Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Vantin 200mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Vantin 200mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Vantin 200mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaCad was used to localize the two T2 hypointense enhancing lesions in the left apex and right base peripheral zone of the prostate. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the right and left sides of the prostate. Upon confirmation of the tip of the needles close to these two suspected lesions, MR guided biopsy using an 18 gauge biopsy needle was performed and a total of 6 cores (3 cores from each site) were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: 1. Successful core-biopsies of the right base and left apex prostate gland peripheral zone lesions.


Instruction: Generate impression based on findings.

Input: 21-year-old male with pain and swelling of fifth metatarsal The bone marrow signal is within normal limits. The fifth metatarsal specifically appears unremarkable. There is no evidence of fracture or malalignment. Extensor and flexor tendons are intact with normal signal intensity.

Output: No fracture or other specific finding to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Clinical question: Nodule of the left cerebellar lesion versus encephalomalacia. Signs and symptoms: Left-sided ataxia. Nonenhanced brain MRI:Diffusion weighted images demonstrate a focus of restricted diffusion consistent with an acute nonhemorrhagic ischemic stroke along the medial aspect of remaining left cerebellar hemisphere measuring at 31 x 11 mm in transaxial dimensions. As was noted on multiple prior exams there are bilateral paramedian encephalomalacia of bilateral cerebellar hemispheres (L>R) and with resultant mild expansion of fourth ventricle. Findings are believed to be at least partially secondary to a prior midline suboccipital craniectomy and with evidence of residual metallic density (surgical clips/coils?) in the midline similar to prior exam.Images through the supratentorial space demonstrate periventricular and to a lesser degree subcortical patchy foci of FLAIR/T2 hyperintensity suggestive of mild chronic small vessel ischemic strokes considering patient's stated age of 74. There is also prominence of of the supratentorial ventricular system with maintained midline and to a lesser degree prominence of the cortical sulci which although could be within normal range for patient of stated age possibility of mild underlying parenchymal volume loss should also be considered. A large focus of T2 hyperintensity extends from the lateral wall of left lateral ventricle superiorly to the inner table of the right frontal cortex believed to represent a focus of encephalomalacia along the track of a previously removed ventricular catheter. This finding is immediately under a right frontal calvarial burr hole.Unremarkable images through the orbits.Moderate right maxillary chronic sinus disease and well pneumatized other paranasal sinuses.Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Diffusion-weighted images demonstrate a small acute nonhemorrhagic left cerebellar stroke measuring at 11 x 31 mm in transaxial dimensions.2.Bilateral (L>R) paramedian cerebellar encephalomalacia under a midline suboccipital craniectomy stable since multiple prior studies.3.Supratentorial images demonstrate mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter.4.Prominence of the supratentorial ventricles and to a lesser degree cortical sulci for patient of stated age could be within upper limits of normal however possibility of underlying parenchymal volume loss should also be considered.


Instruction: Generate impression based on findings.

Input: AMS. Fever. Evaluate for mass or intracranial hemorrhage. Similar to the brain MRI from 2004, there is extensive parenchymal volume loss, leukomalacia, and stable hydrocephalus. There is no evidence acute intracranial hemorrhage, mass or edema. The calvaria and skull base are radiographically normal. Minimal mucosal thickening is noted in the left maxillary sinus and ethmoid air cells. The remainder of the visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable parenchymal volume loss and hydrocephalus with no acute abnormality.


Instruction: Generate impression based on findings.

Input: 68-year-old female patient left sided weakness, recent TIA versus stroke. Evaluate for signs of ischemia, infarction, or mass. MRI: There is restricted diffusion and high T2 signal in the right basal ganglia and corona radiata. There are areas of encephalomalacia with susceptibility effect in the left basal ganglia and corona radiata, bilateral thalami, and right cerebellar hemisphere. There are also a few scattered supratentorial and infratentorial punctate foci of susceptibility effect without associated gross encephalomalacia. There is a background of cerebral white matter T2 hyperintensity without restricted diffusion. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There appears to be at least mild narrowing of the bilateral proximal middle cerebral arteries. There is also narrowing of the left posterior cerebral artery in the P2 segment region. There is mild irregularity of the bilateral carotid siphons. Otherwise, there is no evidence of significant occlusive lesions or aneurysms. There is an incidental right fetal PCA.

Output: 1. Acute infarction in the right basal ganglia and corona radiata with a punctate focus of susceptibility in this area, which may represent associated petechia hemorrhagic transformation versus pre-existing chronic microhemorrhage or calcification.2. Chronic left basal ganglia and corona radiata, bilateral thalamic, and right cerebellar lacunar infarcts with associated chronic hemorrhages, superimposed upon chronic small vessel ischemic disease. 3. Apparent narrowing of the bilateral proximal middle cerebral arteries, as well as the left posterior cerebral artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of side branch type right IPMN since 2008. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic neck/body cystic lesion measures 1.2 x 0.9 cm (series 701/24), compared to 1.2 x 0.8 cm previously. No suspicious mural nodularity or postcontrast enhancement. There is an adjacent punctate cystic focus, minimally increased in size. The remainder of the pancreas demonstrates normal morphology signal intensity and enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Relatively stable non-specific moderately enlarged mesenteric lymph nodes dating back to 2008.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Relatively stable pancreatic neck/body side-branch IPMN measuring up to 1.3 cm in size without suspicious imaging features.


Instruction: Generate impression based on findings.

Input: History of hepatitis C, assess for hepatocellular carcinoma ABDOMEN:LIVER, BILIARY TRACT: Arterially enhancing lesion in segment 7-8 measures 9 x 11 mm, unchanged. There is no demonstrable washout within this lesion. Additionally, there is a punctate hyperenhancing lesion at the hepatic dome.Portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No focal hepatic lesions which meet criteria for HCC. Continued surveillance is recommended.


Instruction: Generate impression based on findings.

Input: Is a large solid and cystic mass in the left cerebellar hemisphere, currently measuring 2.4 x 2.8 cm in greatest axial dimensions, x 1.7 cm CC. This appears similar to the prior outside MRI. It abuts the inferior margin of the distal left transverse sinus without definite invasion or narrowing. There is an additional ring-enhancing low central signal intensity lesion in the right posterior peripheral occipital lobe, measuring 1.4 x 1.2 cm in greatest axial dimensions, x 1.1 cm CC. This previously demonstrated more homogeneous central enhancement on the outside images. There is an additional nodular area of enhancement in the midline posterior inferior vermis measuring up to 5 mm in greatest axial dimensions (501/69, 502/174), which can be identified on the prior exam with a similar appearance.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is scattered foci of punctate T2 hyperintensity within the subcortical white matter bilaterally, although not as well delineated given lack of FLAIR images. There is also corresponding T2 hyperintensity to the above-described larger parenchymal lesions. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Redemonstration of dominant left cerebellar and smaller right occipital lobe enhancing lesions, consistent with known areas of presumed metastatic disease. Interval decreased central enhancement of now ring-enhancing right occipital lesion.2. Additional small focus of nodular enhancement in the posterior inferior vermis, also suspicious for metastatic disease.3. Grossly stable scattered punctate foci of T2 hyperintensity in the subcortical white matter which are nonspecific.


Instruction: Generate impression based on findings.

Input: Reason: Prostate cancer eval History: see above PELVIS:PROSTATE: 1.5 x 1.5 cm low T2, low ADC enhancing mass with irregular borders in the anterior central gland (501:54, 701:118, 1301:1293) suspicious for central zone tumor. No obvious peripheral zone abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Anterior 1.5 cm central zone tumor as described above. No obvious metastatic lymph nodes. No suspicious peripheral zone lesions.


Instruction: Generate impression based on findings.

Input: Right hip pain, hit by a bus at age 4, fractured pelvis, groin pain, evaluate for labral tear ACETABULAR LABRUM: A very small tear is seen at the base of the right anterosuperior labrum.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. Normal bone marrow signal.SOFT TISSUES: No significant abnormality noted. The pelvic muscles are unremarkable.ADDITIONAL

Output: Very small tear of the base of the right anterosuperior acetabular labrum.


Instruction: Generate impression based on findings.

Input: 43 years, Female, ataxia, progression of multiple sclerosis. Again seen are numerous T2/FLAIR hyperintense lesions in the supratentorial and infratentorial brain consistent with known demyelinating disease. Compared to 3/2/2015, there is a new lesion involving the left dorsal pons. No associated enhancement, or abnormal enhancement elsewhere in the brain. No additional new lesions are definitively appreciated. There is a moderate burden of T1 hypointense lesions throughout the brain. There is moderate degree of brain parenchymal volume loss including thinning of the corpus callosum, which is similar to prior.No evidence of intracranial mass effect, midline shift, or herniation. No hydrocephalus. Calvarium and extracranial soft tissues are grossly unremarkable. Lesion in the cervical cord at the C2 level is noted and was present previous.

Output: Chronic demyelinating disease with numerous supra- and infratentorial lesions. There is a new lesion in the left dorsal pons compatible with progression when compared to prior exam from 3/2/2015. No lesions with enhancement to suggest active demyelination.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for MS progression. Signs and symptoms: Left leg and arm numbness Pre-and post-enhanced cervical MRI:Examination is performed utilizing Dr, Javed's dedicated multiple sclerosis protocol.Examination demonstrates stable multiple small demyelinating plaques primarily in the upper cervical spine with out detectable abnormal enhancement or interval progression since prior study. The caliber of the cervical cord remains within normal and stable since prior study.The signal intensity and the alignment of vertebral column remains within normal. No appreciable degenerative changes, neural foraminal or central spinal stenosis is identified.

Output: 1.Stable chronic demyelinating disease of the cervical spinal cord as detailed.2.No detectable signal abnormality or enhancement of the uppermost visualized thoracic cord at T4 level.3.No spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: There is suggestion of treatment response with decrease in size of multiple previously seen enhancing lesions in the brain. Postcontrast sequences are severely motion degraded. Previously seen right posterior frontal lesion is not definitively appreciated. Left posterior temporal lesion is also not significantly definitively appreciated. There appears to be decreased since size of the enhancing right posterior lateral medulla and right inferior cerebellar lesions. For example right posterior medullary lesion previously measuring 10 x 8 mm measures approximately 7 x 6 mm. Foci of susceptibility are seen compatible with chronic blood products and/or mineralization associated with the prior lesions.No new edema intracranial mass effect, midline shift, or herniation. No hydrocephalus. No extra-axial collections. No evidence of infarct orThere is opacification of the right mastoid air cells.CERVICAL SPINE

Output: 1. Please note patient had difficulty tolerating the study and the postcontrast brain sequences are severely motion degraded. There does however appear to be decrease in size and number of the multiple metastatic lesions in the brain. No large new lesion is appreciated. Repeat post gadolinium brain MRI sequences can be considered as clinically indicated. 2. Evaluation of the spine demonstrates no definite evidence of metastatic disease within the limitations of the motion degraded postcontrast sequences. Compared to 8/12/2015, 8 mm enhancing lesion involving the L4 vertebral body remains unchanged. This lesion is nonspecific and may be benign.3. Given the extent of motion degradation on the brain and spine sequences, if there is high suspicion of progression of metastatic disease, repeat study limited to post gadolinium sequences of the brain and complete spine can be considered.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is no rotator cuff full thickness tear or significant tendinosis. Muscle bulk is appropriate for age without muscle edema.BICEPS TENDON: The long head of the biceps tendon is normal in caliber, signal, and positioned within the intertubercular sulcus.LABRUM: The glenoid labrum is intact for non-arthographic technique.OSSEOUS STRUCTURES: The osseous structures are normal in alignment and marrow signal.ADDITIONAL

Output: Placement of a marker at the right supraclavicular region at the region of interest and no abnormal enhancement at this area. Dedicated ultrasound could be performed for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: 62 years, Male, Reason: L hemispheric lesion? History: recent syncopal/ possible seizure episode; R hyperreflexia; h/o colon CA. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Extensive patchy foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as in the brainstem which are compatible with moderate to severe chronic small vessel ischemic disease. Scattered lacunar infarcts are also evident including the centrum semiovale, corona radiata, right anterior putamen, and right subinsular region. Focus of FLAIR signal abnormality in the left thalamus may also be related to prior ischemia. Several scattered foci of susceptibility are compatible with chronic microhemorrhages and in a nonspecific distribution.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Minimal paranasal sinus mucosal thickening. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastatic disease. No evidence of acute infarct.2. Moderate to severe chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Per EPIC, patient presented with a right neck lump in 2011 found to have squamous cell cancer of the right tonsil and underwent CRT in 2011. In 9/2013, he had a biopsy of the right pharynx which revealed SCCA, P16+. Underwent salvage right oropharyngectomy and right LN dissection in 2/2014. Completed reconstruction with supraclavicular flap. Pathology revealed a pT1N0 posterior oropharyngeal wall residual focus of p16+ SCC measuring 1.0 cm and extending within 4 mm of the deep margin. He developed a second local recurrence in 9/2014 at the right neck. He underwent a salvage surgery (12/10/14) with pathology revealing a 2.4 cm poorly differentiated non-keratinizing SCC of the right oral cavity. On 6/8/15, a mass is noted in the right nasopharynx (biopsy showed SCC). BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild mucosal thickening of the right frontal sinus and moderate mucosal thickening of the right maxillary sinus. There is partial opacification of the anterior ethmoid air cells. There is partial opacification of the right mastoid air cells. NECK SOFT TISSUE: There is an ill-defined and infiltrative enhancing mass centered within the right lateral and posterior nasopharynx with effacement of the fossa of Rosenmuller, which extends anteriorly to the right pterygoid plates, laterally into the masticator space, posteriorly to the carotid space and superiorly to the skull base. The exact dimensions are difficult to delineate. The right mandibular condyle is inferiorly displaced relative to the left side, which may be degenerative versus tumor infiltration. The lesion surrounds the right V3 nerve but does not demonstrate definite intracranial perineural extension.Redemonstrated are postoperative findings related to resection of posterior right hemimandible as well as flap reconstruction of the right-sided pharyngeal soft tissues. There are postoperative findings related to right neck dissection. A screw plate extending from the mandibular symphysis along the right anterior mandibular body is better seen on prior CT. There is no evidence of significant cervical lymphadenopathy. The thyroid gland is unremarkable. The right internal jugular vein is not visualized. The airways are patent.

Output: 1. An ill-defined, infiltrative and heterogeneously enhancing lesion within the right nasopharynx extending anteriorly to the pterygoid plates, laterally into the masticator space, posteriorly to the carotid space and superiorly to the skull base with possible tumor infiltration at the right temporomandibular joint is consistent with known recurrent squamous cell carcinoma. No significant cervical lymphadenopathy.2. The lesion surrounds the extracranial right V3 nerve, but there is no definite evidence of intracranial extension.


Instruction: Generate impression based on findings.

Input: 9-year-old male with history of rectal pain, perineal swelling, redness and induration. Evaluate for perianal abscess. BONE MARROW: No significant abnormality noted.SOFT TISSUES: In the superficial soft tissues adjacent to the left wall of the anus is an approximately 2.4 x 1.5 x 2 cm peripherally enhancing collection with restricted diffusion, consistent with abscess. Although the adjacent high T2 signal intensity indicates inflammation affecting the perianal musculature on the left, the abscess cavity appears to be inferior to these muscles within the subcutaneous fat. Given the amount of adjacent inflammation it is impossible to completely exclude fistulous connection with the very distal anus.JOINTS: No significant abnormality noted.ADDITIONAL

Output: Left superficial perianal abscess as above. Cannot completely exclude fistulous connection with the distal anus.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness Left: The femur demonstrates normal marrow signal. The surrounding muscle is normal in signal and caliber without evidence of atrophy or inflammation. Following contrast administration, there is no abnormal enhancement.Right: The femur demonstrates normal marrow signal. The surrounding muscle is normal in signal and caliber without evidence of atrophy or inflammation. Following contrast administration, there is no abnormal enhancement.

Output: Normal MRI of the thighs.


Instruction: Generate impression based on findings.

Input: 69-year-old male with syncope. There is no evidence of intracranial hemorrhage, mass or edema. Lacunar changes within the left basal ganglia and diffuse hypodensity within a periventricular and subcortical white matter distribution consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: Reason: are there any abnormalities? History: term infant with perinatal depression, post cooling. 41 weeks gestational age, L GA, convulsions, respiratory distress with pneumothorax. There is evidence of restricted diffusion within the right posterolateral thalamus, the bilateral midthalami, and the corpus callosum without cortical involvement. There is also a small focus of susceptibility within the right posterolateral thalamus, representing microscopic blood products.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The posterior cerebellar vermis may be hypoplastic versus anatomic variation, with a prominent posterior fossa CSF space. There is fluid adjacent to the torcula and the right transverse sinus which displaces the adjacent sinuses, perhaps representing an effusion due to molding of the skull. The myelination patterns are appropriate for the patient's gestational age. There is no evidence of definite intracranial hemorrhage. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is a 1.1 cm subgaleal hematoma extending across the midline parietal scalp.

Output: 1. Findings consistent with hypoxemic ischemic injury, likely profound given the involvement of the posterolateral thalamus.2. Small parietal subgaleal hematoma.3. T1 hypointense fluid adjacent to the torcula, which likely represents an effusion due to skull molding. No evidence of intracranial hematoma.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out extension of the hemorrhage, tumor. Signs and symptoms: ICH. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrate a focus of susceptibility signal change and hypointensity on T2-weighted images consistent with hemosiderin deposition at the site of previously known left anterior frontal hematoma. There is interval decreased size hemorrhage and complete resolution of surrounding vasogenic edema. There is no associated mass effect or gliosis. This focus measures approximately 9.5 x 27-mm in size. On post enhanced images there is significant interval decrease in the enhancement of the lesions since prior study and only tiny residual foci of enhancement in the rim of the lesion is identified. There is no evidence of mass as is questioned clinically. Appearance of the finding also is not suggestive of a cavernoma however this possibility cannot be entirely excluded.There are a few tiny foci of flair hyperintensity in the periventricular and subcortical white matter which although nonspecific considering patient's stated age of 69 the possibility of minute chronic nonhemorrhagic small vessel ischemic strokes should be considered.The anatomical morphology as well as signal intensity of brain parenchyma otherwise remains within normal patient's stated age of 69.Calvarium and soft tissues of the scalp are unremarkable. Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. A single left posterior ethmoid air cell opacification however is detected.

Output: 1.Negative diffusion weighted images.2.Interval decreased size of left frontal hematoma and complete resolution of surrounding edema and with trace residual enhancement as detailed. There is no evidence of an underlying vascular malformation or mass present as is question clinically.3.Finding suggestive of minimal chronic nonhemorrhagic small vessel ischemic strokes


Instruction: Generate impression based on findings.

Input: 28 year old woman with no medical history who presents with new onset of heart failure symptoms and was found to have significant left ventricular hypertrophy on echo suggestive of possible hypertrophic cardiomyopathy. She was referred for cardiac MRI to evaluate for possible HCM. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. There is severe hypertrophy with regional variation. The interventricular septum is thickest with a wall thickness of 20mm. The anterolateral wall is ~9mm thick. The overall LV ejection fraction is 74%; however, based on myocardial tagging intramyocardial motion is significantly reduced. The LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), the LVEDV is 141ml (normal range 109+/-23), the LV end systolic volume index is 17ml/m2 (normal range 18+/-5), the LVESV is 36ml (normal range 31+/-10), the LV mass index is moderately increased, measuring 107g/m2 (normal range 67+/-11), and the LV mass is 233g (normal range 114+/-24). No evidence of myocardial iron deposition. There is patchy late gadolinium enhancement in the septum consistent with macroscopic myocardial fibrosis. The overall burden of fibrosis is mild. The native myocardial T1 time ranges between 1150-1250ms suggest that there is a significant amount of microscopic fibrosis. Left AtriumThe left atrium is moderately enlarged. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 51ml/m2 (normal range 69+/-14), the RVEDV is 112ml (normal range 110+/-24), the RV end systolic volume index is 18ml/m2 (normal range 22+/-8), and the RVESV is 39ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild systolic anterior motion of the mitral valve with mild regurgitation and mild flow acceleration in the left ventricular outflow tract. 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 bovine brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is a 11mm lymph node in the left axilla. 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. Severe, asymmetric hypertrophy of the left ventricle with normal systolic function (EF = 74%) . The interventricular septum is most prominently hypertrophied with a maximum wall thickness of 20mm. There is a small burden of macroscopic fibrosis/ late gadolinium enhancement noted in the septum. Based on native myocardial T1-mapping, the patient likely has a significant amount of microscopic myocardial fibrosis. These findings are consistent with the diagnosis of hypertrophic cardiomyopathy. 2. Normal size RV with normal systolic function (EF = 65%). 3. Systolic anterior motion of the mitral valve with mild mitral regurgitation and mild flow acceleration in the LVOT. 4. Moderate left atrium dilatation. 5. There is a 11mm lymph node in the left axilla.Findings were reviewed with cardiology consult team. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Choreic movements, parkinsonism, and history of cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal nonspecific scattered foci of T2 hyperintensity in the cerebral white matter, which may represent chronic small vessel ischemic disease. The caudate nuclei and the rest of the basal appear to be intact. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There ia a partially-imaged low signal intensity focus in the right cheek subcutaneous tissues, which may represent scar tissue.

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


Instruction: Generate impression based on findings.

Input: Mass in the right lateral thigh. There is a 11 x 15 x 18 mm lesion within the distal vastus lateralis muscle just above the knee which follows fat signal on all sequences. The lesion questionably has at least two septae, but these do not show appreciable enhancement on post-contrast imaging. The remaining musculature is within normal limits. Bone marrow signal is within normal limits.

Output: Lesion within the distal vastus lateralis muscle is most likely a benign intramuscular lipoma.


Instruction: Generate impression based on findings.

Input: Concern of tethered cord: sacral dimple. The conus medullaris is positioned at the T12 level and the imaged spinal cord and cauda equina nerve roots are unremarkable. There appears to be appropriate shifting of the spinal canal contents between prone and supine imaging. There is no evidence of fibrofatty filum. However, there is prominent epidural fat from L4 to the inferior sacral canal, with variable narrowing of the spinal canal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The right kidney is absent.

Output: 1. No specific findings to suggest tethered cord or associated anomalies.2. Epidural lipomatosis from L4 to the inferior sacral canal.3. The right kidney is absent.


Instruction: Generate impression based on findings.

Input: History of 3 mm pancreatic body cyst on outside CT. History of prostatectomy in 2008 for prostate cancer. Evaluate for abnormalities. ABDOMEN:LIVER, BILIARY TRACT: Few nonenhancing T2 hyperintense hepatic lesions are identified, compatible with cysts, the largest within segment 5 measures 2.7 x 1.7 cm. No enhancing hepatic lesion is identified. The liver is smooth in contour and normal in morphology. The portal and hepatic veins are patent. No biliary ductal dilatation is identified.SPLEEN: No significant abnormality noted.PANCREAS: There is a 9 mm cystic lesion arising from the pancreatic head (series 5, image 77) contiguous with a side branch of the main pancreatic duct, probable sidebranch IPMN. No pancreatic ductal dilatation is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a large lesion containing multiple cysts arising from the left lower pole measuring 14.2 x 12.4 cm (series 3, image 30), favor multilocular cystic nephroma given lack of enhancing or nodular components. Multiple right subcentimeter T2 hyperintense lesions are present, too small to characterize, but probable cysts. No hydronephrosis is identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subcentimeter cystic lesion within the pancreatic head, probable IPMN.2.Large left renal cystic lesion, favor multilocular cystic nephroma, but unable to exclude cystic renal cell carcinoma.


Instruction: Generate impression based on findings.

Input: 54 year old female with history of right mastectomy in 2006 for invasive lobular carcinoma. Status post autologous right reconstruction. No current breast complaints. Status post right mastectomy and reconstruction.There is heterogeneous amount of fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or reconstructed right breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Anesthesia of skin [R20.0] / Paresthesia of skin [R20.2], Reason for Study: ^Reason: stroke workup History: left arm numbness Brain MRINo evidence of acute ischemic or hemorrhagic lesion.A couple of T2/FLAIR high signal intensity lesions on subcortical white matter which are nonspecific.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

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


Instruction: Generate impression based on findings.

Input: Pain with locking up. ROTATOR CUFF: There is mild thickening and increased signal intensity within the distal fibers of the infraspinatus tendon compatible with mild tendinosis. Additionally, there is a small partial thickness insertional tear of the anterior fibers of the infraspinatus tendon. There is no supraspinatus or infraspinatus muscle atrophy. The teres minor and subscapularis muscles and tendons are intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is no significant fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a hypoplastic osseous posterior glenoid with fragmentation of the cartilage labrum. There is thinning of the glenoid cartilage posteriorly. There is a small to moderate joint effusion.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: 1. Partial thickness insertional tear and mild tendinosis of the infraspinatus tendon.2. Hypoplastic glenoid.


Instruction: Generate impression based on findings.

Input: Ms.Sue Barauski, 69 years old, submitted outside study for review. Images performed at Northwestern Memorial Hospital submitted for review: Mammogram 12/2/2015Ultrasound 12/2/2015MRI breasts 12/24 2015Images submitted for comparison:None Mammogram 12/2/2015: Of note, outside screening mammogram is not available. 6 diagnostic views of the right breast were obtained. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . There is a dense mass with spiculated margin identified in the far posterior lateral right upper outer breast measuring 1.4 cm in superior-inferior dimension. Two adjacent clustered calcifications (each measuring 5 mm), spanning approximately 2.2 cm, are noted in the mid and posterior aspect of the right upper outer breast. The total distance from the anterior calcification to the posterior mass is approximately 7.7 cm on the cc view.Right Breast Ultrasound 12/2/2015 : Static ultrasound images are submitted for interpretation.In the right breast, 10:00 position, 8 cm from the nipple, labeled as palpable, is a 1.2 x 1 x 1.3 cm hypoechoic mass with angular margin. There is associated peripheral flow. No definite mass or cystic lesion identified ton the provided images marked 7 to 11:00 position, 6 cm from the nipple. Ultrasound of the right axilla demonstrate a few normal-appearing lymph nodes.Ultrasound-Guided and a stereotactic guided Biopsy Of the right breast Breast 12/2/2015: Previously identified mass in the the right breast breast 10:00 position 8 cm from the nipple is the target for the ultrasound biopsy. Targeting appears appropriate. Stereotactic guided biopsy imaging of the posterior calcification in the right breast also showed appropriate targeting.Post Procedure Mammogram (10/19/2015): A coil -shaped clip is placed in the right breast posteriorly at site of ultrasound-guided biopsy. A central bow tie shaped clip is placed in the right breast anteriorly at site of stereotactic guided biopsy. Residual anterior calcifications are noted in the right upper outer quadrant.Distance between the 2 clips is 5.5 cm.PER OUTSIDE PATHOLOGY:A. The right breast, 10:00 position, 8 cm from the nipple; ultrasound guided core needle biopsy:- Invasive carcinoma with mixed ductal and lobular feature, grade 1 and associated microcalcifications.B. the right breast calcification, upper Outer quadrant; stereotactic guided core needle biopsy:- ductal carcinoma in situ, grade 2MR breast 12/24/2015:Multisequence axial MRI of both breasts was performed with and without IV contrast as per outside facility breast MRI protocol. The breasts are composed of heterogeneous fibroglandular tissue. There is moderate background parenchymal enhancement.Right breast:In the right breast, 10:00 position, approximately 10 cm from the nipple, there is a 1.4 x 1.4 x 1.4 cm (AP X ML X SI) enhancing mass with irregular margin which demonstrates suspicious enhancing kinetics. This is compatible with the biopsy proven invasive carcinoma. The biopsy clip is centered in the mass.Anterior to the index mass is the susceptibility artifact from the stereotactic guided biopsy clip. There is 9 mm nonmass enhancement adjacent to this clip. Additionally, there is asymmetric nonmass enhancement and enhancing foci in segmental distribution in the right breast extending anteriorly, medially and inferiorly from the enhancing index mass. The total extent of this enhancement and the index mass measures 7 x 5 x 6 cm (AP x ML x SI). The anterior most of this enhancement is approximately 12 mm from the nipple base.Left breast:A few enhancing foci are noted in the left breast, which is nonspecific. No suspicious enhancement in the left breast.Bilateral axillary lymph nodes are unremarkable.

Output: 7 x 5 x 6 cm index mass with adjacent asymmetric segmental nonmass enhancement in the right breast, more extensive than mammographic measurement. Distance between the 2 clips is 5.5 cm. If additional tissue sampling is considered, stereotactic guided biopsy of the anterior most calcification can be performed.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male 8 years old Reason: Ao root dilatation Left VentricleThe left ventricle is normal in size. 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. Global LV function is normal.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely. There is dephasing inferior to the aortic valve suggesting aortic regurgitation. Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaStatus post transposition correction (arterial switch correction, LeCompte maneuver). The ascending thoracic aorta is dilated. There is a left sided aortic arch. The right coronary artery arises from the posteriorly rotated right sinus of Valsalva and branches normally. The left coronary artery, arises from the anterior left sinus of Valsalva and courses posteriorly in between the aortic root and the left atrial appendage with no intramural portion or evidence of compression and branches normally.AORTA MEASUREMENTS: aortic valve ring: 18 mmsinuses of Valsalva: 38.5 mmsinotubular junction: 11.3 mmascending aorta: 14 mmaortic arch: 11 mmdescending aorta: 11.7 mmdiaphragmatic hiatus: 14 mmAORTA FLOW QUANTITATION: Stroke volume in ml: 40.3 Forward flow volume in ml: 74.8Backward flow volume in ml: 34.5Regurgitant factor in %: 46.1Pulmonary ArteryStatus post transposition correction (arterial switch correction, LeCompte maneuver). The main pulmonary artery is normal in size. The left pulmonary artery appears to be mildly narrowed, however flow quantification measurements demonstrate equal flow to the right and left pulmonary branches.PULMONARY ARTERY MEASUREMENTS:MAIN: 17 mmRIGHT: 13.4 mmLEFT: 8 mmPULMONARY ARTERIES FLOW QUANTITATION:Main pulmonary arteries flow quantitation values are as follows:Stroke volume in ml: N/AForward flow volume in ml: N/ABackward flow volume in ml: N/ARegurgitant factor in %: N/ARight pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 17.2Forward flow volume in ml: 20Backward flow volume in ml: 2.72Regurgitant factor in %: 13.6Left pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 19.6Forward flow volume in ml: 19.7Backward flow volume in ml: 0.1Regurgitant factor in %: 0.6Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.

Output: 1. Status post arterial switch operation.2. Normal right and left ventricle function. 3. Significant aortic root dilatation (38 cm in diameter), significant aortic valve insufficiency.4. Particular coronary anatomy as described above.5. Normal cardiac viability, no evidence of intracardiac shunt.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: CT scan of 11/12/15 recommended MRI of skull base/ sinus: Confirmed CSF rhinorrhea with question of cephalocele in right sphenoid and posterior ethmoid sinus. There is herniation of dysplastic brain parenchyma, adhesions, and cerebrospinal fluid into the right sphenoid sinus, posterior ethmoid sinus, and nasal cavity via a 7 mm wide defect in the right planum sphenoidale, which is compatible with an encephalocele. The encephalocele measures up to 3 cm in length. There is associated distortion and encephalomalacia of the right gyrus rectus. Fluid surrounding the encephalocele may represent leakage of cerebrospinal fluid. There are prominent arachnoid granulations in the floor of the middle cranial fossae bilaterally. There is also an enlarged partially-empty sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is a nonspecific focus of susceptibility effect in the left posterior fossa. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a retention cyst formation within the left maxillary sinus.

Output: 1. Encephalocele within the right sphenoid sinus and extending into the posterior ethmoid sinus and nasal cavity via a skull base defect with associated right gyrus rectus encephalomalacia. Fluid in the right sphenoid sinus may represent associated cerebrospinal fluid leakage.2. Prominent arachnoid granulations in the floor of the middle cranial fossae bilaterally and an enlarged partially-empty sella suggest underlying pseudotumor cerebri, which can also predispose to encephalocele formation and cerebrospinal fluid leakage.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:9/19/1943)Reason: assess for T11 compression fracture History: back painPROVIDER/ATTENDING NAME: MAGDALENA ANITESCU MAGDALENA ANITESCU MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a subcutaneous well-circumscribed lesion present behind the T9 spinous process measuring 25 x 16 mm sagittal dimensions. It is predominantly low signal on T1 and intermediate signal on T2 STIR. Most likely this represents a sebaceous cyst. It was also present in the MRI of the lumbar spine from 3/14/2012 and has not changed.There is a small central disc protrusion present at C2-3. There is a small right paramedian disc protrusion at T3-4 there is a right paramedian disc extrusion at T4-5, T5-6 and T6-7 which impress on the ventral aspect of the thecal sac but do not effaces spinal fluid behind the spinal cord.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disc bulge and some disc desiccation at this level associated with facet and ligamentum flavum hypertrophy. There is some triangulation of the thecal sac. The fat at the lateral recess is not effaced on either left or right side. This has not changed since the prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some mild disc desiccation at this level. There is ligamentum flavum hypertrophy at this level. This has not changed since the prior exam.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with some ligamentum flavum hypertrophy. There is some mild crowding of the nerve roots at this level. This has not changed since the prior exam.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in the lumbar spine in the form of facet hypertrophic change but also some disc desiccation and disc bulges without significant compromise to spinal canal or neural foramina. This is stable compared2.There are small disc protrusions and extrusions in the thoracic spine without significant compromise to the spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 36-year-old female. Pain with popping sensation and knee. ? meniscal tear. Due to the patient's body habitus, a knee coil could not be used. A flex coil was used instead, which results in slightly suboptimal image quality. Additionally, there is limited evaluation of multiple sequences due to motion artifact.MENISCI: The lateral half of the posterior horn of the medial meniscus is replaced with abnormal signal intensity indicating a large tear, likely a root avulsion. This is associated with mild medial extrusion of the body of the medial meniscus. A focus of fat signal intensity within the remaining fibers of the posterior horn may represent a meniscal ossicle. The anterior horn of the medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Evaluation of the articular cartilage is suboptimal due to the aforementioned limitations. Moderate to severe osteoarthritis affects the patellofemoral joint with findings suggestive of full-thickness cartilage loss along the patella. There also appears to be near full thickness to full thickness cartilage loss along the medial femoral condyle and medial tibial plateau anterior to the posterior horn of the medial meniscus. Relatively mild cartilage degeneration affects the lateral tibiofemoral compartment cartilage. Foci of edema within the tibial plateau are likely degenerative in etiology.LIGAMENTS: The ACL is thickened and of increased signal intensity; we suspect this reflects mucoid degeneration with a tear considered less likely. The PCL is intact. Edema along the superficial band of the MCL could represent a sprain in the correct clinical context but may also be seen in patients with underlying meniscal tears and osteoarthritis. The lateral collateral ligamentous complex appears intact.EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact. There is nonspecific edema in the subcutaneous fat anterior to the patellar tendon.ADDITIONAL

Output: 1. Limited study, as described above.2. Large tear of the posterior horn of the medial meniscus, as described above, suggestive of a root avulsion.3. Osteoarthritic changes and other findings, as described above.


Instruction: Generate impression based on findings.

Input: Lower back pain x 2 weeks There are 5 lumbar vertebral bodies. Chronic loss of vertebral body height of L4 is again seen, similar to MRI exam dated 7/14/2009. There is new slight anterior wedging of L2 but we suspect this is chronic in etiology. Severe degenerative disc disease affects L3-L4 with probable neural foraminal narrowing at L3. Moderate degenerative disc disease affects L2-L3 with associated inferior endplate degenerative changes at L2. Degenerative disc disease at L1-L2 appears to have progressed compared to prior MRI. There are post-surgical laminectomy defects at L3 and L4. There is grade I retrolisthesis of L3 and L5. The bones appear demineralized, suggesting osteopenia. Severe osteoarthritis affects the partially visualized left hip.

Output: Chronic appearing compression deformities, degenerative disc disease, and other findings as described above.


Instruction: Generate impression based on findings.

Input: 83-year-old man with right frontal contusion and left frontal epidural hematoma. Question extension of hematoma. There are bilateral, fluid-density subdural CSF collections. These appear slightly enlarged from previous studies, although the previous exam is suboptimal. The crescent shaped lesion in the left pterion region is isodense to the brain parenchyma and consistent with a meningioma -- this could be better evaluated with MRI. The lesion measures 1.5 x 0.8 cm (series 1430 image 12).There are periventricular regions of hypoattenuation consistent with age-indeterminate, small vessel ischemic disease.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.The right frontal scalp hematoma is decreased in size from the prior study.

Output: 1. Bilateral subdural CSF collections with slight increase in size from previous study.2. Left pterion lesion consistent with meningioma.3. No CT evidence of epidural hematoma as questioned on requisition.


Instruction: Generate impression based on findings.

Input: Elevated PSA. Previous negative biopsy. Evaluate for prostate tumor. PELVIS:PROSTATE:Prostate Size: 4.9 x 3.6 x 4.3 cmPeripheral Zone: 7 x 5 mm focus of T2 hypointensity with diffusion restriction and early enhancement in the right mid-gland is suspicious for carcinoma.Central Gland: Heterogeneous and enlarged with nodules, compatible with marked BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The aforementioned 7 mm lesion abuts the capsule adjacent to the neurovascular bundle, without extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.7 x 5 mm focus in the right peripheral zone at mid-gland suspicious for carcinoma.2.Marked BPH.


Instruction: Generate impression based on findings.

Input: Female, 29 years old, with low back pain, possible herniated disk. The L5 vertebral body demonstrates a lumbosacral transitional morphology. Vertebral morphology is otherwise typical and unremarkable. No evidence of concerning marrow replacement or marrow edema is seen.The conus tip terminates at the L1 level which is normal. The visualized spinal cord and conus as well as the nerve roots of the cauda equina are unremarkable. The lower lumbar spinal canal is very capacious, perhaps even a bit ectatic. Large perineural root sleeve cysts are evident within the lower sacral canal and along the sacral foramina.The intervertebral disks demonstrate normal height and signal.From T12-L1 through L3-4, there is no evidence of significant disk herniation, spinal canal stenosis or neuroforaminal narrowing. L4-5, there may be mild disk bulging without significant spinal canal or neuroforaminal stenosis.At L5-S1, there is no evidence of significant disk disease or spinal canal stenosis. A perineural root sleeve cyst occupies the right L5-S1 neural foramen, but the neural foramina are otherwise patent.

Output: 1. At most, minimal disk bulging is seen at L4-5. At no level is there any significant spinal canal or neuroforaminal stenosis.2. Multiple large perineural root sleeve cysts are evident in the lower sacral spinal canal as well as the sacral neural foramina. These are a common incidental finding and are usually of no significance, but they can occasionally be symptomatic. Correlation with radicular type symptomatology is suggested.


Instruction: Generate impression based on findings.

Input: A few sequences are motion degraded. Given this caveat:There are new small focal parenchymal defects within the basal ganglia, as well as inferior right cerebellar hemisphere, with central CSF intensity. There are progressive patchy foci of T2 hyperintensity within the white matter, predominantly periventricular in location, without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are unchanged. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Scattered foci of mucosal thickening can be found within the paranasal sinuses. The mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Small bilateral basal ganglia lacunar infarcts and inferior right cerebellar hemisphere small vessel infarct. These are new since the 2009 comparison study, however are chronic in appearance.2.Progressive chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Clinical question : evaluate for bleed. Signs and symptoms: Headaches. Nonenhanced head CT:No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal.Calvarium demonstrate a sclerotic lesion measuring 15 times 7-mm in size in the diploic space are right parietal bone. There is no erosive changes of outer or the inner table of the skull. There is no associated soft tissue abnormality with this finding and the scalp or in the epidural space. A second similar lesion is noted in the left parietal bone measuring 7 times 10-mm in size. A questionable low density lesion of calvarium in the left parietal bone is also suspected. Recommend correlation with history and follow-up with an MRI exam to exclude metastatic lesions.Visualized orbits, paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.No evidence of intracranial abnormality.2.Two small focus of sclerotic bony changes of calvarium may represent bony islands. Less likely possibility of sclerotic metastatic disease cannot be ruled out. A questionable left parietal lucent lesion is also noted measuring 7 times 7-mm in size which could represent a mass. Recommend correlation with history and follow-up with an MRI exam.


Instruction: Generate impression based on findings.

Input: Clinical question: New bleed. Signs and symptoms cord status post fall, altered mental status. Non-enhanced CT brain: Images through posterior fossa demonstrate no definitive evidence of abnormality and stable since prior study.There is a focal area of edema involving the anterior tip of right temporal lobe (gray and white matter) with possible minimal hemorrhage which is similar to prior study. This results in effacement of adjacent cortical sulci. There is however no midline shift. This finding is concerning for a foci of contusion. Additional area of low attenuation involving the cortex and subcortical white matter of right frontal pole measuring 30-mm times 20 mm size. There is no detectable parenchymal hemorrhage in this region.Small amount of blood within the subarachnoid space in the right anterior parietal on axial image 21 is noted.There is a CSF density subdural hygroma which extends from approximately the level of the floor of the left anterior and middle cranial fossa superiorly to the vertex. There is interval increase in the size of these finding since prior exam. The thickest segment of this extra-axial CSF collection measures approximately 6 mm. There is resultant mild effacement of adjacent cortical sulci. A very small right sided frontal CSF density extra-axial collection is also suspected. This finding was present on prior exam and shows no change. There is no evidence of new bleed since prior exam. Ventricular size remains within normal and with no midline shift. No evidence of intraventricular hemorrhage. Follow-up with an MRI examination for further detailed evaluation of extent of injury is recommended. Calvarium is intact. Limited view of the orbits are unremarkable. Visualized paranasal sinuses demonstrate minimal soft tissue density within the right maxillary sinus. Mastoid air cells and middle ear cavities are pneumatized and unremarkable.

Output: 1.No evidence of new hemorrhage is prior study.2.Foci of edema in the right anterior temporal with minimal hemorrhage, edema in the right anterior frontal lobe with no hemorrhage or bleed can represent areas of contusion. A small amount of subarachnoid hemorrhage in right parietal region.3.CSF density subdural collections bilaterally as detailed. This finding is more pronounced on the left and the suggestion of interval increase since prior examination of the same date.4.Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Right lumbar radicular pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Bone marrow signal is benign. There is grade 1 anterolisthesis of L4 and L5. Alignment is the lumbar spine is otherwise maintained. The conus medullaris is normal in position. There is desiccation of the L4-L5 and L5-S1 discs. Multilevel degenerative changes are seen with individual levels as below: Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. Mild bilateral facet arthropathy and ligamentum flavum thickening which partially effaces the lateral aspects of the thecal sac. Otherwise no significant spinal canal or neural foraminal stenosis.L1-L2: Mild bilateral facet arthropathy and ligamentum flavum thickening which partially effaces the left lateral aspect of the thecal sac. Otherwise no significant spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Mild bilateral facet arthropathy and ligamentum flavum thickening which partially effaces the lateral aspects of the thecal sac. Otherwise no significant spinal canal stenosis. There is mild to moderate right neural foraminal stenosis. No significant left neural foraminal stenosis.L3-L4: Small right foraminal disc protrusion, mild bilateral facet arthropathy, and ligamentum flavum thickening. There is mild effacement of the left lateral thecal sac, otherwise no significant central canal stenosis. There is mild bilateral neural foraminal narrowing.L4-L5: There is mild disc bulge with dorsal annular fissure. There is advanced bilateral facet arthropathy. No significant central canal stenosis. There is mild to moderate bilateral, left greater than right, neural foraminal stenosis.L5-S1: There is mild disc bulge and mild facet arthropathy. No spinal canal stenosis. There is moderate to severe right neural foraminal stenosis where there may be impingement of the right L5 nerve root. Mild left neural foraminal narrowing.There is a large T2 hyperintense, cystic structure measuring greater than 12 cm in the right abdomen at the level of the right kidney.

Output: 1. Multilevel degenerative changes in the lumbar spine. Right-sided neural foraminal stenosis is worst at the L5-S1 level where there may be impingement of the right L5 nerve root. No high-grade spinal canal stenosis at any level. Additional levels as above.2. Large T2 hyperintense, cystic structure measuring greater than 12 cm in the right abdomen at the level of the right kidney. Consider ultrasound or CT for further assessment or comparison with prior imaging if available.


Instruction: Generate impression based on findings.

Input: 57 year old man with history of ESRD, NASH cirrhosis, CVA and CAD s/p CABG presenting with chest pain Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 71%, the LV end diastolic volume index is 103 ml/m2 (normal range: 74+/-15), the LVEDV is 207 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 61 ml (normal range 47+/-19), the LV mass index is 67 g/m2 (normal range 85+/-15), and the LV mass is 134 g (normal range 164+/-36). There are no regional wall motion abnormalities present. No evidence of intracardiac iron (T2 *decay time 39 ms). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 93 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 66 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 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 normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsIron present in liver. 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. Normal biventricular function2. No evidence of cardiac iron overload.


Instruction: Generate impression based on findings.

Input: New headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a defect in the left medial orbital wall, which may represent a prior fracture. There is susceptibility effect in the left frontal scalp region, which may represent metal within or overlying the scalp. There is a nonspecific enhancing lesion in the right frontal skull that measures up to 10 mm.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Mild scattered cerebral white matter T2 hyperintensity may represent chronic small vessel ischemic disease. 3. Nonspecific enhancing lesion in the right frontal skull that measures up to 10 mm. Follow up via a head CT may be useful for further characterization.


Instruction: Generate impression based on findings.

Input: 50-year-old man with atherosclerotic gangrene of the hands. Left hand:The middle finger is absent with what appears to be a soft tissue defect distal to the third metacarpal head with overlying bandage material. There is also swelling of the soft tissues of the hand with additional foci of gas density dorsal to the third, fourth and fifth metacarpals. There is loss of soft tissue along the ulnar aspect of the distal and middle phalanges of the index finger, compatible with gangrene. We see no frank osteolysis to confirm osteomyelitis. There is extensive arterial calcification in the forearm, wrist and hand as well as surgical clips the distal forearmRight hand:There is loss of soft tissue along the phalanges of the index and middle fingers which is compatible with gangrene, but we see no frank osteolysis to confirm osteomyelitis. There is a linear metallic fragment within the distal phalanx of the thumb, which may represent a foreign body, with osteolysis of the surrounding bone, which may reflect sequelae of prior infection/foreign body reaction. There is extensive arterial calcification in the forearm, wrist and hand.

Output: Gangrene of both hands and extensive arterial calcification as described above.


Instruction: Generate impression based on findings.

Input: Male, 58 years old, with history of multiple sclerosis, assess for interval change. Multiple small T2 hyperintense lesions are evident involving the periventricular and juxtacortical white matter of both cerebral hemispheres. The brainstem and cerebellum are spared.On comparison with the prior examination, two new lesions are seen, one in the left frontal operculum (image 54 series 501), and one in the superficial right middle frontal gyrus (image 69 series 501). Another lesion in the right occipital periventricular white matter (image 117 series 401) is larger. The remaining lesions are unchanged. The lesions demonstrate mild to moderate T1 hypointensity.No areas of significant parenchymal edema or mass effect are detected. No abnormal extra-axial collections are seen. The sulci and ventricles are very mildly prominent compatible with underlying volume loss.

Output: Several scattered lesions are seen compatible with multiple sclerosis in the bilateral cerebral hemispheres. On comparison with the prior examination, two lesions are new and one is larger.


Instruction: Generate impression based on findings.

Input: Evaluate for spinal stenosis. There is a normal lumbar lordosis. The lumbar spine alignment and the vertebral body height appear normal. T12/L1, L1/L2, L2/L3: unremarkable. L3/L4: mild disc bulge; no neuroforaminal compromise or spinal canal stenosis. L4/L5: disc bulge; bilateral facet joint and ligamentum flavum hypertrophy; bilateral facet joint space widening with fluid accumulation on the right and air accumulation on the left; bilateral neuroforaminal compromise; spinal canal stenosis (8 mm in AP). L5/S1: mild disc bulge; no neuroforaminal compromise or spinal canal stenosis. Incidental findings are atrophy of bilateral kidneys and heavy calcification in the abdominal aortic and iliac arteries.

Output: Degenerative disease of the lumbar spine, most pronounced at L4/L5, as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: Patella Chondromalacia History: Pain MENISCI: There is linear and globular increased signal intensity within the anterior horn of the lateral meniscus that also extends into the body of the meniscus in a horizontal fashion indicating degeneration. This linear signal intensity appears to contact the tibial articular surface suggesting a degenerative horizontal tear. Furthermore, the mucoid material extends to the periphery of the meniscus to form an elongated parameniscal cyst that runs along the anterior, lateral, and possibly posterior aspects of the meniscus. There is slight blunting of the posterior horn of the lateral meniscus which may represent mild fraying. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the medial facet of the patella and femoral trochlea with much of the facets being devoid of articular cartilage. There is associated degenerative subchondral signal abnormality in the surrounding area. There is relatively mild degeneration of the articular cartilage of the lateral facet of the patella. We see no fluid-filled articular cartilage defects affecting the medial and lateral tibiofemoral compartments. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is a lobulated collection of fluid signal intensity along the posterior margin of the PCL which may represent ganglion formation. There is thickening and intermediate signal intensity within the proximal fibers of the LCL proper which may represent prior sprain or degeneration.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Severe osteoarthritis of the patellofemoral joint, predominantly involving the medial facets.2. Degeneration and degenerative tearing of the lateral meniscus with parameniscal cyst formation.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 50-year-old male with mechanical symptoms, evaluate for medial meniscal tear MENISCI: There is an oblique undersurface tear involving the body and posterior horn of the medial meniscus extending to the tibial articular surface. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal. The patellar and trochlear cartilage is intact. There is diffuse thinning within the medial and lateral compartments without a fluid-filled full-thickness defect. Small tricompartmental osteophytes are again seen.LIGAMENTS: Medial and lateral collateral ligament complexes are intact. ACL and PCL are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Medial meniscal tear.2.Mild osteoarthritis.


Instruction: Generate impression based on findings.

Input: Brain metastases for SRS. There are multiple supratentorial and infratentorial metastases, which appear to be similar in size as on the prior MRI. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Pre-treatment planning MRI demonstrated multiple supratentorial and infratentorial metastases.


Instruction: Generate impression based on findings.

Input: There are a few patchy foci of T2 hyperintensity primarily involving the subcortical white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is appropriate for age. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Fluid is noted within a few mastoid air cells (left greater than right). Middle ear cavities are clear. There is no abnormal enhancement within the brain. Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: 1.There are a few patchy foci of T2 hyperintensity primarily involving the subcortical white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. Per Epic notes, the patient was born term via spontaneous vaginal delivery without complication. Given this constellation of imaging features, in the context of patient history, these findings are nonspecific and the differential diagnosis would include non-acute ischemic sequelae, inflammation, demyelination, dysmyelination, or perhaps a metabolic etiology (such as mitochondrial disorder).2.The seventh and eighth nerves are normal in size and are symmetric bilaterally.


Instruction: Generate impression based on findings.

Input: 78-year-old female with right elbow pain. Evaluate for right elbow mass. Evaluation is markedly limited by motion artifact throughout the entire study. Markers were placed in particular attention was placed in this region.A focal somewhat elongated fusiform intramuscular mass is observed in the area of the patient's markers with mild enhancement. Minimally immediately adjacent fat is suggested the lesion is possibly best observed on the sagittal STIR images and is grossly homogeneous (series 8, image 20).The remaining osseous structures are otherwise grossly intact, specifically marrow signal is unremarkable. The remaining muscular compartments and soft tissues are also grossly unremarkable within this limited study, however please note ligaments are not evaluated adequately for comment.

Output: Markedly limited exam with findings suggesting possible nerve sheath abnormality observed immediately lateral to the radial head and neck. Consultation with Dr Haydon in orthopedics is suggested before further evaluation is considered.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Post resection follow-up of cavernoma. Redemonstration of right insular and right lateral aspect of basal ganglia resection cavity with hemosiderin deposition. No change since prior scan.There is no evidence of new susceptibility artifact lesions.Enhancement of development of venous anomaly on the anterior mesial aspect of the resection cavity does not show interval change.Minimal extraocular changes of the right lateral ventricle, again no change since prior scan. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Minimal fluid collection on the right mastoid air cells, no change since prior scan.

Output: Stable post resection status of the right insular and lateral aspect of the basal ganglia cavernoma since prior exam.There is no evidence of new acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: HCV cirrhosis, evaluate for HCC ABDOMEN:LIVER, BILIARY TRACT: Liver contour: The liver contour is nodular. Features of portal hypertension: None.Portal vein: Patent.Hepatic veins: Patent.Hepatic artery: Conventional.Lesions: Several arterially enhancing parenchymal foci in the liver without washout.SPLEEN: Accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Status post right mastectomy. Band-like left base atelectasis.

Output: Cirrhosis without suspicious lesions to suggest HCC.


Instruction: Generate impression based on findings.

Input: Altered mental status, Due to patient's motion, the MR examination was prematurely stopped thus this examination does not include gradient echo scans.Subtle restricted diffusion on the right thalamus as well as involving posterior limb of right internal capsule is seen which may indicate subacute ischemic infarction. Since there is no gradient echo scans, possibility of focal hemorrhagic transformation cannot be evaluated. There is another high signal intensity lesion on the left lateral ventricle occipital horn on the diffusion weighted image which again shows subtle diffusion restriction as well as subtle high signal intensity on T2 weighted image. This lesion also may represent subacute ischemic infarction.There are focal small tissue losses on the bilateral basal ganglia and left centrum semiovale indicate multifocal chronic lacunar infarcts.Scattered high signal intensity lesions on bilateral trigone area as well as lower pons may indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Subacute ischemic infarction on the right thalamus and periventricular white matter around the left lateral ventricle occipital horn as described above.2. Multifocal chronic ischemic lacunar infarctions and non specific small vessel ischemic disease as described above.3. No MR evidence of PRES.


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness, altered mental status, evaluate for stroke. MRI HEAD: Examination is significantly limited secondary to motion artifact. Numerous punctate foci of diffusion restriction are demonstrated predominantly in the bilateral frontal lobes with a few punctate foci present in the bilateral parietal lobes well. Additionally, there are punctate foci of diffusion restriction involving the basal ganglia. Extensive patchy and nodular areas of T2/FLAIR hyperintensity are demonstrated in the periventricular and subcortical white matter, most prominent at the frontal lobes. No midline shift or mass effect is appreciated.MRA HEAD: The internal carotid arteries are unremarkable. The bilateral middle and anterior cerebral arteries appear unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries appear grossly unremarkable.

Output: 1. Numerous punctate foci of acute ischemia predominantly involving the frontal lobes, basal ganglia, and to a lesser degree the parietal lobes.2. Extensive patchy and nodular areas of T2/FLAIR hyperintensity involving the periventricular and subcortical white matter may be related to chronic vascular ischemic change.3. Unremarkable MRA of the head.


Instruction: Generate impression based on findings.

Input: There are stable postsurgical changes related to left C2-3 laminotomy, left C3-4 hemilaminectomy as well as left C7-T1 and T1-2 laminotomies. There is improved associated paraspinal soft tissue edema. However, superficial fluid has increased in the midline posterior paraspinous soft tissues along the surgical tract. A surgical drain terminates in the left paraspinal musculature at the level of C2.There has been apparent interval resolution of the fluid collection involving the ventral epidural space throughout the cervical and visualized upper thoracic spine. Lack of intravenous contrast does limit assessment for minimal residual abscess. There is no significant residual associated spinal canal stenosis or mass effect on the visualized spinal cord. No cord signal abnormality. Mild edema in the spinous processes of the cervical spine may be reactive. Mild multilevel degenerative changes are redemonstrated throughout the cervical spine with mild resultant multilevel neural foraminal stenoses, which is relatively worse at C3-4, right more than left, and to a lesser degree at the C4-5 and C5-6 levels. Vertebral body heights in the cervical spine are maintained. No suspicious osseous lesions. No findings to suggest discitis-osteomyelitis in the cervical spine.

Output: 1. Lack of contrast may limit evaluation for minimal residual abscess. There is however no significant residual fluid collection evident or residual mass effect on the cervical or upper thoracic cord. 2. Mild increase in subcutaneous fluid in the midline of the posterior paraspinous soft tissues along the surgical tract. Left paraspinal surgical drain remains in place.


Instruction: Generate impression based on findings.

Input: Ascending aortic aneurysm follow-up. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: The ascending thoracic aorta measures 4.1 x 4.1 cm at the level of the main pulmonary artery unchanged from the prior exam.. The main pulmonary artery measures 2.8 cm. The remainder of the thoracic aorta is unremarkable.CHEST WALL: No significant abnormality noted

Output: Aneurysmal dilatation of the ascending aorta without significant interval change compared to prior exam dated 9/16/2014


Instruction: Generate impression based on findings.

Input: 73 year-old female with a right hemipelvis retroperitoneal mass extending into the right hip. Again seen is a predominantly fatty mass within the adductor musculature of the right hip extending through the obturator foramen to involve the obturator internus muscle, measuring approximately 12 x 4.5 cm in the transverse dimension and approximately 11.5 cm in the craniocaudal dimension. The mass also appears to extend slightly into the acetabular fossa. We see no invasion of the bone. There are septations within the mass, some of which appear to show mild enhancement. There are additional nonadipose elements within the superomedial aspect of the mass that appear similar to the prior study and may represent small regions of necrosis, but we see no dominant soft tissue nodule to suggest dedifferentiation.The obturator nerve and artery are not well seen below the level of the pubic ramus. The mass results in slight lateral displacement of the right femoral artery and vein. There is also slight posterior displacement of the right sciatic nerve. The bone marrow signal intensity is within normal limits. Degenerative disc disease affects the visualized lower lumbar spine, most pronounced at the level of L3/L4. There is low signal intensity within the uterus which likely represents fibroids, as seen the prior study. There is also a mass with fat signal intensity measuring approximately 2.0 cm within the left adnexal region which may represent a dermoid.

Output: Predominately fatty mass as described above, appearing similar to the prior study. The differential diagnosis includes a lipoma as well as an atypical lipomatous tumor.


Instruction: Generate impression based on findings.

Input: 18 year old male with a history of hypoplastic right ventricle who under went BT shunt as infant followed by take down of BT anastomosis, creation of bidirectional Glenn shunt, enlargement of atrial septostomy, and followed by lateal tunnel Fontan with fenestrations who is referred for cardiac MRI for further evaluation to evaluate for hypoxia. Overall AnatomyHypoplastic right ventricle s/p bidirectional Glenn shunt and Fontan (lateral tunnel) procedure. The interatrial septum has been resected. There is tricuspid valve atresia with hypoplastic right ventricle. The left ventricle is dominant and is the systemic ventricle.Systemic Venous Return (Fontan)A Glenn shunt connects the SVC to the right pulmonary artery. There is a conduit connecting the IVC to the right pulmonary artery. There are no obstruction or leak noted in or around the Glenn shunt. The possibility of a stenosis or a Fontan leak in the distal part of the lateral tunnel can not be excluded due to imaging artifact in that territory. Systemic Ventricle (i.e. Left Ventricle)The left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 92 ml/m2 (normal range: 74+/-15), the LVEDV is 156 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 78 ml (normal range 47+/-19). 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.Pulmonary Venous ReturnThere are four pulmonary veins which seem to drain into the common atrium; unfortunately, the anatomy is not optimally defined due to large artifact related to surgical material posterior to the heart. Right VentricleThe right ventricle is hypoplastic.Common AtriumThe interatrial septum has been resected resulting in a common atrium. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve is not well seen due to the above described imaging artifact.Tricuspid ValveThe tricuspid valve is atretic.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no thoracic aortic aneurysm or thoracic aortic dissection. Left and Right Pulmonary ArteryThe left pulmonary artery has a diameter of ~10mm. The right pulmonary artery has a diameter of ~9mm.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. Glenn shunt and lateral tunnel Fontan noted. The Glenn shunt is without obstruction or obvious other abnormality. The IVC is dilated and the possibility of a stenosis or leak in the distal portion of the Fontan can not be excluded due to imaging artifact. 2. Normal left ventricular size with low normal systolic function (LVEF 50%).3. Hypoplastic right ventricle/ tricuspid atresia4. Coronary sinus drains into the "common" atrium. 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, 64 years old, with upper extremity weakness, fasciculations and atrophy, with history of lumbar foraminal stenosis with weakness and hyperreflexia. Also with asymmetric pupils. There is a reversal of the normal cervical lordosis centered at C3. In addition, there is a trace anterolisthesis of C2 relative three, and a trace retrolisthesis of C5 relative to C6, all of which findings are likely degenerative in nature.Edematous endplate signal alteration is seen along the C3-4 disc, likely degenerative. Elsewhere the marrow signal intensity is heterogeneous but without frankly worrisome features. Facet arthropathy with osseous and paraspinal edema is noted at C7-T1 bilaterally.The spinal cord demonstrates normal signal characteristics throughout. Morphology is unremarkable except as discussed by level below. Lobular soft tissue is evident filling the left C7-T1 neural foramen and projecting slightly into the spinal canal with indentation of the adjacent dura. This nodule measures up to 12 x 7 mm. The right vertebral artery flow void is not clearly visualized which may represent slow flow, stenosis or occlusion. The intervertebral discs demonstrate loss of disc height and T2 signal, particularly from C3 through C6. Additional level specific findings are as follows:C2-3: Left facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C3-4: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. C4-5: Mild facet and uncovertebral hypertrophy. No significant spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. C5-6: Mild facet hypertrophy. Disc osteophyte formation. Effacement of ventral thecal sac with slight flattening of the ventral cord but no cord signal abnormality. Moderate left and mild right foraminal narrowing. C6-7: Uncovertebral hypertrophy. No significant spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. C7-T1: Advanced facet arthropathy. Posterior disc-osteophyte complex formation with a small superiorly directed disc herniation. Left foraminal soft tissue nodule as discussed above. Ligamentum flavum thickening. Findings contribute to produce a mild to moderate generalized spinal canal narrowing particularly in the transverse dimension. Mild right foraminal narrowing. Moderate to severe left foraminal narrowing.

Output: 1. Nodular soft tissue is evident within the left neural foramen at C7-T1. The differential for this finding would include a small tumor such as a schwannoma, or perhaps an extruded disc or inflammatory tissue related to the adjacent severe facet arthropathy. Further evaluation with contrast-enhanced MRI images is suggested as this would better assess for the possibility of a tumor.2. Multilevel degenerative findings are seen affecting with the discs and posterior elements. Spinal canal stenosis are seen at C5-6 and at C7-T1. Advanced facet arthropathy is also noted at C7-T1.


Instruction: Generate impression based on findings.

Input: Memory loss. Many of the sequences are degraded by patient motion. There is moderate diffuse cerebral white matter T2 hyperintensity and left basal ganglia encephalomalacia with susceptibility effect. There is also right occipital lobe encephalomalacia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse cerebral volume loss, which is particularly pronounced in the medial temporal lobes bilaterally. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a small atlanto-axial articulation effusion.

Output: 1. Diffuse cerebral volume loss, which is particularly pronounced in the medial temporal lobes bilaterally may be a manifestation of Alzheimer's disease. 2. Moderate diffuse chronic small vessel ischemic disease and chronic right occipital lobe infarct and left basal ganglia hemorrhagic lacunar infarct, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 62 year-old female status post mucinous cystadenoma resection which contained a focus of invasive adenocarcinoma. Evaluate for metastatic pancreatic cancer. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodense lesion near the falciform ligament in the left lobe of the liver is nonspecific (image 20/112 on series number 4).SPLEEN: Status post splenectomyPANCREAS: Patient is status post distal pancreatectomy. Within the distal remaining pancreas there is a 3.1x 1.9 cm cystic collection which may be in continuity with the pancreatic duct, however this is unclear. There is no solid enhancing component to this collection. The pancreatic remnant is otherwise unremarkable.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Small aortocaval and mesenteric lymph nodes are not pathologically enlarged by CT criteria.BOWEL, MESENTERY: A small left of midline hernia contains mesenteric fat.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Left adnexal cyst measures 3.8 x 3.6 cm (image 82/112). This can be further evaluated with gynecologic ultrasound or MRI.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. No definite evidence of metastatic disease. There is a fluid attenuation collection at the distal portion of the pancreatic remnant as described above.2. Left adnexal cyst which is incompletely evaluated on this examination and should be further evaluated with gynecologic ultrasound or MRI if this patient is post-menopausal.


Instruction: Generate impression based on findings.

Input: There is no suspicious intracranial enhancement, acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No findings to explain patient's headaches.


Instruction: Generate impression based on findings.

Input: Aphasia, right sided weakness. MRI: There is encephalomalacia and susceptibility effect in the inferior left parietal lobe. There is also gyriform susceptibility effect and punctate subcortical susceptibility effect in the left occipital lobe. There is a background of diffuse cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of acute infarct. There is diffuse mild 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.MRA: There is no evidence of significant steno-occlusive lesions in the major head and neck arteries. There is a three vessel aortic arch. The bilateral vertebral arteries are tortuous and the left vertebral artery is diminutive diffusely. There is no evidence of cerebral aneurysms. There is a fetal left posterior cerebral artery, which represents an anatomic variant.

Output: 1. No evidence of acute acute infarct. Encephalomalacia and susceptibility effect in the inferior left parietal lobe, as gyriform susceptibility effect and punctate subcortical susceptibility effect in the left occipital lobe may represent prior hemorrhages, perhaps related to amyloid angiopathy.2. No evidence of significant steno-occlusive lesions in the major head and neck arteries.