Instruction: Generate impression based on findings.

Input: 26 years, Female, Reason: 25F with history of spindle cell tumor arising from left kidney, s/p left nephrectomy in July 2013. Surveillance imaging History: history of left renal spindle cell tumor. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: LesionsSPLEEN: Small splenule with an adjacent surgical clip.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes of left nephrectomy. No residual enhancing tissue within the nephrectomy bed to suggest residual tumor.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: 74-year-old male with left shoulder pain. Evaluate for shoulder cuff tear. ROTATOR CUFF: Note is made of postsurgical changes of prior rotator cuff repair. There is a small partial-thickness articular surface tear of the supraspinatus at the level of its insertion on the greater tuberosity involving less than 50% of the tendon width, measuring approximately 6 mm in AP dimension. There is also a small partial thickness tear of the bursal surface fibers of the supraspinatus. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is increased signal abnormality and heterogeneity within the glenoid labrum indicating degenerative tearing. Linear fluid signal abnormality is identified within the superior glenoid labrum indicating a tear. Severe degenerative changes affect the glenohumeral joint with full-thickness articular cartilage degeneration and osteophyte formation. There is associated subchondral signal abnormality within the glenoid, likely degenerative in etiology. There are subchondral cysts within the humeral head. There is slight posterior translation of the humeral head with relation of the glenoid. BICEPS TENDON: There is circumferential fluid within the tendon sheath which may represent fluid extension from the glenohumeral joint versus a tenosynovitis. Foci of low signal intensity within the tendon sheath may represent a loose body or synovitis. ADDITIONAL

Output: 1. Postsurgical changes of prior rotator cuff repair with partial-thickness tearing of the rotator cuff as described above. 2. Severe osteoarthritis affects the glenohumeral joint with full-thickness articular cartilage degeneration. 3. Degenerative tearing of the labrum and other findings as described above.4. Findings suggestive of multiple loose bodies within the joint space versus a synovitis.


Instruction: Generate impression based on findings.

Input: Right-sided acoustic neuroma, resected: yearly follow up. There are stable postoperative findings related to suboccipital craniotomy for resection of a right vestibular schwannoma, including right cerebellar hemisphere and middle cerebellar peduncle encephalomalacia. There is no evidence of recurrent vestibular schwannoma. There is disruption of the right cranial nerve 7 and 8 complex as well as volume loss of the right trigeminal nerve. There is also persistent loss of fluid signal within the right cochlea. The left internal auditory canal contents and inner ear structures are unremarkable. There is no evidence of intracranial hemorrhage or acute infarct. The supratentorial brain parenchyma appears unremarkable. The ventricles are stable in size and configuration. There is no midline shift or herniation. The major cerebral vessels are grossly intact. The skull and extracranial soft tissues are unchanged, including asymmetric loss of bulk of the right mimetic muscles.

Output: Postoperative findings related to right retrosigmoid resection of a vestibular schwannoma without evidence of gross recurrent tumor.


Instruction: Generate impression based on findings.

Input: Known CCM near brainstem, seen on outside imaging. There is a subcentimeter focus of susceptibility effect in the left periaqueductal region of the midbrain. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A subcentimeter focus of susceptibility effect in the left periaqueductal region of the midbrain may represent a cavernous malformation.


Instruction: Generate impression based on findings.

Input: Syncope and collapse [R55], Reason for Study: ^Reason: rule out structural lesion History: syncope No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. There are scattered foci of T2 hyperintensity within the white matter without associated mass effect. The cerebellar tonsils are in appropriate position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There has been previous sinus surgery and opacification is noted throughout all the paranasal sinuses, sparing the sphenoid sinuses. The mastoid air cells demonstrate fluid within a few bilateral dependent air cells. There is no abnormal enhancement within the brain.

Output: 1.Chronic small vessel ischemic disease.2.No masses, mass affect, or midline shift.


Instruction: Generate impression based on findings.

Input: 15 year old female with a history of pulmonary atresia with ventricular septal defect and major aorto-pulmonary artery collaterals, status post unifocalization and right ventricle to pulmonary artery conduit. Referred for a limited non-contrast cardiac MRI to evaluate right ventricular volume and pulmonary regurgitant fraction as part of a research protocol. Systemic Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. Right AtriumThe right atrium is mildly dilated. Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.Right VentricleThe right ventricle is severely dilated with mildly reduced systolic function. There is systolic flattening of the interventricular septum, suggesting elevated right ventricular systolic pressure. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 137 ml/m2 (normal range 69+/-14), the RVEDV is 196 ml (normal range 110+/-24), the RV end systolic volume index is 81 ml/m2 (normal range 22+/-8), and the RVESV is 117 ml (normal range 35+/-13). Pulmonic ValveThere is a prosthetic pulmonary valve with mild insufficiency. Pulmonary valve regurgitant fraction is 26%. Peak velocity through the pulmonary valve is 2.7 m/s, suggesting a peak pressure gradient of 29 mmHg.Pulmonary ArteryThere is a valved conduit from the right ventricle to the pulmonary artery: 35 x 31mmThe right pulmonary artery has long segment distal stenosis, with narrowest dimension 8 x 5 mm. The right pulmonary artery receives approximately 50% of forward flow.The left pulmonary artery is normal in size, measuring 11 x 16mm, and receives approximately 50% of forward flow.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Left AtriumThe left atrium is normal in size. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 84 ml/m2 (normal range: 65+/-11), the LVEDV is 120 ml (normal range 109+/-23), the LV end systolic volume index is 35 ml/m2 (normal range 18+/-5), the LVESV is 50 ml (normal range 31+/-10), the LV mass index is 45 g/m2 (normal range 67+/-11), and the LV mass is 64 g (normal range 114+/-24). There are no regional wall motion abnormalities present. No intracardiac thrombus.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation. The aortic valve overrides a VSD which is closed by patch technique. AortaAortic root is mild to moderately dilated. Left aortic arch with normal brachiocephalic branching pattern.Aortic Valve: 25 x 25 mm, Z-score +3.5Aortic Sinuses: 29 x 33 mm, Z-score +2.5ST Junction: 31 x 31 mm, Z-score +3.5PericardiumThere is no pericardial effusion.

Output: 1. Right ventricle is severely dilated with mildly reduced systolic function. RVEF 41%. RVEDV indexed 137 mL/m2.2. Normal left ventricular size and systolic function. LVEF 58%.3. Systolic flattening of the interventricular septum, suggesting elevated RV systolic pressure.4. Mild regurgitation of the prosthetic valve. Regurgitant fraction 26%.5. Long segment distal narrowing of the right pulmonary artery (8 x 5 mm)6. Mild to moderate aortic root dilation7. Mild aortic regurgitation.8. Mild mitral regurgitation.9. Mild tricuspid regurgitation.


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings are related to burr hole for previous left frontal lobe biopsy. There is unchanged confluent T2 hyperintensity throughout the bilateral cerebral hemispheres, most prominent within the frontal lobes. There are unchanged focal regions of cystic volume loss and an unchanged focus of T1 hyperintense susceptibility within the posterior callosal body. There has been interval increase in size of previously linear enhancement within the left thalamus into a now peripherally enhancing 11x 7 mm lesion with associated T2 hyperintensity and adjacent linear enhancement. There is no evidence of elevated perfusion although evaluation of a lesion of this size in this location is somewhat limited. In comparison with prior exams, areas of cystic volume loss previously showed a similar enhancing evolution prior to becoming frankly cystic. There is unchanged dura-arachnoid thickening along the left cerebral hemisphere and less prominently along the right frontal lobe. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is maxillary sinus mucosal thickening.

Output: Developing left thalamic ring enhancement has an appearance similar to that of the scattered regions of cystic volume loss prior to them becoming cystic. The differential diagnosis includes a subacute lacunar infarct vs radiation necrosis with tumor progression felt much less likely. The examination is otherwise stable.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. Minimal degenerative changes are seen in the cervical spine. No significant spinal canal or foraminal stenosis within the cervical spine. No abnormal enhancement.THORACIC SPINE

Output: 1. No abnormal intraparenchymal or meningeal enhancement within the brain to suggest intracranial disease. Again seen is CSF collection surrounding the Ommaya catheter with surrounding vasogenic edema in the right frontal lobe and associated mass effect.2. Diffuse abnormal leptomeningeal enhancement involving the cauda equina nerve roots and surface of the lower thoracic cord. This finding is similar to outside MRI from 10/9/2014 and compatible with leptomeningeal disease. No evidence of epidural tumor or masses. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: 75-year-old male with metastatic lung cancer, possible small cerebellar metastasis on the previous MRI, presenting with bilateral lower extremity weakness and falls, please evaluate for additional metastases. The exam is degraded by patient motion. There is a punctate focus of enhancement within the superior right cerebellum. There also a punctate area of high T2 signal and susceptibility effect, with possible mild enhancement in the posterior right cerebellar peduncle. There is no evidence of acute infarct. There is diffuse periventricular and subcortical deep white matter T2 abnormality. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: Redemonstration of punctate focus of enhancement in superior right cerebellum and possible metastasis in the posterior right cerebellar peduncle in a background of chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Probable neurosarcoidosis; evaluate for progression History: paresthesias The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The patient is status post suboccipital craniotomy for Chiari I.A small focus of cortical dysplasia is present in the right parietal lobe.There is a redemonstration of a small focus of susceptibility effect in the right centrum semi-ovale associated with central T2 and flair signal hyperintensity.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. They have not changed significantly when compared to the previous exam.2.The patient is status post suboccipital craniotomy for Chiari I. there is no evidence for ventriculomegaly on the current exam.3.A small focus of cortical dysplasia is present in the right parietal lobe.4.A small hemorrhagic appearing lesion in the right centrum semi-ovale is nonspecific. It is stable since prior exams


Instruction: Generate impression based on findings.

Input: NF1 with history of MPNST. Question of change in size of the sacral root lesion. An enhancing lesion at right S3 nerve root measures approximately 16 x 16 mm and is not significantly changed in size since the prior study. Numerous tiny scattered subcutaneous superficial nodules are noted, compatible with neurofibromas.There is increased signal intensity within the right anterior femoral head/neck junction which was not seen on the prior study and likely represents a focus of bone marrow edema.

Output: No significant change in size of the sacral nerve root lesion.


Instruction: Generate impression based on findings.

Input: Low back pain, evaluate for lumbar stenosis. Please note for the purposes of numbering, there appear to be 6 nonrib-bearing lumbar type vertebral bodies. The most inferior well-defined disc space is labeled L6-S1. Vertebral body heights are grossly maintained without evidence of an acute compression fracture. There is minimal retrolisthesis of L2 on L3 and L4 on L5. Bone marrow signal is benign, with prominent edematous marrow signal changes noted involving the inferior L3 vertebral body and to a lesser degree involving the endplates more inferiorly related to degenerative disease. There is severe disc height loss affecting the L2-L3, L4-L5, and L5-L6 levels. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is disc bulge and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is relatively mild bilateral narrowing of the neural foramina, however, the exiting right-sided nerve root may be impinged extra-foraminally related to prominent right lateral osteophyte.L3-L4: There is moderate to severe spinal canal stenosis related to disc bulge, facet arthropathy, ligamentum flavum thickening, and prominence of the dorsal epidural fat at this level. There is moderate to severe right and moderate left neural foraminal stenosis.L4-L5: Mild retrolisthesis and bilateral facet arthropathy contribute to partial effacement of the lateral recesses, right worse than left, but without significant central canal stenosis. There is severe right and moderate left neural foraminal stenosis.L5-L6: There is a dorsal annular fissure with tiny central protrusion superimposed on a mild bulge. There is bilateral facet arthropathy, more advanced on the right. There is mild effacement of the right lateral recess. No significant central canal stenosis. There is moderate to severe right and moderate left neural foraminal stenosis. L6-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues demonstrate some lower lumbar paraspinous muscular atrophy but are otherwise unremarkable.

Output: 1. Please note transitional anatomy with 6 presumed lumbar type vertebral bodies and the most inferior preserved disc space labeled L6-S1 for the purposes of this study.2. Degenerative changes throughout the lumbar spine with up to moderate to severe spinal canal stenosis at the L3-L4 level. Multilevel neural foraminal stenosis is also seen as detailed above.


Instruction: Generate impression based on findings.

Input: The pituitary gland enhances homogenously. There is no evidence of sellar or parasellar lesions. The infundibulum is intact and situated in the midline. There is an intact posterior pituitary bright spot. The optic apparatus is intact. There are nonspecific scattered foci of T2 hyperintensity in the partially-imaged cerebral white matter.

Output: No evidence of pituitary adenoma or other sellar lesion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 45 years old. Reason: r/o spinal stenosis, r/o disc herniation History: bilateral leg pain, LBP Five lumbar type vertebral bodies are presumed to be present. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. There are ill-defined foci of low T1 and T2 signal involving the T12 and L1 vertebral bodies, which are nonspecific. The conus medullaris on sagittal imaging is grossly intact.Mild disc bulges at T11-T12 and T12-L1. There is congenital narrowing of the lumbar spinal canal, worst at the L5-S1 level. Individual levels as below:L1-L2: There is disc bulge with a superimposed small left central disc protrusion with minimal associated central canal narrowing. No significant neural foraminal narrowing.L2-L3: No significant disc disease. No significant spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No significant spinal canal or neural foraminal stenosis.L4-5: No significant disc disease. No significant spinal canal or neural foraminal stenosis.L5-S1: There is moderate spinal canal stenosis which is primarily on a congenital basis with superimposed degenerative changes including mild disc bulge, thickening of the ligamentum flavum, and facet arthropathy. There is partial effacement of the lateral recesses. No significant neural foraminal stenosis.Note is made of right renal cysts.

Output: 1. Moderate spinal canal stenosis at L5-S1 which is primarily on a congenital basis, with superimposed degenerative changes including mild disc bulge, thickening of the ligamentum flavum, and facet arthropathy. No significant neural foraminal stenosis at any level.2. Ill-defined focus of low T1 and T2 signal involving the T12 vertebral body is nonspecific and can be correlated with prior studies if available. No osseous destructive lesions.


Instruction: Generate impression based on findings.

Input: Ms. Balling is a 61-year-old female with biopsy-proven left breast cancer and disease positive lymph nodes status post neoadjuvant chemotherapy. She presents today for MR imaging to evaluate treatment response. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left central breast, there has been an interval decrease in size and overall enhancement pattern of the biopsy-proven malignancy. Residual enhancement consists of scattered enhancing masses/foci spanning approximately 3.9 x 1.7 x 1.7 cm (AP x ML x SI), previously measuring 5.1 x 4.4 cm. Susceptibility artifact from biopsy marker clip is seen within the central aspect of this malignancy. Of note, there is an enhancing intramammary lymph node identified in the left medial breast, which is stable in size and appearance when compared to the prior MRI from 5/2015.In addition, there has been an interval decrease in size of disease positive left axillary lymph node, now measuring 1.8 x 1.9 x 1.9 cm, previously measuring up to 4.1 cm on prior MRI from 5/2015. There is no abnormal enhancement identified in the right breast. No abnormal lymph nodes are identified in the right axillary region.

Output: (1) Interval decrease in size/enhancement of the biopsy-proven malignancy in the left central breast and disease positive left axillary lymph node. Residual disease in the left breast measures approximately 3.9 cm in the AP dimension.(2) No MR evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: There is an unchanged 11 mm AP x 7 mm CC x 11 mm ML enhancing extra-axial lesion which intimately involves the superior sagittal sinus. There is a stable dural based right parafalcine enhancing lesion on series 11 image 131 measuring up to 5 mm. There is stable right frontal convexity dural based thickening with enhancement measuring up to 4 mm thick on series 11 image 117. There is also a stable tiny 5-mm dural based focus of enhancement along the left inferior cerebellar hemispheric regional dura on series 1100 image 107. These lesions presumably represent additional tiny stable meningiomas. There are postoperative findings from right frontal craniotomy and skull flap with underlying dural thickening and enhancement. There are two small foci of enhancing tissue closely associated with the craniotomy site which are unchanged and likely postoperative.There are a few tiny nonspecific T2 hyperintense white matter foci without significant change. The ventricles and sulci are unchanged. There is no acute infarct, vasogenic edema or mass effect/herniation.

Output: Stable meningiomas and postoperative findings as described above.


Instruction: Generate impression based on findings.

Input: History of liver transplant with IVC compression and aneurysm. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from liver transplant. Stable peripheral wedge-shaped T2-weighted hyperintensity with restricted diffusion likely represents fibrosis. No new suspicious lesion.The portal vein and hepatic veins are patent. The hepatic artery is suboptimally evaluated.The suprahepatic IVC is again poorly opacified and visualized, which is likely a combination of susceptibility artifact from adjacent surgical clips and stenosis. Dorsal to the IVC there is a markedly aneurysmally dilated collateral vessel measuring up to 4.5 x 3.6 cm, similar to prior. Multiple large body wall and retroperitoneal/azygos collateral vessels are again noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, some of which are proteinaceous/hemorrhagic, similar to prior. Subtraction imaging, although limited on the left, demonstrate no abnormal post-contrast enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly dilated focal loop of small bowel in the midabdomen is again noted and appears slightly increased in caliber compared to the prior study. No evidence of bowel obstruction. This may be postsurgical in etiology.The SMA appears to originate immediately inferior to the celiac artery.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Cardiomegaly without pericardial effusion.

Output: 1.No focal suspicious hepatic lesion.2.Persistent narrowing of the suprahepatic IVC is suspected with extensive abdominal wall and retroperitoneal collateralization, some of which are aneurysmally dilated, unchanged.


Instruction: Generate impression based on findings.

Input: 50 serial female with spinal fusion L4/L5 9/05. Continued low back pain.IMAGE ACQUISITIONS: Thoracic/lumbar spine CT without contrast Thoracic spine alignment is normal. No evidence of central canal or neuroforaminal stenosis.Lumber spine alignment is normal. There is fusion of L4 and L5 with bilateral intrapedicular screws.L1-2: No central canal or neuroforaminal narrowing.L2-3: Minimal right facet joint hypertrophy. No central canal or neuroforaminal stenosis.L3-4: Posterior disk bulge cause centrally and left laterally. Mild left neuroforaminal impingement and mild central canal narrowing.L4-5: L4 Intrapedicular screws and right laminectomy. There is effacement right lateral and anterior to the thecal sac which raises the question of epidural fibrosis. MRI with contrast can be used to further evaluate.L5-S1: L5 interpedicular screws. There is narrowing of the right neural foramen.

Output: Postsurgical and degenerative changes as described above. There is question of right-sided epidural fibrosis at L4-5 for which MRI can be used to further evaluate.


Instruction: Generate impression based on findings.

Input: 60-year-old male with past medical history of orthotopic liver transplant in 1994 with recurrent cirrhosis. Possible thrombus of portal vein on recent outside CT. ABDOMEN:LIVER, BILIARY TRACT: Susceptibility artifact of the right hepatic lobe and left anterior abdominal wall (series 501 image 19). Cirrhotic liver morphology. Small cyst of the left hepatic lobe demonstrates peripheral T1 hyperintense signal intensity suggestive of proteinaceous material (series 601 image 30, series 902 image 286). Mild narrowing of the intrahepatic IVC. Adherent nonocclusive thrombus of the anterior main portal vein (series 903 image 147). No suspicious parenchymal lesions with washout are identified.SPLEEN: Splenomegaly measuring 22 cm in length. Small anterior splenule. Splenic varices.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion with overlying passive atelectasis. Cardiomegaly.

Output: 1.Cirrhotic morphology with sequelae of portal hypertension including splenomegaly, splenic varices, and moderate ascites. No suspicious liver parenchymal lesion delineated.2.Adherent nonocclusive thrombus of the anterior main portal vein.


Instruction: Generate impression based on findings.

Input: 8 years Male (DOB:2/21/2008)Reason: questioning communicating hydrocephalus History: Frequent headaches and EpistaxisPROVIDER/ATTENDING NAME: BRENDA GILES BRENDA GILES MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a minor opacity in the left frontal sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size.. The posterior communicating arteries are readily identified and are medium-sized. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm or arteriovenous malformation.3.No evidence for intracranial mass lesion or hemorrhage4.No evidence for ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Seizure like episodes x4. There is no evidence of intracranial heterotopia, hemorrhage, mass, or infarct. The brain parenchyma appears unremarkable, with an appropriate degree of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of gross seizure foci.


Instruction: Generate impression based on findings.

Input: Compared to the previous study again seen is fusiform enhancing tissue along the posterior orbital segment of the left optic nerve sheath with extension posteriorly into the optic canal and superiorly along the posterior planum sphenoidale. There is a mild decrease in the size of the intraorbital component of the mass from 8 mm previously to 6 mm in the current study (measured in the coronal plane). It is difficult to assess the mass in the planum sphenoidale due to susceptibility artifact, but appears decreased from 4 mm in the previous study to 3 mm in the current study measured in the coronal plane. Again seen is mild distention of the optic nerve sheath with CSF anterior to the mass.

Output: Mild interval decrease in size of left optic nerve sheath meningioma


Instruction: Generate impression based on findings.

Input: 18-year-old male patient status post cavernous malformation resection. Patient refused contrast during examination. There are postsurgical changes from a right frontal craniotomy for resection of right frontal vascular lesion/cavernous malformation. There is a surgical tract extending through the frontal lobe to the right periventricular region areas of signal void and susceptibility artifact, compatible air and blood product, as seen on prior CT. There is restrict diffusion along the surgical tract compatible with cytotoxic edema. There is a small amount of residual pneumocephalus anterior to the right frontal lobe. Again seen more superiorly is a right frontal lobe developmental venous anomaly coursing cranially into a curvilinear vascular malformation within the right superior frontal gyrus measuring approximately 9 x 6 mm, which on prior demonstrates significant enhancement which would be unusual for a cavernoma. Blooming artifact is again noted on susceptibility. Remainder of the brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The right maxillary sinus, anterior ethmoids and right frontal sinus remain opacified.

Output: 1.Expected postoperative findings related to resection of right frontal lobe vascular lesion/possible cavernous malformation.2.Stable vascular malformation in the right superior frontal gyrus with chronic hemosiderin deposition. Catheter angiogram can better assess for arteriovenous shunting.3.Persistent right paranasal sinus disease.


Instruction: Generate impression based on findings.

Input: dizziness There is about 18mm sized restricted diffusion lesion with surrounding edema on the left basal ganglia especially centered on the left globus pallidus. The lesion shows irregular enhancement on Gad enhancement with central non enhancing portion. There is another focal enhancing lesion on the left internal capsule posterior limb as well as diffuse thick enhancement of the left parieto-temporal area pachymeninges.Surrounding edema extends toward left midbrain and there is midline shift toward left side and left lateral ventricle frontal horn appears to be compressed due to mass effects. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Peripheral irregular enhancing restricted diffusion mass with significant surrounding edema and mass effects on the left basal ganglia with another enhancing nodule on the left internal capsule posterior limb indicating possibility of brain abscess. Differential diagnosis include malignant tumor including metastasis.2. Relatively thick enhancing left parieto temporal area pachymeninges indicate associated meningitis.


Instruction: Generate impression based on findings.

Input: Female; 47 years old. Reason: History of UC and PSC History: Elevated ALP. ABDOMEN:LIVER, BILIARY TRACT: Questionable minimal irregularity of the intrahepatic biliary ducts and mild intrahepatic biliary ductal dilatation. There is a 6 mm stricture in the common hepatic duct which extends to Klatskin's point on series 4, image 65. Although no obvious associated enhancing masses are seen, these would be difficult to visualize given the location of this stricture. No suspicious hepatic lesions. Patent hepatic vasculature. SPLEEN: No significant abnormality noted.PANCREAS: No suspicious lesions or definite pancreatic ductal dilatation. Findings of pancreatitis seen on prior CT have resolved. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Questionable minimal irregularity and mild dilatation of the intrahepatic biliary ducts, which may correlate with the patient's recent diagnosis of primary sclerosing cholangitis (PSC). 2.Dominant 6 mm stricture in the common hepatic duct extending to Klatskin's point. Although no definite associated enhancing mass is seen, it should be noted that evaluation is limited given the stricture location and small size.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of gastric cancer status post gastrectomy. Recent CT scan indicative of pancreatic ductal dilatation to 5 mm. Evaluate pancreatic duct and portal mass. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. No evidence of intra or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Normal T1 intrinsic hyperintensity without evidence of a pancreatic lesion or edema. There is mild dilatation of the pancreatic duct near the head measuring up to 5 mm with a normal common bile duct; there is possibly mild narrowing at the ampulla. Portion of the main pancreatic duct drains via the minor papilla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys enhance symmetrically without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of gastrectomy again noted. No bowel dilatation is present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild dilatation of the pancreatic duct near the head without evidence of pancreatic mass as above.2.Common bile duct is normal.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with altered mental status, seizure. No restricted diffusion is seen. Numerous scattered foci of periventricular and subcortical T2 hyperintensity are seen within the cerebral hemispheres. The caudate heads and putamina are also involved, left side more than right. Fairly conspicuous central pontine T2 hyperintensity is noted as well. No evidence of edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. On postcontrast images, there is no evidence of pathologic parenchymal or extra-axial enhancement.

Output: Patchy T2 hyperintensity is seen in the periventricular white matter, basal ganglia and central pons. The differential for these findings is broad and would include sequelae of small vessel ischemic disease, vasculitis, demyelination, or toxic/drug exposure. Similar features can also be seen in osmotic demyelination within the context of an electrolyte derangement.


Instruction: Generate impression based on findings.

Input: Right upper extremity paresthesia and pain. Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is straightening of the cervical spine curvature with minimal anterolisthesis of C4 on C5. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Mild disk bulge. No significant compromise to the spinal canal or neural foramina.C5-6: There is left paracentral disk extrusion with effacement of the left ventral thecal sac and minimal impression on the left ventral cord. Dorsal thecal sac is patent. No significant compromise to the neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: There is moderate narrowing of the right neural foramen related to combination of uncovertebral hypertrophy and disk material. There is mild narrowing of the left neural foramina. No significant spinal canal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Brachial Plexus:Subtle increased T2 hyperintensity is noted involving the C8 nerve root which is favored to be related to the stenosis more proximally in the right C7-T1 neural foramen. Otherwise, remainder of the brachial plexus nerve roots and more distal trunks, divisions, and cords are symmetric in signal and caliber with no abnormal T2 signal or enhancement. No neck masses to suggest compression.

Output: 1. Degenerative changes in the cervical spine as detailed above with moderate right neural foraminal stenosis at C7-T1 related to combination of disc material and uncovertebral hypertrophy. There is suspected impingement of the right C8 nerve root. Additional level findings as above.2. No high-grade spinal canal stenosis, cord compression, or cord signal abnormality.3. Subtle T2 hyperintensity/edema involving the proximal right C8 nerve root likely related to stenosis proximally in the neural foramen. Otherwise remainder of the brachial plexus is unremarkable.


Instruction: Generate impression based on findings.

Input: Right arm numbness. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral body heights are intact. There is mild multilevel disc height loss. At C2-3 and C7-T1, there is no significant compromise to the spinal canal or neural foramina. At C3-4, there is a disc osteophyte complex and small right foraminal disc protrusion with facet hypertrophy, mild spinal canal stenosis and mild right neuroforaminal narrowing. At C4-5, there is a disc osteophyte complex, facet hypertrophy and moderate right neuroforaminal narrowing. There is no left neuroforaminal spinal canal stenosis at this level. At C5-6, there is a disc osteophyte complex and facet hypertrophy with moderate left neuroforaminal narrowing. There is no spinal canal stenosis at this level. At C6-7, there a disc osteophyte complex and facet hypertrophy with mild spinal canal stenosis and moderate to severe bilateral neuroforaminal narrowing. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative cervical spondylosis of the cervical spine most prominently involving the bilateral C5-6 and C6-7 neural foramina, left worse than right, as well as at most mild spinal canal stenosis at the C3-4 and C6-7 levels.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, 25 years old, with paresthesias. Evaluate for MS. Brain:Numerous scattered white matter lesions are seen within the periventricular and juxtacortical regions, corpus callosum, the brainstem and cerebellum. Most of these lesions are associated with mild to moderate T1 hypointensity, but one lesion along the left cingulate gyrus is associated with marked T1 hypointensity.Brain parenchymal morphology is otherwise unremarkable. No significant mass effect or edema is detected. Parenchymal volume is relatively preserved. No evidence of any abnormal extra-axial fluid collection is seen. The ventricles remain normal in size and morphology.Cervical spine:Axial images are degraded by motion artifact. Nevertheless, a focus of T2 hyperintensity is seen within the right dorsal cord at T2-3. Additional foci are suspected within the left lateral cord at C4-5 and at C5-6.Spinal alignment is anatomic. Vertebral body height and morphology are normal. Marrow signal characteristics are unremarkable. No significant compromise of the spinal canal or neural foramina is seen.

Output: Multiple scattered lesions are seen within the cerebral and cerebellar white matter as well as in the visualized spinal cord compatible with demyelinating disease.


Instruction: Generate impression based on findings.

Input: Hereditary ataxia, unspecified [G11.9] / Other symptoms and signs involving the musculoskeletal system [R29.898], Reason for Study: ^Reason: left side root entrapment History: ataxia and leg weakness, sciatica For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are disc herniations one at the level of L34, toward left neural foramen which abuts left L3 nerve root, and another one is L45, toward right side neural foramen which abuts right L4 nerve root.There is lenticular shaped low signal intensity lesion at the level of L23 which appears to be connected with L34 disc thus indicate extruded disc material with cranial migration but could represent sequestrated disc.There is Modic type 2 degenerative changes of L45. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. 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.

Output: 1. Left neural foraminal disc herniation (extrusion) at the level of L34 with cranial migration of disc material.2. Right neural foraminal disc herniation (protrusion) at the level of L45 with mild neuroforaminal stenosis.3. Modic type 2 degenerative changes of L45 disc space.


Instruction: Generate impression based on findings.

Input: 46-year-old female with bilateral breast with pain involving left fifth finger. Check for mass Exam limited without contrast, patient declined.LIGAMENTS: Visualized ligaments appear intact and throughout. TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: Visualized tendons appear intact. Specifically the fifth flexor complex is only minimally displaced radially by the small loculated subcentimeter nodule just distal to the MCP. This mildly multilocular nodule measures 8 x 6 mm axially (image 12 series 11) and 12 mm craniocaudally (image 5 series 9). Margins remain discrete and sharp but inseparable from the tendon sheath along the ulnar margin. Internal signal is uniform and without discrete fluid fluid or internal contents observed. Bright T2 and mid to mildly decreased signal characteristics relative to muscle on T1 imaging. Comment about enhancement is not possible for reasons described.BONES: No significant abnormality noted. Specifically no adjacent osseous abnormalities or associated periosteal reactionADDITIONAL

Output: Moderately limited exam yet appearance is most suggestive of a juxta-articular ganglion cyst, specifically not additional findings or secondary findings to support a soft tissue malignancy or PVNS


Instruction: Generate impression based on findings.

Input: Reason: 3 t scanner pre depth electrode placement History: epilepsy There is redemonstration of asymmetric volume loss involving the left hippocampus with associated increased T2 signal especially along the mid to distal hippocampus. There again may be suggestion of mild diminished size of the left mamillary body.The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. A few scattered punctate foci T2 hyperintensity are again seen within the white matter. There is no pathological enhancement. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. A chronic right lamina papyracea fracture is again noted. There is trace mucosal thickening in ethmoid air cells bilaterally.

Output: 1.Redemonstration of findings compatible with left mesial temporal sclerosis.2.Stable nonspecific scattered punctate foci of nonenhancing T2 hyperintensity within the white matter.


Instruction: Generate impression based on findings.

Input: 72-year-old male with history of prostate cancer. Biopsy 9/19/2016: Gleason 6 right base lateral; Gleason 7 right mid lateral; Gleason 6 right apex medial; Gleason 6 right apex lateral; Gleason 6 left apex medial PELVIS:PROSTATE: Examination is limited due to patient motion.Prostate Size: 4.4 x 5.2 x 3.3 cm perPeripheral Zone: There is intrinsic T1 signal throughout the peripheral zone which may reflect hemorrhage from recent biopsy.Focus of early arterial enhancement corresponding to a focus of T2 hypointensity in the right peripheral zone apex and mid gland.Central Gland: Severe degree benign prostatic hypertrophy. The anterior transitional zone is abnormal in appearance with low T2 signal. Seminal Vesicles: Seminal vesicles are atrophic. Focus of T1 hyperintensity in the left seminal vesicle may represent blood product from hemorrhage. Extracapsular Extension: There is probable extracapsular extension of right apex peripheral zone lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is small volume pelvic ascites.

Output: 1.Limited examination due to diffuse T1 hyperintensity reflecting hemorrhage in the peripheral zone and due to motion. 2.Right apex lesion is suspicious for malignancy with probable extracapsular extension. 3.Abnormal appearance and low T2 signal in the anterior transitional zone. Cannot exclude malignancy in this region. 4.Small pelvic ascites.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect or midline shift. There is an unchanged small linear focus of T2 hyperintense signal in the right centrum semiovale, nonspecific. The hippocampi are symmetric in volume and signal. There is no detectable asymmetric gyral thickening or abnormal sulcation pattern. There are no definite gray matter heterotopias. The ventricles and sulci are normal for patient age. The flow-voids of the skull base are preserved.

Output: No findings to account for patient's seizures.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 87-year-old female with history of pancreatic cystic lesion. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Stable 2.6-cm nonenhancing distal pancreatic tail cystic lesion. No pancreatic ductal dilatation. Redemonstration of pancreatic divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral T2 bright lesions, likely representing cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable 2.6 cm pancreatic tail lesion, suggestive of mucinous cystic neoplasm.2.Pancreatic divisum


Instruction: Generate impression based on findings.

Input: 44 year old woman with dyspnea, on echocardiography, there is concern for sub-aortic membrane, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 75%, the LV end diastolic volume index is 82 ml/m2 (normal range: 65+/-11), the LVEDV is 179 ml (normal range 109+/-23), the LV end systolic volume index is 21 ml/m2 (normal range 18+/-5), the LVESV is 45 ml (normal range 31+/-10), the LV mass index is 50 g/m2 (normal range 67+/-11), and the LV mass is 109 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is hypertrophy of the basal septum, measuring 16mm at the antero-basal segment and 17mm at the infero-basal segment.No intracardiac thrombus is present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with hyperdynamic systolic function. The overall RV ejection fraction is 79%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 143 ml (normal range 110+/-24), the RV end systolic volume index is 14 ml/m2 (normal range 22+/-8), and the RVESV is 30 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve leaflets demonstrate low signal focus suggestive of calcification of the non coronary cusp. There is aortic stenosis with incomplete separation of the basal commissures of what appears to be a trileaflet but degenerative aortic valve. There is flow acceleration at the level of the aortic valve with aliasing artifact at 2 m/s. Approximately 0.5 cm below the level of the aortic valve annulus is an incomplete filamentous low signal membrane (series 1901, image 11) that arises from the basal septum (series 2001 image 5) as well as the aorto mitral skeleton. Flow acceleration is demonstrated at this level, as well.Mitral ValveThe mitral valve opens widely. There is mild systolic anterior motion of the anterior mitral leaflet. There is at least trace mitral regurgitation. Acceleration of flow is demonstrated as the anterior mitral leaflet hits the basal septum at and systole.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsA small hiatal hernia is present.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 75%. No abnormal enhancement.2. The right ventricle is normal in size with hyperdynamic systolic function. The overall RV ejection fraction is 79%.3. There is outflow tract flow acceleration resulting from 3 abnormalities:Basal septal hypertrophy measuring up to 17 mm at end diastole. During systole, there is flow acceleration at the level of muscular hypertrophy.Incomplete subvalvular membrane approximately 0.5 cm below the aortic valve annulus.The configuration of the aortic valve appears to be trileaflet with incomplete separation of the basal commissures, secondary to degeneration with calcification. This results in a degree of aortic stenosis. The peak velocity at the leaflet tips is greater than 2 m/s.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with history of low-grade glioma with CSF dissemination status post cranial spinal radiation. Brain:A subcentimeter nodule is redemonstrated within the left frontal horn showing susceptibility effect and intrinsic T1 hyperintensity likely reflecting calcification. The nodule enhances mildly on postcontrast images. No significant interval change is seen in the size of this lesion.Ependymal and subependymal enhancement centered on the left frontal horn is again seen. The geographic extent of this enhancement is similar to prior though in some areas the thickness of this enhancement has increased by 1 or 2 mm. No entirely new enhancing lesions are seen.The lateral ventricles remain prominent which likely reflects volume loss of the surrounding white matter, slightly progressed from prior. T2 hyperintensity surrounding the lateral ventricles is similar in pattern and extent. Numerous scattered foci of susceptibility are seen indicating sites of chronic microhemorrhage, particularly around the left frontal horn but also elsewhere in the brain. Susceptibility effect is also seen in the brain stem and along the fissures of the vermis. These findings have also likely progressed and are probably related to therapy.No new lesions are seen. No local or generalized mass effect is seen. The right mastoid air cells remain chronically opacified.C-spine:Within the limitations of motion degraded images, the following observations are made.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema or marrow replacement is seen. However, the marrow does demonstrate conspicuous fatty signal characteristics which may reflect prior radiation. No pathologic marrow enhancement is seen.The spinal cord is of smaller than normal caliber, particularly beginning at the C5 level and continuing down into the thoracic region where it becomes quite atrophic. No focal cord signal abnormality is detected. No epidural abnormalities are seen. No pathologic parenchymal or leptomeningeal enhancement is seen.Minimal disc osteophyte formation is seen at C4-5 and C5-6. No significant spinal canal or foraminal stenosis is identified at any level.

Output: 1.Stable calcified and mildly enhancing nodule within the left frontal horn.2.Mild increased thickness of the ependymal and subependymal enhancement which has been seen on numerous prior examinations along the left frontal horn. This finding is nonspecific, particularly given the long imaging interval, and could in part be technical in nature. No new enhancing or nonenhancing lesions are identified.3.Progressive periventricular white matter volume loss and progressive likely treatment-related hemosiderin deposition is seen.4.Redemonstration of spinal cord atrophy particularly in the lower cervical and thoracic regions. No findings are seen to suggest active or progressive tumor in the cervical spine.


Instruction: Generate impression based on findings.

Input: Again seen are postsurgical changes of resection of previously seen enhancing extra-axial mass at the right cerebellopontine angle via retrosigmoid approach. There is no abnormal enhancement to suggest residual or recurrent tumor. The bilateral internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle cisterns bilaterally or within the internal auditory canals. Limited evaluation of the remainder of the brain parenchyma demonstrates no evidence of intracranial mass effect, herniation, or hydrocephalus.

Output: Postsurgical changes of resection of right cerebellopontine angle meningioma without evidence of recurrent tumor.


Instruction: Generate impression based on findings.

Input: 45 years Male (DOB:11/28/1970)Reason: Eval for cord lesion, concern for NMO History: b/l optic neuritis PROVIDER/ATTENDING NAME: RIMAS V. LUKAS JAMES A MASTRIANNI Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are appreciated within the cervical spinal cord, though, artifacts may obscure more subtle abnormalities.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is 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.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal lesions are appreciated within the thoracic spinal cord, though, artifacts may obscure more subtle abnormalities.No abnormal enhancing lesions are appreciated in the thoracic spine.

Output: 1.No abnormal lesions are appreciated within the cervical or thoracic spinal cord, though, artifacts may obscure more subtle abnormalities.2.There is no significant compromise to cervical thoracic spinal cord exiting nerve roots appreciated.


Instruction: Generate impression based on findings.

Input: 11 year old female with history of moyamoya disease and headache at the surgical site Postsurgical changes status post left parietal burr hole and left temporal craniotomy is noted. The bones appear to be in normal anatomic alignment.There is no evidence of intracranial hemorrhage, midline shift, mass or edema. Previously identified periventricular hypoattenuation are again noted and not significantly changed considering positional and technical differences, compatible with known moyamoya disease. The ventricles, cortical sulci and basal cisterns are normal in size and configuration.The visualized paranasal sinuses and mastoid air cells are well pneumatized.

Output: 1.No acute intracranial abnormality.2.Postsurgical changes status post left parietal burr hole and left temporal craniotomy.3.Periventricular white matter hypoattenuation not significantly changed compared to prior exam considering positional and technical differences, and compatible with known history of moyamoya disease.


Instruction: Generate impression based on findings.

Input: 45-year-old female with left knee pain status post fall. Evaluate for medial meniscus tear. MENISCI: The medial lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The anterior cruciate ligament and posterior cruciate ligament appear intact. There is thickening and increased signal abnormality within the superficial band of the MCL suggestive of a sprain. The MCL appears intact. The LCL is intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Findings consistent with a moderate MCL sprain. The MCL appears intact. 2. Small joint effusion.


Instruction: Generate impression based on findings.

Input: Status post right pleurectomy decortication. Evaluate for postop changes. CHEST:LUNGS AND PLEURA: The extensive opacity in the right hemithorax consistent with atelectasis and a non-specific consolidation, mainly in a peripheral location.There is probably some loculated fluid at the apex and I cannot exclude residual pleural disease.Radiopaque surgical material is present at the right base probably at the site of partial diaphragmatic resection.A moderately large loculated subpulmonic effusion this present.MEDIASTINUM AND HILA: Lower right and left paratracheal lymphadenopathy with several nodes measuring greater than 10 mm in short axis, unchanged from the previous scan and suspicious for metastatic involvement.Extensive coronary artery calcification.CHEST WALL: No specific evidence of chest wall invasion.Extensive degenerative abnormalities in the spine.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific hypodense lesion measuring about 10 mm x 25 mm in segment 4 B.. This was not visible previously but likely obscured by respiratory motion. The differential diagnosis includes hemangioma, atypical cyst and, less likely, metastasis. If clinically indicated this could be further evaluated with by dedicated CT with multiphase contrast, or MRI scan. Alternatively, a follow-up scan could be performed to confirm stability.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal calculi which may be in the collecting systems. Irregular renal margins with perirenal fat stranding.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Loculated right pleural effusion and atelectasis. 2. Mediastinal lymphadenopathy, unchanged.


Instruction: Generate impression based on findings.

Input: Resection of a large right parietal WHO grade 1 meningioma in September of 2012. There are postoperative findings related to right frontal craniotomy for resection of a meningoma without evidence of gross tumor. There is also unchanged mild residual confluent T2 hyperintensity along the margins of the resection cavity. There are unchanged mild nonspecific scattered foci of cerebral white matter T2 hyperintensity, which may be related to microangiopathy. There is no evidence of acute infarct. The ventricles are stable in size and configuration. There is no midline shift. The major cerebral flow voids are intact. There is unchanged heterogeneity of the calvarium at the craniotomy site. The extracranial structures are unchanged.

Output: Post-treatment findings in the right frontal region without evidence of gross tumor recurrence.


Instruction: Generate impression based on findings.

Input: Lower extremity hyperreflexia, bilateral upper limb tingling. Gait impairment. Left lower extremity weakness. Brain: There are a few scattered foci of T2/FLAIR hyperintensity in the subcortical and periventricular white matter, which are nonspecific. Brain appears otherwise unremarkable. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical spine: There are postsurgical changes related to anterior cervical fusion at the C5-C6 and C6-C7 levels with residual C5-C6 hardware better assessed on recent CT from June 20, 2015. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign. No abnormal cord signal is appreciated.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a disc osteophyte complex eccentric to the right with a right paracentral disc protrusion which results in effacement of the ventral thecal sac and mild impression on the right ventral aspect of the cord. Finding is progressed since prior MRI cervical spine from 7/7/2012. There is mild to moderate right neural foraminal stenosis. No significant left neural foraminal narrowing.C4-5: Small disc osteophyte complex and uncinate hypertrophy on the left with moderate left neural foraminal stenosis. Minimal right neural foraminal narrowing. Mild spinal canal stenosis.C5-6: Disc osteophyte complex and uncovertebral hypertrophy with moderate right and mild left neural foraminal stenosis. Mild spinal canal stenosis.C6-7: There is bilateral uncovertebral hypertrophy with moderate to severe left and moderate right neural foraminal stenosis. No significant spinal canal stenosis.C7-T1: No significant compromise to the spinal canal. There is facet arthropathy, particularly on the left with with mild left neural foraminal narrowing. No significant right neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Brain MRI is within normal limits for age. Specifically no evidence of infarct, hemorrhage, mass or mass effect. 2. Multilevel degenerative changes in the cervical spine with evidence of prior anterior cervical fusion at C5-C6 and C6-C7 with residual C5-C6 hardware better seen on recent CT. There is up to moderate stenosis involving the right aspect of the spinal canal at the C3-C4 level related to disc protrusion which has progressed since prior MRI from 2012. There is mild spinal canal stenosis at the C4-C5 and C5-C6 levels. There is also foraminal stenosis at multiple levels as detailed above. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: The study is degraded by extensive motion artifact.MRI BRAIN:A small triangular shaped area of peripheral diffusion hyperintensity is seen in the left corona radiata, which is iso- to hyperintense on ADC, suggestive of subacute infarct.There is encephalomalacia in the right temporal lobe lobe with ex vacuo dilatation of the right lateral ventricle. There are areas of high T2/FLAIR hyperintensity in the subcortical and the periventricular white matter bilaterally, including the right occipital periventricular white matter somewhat asymmetrically, consistent with chronic ischemic disease.The ventricles and the sulci are prominent suggestive of volume loss. Punctate susceptibility is seen in the right temporal lobe, suggestive of chronic blood products in the area of previous infarct. There is a chronic lacunar infarct involving the right corona radiata.MRI BRAIN:There is slight dorsal convexity of the right internal carotid artery terminus but appears to represent a minimally tortuous A1 origin, with no definite aneurysm. The left A1 segment is hypoplastic, and therefore the left ICA is smaller than the right. Otherwise, there is no flow limiting stenosis or aneurysm in the cerebral arteries.NECK MRA: There are mild irregularities of the carotid vessels. There is eccentric convexity of the medial margin of the mid left common carotid artery, likely related to atherosclerotic ulcerated plaque. There is mild narrowing of the left carotid bulb.There is eccentric narrowing of the left subclavian artery just distal to the left thyrocervical trunk, likely related to atherosclerotic plaque.There is anterolisthesis of C3 on C4.

Output: 1. A small focus of probable subacute infarct in the left corona radiata.2. Right temporal lobe chronic infarct, with chronic ischemic changes in the right occipital white matter and elsewhere in the periventricular white matter.3. Significantly motion-limited exam. No definite aneurysm or hemodynamically significant stenosis in the cerebral and the cervical arteries. There are irregularities of the cervical carotids with mild narrowing of the left carotid bulb.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: colorectal ca with L cerebellar met s/p resection and post-op radiationSigns and Symptoms: eval for extent of disease The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post posterior fossa surgery for removal of a left cerebellar lesion. There is a loss of volume along the superior aspect of the cerebellar vermis associated with adjacent T2 signal hyperintensity and susceptibility effect. There is enhancement along the margins of the resection site. This enhancement was also present on prior exams, however, prior exams are somewhat degraded by patient motion. There is a 8 mm ring-enhancing focus along the superior aspect of the surgical resection site which has low signal centrally on T2 and associated with some adjacent signal change in the left superior cerebellar hemisphere.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is thinning of the left posterior sclera compatible with staphyloma. The right eye is irregular in shape. There is no enhancing lesion identified in either eye. These findings are stable compared to prior exams.

Output: 1.Status post removal of a mass from the cerebellar vermis. A small nodule at the superior aspect of the resection site could potentially represent evolving postoperative change, however, it is somewhat nonspecific and could also represent some local recurrence. A follow-up exam could be helpful2.Stable appearance of the eyes with staphyloma in the left eye and ocular deformity on the right eye.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: There are no fractures. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.Modic type I reactive endplate changes are present at C4/5, C5/6, and to a lesser extent C6/7.C2/3: Focal right paramedian osteophyte disc complex causes slight flattening of the anterior right hemicord without intrinsic cord signal abnormality, displacing adjacent traversing nerve roots..C3/4: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is severe left neural foraminal and moderate to severe right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is severe left neural foraminal and moderate right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate left neural foraminal and moderate to severe right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is severe left neural foraminal and moderate to severe right neural foraminal stenosis.C7/T1: There is trace anterolisthesis C7 on T1 secondary to bilateral facet hypertrophy (right greater than left). There no significant stenoses.

Output: 1.C2/3: Focal right paramedian osteophyte disc complex causes slight flattening of the anterior right hemicord without intrinsic cord signal abnormality, displacing adjacent traversing nerve roots..2.C3/4: Severe left neural foraminal and moderate to severe right neural foraminal stenosis.3.C4/5: Severe left neural foraminal and moderate right neural foraminal stenosis.4.C5/6: Moderate left neural foraminal and moderate to severe right neural foraminal stenosis.5.C6/7: Severe left neural foraminal and moderate to severe right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Pre op planning for surgical resection of brain tumor. There is a centrally low T1 and high T2 hemorrhagic lesion that measures up to 4.5 cm in the left frontal lobe. There is also a low T2 signal along margin of the right lateral ventricle body that measures up to approximately 15 mm. The ventricles and basal cisterns are unchanged in size and configuration. There is unchanged mild midline shift to the right. Skin fiducial markers are present.

Output: Treatment planing MRI for a left frontal lobe hemorrhagic lesion, which may represent a metastasis. A lesion along margin of the right lateral ventricle body may also represent a hemorrhagic metastasis.


Instruction: Generate impression based on findings.

Input: Left shoulder pain and weakness Note that the examination is limited by motion artifact. Additionally, the patient is internally rotated which limits evaluation of the intra-articular biceps tendon.ROTATOR CUFF: The supraspinatus tendon is diffusely enlarged with increased signal reflecting tendinopathy. There is a small focus of fluid signal within the bursal surface fibers of the supraspinatus indicating a high-grade partial-thickness tear. The infraspinatus tendon appears intact as do the subscapularis and teres minor tendons. There is minimal atrophy of the rotator cuff musculature particularly of the supraspinatus and teres minor.SUPRASPINATUS OUTLET: There is moderate arthrosis of the acromioclavicular joint. A trace amount of subacromial subdeltoid fluid is present.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. There is severe joint space narrowing and osteophyte formation of the glenohumeral joint indicating moderate to severe osteoarthritis. There is no sizable joint effusion however there is a collection of fluid within the subcoracoid bursa indicating some bursitis.BICEPS TENDON: Evaluation of the biceps tendon is limited by motion and and internal rotation of the humerus. Within these limits, there is increased signal and thickening within a portion of the intra-articular biceps indicating tendinosis. The extra-articular biceps is intact.ADDITIONAL

Output: 1. High-grade partial-thickness bursal surface tear of the supraspinatus tendon.2. Subcoracoid bursitis.3. Moderate to severe osteoarthritis of the glenohumeral joint.


Instruction: Generate impression based on findings.

Input: 86-year-old female with mental status change and fall. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensities in the periventricular and subcortical white matter distribution consistent with small vessel disease age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Multiple punctate hypodensities consistent with old lacunar infarcts. Large white matter hypodensity in the distribution of the right posterior cerebral artery consistent with prior stroke.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified disorder of the pituitary gland and its hypothalamic control. Subarachnoid hemorrhageClinical question: sellar mass, SAH, SDH, unilateral vision loss MRI of the brainThere are small foci of diffusion restriction along the territory of the right anterior choroidal artery including the uncus, internal capsule. There is a .punctate focus of diffusion restriction along the right ACA territory at the anterior aspect of the cingulate gyrus. There are a couple punctate foci of diffusion restriction along the left centrum semiovale..There is subdural blood present along the tentorium, falx and adjacent to the right frontal bone and right parietal bone. There is redemonstration of blood products within the sella and suprasellar cistern within the subarachnoid space.There is a hemorrhagic lesion along the sella and suprasellar cistern.The patient is status post transsphenoidal surgery. There is packing material within the posterior superior aspect of the nasal cavity. The visualized portions of the paranasal sinuses demonstrate some air-fluid levels in the maxillary sinuses and partial opacification of the sphenoid sinus as well as the posterior and middle ethmoid air cells. 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 partially opacified. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is associated narrowing of the ophthalmic segment of the right internal carotid artery associated with the above-described aneurysmal type lesion with approximately 70% stenosis. There is also some milder narrowing of the distal left internal carotid artery at the ophthalmic segment with approximately 40% narrowing of this vessel.There is a 2 mm x 2 mm sessile left cavernous internal carotid artery aneurysm directed laterally at the proximal portion of the horizontal portion of the cavernous segment.There is no evidence for cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.There is extracranial origin of the PICA bilaterally.

Output: 1.Acute infarctions along portions of the right anterior choroidal artery territory with small/punctate infarctions at the right ACA territory and left centrum semiovale.2.The patients known pseudo aneurysm is not well demonstrated on this exam. Because it is slow filling a CTA or alternatively possibly a phase contrast MRA or MRV with contrast would be more sensitive to identifying it than an MRA3.There is 70% stenosis of the distal right internal carotid artery and mild narrowing of the left internal carotid artery along the respective ophthalmic segments. Please note that this is associated with a hypoplastic right A1 segment and nonvisualization of the right posterior communicating artery suggesting isolation of the right middle cerebral artery from the rest of the circulation.4.Subarachnoid and subdural hematomas 5.2 mm left cavernous internal carotid artery aneurysm.6.Status post transsphenoidal surgery with postoperative changes.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate cord. Signs and symptoms: Pain. Nonenhanced cervical MRI:There is normal anatomical alignment of cervical spine however with mild reversal of cervical lordosis at C5-C6 level.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate a right lateral linear T2 hyperintensity within the annulus of the disc suggestive of an annular fissure. Finding is best appreciated on axial T2 series 901 image 24 and sagittal T2/T2 STIR image 8. No spinal stenosis or neural foraminal compromise.C4-C5 demonstrate mild degenerative changes and unremarkable otherwise.C5-C6 demonstrate mild bilateral uncovertebral hypertrophy changes resulting in mild right neural foraminal compromise and unremarkable otherwise.C6-C7 demonstrate mild disc disease, shallow central and left paramedian disc protrusion minimally indents the thecal sac without spinal stenosis. Moderate bilateral neural foraminal compromise (R>L).C7-T1 is unremarkable.T1-T2 is unremarkable.There is normal signal intensity of cervical and upper most visualized thoracic cord to T2 level.

Output: 1.Mild degenerative changes of cervical spine without evidence of spinal stenosis at any level.2.Mild to moderate neural foraminal compromise as detailed per level above.3.Normal signal intensity and caliber of the cervical and upper most visualized thoracic cord.


Instruction: Generate impression based on findings.

Input: 32 years Female (DOB:8/19/1984)Reason: Headaches and confusion spells post head injury History: abovePROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 67 years, Female, multiple sclerosis, atrophy, evaluate for change There are greater than 20 T2/FLAIR hyperintense lesions in the bilateral periventricular and subcortical white matter with distribution and morphology consistent with known demyelinating disease. Several juxtacortical as well as infratentorial lesions are also noted. There is also a mild to moderate burden of T1 hypointense lesions. No intracranial mass effect, midline shift, or herniation. There is mild global parenchymal volume loss.

Output: Multiple T2/FLAIR hyperintense lesions consistent with known demyelinating disease. Addendum can be made if prior MRI is made available for comparison.


Instruction: Generate impression based on findings.

Input: Male 36 years old assess left hip AVN. ACETABULAR LABRUM: There is linear increased T2 signal within the anterior superior acetabular labrum (series 501, image 16 and series 1401, image 4) likely representing a labral tear.ARTICULAR CARTILAGE AND BONE: There is low T1 and heterogeneously high T2 signal within the anterior superior aspect of the humeral head. These areas are outlined with a band of low T1 signal consistent with avascular necrosis. There is associated irregularity of the cortex along the anterior superior femoral head with increased T2 signal most likely due to subchondral fracture. Small round, well-circumscribed areas of high T2 signal likely represent cystic changes from secondary osteoarthritis. The left acetabulum is preserved.Outside of the left humeral head marrow signal is within normal limits, no evidence for avascular necrosis elsewhere. There is one small subchondral cyst in the right femoral head possibly degenerative in etiology.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1.Avascular necrosis of the left femoral head with subchondral fracturing along the anterior superior femoral head.2.Probable tear of the anterior superior acetabular labrum.


Instruction: Generate impression based on findings.

Input: Right knee pain. Evaluate for lateral meniscus tear. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the inferior aspect of the lateral facet of the patella along with a small full-thickness defect with underlying degenerative subchondral signal abnormality. There is also focal blistering of the articular cartilage of the medial facet of the patella. There is also a partial-thickness cleft in the articular cartilage of the medial facet of the femoral trochlea. The tibiofemoral articular cartilage is unremarkable. The remaining bone marrow signal intensity is within normal limits.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. No evidence of meniscal tear.2. Degeneration/defects of the articular cartilage of the patellofemoral joint.3. Baker's cyst.


Instruction: Generate impression based on findings.

Input: Other malaise and fatigue [780.79], Reason for Study: ^Reason: muscle weakness pain, mother with h/o MS; h/o lymhoma in remission History: transient, intermittent muscle weakness, pain in B LE/UE over 1 year No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: 60-year-old female with knee pain. Evaluate for patellar chondral defect. MENISCI: There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. There is degeneration of the anterior horn of the lateral meniscus near its root, with heterogeneous material anterior to the meniscus likely representing extrusion of mucoid material.ARTICULAR CARTILAGE AND BONE: There is severe osteoarthritis affecting the patellofemoral joint with much of the lateral facet of the patella, median eminence of the patella, and lateral facet of the femoral trochlea devoid of articular cartilage; this has progressed when compared to the prior study. There are underlying subchondral cysts. There is relatively mild degeneration of the articular cartilage of the medial facet of the patella and femoral trochlea. Subjectively, the articular cartilage of the medial tibiofemoral compartment appears thinned, but the articular cartilage of the lateral tibiofemoral compartment appears relatively spared. There are small tricompartmental osteophytes. There are small cysts within the intercondylar eminence of the tibia which are likely degenerative in etiology.LIGAMENTS: There is thickening and increased signal intensity in the anterior cruciate ligament likely representing mucoid degeneration. The PCL, MCL, and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Severe osteoarthritis of the patellofemoral joint, which has progressed compared to the prior study. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 16 year old female with syndromic enchondroma. BONE MARROW: There are numerous intermediate T1 and high T2 lesions especially medially along the proximal left femoral neck that appear similar to recent radiographs and increased when compared to prior MRI. One lesion extends from the femoral neck into the head, crossing the physis. Many similar lesions are noted in the femoral diaphysis, where they become confluent and expand the diaphysis and thin the cortical margin of the bone. These lesions also demonstrate a low T2 rim. No fracture line is identified.These lesions demonstrate peripheral and septal enhancement while centrally intermediate T1 signal remains.SOFT TISSUES: There are a few prominent subcentimeter lymph nodes in the left inguinal region. No soft tissue masses. JOINTS: Joint spaces are well-maintained. No joint effusion present.ADDITIONAL

Output: Multiple areas of marrow replacement by a nonaggressive appearing lesions. There is peripheral and septal enhancement with areas of endosteal scalloping. The differentiation between enchondroma and low-grade chondrosarcoma is difficult by imaging. This is favored to represent enchondroma given lack of radiographic changes from 2011.


Instruction: Generate impression based on findings.

Input: 55 year old female patient with history of epigastric pain, weight loss, mildly elevated lipase. CT demonstrated prominence of the pancreatic duct. Evaluate for pancreatitis and pancreatic inflammation. ABDOMEN:LIVER, BILIARY TRACT: There is paradoxic loss of signal on in phase imaging of the hepatic parenchyma compatible with iron deposition. No focal T2 hyperintense lesion is identified.SPLEEN: There is paradoxic loss of signal on in phase imaging of the splenic parenchyma compatible with iron deposition.PANCREAS: The pancreatic duct within the head and proximal body is prominent in size, however, there is no evidence of an obstructing lesion. The pancreas demonstrates normal, uniform signal on T1 weighted imaging. Lack of IV contrast limits evaluation, however, no pancreatic lesion is identified. There is no significant peripancreatic inflammation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are innumerable bilateral T2 hyperintense renal lesions, which are incompletely evaluated on non-contrast imaging, however likely represent renal cysts related to chronic kidney disease. There is interval development of a septated right lower pole renal mass measuring 6.5 x 5.4 x 5.4 cm which demonstrates intermediate T2 signal and regions of internal T1 signal indicative of hemorrhage; this lesion is incompletely evaluated without IV contrast.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of pancreatitis or pancreatic mass.2.New right lower pole renal mass is incompletely evaluated with IV contrast. While this could represent a new hemorrhagic cyst, an underlying lesion is not excluded; contrast enhanced dedicated renal CT is recommended for further evaluation given patient's ESRD. 3.Bilateral renal cysts likely related to chronic kidney disease.4.Iron deposition within the liver and spleen.


Instruction: Generate impression based on findings.

Input: 72 year old with history of hypertension, diabetes, chronic kidney disease, valvular heart disease, coronary artery disease (CABG 2014) and diastolic heart failure presenting from OSH with acute decompensated heart failureTechnical: The quality is poor, due to inability to perform breath hold and motion artifact Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 106 ml/m2 (normal range: 74+/-15), the LVEDV is 252 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 103 ml (normal range 47+/-19), the LV mass index is 87 g/m2 (normal range 85+/-15), and the LV mass is 208 g (normal range 164+/-36). There is septal flattening at inspiration and expiration consistent with RV pressure and volume overload. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, however LGE imaging significantly limited by motion artifact.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 145 ml/m2 (normal range 82+/-16), the RVEDV is 346 ml (normal range 142+/-31), the RV end systolic volume index is 72 ml/m2 (normal range 31+/-9), and the RVESV is 171 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThere is a prosthetic valve in the aortic position. 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 moderate-severe eccentric 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 is normal in size and drain normally into the right atrium. The IVC is dilated.PericardiumThe pericardium is borderline thickened in some regions (the maximum measured thickness is only 4mm). Based on tagging, the myocardium does not appear adherent to the pericardium. Free breathing does not show significant interventricular dependence to support constrictive physiology. Extracardiac FindingsSternotomy wires present. Bilateral interstitial markings, left greater than right. 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. This is a technically difficult study because of patient inability to cooperate with breath-holds. Within the limitations of image quality, it can be noted that the pericardium is at most borderline thickened. There is no obvious evidence of pericardial tethering to the myocardium or respiratory variation in the septal position. There is also no significant late gadolinium enhancement of the pericardium. Taken together there is no strong evidence for pericardial constriction.2. Mild LV dilation with normal systolic function (LVEF 59%) with septal flattening which seems to occur more often during systole suggesting the presence of increased RV systolic pressures. There is no obvious late gadolinium enhancement to suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration; however, image quality is somewhat limited. 3. Severe RV dilation with normal systolic function (RVEF 51%).4. Moderate to severe tricuspid regurgitation. 5. Severe RA dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Diaz is a 35 year old female with a strong family history of breast cancer (mother diagnosed at the age of 32 and three maternal aunts). Personal history of benign right breast biopsy in 2010. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Artifact from the right central breast biopsy clip is again noted.No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Signal heterogeneity is noted within the palatine tonsils, including a 6 mm cyst on the right. Correlation with previous soft tissue neck CT demonstrates prior bilateral, palatine, tonsillar abscesses. Thus, these MRI findings are felt to represent postinflammatory changes.There is reversal of normal upper cervical curvature which is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Other than the aforementioned tonsillar findings, the visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: UnremarkableC6/7: UnremarkableC7/T1: Unremarkable

Output: 1.Signal heterogeneity is noted within the palatine tonsils, including a 6 mm cyst on the right. Correlation with previous soft tissue neck CT demonstrates prior bilateral, palatine, tonsillar abscesses. Thus, these MRI findings are felt to represent postinflammatory changes.2.Otherwise negative noncontrast cervical spine MRI. Specifically, there are no MRI findings to explain the patient's left leg weakness.


Instruction: Generate impression based on findings.

Input: Evaluate for new bleed. History of altered mental status. Nonenhanced head CT:There is no evidence of any new finding since prior exam. The cortical sulci, ventricular system and all CSF cisterns remain within normal. The gray -- white matter differentiation is also within normal. If patient's condition persist recommend an MRI examination.Calvarium is intact. Visualized mastoid air cells and middle ear cavities as well as paranasal sinuses are unremarkable.

Output: 1.No evidence of acute new findings.2.CT is insensitive for detection of any ischemic process. Recommend MRI if patient's clinical condition persists.