Instruction: Generate impression based on findings.

Input: Ms. Bianchi is a 38 year old female with a family history of breast cancer in her mother (diagnosed at the age of 51) and maternal great aunt. Personal history of bilateral silicone implants and BRCA2 mutation carrier. There is extreme amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally. There are intact bilateral retropectoral silicone implants. A focal area of T2 hyperintensity within the right upper outer breast is unchanged and appears benign.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Newly diagnosed right breast ILC presents for staging MRI. There is scattered fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, a limitation to the study.The biopsied cancer in the right upper outer breast measures 2.1 x 1.4 x 2.0 cm and has internal artifact from the biopsy clip. Extending anterior to the mass are two 7 mm masses which are suspicious for satellite lesions given their proximity to the known cancer. The AP extent of the index lesion and satellites is 4 cm. Additionally, in the mid depth of the right inner breast near 2:00, there is an enhancing focus measuring 5 mm. In the right axilla, there are multiple lymph nodes that are slightly enlarged compared to the left side. These however retain fatty hila. A subpectoral node has a uniformly thickened cortex of 4 mm, though it too retains a fatty hilum. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in the left axillary region.

Output: 1. Biopsy proven cancer in the right breast measures up to 2.1 cm and is associated with anterior satellite lesions for an AP extent of 4.0 cm. MRI directed ultrasound is suggested to look for correlates to the satellite masses. 2. Right inner breast focus measuring 5 mm may be benign. An MRI directed ultrasound is recommended to ensure no suspicious sonographic correlate. As long as ultrasound is negative or typically benign, a 12 month MRI follow up is suggested to ensure stability. 3. Asymmetric right axillary lymph nodes, including a borderline thickened subpectoral node.4. No evidence of left breast malignancy. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: History of lateral and third ventriculomegaly. History of prematurity, born at 28 wk station age. Also, history of tracheal esophageal fistula and esophageal atresia; status post repair. On antibiotics for Enterococcus bacteremia. Minimal susceptibility effect is present in the occipital horns of the lateral ventricles, are reflective of blood products from previous hemorrhage. There is mild dilatation of the third and lateral ventricles. The third ventricle measures in width up to 12 mm, which is similar to the previous ultrasound from March 2016. The fourth ventricle is normal size. The sulci are prominent, especially anteriorly. There is no midline shift or brain herniation. There is no acute infarct or other parenchymal signal abnormality. While the degree of myelination seems appropriate for the adjusted gestational age, overall cerebral white-matter volume is diminished which probably also explains the mild, diffuse thinning of the otherwise completely formed corpus callosum. The major intracranial vascular flow voids are preserved.

Output: 1. Trace layering chronic intraventricular blood products.2. Mild lateral and third ventriculomegaly is not significantly changed since the previous ultrasound. This may, at least in part, reflect the cerebral white-matter volume which is globally diminished. There may also be a component of benign enlargement of subarachnoid spaces, which should resolve by two years of age. Follow up imaging may be obtained as clinically indicated.


Instruction: Generate impression based on findings.

Input: New onset tremor and bradykinesia: history of head injury. There is paucity of high SWI signal within bilateral substantia nigra nigrosome-1. There is mildly reduced T2 signal in the bilateral putamen and globi pallidi along with susceptibility effect, suggestive of mineral deposition. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is retention cyst formation in the left maxillary sinus.

Output: Findings indicative of Parkinson disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 83-year-old male with severe foot pain with ulcer, rule out osteomyelitis There are postsurgical changes of transmetatarsal amputation as seen on prior radiographs. There is edema within the lateral aspect of the foot and immediately adjacent to the stump. There is also ulceration and skin thickening in the soft tissues immediately adjacent to the stump with edema approaching the bone, however there is no definite signal abnormality to indicate osteomyelitis. There is edema within the fifth metatarsal stump without associated low T1 signal, likely representing reactive osteitis. Linear T1 signal through the fifth metatarsal stump may represent an old nondisplaced fracture. Edema is also seen within the subcutaneous tissues along the posterior aspect of lower leg and medial aspect of the ankle. No focal fluid collection is present.

Output: Ulceration along the distal stump with edema extending to the bones, however there is no definite evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 61-year-old male with prostate cancer. PELVIS:PROSTATE:Please note that dynamic contrast enhanced images were limited due to scanner malfunction.Prostate Size: 4 x 4.2 x 3.6 cm.Peripheral Zone: Dominant focus of low T2 signal with restricted diffusion measuring up to 10 x 9 mm (series 903/1 44), compatible with prostate cancer in the left inferior mid gland. The lesion abuts the capsule with slight extracapsular extension.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Slight extracapsular extension of the above-described left inferior mid gland prostate cancer.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left-sided prostate cancer with slight extracapsular extension.


Instruction: Generate impression based on findings.

Input: 35-year-old female with Crohn's disease with fistulization. Status post multiple resections. Presents with abdominal pain, diarrhea, and fever. There is a question of a ruptured left ovarian cyst. ABDOMEN:LIVER, BILIARY TRACT: Again seen is a large right hepatic lobe hemangioma, appearing similar to the prior study. An additional subcentimeter focus of fluid signal intensity is identified in the left lobe of the liver, which is too small to characterize, but likely represents a simple cyst, unchanged. There is no intra-or extrahepatic biliary ductal dilatation. The hepatic vasculature is patent.SPLEEN: Subcentimeter focus of fluid signal intensity in the spleen is too small to characterize, but may represent a simple cyst.PANCREAS: Again seen are findings consistent with pancreatic divisum. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is a long segment area of wall thickening, hyper enhancement and hypomotility measuring approximately 13 cm in length. The previously described wall thickening and stenosis appears less pronounced when compared to the prior study. The previously described marked enhancement of the distal ileum also appears decreased when compared to the prior study. The ileo-cecal anastomosis is again noted to be patent without significant inflammation or stenosis.Again seen is hyperenhancement of the distal sigmoid colon with wall thickening compatible with active fibro-stenotic disease, also appearing improved when compared to the prior study.Again seen is a transsphincteric perianal fistula formation at the 7 to 8 o'clock position of the rectum. This fistula is again noted to communicate with an intersphincteric perianal fistula located at the 6 o'clock position. The intersphincteric fistula is associated with a small subcentimeter perirectal fluid collection which appears decreased in size when compared to the prior study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral retropectoral breast implants are incompletely visualized.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is a long segment area of wall thickening, hyper enhancement and hypomotility measuring approximately 13 cm in length. The previously described wall thickening and stenosis appears less pronounced when compared to the prior study. The previously described marked enhancement of the distal ileum also appears decreased when compared to the prior study. The ileo-cecal anastomosis is again noted to be patent without significant inflammation or stenosis.Again seen is hyperenhancement of the distal sigmoid colon with wall thickening also appearing improved when compared to the prior study.Again seen is a transsphincteric perianal fistula formation at the 7 to 8 o'clock position of the rectum. This fistula is again noted to communicate with an intersphincteric perianal fistula located at the 6 o'clock position. The intersphincteric fistula is associated with a small subcentimeter perirectal fluid collection which appears decreased in size when compared to the prior study.BONES, SOFT TISSUES: Note is made of multiple foci of metallic susceptibility artifact in the soft tissues overlying the anterior aspect of the right hemipelvis.OTHER: Note is made of nonspecific free fluid within the pelvis which is nonhemorrhagic. No definitive ovarian cysts are identified on the prior examination and clinical correlation is indicated. Multiple follicles in the left ovary.

Output: 1.Interval improvement of the previously described findings, as detailed above. 2.Persistent perianal fistula formation.3.Nonspecific free fluid in the pelvis.


Instruction: Generate impression based on findings.

Input: A lesion with high signal in the T2 and FLAIR, low signal in T1 without enhancement is seen in the right parietal region. This lesion measures 25 x 18 mm in transaxial view.There is another lesion in the left inferior and middle frontal gyrus with mixed and heterogenous high signal in T2 and FLAIR and mixed high and low signal in T1 and partial enhancement. In its largest transaxial view the lesion measures 43 x 35 mm. Note is made that the lesion abuts the anterior horn of the left lateral ventricle which is partially effaced. There are heterogenous low signal in the susceptibility sequences representing a hemorrhagic lesion.There is a lesion in the right frontal lobe with heterogenous high signal in T2 and FLAIR, mixed signal in T1, minimal surrounding edema with peripheral enhancement, measuring approximately 18 x 33 mm in transaxial view. There are foci of low signal in this region representing hemorrhage.There is a lesion located in the right supramarginal gyrus, abutting the occipital horn of the right lateral ventricle. The lesion has peripheral high signal in T2 and FLAIR with minimal surrounding edema, low signal in T1 and peripheral enhancement. This lesion measures 11 x 8 mm in transaxial view.There is a lesion in the left occipital lobe with high signal in T2 and FLAIR, low signal in T1, partial enhancement and punctate of flow signal in the susceptibility images, measuring 18 x 33 mm. The lesion is hemorrhagic.Two lesions of high signal in T2 and FLAIR with low signal in T1, peripheral enhancement and punctate low susceptibility signal are seen in the left cerebellar lobe.Ventricular size is normal. No evidence of midline shift. Basal cisterns are patent.Paranasal sinuses are normal.The orbits are normal.There is a partially empty sella.There are no convincing metastatic lesion in the calvarium.

Output: The lesions described above in the supratentorial region and in the left cerebellar hemisphere are of high signal in T2 and FLAIR, some necrotic, some with surrounding vasogenic edema, and some hemorrhagic. These lesions most likely represent metastatic lesions.


Instruction: Generate impression based on findings.

Input: 62 years, Male, Reason: Eval biliary system, assess hepatic vessel patency History: s/p liver transplant May 2008, history of hepatolithiasis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT:Postsurgical changes of orthotopic liver transplant. No focal hepatic lesions. Hepatic and portal veins are patent.Narrowing of the extrahepatic duct at the anastomosis with more distal irregularity is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts and perinephric fluid is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fat-containing ventral hernia is unchanged.OTHER: No significant abnormality noted.

Output: Mild narrowing at the biliary anastomosis with more distal irregularity is stable.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with disseminated histoplasmosis, Candida fungemia, evaluate for fungal/histo focus in the brain. Encephalomalacia and signal abnormality suggesting gliosis are seen at the junction of the right inferior parietal lobe and temporal lobe. A small but similar-appearing lesion is also seen in the left frontal lobe. No evidence of restricted diffusion is seen. No edema or mass effect is detected. A few punctate scattered foci of T2 hyperintensity are nonspecific. Prominence of the CSF spaces is suggestive of underlying parenchymal volume loss. Prominent prevascular spaces are seen in the left basal ganglia.Asymmetry of the ventricles is likely congenital. The size of the ventricles remains within normal limits. There may be a small ependymal cyst at the left atrium. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen.

Output: 1.No findings are seen to suggest active intracranial infection. No acute abnormalities are evident.2.Encephalomalacia and gliosis of the right inferior parietal lobe may reflect prior ischemia. A smaller lesion in the left frontal lobe is also possible ischemic in nature.


Instruction: Generate impression based on findings.

Input: Tibial lesion There is a bony exostosis of the medial portion of the proximal left tibial metadiaphysis. There is clear extension from the marrow (series 8 image 60/80 and series 4 image 7/23) without evidence of a soft tissue mass. There is no evidence to suggest malignancy or osteomyelitis. The marrow signal of both the exostosis and the accompanying tibia is normal. There is no abnormal enhancement.There is diffuse subcutaneous edema of the lower extremity, particularly anteriorly. There is no evidence of a focal fluid collection. There is mild diffuse fatty atrophy of the musculature.

Output: 1. Bony exostosis of the proximal left tibia. There is no evidence of malignancy or osteomyelitis.2. Diffuse subcutaneous edema of the lower extremity without focal fluid collection.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis. Recent urinary retention. PELVIS:UTERUS, ADNEXA: The uterus and adnexa are normal in appearance.BLADDER: The bladder is distended with fluid. There is no bladder wall thickening.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction. Partially imaged neurofibroma left of the L4 lumbar vertebral body is again identified, only included on the field-of-view on coronal imaging.BONES, SOFT TISSUES: Dural ectasia with scalloping of the posterior lumbar vertebral bodies is unchanged. There is mild asymmetry of the soft tissues about the thigh, with medial skin thickening and conglomerate T2 hyperintensity within the subcutaneous tissues, unchanged from prior. There are scattered round T2 hyperintense masses throughout the subcutaneous tissues and musculature of the right thigh and posterior to the right knee, which have increased in size. Index neurofibroma in the adductor musculature measures 3.6 x 2.3 cm (series 1001, image 24), previously 1.7 x 1.3 cm. Index neurofibroma in the deep posterior compartment of the thigh measures 1.3 x 1.3 cm (series 901, image 39), previously 1.2 x 1.1 cm.OTHER: None

Output: Increased size of neurofibromas within the right thigh musculature. Please refer to separate MRI of the thoracic and lumbar spine for spinal findings.


Instruction: Generate impression based on findings.

Input: 63-year-old female, with a history of right lumpectomy for DCIS in 2002. Patient received radiation and tamoxifen. Known BRCA two mutation carrier. Family history breast carcinoma in her mother, maternal first cousin, and paternal aunt. Family history of ovarian carcinoma in her maternal aunt at age 35. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Postsurgical changes are present within the right retroareolar region, unchanged from prior examinations. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 63 year old man s/p heart transplant (with graft vasculopathy s/p PCI), Gerbode defect, referred for stress perfusion imaging.MEDICATIONS: ASA, amlodipine, lipitor, plavix, lisinopril, prograf, cellcept. First Pass PerfusionDuring hyperemia, there is no perfusion defects consistent with ischemia. There are fixed perfusion defects in the basal inferoseptum and basal to apical inferior wall in areas noted to have scar from prior myocardial infarctions.Viability/ Myocardial ScarThere is subendocardial late gadolinium enhancement noted in the basal to mid inferior and inferoseptal walls. It is in a pattern suggestive of prior myocardial infarction, and occupies greater than 50% of the myocardial thickness, indicating low likelihood of viability. The remaining myocardium is viable.Left VentricleThe left ventricle is normal in size with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 78 ml/m2 (normal range: 74+/-15), the LVEDV is 166 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 99 ml (normal range 47+/-19), the LV mass index is 51 g/m2, and the LV mass is 109 g. There is dyskinesis and thinning of the basal to mid inferior and inferoseptal walls. There is a Gerbode ventricular septal defect (LVOT-RA shunt) with left to right flow. Qp/Qs is 1.3. Left AtriumThe left atrium is enlarged consistent with transplant morphology.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 57 ml/m2 (normal range 82+/-16), the RVEDV is 122 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 53 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. There is mild late gadolinium enhancement of the pericardium. 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. During hyperemia, there is no perfusion defects consistent with ischemia. There are fixed perfusion defects in the basal inferoseptum and basal to apical inferior wall in areas noted to have scar from prior myocardial infarctions.2. There is a transmural myocardial infarction involving the basal to mid inferoseptum and inferior walls. These segments have low likelihood of viability. The remaining myocardium is free of myocardial infarction and is viable.3. The left ventricle is normal in size with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%. There is dyskinesis and thinning of the basal to mid inferoseptal and inferior walls. 4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%.5. There is a Gerbode ventricular septal defect (LVOT-RA shunt) with left to right flow. Qp/Qs is 1.3. 6. There is mild late gadolinium enhancement of the pericardium, which could be sequelae from a prior episode of pericarditis. It can not be determined from this study whether this finding is associated with constrictive physiology.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient with past medical history of SLE, presenting with bilateral lower extremity, left greater than the right weakness and decreased sensation below umbilicus. Alignment is anatomic. There is multilevel loss of T2 signal of the intervertebral discs. Conus medullaris terminates at the level of L1-L2. Vertebral body heights are preserved. A hemangioma is noted in the L5 vertebral body.At L1-L2, there is mild bulging of the disc and mild bilateral neural foraminal narrowing. At L2-L3, there is hypertrophy of the ligamentum flavum and facet joint arthropathy with mild disc bulge, resulting in mild spinal canal stenosis and bilateral mild neural foraminal narrowing. At L3-L4, there is facet joint arthropathy and a diffuse disc bulge resulting in effacement of the thecal sac and moderate narrowing of the spinal canal, along with moderate left and mild right neural foraminal stenosis. At L4-L5, there is facet joint arthropathy, small facet effusions, and a diffuse disc bulge resulting in moderate to severe spinal canal stenosis and severe right and moderate left neural foraminal stenosis. Epidural fat appears to contribute to the narrowing of the spinal canal at this level. There is mild loss of intervertebral disc space at this level. At L5-S1, there is facet joint arthropathy and mild disc bulge with no significant spinal canal stenosis. Moderate bilateral neural foraminal narrowing is noted at this level.Large probable fibroid uterus is present. Otherwise the visualized soft tissues are unremarkable.

Output: 1.Multilevel degenerative changes of the lumbar spine, with severe spinal canal and right neural foraminal stenoses at the L4-L5 level.2.Large probable fibroid uterus.


Instruction: Generate impression based on findings.

Input: Clinical question: Chiari and tethered cord, history of decompression and cord repair OSH. Still with symptoms. Signs and symptoms: Unexplained cognitive and growths delay, headaches and back pain. Nonenhanced total spine MRI:Examination demonstrates expected post operative changes of Chiari decompression with resultant expansion of subarachnoid space at the level of surgery. There is no detectable herniation of cerebellar tonsils or tonsillar deformity identified.The signal intensity and the caliber of the entire cord remains within normal and in particular without evidence of syrinx. The cord terminates at L1 -- L2 disk level. The morphology and the signal intensity of the cauda equina is within normal and in particular no evidence of fatty filum present.Sagittal T2 prone images demonstrate distinct anterior movement of the lower thoracic cord, conus and proximal cauda equina compared to sagittal T2 supine images.There is subtle postoperative changes of prior surgical approach for untethering of the cord at S1 level.Unremarkable nonenhanced total spine MRI otherwise.3-D fiesta sequence demonstrate patency of the aqueduct however there is mild narrowing of the lumen of the aqueduct in its most cephalad aspect.CSF flow study demonstrate presence of biphasic flow anteriorly through the foramen magnum.The biphasic flow pulsation posteriorly to the cord terminates at the level of foramen magnum and there is no detectable biphasic flow posterior to the cerebellar tonsils, ventricle or in the aqueduct.

Output: 1.Expected postoperative changes of Chiari decompression and without evidence of tonsillar herniation or deformity.2.Normal signal intensity and caliber of cor and with normal termination at L1 -- L2 disk level.3.Distinct anterior movement of the conus and proximal cauda equina on prone sagittal T2-weighted series.4.Very subtle postoperative changes of cord untethering at S1 level as detailed above.5.Normal signal intensity of cauda equina and in particular without evidence of any fatty deposition of the filum.6.CSF flow study demonstrate presence of a normal appearing biphasic flow through the foramen magnum anterior to the cord. The biphasic flow of CSF posterior to the cord however terminates at the level of the foramen magnum. There is no detectable flow posterior to the cerebellum, fourth ventricle or the aqueduct.


Instruction: Generate impression based on findings.

Input: 57 year old male patient with history of a left renal mass. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a 4.1 x 3.9 x 3.4 cm exophytic mass arising off the interpolar region of the left kidney. The mass demonstrates a peripheral hypointense T2 rim and heterogeneous internal T2 signal. Although there is internal T1 hyperintensity, there is no significant susceptibility on in and out of phase imaging; it is unclear if this represents proteinaceous material or hemorrhage. There is the suggestion of stellate enhancement within the lesion on subtraction imaging.Multiple subcentimeter hypointense lesions within the bilateral kidneys are too small to characterize. There is an exophytic left renal cyst. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left renal mass with encapsulation, low T2 signal, and perhaps a stellate configuration of enhancement; this may represent an oncocytoma vs a renal cell carcinoma.


Instruction: Generate impression based on findings.

Input: 63-year-old female with pain. Evaluate for rotator cuff tear. ROTATOR CUFF: There is a full-thickness near complete tear of the supraspinatus just proximal to the level of its insertion on the greater tuberosity measuring approximately 15 mm in AP dimension. There is approximately 12 mm of retraction of the proximal tendon fragment. There is also interstitial tearing of the supraspinatus at the level of the myotendinous junction. There is intermediate signal intensity within the supraspinatus indicating moderate tendinosis. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small to moderate amount of fluid within the subacromial subdeltoid bursa. There are foci of low signal intensity internally suggestive of a bursitis. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Mild osteoarthritis affects the glenohumeral joint. There is heterogeneity and increased signal intensity within the anterior superior glenoid labrum indicating degeneration, within the limitations of this non arthrogram study.BICEPS TENDON: There is intermediate signal intensity within the intra-articular portion of the long head of the biceps tendon indicating a very mild tendinosis. The tendon appears intact. ADDITIONAL

Output: 1. Full-thickness near complete tear of the supraspinatus with minimal retraction as described above. Rotator cuff tendinosis.2. Very mild tendinosis of the long head of the biceps tendon.3. Findings suggestive of a subacromial subdeltoid bursitis.4. Mild osteoarthritis of the glenohumeral and acromioclavicular joints.


Instruction: Generate impression based on findings.

Input: Metastatic non-small cell lung cancer with brain metastases No abnormal parenchymal or meningeal enhancement is appreciated. No intracranial mass or mass effect. Again seen is extensive confluent T2/FLAIR hyperintensity in the bilateral frontoparietal and to a lesser degree temporal and occipital white matter most compatible with treatment related encephalopathy. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. There are multiple scattered foci of susceptibility effect including the right temporal lobe, as well as the bilateral cerebellar hemispheres similar to prior.Major flow-voids are preserved. There is prominent flow-void involving the right supraclinoid internal carotid artery consistent with aneurysm and similar to prior.There is moderate opacification of the right sphenoid sinus including the lateral recess, new since prior. Left maxillary mucous retention cyst again seen. Minimal fluid within the bilateral mastoid air cells again seen. There is a 1 cm enhancing lesion involving the left frontal calvarium at the vertex and the right parietal calvarium, axial post gad T1 fat-sat series 11 images 5 and 8, not seen previously. No large destructive osseous lesions.

Output: 1. No evidence of intraparenchymal or leptomeningeal metastatic disease.2. There are two, approximately 1 cm in size, enhancing lesions in the left frontal and right parietal calvarium which are not seen on prior studies (axial postgad T1 fat-sat series 11, images 5 and 8). These are nonspecific but possibility of osseous metastatic disease is not excluded. Consider close follow-up examination.3. Unchanged extensive supratentorial white matter abnormality most compatible with treatment-related leukoencephalopathy.4. Unchanged scattered punctate foci of chronic microhemorrhages which are nonspecific and can be seen with entities such as chronic hypertension as well as sequela of radiation treatment. 5. Right supraclinoid internal carotid artery aneurysm again seen and grossly similar in size to prior but can be better evaluated with dedicated MR or CT angiogram.6. New right sphenoid sinus opacification with fluid-level which can be seen with acute sinus disease in the appropriate clinical setting.


Instruction: Generate impression based on findings.

Input: UGIB, dilated CBD ABDOMEN:Bilateral pleural effusions and left basilar consolidation/atelectasis.LIVER, BILIARY TRACT: T2 hyperintense focus in the left hepatic lobe compatible with a hemangioma. Additional scattered hepatic cysts. Perihepatic ascites. The hepatic and portal veins are patent. Intra and extrahepatic biliary ductal dilation. Common bile duct measures 11 mm with layering sludge and stones. The gallbladder is distended.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post gastrojejunostomy with nasojejunal catheter. Foci of susceptibility in the left upper quadrant reflect postoperative changes better evaluated on comparison CT. BONES, SOFT TISSUES: Orthopedic hardware in the spine.

Output: 1.Dilated CBD and choledocholithiasis as described above.2.Left upper quadrant postsurgical changes better evaluated on comparison CT.3.Bilateral small pleural effusions and left basilar consolidation / atelectasis.


Instruction: Generate impression based on findings.

Input: History of complex partial epilepsy. There are a few scattered nonspecific T2 hyperintense cerebral white matter lesions. The rest of the brain, including the hippocampi, brainstem, and cerebellum appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a partially empty sella. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid in the left mastoid air cells. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Mild scattered nonspecific cerebral white matter lesions.2. Nonspecific partially empty sella, which may be related to pseudotumor cerebri or pituitary atrophy, for example.3. Fluid in the left mastoid air cells may represent mastoiditis.


Instruction: Generate impression based on findings.

Input: 61 years Male (DOB:5/19/1955)Reason: Patient with a history of CVID, head and neck Ca, alpha 1 AT defic and recurrent zoster with facial pain. R?o recurrent malignancy or other etiology of nerve pain History: left sided facial painPROVIDER/ATTENDING NAME: KATHLEEN M. MULLANE KATHLEEN M. MULLANE The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate focus of signal loss and susceptibility imaging located in the left inferior frontal gyrus.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The patient status post paranasal sinus surgery. There is a craniotomy defect along the frontal sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for intracranial mass lesion or other explanation for the patient's headache. 2.The patient is status post paranasal sinus surgery.


Instruction: Generate impression based on findings.

Input: 86-year-old female with acute onset of dizziness. Concern for posterior circulation stroke. MRI Brain: There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. There is no diffusion abnormality. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense lesions are appreciated in the brainstem and thalami.A punctate lesion in the left centrum semiovale which is low signal on susceptibility weighted imaging most likely represents a microhemorrhage which in isolation is of little clinical significance.There is a small T2 and FLAIR hyperintense focus along the right postcentral gyrus along its more medial aspect of her presenting an old tiny vascular infarct.Normal flow-voids are demonstrated in the major intracranial vascular structures.There is mild thickening of the right nasal turbinates. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.MRA Neck: The carotid syphons are fusiformly dilated bilaterally. The intracranial internal carotid arteries are otherwise normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The right vertebral artery is somewhat narrowed relative to the left but this may be congenital and there is no evidence of flow-limiting stenosis. The basilar artery and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The distal internal carotid arteries are very patulous measuring up to 7 mm in diameter along the carotid siphon. There is fetal origin of the right posterior cerebral artery with a small right P1 segment. The right vertebral artery is larger than the left vertebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. Some of the intracranial vasculature is irregular but not significantly narrowed.The anterior communicating artery is identified and is medium size. The left posterior communicating artery is intact.

Output: 1.No evidence of acute ischemic or hemorrhagic infarction is appreciated.2.No evidence of flow-limiting stenosis or aneurysm of the vasculature of the head and neck is appreciated. There is some vascular ectasia present intracranially along the anterior circulation.3.Periventricular and subcortical white matter lesions as well as patchy lesions in the brainstem of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for labral tear, rotator cuff tear, biceps pathology History: Left shoulder pain, worsens with abduction ROTATOR CUFF: There is scalloping of the undersurface of the distal supraspinatus tendon, just proximal to its insertion, compatible with a partial-thickness undersurface tear, measuring approximately 1 cm in length and involving less than 50% of the tendon thickness. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact; there is a tiny cyst within the underlying humeral head of doubtful clinical significance. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. We see no fluid within the subacromial/subdeltoid bursa to indicate a full-thickness rotator cuff tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. On the fat-saturated T1-weighted coronal oblique images (series 9), the superior labrum beneath the biceps anchor is indistinct, as seen on image 12, compatible with a superior labral tear. The inferior labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. SLAP tear.2. Shallow undersurface tear of the supraspinatus tendon.3. Normal-appearing tendon of the long head of the biceps.4. Acromioclavicular joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is mild thickening and increased signal intensity of the supraspinatus tendon anteriorly suggesting mild tendinosis. There is also increased signal intensity within the subscapularis which is likely iatrogenic in nature from the contrast injection. There is otherwise no evidence of rotator cuff tear and the rotator cuff musculature is normal.SUPRASPINATUS OUTLET: There is no fluid or gadolinium within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. The glenoid cartilage is intact. The labrum appears intact.BICEPS TENDON: There is abnormal signal intensity and morphology of the biceps tendon as it courses through the rotator interval and into the proximal portion of the intertubercular groove, indicating longitudinal tearing.

Output: 1. Normal appearance of the labrum.2. Longitudinal tearing of the tendon of the long head of the biceps.3. Supraspinatus tendinosis without evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of other parts of nervous system [C79.49] / Malignant (primary) neoplasm, unspecified [C80.1], Reason for Study: ^Reason: 63 yom with h/o cns lymphoma s/p multiple therapies. Now with recent onset of hoarseness and ct scan of describing unilateral vocal cord paralysis. Assess for the evidence of worsening CNS disease. Previously described right ill-defined patchy T2/flair high signal intensity lesion at the right basal ganglia demonstrates interval decrease in its extent and signal intensity since prior scan. The extent of gadolinium enhancement is also decreased since prior scan.Although there are significant motion artifacts, previously seen left optic apparatus enhancement is not as conspicuous than prior scan.There is no other abnormal enhancement on this scan.Right frontal approach Ommaya catheter with the tip position around right side foramen of Monroe is again seen, unchanged since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion.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 mastoid air cells are clear. Mucosal thickenings on bilateral ethmoid and maxillary sinuses.

Output: 1. Interval decrease of the extent of the right basal ganglia T2/flair high signal intensity lesion as well as the extent of its enhancing portion since prior scan.2. Interval decrease of the extent of enhancement of the left optic apparent since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion. No evidence of new enhancing lesion.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with chronic lumbar pain, tingling and numbness. Spinal alignment is within normal limits. Vertebral body heights are maintained. Bone marrow signal intensity is unremarkable. The visualized spinal cord, conus and cauda equina demonstrate normal signal intensity and morphology. No pathologic marrow space, paraspinal or intraspinal enhancement is seen. The L4-5 disc shows loss of T2 signal. The L5-S1 disc shows loss of T2 signal and mild loss of height. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet hypertrophy. Mild laterally bulging disc. No significant spinal canal or foraminal stenosis. L4-5: Mild facet hypertrophy. Mild bilging disc with a small right paracentral protrusion. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L5-S1: Severe left and moderate right facet hypertrophy. Mild bulging disc. No significant spinal canal stenosis. No significant neuroforaminal narrowing.

Output: 1.Degenerative disc disease at L4-5 and L5-S1 without significant spinal canal stenosis or foraminal narrowing.2.Moderate to severe facet arthropathy at L5-S1.


Instruction: Generate impression based on findings.

Input: 17-year-old female with history of esthesioneuroblastoma, status post chemoradiotherapy and resection. Neck: Post-operative findings related to right medial maxillectomy with right anterior and posterior ethmoidectomy are again seen. Previously demonstrated enhancement within the right frontoethmoidal treatment bed is again noted. There is moderate benign mucosal thickening in the right greater than left maxillary sinuses. There is no new or enlarging mass. No new enhancement or mass involving the orbits. There is mild leftward nasal septal deviation. A subcentimeter Thornwaldt or nasopharyngeal retention cyst has further decreased in size. A previously demonstrated nonspecific 9 x 16mm right level II lymph node is again noted and not significantly changed. Additional small scattered cervical lymph nodes are also nonspecific. No significant cervical lymphadenopathy by size criteria. Evidence of right thyroid lobectomy also noted.A small focus of nonspecific hyperintense T2 signal and enhancement is noted in the left cheek (series 26 image 13), which extends to the skin surface.Brain: There is no evidence of intracranial extension of tumor. There is an unchanged prominent perivascular space in the right basal ganglia. The brain parenchyma otherwise appears unremarkable. 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.

Output: 1.Previously demonstrated enhancement within the right frontoethmoidal treatment bed is again noted. No evidence of recurrent disease.2.No evidence of intracranial tumor.3.No pathologic cervical lymphadenopathy.4.Focus of hyperintense T2 signal and enhancement in the left cheek extending to the skin surface likely relates to a benign dermatological process.


Instruction: Generate impression based on findings.

Input: 53 year-old female status post aneurysm clipping with known cerebral cavernous malformation disease. Annual surveillance. Redemonstrated are postsurgical changes from a left-sided craniotomy for placement of an aneurysm clip in the region of the anterior communicating artery. Susceptibility from the aneurysm clip obscures local structures. Encephalomalacia with adjacent gliosis is noted involving the anterior left temporal lobe. These findings are stable in appearance.Redemonstrated are a few scattered punctate foci of T2 hyperintensity primarily in subcortical white matter locations without associated mass effect, restricted diffusion, enhancement, or susceptibility abnormality. These are unchanged in appearance.There are no new masses, mass effect, or midline shift. Ventricular sizes are within normal limits.Redemonstrated is susceptibility artifact involving the left occipital lobe, unchanged in appearance, without associated perilesional edema. Additionally, enhancement images demonstrate an associated developmental venous anomaly. A small rounded focus of susceptibility is again noted involving the posterolateral right putamen, without associated developmental venous anomaly, and without perilesional edema, unchanged in appearance. There are no other foci of susceptibility abnormality.Paranasal sinuses and mastoid air cells remain clear. Orbital contents remain unremarkable.

Output: 1.Stable susceptibility focus involving the left occipital lobe, consistent with a cavernous malformation, without perilesional edema, associated with a developmental venous anomaly. 2.A small rounded focus of susceptibility is again noted involving the posterolateral right putamen, without associated developmental venous anomaly, and without perilesional edema, unchanged in appearance. This may represent a tiny cavernous malformation versus mineralization or prior microhemorrhage.3.Stable postprocedural changes secondary to prior aneurysm clipping.


Instruction: Generate impression based on findings.

Input: 82-year-old male with ischemic cardiac disease, hypertension, diabetes mellitus, history of colon cancer status post urosepsis and extubation with persistent tachycardia today. Evaluate for PE. Findings are limited by patient motion artifact.PULMONARY ARTERIES: No evidence of pulmonary embolus as clinically questioned.LUNGS AND PLEURA: Bilateral pleural effusions with adjacent compressive atelectasis. Multiple granulomas and scattered micronodules.MEDIASTINUM AND HILA: Thinning of the left ventricular apex is concerning for left ventricular aneurysmal dilatation and may be further evaluated with echocardiogram or cardiac MRI as clinically indicated. Mild pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: NG tube with distal portion in the stomach.

Output: 1. No evidence of pulmonary embolus as clinically questioned.2. Persistent bilateral pleural effusions with adjacent compressive atelectasis.3. Left ventricular aneurysmal dilatation may be further evaluated with echocardiogram or cardiac MRI as clinically indicated.


Instruction: Generate impression based on findings.

Input: Evaluate for hemorrhage no onset seizures teslas brain biopsy. 75-year-old male Since the prior exam patient has undergone a right sided to craniotomy for biopsy purpose paired some minor blood products in the air is present at the surgical site.There is a prior MRI of the brain from 10/19/09 which demonstrates enhancing mass at the biopsy site. The degree of hypodensity involving the right parietal, temporal and frontal lobes appears similar to the MRI examination from 10/19/09.There is redemonstration of mid to cisterna magna and arachnoid cyst in the left middle cranial fossa. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient is status post recent craniotomy for Biaxin. Some minor blood products and postsurgical changes are present appeared the degree of hypodensity does not appear different on the current exam when compared to the MRI exam is2.Redemonstration and no change in arachnoid cysts.


Instruction: Generate impression based on findings.

Input: 48 years Female (DOB:4/29/1967)Reason: right leg pain bilateral back pain History: right leg pain bilateral back painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG 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 mild facet hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a small broad based right paramedian disk protrusion at this level associated with T1 signal hyperintensity within the L4 vertebral body adjacent to the anterior aspect of the disk space (chronic end plate reaction) and disk dessication.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are Schmorl's nodes at T12-L1. There is a 10 mm T1 hyperintense - fat suppressing on T2 STIR - lesion at T12 most likely representing hemangioma.

Output: There are mild degenerative changes in the lumbar spine without significant compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 68-year-old female with sciatica. Acute left L5 -- S1 pain status post lifting. The density of vertebral column is within normal limits. There is grade 1 anterolisthesis of L5 in respect to S1. No evidence of pars defect is detected.T12 -- L1.Examined this level is unremarkable.L1 -- L2. Moderate degenerative degenerative disk disease with broad-based bulge of disk material is noted. No neuroforamina compromise or central spinal stenosis.L2 -- L3.Degenerative disk disease with very broad based bulge of disk material at this level is present this is more pronounced on the right side and I cannot entirely rule out possibility of a herniated disk. No should be made that CT is not sensitive for the definitive detection of herniated disk. An MRI is recommended. There is compromise of the right neuroforamina and to a lesser degree left neuroforamina. No central spinal stenosis.L3 -- L4.Mild degenerative disk disease and hypertrophy changes of posterior elements are present. No definitive central spinal stenosis or neural foramina compromise.L4 -- L5. Moderate to advanced degenerative disk disease is present. Diffuse bulge of disk material causes flattening and posteriorly displaces the thecal sac. No definitive evidence of neural foramina compromise is identified. There is however bulge of the hypertrophied ligamentum flavum into the neuroforamina posteriorly. There is also compromise of the lateral recesses of the canal at this level secondary to combination of hypertrophic changes of posterior elements and bulging disk. No definitive central spinal stenosis.L5 -- S1.Advanced degenerative disk disease with significant vacuum phenomenon is noted. There is grade 1 anterolisthesis at this level. There is compromise of bilateral neural foramina are in an. There is diffuse pseudo-bulge of disk material. On this examination I cannot entirely rule out possibility of a herniated disk.

Output: Extensive degenerative changes of disk and posterior elements as detailed above.


Instruction: Generate impression based on findings.

Input: 35 year old woman with history of DLBCL s/p doxorubicin chemotherapy, referred for evaluation of LV function. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 129 ml (normal range 109+/-23), the LV end systolic volume index is 35 ml/m2 (normal range 18+/-5), the LVESV is 57 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 79 ml/m2 (normal range 69+/-14), the RVEDV is 127 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 63 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. A catheter is noted in the SVC, terminating at the SVC-RA junction.PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is an infusion port noted in the R chest. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 51%. Compared to prior MRI studies on 7/1/15, the LVEF is similar (53%). The LV size has decreased to normal indexed range compared to the study on 7/1/15.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%. Compared to prior studies on 4/2/15 and 7/1/15, the RVEF is similar (52 and 55%). The RV size has decreased to normal indexed range compared to study on 7/1/15, but is similar in size to the study on 4/2/15.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The exam is limited secondary to susceptibility artifact from surgical hardware. Again seen are postoperative changes of partial corpectomy of T6 and T7 with expandable cage placement and paraspinous rods and transpedicular screws extending from T4 inferiorly to T11 for fusion. Laminectomies are seen from T6 to T8 with decompression of the spinal canal at these levels.There is extensive marrow infiltration involving the thoracic vertebral bodies which has progressed since prior MRI from 9/15/2015. Most notably there is interval increased infiltration involving the T1, T2, T3, and T4 vertebral bodies extending into the posterior elements, left worse in right.There is mild deformity involving the T1 and T2 vertebral bodies with minimal loss of height which is new since 9/15/2015. There is minimal osseous retropulsion of the T2 vertebral body with mild spinal canal stenosis at this level. Osseous retropulsion involving the T7 vertebral body is again noted, with the spinal canal surgically decompressed at this level. Lack of postcontrast sequence limits evaluation for epidural tumor. There is ill-defined low T1 and low T2 signal involving the upper thoracic spinal canal which appears worse and suspected to represent worsening epidural tumor and can be confirmed with postcontrast sequence. No obvious cord signal abnormality.Limited view of the cervical spine on the sagittal counting sequence demonstrates moderate to severe spinal canal stenosis at the C2-C3 level which is not well assessed but appears worse since prior MRI from 9/15/2015.Mediastinal lymphadenopathy again seen.

Output: 1. Compared to MRI from 9/15/2015 there is evidence of progression of metastatic disease with increased marrow infiltration particularly of the T1 to T4 vertebral bodies extending into the posterior elements. There appears to be increased epidural tumor at these levels which can be better assessed/confirmed with postcontrast sequence. No new cord signal abnormality within the limitations of susceptibility artifact from the hardware.2. Postsurgical changes related to partial corpectomy of T6 and T7 with cage placement, posterior fusion from T4 to T11, and laminectomies from T6 to T8.3. Mild deformity/compression fractures involving the T1 and T2 vertebral bodies with mild osseous retropulsion involving the T2 vertebral body which is new since prior MRI. There is mild spinal canal stenosis at this level.4. Limited view of the cervical spine on the sagittal counting sequence demonstrates moderate to severe spinal canal stenosis at the C2-C3 level which is not well assessed but appears worse since prior MRI from 9/15/2015. Consider dedicated cervical spine MRI for further evaluation.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is a prominent area of restricted diffusion involving the posterior limb of the right internal capsule and right corona radiata compatible with an acute infarct. Encephalomalacia the left basal ganglia, left internal capsule and left centrum semiovale probably represents sequela of a previous stroke. There is additional periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. Post-treatment changes are seen in the left globe secondary to prior retinal detachment. 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 mild scattered paranasal sinus mucosal thickening.MRA Brain: Again demonstrated is narrowing of the bilateral cavernous ICAs secondary to atherosclerotic disease. Additional scattered atherosclerotic stenoses are visualized elsewhere, including the right MCA trifurcation, left proximal A1 segment and right P2/P3 segments. There is no evidence of aneurysm or vascular malformation. MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.

Output: Evidence of a recent ischemic infarct involving the right internal capsule and right corona radiata. No evidence of hemorrhagic conversion, midline shift, or herniation.Encephalomalacia involving the left basal ganglia/IC and left anterior centrum semiovale related to chronic infarction.Underlying mild chronic small vessel ischemic disease.Atherosclerotic narrowing of the cavernous portions of the ICAs similar to previously. Additional scattered atherosclerotic stenoses are visualized elsewhere in the intracranial circulation. No evidence of significant steno-occlusive vascular disease in the neck.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: MS, f/u progressionSigns and Symptoms: AtaxiaComments: MS Protocol. Please consult Dr. Jack Collins for this MS Protocol. No DTI | 3T MRI | MRI brain:There is a moderate degree of periventricular and to lesser degree subcortical white matter lesions present. These are hypointense on T1-weighted imaging. Many of these are perpendicularly oriented to the lateral ventricles. There is some involvement of the corpus callosum at the colossal-cingulate junction.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There are patchy signal hyperintense lesions present in the cervical spinal cord. One lesion involves the left hemicord at the C6-7 disc space level. Another small one involves the right lateral aspect of the spinal cord at the C6 vertebral level . Another one involves the left hemicord at the C5 vertebral level and yet another involves the left hemicord at the C3 level. There is no associated cord enlargement and in general these are fairly small lesions based on size.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple brain parenchymal lesions present in the periventricular and subcortical white matter which are compatible with patient's clinical diagnosis of demyelinating disorder.2.There are multiple lesions in the spinal cord which are also compatible with demyelinating disorder.


Instruction: Generate impression based on findings.

Input: Pain and decreased range of motion. ROTATOR CUFF: Abnormally increased signal within the supraspinatus tendon near its insertion indicates moderate tendinosis. No discrete full-thickness tears are identified. The supraspinatus muscle does not exhibit significant atrophy. The remaining tendons and muscles of the rotator cuff are grossly unremarkable.SUPRASPINATUS OUTLET: Moderate-severe osteoarthritic changes affect the acromioclavicular joint with fluid signal present within the joint. A small amount of fluid is present within the subacromial/subdeltoid bursa which in the absence of full-thickness rotator cuff tear suggests bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Degenerative changes affect the glenohumeral joint with several subchondral cysts within the humeral head most prominent subjacent to the subscapularis and infraspinatus tendon insertions. The remaining bone marrow signal is within normal limits with some foci of red marrow reconversion. The labrum and articular cartilage of the glenohumeral joint are grossly intact.BICEPS TENDON: The long head biceps tendon is grossly intact. ADDITIONAL

Output: 1.Supraspinatus tendinosis without discrete full-thickness rotator cuff tears.2.Additional degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: 69-year-old female with metastatic pancreatic cancer and meningismus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal nonspecific foci of high T2 signal in the cerebral white matter without abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are a mild amount of scattered foci of hyperintense T2 to signal in the periventricular and subcortical white matter, likely related to chronic small vessel ischemic changes. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is fluid signal within and enhancement surrounding a few of the left mastoid air cells. There are degenerative changes in the left temporomandibular joint.

Output: 1. No evidence of intracranial metastases. 2. Fluid signal and enhancement in the left mastoid air cells may represent mastoiditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 83-year-old female with history of foot ulcers and bacteremia, please rule out osteomyelitis. Large amounts of soft tissue signal abnormality, compatible with edema of the right lower extremity, more severe posteriorly, though all compartments of the leg are involved. Fascial planes appear intact without gross displacement to suggest a compartment syndrome. No fluid collections are visualized.Cutaneous defect with underlying edema is visualized just lateral to the distal fibular diaphysis and is compatible with history of known ulcer. However, underlying bone cortex appears intact without evidence of significant signal change within the marrow. There is severe atrophy of the right lower extremity musculature, compatible with disuse. Further, demineralization compatible with osteopenia/osteoporosis is also demonstrated.

Output: 1. Diffuse soft tissue edema without evidence of osteomyelitis or cortical destruction as specifically outlined above.2. Diffuse muscular atrophy and demineralization compatible with chronic disuse.


Instruction: Generate impression based on findings.

Input: Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: stroke r/o History: slurred speech, R \T\ L facial droop, R-sided weakness Brain MRI:No evidence of acute ischemic or hemorrhagic lesion.Patchy scattered high signal intensity lesions on FLAIR/T2 at bilateral periventricular white matter and centrum semiovale are non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 3mm sized luminal bulging at the right MCA distal M1 segment - MCA bifurcation which suggest possible intracranial arterial aneurysm. The lesion is better seen on Neck MRA scan.Otherwise normal ICAs, left 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. Again, right MCA distal M1 - MCA bifurcation area shows round luminal bulging which may suggest possible intracranial aneurysm. However, overlapped MCA branches cannot be completely excluded.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific white matter lesions.3. Possible right MCA distal M1-MCA bifurcation aneurysm. Head CT angiography can be considered for further imaging evaluation.


Instruction: Generate impression based on findings.

Input: 61 year old with history of AML and coronary artery disease presenting for cardiac evaluation prior to stem cell transplant. MEDICATIONS: none First Pass PerfusionDuring hyperemia, there is a perfusion defect involving the mid to basal inferior and inferoseptal walls.Viability/ Myocardial ScarThere was a non-transmural myocardial infarction involving the mid to basal inferior and inferoseptal walls. These segments have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is mild hypokinesis of basal inferior and inferoseptal walls. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 101 ml/m2 (normal range: 74+/-15), the LVEDV is 195 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 100 ml (normal range 47+/-19), the LV mass index is 40 g/m2, and the LV mass is 77 g. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 174 ml (normal range 142+/-31), the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9), and the RVESV is 70 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There aorta is mildly tortuous. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is "ischemia" involving the mid to basal inferior and inferoseptal walls. These segments have a non-transmural myocardial infarction and have an intermediate probability of viability. The remainder of the myocardium is free of ischemia and myocardial infarction. 2. Normal LV size with mildly reduced systolic function (LVEF 49%) with mild hypokinesis of the basal inferior and inferoseptal walls.3. Normal RV size and systolic function (RVEF 60%).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, 77 years old, with bilateral ptosis and concern for aneurysmal compression. No restricted diffusion is seen. No evidence of parenchymal edema or mass effect is detected. Scattered foci of FLAIR hyperintensity are seen in the periventricular white matter. No acute intracranial hemorrhage or any abnormal extra axial fluid collections are detected. The ventricles and sulci are mildly prominent compatible with mild underlying parenchymal volume loss.Within the limitations of MRA technique, no evidence of any aneurysm, vascular malformation or obvious high-grade stenosis is seen. At most there may be several scattered mild to moderate areas of vascular narrowing in the right M1 and proximal M2 branches, but this could also be artifactual. Fetal origin of the right PCA is seen.

Output: 1.No acute intracranial abnormality.2.No evidence of aneurysm or other specific findings to account for the patient's symptoms.3.Findings are seen which would be compatible with chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: MRI CARD WWO CNTRST, VIABLTY/SCAR IMAG.MORPH/FUNCT, 9/15/2016 4:35 PM Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 44%. The LVEDV is 134 ml (normal range 142+/-34), the LV end diastolic volume index is 63 ml/m2 (normal range: 74+/-15), the LVESV is 78 ml (normal range 47+/-19) and the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9). Sigmoid septum present. There are regional wall motion abnormalities present in 3 discrete areas of myocardium. There is akinesis of the apical inferior wall with transmural enhancement suggesting non-viability. There is hypokinesis of the mid inferolateral wall with < 50% transmural enhancement suggesting viability. Lastly there is a subendocardial 50% transmural enhancement in the mid-distal anterior wall. While all these segments are c/w an ischemic etiology, they clearly represent discrete vascular territories. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%. The RVEDV is 132 ml (normal range 142+/-31), RV end diastolic volume index is 60 ml/m2 (normal range 82+/-16), the RVESV is 75 ml (normal range 54+/-17), and the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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 dilated.Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is a catheter in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsChest wall artifact from pacer device. 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 LV size with mildly reduced systolic function (LVEF 44%).2.Normal RV size with mildly reduced systolic function (RVEF(44%).3.There are regional wall motion abnormalities present in 3 discrete areas of myocardium. There is akinesis of the apical inferior wall with transmural enhancement suggesting non-viability. There is hypokinesis of the mid inferolateral wall with < 50% transmural enhancement suggesting viability. Lastly there is a subendocardial 50% transmural enhancement in the mid-distal anterior wall. While all these segments are c/w an ischemic etiology, they clearly represent discrete vascular territories. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The basal cisterns are patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, corpus callosum, cerebellum and brainstem, consistent with history of multiple sclerosis. No enhancing lesions. A small focus of susceptibility artifact in the periventricular right parietal lobe is consistent with hemosiderin deposition. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is extensive mucosal thickening involving all the sinuses with multiple areas of low T2 signal, consistent with fungal sinusitis. There are erosive changes with bulging of the contents of the left ethmoid sinus into the subcutaneous tissue along the left nasolabial fold/cheek (image 7, series 1001). There is nasal septum deviation towards the right.MRI of the orbits demonstrates no mass lesion. Subtle enhancement along the left optic nerve is suspected. Evaluation is somewhat limited by motion artifact, but no definite signal abnormality is identified. The retroorbital fat is preserved. The extraocular muscles are intact.

Output: 1. Multiple foci of abnormal T2 signal within the supra- and infratentorial white matter, consistent with history of multiple sclerosis. 2. Subtle enhancement of the left optic nerve is suspected. Motion artifact somewhat limits evaluation, but no other definite signal abnormality is identified.2. Extensive chronic fungal pansinusitis, with focal bulge of sinus contents into the subcutaneous tissue along the left nasolabial fold/cheek.


Instruction: Generate impression based on findings.

Input: 61-year-old male with shoulder pain and symptoms of rotator cuff tear. ROTATOR CUFF: There is a partial-thickness undersurface tear of the anterior fibers of the infraspinatus tendon at the level of its insertion on the greater tuberosity, measuring approximately 6 mm in the AP dimension, involving less than 50% of the tendon width. There is no significant retraction. The supraspinatus tendon and muscle appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: Moderate degenerative changes affect the acromioclavicular joint. There is a small amount of fluid within the subacromial subdeltoid bursa which may reflect a mild bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. No articular cartilage defects are identified. Although this examination was not protocoled for evaluation of the glenoid labrum, there is heterogeneity and increased signal abnormality affecting the anterior inferior glenoid labrum suggestive of degenerative tearing.BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of the biceps which may reflect fluid extension from the glenohumeral joint versus a mild tenosynovitis.ADDITIONAL

Output: Small partial thickness tear of the infraspinatus tendon without evidence of a full-thickness rotator cuff tear. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for intracranial hemorrhage. Signs and symptoms: Known brain metastases, increasing seizure frequency. Nonenhanced head CT:Examination demonstrates small foci of cortical increased density in the right anterior parietal and posterior frontal lobes, suspected for small hemorrhage/hemorrhagic tumor and or mineralization from prior treatment. The largest of these lesions measures 8.2 x 5.5 -mm in size. There are no prior exams for comparison.Examination also demonstrates fairly extensive periventricular and subcortical low attenuation of white matter with no apparent mass effect which may represent posttreatment changes / encephalomalacia / residual edema from metastatic brain lesions. There is a well demarcated area of CSF density in the left frontal lobe with apparent communication with the left frontal horn. This finding is under a left frontal craniotomy and may represent area of encephalomalacia/ surgical cavity. There is no evidence for midline shift or hydrocephalus. Ventricular system however is mildly dilated. Images through posterior fossa are unremarkable.Follow-up with an enhanced MRI is recommended.

Output: Constellation of intracranial abnormalities as detailed above. Please see above comments.


Instruction: Generate impression based on findings.

Input: 40 year-old male status post flap for rhabdomyosarcoma on back with syncope x 2. History of neurofibromatosis. Please evaluate if neurofibroma intracranially are present to explain the syncope. Syncope is not believed to be cardiac in etiology. HEAD CT:Multiple superficial neurofibromas are identified within the scalp. (image 25/32). No evidence of abnormal intracranial enhancement.The cerebral hemispheres, cerebellum and brainstem are normal in structure and attenuation. No intracranial hemorrhage, infarctions, edema or areas of mass effect are identified. No abnormal extra-axial fluid collections are identified. The ventricles are normal in volume and are midline.The visualized paranasal sinuses and mastoid air cells are normally aerated.There is a bony dehiscence between the right jugular fossa and the middle ear with an enlarged right jugular fossa. This can result in pulsatile tinnitus. Differential considerations for this finding include a normal large dominant right jugular vein secondary to a large right lateral and sigmoid sinuses, a high riding jugular fossa most likely due to the increased size of the sigmoid sinus, and a paraganglioma resulting from the pars nervosa in this location. An MRI is recommended to exclude tumor given the patient history of neurofibromatosis.

Output: 1. The right jugular fossa appears enlarged as described. An MRI of the internal auditory canal with contrast is recommended to exclude the presence of a nerve sheath tumor given the history of neurofibromatosis. Findings were discussed with Dr. Hofer following interpretation.2. No evidence of abnormal intracranial enhancing masses. 3. Superficial neurofibromas in the scalp.


Instruction: Generate impression based on findings.

Input: Clinical question: Back pain and possible new malignancy, evaluate for fracture, metastasis. Signs and symptoms: Back pain. Nonenhanced thoracic MRI:The alignment of the vertebral column is anatomical.The signal intensity of the vertebral column is unremarkable.There is normal signal intensity and caliber of the thoracic cord.At T11-T12 there is a small shallow disc protrusion on the left with mild extension to the left neural foramen with questionable compromise and unremarkable otherwise.There is mild degenerative disc disease without spinal stenosis or neural foraminal compromise at any other level.Unremarkable paraspinal soft tissues.Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column with normal signal intensity on all MRI sequences.There is mild degenerative disc disease and and mild to moderate facet and ligamentum flavum hypertrophy in the lower lumbar spine, however without evidence of spinal canal or neural foraminal compromise at any level.Unremarkable paraspinal soft tissues.

Output: 1.MRI of thoracic spine demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. Small shallow disc protrusion at T11-T12 on the left with questionable left foraminal compromise and unremarkable exam otherwise.2.MRI of lumbar spine demonstrate multilevel mild degenerative disc disease and mild to moderate facet and ligamentum flavum hypertrophy without foraminal or central spinal stenosis at any level.3.Unremarkable para spinal soft tissues of thoracic and lumbar regions.


Instruction: Generate impression based on findings.

Input: 42 year-old female with pulmonary sarcoid. Referred for CMR to evaluate for cardiac sarcoid disease burden, evaluate disease progression. Left VentricleThe left ventricle is severely dilated. The overall LV ejection fraction is 23%, the LV end diastolic volume index is 150 ml/m2 (normal range: 65+/-11), the LVEDV is 340 ml (normal range 109+/-23), the LV end systolic volume index is 115 ml/m2 (normal range 18+/-5), the LVESV is 262 ml (normal range 31+/-10), the LV mass index is 93 g/m2 (normal range 67+/-11), and the LV mass is 211 g (normal range 114+/-24). There is inferior and inferolateral hypokinesis extending from the base to the apex. There is hyperenhancement on T2 STIR images in the lateral, inferolateral and septal walls (myocardial to skeletal muscle ratio 1.8-2.4). This appears similar to previous. There are multiple patchy areas of late gadolinium enhancement throughout the septum which spares the subendocardium and is atypical for myocardial infarction, and suggests an infiltrative, inflammatory or fibrotic process. There is a small focus of late gadolinium enhancement in the apical anterior wall, also suggestive of an infiltrative, inflammatory or fibrotic process. There is a transmural patch of late gadolinium enhancement in the basal inferolateral and inferior wall. When compared side-by-side with the previous MRI of 3/2016 the findings in this study are similar. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with mildly reduced ejection fraction. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 171 ml (normal range 110+/-24), the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8), and the RV ESV is 91 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a 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 (29.7 mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsInterstitial pattern at lung bases. There is lymphadenopathy. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated. The overall LV ejection fraction is 23%. There is inferior and inferolateral hypokinesis extending from the base to the apex. There is anteroseptal hypokinesis. 2. There is hyperenhancement on T2 STIR images in the lateral, inferolateral and septal walls (myocardial to skeletal muscle ratio 1.8-2.4) suggestive of myocardial edema and/or inflammation. There are multiple patchy areas of late gadolinium enhancement throughout the septum which spares the subendocardium which suggest an infiltrative, inflammatory or fibrotic process. There is a small focus of late gadolinium enhancement in the apical anterior wall, and a transmural patch of late gadolinium enhancement in the basal inferolateral and inferior wall. These findings appear similar to previous cardiac MRI 3/2016.3. The right ventricle is normal in size with mildly reduced ejection fraction. The overall RV ejection fraction is 47%4. Overall findings are similar to previous except for mild improvement in RV systolic function.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 46-year-old female presents for evaluation of a palpable mass in the left breast. A patient submitted outside study for review. Submitted for review are performed at . For comparison,Left unilateral diagnostic mammogram with ultrasound dated 3/30/2015Left breast ultrasound-guided core biopsy with postprocedure mammogram dated 4/10/2015 are available.Comparison mammogram dated 8/9/14 Left unilateral diagnostic mammogram dated 3/30/2015 demonstrates a palpable marker overlying and irregular ill-defined partially obscured hyperdense mass measuring 2.6 cm in the left upper outer quadrant posterior depth. The breast parenchyma is heterogeneously dense, without any suspicious masses or microcalcifications in the right breast. Normal morphology left axillary lymph nodes are noted. No associated calcifications are noted on spot compression views. Ultrasound demonstrates irregular multilobulated hypoechoic mass with apical blood flow measuring 1.8 x 1.9 x 2 cm at 2:00 position of the left breast. This was subsequently biopsied with a clip placement. Postprocedure mammogram demonstrates clip to be in the center of the mass. Pathology report has not been submitted but as per MRI report it is papillary carcinoma.

Output: Biopsy-proven unifocal cancer in the left breast corresponding to the palpable abnormality.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Pain in right knee [M25.561], Reason for Study: ^Reason: right leg pain History: right leg pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-2 level.The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: minimal bulging of disc. no neuroforaminal narrowing or spinal stenosis. L4-L5: diffuse bulging of disc associated with bilateral minimal facet joint hypertrophy and ligamentum flavum thickening result minimal spinal canal stenosis and bilateral neuroforaminal stenosis. Unchanged since prior scan.L5-S1: diffuse bulging of disc results minimal neuroforaminal stenosis bilaterally. No spinal stenosis. Unchanged since prior scan.

Output: 1. Degenerative changes of Lumbar spine 2. Minimal spinal stenosis with minimal bilateral neuroforaminal stenosis at the level of L45, unchanged since prior scan. 3. Minimal bilateral neuroforaminal stenosis at the level of L5S1, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, with altered mental status. Evaluate for worsening brain metastases and new ischemia. Evidence of a prior large resection is again seen involving portions of the left frontal and temporal lobes. Since the prior examination, thickened enhancing tissue surrounding the cavity on all sides has progressed. Pathologic enhancement extends up to and along the ependymal margin of the left lateral ventricle which is partially effaced similar to prior. Enhancement also extends up to the left temporal horn which is progressively effaced. Extensive confluent T2 hyperintensity is again seen involving the white matter of both cerebral hemispheres, more so on the left right. The geographic extent of this abnormal signal has progressed mildly at least within the left hemisphere. There is perhaps slightly increased left cerebral mass effect but only a 2 to 3 mm midline shift to the right. The left suprasellar cistern is partially effaced similar to prior. The quadrigeminal plate cistern remains patent.Progressive T2 hyperintensity is evident within the left cerebral peduncle. Also noted is new ill-defined ependymal enhancement along the right ventricular atrium and along the left posterior fourth ventricle.Signal abnormality compatible with an evolving hematoma is again seen along the floor of the left middle cranial fossa. No new acute intracranial hemorrhage is suspected. The caliber of the right lateral ventricle, third and fourth ventricles is similar to prior.

Output: Findings compatible with progression of tumor are seen within the left cerebral hemisphere surrounding the previous resection site. Only mild increased mass effect is seen, however. Evidence of scattered new ependymal disease is also noted, for example at the right atrium and along the left posterior fourth ventricle, findings which may reflect dissemination via the CSF.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with progressing ascending lower extremity weakness. Assess for intrinsic cord lesion. Please note that the present examination consists of T1 weighted pre- and postcontrast images only, as a complete dedicated noncontrast MRI was just performed on 2/11/15.No evidence of any intramedullary or leptomeningeal pathologic enhancement is seen. No pathologic marrow space or paraspinal enhancement is seen.

Output: No enhancing lesions are detected on this examination.


Instruction: Generate impression based on findings.

Input: Increased severity headache symptoms. History of LCH, s/p OLT. On head CT 9/30, a lucent lesion concerning for LCH reactivation was seen at R occipital skull. The images are degraded by dental brace artifact, particularly in the anterior region. There is an enhancing focus near the midline of the occipital bone that measures up to 12 mm. There is no evidence of intracranial hemorrhage or acute infarct, within the limitations of artifact. 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.

Output: An enhancing focus near the midline of the occipital bone that measures up to 12 mm is nonspecific. The images are otherwise degraded by dental brace artifact, particularly in the anterior region.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified site of right female breast [C50.911], Reason for Study: For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There multifocal bone marrow replacing lesions seen on T12, L2, L3, L4, L5, and S1 vertebral bodies which are consistent with metastatic lesions. In particular, L5 vertebral body shows about 20% of height loss with bone marrow edema indicating acute/subacute compression fracture. There is no evidence of retropulsion of the fracture fragment at this level.Bilateral iliac bones also demonstrate multiple bony lesions consistent with metastatic lesions. There is normal lumbar lordosis. The spine alignment is anatomic. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Diffuse bulging of intervertebral disc is seen at the level of L45, otherwise lumbar intervertebral discs are unremarkable.

Output: 1. Multiple bony metastasis involving lumbar spine, sacrum and bilateral iliac bones.2. About 20% pathologic compression fracture of the L5 vertebral body with bone marrow edema as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Pt is an 11 y/o F with hx of neuroblastoma, change in size of mass? Signs and Symptoms: hip pain, inability to walkComments: Please focus on paraspinal muscles and lumbar plexus | Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is redemonstration of a 20 x 47 x 78 mm left-sided retroperitoneal mass which is adjacent to the aorta, left common iliac artery and the left psoas muscle which extends from the L1-2 disc space level down to the L5 vertebral body level.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.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is redemonstration of atrophy of the left kidney.

Output: A left-sided retroperitoneal mass is stable when compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Seizures and visual disturbance. History of crack cocaine use. Many of the sequences are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues appear unchanged, including nonspecific diffuse bone marrow hypointense signal on T1 and T2 -weighted sequences and areas of soft tissue thickening in the scalp.

Output: No potential seizure foci are identified, within the limits of motion artifacts.