Instruction: Generate impression based on findings.

Input: 35-year-old woman with history of Crohn's disease and prior episodes of pancreatitis, now with abdominal pain and bilious emesis. ABDOMEN:LIVER, BILIARY TRACT: There is mild loss of signal of the hepatic parenchyma on the opposed phase images indicating fatty infiltration. No focal lesions are identified. The gallbladder is normal. Mild intrahepatic biliary duct dilatation appears similar to the prior examination. The common bile duct is stable and measures 8 mm.SPLEEN: The spleen is normal. The splenic vein is not visualized and a few gastrosplenic varices are identified.PANCREAS: The entire pancreas is markedly edematous and there is a small amount of peripancreatic fluid. The pancreatic parenchyma enhances uniformly. There is a multilobulated area of mild T2 hyperintensity located between the pancreas and aorta with components extending into the pancreatic tail (series 501, image 9).In widest axial dimension, this lesion measures 66 x 20 mm (series 501, image 5) and there is mild, peripheral diffusion restriction and mild, peripheral enhancement. There is absence of central enhancement.Pancreatic duct stent is identified. The pancreatic duct is mildly dilated, similar in degree to the prior examination measuring up to 8 mm in the pancreatic head (series 701, image 28). Numerous ectatic side branch ducts are seen. A small focus of T2 hyperintensity in the pancreatic head (series 901, image 15) is unchanged from the prior examination. Additionally, there is a similar, round focus of T2 hyperintensity in the dorsal pancreatic head (series 901, image 12) which measures 9 x 8 mm. ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The left renal vein is narrowed by the lesion posterior to the pancreas. There is slightly delayed nephrogram on the left, otherwise the kidneys are normal.RETROPERITONEUM, LYMPH NODES: See above for description of retroperitoneal lesion.BOWEL, MESENTERY: There is mild wall thickening of the third portion of the duodenum. The small bowel and colon are otherwise normal.The SMA and SMV are anteriorly displaced by the peripancreatic lesion. The SMV appears narrowed but is patent.BONES, SOFT TISSUES: Midline anterior surgical sutures are noted.OTHER: No significant abnormality noted.

Output: 1.Acute on chronic pancreatitis.2.Multilobulated lesion between the pancreas and aorta with mild peripheral diffusion restriction and enhancement. These findings are suggestive of a multiloculated pseudocyst with possible superimposed infection or necrotic lymphadenopathy, differential considerations which may have similar imaging appearances.3.Findings discussed with Jennifer Labas, NP by phone on 9:56 on 10/27/15.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with up going left toe and urinary issues. Assess for cervical spine disease. Alignment is anatomic. Vertebral body height and morphology are unremarkable. No worrisome marrow replacement or marrow edema is seen.The visualized spinal cord is free of pathologic signal abnormality.C2-3: Right facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. No interval changes. C3-4: Right facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. No interval changes. C4-5: Bilateral facet hypertrophy. Ligamentum flavum thickening. Disc osteophyte formation with a small central focal component which is similar to the prior examination. The ventral cord is minimally indented. Mild generalized spinal canal narrowing. No significant foraminal narrowing. No interval changes. C5-6: Left greater than right facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No foraminal narrowing. No interval changes. C6-7: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Left uncovertebral hypertrophy. Minimal left foraminal narrowing. No interval changes. C7-T1: Facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. T1-2: As partially visualized, the left facet complex and ligamentum flavum are hypertrophic which contribute to a left foraminal narrowing, not significantly changed.

Output: Mild degenerative findings as discussed above without significant interval change. No new findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Clinical question: 28 day old male HSV in CSF. Drain involvement? Signs and symptoms: HSV in CSF. Non-enhanced CT of brain:There are small foci of increased density along the medial aspect of right anterior temporal tip. The larger of these findings measures approximate the 4-mm times 4-mm on coronal reformatted image 17 an approximately 5 mm in transverse axis on axial post infusion imaging 8. The smaller lesions measure approximately 3 mm on axial image 7. I cannot be certain whether these represent subtle enhancement which which could represent a meningeal enhancement or may represent minimal parenchymal hemorrhage. In either case considering patient's clinical history a follow-up exam with an MRI is recommended. There is paucity of cortical sulci and the ventricular system remains small the patient's stated age of 27 days although no definitive edema is detected the findings may represent subtle underlying diffuse parenchymal edema. There is no evidence of midline shift. Images through posterior fossa are essentially unremarkable.Above findings were discussed at the time of interpretation with Dr.Gui.

Output: Small foci of increased density in the right anterior temporal lobe which may represent minimal enhancement or small amount of parenchymal hemorrhage. Paucity of cortical sulci and the small lateral ventricles may also represent subtle underlying parenchymal edema. Further follow-up with a dedicated MRI examination is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Pituitary adenoma. Signs and symptoms: Headache. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrate diffuse punctate foci of flair hyperintensity primarily in the subcortical and periventricular white matter of cerebral hemispheres consistent with chronic small vessel ischemic strokes of mild degree. Minimal similar signal changes are noted in basal ganglia and more extensively in the pons as well concerning for chronic microvascular ischemic changes.Tiny foci of flair hyperintensity in the cerebellar hemispheres consistent with prior ischemic strokes.There is a slight prominence of cortical sulci and cerebellar -- vermian folia.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is within normal.Thin coronal T1 and T2-weighted images through the sella demonstrate a slight thickening along the left lateral aspect of pituitary gland with T2 hyperintensity suggestive of an adenoma. This finding results in subtle deviation of pituitary stalk to the right. There is no convincing evidence of extension of tumor into the cavernous sinus or basal cistern on this nonenhanced dedicated imaging. The finding measures approximately at 8.5 x 5.5-mm and coronal T2 weighted series 1301. Compared to prior exam from 2014 there is no convincing evidence of any appreciable interval change..

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Findings of chronic small vessel ischemic strokes as detailed.3.Pituitary microadenoma on the left measuring approximately at 8.5 x 5.5-mm on this nonenhanced exam and without convincing evidence of interval change.


Instruction: Generate impression based on findings.

Input: Systemic lupus erythematosus, unspecified [M32.9], Reason for Study: ^Reason: Findings suggestive of neuropsychiatric lupus History: Severe headaches, symptoms of depression There is no evidence of acute ischemic or hemorrhagic lesion.There is no abnormal signal intensity on FLAIR/T2 images.There is no evidence of abnormal enhancement.There is about 9.8 x 8.8 mm sized well-circumscribed nonenhancing fluid containing lesion at the area of the pineal gland indicating pineal cyst.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no 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: 1. 9.8 mm x 8.8 mm sized pineal cyst as described above.2. Otherwise unremarkable brain MRI.


Instruction: Generate impression based on findings.

Input: Chiari malformation, right arm pain Examination is mildly motion degraded. There are postoperative changes of suboccipital craniectomy and removal of posterior arch of C1 for Chiari decompression. There is dorsal angulation of the dens. There is minimal residual effacement of the CSF spaces at the neo-foramen magnum with preserved biphasic CSF flow. Dorsal cerebellum abuts the dural surface where there may be scarring. The cervical vertebral bodies are appropriate in height. There is mild loss of cervical lordosis and minimal anterolisthesis of C5 on C6; these changes are progressed since remote MRI from 2003.. Bone marrow signal is benign.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: No significant compromise to the spinal canal. There is mild right neural foraminal narrowing related to uncovertebral hypertrophy. No significant left neural foraminal narrowing. Mild facet arthropathy, worse on the right.C5-6: Small disc bulge without significant spinal canal or left neural foraminal stenosis. Mild right neural foraminal narrowing related to uncovertebral hypertrophy. Mild facet arthropathy, worse on the right.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Postoperative changes of Chiari decompression with preserved biphasic CSF flow at the foramen magnum.2. Mild degenerative changes in the cervical spine which have progressed since remote MRI from 2003. There is mild right C4-C5 and C5-C6 neural foraminal narrowing. No high-grade neural foraminal stenosis or spinal canal stenosis at any level. Please see details above.


Instruction: Generate impression based on findings.

Input: evaluate for cord compression or epidural abscessSigns and Symptoms: back pain, incontinence Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. A small high signal focus on T1-weighted imaging within the L4 vertebral body is present in most likely represents a small hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level associated with a disc bulge and partial effacement of the fat at the lateral recesses bilaterally.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina. There is a disc bulge present at L5-S1 without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Ankle pain TENDONS: There is a mild amount of fluid surrounding the posterior tibialis tendon which is otherwise normal in course and caliber. The remaining extensor and flexor tendons are intact.LIGAMENTS: There is poor visualization of the anterior and posterior tibiofibular ligaments which may relate to prior injury. The anterior and posterior talofibular ligaments appear thinned but intact.ARTICULAR SURFACES AND BONE: Severe osteoarthritic changes affect the talocalcaneal articulation particularly anteriorly. There is subchondral cystic change and sclerosis along both portions of the joint. The posterior talocalcaneal demonstrates mild degeneration. The ankle mortise is intact. Small cystic changes are noted both in the lateral and medial aspects of the talar dome which are likely degenerative in nature. A possible loose body is seen within the posterior joint space.ADDITIONAL

Output: 1. Severe osteoarthritis of the talocalcaneal joint anteriorly.2. Absence of the anterior and posterior tibiofibular ligaments which may relate to prior injury.3. Minimal tenosynovitis of the posterior tibialis.


Instruction: Generate impression based on findings.

Input: 80 year-old male status post fall with head laceration. CT HEAD:There is a left parietal scalp hematoma with foci of subcutaneous air consistent with the patient's history of scalp laceration. No skull fracture underlying this location or elsewhere.There is no acute intracranial hemorrhage or extra-axial fluid collection. Ventricles and sulci are normal. There is no mass effect, midline shift, or basal cistern effacement.Again seen is an area of hypoattenuation in the right insular cortex and temporal lobe which appears grossly unchanged when compared to the MRI performed last month. There is no evidence of new intracranial mass. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. Previously described small vessel ischemic disease is poorly seen on CT examination. Moderate calcification of the intracranial vessels. Small maxillary sinus retention cysts or polyps are present. The visualized mastoid air cells and remaining paranasal sinuses are clear. The visualized orbits are within normal limits. There is no evidence of retrobulbar hematoma. The lenses are not well visualized bilaterally consistent with the prior MRI findings of cataract surgery. CT CERVICAL SPINE:There is mild rightward curvature at the cervicothoracic junction. However, there is no evidence of acute malalignment or fracture. It should be noted that CT does not evaluate for ligamentous stability. There is moderate to severe degenerative disc disease affecting the cervical spine. There are multilevel disc osteophyte complexes most pronounced at the level of C5/6 and C6/7 with partial ventral thecal sac effacement. Severe facet arthropathy is present, greatest at left C4-C5 which appears nearly fused. There is severe uncovertebral joint hypertrophy at the levels of C5/6 and C6/7, associated with severe neuroforaminal narrowing at right C6/7.Redemonstrated bilateral pleuroparenchymal scarring, on the left with associated calcifications. The remainder of the lung apices are clear. There is diffuse heterogeneity of the thyroid gland without evidence of a dominant nodule. Severe left and mild right carotid bifurcation calcifications.

Output: 1. Left scalp laceration without skull fracture or acute intracranial hemorrhage. 2. Redemonstration of right temporal lobe mass characterized by recent MRI examination.3. No evidence of fracture or acute malalignment of the cervical spine. It should be noted that CT does not evaluate for ligamentous stability. 4. Moderate cervical spine degenerative changes.


Instruction: Generate impression based on findings.

Input: Clinical question: Multiple sclerosis, evaluate for progression. Signs and symptoms: Paresthesias. Nonenhanced brain MRI:Examination is performed utilizing a dedicated Dr.Javed's nonenhanced multiple sclerosis protocol.Lack of intravenous contrast, different in slice positioning and large number of lesions makes precise comparison with prior study difficult. Within this limitation however there is no convincing evidence of any appreciable interval progression of disease. Note however is made of interval decreased size of several of the demyelinating plaques since prior exam in supratentorial brain parenchyma. Similar to prior study there is no significant disease in the posterior fossa and moderate findings of demyelinating disease in the supratentorial space is again identified.Mild prominence of cortical sulci for age without significant change. Normal size of ventricular system and with maintained midline.

Output: 1.Revisualization of numerous supratentorial demyelinating plaques.2.No convincing evidence of interval progression of disease.3.Interval decreased size of several of the demyelinating plaques since prior study in the supratentorial space.


Instruction: Generate impression based on findings.

Input: Ms. Lehnhardt is a 45 year-old female who presented in March 2013 with breast pain, discharge is strong family history of breast cancer. She was found to have intraductal mass on ultrasound, likely papilloma. Tyrer-Cuzick score of 31% lifetime risk. There is heterogeneous amount of fibroglandular tissue in both breasts. Marked parenchymal enhancement is noted bilaterally, unchanged from prior. There are multiple enhancing foci within the right, greater than left, breast, with no unique focus of enhancement.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Male, 15 years old, with multiple sclerosis. Assess for progression or new inflammatory activity. Brain:Approximately 10 T2 hyperintense lesions are seen within the brain. Most are supratentorial and several involve the periventricular white matter or are radially oriented with respect to the ventricles. One or two small lesions are seen within the cerebellum. All of these lesions were evident on the prior examination and they are either stable or decreased in size. In particular, the dominant left periatrial lesion has decreased significantly in size, and a previously demonstrated lesion at the cervicomedullary junction is no longer detectable. No new lesions are seen. There is no pathologic intracranial enhancement. No areas of significant edema or mass effect are detected. Brain parenchymal volume is preserved. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits.Thoracic spine:No evidence of any focal spinal cord lesion is seen. Within the limitations of motion degradation, no pathologic spinal cord or leptomeningeal enhancement is observed. No epidural lesions are suspected. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable. Mild disc bulging has developed at T6-7, T7-8 and T8-9. However, there is no significant associated spinal canal or foraminal stenosis.

Output: 1.Multiple lesions are identified in the brain compatible with demyelinating disease. When compared to the prior examination, lesions are either stable or decreased in size. No new lesions are seen. No pathologic enhancement is detected to suggest active inflammation.2.A lesion seen previously at the cervico-medullary junction is no longer detectable. Within the thoracic region, no focal spinal cord lesions are identified.


Instruction: Generate impression based on findings.

Input: Metastatic head and neck cancer. Head CT:There is no evidence of intracranial hemorrhage or infarction. There is extensive soft tissue abnormality extending from masticator space through the foramen ovale into the right middle cranial fossa and into the right cavernous sinus, better seen on the prior MR study. This appears slightly less prominent. However the subtle interval difference may be secondary to imaging techniques. No new intracranial mass is seen.There is slight prominence of the right superior ophthalmic vein which is unchanged, probably secondary to involvement of mass at the right orbital apex and cavernous sinus, causing impairment of drainage of the vein.Neck CT:Extensive post-treatment changes are again present at the right maxillofacial region. There is extensive enhancing soft tissue abnormality extending from the masticator space, superiorly into the right orbit with involving the right orbital apex, and inferior and medial aspect of the right orbit, along the lamina papyracea. The lesion extends through the skull base, including the foraminal ovale, into the intracranial compartment. Soft tissue abnormalities are also seen in the right ethmoid air cells. There is opacification in the right frontal sinus and frontal sinus ostium, which likely represent trapped secretions. There is involvement of right pterygo-maxillary fissure, pterygopalatine fossa, sphenopalatine foramen, inferior orbital fissure, and foramen rotundum, which is better seen on prior MRI study. Accounting for sampling differences, there is no significant change of the extensive soft tissue abnormality. There is possibly minimal decrease at the right orbit. Opacification of right mastoid air cells is likely secondary to eustachian tube dysfunction.No evidence of adenopathy is seen in the neck.There is degenerative disease of the cervical spine, but no ossenous metastasis is identified.

Output: 1. Status post surgical changes in right maxillofacial region.2. Extensive soft tissue abnormality extending from the right masticator space through the skull base into the right middle cranial fossa, with involvement of the right orbit, cavernous sinus, and right ethmoid air cells. Perineural spread is better seen on prior MRI study. Accounting for sampling differences, there is no significant interval change. There is possibly minimal decrease of the lesion at the medial aspect of the orbit.


Instruction: Generate impression based on findings.

Input: 51 years, Female, memory loss, evaluate for structural lesion No intracranial mass or mass-effect. Scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. 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 grossly clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: MRI of the brain is within normal limits for age.


Instruction: Generate impression based on findings.

Input: 23 year old female patient with abdominal pain. Question of retroperitoneal mass. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal mass is identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post-surgical changes to the anterior abdominal wall.OTHER: Trace bilateral pleural effusions, right greater than left, with overlying compressive atelectasis.PELVIS:UTERUS, ADNEXA: There is a 5.2 x 1.8 cm non-enhancing structure within the left adnexa which demonstrates heterogeneous internal T2 signal; this may represent a complicated ovarian or paraovarian cyst. The right ovary is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis.

Output: 1.No evidence of a retroperitoneal mass.2.Non-enhancing, heterogeneously cystic left adnexal lesion may represent a complicated ovarian or paraovarian cyst. 3.Cholelithiasis without evidence of acute cholecystitis.


Instruction: Generate impression based on findings.

Input: Male 26 years old Reason: Evaluate Renal Angiomyolipomas for change History: Tuberous Sclerosis ABDOMEN:LIVER, BILIARY TRACT: Multiple small hepatic T2 hyperintense lesions which is signal on fat suppression imaging are compatible with multiple small hepatic angiomyolipomas and are unchanged compared to prior study. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Arterial enhancing lesion in the pancreatic tail has further increased in size. It measures 3.6 x 2.9 cm (series 100, image 17), remeasured on prior study at 2.5 x 1.6 cm and this remains suspicious for a neuroendocrine tumor.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal masses are again seen compatible with angiomyolipomas. The dominant exophytic mass arises from the lower pole of the left kidney and demonstrates an increase in size measuring 6.4 x 4.5 cm (series 6, image 28), previously 5.6 x 3.9 cm. Additional lesions are subjectively stable in size. No new lesions are identified. Multiple small renal cysts are also identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A fatty lesion adjacent to the left ventricle is again seen and is unchanged.

Output: 1.Enlarging pancreatic lesion which is compatible with a neuroendocrine tumor.2.Bilateral renal masses are again noted which are compatible with angiomyolipomas. The dominant lesion at the lower pole of the left kidney has increased in size compared to prior studies, and renal cell carcinoma is not excluded.3.Multiple hepatic lesions which are compatible with angiomyolipomas are unchanged compared to prior study.


Instruction: Generate impression based on findings.

Input: Cord compression, right upper extremity and right lower extremity weakness Examination is motion degraded. Vertebral body heights in the thoracic spine are normal. Alignment is normal. There are multilevel degenerative changes with disk bulges, slightly more prominent at the C7-T1 and T1-T2 levels. There is also ligamentum flavum thickening which partially effaces the dorsal thecal sac at T3-T4, T5-T6, and T7-T8 levels. There is mild to moderate spinal canal stenosis at the T10-T11 level related to bilateral facet arthropathy and ligamentum flavum thickening. No high-grade spinal canal stenosis is seen. Examination is inadequate to assess for small cord signal abnormalities. However, no obvious long segment cord signal abnormality is appreciated. There is extensive myelomalacia involving the cervical cord better demonstrated on recent cervical MRI study. Post surgical changes of anterior cervical fusion from C2 to C5 and multilevel posterior decompressive laminectomies are also noted on the localizer sequence. There is T2 hyperintensity involving the C6-C7 interspace which may be on a degenerative basis. There is moderate right neural foraminal stenosis at T4-T5 and left greater than right at T1-T2.Small bilateral pleural effusions.

Output: Motion degraded exam demonstrates no high-grade spinal canal stenosis or obvious cord signal abnormality. Spinal canal narrowing in the thoracic spine is relatively worse at the T10-T11 level where there is mild to moderate stenosis related to facet arthropathy and ligamentum flavum thickening.Postsurgical changes and extensive myelomalacia involving the cervical cord as seen on recent cervical spine MRI.


Instruction: Generate impression based on findings.

Input: No significant interval change is seen. The trigone of the right lateral ventricle remains mildly expanded representing the site of a previously fenestrated intraventricular cyst. Minimal linear transparietal encephalomalacia is again seen representing the surgical tract. Foci of susceptibility involving the right lateral ventricle as well as the right medial temporal lobe also remain unchanged and compatible with chronic blood products and/or mineralization.The cerebral cortex, cortical sulci, ventricular system, and CSF spaces are otherwise unremarkable. No evidence of acute ischemia or hemorrhage. No extra-axial collections. Incidentally noted is a 6 x 5 mm pineal cyst and remains unchanged. Major flow-voids are patent.

Output: No evidence of reexpansion of the previously fenestrated right intraventricular cyst.


Instruction: Generate impression based on findings.

Input: Patient is a 50 year-old female with BRCA1 mutation and a strong family history of breast/ovarian cancer including sisters with breast and ovarian cancers, mother with ovarian cancer and father with colon cancer. No current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.A stable cyst is noted in the posterior right breast. The focal enhancement in the left breast 6:00 position has been stable since 2012. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Male, 32 years old, with epilepsy. Functional localization of language, motor and visual cortex for presurgical evaluation. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Passive visual stimulation elicits activation along the bilateral calcarine sulci.Of the tested language paradigms, the cleanest and most reliable language related cortical activation is seen with the verb generation paradigm. Language is left dominant. Broca's area is identified in its customary location of the left inferior frontal gyrus. Wernick's area is identified in its customary location along the posterior aspect of the left superior temporal sulcus.

Output: Technically successful functional MRI for presurgical mapping. The sensorimotor and visual cortices are well delineated. Language is left dominant with Broca's and Wernicke's areas identified in their customary locations.


Instruction: Generate impression based on findings.

Input: Other specified types of non-hodgkin lymphoma, extranodal and solid organ sites [C85.89], Reason for Study: ^Reason: evaluate for etiology of double vision History: cocern for recurrence of orbital lymphoma Orbit MRINo evidence of recurrence mass within the orbit. There is no evidence of abnormal enhancement.The globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement.  Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Focal encephalomalacia on the left frontal lobe is again seen, unchanged.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 mastoid air cells are clear.Mucosal thickening are seen within the frontal sinus and ethmoid sinus. Empty sella is noted.Lumbar spine MRIFor the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is evidence of left side laminectomy at the level of L34, L4-5 and L5-S1.Soft tissue fluid collections are seen from L23 to L45 which likely represent postoperative changes.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal.The conus medullaris terminates at the L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L1-L2: Broad-based disc protrusion central to left which abuts thecal sac. However, no significant neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation with diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis. L3-L4: Left sided total laminectomy status. Diffuse bulging of disc with bilateral ligamentum flavum thickening results mild to moderate spinal canal stenosis. L4-L5: Left sided total laminectomy status. Diffuse bulging of disc with bilateral ligamentum flavum thickening results moderate to severe spinal canal stenosis. L5-S1: Left sided total laminectomy status. Diffuse bulging of disc with left side lateral recess stenosis.

Output: 1. No evidence of recurrence orbital tumor or abnormal enhancement within the orbit.2. No evidence of acute ischemic or hemorrhagic lesion or abnormal enhancement of the brain.3. Unchanged left frontal encephalomalacia since prior scan.4. Postoperative status, left side laminectomy from L3-4 to L5-S1.5. Degenerative changes of lumbar spine including various degree spinal canal stenosis at the level of L3-4, L4-5 and left lateral recess stenosis at L5-S1.


Instruction: Generate impression based on findings.

Input: History of multiple sclerosis, history of radiotherapy to trigeminal with residual edema. Multifocal variable sized bihemispheric, supra and infra tentorial high signal foci indicating multiple sclerosis lesions do not show any significant interval change in terms of lesion number is and signal intensity on FLAIR imaging since prior scan.Localized enhancing lesion on the right hippocampus appears to be slightly smaller in terms of enhancement extent but the extent of surrounding edema does not show any significant interval change since prior scan.Diffuse enhancement of cistern segment of the right trigeminal nerve does not show significant interval change since prior scan.High signal intensities on FLAIR images on the right middle cerebellar peduncle and lateral aspect of lower pons do not show any interval change either.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No interval change of 1) multiple FLAIR high signal intensity lesions indicating MS lesions, 2) focal enhancing lesion on the right hippocampus as well as right trigeminal nerve and 3) right middle cerebellar peduncle and right side of lower pons since prior exam.2. No evidence of new ischemic or hemorrhagic lesion. No evidence of new abnormal enhancement.


Instruction: Generate impression based on findings.

Input: History of right mastectomy 1/2014 for multifocal invasive ductal carcinoma. Patient received radiation, chemotherapy and hormonal therapy. History of breast cancer in maternal cousin. History of ovarian cancer in paternal cousin. Since the prior study, the patient has undergone right mastectomy. Marked amount of glandular tissue is present in the left breast.Minimal parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in the right chest wall. Postsurgical scarring is present in the right axilla. No abnormal axillary lymph nodes are identified in the right axillary region.No abnormal enhancement is present in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region.

Output: Status post right mastectomy. No MRI evidence for malignancy of the right chest wall or left breast. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 59-year-old male with history of PSC. Evaluate for obstruction. ABDOMEN:LIVER, BILIARY TRACT: Redemonstrated are multifocal areas of extensive dilatation and stricturing of the intrahepatic bile ducts particularly in the left hepatic lobe. The most dilated duct measures 5 mm today. There is left hepatic lobe atrophy. Persistent periductal enhancement is appreciated bilaterally. The common bile duct appears unremarkable. No suspicious masses identified. Unchanged segment 8 nonenhancing cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right lower lobe scarring/atelectasis.

Output: Findings of chronic PSC, worse in the left hepatic lobe, relatively stable compared to the prior study with no new suspicious masses or strictures. Persistent periductal enhancement likely secondary to fibrosis.


Instruction: Generate impression based on findings.

Input: 70 year-old male with metastatic adenocarcinoma of the appendix with new right-sided headaches and some unsteadiness. No focality on physical exam. There is no evidence of intracranial hemorrhage, mass or edema. Mild diffuse hypodensities in a periventricular and subcortical distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: Left back and foot numbness, history of multiple myeloma Five lumbar type vertebral bodies are presumed to be present. There is transitional anatomy at the lumbosacral junction with pseudoarticulation associated with the right lateral L5-S1 junction. Vertebral body heights are within normal limits. Alignment is within normal limits aside from minimal anterolisthesis at L3 on L4 which is similar to prior. The conus medullaris is normal in position. Diffuse heterogeneity of the bone marrow which may be related to patient's known multiple myeloma is again seen. Compared to 4/18/2014, there is interval development of a 21 x 30 mm T1 hypointense lesion involving the left anterior aspect of the sacrum and without appreciable mass effect on the adjacent sacral neural foramina. There is otherwise no new large lesion in the visualized lumbosacral spine. Cystic lesion at the left S2 level is similar to prior and likely represents a Tarlov cyst.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.L3-L4: Grade 1 anterolisthesis and disc uncovering. No significant spinal canal or neural foraminal stenosis. Advanced bilateral facet arthropathy.L4-L5: Significant disc height loss similar to prior. Bilateral facet arthropathy, advanced on the right. No significant spinal canal stenosis. Mild to moderate neural foraminal stenosis with endplate osteophytes and facet arthropathy narrowing the medial aspect of the facet joints better seen on prior CT from 3/17/2016. L5-S1: No significant disc disease. Bilateral facet arthropathy. No spinal canal or neural foraminal stenosis. Transitional anatomy on the right with pseudoarticulation which is associated with up to moderate stenosis involving the extraforaminal right L5 nerve root.Right kidney not visualized. Left kidney contains a cystic lesion similar to prior.

Output: 1. Compared to MRI dated 4/18/2014, there is a new osseous lesion involving the left anterior aspect of the sacrum measuring 2.1 x 3.0 cm, which may be related to myeloma or urothelial cancer. No associated stenosis involving the sacral neural foramina. 2. Multilevel degenerative changes without significant spinal canal stenosis at any level. Mild to moderate neural foraminal stenosis involving the medial aspect of the neural foramina at the L4-L5 level is similar to prior. Neural foramina are otherwise preserved. Additional details as above.3. Unchanged cystic lesion in the left sacrum likely representing a Tarlov cyst.


Instruction: Generate impression based on findings.

Input: Other malaise and fatigue [780.79], Reason for Study: ^Reason: Stroke r/o History: Weakness Brain MRI:No evidence of acute ischemic or hemorrhagic lesion.Multiple scattered high signal foci on FLAIR imaging on bilateral white matter indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Nonspecific small vessel ischemic disease. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. Normal brain MRA, normal neck MRA.


Instruction: Generate impression based on findings.

Input: History brain metastasis. Possible diskitis at T7-T8. Back pain. Alignment of the thoracic spine is anatomical. This compression deformity of T8, choroid compression fractures seen on the prior MRI study. No severe retropulsion is seen. The spinal canal and neural foramina remain patent. His face. There is noted at T8. The T9 level. A small sclerotic focus in T2 vertebra is nonspecific, but is compatible with enostosis.In L4 vertebra, there is sclerotic lesion with depression of end plate superiorly. Imaging findings is not significantly changed compared to the prior MRI study. There is no evidence of epidural lesion.There are degenerative changes in the thoracic and lumbar spine, which are better visualized on the prior MRI study.An IVC filter is noted. There is increased interstitial densities in bilateral lungs, greater on the left.

Output: 1. No significant interval change in the compression deformity of T8 and sclerotic lesion of L4. Diskitis at T7-T8 cannot be excluded based on CT findings. Lesion at L4 can represent chronic compression injury but sclerotic metastasis can have similar appearance. Continuing followup and correlation with clinical findings are recommended.2. Please refer to dedicated chest study for additional findings of the lungs.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer with worsening headaches and blurry vision (attention to orbits) History: worsening headaches and blurry vision. There is an infiltrative, enhancing lesion in the right retrobulbar region. There is a right superotemporal glaucoma drainage device with associated bleb and bilateral lens implants. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and paranasal sinuses are grossly unremarkable. There is a probable Thornwaldt cyst that measures up to 14 mm. There is a 7 mm thick lipoma in the mid frontal scalp. There is a small skin excrescence along the left posterolateral upper neck.

Output: 1. An infiltrative lesion in the right retrobulbar region is compatible with metastatic disease. 2. No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 51-year-old male with elevated PSA (5.91 in 5/2016). Evaluate for prostate cancer. Biopsy showed Gleason 3+3 in left mid (<5%, <1mm), left apex (<5%, <1mm). PELVIS:PROSTATE:Prostate Size: The prostate measures 4.3 cm in transverse, 2.6 cm in AP, and 3.8 cm in craniocaudal diameter.Peripheral Zone: Nonspecific linear T2 hypointense appearance throughout the peripheral zone.Central Gland: In the anterior apex central gland, there is a 1 x 0.6 cm ADC hypointense focus (series 708 image 244) with ill-defined margins and is likely invading the left urethral wall. Early contrast enhancement and washout is noted on the postcontrast series.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: In the left anterior apex, there is a 1 x 0.6 cm suspicious lesion likely invading the left urethral wall.


Instruction: Generate impression based on findings.

Input: altered mental status No evidence of acute ischemic or hemorrhagic lesion on this scan.Patchy scattered high signal intensities on FLAIR images on bilateral periventricular white matter indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The sphenoid sinus shows opacification.Bilateral mastoid air cells show fluid collections indicating possible mastoiditis. Clinical correlation is recommended.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal flow enhancement in bilateral ICAs, MCAs, ACAs and vertebrobasilar system.Acom artery and bilateral Pcom arteries are patent.There is no evidence of intracranial arterial aneurysm or stenosis.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Non specific small vessel disease as described above.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.3. Normal brain MRA and neck MRA3. Sphenoid air cell opacification and bilateral mastoid fluid collections, clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: Known right breast DCIS with calcifications extending to the nipple. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is extensive non-mass enhancement in the right upper outer breast extending from the posterior depth to near the nipple. This contains artifact from the two biopsy clips. Overall extent is 6.6 x 1.2 x 2.3 cm (AP x LM x CC). The abnormal enhancement extends to within approximately 1.4 cm of the nipple. In the left outer breast near the 3:00 position, a typically benign morphology focus measuring 5 mm that has a notched non-enhancing area is seen. The lesion cannot be well differentiated from background tissue on T2 images, though high signal is suggested. More likely this represents a small intramammary lymph node or a fibroadenoma.  No abnormal axillary lymph nodes are identified in either axillary region.

Output: 1. Extensive non-mass enhancement at the sites of biopsy proven DCIS measures up to 6.6 cm and extends to within 1.4 cm of the nipple.2. No enlarged axillary lymph nodes.3. Probably benign focus of enhancement in the left breast. Ultrasound correlation is recommended to look for a benign correlate such as a lymph node or fibroadenoma. If no correlative finding is seen on ultrasound, then a 6 month follow up MRI is recommended. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Dizziness and headache since March 4. Evaluate for mass. The brain parenchyma appears unremarkable. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. Minimal mucosal thickening in the bilateral maxillary and ethmoid sinuses noted.

Output: Brain parenchyma appears within normal limits. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Back pain The sacroiliac joints appear normal with no abnormal enhancement to suggest sacroiliitis. The bone marrow signal of the pelvis is normal. There is minimal subcutaneous edema of the lower back which is of doubtful clinical significance. The remaining soft tissues appear normal as well. Mild susceptibility artifact of the lower pelvis relates to intrauterine device.

Output: Normal appearance of the sacroiliac joints without evidence of sacroiliitis or other specific findings to account for the patient's back pain.


Instruction: Generate impression based on findings.

Input: Reason: please comment on the "lesion" in the midportion of the abd hallucis. Please compare to previous outside MRI in pacs History: pain medial arch There is a fusiform enhancing mass in the abductor hallucis muscle inferior to the medial cuneiform measuring approximately 1.5 x 1 cm in AP and transverse dimension. The longitudinal dimension is less well-defined but measures approximately 3 cm including a thin tail of enhancement that extends along the proximal tendon of the muscle. There is mild edema in the adjacent soft tissue. The lesion is predominantly isointense to skeletal muscle on T1 weighted images and heterogeneous on T2 weighted images with components that are hyperintense, isointense, and perhaps hypointense to skeletal muscle. The enhancement is likewise heterogeneous with a region of relative nonenhancement centrally. This mass has no appreciable effect on adjacent bones. Superficial to this mass are small foci of signal void, likely representing metallic susceptibility artifact from prior surgery. Proximal and distal to this mass there is mild fatty atrophy of the abductor hallucis muscle. The size of the mass is similar to that seen on outside MRI from 4/4/2016 accounting for technical differences. Of note, on this outside study the mass is of low to intermediate signal intensity on non-fat-saturated T2 weighted images. The mass has increased in size from the 9/3/2014 study, at which time the margins were less well defined.Slight irregularity of the medial navicular tuberosity is noted, which could conceivably be postoperative in nature, but this is equivocal. Only the distal posterior tibialis tendon is included on this study, but it appears to attach to the navicular tuberosity. The mass in question is clearly distal to the insertion of the posterior tibialis tendon, as is the most of the metallic susceptibility artifact. We see no additional masses. The remaining bones and soft tissues appear normal.

Output: Enhancing mass within the abductor hallucis muscle as described above, which appears to underlie the site of prior surgery. Although nonspecific, the signal characteristics of this mass as well as tail-like extension along the tendon is a common feature of proliferating fibrous lesions.


Instruction: Generate impression based on findings.

Input: Multiple myeloma, sciatic pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights in the lumbar spine are grossly within normal limits. There is mild anterior wedging involving the vertebral bodies at the thoracolumbar junction which can be physiologic versus related to remote mild chronic compression fracture and unchanged since 2012. No edema to suggest a recent compression fracture. Alignment is within normal limits. Bone marrow signal is benign with scattered foci of T1 hyperintensity compatible with foci of fat or small hemangiomas. Small Schmorl's nodes involving the endplates at the T11 and T12 levels are also noted. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Small left foraminal annular fissure with small protrusion. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is a right paracentral disc extrusion with less than 1 cm of caudal migration. There is contact of the right L5 nerve root in the lateral recesses without clear evidence of impingement. No significant central canal stenosis. There is minimal bilateral neural foraminal narrowing. L5-S1: There is moderate loss of disc height and disc bulge which is eccentric to the left. There is moderate bilateral facet arthropathy. There is no significant spinal canal stenosis. There is moderate to severe bilateral neural foraminal stenosis. Possible remote right laminotomy at L5 which can be correlated with surgical history.Paraspinous soft tissues are grossly unremarkable. Small bilateral renal cysts are noted.

Output: 1. No discrete multiple myeloma lesions involving the lumbar spine are appreciated. Patient did not wish to proceed with the postcontrast sequences which which limits sensitivity small lesions. 2. Degenerative changes are seen in the lumbar spine particularly at the L4-L5 and L5-S1 level. There is moderate to severe neural foraminal stenosis at L5-S1 where there may be impingement of the exiting L5 nerve roots. There is also a right paracentral disc extrusion at the L4-L5 level which abuts the descending L5 nerve root at this level without clear evidence of impingement.


Instruction: Generate impression based on findings.

Input: There is mild motion degradation of some sequences limiting evaluation for more subtle abnormalities. There is no gross evidence of cortical dysplasia, gray matter heterotopia or mesial temporal sclerosis. There is no acute infarct, mass effect, or cerebral edema. There is a normal variant cavum septum et vergae. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Mildly motion degraded exam. Otherwise, unremarkable.


Instruction: Generate impression based on findings.

Input: Evaluate for CVA, small vessel disease. History of dizziness, hypertension, hyperlipidemia, and TIA. There is mild subcortical and periventricular increased T2/FLAIR signal compatible with chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. There is mild subcortical and periventricular chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of small bowel disease. History of back pain. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free fluid in the pelvis. Please see the separately dictated report of the recent MR enterography for evaluation of the small bowel.BONES, SOFT TISSUES: There is no evidence of a perianal sinus tract and/or fistula. No perianal fluid collections.OTHER: No significant abnormality noted.

Output: No evidence of perianal disease. Please see the separately dictated report of the recent MR enterography for evaluation of the small bowel.


Instruction: Generate impression based on findings.

Input: Reason: eval for ATFL tear History: ankle sprain x 10 with recurrent instability and pain TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The ATFL is poorly visualized with associated increased signal abnormality on fluid sensitive sequences indicating a tear. The PTFL appears intact. The calcaneofibular ligament appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormalities are identified. No osteochondral defect is seen. Mild osteoarthritic changes affect the third tarsometatarsal articulation. ADDITIONAL

Output: Disruption of the ATFL.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [340], Reason for Study: ^Reason: MS; eval for progression History: paresthesias Multifocal various sized high signal intensity lesions on bilateral hemispheres, brainstem and posterior fossa are again demonstrated. Overall, the number and signal intensity of which lesions do not show any significant interval changes since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift. The midline structures and cranial-cervical junction are normal.The paranasal sinuses and mastoid air cells are clear.

Output: Multiple scattered high signal intensity lesions on FLAIR imaging, no significant interval change in terms of the size and signal intensity since prior scan.


Instruction: Generate impression based on findings.

Input: Reason: please do dr jave d ms protocol compare to prior History: progression MS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. There is a moderate degree of periventricular and subcortical punctate and confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable compared to last years exam.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is redemonstration of small foci of signal hyperintensity within the posterior aspect of the spinal cord along its midline at the C2, C3 -4 and C5-6 vertebral levels. These were also present on the prior exam from March of last year and is not display any interval change. No abnormal enhancing lesions are identified in the cervical spine.There is multilevel disk desiccation present cervical spine and mild reversal of the normal cervical curvature which is stable compared to the prior exam.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. There is a mild disk bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge present at this level.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.A single hyperintense lesion measuring 12 mm in diameter is present which is bright on T2 and isointense on T1. It was not included on imaging on the prior exam it is associated with some enhancement following gadolinium administration.

Output: 1.There are periventricular white matter lesions present which are stable since the prior exam and compatible with patient's clinical history of demyelinating disorder.2.There are several lesions present in the spinal cord which are compatible with a diagnosis of demyelination and stable since the prior exam. 3.There are mild degenerative changes present in the cervical spine without significant compromise of spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 75 years, Female, status post tumor resection. Examination is motion degraded and limited to axial diffusion, FLAIR, T2, and sagittal T1-weighted sequences. There are postoperative changes of right frontal craniotomy for resection of previously seen enhancing right frontal lobe mass which extended underneath the falx into the left frontal lobe. There is restricted diffusion along the margins of the resection cavity compatible with cytotoxic edema. There is extensive vasogenic edema in the right frontal lobe, involving the callosal genu and anterior body, and extending into left frontal lobe. Expected postsurgical changes include blood products within the resection cavity and small volume pneumocephalus. Lack of contrast limits evaluation for small lesions however no obvious residual tumor is appreciated. There is mass effect with effacement of the frontal horns and mild leftward subfalcine herniation which are similar to prior. No large hemorrhage, hydrocephalus, new mass effect or new herniation is demonstrated.

Output: Patient could not tolerate the full study, and only noncontrast sequences could be obtained. Within this limitation, there appears to be gross total resection of the previously seen enhancing mass involving the right frontal lobe with mild extension underneath the falx into the left frontal lobe. Extensive vasogenic edema and mild leftward subfalcine herniation are similar to prior


Instruction: Generate impression based on findings.

Input: BRAIN: There is mild motion artifact degrading image quality. There is no acute infarct, mass effect or midline shift. There are mild nonspecific T2 hyperintensities in the periventricular and subcortical white matter which likely represent chronic microvascular ischemic changes. This tiny focus of T2 hyperintensity with a linear configuration in the right parietal lobe with mild susceptibility which maybe related to chronic ischemic injury or possibly developmental venous anomaly which can be better assessed with postgadolinium sequence. There is mild diffuse global volume loss for patient age. There is a partial empty sella incidental noted. The flow-voids of the skull base are intact. There is a left maxillary sinus mucous retention cyst versus polyp. There is mild ethmoid sinus mucosal thickening.CERVICAL: There is mild motion degradation limiting evaluation. There is anterior fusion C5 and C6 with fusion at the disk space. There is slight interval enlargement of disk osteophyte complexes at C3-4, C4-5 and C6-7 as compared to the prior MRI from 11/7/2011. There are type I degenerative changes at the inferior endplate of C4. The alignment of the cervical spine is within normal limits. The osseous marrow signal is benign. The cervical cord signal is within normal limits. C2-3: No spinal canal or neural foraminal stenosis.C3-4: Disk osteophyte complex and ligamentum flavum thickening with mild central spinal canal stenosis. Bilateral uncovertebral hypertrophy, right greater than left with moderate right and mild left neural foraminal stenosis.C4-5: Disk osteophyte complex and bilateral uncovertebral hypertrophy with ligamentum flavum thickening causing mild to moderate central spinal canal stenosis and moderate right and mild left neural foraminal stenosis.C5-6: Disk osteophyte complex with left greater than right uncovertebral hypertrophy causing mild left neural foraminal stenosis and minimal central spinal canal stenosis. No right neural foraminal stenosis.C6-7: Disk osteophyte complex eccentric to the left with ligamentum flavum thickening causing mild central spinal canal stenosis. Bilateral uncovertebral hypertrophy with mild to moderate bilateral neural foraminal stenosis.C7-T1: Small disk osteophyte complex with no significant central spinal canal or neural foraminal stenosis.THORACIC: There is mild motion artifact limiting evaluation. Within this limitation, the cord signal and caliber are unremarkable. There is normal alignment of the thoracic spine. The vertebral body heights are preserved. There is mild disk desiccation at multiple levels in the thoracic spine. There are small superior endplate Schmorl's nodes at T3 and T5, stable from prior exam. There is minimal overall loss of vertebral body height without evidence of edema to suggest an acute compression fracture. There are minimal disk bulges at T1-T2, and T8-T9. No spinal canal or neural foraminal stenosis in the thoracic spine. Small T9 vertebral body hemangioma.Intrathecal catheter is faintly seen. No obvious granuloma formation is seen although axial thoracic images are motion degraded. Catheter appears to terminate in the lower thoracic spine.LUMBAR: The first non-rib bearing vertebral body is referred to as L1, with the last well-formed disk space being referred to as L5-S1, consistent with prior exam. There is normal alignment of the lumbar spine. The osseous marrow signal is benign. Vertebral body heights are preserved. There is desiccation with moderate loss of disk height at L4-5, and mild loss of disk height at L3-4 and L5-S1. There is mild stranding in the subcutaneous soft tissues of the back and the left upper gluteal region consistent with postsurgical changes. The conus terminates at L2, within normal limits.L1-2: No disk herniation, central spinal canal or neural foraminal stenosis.L2-3: Minimal disk bulge and facet arthropathy with no significant central spinal canal or neural foraminal stenosis.L3-4: Diffuse disk bulge, facet arthropathy encroach upon the bilateral subarticular zones without significant subarticular zone stenosis or central spinal canal stenosis. No significant neural foraminal stenosis.L4-5: Diffuse disk bulge with central disk protrusion, advanced right facet arthropathy and moderate left facet arthropathy causing no significant central spinal canal stenosis with mild right neural foraminal stenosis. No significant left neural foraminal stenosis.L5-S1: Diffuse disk bulge with central/left paracentral protrusion. No significant central spinal canal stenosis. Moderate facet arthropathy. Mild bilateral neural foraminal stenosis.There are few small right renal cysts. There is an incompletely characterized 24 x 19 mm left adrenal nodule, grossly stable from prior exam dated 1/3/2011.

Output: 1.No acute infarct, mass effect or midline shift.2.Mild diffuse global volume loss and mild chronic small vessel ischemic changes. Tiny linear focus of T2/flair hyperintensity in the right parietal lobe with susceptibility favored to represent a small chronic infarct with chronic microhemorrhage. Tiny developmental venous anomaly is also possible at this location and can be better assessed with postgadolinium study if clinically indcated.3.Stable postsurgical changes from anterior fusion at C5-6 with adjacent segment disease and mild enlargement of disk osteophyte complexes at C3-4, C4-5 and C6-7 compared to 11/7/2011 MRI. There is resulting mild to moderate central spinal canal stenosis and variable degrees of neural foraminal stenoses as detailed above.4.No significant disk herniation, central spinal canal or neural foraminal stenosis in the thoracic spine. Small Schmorl's nodes with mild chronic compression deformities at T3 and T5 is unchanged since 2011 without evidence of vertebral body edema. Multilevel lumbar spondylosis with significant interval change from 2011. 5.Intrathecal catheter is faintly seen. No obvious granuloma formation is seen although motion degradation slightly limits evaluation.6.Stable incompletely characterized left adrenal nodule.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, 65 years old, with left-sided face, arm and leg weakness and numbness. Evaluate for acute stroke. Numerous scattered small foci of restricted diffusion are seen within the paramedian right frontal lobe and along the right cingulate gyrus. No evidence of restricted diffusion is seen elsewhere in the brain.Elsewhere in the brain, numerous areas of patchy periventricular T2 hyperintensity are seen in both cerebral hemispheres. This is most conspicuous along the left frontal horn. There are also numerous scattered chronic lacunar infarcts in both basal ganglia with a large chronic hemosiderin stained infarct on the left.No evidence of significant generalized mass effect is seen. No abnormal extra-axial fluid collection or acute intracranial hemorrhage is suspected. Scattered punctate foci of susceptibility are seen in both cerebral hemispheres and the pons likely indicating chronic microhemorrhage. The left lateral ventricle is larger than the right which probably represents some degree of ex vacuo dilatation due to prior ischemic lesions. Ventricular morphology is otherwise unremarkable.On MR imaging of the head, no evidence of any significant vascular stenosis or occlusion is seen in the proximal circle of Willis vessels. The right callosomarginal artery is of small caliber and the right pericallosal artery is not distinctly visualized. There may be some scattered areas of mild to moderate vascular narrowing in the MCA distributions. No aneurysm is suspected.MR imaging of the neck reveals conventional aortic branching. The origins of the great vessels are patent. No significant vascular stenosis is detected in the carotid or vertebral vessels of the neck. Both common carotid arteries take a retropharyngeal course.

Output: 1.Scattered patchy areas of acute ischemia involving the right paramedian frontal lobe and cingulate gyrus.2.Evidence of extensive background chronic microvascular and lacunar ischemic disease.3.The right callosomarginal artery is not visualized and the right pericallosal artery is of small caliber. These findings may correlate to the right paramedian ischemic lesions.4.No significant vascular abnormalities in the neck.


Instruction: Generate impression based on findings.

Input: Research MRI performed as part of the Alan Penn study. Suspicious right breast findings on mammography and ultrasound. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is extensive abnormal enhancement in the right outer breast corresponding to the area of the mass and abnormal calcifications from conventional imaging. Abnormal enhancement measures 6.2 x 4.0 x 2.0 cm (AP x CC X LM). Abnormal enhancement extends to about 1.3 cm from the nipple, similar to the extent of anterior calcifications on the mammograms.No abnormal enhancement is seen in the left breast. A few scattered enhancing foci are present, but none are uniquely suspicious.No abnormal axillary lymph nodes are identified in either axillary region.

Output: Extensive abnormal enhancement in the right outer breast extending up to 6.2 cm AP corresponding to findings from conventional imaging. This enhancement extends to within about 1.3 cm of the nipple. Biopsies were performed after this exam.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Multiple myeloma Note that evaluation of the right femur is limited by susceptibility artifact from the intramedullary rod.There are scattered areas of abnormal marrow signal within the pelvis reflecting myelomatous deposits. The largest focus is noted within the right sacral ala along involving the S1 neural foramen, measuring approximately 3 x 3.5 cm in the greatest transaxial dimensions.. Additional examples are seen within the left posterior ilium and right anterior iliac wing. Following contrast administration, these lesions demonstrate enhancement.The uterus demonstrates the presence of multiple fibroids.

Output: Multiple areas of marrow replacement and enhancement within the pelvis consistent with multiple myeloma. The largest focus involves the right sacrum.


Instruction: Generate impression based on findings.

Input: 49 years, Female, increasing headaches and confusion, evaluate for CNS lupus. Compared to 10/17/2011, there has been mild interval increase in patchy areas and scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter. In particular, there is a new patchy area of T2/FLAIR hyperintensity in the left posterior frontal corona radiata. No large vascular territory infarcts are evident. There is T1 hyperintensity involving the bilateral basal ganglia which is nonspecific.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. No hydrocephalus. There is mild volume loss which appears slightly advanced for age. Bone marrow signal is heterogeneous without destructive lesions. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Compared to 10/17/2011, there has been some interval progression of multiple patchy areas and scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter. These are nonspecific but given history may represent chronic small vessel ischemic disease related to lupus-related vasculopathy. No large territory infarcts are evident. No evidence of acute infarct or abnormal enhancement to suggest an active inflammatory process.2. T1 hyperintensity in the bilateral basal ganglia which while nonspecific has been reported with CNS lupus.


Instruction: Generate impression based on findings.

Input: Reason: 56 with with RA c/o L achilles pain evaluate History: L achilles pain, mild swelling TENDONS: The Achilles tendon is slightly thickened, suggesting very mild tendinosis. Mild edema in the vicinity of the retrocalcaneal bursa suggests mild inflammation. We see no Achilles tendon tear. There is a small amount of fluid in the sheaths of the medial and peroneal tendons, which is within normal limits. The tendons of the ankle appear normal. LIGAMENTS: The ligaments of the ankle appear intact.ARTICULAR SURFACES AND BONE: Bone marrow signal intensity is within normal limits. There are small amounts of fluid within the tibiotalar, subtalar and talonavicular joints, within normal limits. We see no osteochondral defect. ADDITIONAL

Output: 1.Mild Achilles tendinosis and perhaps mild inflammation in the adjacent retrocalcaneal bursa, but we see no Achilles tendon tear.2.Mild nonspecific inflammation of the deep intermuscular tissues plantar to the tarsal bones of uncertain etiology or significance but perhaps reflecting mild inflammation.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with brain metastases status post stereotactic radiosurgery. Evaluate for progression. A small hemosiderin stained resection cavity is again seen involving the left precuneus. No pathologic enhancement or new signal abnormality is detected in this vicinity. A 2 to 3 mm focus of enhancement within the left putamen with associated susceptibility effect is unchanged. No new enhancing lesions are seen. Scattered foci of nonspecific FLAIR hyperintensity within the cerebral hemispheres show no significant interval change. Diffuse prominence of the perivascular spaces is seen. No abnormal extra axial collections are detected. The ventricles are stable in size and morphology.

Output: 1.Stable postoperative findings in the left parietal lobe with no evidence of tumor recurrence.2.Stable focus of enhancement within the left putamen.3.No new intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: Nausea/vomiting. New pancreatic and liver masses on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without biliary ductal dilatation or vascular abnormality. The segment 8 hypoenhancing lesion seen on the recent CT is poorly seen and measures approximately 1.0 cm (series 1603/78). No additional lesions are evident. Normally distended gallbladder without gallstones.SPLEEN: No significant abnormality noted.PANCREAS: Superior peripancreatic / perihepatic hilar mass measures approximately 4.0 x 3.5 cm (series 1603/54) and demonstrates heterogeneous central hypoenhancement. The more inferior peripancreatic mass measures approximately 4.2 x 3.0 cm (series 1603/32).The pancreatic parenchyma demonstrates normal morphology and signal intensity. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two stable peripancreatic masses are again favored to represent metastatic adenopathy of unknown primary. A primary pancreatic lesion is considered less likely given the lack of parenchymal atrophy or ductal dilatation, however not entirely excluded. Histological sampling is recommended and may be amenable to endoscopic ultrasound-guided biopsy.2.Indeterminate liver lesion, unchanged.3.No additional sites of disease are identified.


Instruction: Generate impression based on findings.

Input: Left retromolar trigone cancer status post resection. Neck: There are postoperative findings related to left oral cavity region tumor resection, along with left mandible resection, left partial glossectomy, left partial pharyngectomy, and graft reconstruction. There is diffuse enlargement of the left trigeminal nerve in the infratemporal fossa along a length of approximately 3 cm, which is compatible with perineural tumor. There is extension tumor through foramen ovale into the left cavernous sinus, as well as perhaps slightly into the inferior left Meckel cave and posterior portion of the foramen rotundum. There is no gross tumor along the cisternal portion of the left trigeminal nerve. There is abnormal enhancement along the anterior aspect of the left petrous apex. There is a subcutaneous fluid collection overlying the posterolateral aspect of the graft, which measures up to approximately 5 cm. There are small fluid collections more inferiorly along the margins of the graft. Patchy areas of enhancement along the margins of the surgical bed are likely treatment-related and enhancement of the left masticator muscles is likely related to denervation. There is left tympanomastoid fluid. There is scattered inflammation of the right mastoid air cells, as well. There is no definite cervical lymphadenopathy. The paranasal sinuses are unremarkable.Brain: There are no intraparenchymal brain metastases. Please refer to the recent non-contrast brain MRI for additional details.

Output: 1. Postoperative findings related to left oral cavity region tumor resection with graft reconstruction with perineural tumor in the left infratemporal fossa and into the left cavernous sinus, as well as perhaps to a small extent into the inferior left Meckel cave and posterior portion of the foramen rotundum. 2. Fluid collection along the margins of the graft may represent seromas, infection, or fat necrosis, for example.


Instruction: Generate impression based on findings.

Input: 71-year-old male patient with sacral decubitus ulcer. Evaluate for osteomyelitis. There is ulceration of the soft tissues posterior and inferior to the coccyx. The enhancing rim of the ulcer appears to contact the distal coccygeal segment. There is mild edema-type signal within the distal coccyx on the T2-weighted images with preservation of marrow signal intensity on T1-weighted images. These findings are more compatible with reactive osteitis than osteomyelitis. Bone marrow signal in the sacrum appears normal. Mild edema within the ischia bilaterally likely reflects adjacent tendinosis of the hamstring origins.There is bilateral edema type signal and mild enhancement of the adductor musculature of the hips, iliac muscles bilaterally, and gluteal muscles bilaterally which is nonspecific but may reflect a myositis. There is also reticulation of subcutaneous fat indicating edema. There is minimal if any fluid within the hip joints. There is poorly defined signal abnormality and enhancement within the right femoral head and neck that we suspect is degenerative in etiology. The soft tissues immediately surrounding the hips show relative lack of enhancement following gadolinium administration with enhancement peripherally, but we are uncertain of the etiology of this pattern as we see no drainable fluid collection. It is possible that this could represent tissue necrosis. Foci of increased signal intensity are noted on the nonenhanced T1-weighted fat-suppressed sequence deep to the left iliotibial band which may reflect small hematomas.Degenerative disc disease affects the lower lumbar spine. The prostate gland is enlarged.

Output: 1. Decubitus ulcer with findings suggestive of reactive osteitis of the distal coccyx rather than osteomyelitis.2. Edema and enhancement of the musculature of the pelvis with peculiar relative nonenhancement of the juxta-articular soft tissues of uncertain etiology. This may in part reflect a myositis, possibly with regions of myonecrosis. We see no drainable fluid collection.3. Abnormal signal intensity and enhancement of the right hip which we suspect is degenerative.4. Degenerative disc disease of the lumbar spine.


Instruction: Generate impression based on findings.

Input: 63 year male with history of past NSTEMI, cardiomyopathy, HTN, CVA who presents for stress cardiac MRI to evaluate for ischemic etiology of cardiomyopathy.MEDICATIONS: aspirin, lisinopril, metoprolol bid, pravastatin, thiamine, ferrous sulfate First Pass PerfusionDuring hyperemia, there is a moderate sized defect of moderate severity of most of the inferior wall. Viability/ Myocardial ScarThere are two patterns of late gadolinium enhancement noted. The first is a transmural myocardial infarction involving most of the inferior wall. This territory is not viable. The second is a diffuse mid-myocardial late gadolinium enhancement in the anteroseptal, inferoseptal, anterolateral, and inferolateral walls suggestive of fibrosis, inflammation, or infiltration. This pattern is not consistent with prior myocardial infarction. Left VentricleThe left ventricle is severely enlarged with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 138 ml/m2 (normal range: 74+/-15), the LVEDV is 246 ml (normal range 142+/-34), the LV end systolic volume index is 92 ml/m2 (normal range 25+/-9), the LVESV is 163 ml (normal range 47+/-19), the LV mass index is 74 g/m2, and the LV mass is 131 g. There is global hypokinesis with additional akinesis of most of the inferior wall. There is no LV thrombus.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 129 ml/m2 (normal range 82+/-16), the RVEDV is 229 ml (normal range 142+/-31), the RV end systolic volume index is 83 ml/m2 (normal range 31+/-9), and the RVESV is 149 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated. The sinus of Valsalva is 41 mm in diameter.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. During hyperemia, there is a perfusion defect which involves most of the inferior wall. These segments are also thinned, akinetic and has a transmural myocardial infarction. This territory is unlikely to be viable. 2. There is also a pattern of mid-myocardial late gadolinium enhancement in the anteroseptal, inferoseptal, anterolateral, and inferolateral walls suggestive of fibrosis, inflammation, or infiltration. This suggests that the patient has both an ischemic and non-ischemic component to his cardiomyopathy.3. The left ventricle is severely enlarged with moderately reduced systolic function [LVEF 33%]. There is akinesis and scarring of the basal to mid inferior wall. 4. The right ventricle is mildly dilated with moderately reduced systolic function[RVEF 33%]5. Mild aorta root dilation with mild aortic regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient states having 2 seizures previously with no treatment. Reported history of subdural hematoma treated at outside hospital. Evaluate for volume loss, evidence of prior trauma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral mastoid effusions.

Output: No evidence of acute intracranial hemorrhage, mass, or cerebral volume loss.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: L knee meniscus tear History: L knee pain MENISCI: The medial and lateral meniscus appear intact. There is globular signal within the posterior horn of the medial meniscus indicating intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: There is a full-thickness articular cartilage cleft along the median eminence of the patella. There is also a focal near full-thickness to full-thickness articular cartilage cleft along the lateral facet of the patella. There is blistering of the articular cartilage along the medial facet of the patella. There is partial-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus. There is focal full-thickness articular cartilage degeneration along the anterior aspect of the medial tibial plateau with underlying subchondral signal abnormality and cyst formation. There is a focus of low signal intensity within the medial femoral condyle which likely represents a benign bone lesion.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Focal full-thickness articular cartilage clefts and degeneration most pronounced along the patellofemoral articulation.2. 4 mm focus of susceptibility artifact within the subcutaneous tissue along the anterior and medial aspect of the knee which may reflect postsurgical change although this could represent a foreign body in the correct clinical context.3. The menisci appear intact.


Instruction: Generate impression based on findings.

Input: Brain: There is no restricted diffusion to suggest acute ischemia. Scattered predominantly subcortical white matter T2 hyperintense foci are nonspecific, unchanged in number and distribution compared to 1/29/2015. Otherwise, the signal intensity within the brain parenchyma is unremarkable. There is no abnormal focus of enhancement. The ventricles and sulci are normal in size. No regional mass effect, midline shift, or herniation. The visualized orbits are normal. The paranasal sinuses are grossly aerated. There is a small amount of fluid in the right mastoid air cells, unchanged. Flow voids are visualized in the major vessels of the intracranial circulation indicating patency.Neck:Nasopharynx, oropharynx, and hypopharynx are unremarkable without mass lesion or abnormal enhancement. Parotid and submandibular glands are normal in appearance without mass lesion. There is a 2 cm cyst in the right thyroid lobe. There are multiple predominantly subcentimeter lymph nodes in the neck measuring up to 1 cm at level II on the right (series 14, image 20). The airway is patent. Expected vascular flow voids are present demonstrating patency.

Output: 1.Scattered predominately subcentimeter cervical lymph nodes measuring up to 1 cm at level II on the right.2.MRI brain without significant interval change. Scattered T2 hyperintense foci in the subcortical and periventricular white matter are nonspecific.


Instruction: Generate impression based on findings.

Input: 78 year old female with a history of osteoarthritis presents with right knee pain and swelling after a fall. MENISCI: There is attenuation of the posterior horn and body of the medial meniscus that likely reflects chronic extensive degenerative tearing in the absence of known prior surgery. The anterior horn appears relatively normal. There is mild intrasubstance degeneration of the lateral meniscus, but we see no tear.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the knee, particularly the patellofemoral joint, much of which is devoid of articular cartilage. Additional full thickness and partial thickness cartilage degeneration affects the medial and lateral compartments. There are associated degenerative subchondral signal changes that particularly affect the patellofemoral and medial compartments. We see no fracture. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Severe osteoarthritis of the knee.2. Extensive degenerative tearing of the medial meniscus.3. Joint effusion, small Baker cyst, and other findings as above.


Instruction: Generate impression based on findings.

Input: 24-year-old male with left shoulder pain. Evaluate biceps tendon and labrum. ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No fluid or gadolinium is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is linear increased signal abnormality within the anterior glenoid labrum at the 3 o'clock position most consistent with a sublabral foramen. There is increased linear signal abnormality which extends along the superior glenoid labrum posteriorly, consistent with a SLAP tear. There is no evidence of extension into the biceps anchor. There is subchondral cyst formation within the humeral head which is nonspecific but can be seen in patients with internal impingement. BICEPS TENDON: The tendon of the long head of the biceps is normal in appearance. ADDITIONAL

Output: SLAP tear of the glenoid labrum as described above.


Instruction: Generate impression based on findings.

Input: Reason: Biopsy needed of PET positive lesion at the T5 vertebra History: History of Hodgkins Lymphoma Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. No complications were identified following the procedure

Output: T6 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Reason: check fixation History: pain The previously described triquetral fracture seen on recent MRI examination is not well appreciated on this examination. There is faint sclerosis about the base of the ulnar styloid consistent suggestive of a healing nondisplaced ulnar styloid fracture, better visualized on the recent MRI examination, but this is equivocal. There is minimal soft tissue swelling about the wrist.

Output: Findings suggestive of a healing ulnar styloid fracture. The previously described triquetral fracture seen on the recent MRI examination is not well visualized on this exam.


Instruction: Generate impression based on findings.

Input: Reason: 51 yo with abnomral lfts, abdominal pain, gastric bypass, and multipe lesions on RUQ us History: abdomianl pain, elevated lfts, liver lesions ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. There is a 6 mm stone in the distal common bile duct. The common bile duct is dilated to 9 mm. No intrahepatic biliary ductal dilatation. There are multiple lesions within the liver corresponding to hyperechoic foci on the prior ultrasound which are bright on T2 and demonstrate peripheral nodular enhancement, consistent with hemangiomas. The largest in segment 8 measures 1.5 cm (1301/373).SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum. The main pancreatic duct is nondilated. There are 2 small cystic lesions in the pancreatic head which appear to communicate with the main pancreatic duct measuring 5 mm (901/73) and 6 mm (901/70), likely side branch IPMNs.ADRENAL GLANDS: There is a left adrenal nodule measuring 12 mm with loss of signal on out of phase imaging, consistent with an adenoma (1001/33). The right adrenal appears normal.KIDNEYS, URETERS: There is a 5 mm lesion in the peripheral left mid pole corresponding to hyperechoic focus on the prior exam (801/18). This lesion is dark on fat suppressed T2 sequences and loses signal on out of phase sequences, likely representing a small angiomyolipoma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post gastric bypass with a small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Choledocholithiasis with a 6 mm obstructing stone at the distal common bile duct and dilatation of the common bile duct to 9 mm. 2.Multiple liver lesions likely represent hemangiomas.3.Left adrenal adenoma.4.Pancreatic divisum. 5.Cystic lesions in the pancreatic head measuring up to 6 mm likely represent side branch IPMNs.6.Fat-containing lesion in the left kidney measuring 5 mm likely represents a small angiomyolipoma.


Instruction: Generate impression based on findings.

Input: Ulnar sided pain. Evaluate triangular fibrocartilage complex LIGAMENTS: The scapholunate and lunate triquetral ligaments appear intact TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: No evidence of TFCC tear


Instruction: Generate impression based on findings.

Input: 52 years Male (DOB:12/17/1963)Reason: nsclc History: nonePROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 6 mm enhancing lesion in the left gyrus which is stable compared to the prior exam. There is a 12 x 11 mm mass in the right hippocampus which is 11 x 11 mm sagittal dimensions on the current exam. On the prior exam measured x 15 mm sagittal dimensions and 10 x 16 mm axial dimensions. A left occipital lobe lesion previously measured 8 mm and now measures 6 mm. A left temporal lobe lesion measures 7 x 5 mm and previously measured the same.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 mucous retention cysts in the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.

Output: Compared to the prior exam from October the mass in the right hippocampus and another in the left occipital lobe have decreased in size whereas other lesions have remained stable. Please note that these lesions remain larger than on the exam from February.