum cannot be excluded.BICEPS TENDON: The biceps tendon is normally positioned within the glenohumeral groove. ADDITIONAL

Output: Postsurgical changes related to prior labral repair, with findings concerning for a possible re-tear of the posterior labrum as detailed above.


Instruction: Generate impression based on findings.

Input: Female 39 years old Reason: large symptomatic fibroids, surgery planning. Pt special needs, down syndrome. History: bulk symptoms, painful cramping PELVIS:UTERUS, ADNEXA: Uterus measures 13.0 x 11.3 x 9.0 cm. At the posterior/fundal region there is a dominant leiomyoma measuring 12 x 11 x 9 cm approximately. The leiomyoma has central areas of nonenhancement suggesting areas of necrosis. The majority of the leiomyoma enhances.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic ascites.

Output: 1.Enlarged uterus with a dominant leiomyoma as detailed above.


Instruction: Generate impression based on findings.

Input: Male, 88 years old, with history of central cord syndrome at C4, prior cervical fusion, evaluate decompression. Findings are seen compatible with laminectomy from spinal canal decompression from C3 through C6. Posterior fusion instruments are also in place from C2 down to T3.The spinal canal is well decompressed through the operative region with relief of multilevel stenoses seen on the prior examination. Patchy cord T2 signal at the C4-5 level is seen which, in the absence of cord swelling, likely represents myelomalacia. The spinal cord otherwise demonstrates normal signal and caliber.Straightening of the cervical lordosis may be related to fixation. Minimal grade 1 anterolisthesis of C7 relative to T1 is unchanged. Vertebral body heights are preserved. Marrow signal characteristics are heterogeneous but there are no areas of concerning marrow replacement. STIR hyperintense signal within the C6-7 disc space is less conspicuous than on the prior examination. Prevertebral soft tissue signal abnormality seen on the prior examination is no longer clearly identified.C2-3: No significant spinal canal or foraminal stenosis. C3-4: Posterior disc-osteophyte complex formation. Posterior spinal canal decompression. Moderate right and mild left foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation. Posterior spinal canal decompression. Moderate bilateral foraminal narrowing.C5-6: Posterior disc-osteophyte complex formation. Posterior spinal canal decompression. Moderate bilateral foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation. Posterior spinal canal decompression. Moderate bilateral foraminal narrowing. C7-T1: No significant spinal canal or foraminal stenosis.

Output: Findings are redemonstrated compatible with spinal canal decompression and posterior instrumented fusion. The canal is expanded through the surgical region with relief of multilevel stenoses seen on the preoperative study.Patchy signal abnormality within the spinal cord at the C4-5 level likely represents myelomalacia. No other spinal cord abnormalities are seen.Signal abnormality within the C6-7 disc and along the anterior prevertebral soft tissues at this level has improved which may represent healing of the previously suspected hyperextension injury.


Instruction: Generate impression based on findings.

Input: Ms. Terry is a 53 year old female with a personal history of right breast mastectomy in 2006 for ILC/IDC status post chemotherapy and Tamoxifen. Family history of breast cancer in maternal aunt. Patient is status post right breast mastectomy. There is no abnormal enhancement seen in the right chest wall.There is scattered fibroglandular tissue in the left breast. Mild parenchymal enhancement is noted. There is focal enhancement seen within the left nipple, which is stable in appearance when compared to multiple prior examinations. There is no new abnormal enhancement seen in the left breast.No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Meningioma, 6 month follow up. There is no significant interval change in size of the extra-axial enhancing left lateral skull base mass centered along the left petrous apex with extension into the cavernous sinus, left prepontine cistern, and along the left tentorial leaflet. There is also associated hyperostosis and permeation of tumor into the underlying skull. There is encasement of the left cavernous carotid artery, which is mildly narrowed. There is persistent mass effect with vasogenic edema in the left temporal lobe. There is also mass effect upon the left brainstem. There is no evidence of acute intracranial hemorrhage or acute infarction. The ventricles are unchanged in size and configuration. There is no significant midline shift. There is staphylomatous deformity of the bilateral globes. There is mild high T2 signal within the left mastoid air cells suggestive of fluid or mucosal thickening. There appears to be filler material within the bilateral nasolabial folds. There are unchanged patchy T1 hyperintense areas in the left parietal skull.

Output: No significant interval change in size of the left petroclival meningioma with extension into the cavernous sinus, left prepontine cistern, and along the left tentorial leaflet, and permeation of tumor into the underlying skull, as well as encasement and narrowing of the left cavernous carotid artery. Associated vasogenic edema in the left temporal lobe persists.


Instruction: Generate impression based on findings.

Input: 84 year old man who is s/p mitral valve repair, has chronic atrial fibrillation, history of TIA presents with shortness of breath and newly diagnosed LV dysfunction. He is referred to assess for etiology. First Pass PerfusionDuring hyperemia, no perfusion defects were present; however, a prominent dark rim artifact was noted.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 moderately reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 93 ml/m2 (normal range: 74+/-15), the LVEDV is 190 ml (normal range 142+/-34), the LV end systolic volume index is 59 ml/m2 (normal range 25+/-9), the LVESV is 120 ml (normal range 47+/-19), the LV mass index is 69 g/m2 (normal range 85+/-15), and the LV mass is 140 g (normal range 164+/-36). There is global hypokinesis with regional variation. Abnormal septal motion likely due to known conduction delay and sternotomy. No evidence of myocardial iron overload. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 171 ml (normal range 142+/-31), the RV end systolic volume index is 47 ml/m2 (normal range 31+/-9), and the RVESV is 96 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. A mitral annular ring is noted.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate to severe 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 FindingsAscites with evidence of bowel noted superior to the liver. Hilar and mediastinal lymph nodes are noted. Sternal wires are noted. T2-star relaxation time is reduced in the liver and spleen; however, image quality is degraded by respiratory motion, thus I am not sure if this finding represents iron overload or just artifact. If hepatic or splenic iron overload are a clinical concern, consider dedicated imaging. 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. No perfusion defects/ "ischemia" present during hyperemia; however, the diagnostic sensitivity of vasodilator stress testing in patients with significant LV dysfunction may be reduced. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with moderately reduced systolic function (LVEF 36%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration. 4. Normal RV size with mildly reduced systolic function (RVEF 44%).5. Severe biatrial dilation.6. Mitral annuloplasty ring is noted. 7. Moderate to severe tricuspid regurgitation. 8. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 32-year-old female with cystic fibrosis altered mental status. Evaluate for abnormalities.Additional EMR Data: pancreatic exocrine insufficiency, recurrent pseudomonas pneumonia, and chronic hemoptysis s/p multiple bronchial embolizations with ongoing hemoptysis presents with AMS and witnessed seizure. Intubated in the setting of low O2 sat, possibly during seizure activity. Limited sequences were obtained. Redemonstrated is diffuse gyriform restricted diffusion in the right greater than left cerebral hemispheres in a watershed distribution, including the right frontal and parietal lobes and left frontal lobe, with underlying white matter cytotoxic edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is scattered paranasal sinus mucosal thickening and secretions, with focal oval FLAIR hyperintense lesion in the right frontoethmoidal recess which may represent a mucous retention cyst or small mucocele.

Output: 1.Limited sequences were obtained secondary to patient discomfort.2.Persistent but unchanged gyriform restricted diffusion in the bilateral cerebral hemispheres in a watershed distribution, right more than left, with underlying white matter edema.3.Pansinus disease likely related to cystic fibrosis.


Instruction: Generate impression based on findings.

Input: BRAIN: There has been interval removal of right frontal intracranial pressure monitoring bolt. There has been evolution of multiple hemorrhagic contusions involving the bilateral frontal lobes, left larger than right, and anterior left temporal lobe with signal intensity consistent with a subacute hemorrhage. There is also high T2 signal surrounding the hemorrhages, suggestive of residual edema and perhaps gliosis, but with overall decreased associated rightward midline shift. There is no evidence of downward herniation. There is T1 and T2 hyperintense material along the tentorial leaflets and posterior falx cerebri that measures up to approximately 5 mm in thickness, compatible with subdural hematomas. There is also extra-axial hemorrhage overlying the right frontal convexity that measures up to 5 mm in width. There is a left parieto-occipital subgaleal hematoma that measures up to 10 mm. There is bilateral maxillary sinus mucosal thickening that is slightly increased. There is fluid within the bilateral mastoid air cells, sinonasal cavities, and upper aerodigestive track likely related to intubation and/or residual hemorrhage. Stigmata of multiple calvarial and maxillofacial fractures are evident, but better delineated on the prior CT.CERVICAL SPINE: The cervical spine alignment is anatomic. The vertebral bone marrow signal is unremarkable. The cervical and upper thoracic cord display normal signal characteristics. However, there is diffuse high T2 signal in the paraspinal soft tissue of the posterior craniocervical junction region. Otherwise, the major ligamentous structures appear to be grossly intact. There is a partially-imaged consolidation in the posterior right lung apex.

Output: 1.Extensive subacute hemorrhagic contusions involving the left greater than right anterior frontal lobes and left anterior temporal lobe with slight interval decrease in associated edema.2.Persistent subdural hemorrhage along the falx cerebri and tentorium and a right frontal convexity extra-axial hematoma.3.Stigmata of multiple calvarial and maxillofacial fractures are evident, but better delineated on the prior CT.4.Apparent mild paraspinal soft tissue edema in the posterior craniocervical junction region that may be related to a strain injury, but no evidence of acute fracture, ligamentous disruption, or spinal cord injury in the cervical spine.5.Partially-imaged right pulmonary atelectasias or contusion.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils extend up to approximately 2 cm inferior to the foramen magnum. The craniocervical junction and cervical spine are otherwise incompletely characterized. There is a long segment thoracic syrinx that is most prominent between T5 and T8, where it measures up to 6 mm in width. The vertebral bone marrow signal is within the normal limits. The alignment of the vertebral bodies is normal. There is normal alignment of the lumbar vertebral bodies. The vertebral bone marrow signal appears normal. The conus medullaris is seen at the level of L1. The filum terminale appears normal. There is no evidence of spinal canal or neural foraminal stenosis. The paraspinal soft tissues are unremarkable.

Output: 1. The cerebellar tonsils extend up to approximately 2 cm inferior to the foramen magnum, which is compatible with Chiari malformation. The craniocervical junction and cervical spine are otherwise incompletely characterized.2. Long segment thoracic syrinx.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified transient cerebral ischemia.Clinical question: recurrent left leg weakness event, rule out intracranial stenosisSigns and Symptoms: recurrent left leg weakness. MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several punctate T2 hyperintense lesions in each cerebellar hemisphere.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.There is metal artifact originating from the medial aspect of the left eyelid which on a recent CT of the head represents a metallic foreign body on the skin surface.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. There is medial deviation of the left lamina papyracea compatible old medial blowout.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 again defined. The left posterior communicating artery is medium-sized wires the right posterior communicating artery is small. Anterior communicating artery is small.. The right vertebral artery is larger than the left vertebral artery. The left vertebral artery is hypoplastic distally.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for intracranial mass lesion4.Punctate lesions in the cerebellar hemispheres are most likely vascular related


Instruction: Generate impression based on findings.

Input: 20-year-old male. Pain, swelling after landing on knee. MENISCI: Bandlike signal abnormality within the posterior horn and body of the medial meniscus extending to the tibial articular surface (series 3, image 10), consistent with a large horizontal/oblique tear. There is blunting of the free edge of the anterior horn of the medial meniscus consistent with a partial radial tear. No evidence of a tear in the lateral meniscus.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits without evidence of a contusion. Tibiofemoral and patellofemoral cartilage is intact.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Complex tear of the medial meniscus, as detailed above.


Instruction: Generate impression based on findings.

Input: History of recurrent small bowel Crohn's disease and ileo-colonic anastomosis stenosis. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: 6 mm cystic lesion in the pancreatic body (series 4 image 16), compatible with a side branch IPMN. The pancreatic duct is normal in caliber. Pancreatic parenchyma is otherwise unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several bilateral subcentimeter simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a propensity of mesenteric fat without specific evidence of acute inflammation. This may reflect chronic fibrofatty perforation, or postsurgical changes.There is a mild circumferential thickening of a short segment of terminal ileum measuring approximately 3.1 cm in length measuring very low signal intensity suggesting chronic fibrosis (series 8 images 19 through 21). This segment of bowel demonstrates mild restricted diffusion (series 9 image 87) and postcontrast enhancement (series 14 image 86; series 11 image 330) compatible with acute inflammation. The immediate proximal small bowel is mildly distended up to 3.4 cm (series 8 image 18). More proximally the small bowel is normal in caliber and wall thickness.No fluid collections or findings to suggest fistula formation.The colon is normal in appearance.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Short segment of suspected acute on chronic inflammatory disease involving approximately 3 cm of the terminal ileum with mild distention of the small bowel into the proximal to this region. No additional sites of disease.


Instruction: Generate impression based on findings.

Input: 52-year-old female with history of vulvar Crohn's disease. Evaluate. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple inguinal and pelvic sidewall lymph nodes with the largest on the right pelvic sidewall measuring 1.5 x 1.0 cm (series 4, image 51) and left inguinal measuring 1.3 x 1.0 cm (series 4, image 44).BOWEL, MESENTERY: Partially visualized right lower quadrant ileostomy. Status post colectomy.BONES, SOFT TISSUES: There is a fistulous tract which originates at the location of the prior anal region with branching. One branch extends anteriorly to the right labia and the other branch extends posteriorly, exiting at medial right gluteal area. No evidence of drainable abscesses. Mildly increased T2 signal is present, consistent with inflammatory changes.Small volume pelvic ascites.OTHER: No significant abnormality.

Output: 1.Branching perianal fistula as detailed above.2.No drainable abscess.3.Small volume pelvic ascites.4.Prominent pelvic and inguinal lymph nodes, likely reactive in etiology.


Instruction: Generate impression based on findings.

Input: Asymptomatic female presents for routine screening mammography. Strong family history of breast cancer. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C). There is a mass in the right lower central breast best seen on MLO tomosynthesis, compatible with one of the cysts seen on MRI. Other cysts are also suggested, though largely obscured. Additionally, 2 clusters of calcifications are noted in the left breast.

Output: 1. Left breast calcifications should be compared to prior mammograms to ensure stability. If stability cannot be demonstrated then further evaluation with spot views would be necessary.2. The patient's breast MRI will be separately dictated.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OC - OLD FILM FOR COMPARISON


Instruction: Generate impression based on findings.

Input: Female 60 years old Reason: left hip mass History: pain There is flattening of the left femoral head with low T1, serpiginous signal and corresponding T2 hyperintense subchondral cysts and edema. Osteophyte formation and near-complete degeneration of articular cartilage indicating severe osteoarthritis. No appreciable joint effusion. There is diffuse fatty atrophy of the musculature about the left hip. There is a 5 x 3 cm mass in the subcutaneous fat overlying the gluteus maximus corresponding to calcified lesion seen on prior radiograph, which demonstrates homogeneous low signal on all sequences with no enhancement on postcontrast images.

Output: Severe left hip osteoarthritis with avascular necrosis. Benign-appearing subcutaneous mass corresponding to calcified lesion on radiograph.


Instruction: Generate impression based on findings.

Input: ALL; Headaches, Peripheral neuropathy; Syringomyelia on past MRI. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The cerebellar tonsils are not low-lying. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There is a long-segment thoracic syrinx that measures up to 3 mm in width. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. The partially-imaged urinary bladder is distended.

Output: 1. No evidence of intracranial tumor. 2. A long-segment thoracic syrinx that measures up to 3 mm in width, without evidence of associated tumor or Chiari malformation.


Instruction: Generate impression based on findings.

Input: 3-year-old female with episodes of syncope, please evaluate for mass or hemorrhage. There is no evidence of. mass or edema. The ventricles and basal cisterns are normal in size and configuration. Small area of low attenuation measuring 1.4 x 1.2 cm (image 24/48, series 2) just below the torcula is of uncertain significance and can be further characterized with MRI.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Region of low attenuation just inferior to the torcula of uncertain etiology as detailed above. MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 61 year old female with history of ischemic cardiomyopathy, hypertension, COPD, diabetes, chronic kidney disease, peripheral arterial disease, Hodgkin's lymphoma s/p chemotherapy here for evaluation for advanced options. Left VentricleThe left ventricle is normal in size with mild to moderately reduced systolic function. There is a basal septal hypertrophy. The overall LV ejection fraction is 42% The left ventricular systolic function is global with regional variation. Specifically, the apical inferior, lateral and anterior wall, mid inferolateral and anteroseptal walls, the LV end diastolic volume index is 87 ml/m2 (normal range: 65+/-11), the LVEDV is 168 ml (normal range 109+/-23), the LV end systolic volume index is 51 ml/m2 (normal range 18+/-5), the LVESV is 98 ml (normal range 31+/-10), the LV mass index is 52 g/m2 (normal range 67+/-11), and the LV mass is 100 g (normal range 114+/-24). There is late gadolinium enhancement (LGE) in the pattern of coronary artery disease with multiple infarctions. In the apex, there is a full thickness transmural infarct. In the junction of the basal 1/3 and mid 1/3 of the there is a punctate area of LGE that is less than 50% in thickness. The anterior apical wall has a 60% subendocardial infarct present and the infero-lateral and inferior walls have a greater than 50% thickness infarct from the mid to apical portions. These areas of LGE are likely not viable. and there is no left ventricular thrombus present. Left AtriumThe left atrium is mild-moderately enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 60 ml/m2 (normal range 69+/-14), the RVEDV is 116 ml (normal range 110+/-24), the RV end systolic volume index is 51 ml/m2 (normal range 22+/-8), and the RVESV is 98 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 at least trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is tricuspid regurgitation.AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid artery. The aorta is normal in size. There atherosclerosis in the descending aorta. 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.Extracardiac FindingsThere is a T2 hyperintense lesion in the liver that may represent a cyst; however, this is not completely characterized. There is T2 hyperintensity in several mid thoracic vertebrae which may represent hemangiomas which not completely characterized on the current exam. Sternotomy wires are present consistent with coronary artery bypass surgery.

Output: 1. The left ventricle is normal in size with mild-moderately reduced systolic function (LVEF 42%)2. The right ventricle is normal in size and systolic function (RVEF 52%)3. The left ventricular systolic function is global with regional variation as described above, there are significant areas of late gadolinium enhancement which are likely not viable (described above).


Instruction: Generate impression based on findings.

Input: 31-year-old man with history of Crohn's disease, perirectal abscess. PELVIS:PROSTATE/SEMINAL VESICLES: The prostate and seminal vesicles appear normal.BLADDER: Bladder appears normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel appears normal. There are no perirectal collections suspicious for abscess.Two T2 hyperintense linear tracks are identified. The first (401/9-24) extends from the images at the 12:00 position to the right medial gluteal cleft traversing the internal and external sphincter complex. The second (401/14) is more medial and extends from the 9:00 position of the anal verge to the right medial gluteal cleft remaining medial to the external sphincter complex.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Transsphincteric perianal fistula to the right gluteal cleft.2.Intersphincteric perianal fistula to the right gluteal cleft.3.No evidence of abscess.


Instruction: Generate impression based on findings.

Input: 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. There is a mild levocurvature to the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge and disc desiccation at this level associated with some endplate reactive changes. The endplate reactive changes are high signal on T1.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy and facet hypertrophy at this level associated with a diffuse disc bulge. There are some endplate reactive changes present at this level which are high signal on T1-weighted imagingAt 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. There is a disc bulge present at this level.

Output: There are some mild degenerative changes present in the lumbar spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Partial complex seizure. Headaches. Previous MRI showed T2-hyperintensity of the left amygdala. Video EEG did not show epileptiform or post-ictal activity. There is an apparent subtle increase in T2/FLAIR signal involving the left hippocampus, amygdala and insular cortex on axial imaging and to lesser extent also on the coronal imaging, although overall there are other areas on the left which appear increased in signal diffusely, with relatively lower signal in right-sided structures. There is no definite associated left-sided volume loss or architectural distortion. Previous increased thickening of structures on the left is not apparent on the current exam, and likely related to slice selection. Focal T2/FLAIR hyperintensity in the anterior left subinsular white-matter at the level of the anterior commissure may represent dilated perivascular spaces with associated minimal gliosis. The remainder of the brain is unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, sinuses, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the paranasal sinuses which is nonspecific. There are prominent lymph nodes in the upper neck, including the nodes of Rouvière, which is a common, probably reactive phenomenon in this age group.

Output: 1.An apparent increase in T2/FLAIR signal involving the left hippocampus, amygdala and insular cortex on axial imaging but not on coronal imaging and without associated volume loss or architectural distortion is favored to represent artifact given more extensive left-sided high signal as compared to right when narrowly windowed. Previous left amygdala thickening is not appreciated, likely artifactual.2.Focal T2 FLAIR hyperintensity in the left subinsular region is most suggestive of dilated perivascular spaces with associated minimal gliosis. There is no other abnormality of the brain.


Instruction: Generate impression based on findings.

Input: Anaplastic astrocytoma, WHO grade III, treated with TMZ and radiation therapy. There are post-treatment findings unchanged cystic cavities in the left parietal lobe. However, there is interval increase in size and number of the enhancing lesions with susceptibility effect in the treatment bed region. For example, an enhancing lesion in the left periatrial white matter measures 10 x 18 mm, previously 8 x 14 mm. There appears to be increased blood volume associated with at least some of the lesions, although a few are too small to characterize on perfusion imaging. There is persistent surrounding confluent white matter T2 hyperintensity. There is an unchanged lesion with susceptibility effect and central T1 hyperintensity in the inferior pons, with an associated developmental venous anomaly, but no surrounding T2 hyperintensity. There is diffuse surrounding confluent T2 hyperintensity in the white matter, without associated mass effect. There is no midline shift or herniation. The orbits are unremarkable. There are bilateral maxillary sinus retention cysts.

Output: 1. Post-treatment findings in the left parietal region with interval increase in size and number of lesions in the treatment bed region, which may represent tumor progression.2. Subcentimeter pontine cavernous malformation with associated developmental venous anomaly, but no evidence of surrounding edema.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 14 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 66 seconds

Output: Successful fluoroscopic-guided injection of dilute gadolinium into the right hip.


Instruction: Generate impression based on findings.

Input: Superior wall nasopharyngeal carcinoma, completed CRT, with visual changes. Orbits: The globes, ocular adnexa, optic nerves, and orbital fat are unremarkable, without evidence of intraorbital mass lesions. There are post-treatment findings in the nasopharyngeal region, where there is diffuse swelling and associated persistent enhancement of the central skull base, but no measurable residual tumor in the soft tissues. There is also no evidence of significant regional lymphadenopathy. There is diffuse paranasal sinus mucosal thickening and fluid within the bilateral maxillary sinuses and left sphenoid sinus. 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. There is fluid within the bilateral mastoid air cells.

Output: 1. Extensive post-treatment findings in the nasopharyngeal region without definite evidence of measurable tumor progression in this area and not evidence of intraorbital lesions. 2. Persistent enhancement of the central skull base is likely related to sequela of skull base invasion by the tumor and superimposed treatment-effects, but may be responsible for cranial nerve deficits that contribute to diplopia.3. Inflammatory changes in the paranasal sinuses with evidence of acute sinusitis.4. Persistent bilateral mastoiditis.


Instruction: Generate impression based on findings.

Input: 37-year-old male with L5 enhancing lesion seen on MRI. CT for further evaluation. Alignment of the lumbar spine is within normal limits. Morphology of the vertebral bodies and intervertebral disk spaces is within normal limits. No evidence of fracture or malalignment. No evidence of spinal stenosis or lumbar disk herniation.L5 vertebral body appears unremarkable without discernible lesion or abnormal post contrast enhancement.Given the enhancement characteristics seen on recent MRI scan and lack of benign findings on this current examination further evaluation with lumbar biopsy may be considered as clinically warranted.

Output: 1. Unremarkable CT examination of the lumbar spine.2. Biopsy of L5 vertebral body lesion for further evaluation may be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: Male 46 years old Reason: follow-up after microfracture medial femoral condyle April of 2014. evaluate healing of microfracture History: left knee pain. MENISCI: There is attenuation of the body and posterior horn of the medial meniscus consistent with partial meniscectomy. There is fluid signal intensity within the posterior horn of the meniscus near its root consistent with a tear that we suspect extends to the inner margin of the remaining meniscus. There is also branching intermediate signal intensity within the peripheral one third of the posterior horn of the medial meniscus suggesting additional complex tearing that we suspect extends to the tibial articular surface. The anterior horn of the medial meniscus appears intact. We see no lateral meniscus tear.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the articular cartilage of the weight-bearing portion of the medial femoral condyle but we see no full-thickness fluid filled defect. A small focus of signal abnormality within the subchondral bone of the weight-bearing portion of the medial femoral condyle may represent site of prior microfracture. The articular cartilage of the lateral femoral condyle and patella are relatively well preserved.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Signal abnormality within the posterior horn of the medial meniscus suggestive of a tear as described above.2. Thinning of the articular cartilage of the weight-bearing portion of the medial femoral condyle without fluid filled defect.