Instruction: Generate impression based on findings.

Input: Right hip pain ACETABULAR LABRUM: There is a defect along the undersurface of the anterior superior labrum indicating an undersurface tear, which on the radial sequence may extend through the width of the labrum. The defect is estimated to extend from the 1:00 to 4:00 position anteriorly.ARTICULAR CARTILAGE AND BONE: There are no articular cartilage defects and the bone marrow signal is normal with no evidence of stress fracture. There is slight prominence of the anterior superior aspect of the femoral head neck junction suggesting a mild cam deformity. The alpha angle is borderline at 55 degrees.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Anterior labral tear as described above. There is no evidence of a stress fracture.


Instruction: Generate impression based on findings.

Input: 46 year old female with acute onset of mental status changes; evaluate for mass lesions or bleed There is a hypodense lesion in the right periventricular white matter extending to the centrum semiovale which is nonspecific and age indeterminate. The lesion could be vascular related or may be related to demyelination. MRI may be obtained for further characterization if clinically warranted. There is no evidence of acute intracranial hemorrhage, mass or edema. 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: Nonspecific hypodense lesion in the right periventricular white matter which is age indeterminate. No evidence of acute intracranial hemorrhage or mass. CT is insensitive for the diagnosis of nonhemorrhagic CVA. MRI may be obtained for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: 25 year old male with Tetralogy of Fallot, Absent pulmonary valve. Status post bioprosthetic pulmonary valve replacement in 2001. Referred for a research protocol cardiac MRI to evaluate right ventricular volume and pulmonary regurgitation. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 108 ml/m2 (normal range: 74+/-15), the LVEDV is 164 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 62 g/m2 (normal range 85+/-15), and the LV mass is 94 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is septal flattening during diastole, suggesting elevated right ventricular diastolic pressure.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 148 ml/m2 (normal range 82+/-16), the RVEDV is 224 ml (normal range 142+/-31), the RV end systolic volume index is 81 ml/m2 (normal range 31+/-9), and the RVESV is 123 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. The right coronary cusp appears mildly thickened, but moves freely.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThere is a prosthetic pulmonary valve in place, with moderate stenosis and severe insufficiency.Peak velocity is 3.2 m/s, suggesting peak systolic gradient of 41 mmHg.Pulmonic regurgitant fraction at the level of the valve could not be calculated accurately due to artifact associated with the prosthetic valve.RPA flow 48 mL (5 mL regurgitation)LPA flow 32 mL (18 mL regurgitation)Regurgitant fraction based on branch pulmonary artery measurements is 29%, which may underestimate the regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch. The left carotid arises from a common trunk with the innominate artery. The aortic root is normal in size.Aortic annulus 28 mmAortic Sinuses 42 mm x 44 mm (Z-score +5)S-T Junction 34 mm x 34 mmTransverse arch 21 mm x 21mmProximal descending aorta 17 mm x 18 mmDescending aorta at diaphragm 16 mm x 16mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.MPA 39 mm x 42 mmRPA 31 mm x 37 mmLPA 31 mm x 38 mmVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. Mildly dilated left ventricle, with normal systolic function.2. Severely dilated right ventricle with mildly reduced systolic function. (RVEDV 148 mL/m2, RVEF 45%)3. Severe regurgitation of prosthetic pulmonary valve.4. Severely dilated aortic root.5. Severely dilated main and branch pulmonary arteries.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with history of brain metastases status post surgery and radiotherapy. A small right frontal resection cavity is redemonstrated without significant interval change in size or morphology. The degree of T2 hyperintensity surrounding the cavity is also unchanged. At most there may be minimal peripheral enhancement surrounding cavity but no concerning enhancement is demonstrated and the findings are unchanged.An enhancing lesion adjacent to the right ventricular trigone is redemonstrated showing a mild interval increase in size, now measuring 10 mm in diameter, previously 8 mm. Degree of surrounding T2 hyperintensity is also mildly increased. Nevertheless, there is no significant associated mass effect.A punctate focus of enhancement just below the left frontal horn has not significantly changed. However, a focus of enhancement in the left inferior temporal lobe has slightly increased in size now measuring 7 mm, previously 4 mm.No entirely new lesions are seen. No significant generalized mass effect is detected. The ventricles remain stable in size and morphology. No evidence of acute intracranial hemorrhage is noted.

Output: 1.No change in the appearance of the right frontal resection cavity to suggest recurrent or progressive disease.2.Mild interval increase in size of enhancing lesions in the right peritrigonal region and in the left inferior cerebellum. 3.A punctate enhancing lesion adjacent to the left frontal horn has not significantly changed.


Instruction: Generate impression based on findings.

Input: There are numerous foci of susceptibility effect throughout the supratentorial and infratentorial brain. The largest of these lies along the posterior aspect of the midbrain/pons measuring 16 mm AP x 20 mm transverse x 22 mm craniocaudal (as measured on T2 sequences). The majority of these are T2 hypointense, with a few demonstrating central T1/T2 hyperintensity. None demonstrate perilesional edema nor associated development of venous anomaly. Note is made of a small, fat-containing focus within the right parietal/occipital bone, presumably representing hemangioma. There are other subtle and very faint foci of suspected enhancement involving the calvarium, again suggestive of hemangiomas.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no midline shift. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within right frontal sinuses, bilateral ethmoid air cells (right greater than left) and left mastoid air cells. There is no abnormal enhancement within the brain.

Output: 1.Numerous supratentorial and infratentorial cerebral cavernous confirmations.2.Suspected multiple calvarial hemangiomas.


Instruction: Generate impression based on findings.

Input: Male, 20 months old, with history of 8-9 seizures in a febrile setting. Brain morphology and signal characteristics are within normal limits. No areas of edema or mass effect are seen. No findings to suggest a dysplasia or migrational anomaly are detected. The mesial temporal structures are symmetric and intact. The pattern of white matter myelination is appropriate for age. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology. Mucosal thickening is evident in the right maxillary sinus.

Output: Unremarkable evaluation with no findings to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with history of HPV positive T3 N2b left tonsil or scar cell carcinoma, status post radiotherapy. No evidence of any mucosal masslike lesion is seen. No pathologic adenopathy is detected by size criteria. The salivary glands and thyroid are unremarkable. Mild cervical spondylosis is demonstrated. Bone marrow signal characteristics are unremarkable. Mucosal thickening is demonstrated in the paranasal sinuses, similar to that seen previously. Limited views of the brain and spinal cord are unremarkable.

Output: No evidence of recurrent mucosal tumor or pathologic adenopathy.


Instruction: Generate impression based on findings.

Input: Facial numbness, rule out stroke. MR brain: This is a motion degraded exam. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are diffuse periventricular and subcortical white matter hyperintensities which are nonspecific, but most commonly represent chronic small vessel ischemic disease. In addition, there are a few foci of T2 hyperintensities in the pons and basal ganglia representing chronic lacunar infarcts. There are punctate foci of susceptibility effects in the pons and a few scattered right more than and the left thalami, compatible with chronic microhemorrhages.The ventricles and cortical sulci are mildly prominent .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.MRA brain: No significant or high-grade vascular stenosis. The proximal vessels including circle of Willis appears patent. However, image quality is not adequate to assess for mild stenosis or more distal vascular lesions.

Output: 1. No evidence of acute intracranial hemorrhage or acute infarct.2. Chronic pontine and thalamic microhemorrhage. 3. Chronic small vessel ischemic disease, unchanged.4. No significant or high-grade vascular stenosis. Degraded image quality limits evaluation for subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 58-year-old female with recurrent colorectal cancer, restaging after chemoradiotherapy. CHEST:LUNGS AND PLEURA: Biapical scarring. Few bilateral micronodules.MEDIASTINUM AND HILA: Subcarinal lymph node, not enlarged by CT criteria.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Duplicated collecting system on the left side with upper collecting system showing mild hydroureter in the midportion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fat containing umbilical hernia. PELVIS:UTERUS, ADNEXA: Surgically removed.BLADDER: No significant abnormality noted.LYMPH NODES: Stable cystic lymph node in the left pelvis measures 9 x 12 mm at image 183 of series 3. BOWEL, MESENTERY: Status post proctectomy with surgical staples near the anus. Small gas and fluid filled left presacral extension of the neorectum is stable, probably post-op change. Lesion in the left rectum seen on the prior MRI and PET exams is not definitely found. BONES, SOFT TISSUES: ScoliosisOTHER: Multiple radiodensities in superficial buttock soft tissues bilaterally may be calcifications - injection granulomata.

Output: Small left peri-rectal lesion seen on prior MRI and PET exam is not seen.Otherwise stable exam.


Instruction: Generate impression based on findings.

Input: Ms. Feld is a 53 year old female with a family history of ovarian carcinoma in mother and breast carcinoma in maternal grandmother. BRCA1 positive. Minimal parenchymal enhancement is noted bilaterally. Very few foci of enhancement are seen in both breasts, stable from prior exams.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 23 year old man who presents with recurrent pericarditis of unclear etiology, now referred for cardiac MRI. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVEDV is 216 ml (normal range 142+/-34), the LV end systolic volume index is 45 ml/m2 (normal range 25+/-9), the LVESV is 91 ml (normal range 47+/-19). Global relative enhancement is normal (<1). Native T1 time is between 950-990ms, which is not elevated. There are no regional wall motion abnormalities present. There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory myocardial process.Left AtriumThe left atrium is normal in size . Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 107 ml/m2 (normal range 82+/-16), the RVEDV is 218 ml (normal range 142+/-31), the RV end systolic volume index is 54 ml/m2 (normal range 31+/-9), and the RVESV is 110 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a small-moderate pericardial effusion. There is increased signal within the pericardium on T2-STIR sequences to suggest pericardial edema. Additionally, there is late gadolinium enhancement of the visceral and parietal pericardium which is consistent with pericarditis. With free breathing sequences there is no abnormal septal motion with inspiration to suggest constrictive physiology.Extracardiac FindingsBilateral pleural effusions (left greater than right) with associated left lower lobe atelectasis. 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. Mildly dilated LV with normal systolic function (EF 58%). 2. No myocardial late gadolinium enhancement to suggest underlying inflammation, infiltration or fibrosis. Additionally, native T1 relaxation time in the myocardium is normal.3. However, there is increased signal on T2-STIR imaging of the pericardium, pericardial thickening and late gadolinium enhancement of the visceral and parietal pericardium which is suggestive of active pericarditis. 4. Normal size RV with normal systolic function (EF 50%).5. Bilateral pleural effusions. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Nausea with vomiting, unspecified. Malignant neoplasm of stomach, unspecified. Other complicated headache syndrome.Clinical question: hx metastatic gastric adeno no known brain mets p/w worsening headaches nausea vomiting x2 weeks, please evaluate for brain mets The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits. There is no evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: 71-year-old female patient with dilated common bile duct on abdominal ultrasound. Evaluate for stone/sludge/stricture leading to obstruction. Nausea/vomiting. ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is absent. The common bile duct is dilated up to 14 mm in diameter with smooth tapering distally without evidence of an obstructing lesion; this is likely secondary to a postcholecystectomy state. There is minimal intrahepatic biliary ductal dilatation. A subcentimeter mildly T2 hyperintense lesion within the left hepatic lobe is too small to characterize, but possibly represents a cyst or hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 1.3 cm exophytic lesion arising from the midpole of the left kidney with intermediate to low T2 signal; this is incompletely evaluated on single phase imaging.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is extensive body wall edema.OTHER: There is ascites and a large left pleural effusion.

Output: 1.Common bile duct dilatation without evidence of obstructing lesion is likely secondary to a postcholecystectomy state.2.Exophytic left renal lesion is indeterminate on single phase imaging; this can further evaluated with dedicated contrast enhanced renal imaging.3.Large left pleural effusion and ascites.


Instruction: Generate impression based on findings.

Input: Bowel incontinence since the fall yesterday also with poor rectal tone, new since last MRI. Evaluate for cord compression. The vertebral bodies are appropriate in overall alignment and height. The bone marrow is heterogenous with scattered STIR signal abnormality, some or all of which could be due to degenerative disease. Again seen is evidence of an intramedullary lesion at the T7-T8 level which is better characterized on the recent previous whole spine MRI from 10/29/2015. There are endplate signal abnormalities at many levels which more likely represent edematous degenerative disease. There is severe disc height loss of the L4-5 level with a large disc extrusion which causes severe spinal canal stenosis at this level but this appears not significantly changed compared to the prior exam.

Output: 1.Redemonstration of cord edema at the T7-8 level which corresponds to the previously seen intramedullary lesion on recent MRI. This does not appear to be significantly changed.2.Severe disc height loss and disc protrusion at the L4-5 level causing severe spinal canal stenosis. There does not appear to be significant change compared to the recent previous MRI exam.3.No change in the degenerative findings at most other lumbar levels.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for hemorrhage. Signs and symptoms: Left-sided weakness. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal range and unchanged since prior exam. Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable. Limited images through the orbits are unremarkable. Considering provided clinical inflammation of left-sided weakness recommend follow-up with an MRI.

Output: Negative nonenhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: 54 year old female. Right hip labral debridement, microfracture of acetabulum and iliopsoas release. Continued pain despite PT, NSAIDS. Evaluate for healing of microfracture and a new labral tear. ACETABULAR LABRUM: Again seen is intermediate signal abnormality in most of the anterior labrum, likely representing degenerative tearing and postsurgical change.ARTICULAR CARTILAGE AND BONE: Near full thickness to full-thickness cartilage loss in the right anterior superior femoral and acetabular cartilage, stable to mildly increased in extent. New subchondral marrow edema and small cysts in the acetabulum, probably degenerative in etiology. Small acetabular and femoral osteophytes. Postsurgical scalloping along the femoral head/neck junction, unchanged.Large field-of-view images show mild osteoarthritis of the left hip.SOFT TISSUES: Small lipoma in the iliopsoas near the musculotendinous junction, unchanged. ADDITIONAL

Output: 1. Intermediate signal abnormality in most of the anterior labrum likely representing a combination of extensive degenerative tearing and postoperative changes, not significantly changed.2. Near full thickness to full thickness cartilage loss of the superior femoral and acetabular surface, stable to mildly increased in extent.


Instruction: Generate impression based on findings.

Input: 40 years Female (DOB: 1/31/1976)Reason: Evaluate for syringomyelia History: prior diagnosis of Chiari, headache with valsalva, and LUE numbnessPROVIDER NAME: THOMAS J KELLY THOMAS J KELLY MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several punctate periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. The cerebellar tonsils extend 8 mm below the level of foramen magnum.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this levelAt C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: Findings are compatible with Chiari I malformation. There is no associated evidence for ventriculomegaly or syrinx.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. Most likely given their small number these are of little clinical significance. It is conceivable that these could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Persistent right hip pain ACETABULAR LABRUM: There is increased signal of the anterior superior labrum consistent with tear (series 1201 image 1).ARTICULAR CARTILAGE AND BONE: The osseous alignment is anatomic. The bone marrow signal is within normal limits. Mild thinning of the articular cartilage otherwise cartilage is intact. SOFT TISSUES: There is mild atrophy of the gluteus maximus and tensor fascia latae. ADDITIONAL

Output: 1. Anterior superior labral tear.2. Mild atrophy of the gluteus maximus and tensor fascia latae.


Instruction: Generate impression based on findings.

Input: Parkinson's disease status post renal transplant. Tremor, gait disorder. The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of cavum septum pellucidum and cavum vergae. Couple punctate periventricular white matter lesions which are hyperintense on T2 and FLAIR MRI are present which are nonspecific and likely of little clinical significance.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 demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: There is no evidence for intracranial mass lesion .


Instruction: Generate impression based on findings.

Input: Shoulder pain Note that evaluation of the pectoralis musculature is limited but within these limits, the visualized portions are unremarkable.HUMERUS

Output: 1. Although limited by lack of intra-articular contrast, findings suggestive of labral tear, particularly anteriorly and superiorly. Cystic changes within the humeral head along with possible additional posterior labral pathology raises the question of posterosuperior glenoid (internal) impingement.2. Lobulated focus within the mid shaft of the diaphysis may represent cartilaginous lesion. There is no soft tissue component but CT may be of benefit to determine the presence of cartilaginous or osteoid matrix. Regardless, short-term follow-up is recommended given the history of pain in the area.3. Small focus of increased signal within the brachialis muscle laterally along the mid shaft of the diaphysis may represent a small contusion.


Instruction: Generate impression based on findings.

Input: Precocious puberty and headaches, abnormal pituitary on MRI, back pain, gait changes: 6month follow up. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Pituitary: The pituitary gland is not enlarged and enhances appropriately. The posterior pituitary bright spot and infundibulum are intact. The cavernous sinuses and optic apparatus are unremarkable. There is no evidence of sella or parasellar mass lesions.Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is situated at the L1-2 level. The cauda equina nerve roots are unremarkable. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or hydrocephalus. 2. No evidence of pituitary lesions3. No evidence of spine lesions.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with multiple myeloma and acute back pain, concern for progressive disease. Numerous foci of marrow replacement with corresponding enhancement are seen throughout the visualized spine. Most of these lesions are on the order of 1 cm in size, but larger lesions are evident within the left lateral mass of C1 and particularly the right sacrum. The sacral mass encroaches upon the right sided foramina and the sacral spinal canal to a mild degree. Elsewhere, no significant epidural disease spread is seen. The spinal canal demonstrates normal signal intensity and morphology throughout and is free of pathologic enhancement.Cervical alignment is anatomic and vertebral body heights are preserved. Disc osteophyte formation is present at multiple levels, most notably affecting the C5-6 level where the left ventral spinal canal is slightly effaced and the left neural foramen is narrowed.The thoracic kyphosis is slightly exaggerated likely due to numerous moderate compression deformities and/or areas of endplate concavity. Loss of vertebral body height has progressed at T9. Evidence of kyphoplasty is seen at T12. Mild disc degeneration is evident at lower thoracic levels without significant spinal canal compromise. The neural foramina are patent.Lumbar alignment is within normal limits. Endplate concavity at L2-L4 results in mild loss of vertebral body height. Mild disc bulging is evident at all levels as well as facet arthropathy at lower lumbar levels. However, no significant compromise of the spinal canal or neural foramina is seen.

Output: Diffuse myelomatous involvement of the spine is seen. In most cases, the myelomatous deposits are small and on the order of 1 cm in size. Larger lesions are evident in the left lateral mass of C1 and particularly in the right sacrum. The sacral lesion encroaches upon the right sided sacral neural foramina and the right sacral spinal canal to a mild degree. Elsewhere no significant tumoral encroachment on the spinal canal is demonstrated. The spinal cord remains within normal limitsCompression deformities and loss of vertebral body height are evident at numerous levels in the thoracic and lumbar spine. Evidence of kyphoplasty at T12 is seen.


Instruction: Generate impression based on findings.

Input: Memory impairment. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral and pontine white matter T2 hyperintensity. There are also areas of high T2 signal in the bilateral basal ganglia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a punctate fluid signal lesion in the left lateral eyelid region. There is also a subcentimeter fluid signal rounded lesion in the anterior parotid gland.

Output: 1. Scattered cerebral and pontine white matter T2 hyperintensity are nonspecific, but may represent chronic small vessel ischemic disease. Likewise, areas of high T2 signal in the bilateral basal ganglia may represent chronic lacunar infarcts. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. A subcentimeter fluid signal rounded lesion in the anterior parotid gland may represent a cyst or focal ductal dilatation. Dedicated imaging of this area may be useful for further evaluation.3. A punctate fluid signal lesion in the left lateral eyelid region may represent hidradenitis suppurativa.


Instruction: Generate impression based on findings.

Input: 30 years Female (DOB:8/6/1985)Reason: evaluate for intracranial abnormality given CT findings History: concern for PRESSPROVIDER/ATTENDING NAME: TIEN S DONG TIEN S DONG The CSF spaces are appropriate for the patient's stated age with no midline shift. A focus of encephalomalacia is present in the left parietal lobe. It is associated with some adjacent dilation of the left lateral ventricle.There is a small T2 and FLAIR hyperintense focus present along the gyri adjacent to the posterior aspect of the left superior frontal sulcus measuring 15 mm suggestive of a small focus of encephalomalacia.There is patchy T2 and FLAIR signal hyperintensity within the brainstem associated with volume loss in the brainstem. The cerebellum is relatively small.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is generalized brain atrophy present.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin.

Output: 1.There is generalized brain atrophy present which is unusual for age 30.2.There is encephalomalacia involving the left parietal lobe. A possible this is related to prior vascular type injury.3.A small focus of encephalomalacia is present in the left frontal lobe.4.There is cerebellar atrophy present. This is in excess of the patient's stated age.5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. It is possible they're vascular related, however, they're nonspecific it could also be related to other entities. They are unusually high in number for this age.6.Lesions within the brainstem are suspected to be vascular related.


Instruction: Generate impression based on findings.

Input: 65-year-old female with pain and history of Crohn's disease. PELVIS:UTERUS, ADNEXA: Atrophic uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post proctocolectomy and creation of an ileal pouch anastomosis. No wall thickening or enhancement to suggest active inflammatory bowel disease. The anastomosis is not clearly identified. No anal fissures are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post proctocolectomy and creation of an ileal pouch anastomosis. No wall thickening or enhancement to suggest active inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: 19 years Female (DOB:6/28/1997)Reason: ocular migraine History: photopsias with or without HAsPROVIDER/ATTENDING NAME: JEFFREY W. NICHOLS JEFFREY W. NICHOLS The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for intracranial mass lesion. MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Reason: eval thumb MP joint for intraarticular pathology - please use fine cuts History: mp prior dislocation - pain There is mild edema-type signal within the volar aspect of the head of the first metacarpal and to a lesser degree within the volar aspect of the base of the proximal phalanx which may represent bone contusions, but we see no discrete fracture line. The volar plate appears detached from the volar aspect of the base of the proximal phalanx with minimal displacement. The distal fibers of the ulnar collateral ligament appear thickened at their attachment to the base of the proximal phalanx, indicating a sprain. Furthermore, the ulnar collateral ligament appears partially detached from the base of the proximal phalanx. We see no findings to suggest a Stener lesion. The radial collateral ligament appears intact. The sesamoid bones appear intact. There is mild edema along the extensor pollicis longus and brevis tendons as they course dorsal to the first metacarpal neck, but we see no tendon disruption. The remainder of the visualized tendinous structures appear normal.

Output: 1. Detachment of the volar plate from the base of the proximal phalanx of the thumb with minimal displacement.2. Partial-thickness tear of the ulnar collateral ligament at its attachment to the base of the proximal phalanx of the thumb, but we see no full-thickness tear or Stener lesion.


Instruction: Generate impression based on findings.

Input: 63-year-old man with history of distended pancreatic duct on outside CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The gallbladder is normal.SPLEEN: The spleen is normal.PANCREAS: The body and tail of the pancreas are markedly atrophied and the pancreatic duct is irregularly dilated with numerous dilated side branches (series 7, image 62). Small filling defects are noted including a 10 mm defect in the duct of the pancreatic body which is unchanged from the comparison outside examination (series 3, image 16). No mass lesion is identified.ADRENAL GLANDS: Bilateral fat-containing adrenal nodules are likely adenomas.KIDNEYS, URETERS: There is moderate left hydronephrosis with proximal hydroureter. Layering debris is seen in some of the dilated calyces. No enhancing renal masses identified, however the mid and distal ureters are not visualized. The right kidney appears normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: Small perineural cysts are noted in the lower thoracic, upper lumbar, and sacral spine. Median sternotomy sutures are noted.OTHER: No significant abnormality noted.

Output: 1.Atrophy pancreatic body and tail with ductal dilatation and small filling defects. No discrete mass is seen. These findings are similar to the prior, outside examination and may be due to a small obstructing lesion, benign stricture, or main duct IPMN. CT can be considered for further evaluation and identification of possible intraductal calcification.2.Left hydronephrosis with proximal hydroureter similar to the prior, outside study. The mid and distal ureters are not visualized.


Instruction: Generate impression based on findings.

Input: 63-year-old with gait imbalance. Evaluate cerebellum. No acute ischemia. Minimal punctate periventricular and subcortical T2 hyperintensities compatible with minimal small vessel ischemic disease.There is no evidence of intracranial hemorrhage, mass or edemaThe ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Essentially normal MRI of brain for patient age with minimal chronic small vessel ischemic changes in the cerebral white matter.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with new onset dizziness and headaches. Assess for mass. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. A single punctate focus of mild susceptibility effect is seen within the right parietal white matter which is nonspecific. The ventricular system is normal in caliber and morphology. On postcontrast images, no evidence of any pathologic parenchymal or extra-axial enhancement is seen.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: No significant abnormalities are seen, and in particular, no findings are noted to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Headache for 3 weeks. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a right parietal lobe developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and mastoid air cells are grossly unremarkable. There is a small left maxillary retention cyst. There is also a subcentimeter low signal nodule in the left occipital scalp, which may represent an epidermoid.

Output: Incidental right parietal lobe developmental venous anomaly, but no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: 87-year-old female with metastatic SCC of esophagus status post SRS to the left posterior central lesion, evaluate other metastatic lesions for progression. SRS planning. Signs and symptoms: None. Pre and post enhanced Stealth brain MRI:Examination is performed utilizing stealth protocol for treatment planning and is not a complete diagnostic exam.Examination demonstrate interval increased size and internal necrosis of a previously noted metastatic lesions in the right postcentral gyrus measuring at approximately 9 x 9 mm in transaxial dimensions compared to prior study measurement of 4 mm. This lesion also demonstrates new surrounding vasogenic edema with very subtle regional mass effect. There is a second smaller enhancing carotic metastatic lesion at this site measuring approximately 5 x 6 mm in transaxial dimensions compared to prior study measurement of approximately 3.5 mm.Interval increased size, necrosis and new surrounding vasogenic edema of a left posterior parietal single gyrus measuring approximately at 9 x 13 mm compared to prior study measurements of approximately 5 x 3 mm. This lesion results in subtle regional mass effect. There is however interval decreased size of a metastatic lesion in the left precentral gyrus since prior exam measuring approximately 5.5 x 3 mm.No convincing evidence of new metastatic lesions.No detectable calvarial abnormal enhancement/metastases.There is revisualization of a small left posterior temporal-parietal developmental venous anomaly..

Output: Examination demonstrate interval increased size, internal necrosis and new vasogenic edema of previously known mets since prior exam as detailed/measured above.


Instruction: Generate impression based on findings.

Input: MRA BRAIN: Again seen is a congenitally hypoplastic left vertebral artery with minimal contribution to the basilar artery. The left PICA artery is not visualized. Very small P-comm arteries are again noted bilaterally. There is a large right vertebral artery which is patent and likely the predominant source of contribution to the posterior circulation. The right PICA artery is visualized. The basilar artery appears within normal limits. Bilateral PCA arteries are patent. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. No evidence of aneurysms or vascular malformations.MRA NECK: Again demonstrated is a severely hypoplastic left vertebral artery beginning at its origin and extending up along most of its length within the neck. Again seen is a large right vertebral artery which is likely the dominant contribution to the posterior circulation. The carotid arteries within the neck are within normal limits.

Output: 1.No evidence of aneurysm, significant steno-occlusive disease or dissection in the arteries of the brain or neck.2.Congenitally hypoplastic left vertebral artery and small bilateral PComm arteries unchanged from the recent head and neck CTA.


Instruction: Generate impression based on findings.

Input: Metastatic melanoma status post 4 cycles Pembro. There are postoperative findings in the left temporal lobe with persistent confluent T2 hyperintensity diffusely along the margins of the resection cavity patchy enhancement along the medial aspect of the resection cavity. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues appear unchanged. There is a small defect in the left orbital floor.

Output: Post-treatment findings in the left temporal lobe with persistent nonspecific patchy enhancement along the medial aspect of the resection. Otherwise, no new intracranial metastases are identified.


Instruction: Generate impression based on findings.

Input: 36-year-old female with low back pain. Three views of the sacroiliac joints are provided. The sacroiliac joints appear normal. No findings to account for the patient's pain.

Output: Normal sacroiliac joints without findings to account for the patient's pain. If there is strong clinical concern for inflammatory sacroiliitis, then MRI with and without contrast can be considered.


Instruction: Generate impression based on findings.

Input: Reason: seizure and nystagmus horizontal \ vertical The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 28-year-old man with history of Crohn's, now with right lower quadrant fullness and elevated CRP on infliximab therapy. ABDOMEN:LIVER, BILIARY TRACT: A few, punctate areas of T2 hyperintensity are noted, likely cysts. Liver is normal in signal and morphology. Gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right upper pole renal cyst noted. No hydronephrosis or suspicious focal renal parenchymal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a 9 cm area of circumferential bowel wall thickening with approximately 3.5 cm of narrowing involving the terminal ileum and ileocecal valve (3/18). This bowel wall enhances abnormally (20/90). Additionally, there is a 35 x 27 mm area of enhancing soft tissue in the medial mesentery (20/99) without fistulous tract identified.There is fibrofatty proliferation, regional lymphadenopathy measuring up to 13 mm (20/85), and free fluid (4/40). Proximally, the small bowel is dilated measuring up to 37 mm in diameter.The remainder of the colon appears normal. Jejunal loops are not well distended and difficult to evaluate however there are no gross signs of inflammatory change.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The rectosigmoid colon appears normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Inflammation involving the terminal ileum with stricturing and marked proximal dilation compatible with active Crohn's.2.Inflammatory soft tissue in the adjacent mesentery without discrete fistulous tract identified.


Instruction: Generate impression based on findings.

Input: History of cardiac arrest. Rule out hypoxic anoxic brain injury or hemorrhage. There are diffuse areas of cortical diffusion restriction involving the perirolandic regions, as well as the more posterior parietal and occipital cortices bilaterally. These are associated with cortical swelling and increased T2 signal. Similar cortical involvement is present in the mesial temporal lobes. Other areas of diffusion restriction are present in the corpus callosum, mid brain, pons, thalami, and putamina. The major arterial and venous flow voids are grossly intact. The parenchymal abnormalities would be compatible with a severe type of hypoxic ischemic injury. There is no associated intracranial hemorrhage. There is no midline shift, but the cerebellar tonsils are mildly low-lying. The ventricles are normal in size and symmetric. The orbits, skull and scalp soft tissues are grossly unremarkable. There are scattered sinonasal secretions and mucosal thickening, as well as minimal fluid in the mastoid air cells, which may be related to intubation.

Output: Widespread cortical diffusion restriction with additional involvement of the deep gray nuclei as well as the brainstem is compatible with severe hypoxic ischemic injury without hemorrhagic transformation.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: mri right wrist to evaluate TFCC repair s/p repair on 5/13/2016. Patient with continued popping and pain. LIGAMENTS: Linear increased signal intensity separates the membranous portion of the scapholunate ligament from the scaphoid, indicating a tear. We suspect that the dorsal and volar components of the ligament are intact. The lunotriquetral ligament appears intact.TRIANGULAR FIBROCARTILAGE COMPLEX: There is marked irregularity and disruption of the triangular fibrocartilage complex, which may be posttraumatic but may have surgical component. Multiple small adjacent metal artifacts are noted.TENDONS: Mild increased signal intensity within the extensor carpi ulnaris tendon suggests mild tendinosis. The remaining tendons appear intact. BONES: Interval improvement in bone marrow signal abnormality from comminuted intra-articular distal radial fracture. The fracture line is still faintly visible. Alignment is near-anatomic. There is ulnar styloids deformity compatible with prior fracture. Mild osteoarthritis affects the scaphotrapezoid articulation.ADDITIONAL

Output: 1. Marked irregularity and disruption of the triangular fibrocartilage complex.2. Redemonstration of distal radial fracture in near-anatomic alignment.


Instruction: Generate impression based on findings.

Input: 49-year-old male with AML and neutropenic fever. Status post SCT. Now with recent seizure and fevers Suboptimal exam secondary to extensive motion artifact.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. Further follow-up with an MRI recommended.The paranasal sinuses are unremarkable and no pneumatized.Mastoid air cells demonstrates opacification bilaterally which was present on the prior exam.

Output: Poor quality exam and no definitive evidence of an acute findings.


Instruction: Generate impression based on findings.

Input: 33-year-old female, status post laparoscopic total proctocolectomy for Crohn's disease. Status post ileostomy takedown and intravesical fistula repair of bladder in 10/09. Persistent pelvic pain with periodic drainage. Evaluate for abscess or other abnormality. ABDOMEN:LUNG BASES: Clear lung bases. No infiltrates, nodules or effusions.LIVER, BILIARY TRACT: Cholelithiasis. No biliary duct dilatation or obstruction. The anterior branch of the right portal vein is patent and the previous noted portal vein thrombosis has resolved. Otherwise, hepatic vasculature remains patent.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: Postoperative changes status post total proctocolectomy and end ileostomy in the right lower quadrant. Moderate amount of soft tissue inflammation and fat stranding surrounding the ileostomy site has resolved. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: New 2.2 cm diameter left adnexal cyst has an enhancing rim at image 117 of series 3. This may represent a small abscess that can be imaged with transvaginal ultrasound or pelvic MRI, if indicated. This uniloculated cyst may be physiologic, as there is no adjacent fat stranding, excess free fluid or lymphadenopathy. BLADDER: Moderate thickening of the posterior bladder wall is likely postoperative status post takedown of the iliovesicular fistula with bladder wall repair.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The presacral percutaneous right pelvic drain has been removed. No acute abnormality was found. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. Percutaneous pigtail drain in presacral region has been removed. New left adnexal cyst has an enhancing rim. Transvaginal ultrasound or pelvic MRI exam may be helpful for further evaluation. 2. Thrombosis of the anterior branch of the right portal vein has resolved. Cholelithiasis. 3. Otherwise, stable postoperative changes.


Instruction: Generate impression based on findings.

Input: 59 year old woman with non-ischemic cardiomyopathy, referred for further evaluation of underlying etiology. Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 25%, the LV end diastolic volume index is 102 ml/m2 (normal range: 65+/-11), the LVEDV is 223 ml (normal range 109+/-23), the LV end systolic volume index is 77 ml/m2 (normal range 18+/-5), the LVESV is 167 ml (normal range 31+/-10). LV dysfunction is global with regional variation. The native myocardial T1 mapping suggests abnormal myocardium in the basal inferoseptum. There is no evidence of inflammation or edema on T2 STIR and T1 BB imaging. There is late gadolinium enhancement in the basal inferoseptal and inferior walls. It is mid-myocardial in a pattern atypical for infarction and may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 43 ml/m2 (normal range 69+/-14), the RVEDV is 95 ml (normal range 110+/-24), the RV end systolic volume index is 23 ml/m2 (normal range 22+/-8), and the RVESV is 49 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 ValveThere is bi-leaflet tethering of the mitral valve with at least mild MR.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 25%. 2. There is late gadolinium enhancement in the basal inferoseptal and inferior walls. It is mid-myocardial in a pattern atypical for infarction and may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 7 years old, with right sixth nerve palsy and hydrocephalus. Enlargement of the lateral, third and fourth ventricles is unchanged relative to the prior MRI. No parenchymal diffusion restriction is detected. No areas of significant parenchymal signal abnormality, edema or mass effect are detected. No evidence of acute intracranial hemorrhage or any abnormal extra-axial collections are seen. The sella is partially empty.

Output: 1.Redemonstration of diffuse ventriculomegaly without significant change from the prior examination.2.No new or acute findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Altered mental status. The images are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific periventricular white matter T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is mild fluid signal in the mastoid air cells.

Output: The images are degraded by patient motion, but no definite evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, with aphasia and left handed weakness. A 10 mm focus of restricted diffusion is seen at the junction of the right inferior frontal lobe and insula. There may be a punctate focus of restricted diffusion within the right superior parietal lobule, and another within the left cerebellum.Extensive patchy periventricular T2 hyperintensity is seen, slightly progressed from the prior examination. No evidence of significant parenchymal edema or generalized mass effect is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is observed. Ventricular size and morphology are within normal limits. No pathologic intracranial enhancement is suspected, though postcontrast images are motion degraded.

Output: 1.A diffusion restricting lesion at the junction of the right inferior frontal lobe and insula most likely represents acute ischemia. A number of additional punctate scattered diffusion restricting lesions are seen in both hemispheres and the cerebellum which may also represent small ischemic lesions.2.Extensive background periventricular T2 hyperintense lesions are seen compatible with advanced chronic small vessel ischemic disease.3.No evidence of significant generalized edema or mass effect is seen. No enhancing lesions are detected.


Instruction: Generate impression based on findings.

Input: 45 year old with strong family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Multiple high T2 cysts are again seen bilaterally. Marked parenchymal enhancement is noted bilaterally.Asymmetric parenchymal enhancement greater in the right breast than left is unchanged.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of abdominal pain with elevated alkaline phosphatase. Multiple sequences degraded by patient motion. ABDOMEN:LUNGS: Trace basilar atelectasis/effusions.LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal intensity. The hepatic vasculature is not well evaluated given lack of intravenous contrast. There is no significant biliary ductal dilatation within the limitations of motion artifact. The common bile duct measures up to approximately 6 mm. There is cholelithiasis with some pericholecystic fluid which is nonspecific in the setting of ascites. The gallbladder is not distended. There are filling defects within the distal common bile duct (series 401, image 22) compatible with choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Evaluation of the pancreas and pancreatic duct is severely limited by motion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts.RETROPERITONEUM, LYMPH NODES: Severe atherosclerosis of the abdominal aorta and its branches.BOWEL, MESENTERY: Bowel wall thickening involving the ascending colon.BONES, SOFT TISSUES: Sternotomy changes. OTHER: Mild abdominal pelvic free fluid, most prominent along the right colon and in the perihepatic space. There is a bladder diverticulum arising from the bladder dome.

Output: 1.Examination limited by motion and lack of intravenous contrast.2.Cholelithiasis with some pericholecystic fluid which is nonspecific in the setting of ascites.3.Choledocholithiasis without associated significant biliary ductal dilatation.4.Partially visualized findings of proctocolitis with associated mild abdominal pelvic free fluid as characterized on recent CT.Findings discussed with DAVIES, ANDRE at 9:30 a.m. on 8/29/2016.


Instruction: Generate impression based on findings.

Input: Male, 43 years old. History of paraplegia with right shin and sacral wound. Evaluate for osteomyelitis. Right tibia/fibula: There is focal skin thickening and mild enhancement along the anterolateral aspect of the leg with mild inflammatory changes of the adjacent subcutaneous fat. There is additional reticulation of the subcutaneous fat particularly anteriorly suggesting mild edema. There is moderate atrophy of the muscles of the leg. There is increased signal intensity of the leg musculature seen on fluid sensitive sequences which may represent atrophy or superimposed edema. Minimal if any enhancement of the musculature is present. We see no fluid collection to suggest an abscess. We see no abnormal signal intensity within the tibia or fibula to suggest osteomyelitis.Pelvis: There is heterogeneous signal intensity with mild enhancement of the subcutaneous fat posterior to the sacrum which likely represents a combination of edema, scar tissue, and heterotopic ossification. There is irregularity of the overlying skin presumably representing ulceration. We see no findings to suggest osteomyelitis of the underlying sacrum.Again seen is a deep ulcer along the left gluteal fold extending to the left ischium which was present on CT study from 2014. There is relatively mild signal abnormality within the ischium which is favored to represent sequela of prior osteomyelitis or perhaps reactive edema. We see no interval bone destruction when compared to prior. Heterogeneous signal adjacent to the left ischium likely represents edema, scar tissue, and heterotopic ossification.There is an additional sinus tract which extends from the right gluteal fold to the right ischium but we see no signal abnormalities to suggest osteomyelitis.Patient has undergone a right Girdlestone procedure. Although the lateral margin of the right greater trochanter is not imaged in its entirety, we see no signal abnormality in the proximal right femur to suggest osteomyelitis.There is a deformity of the left proximal femur with adjacent heterotopic ossification. There is osteoarthritis of the left hip and heterogeneous signal in the surrounding soft tissues which likely represents scar tissue and additional heterotopic ossification.There is ankylosis of the sacroiliac joints, particularly on the right. There is edema within the body of the pubic bones along with the symphysis which is likely degenerative. There is diffuse muscle atrophy. Mild edema and enhancement within the gluteal musculature is present but we see no focal collection to suggest an abscess. There is also increased signal intensity within the adductor muscles of the hips which may represent atrophy or mild edema. There is a Foley within the bladder.

Output: 1. Pelvic soft tissue ulcers as described above with imaging features of the sequela of prior osteomyelitis, particularly involving the left ischium, but we see no sacral osteomyelitis.2. Focal ulceration of the anterolateral soft tissue of the right leg with mild inflammation of the subcutaneous fat but we see no osteomyelitis.3. Other findings as above.


Instruction: Generate impression based on findings.

Input: Tingling in 4 limbs, evaluation for NMO. Confluent T2 signal in distal medulla to C7 and T3-T12 in NW MRI from November 2015. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal residual T2 hyperintensity in the inferior medulla. The brain parenchyma and cerebellum otherwise appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There is decrease in the degree of T2 hyperintensity and swelling involving the majority of the cervical and thoracic spinal cord. The cauda equina nerve root sare unremarkable. The vertebral column alignment is unchanged. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Interval decrease in the degree of edema involving the medullar and large portions of the spinal cord.


Instruction: Generate impression based on findings.

Input: A 19 year old female with strong family history of cardiomyopathy, a recent echocardiography showed reduced function of the right ventricle and the patient complaint about palpitations recently. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 85 ml/m2 (normal range: 65+/-11), the LVEDV is 145 ml (normal range 109+/-23), the LV end systolic volume index is 37 ml/m2 (normal range 18+/-5), the LVESV is 63 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. The LA volume is 62 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 158 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 75 ml (normal range 35+/-13). No aneurysm or fat infiltration was seen. No MRI findings compatible with ARVD.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet and opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 56%. There are no regional wall motion abnormalities present. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function, the RVEF is 52%. No MRI findings compatible with ARVD.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 70 year-old male with the history of recent CVA in the right MCA found unresponsive. Right frontal cortical hypoattenuation consistent with infarction noted on MRI of 2/21/2008. Periventricular hypoattenuation consistent with microangiopathic vascular disease demonstrated on prior MRI. There is no evidence of intracranial hemorrhage, mass or edema. 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: Right frontal infarction and white matter hypoattenuation compatible with microangiopathic vascular disease as demonstrated on prior MRI.


Instruction: Generate impression based on findings.

Input: Suspicion for left ACL tear. MENISCI: Bucket handle-type tear of the posterior horn of the medial meniscus, with the meniscal fragment displaced anteromedially. No significant abnormality noted in the lateral meniscus.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. No bone contusions are evident.LIGAMENTS: There is a complete tear of the ACL. No significant abnormality noted in the PCL. The MCL and LCL complex are normal.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complete tear of the ACL.2. Bucket handle tear of the posterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Known right breast cancer on I-Spy 2 protocol. MRI #2. Index mass in the right retroareolar region is larger than on the prior and predominately peripherally enhancing, with nodular peripheral enhancing areas measuring up to 1.3 cm. It is now not possible to differentiate exactly the boundary between the mass and the medial fluid collection, as the clip that was previously in the fluid collection is contiguous with the mass. At least a portion of the fluid collection appears pushed towards the skin by the mass. Overall measurement of the mass/collection is 6.5 x 4.9 x 5.2 cm, previously, the mass and collection separately measured 3.9 x 3.7 x 3.8 cm and 2.6 cm respectively. In a few locations, the rim enhancement may be less, though this is an equivocal finding given the increase in size/ increase in central necrosis. Associated skin thickening again noted. Satellite masses posterior to the index lesion are similar to prior measurements, up to 1.5 and 0.9 cm respectively. An enhancing 8 mm focus medial to the mass is seen now as well.The left breast scattered benign foci and masses are not significantly changed.Proven metastatic right axillary node with clip measures 2.4 x 1.6 cm, previously 2.9 x 1.9 cm. An additional node adjacent to the biopsied node is now seen and has areas suggesting central necrosis. This node measures 1.6 x 1.3 cm. Normal left axillary nodes.Probable hepatic cyst in the dome again noted. Non-specific heterogeneous signal in the sternum is noted but there is no specific enhancing lesion within it.

Output: Known right breast cancer is increased in size overall. There may be a few areas where the peripheral enhancement is less compared to prior enhancing areas. Biopsied right axillary lymph node has slightly decreased in size. An additional right axillary node is now noted to be necrotic, likely due to metastatic involvement/treatment effect. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: History of NK/T-cell lymphoma and bone marrow transplant as well as CNS involvement by post transplant lymphoproliferative disorder. Again seen are evolving chronic blood products, with evidence of retraction, and associated encephalomalacia in the right parieto-occipital region underlying the burr hole. Similarly, superficially located multifocal susceptibility effect from previous hemorrhages also remains. Confluent cerebral white-matter T2-hyperintensity, which is more pronounced on the right, also remains unchanged. There is no mass-effect, midline shift or brain herniation. Ex vacuo dilatation of the lateral and third ventricles have slightly increased and remains most pronounced in the posterior right lateral ventricle. No clear evidence of hydrocephalus.There is subtle contrast enhancement in the medial right occipital lobe, medial to the hemorrhage at the site of the previous lesion, as before, which is nonspecific in the setting of treatment changes in this region. Otherwise, there is no abnormal enhancement. Focal contrast enhancement involving the posterior aspect of the left insular cortex is resolved compatible with evolution of injury. Major intracranial vascular flow voids are preserved.The orbits are grossly unremarkable. There is moderate mucosal thickening in the paranasal sinuses associated with secretions in the maxillary sinuses. In the proper clinical setting, this may reflect acute or acute on chronic sinusitis.

Output: 1.No new mass or new enhancement to suggest disease progression. Subtle contrast enhancement in the right occipital lobe, medial to the evolving chronic blood products, is nonspecific in the setting of treatment changes in this region. 2.Evolving chronic blood products in the right parieto-occipital region with evidence of retraction. The other areas of signal abnormality indicative of previous multifocal hemorrhage remain unchanged. 3.Confluent cerebral white-matter T2-hyperintensity, which is more pronounced on the right, also remains unchanged and compatible with treatment change.4.Dilatation of the lateral and third ventricles is slightly increased and remains most pronounced in the posterior right lateral ventricle and likely reflective of volume loss. No clear evidence of hydrocephalus.


Instruction: Generate impression based on findings.

Input: 70 years Female (DOB:10/7/1945)Reason: evaluate olfactory bulb/clefts History: anosmia x 7-8 years of unknown etiologyPROVIDER/ATTENDING NAME: SAMANTHA M ZUNICH ROBERT M NACLERIO The CSF spaces are appropriate for the patient's stated age with no midline shift. Findings suggest a developmental venous anomaly in the left frontal lobe. On susceptibility imaging and postcontrast imaging there is a lesion with a cap reduce a appearance within the left frontal lobe white matter directed towards the left inferior frontal gyrus.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Given the patient's stated age of 70 0 little clinical significance.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: No intracranial mass lesion is appreciated and no explanation for the patient's and nausea can be ascertained based on this exam.


Instruction: Generate impression based on findings.

Input: History of allergic fungal sinusitis: nasal congestion. Sinus: There are postoperative findings related to osteoplastic flap surgery with resorption of the flap margins, which is more conspicuous on CT. There is extensive diffuse paranasal sinus mucosal thickening and intraluminal material that predominant displays mildly low T1 and very low T2 signal. In addition, there is expansion of the left frontal lobe with dehiscence of the posterior wall and mild mass effect upon the underlying left frontal lobe. There are also polypoid lesions within the nasal cavity.Brain: Aside from the mild mass effect upon the left frontal lobe, the brain parenchyma otherwise appears unremarkable. There is no evidence of intracranial hemorrhage 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 appear unremarkable.

Output: Findings suggestive of sinonasal polyposis with what may represent superimposed allergic fungal sinusitis and apparent mucocele formation in the left frontal sinus, but no evidence of intracranial abscess or acute infarction.


Instruction: Generate impression based on findings.

Input: Female, 11 years old. Bilateral foot pain RIGHT FOOT: The medial hallux sesamoid has low signal on T1 and PD sequences and increased bone marrow signal on STIR sequences suggesting marrow edema. The sesamoid bone maintains its morphology, without surrounding signal abnormality in the soft tissues. Bone marrow signal elsewhere is normal. No joint effusion, soft tissue edema, or discrete fluid collection.LEFT FOOT: The medial hallux sesamoid is bipartite. The hallux sesamoids, medial greater than lateral, have low signal on T1 and PD sequences, with slightly increased bone marrow signal on STIR sequences. No surrounding signal abnormality in the soft tissues. Bone marrow signal elsewhere is normal. No joint effusion, soft tissue edema, or discrete fluid collection.

Output: Bone marrow edema involving the right medial hallux sesamoid and left hallux sesamoids without surrounding soft tissue edema, compatible with chronic sesamoiditis.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with lung cancer metastases to the brain status post radiation therapy. Multiple scattered small lesions are again seen in the brain and cerebellum compatible with treated metastases. Most of these lesions show minimal if any enhancement, and are primarily visualized by virtue of their susceptibility effect on T2 and SWI images. One lesion, at the junction of the right parietal and occipital lobes, does show heterogeneous enhancement, unchanged from prior. The size of this lesion, at 9 mm diameter, has also not significantly changed from the immediate prior examination and is smaller when compared to older studies. No new enhancing or susceptibility inducing lesions are seen.Patchy bilateral periventricular white matter T2 hyperintensity is seen. The extent of this finding has progressed when compared to prior examinations, though in the absence of mass effect or new enhancement, this is favored to represent posttreatment change. No new areas of parenchymal edema are detected. No acute intracranial hemorrhage is suspected. The ventricles are stable in size and morphology.Patchy opacification of the right mastoid air cells is unchanged. An area of thickening and enhancement involving the bony floor of the right middle cranial fossa is unchanged over multiple prior examinations, possibly representing an incidental benign fibro-osseous lesion or venous space.

Output: Stable posttreatment appearance of numerous intracranial metastatic lesions. No new or growing lesions are seen.


Instruction: Generate impression based on findings.

Input: 62-year-old man with history of extrahepatic cholangiocarcinoma status post Whipple, now with abdominal pain and concern for recurrence. ABDOMEN:LIVER, BILIARY TRACT: There is increased intrahepatic biliary ductal dilatation measuring up to 9 mm (201/18), increased from the prior study. The dilated intrahepatic bile ducts narrow and terminate at the Klatskin point. Although no discrete extrinsic mass is identified, there is periductal soft tissue signal and, along the ducts within the atrophic left lobe of the liver (503/344), there is increased diffusion signal. This diffusion signal abnormality was not present on the prior exam (outside MR abdomen dated 8/13/16, B500 sequence, image 27).SPLEEN: No significant abnormality noted.PANCREAS: The patient is status post Whipple procedure and the pancreatic duct is mildly dilated, stable from the prior examADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cysts are seen bilaterally. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Partially visualized small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of perihepatic ascites.

Output: 1.Examination somewhat limited due to lack of delayed phase perfusion sequence.2.Increased intrahepatic biliary ductal dilatation compared to the prior examination.3.Increased abnormal diffusion signal within the left hepatic lobe from Klatskin's point along the biliary ducts suspicious for lepidic growth of tumor. No discrete measurable lesion identified.


Instruction: Generate impression based on findings.

Input: Reason: hx of HPRCC, evaluate increase in size of 4 renal lesions RIGHT KIDNEY: Right kidney measures 12.2 cm and is normal in echogenicity without hydronephrosis. No evidence of renal calculi.Interval increase in the right mid kidney hypoechoic lesion measuring 2.2 x 2.4 x 2.5 cm, previously 1.8cm on MRI. Right inferior pole hypoechoic lesion measures 1.0 x 1.0 x 0.8 cm and appears without significant change from prior MRI. Hyperechoic foci noted in the right mid kidney measuring 1.5 x 1.2 x 1.6 cm.LEFT KIDNEY: Left kidney measures 11.9 cm and is normal in echogenicity without hydronephrosis. No evidence of renal calculi. No lesion identified. URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.

Output: Interval increase in the right mid hypoechoic lesion. Right inferior pole lesion appears stable. Fourth lesion is not identified on US.


Instruction: Generate impression based on findings.

Input: Female, 13 years old, with left renal atrophy, recurrent urinary tract infections, and vesicoureteral reflux. Assess for spinal cord abnormalities, and specifically for evidence of tethered cord. The visualized spinal cord and conus are within normal limits. The nerve roots of the cauda equina disperse evenly through the thecal sac. The conus tip terminates at the T12-L1 level which is normal. On prone imaging, the conus and cauda equina show evidence of anterior displacement. No fatty filum terminale or other intraspinal fatty lesions are seen. No pathologic intraspinal enhancement is detected.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of any segmentation anomaly is seen. Marrow signal characteristics are unremarkable. No pathologic marrow enhancement is seen. Scattered Schmorl's nodes are seen but no significant disc herniations are evident. The spinal canal and neural foramina are widely patent. The left kidney is not visualized.

Output: No significant spinal abnormalities, and in particular, no evidence of tethered cord.


Instruction: Generate impression based on findings.

Input: 34-year-old female with pain. Evaluate for midcarpal instability. LIGAMENTS: Contrast is noted traversing the lunotriquetral ligament and the scapholunate ligament consistent with ligamentous disruption. TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex appears intact. No intra-articular contrast is identified within the distal radioulnar joint to suggest triangular fibrocartilage disruption.TENDONS: There is ulnar displacement of the extensor carpi ulnaris, which appears perched upon the ulnar styloid, suggestive of extensor carpi ulnaris subluxation, which can be seen in sub-sheath injury or rupture. BONES: There is increased bone marrow signal abnormality within the lunate bone which is nonspecific but may represent a bone contusion in the correct clinical setting although this may be inflammatory or degenerative in etiology. There is surgical resection of the triquetrum. Multiple foci of metallic susceptibility artifact in the overlying soft tissues are likely postsurgical in etiology. Additional metallic susceptibility artifact is identified within the first metacarpal also likely postsurgical in etiology. There is a slight dorsal tilt of the lunate bone.ADDITIONAL

Output: 1. Disruption of the scapholunate and lunotriquetral ligaments.2. Subluxation of the extensor carpi ulnaris suggesting sub-sheath injury or rupture, which may be chronic in etiology as there is no edema in the surrounding area, as described above.3. Findings suggestive of a synovitis consistent with the patients known inflammatory arthritis.4. Nonspecific edema within the lunate bone. Postsurgical changes and other findings, as described above.


Instruction: Generate impression based on findings.

Input: Examination is significantly limited secondary to extensive motion artifact. Of note, the examination was terminated prematurely. The previously identified left parietal lobule and left superior frontal gyrus intraparenchymal hematomas and surrounding vasogenic edema appear grossly similar in size to prior examination. There are scattered areas of subarachnoid hemorrhage. There is a small low T2 and intermediate T1 signal subdural hematoma overlying the left convexity. There is no midline shift i. The ventricles are unchanged in size. There is no evidence for acute ischemia. A large right frontal scalp hematoma is again demonstrated.

Output: 1. Severely limited examination demonstrates left parietal lobe and left superior frontal gyrus hematomas with scattered areas of subarachnoid hemorrhage and small left convexity subdural hematoma, as well as a large right frontal scalp hematoma appear to be grossly similar to the prior examination, accounting for differences in technique. 2. No evidence for acute ischemia. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 85 years old reevaluate complex liver cyst. ABDOMEN:LIVER, BILIARY TRACT: The previous seen left hepatic mass measures 8.5 x 6.8 x 8.3 cm (series 6, image 15 and series 3, image 11), previously 8.1 x 6.5 x 7.3 cm. It is intermediate signal intensity on T2 weighted images and heterogeneously T1 hyperintense with no enhancement. Thin enhancing septations are seen within the structure. There is no nodular enhancement.. An adjacent bilobed cyst and a segment 7 cyst are unchanged. Punctate low T1 and low T2 foci with no enhancement may represent scattered granulomas or other calcifications (for example series 6, image 15). No new hepatic lesion.The gallbladder is normally distended without cholelithiasis. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral renal cysts including the left upper pole cyst that contains a thin, nonenhancing septation. Two subcentimeter T1 hyperintense, T2 hypointense, nonenhancing lesions in the inferior pole of the left kidney are also unchanged and compatible with hemorrhagic/proteinaceous cysts. No suspicious renal lesion No hydronephrosis.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: Since the prior MRI there has been a slight interval increase in size of the cystic liver lesion with thin enhancing septation and findings indicating interval hemorrhage or accumulation of proteinaceous content. The differential again includes a complex hepatic cyst or biliary cystadenoma.


Instruction: Generate impression based on findings.

Input: Pineal parenchymal tumor of intermediate grade. There are post-treatment findings related to right parieto-occipital craniotomy. There is interval decrease in size of the heterogeneously enhancing pineal mass which measures up to 24 mm, previously 31 mm. Furthermore, the predominantly T1 hyperintense hemorrhage within the tumor has dissipated or evolved, with a few punctate areas of residual susceptibility within the tumor. There has been interval decrease in size of the third and lateral ventricles. There is a right transfrontal ventricular catheter that terminates in the right lateral ventricle. There are scattered foci of susceptibility effect within the ventricular system likely represent hemosiderin deposit from the prior intraventricular hemorrhage. There is unchanged encephalomalacia in the right occipital lobe. There are unchanged scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute infarct. There is no midline shift or herniation. There is persistent mild fluid signal in the left mastoid air cells. The left occipital subcutaneous nodule is not significantly changed.

Output: 1. Interval decrease in size of the pineal mass associated with interval subsidence of the intratumoral hemorrhage. 2. Interval decrease in size of the third and lateral ventricles due to decreased obstructive effects from the pineal tumor, but residual areas of chronic intraventricular hemorrahge.3. The nonspecific left occipital subcutaneous nodule is not significantly changed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Dysarthria, gait instability, and spasticity. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and cerebellum 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.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is no evidence of abnormal intraspinal enhancement or mas lesions. The paravertebral soft tissues are unremarkable. The patient is intubated and there is associated fluid in the hypopharynx.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarction. In particular, the cerebellum appears unremarkable.2. No evidence of cervical spinal canal stenosis or spinal cord lesions.


Instruction: Generate impression based on findings.

Input: Status post craniotomy for tumor resection. Assess extent of resection. History of rectal carcinoid cancer in 2011 and breast cancer in 2009. No relevant preoperative imaging studies are available for comparison.There is a 3 cm in diameter resection cavity in the left frontal lobe (middle frontal gyrus) with expected blood products in the cavity and along the resection margin. There are small foci of diffusion restriction along the medial and inferior lateral surgical margins which may reflect postoperative change. There is minimal contrast enhancement along the surgical margin, especially superiorly, which may reflect postoperative change as well. There is minimal T2-hyperintensity surrounding the surgical cavity and no significant mass-effect. There is no midline shift. The ventricles are normal in size. There is minimal extra-axial fluid and dural thickening underlying the left frontal craniotomy flap.While there is no other contrast-enhancing brain lesion, there are tiny foci of diffusion restriction involving the right cerebellar hemisphere correlating with T1 hypointense, T2-hyperintense signal reflecting small acute/subacute infarcts. There is nonspecific ethmoid mucosal thickening and maxillary small retention cyst. The eye globes are elongated anteroposteriorly, which can be associated with severe myopia.

Output: 1.The patient is status post recent left middle frontal gyrus surgery for removal of the lesion. No preoperative exams to compare with. There are postoperative changes within the surgical cavity and adjacent to it include intracranial air and scalp soft tissue swelling suggesting this is recent surgery. Please correlate with the surgical findings.2.Small foci of diffusion restriction in the right cerebellar hemisphere represent acute/subacute microinfarcts3.No other contrast-enhancing brain lesion.


Instruction: Generate impression based on findings.

Input: 14-year-old female patient with scoliosis. Evaluate for Chiari malformation, syrinx, and tethered cord. CERVICAL SPINE: The cerebellar tonsils are normal position. The visualized posterior fossa structures are unremarkable. Biphasic flow is noted ventrally and dorsally at the foramen magnum.There is reversal of the normal cervical lordosis with a mild kyphotic angulation at the C5/C6 level. There is mild disc bulge at the C5/C6 level without significant canal stenosis. Vertebral body heights are maintained. There is no spinal canal or neural foraminal stenosis at the remaining cervical spine levels. No cervical spinal cord syrinx is identified. THORACIC SPINE:There is a thoracolumbar levoscoliosis with an apex at T11. Vertebral body heights are maintained. There is no spinal canal or neural foraminal stenosis. There is no syrinx of the thoracic spinal cord. There is dependent basilar atelectasis within the bilateral lungs.LUMBAR SPINE:There is a thoracolumbar levoscoliosis with an apex at T11. Vertebral body heights are maintained. There is no spinal canal or neural foraminal stenosis. The conus medullaris terminates at the level of L1-L2. The cauda equina moves dependently in the spinal canal with prone positioning. There is no syrinx of the lumbar spinal cord, evidence of fatty filum, or other lesion within the lumbar spinal canal.

Output: 1. No evidence of Chiari malformation, syrinx, or evidence of tethered cord.2. There is levoscoliosis at the thoracolumbar junction. There is also reversal of the cervical lordosis.


Instruction: Generate impression based on findings.

Input: 31-year-old male with lymphadenopathy and brain lesion status post biopsy. Rule-out primary malignancy, calcifications or lymph nodes in the neck. Postoperative changes from a right frontal craniotomy are noted. Peripherally enhancing lesion in the right frontal lobe with associated extra-axial CSF fluid collection are again seen and are also likely secondary to postoperative changes. Ill-defined hypodensities are seen in the bilateral basal ganglia which correlate with the basal ganglia abnormalities seen on prior MRI examination. No new CT findings are seen within the brain.NECK CT

Output: Stable postoperative changes in the brain. No abnormal enhancing lesions or lymphadenopathy within the neck.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild age-related degeneration of the superior labrum noted. Otherwise there is no significant abnormality.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: No significant abnormality. Specifically no evidence of full-thickness rotator cuff tear, biceps tendon tear, or greater tuberosity fracture.