Instruction: Generate impression based on findings.

Input: Male, 58 years old, with left upper extremity radiculopathy and positive Spurling test. The cervical lordosis is straightened. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable.The visualized spinal cord demonstrates normal morphology. Focal prominence of the central canal of the spinal cord is seen at the C7-T1 level, but as this measures no more than 1 mm in diameter, it can be a normal variation.C2-3: Facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Left greater than right facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C4-5: Left facet hypertrophy. Posterior disc-osteophyte complex formation with asymmetric right uncovertebral hypertrophy. No significant spinal canal stenosis. Severe right foraminal narrowing. No significant left foraminal narrowing.C5-6: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation with a central focal component which may slightly impinge upon the ventral spinal cord. No significant generalized spinal canal stenosis. Moderate left foraminal narrowing. C7-T1: Facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the right paracentral zone. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.Posterior disc-osteophyte complex formation at C6-7 results in slight impingement upon the ventral spinal cord and a moderate left foraminal narrowing.2.Posterior disc-osteophyte complex formation at C4-5 results in a severe right foraminal narrowing.


Instruction: Generate impression based on findings.

Input: 63 year old male with history of Hodgkin's lymphoma, hypertension, dyslipidemia, chronic kidney disease and coronary artery disease (on stress perfusion testing) presenting for evaluation of atypical chest pain. MEDICATIONS: valsartan, metoprolol, aspirin, rosuvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present. There was matched defects present on rest and stress images consistent with artifact. Notably the lateral wall perfusion defect seen on previous imaging is no longer seen. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with mild, global reduced systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 105 ml/m2 (normal range: 74+/-15), the LVEDV is 227 ml (normal range 142+/-34), the LV end systolic volume index is 51 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19), the LV mass index is 49 g/m2, and the LV mass is 106 g. No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 181 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 91 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a three vessel arch.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia. Compared to previous study of 12/14/2010, the lateral wall perfusion defect has resolved.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and mildly reduced systolic function (LVEF 51%).4. Normal RV size and systolic function (RVEF 50%).


Instruction: Generate impression based on findings.

Input: 28-year-old female with right leg edema PELVIS:UTERUS, ADNEXA: Numerous ovarian follicles are present in the ovaries bilaterally. Suggestion of a mild uterine anomaly such as arcuate or septate uterus (series 4, image 20).BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: Small amount of free fluid is noted in the dependent portion of the pelvis, likely physiologic. No fluid collection or mass is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No lymphadenopathy or mass to account for the patient's right leg edema.2.Numerous bilateral ovarian follicles are likely physiologic. Provided the number, correlate for PCOS if there is congruent history.3.There is suggestion of a mild uterine anomaly although it is difficult to differentiate whether it is an arcuate or septate uterus. Correlation with ultrasound may be useful.


Instruction: Generate impression based on findings.

Input: OHT presenting with altered mental status. There is a punctate enhancing lesion in the left cerebellar hemisphere. There also appear to be punctate foci of restricted diffusion in the right occipital lobe white matter. There are small areas of encephalomalacia in the bilateral basal ganglia and thalami, right middle frontal gyrus, left superior frontal gyrus, and right middle cerebellar peduncle. There is also a background of diffuse cerebral white matter T2 hyperintensity, primarily in a periventricular distribution. There are several punctate foci of supratentorial and infratentorial susceptibility effect. There are a few small foci of high T1 signal and susceptibility effect in the bilateral basal ganglia, which may represent mineralization or prior hemorrhage. There is no abnormal intracranial enhancement. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right maxillary sinus.

Output: 1. A punctate enhancing lesion in the left cerebellar hemisphere may be ischemic, neoplastic, or infectious in nature.2. Punctate foci of restricted diffusion in the right occipital lobe white matter may represent acute infarcts.3. Multiple small chronic infarcts and a background of probable mild cerebral white matter small vessel chronic ischemia.4. Several punctate foci of supratentorial and infratentorial susceptibility effect are nonspecific, but may represent septic emboli or prior microhemorrhages, for example.


Instruction: Generate impression based on findings.

Input: Reason: Pt with metstatic lung cancer with known mets to spine s/p radiation to T-spine now with worsening back pain. Please evaluate for pathologic fracture History: back pain There are multiple marrow replacing lesions in the thoracic spine as well as the visualized portions of the cervical and lumbar spine. The largest ones in the thoracic spine appear to be at T8, T9 and T12. There is milder encroachment of the right T9-T10 neural foramen resulting from one of these lesions. Compared to the prior exam extraosseous extension previously associated with some of the lesions has regressed and the signal characteristics have changed.There is a mild/minimal T12 and T8 superior end plate compression present which was previously present. The rest of the thoracic vertebral bodies are appropriate in the overall height. The thoracic vertebral bodies are appropriate in the overall alignment. The thoracic spinal cord has normal signal characteristics and overall morphology. There is a right pleural effusion present.There is a right sided lung lesion present adjacent to the paravertebral space at the level of the carina. This was not present on the prior exam

Output: 1.Findings are compatible with diffuse metastases along the entire spine. Although there is some narrowing of the right T9-T10 neural foramen, there is no compromise to the spinal cord . Compared to the prior exam extraosseous extension previously associated with some of the lesions has regressed and the signal characteristics have changed.2.There is a mild/minimal T12 and T8 superior end plate compression present which is stable.3.There is a right pleural effusion present which is also new.4.There is a right sided lung lesion present adjacent to the paravertebral space at the level of the carina. Please refer to recent chest CT for comments.


Instruction: Generate impression based on findings.

Input: Tenderness to palpation and fluid drainage, evaluate for osteomyelitis. Postsurgical changes of bilateral below the knee amputations are present.The bone marrow signal of the visualized right distal femur and remaining proximal tibia/fibula is within normal limits without evidence of osteomyelitis. On the coronal views, the bone marrow signal of the visualized left distal femur and remaining proximal tibia/fibula is within normal limits without evidence of osteomyelitis.Mildly increased T2 signal within the medial soft tissues of the remaining left leg as seen on the coronal views is nonspecific but compatible with soft tissue edema. No discrete, loculated fluid collections are identified.

Output: No osteomyelitis. Mild soft tissue edema within the remaining portion of the medial left leg, correlate clinically for cellulitis.


Instruction: Generate impression based on findings.

Input: 22-year-old female with history of congenital anomaly of cerebrovascular system. Clinical question: On 3T Scanner, s/p stereotactic radiosurgery for AVM in August, s/p crani for AVM resection. MRI of the brainRedemonstrated is a small tangle of flow voids present in the right perimesencephalic cistern and in the right geniculate nucleus which has not significantly changed proximally, although there has been slight decreased vascular enhancement of distal arborizations. On susceptibility imaging a microhemorrhages are redemonstrated in the right thalamus near the arteriovenous malformation. There is new vasogenic edema throughout this region of AVM, with a new centrally located focus of contrast enhancement measuring 12 mm AP x 10 mm transverse x 17 mm craniocaudal.No diffusion weighted abnormalities are appreciated. The patient is status post left-sided craniotomy for removal of an arteriovenous malformation. Some signal changes at the surgical bed and likely represent gliotic changes, stable in appearance. A punctate microhemorrhage is again noted in the left middle frontal gyrus, stable when compared to the prior examThere are no foci of restricted diffusion. The visualized portions of the paranasal sinuses redemonstrate a small mucus retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.Redemonstrated is a 2 mm aneurysm at the right ophthalmic artery origin.Redemonstrated is a small tangle of vascular structures centered in the expected location of the right geniculate nucleus associated with mild enlargement of the the thalamogeniculate branches of the right posterior cerebral artery. There has been slight pruning of distal AVM arborizations presumably representing a therapeutic response.

Output: 1.Redemonstrated is a small tangle of vascular structures centered in the expected location of the right geniculate nucleus associated with mild enlargement of the the thalamogeniculate branches of the right posterior cerebral artery. There has been slight pruning of distal AVM arborizations presumably representing a therapeutic response.2.New associated vasogenic edema with a central focus of new enhancement is suggestive of a therapeutic response to radiosurgery with a small focus of radiation necrosis.3.Redemonstrated is a 2 mm aneurysm at the right ophthalmic artery origin.


Instruction: Generate impression based on findings.

Input: 71-year-old female with pain for 3 weeks not responsive to steroid injection. MENISCI: There is a vertical defect within the posterior horn of the medial meniscus indicating a vertical tear. the tear appears to intersect the tibial and femoral surfaces. The remaining menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the tibiofemoral compartments bilaterally are grossly intact. There is marked thinning of the patellofemoral cartilage with subchondral degenerative cystic changes of the posterosuperior portion of the patellar articular surface of the patellofemoral joint. Small amount of subchondral degenerative cystic change is also noted within the lateral aspect of the medial tibial plateau.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Vertical tear of the posterior horn of the medial meniscus with intersection of both the tibial and femoral surfaces.2.Marked patellofemoral chondromalacia.


Instruction: Generate impression based on findings.

Input: Osseous sarcoid. Brain: There are unchanged multifocal osseous lesions, including within the clivus, right parietal calvarium, occipital bone, right petrous apex, bilateral sphenoid greater wings, C2 body, and right mandible condyle and neck. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal leptomeningeal 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 are grossly unremarkable.Pituitary: There is mild asymmetric prominence of the right lobe of the pituitary gland, but otherwise no evidence of discrete pituitary or infundibular lesions. The cavernous sinuses and optic apparatus are intact.

Output: 1. Unchanged stigmata of multifocal osseous sarcoidosis in the head and upper cervical spine.2. No evidence of neurosarcoidosis involving the brain. 3. Nonspecific mild asymmetric prominence of the right lobe of the pituitary gland, but otherwise no evidence of discrete pituitary or infundibular lesions.


Instruction: Generate impression based on findings.

Input: Evaluate cortical tubers, SEGA: tuberous sclerosis. There are intracranial stigmata of tuberous sclerosis complex, including multiple cortical tubers and punctate subependymal nodules with associated susceptibility effect. There are postoperative findings related to transfrontal left lateral intraventricular tumor resection. There is no evidence of acute intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is an apparent small lipoma in the left lateral retropharyngeal space.

Output: Extensive intracranial stigmata of tuberous sclerosis complex and postoperative findings related to transfrontal intraventricular tumor resection, without evidence of subependymal giant cell tumor.


Instruction: Generate impression based on findings.

Input: Surveillance. Additional history per chart, history of large posterior fossa ependymoma WHO grade 2 s/p resection x2 with VP shunt placement and adjuvant proton radiotherapy who presents for post-operative management following stereotactic cyst puncture and insertion of Rickham catheter. Following radiation therapy, the patient formed a large cystic structure in the former resection cavity in the right cerebellopontine angle. Subsequently, the patient developed a 7th nerve palsy and compression of the brainstem with right side weakness. Again seen are postsurgical changes of right occipital craniotomy related to partial tumor resection. The right occipital approach catheter traversing the right CP angle cystic lesion is unchanged in position. There is no significant change in cystic components at the right cerebellopontine angle which measures approximately 22 mm x 11 mm in the axial plane. The enhancing posterior fossa mass also does not demonstrate significant change in size measuring approximately 45 x 50 mm, axial image 11 series 1101. Mass measures approximately 37 mm in the craniocaudal dimension which is also not significantly changed. There is feathery pattern of enhancement likely reflective of posttreatment change. Mass effect on the cerebellum and brainstem with leftward deviation is unchanged. Unchanged pineal cyst with peripheral enhancement.Left frontal approach ventriculostomy catheter terminates at the foramen of Monro, unchanged. Ventricles are unchanged in size without evidence of hydrocephalus. Additional prior bilateral catheter tracts are noted with chronic blood products.Flow voids are present within the major vessels indicating patency. There is been significant interval increase in diffuse paranasal sinus opacification. Mastoid air cells also demonstrate increased opacification bilaterally.

Output: 1. Compared to 2/5/2016 there is no significant change in size of the posterior fossa ependymoma including the cystic components and associated mass effect. 2. There is increased diffuse opacification of the paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: 47 year old female with suspicious mass in the left breast with suspicious left axillary lymph node, presents for research MRI scan. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Highly suspicious, lobulated enhancing mass is demonstrated at posterior 2 o'clock position, measuring 27 x 28 x 30 mm (AP x LR x CC), in the left breast. It is located near pectoralis muscle, but there is a fatty plane between the mass and the muscle. No other suspicious lesions are present in the left breast.In the left axilla, one enlarged lymph node, measuring 23 mm in maximum diameter, with effaced hilum at upper aspect.In the right breast, there is an enhancing mass with possible internal dark septation, measuring 8 x 9 x 9 mm at 3 o'clock position.No abnormal lymph nodes are identified in either axillary region.

Output: 1. Highly suspicious mass in the left breast with suspicious left axillary lymph node. Ultrasound guided biopsy were performed for both lesions later today.2. Enhancing mass in the right 3 o'clock position, likely fibroadenoma. MR directed ultrasound, performed later today, detected a correlate, and subsequently biopsy was performed under ultrasound guidance.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Brain tumor. Signs and symptoms: Brain tumor. Pre-and post-enhanced brain MRI:Examination redemonstrate previously known cluster of extra axial dural based rim enhancing lesion in the left subfrontal and left anterior middle cranial fossa at the site of previous meningioma resection. Compared to prior exam there is noticeable interval decreased size of this finding which is highly suggestive of postoperative change and likely loculated hemorrhage. The focus of rim enhancement in the left subfrontal region measures at 10 x 14-mm in size compared to prior study measurement of 14.5 x 18.5-mm.The largest focus of enhancement along the anterior left middle cranial fossa measures at approximately 12.5 x 21 mm compared to prior study measurement of 14 x 26.Additional well-demarcated focus of rim enhancement in the left anterior middle cranial fossa measures at 7.3 x 7-mm compared to prior study measurement of 11.5 x 11.6mm. The findings in left anterior up fossa and left subfrontal region are highly suggestive of postoperative change and very unlikely to represent tumor.Flair hyperintensity of the left anterior temporal lobe demonstrate interval decreased size and extent and consistent with gliosis.There is no convincing evidence of residual or recurrence of tumor however further follow-up is recommended considering presence of residual postoperative enhancement which could obscure small tumor recurrence. There is a tiny focus of nonspecific flair hyperintensity in the cingulate gyrus of the right frontal lobe is again identified and without change.

Output: 1.Internal improvement with decreased size of cluster of extra axial rim enhancing lesions in the left anterior middle cranial fossa and left subfrontal region consistent with postsurgical change as detailed/measured above.2.Interval decrease left anterior temporal tip flair hyperintensity suggesting improvement of residual vasogenic edema at the surgical site.3.Stable tiny focus of nonspecific flair hyperintensity in the right frontal single he gyrus and with minimal enhancement.


Instruction: Generate impression based on findings.

Input: Female, 65 years old, status post isthmusectomy and neck exploration for possible branchial arch track involving the left peripheral sinus, now undergoing preoperative imaging for thyroidectomy and repeat neck dissection. The left piriform sinus is effaced due to thickening of the adjacent hypopharyngeal mucosa as well as anterior displacement of that mucosa. This mucosal displacement appears to be related to a band of T2 hyperintense, mildly enhancing tissue situated posterior to the pharynx, beginning just above the level of the piriform sinus and continuing approximately 3 cm inferiorly reaching to the level of the left thyroid bed. On prior CT examinations, there was a rim-enhancing fluid collection which occupied approximately this same territory. No discrete or rim-enhancing fluid collections are seen on today's exam. No pathologic adenopathy is observed. The thyroid gland is small which may be related to prior surgery. The salivary glands are free of suspicious focal lesions. There may be a small esophageal diverticulum which projects anteriorly, along the left posterior margin of the trachea, heading towards the left thyroid bed.

Output: A band of thickened, solidly enhancing tissue is evident spanning from just behind the hypopharynx at the level of the left piriform sinus, down to the level of the left thyroid bed. On prior examinations, there was a rim-enhancing collection which occupied this territory. The solid tissue on today's examination may represent scarring or granulation related to prior inflammation. The location and general trajectory of this tissue would be compatible with a fourth branchial apparatus anomaly. There may also be a small esophageal diverticulum which projects anteriorly toward the left thyroid bed.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for osteomyelitis History: left foot ulcer, diabetes, PAD Bone marrow signal is unremarkable. No abnormal enhancing foci suggestive of osteomyelitis. No sinus tract to the bone identified.

Output: No specific evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: 25 year old female with history of symptomatic supraventricular tachycardia and premature ventricular contractions presenting for evaluation to rule out arrhythmogenic right ventricular cardiomyopathy. Left VentricleThe left ventricle is mild-moderately dilated and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 102 ml/m2 (normal range: 65+/-11), the LVEDV is 202 ml (normal range 109+/-23), the LV end systolic volume index is 47 ml/m2 (normal range 18+/-5), the LVESV is 92 ml (normal range 31+/-10), the LV mass index is 42 g/m2 (normal range 67+/-11), and the LV mass is 83 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 106 ml/m2 (normal range 69+/-14), the RVEDV is 210 ml (normal range 110+/-24), the RV end systolic volume index is 54 ml/m2 (normal range 22+/-8), and the RVESV is 106 ml (normal range 35+/-13). No RV wall motion abnormalities (akinesia or dyskinesia) noted. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mild-moderately dilated and systolic function. The overall LV ejection fraction is 55%. No late gadolinium enhancement.2. The right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%3. Major criteria for ARVC not met, however RVEDV indexed is mildly dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 62-year-old woman with history of rectal pain and pelvic mass. PELVIS:UTERUS, ADNEXA: The patient is status post hysterectomy and a small focus of air is seen in the vaginal cuff.BLADDER: The bladder is unremarkable and there is no evidence of bladder wall invasion by the rectal mass.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Approximately 3.1 cm superior to the anal verge, there is a 5.0 x 4.2 cm lobulated, enhancing mass within the rectum. This mass abuts but does not appear to invade the levator ani muscles. There is questionable invasion of the right mesorectal fascia (series 701, image 18). The proximal bowel appears normal in caliber.BONES, SOFT TISSUES: A 15 x 16 mm Tarlov cyst is noted.OTHER: No significant abnormality noted.

Output: Multilobulated rectal mass, likely carcinoma, with possible invasion of the right mesorectal fat and fascia.


Instruction: Generate impression based on findings.

Input: Periosteal reaction, skin wounds Note that the exam is significantly limited by motion artifact. The patient also prematurely terminated the exam and all sequences were not able to be performed.Again seen is abnormal marrow signal within the left proximal tibia which is identified on the standing coronal views. There is mild diffuse edema of the soft tissues and muscles of the lower extremity, particularly proximally. There is no evidence of a discrete fluid collection. Within the limits of this exam, there is no abnormal marrow signal of the right tibia/fibula to suggest osteomyelitis.

Output: 1. Abnormal marrow signal within the left proximal tibial metadiaphysis may represent early bone infarction but appears unchanged from the prior exam.2. No evidence of osteomyelitis within the right tib-fib.


Instruction: Generate impression based on findings.

Input: Left hyperacusis: parkinsonism. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. There may be deficiency of bone overlying the left superior semicircular canal. The other inner ear structures otherwise appear unremarkable bilaterally. The bilateral mastoid air cells and middle ears also appear unremarkable. There is what appears to be cerumen in the left external auditory canal.

Output: Possible left superior semicircular canal dehiscence. A temporal bone CT may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: The intra-articular contrast remains within the radiocarpal joint. No contrast is identified within the mid carpal joint or traversing the scapholunate or lunotriquetral ligaments to suggest a tear. No contrast is identified within the distal radioulnar joint to suggest disruption of the triangular fibrocartilage complex. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 30 seconds

Output: Fluoroscopic-guided injection of dilute gadolinium into the right wrist for MRI arthrogram examination. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on findings.

Input: Subarachnoid hemorrhage. Concern for dissection. There is a stable right frontal ventriculostomy catheter, with its tip near the right foramen of Monro. Susceptibility remains within the dependent occipital horns as well as scattered throughout the sulci, consistent with known intraventricular and subarachnoid blood products, with interval expected evolution. There is only minimal residual sulcal FLAIR hyperintensity corresponding to blood products. There is increased conspicuity of FLAIR hyperintensity throughout the midbrain in a relatively symmetric pattern with extension into the periaqueductal gray matter. There is mild residual diffusion restriction noted. There is also now involvement of the ventral and dorsal pons.There is a linear focus of mild diffusion restriction the lateral right cerebellum without significant FLAIR abnormality at this time. There are few scattered punctate foci of nonspecific T2/FLAIR hyperintensity in the cerebral white matter bilaterally, not well delineated on prior exam secondary to motion artifact. There is extra-axial FLAIR hyperintensity along the frontal lobes bilaterally, slightly more prominent on the left, extending into the anterior interhemispheric fissure along the falx. There is a thin collection of increased T1 signal or enhancement along the left anterior cranial fossa floor, with similar findings identified along the left tentorium and posterior fossa. Retrospectively, these findings are likely present on the prior exam.There is no intracranial mass or mass effect. No parenchymal or leptomeningeal enhancement. Right parietal scalp edema is noted. There is trace right mastoid fluid.

Output: 1. Interval acute right cerebellar lacunar infarct.2. Limited evaluation secondary to lack of precontrast T1-weighted images. Persistent now subacute trace right greater than left frontal as well as left tentorial and posterior fossa subdural hematomas/collections with possible reactive dural thickening/enhancement, without gross interval change.3. Probable interval evolution of previous abnormality in the midbrain with now findings involving the ventral and dorsal pons, likely representing edema and ischemic injury. Osmotic demyelination also remains a possibility although distribution is not characteristic.4. Interval expected evolution of diffuse subarachnoid and intraventricular blood products. Stable right transfrontal ventriculostomy catheter in place without evidence of hydrocephalus.


Instruction: Generate impression based on findings.

Input: Female, 44 years old, with history of stage IIIb cervical cancer, now with increasing frequency in headaches. A 7 mm focus of T2 hyperintensity is seen within the right frontal white matter. There is no associated diffusion restriction or susceptibility effect. The lesion induces no detectable mass effect.Elsewhere, brain parenchymal morphology and signal characteristics are within normal limits. No evidence of edema or mass effect is seen. No intracranial hemorrhage or any abnormal extra-axial collections are seen. The ventricular system is normal in size and morphology.

Output: A T2 hyperintense lesion within the right frontal white matter is nonspecific. Follow-up imaging may be considered to assess for stability and should be performed with contrast.No additional specific findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Altered mental status [780.97], Reason for Study: ^Reason: evaluate for etiology of mental status changes, f/u hypodense regions noted on CT, ?PRESS History: mental status change, hypertension, hypodense regions on CT Motion artifacts degraded examination quality.There are ill defined high signal intensity lesions on bilateral occipital lobes subcortical white matter, bilateral frontoparietal lobes especially vertex area and bilateral thalami on FLAIR images without showing evidence of hemorrhages. These findings are suggestive of PRESS.On ADC maps, there are curvilinear low signal intensity lesions on the right middle temporal gyrus without showing high signal intensity on diffusion weighted images. These lesions do not show high signal intensity on neither T2 nor FLAIR images. These signal characteristics may indicate possible hyper acute ischemic infarction or artifacts. There is no evidence of acute hemorrhagic lesion.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 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal luminal narrowings on MIP reconstruction. However, these lesions could all be artifactual due to motion artifacts. 3D MRA neck non contrast enhanced 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. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Patchy high signal intensities on bilateral occipital lobes, thalami and fronto-parietal lobes vertex area indicate possible PRESS.2. Right temporal lobe lesion which showed restricted diffusion on ADC map could represent an artifact or hyper acute ischemic lesion as described above.3. Motion artifacts degraded image quality.


Instruction: Generate impression based on findings.

Input: 55-year-old female right knee pain. Evaluate for right hip labral tear. ACETABULAR LABRUM: There is increased signal abnormality within the anterior superior labrum consistent with mild labral degeneration without evidence of a discrete labral tear. There is no focal fluid signal abnormality or gadolinium identified within the labrum to suggest a tear.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. The cartilage surfaces are intact. Degenerative changes affect the facet joints of the lower lumbar spine.SOFT TISSUES: Tendinous origins of the iliopsoas, hamstrings and gluteal tendons are intact. ADDITIONAL

Output: Mild acetabular labral degeneration without evidence of a discrete labral tear. Degenerative changes of the lower lumbar spine as described above.


Instruction: Generate impression based on findings.

Input: Brainstem glioma: increased dysarthria and ataxia. There is no appreciable change in the heterogenous upper brainstem mass, measuring up to approximately 23 mm, with a small cystic area along the right aspect of the mass. The mass protrudes into the inferior portion of the third ventricle and there is unchanged mild prominence of the bilateral lateral ventricles. There are unchanged punctate foci of susceptibility effect in the brainstem and surrounding areas, which may be related to prior radiation therapy. There is unchanged encephalomalacia in the medial right cerebellar hemisphere. There is also a punctate focus of encephalomalacia at the site of the previously demonstrated acute right external capsule infarct. There is an unchanged small cystic area in the left basal ganglia, which may represent a chronic lacunar infarct or prominent perivascular space. There are unchanged mild nonspecific scattered areas of high T2 signal in the periventricular white matter. 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: 1. No appreciable change in the treated brainstem glioma.2. Unchanged encephalomalacia in the medial right cerebellar hemisphere. 3. Chronic right external capsule lacunar infarct.


Instruction: Generate impression based on findings.

Input: History of spine lesion, evaluate for change in size. Surveillance imaging. The thoracic vertebral bodies again demonstrate diffuse heterogeneous marrow signal abnormality. There are subtle differences, such as at the ventral T7 level with slightly more prominent lower T1 and lower T2 signal. These differences may be related to technique. Low T1 and low T2 signal involving the superior anterior aspect of the T11 vertebral body remains unchanged. No associated edema or enhancement. The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or neural foramina. No abnormal enhancing lesions are identified in the thoracic spine.

Output: Allowing for slight differences in technique, there is no significant change in diffuse marrow signal heterogeneity in the thoracic spine as well as a more focal area of low T1 and low T2 signal involving the T11 vertebral body, which was previously FDG avid on PET. Follow-up with PET may be helpful as clinically appropriate. No new enhancement. No pathologic compression fractures. No evidence of epidural tumor.


Instruction: Generate impression based on findings.

Input: Elbow pain, history of lateral epicondyle release LIGAMENTS: No significant abnormality noted.TENDONS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: There is mild irregularity and increased signal of the lateral epicondyle which may be degenerative in nature. A small amount of fluid is noted between the epicondyle and radial head although there is no fluid signal tracking laterally.SURROUNDING STRUCTURES: No significant abnormality noted.ADDITIONAL

Output: Mild irregularity of the lateral epicondyle which may be degenerative or possibly postsurgical in nature.


Instruction: Generate impression based on findings.

Input: Ms. Piljac is a 44 year old female with a personal history of left breast mastectomy in 2010 for DCIS. Personal history of benign right breast MRI guided biopsy in 2012 for fibrocystic change. She has no current breast related complaints. There are postsurgical changes of left breast mastectomy with tissue-based reconstruction. There is no abnormal enhancement seen in the left reconstructed breast.There is heterogeneous amount of fibroglandular tissue in the right breast. Mild parenchymal enhancement is noted in the right breast. There is no abnormal enhancement seen in the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: There is mild levo thoracolumbar and moderate dextro lumbar S-shaped scoliosis. There is straightening of the usual lumbar lordosis with mild anterolisthesis of L5 on S1 and mild right lateral translation of L4 on L5. There is mild wedge deformity of the L5 vertebral body. There is severe loss of disc height at L2/3 through L5/S1. The vertebral bone marrow signal is mildly heterogeneous with endplate degenerative changes, most severe at L4/5, where there is evidence of edema. The spinal cord displays normal signal and morphology. The tip of the conus medullaris terminates at the level of L1/2. There is a posteriorly directed subcentimeter synovial cyst at L5-S1 on the left. Incidentally noted are degenerative changes at the right grater than left sacroiliac joints. T10/11: Disc bulge, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to moderate bilateral foraminal stenosis and mild spinal canal stenosis.T11/12: Disc bulge eccentric to the right, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to moderate right foraminal stenosis and mild spinal canal stenosis.T12/L1: Disc bulge, bilateral facet arthropathy, and thickening of the ligamentum flavum. No significant spinal canal or foraminal stenosis.L1/2: Disc bulge, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to mild left greater than right foraminal stenosis. No significant spinal canal stenosis.L2/3: Disc bulge, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to moderate left and mild right foraminal stenosis. No significant spinal canal stenosis.L3/4: Disc bulge, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to moderate left and mild right foraminal stenosis and mild spinal canal stenosis.L4/5: Disc bulge, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to moderate bilateral foraminal stenosis. No significant spinal canal stenosis.L5/S1: Disc bulge, bilateral facet arthropathy, and thickening of the ligamentum flavum, contributing to moderate to severe bilateral foraminal stenosis. No significant spinal canal stenosis.

Output: Advanced degenerative lumbar spondylosis and scoliosis with variable degrees of neural foramen and spinal canal stenosis at multiple levels, but most pronounced at L4-5 and L5/S1.


Instruction: Generate impression based on findings.

Input: Reason: r/o acute process History: ongoing severe headache The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction appreciated within the brain parenchyma.On susceptibility imaging there are punctate foci of signal hyperintensity in the subcortical white matter of the temporal and occipital lobes as well as the left and right cerebral peduncles and in the thalami. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.Incidental note is made of a developmental venous anomaly in the right cerebellar hemisphereThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eyeball lens is thin. There is mild asymmetric signal hyperintensity within the posterior chamber of the right eye versus the left.

Output: 1.There is no evidence for acute ischemic infarction.2.Multiple microhemorrhages and are present in the brain parenchyma predominately in the subcortical pattern but involving the deep structures. This pattern is nonspecific.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Asymmetric signal in the right eye posterior chamber versus the left is nonspecific. Because it is only seen on one pulse sequence it may be artifactual, however, correlation to clinical history and exam may help further assess this.


Instruction: Generate impression based on findings.

Input: 42-year-old male with left anterior mesiofrontal abscess s/p drainage and antibiotics IV and PO. Evaluate for changes of drained abscess. Since the prior exam there has been interval decrease in size of the left gyrus rectus enhancing lesion compatible with abscess. It now measures 0.7 x 0.5 cm (series 12, image 63), compared to 1.1 x 1.7 cm previously. The amount of surrounding T2/FLAIR signal abnormality within the left frontal lobe has decreased significantly. Foci of encephalomalacia are present in medial left occipital lobe and in the left cerebellar hemisphere. These are stable compared to the prior exam. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. A linear focus of T2 and FLAIR signal hyperintensity extends through the left frontal calvarial burr hole into the left frontal lobe lesion. This probably represents a prior tract for biopsy/aspiration.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: 1.Interval decrease in size in the left frontal lobe abscess with corresponding decrease in the amount of surrounding edema. 2.Foci of encephalomalacia are redemonstrated in the left cerebellar hemisphere and left occipital lobe which are most likely related to a prior cerebrovascular event. This is stable and unchanged.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. 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 midline structures and craniocervical junction are within normal limits. The hippocampi are symmetric and normal in appearance. The degree of myelination is appropriate for age. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is a 16 mm enhancing lesion within the right cheek soft tissues with questionable foci of susceptibility effect. MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1.MRI of the brain is unremarkable. MRA of the head is also unremarkable. 2.Right cheek lesion may represent a hemangioma or possibly a venous malformation and can be correlated with clinical features.


Instruction: Generate impression based on findings.

Input: Epilepsy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears 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 are grossly unremarkable. There is mucosal thickening in the left ethmoid sinuses. There is probable scar tissue in the right frontal scalp.

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


Instruction: Generate impression based on findings.

Input: Clinical question: History of lung cancer with new brain metastases; evaluate for radiosurgery planning. Signs and symptoms: Brain metastases. Pre- and post enhanced treatment planning brain MRI:8 tiny right posterior cerebellar metastatic lesion is identified without change. A tiny left superior cerebellum metastatic lesion is identified without change. A small enhancing metastatic lesion in the superior right occipital lobe measuring approximately 3 mm in size is identified without change.A ring-enhancing metastatic lesion in the right posterior parietal measuring at approximately 7 mm is identified.No detectable that the meningeal enhancement.Stable normal size of ventricular system and without deviation of midline.Patent all CSF cisterns.No detectable abnormal enhancement of the calvarium.

Output: Multiple small supratentorial and infratentorial enhancing metastatic lesions without significant change since prior exam.


Instruction: Generate impression based on findings.

Input: Diagnosis: Facial weaknessClinical question: strokeSigns and Symptoms: R facial droop MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is a mild degree of punctate lesions in the brainstem which are hyperintense on FLAIR and T2 imaging there are additional T2 hyperintense and FLAIR hyperintense lesions present in the right basal ganglia and internal capsule as well as the left internal capsule.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate 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. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The A1 segments are asymmetric. The right A1 segment is larger than the left A1 segment. There is fetal origin of the right posterior cerebral artery with a medium sized right P1 segment. The left posterior communicating artery is tiny. The left vertebral artery ends in the left posterior inferior cerebellar artery. The right vertebral artery mildly narrows as it enters the subarachnoid space.

Output: 1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions a moderate degree as well as a mild degree of the punctate lesions in the brainstem and right basal ganglia and internal capsules are nonspecific. At this age they are most likely vascular related. 3.No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: 58-year-old female with headache. Previous electronic medical records indicate history of metastatic colon cancer. The lateral and third ventricles are stable compared to the prior examination suggestive of mild hydrocephalus. The supratentorial gray-white matter differentiation is preserved. There is no midline shift, intra- or extra-axial fluid collection.Abnormally decreased diffuse attenuation involving the right posterior fossa with extension across midline, demonstrates mild anterior mass effect at the level of the fourth ventricle. This is not significantly changed compared to the previous examination and consistent with patient's known metastatic disease at this level as seen on CT dated 4/24/2009.A new foci of subcentimeter hyperdensity within this area of low-attenuation is new compared to exam dated 6/24/2009, best seen on image 4/30, and may represent focal hemorrhage. Further evaluation with contrast-enhanced MRI or postcontrast CT is recommended.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable posterior fossa diffuse low-attenuation and edema consistent with known metastatic disease now with new focus of high density which may represent focal hemorrhage. Contrast-enhanced MRI or postcontrast CT is recommended for further evaluation as clinically indicated.


Instruction: Generate impression based on findings.

Input: Reason: r/o cause of urinary retention (?cord compression, but no h/o cancer; has h/o spinal stenosis) History: Urinary Retention Five lumbar type vertebral bodies are presumed to be present. There is a compression fracture at L1 with 30% loss of vertebral height height. Signal characteristics indicate that this is any acute or subacute phase based on low signal on T1 and high signal on T2. There is mild retropulsion with some impression on the ventral aspect of the thecal sac but no associated compression of the conus medullaris. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is loss of disk space height, a broad-based disk extrusion eccentric towards the right with disk material extending behind the L4 vertebral body. There is associated ligamentum flavum and facet hypertrophy as well as mild anterior subluxation of L4 on L5. There is significant narrowing of the thecal sac and encroachment of the right-sided exiting nerve roots within the neural foramen. Compared to the prior exam from 11/15/13 this disk extrusion has progressed and the associated spinal canal stenosis as progressed.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is redemonstration of an enlarged uterus associated with lesions suspected to represent fibroids. The uterus is not completely included on this exam and is not completely evaluated.There is a small cyst in left kidney which was not adequately demonstrated on prior exam due to some of breathing motion on the prior exam.

Output: 1.Since the prior exam spinal stenosis at L4-5 due to degenerative changes and subluxation as progressed. There is now moderate to severe spinal stenosis at this level associated encroachment of the right-sided exiting nerve roots.2.There is an acute or subacute compression fracture present at L1 associated mild retropulsion into the spinal canal and narrowing of the spinal canal. The conus medullaris, however, is surrounded by spinal fluid and is not compressed.3.Findings were reported to David Kopelman pager 3658


Instruction: Generate impression based on findings.

Input: 48 years, Male, postop tumor resection. Seizures. There are postsurgical changes related to tumor resection centered in the right middle frontal gyrus. There appears to be near total resection. There is masslike T2/FLAIR hyperintensity along the superior aspect of the resection cavity measuring approximately 34 x 22 x 12 mm suspected to represent residual tumor. There is also slightly nodular T2 hyperintensity along the posterior superior aspect of the resection cavity which may represent minimal residual tumor although postoperative changes make assessment difficult of this region. Expected postsurgical changes include blood products filling the resection cavity as well as small extra-axial collection along the right cerebral convexity. There is small amount of pneumocephalus. There is minimal leftward midline shift which was seen previously. No significant new mass effect or uncal herniation is evident. There is thin rind of restricted diffusion along the resection cavity margin, relatively greater in its medial aspect compatible with cytotoxic edema involving the right frontal corona radiata. Remainder of the brain parenchyma appears unremarkable. Ventricles are normal in size. Small pocket of air and fluid is noted in the right frontal scalp which may represent postoperative seroma or perhaps pseudomeningocele.

Output: Postoperative changes of right frontal lobe tumor resection as described above. There is near total resection with residual tumor suspected along the superior aspect of the resection cavity and questionably also along the posterior superior aspect of the resection cavity.


Instruction: Generate impression based on findings.

Input: Reason: R knee medial femoral condyle OCD lesion History: R knee pain/swelling MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: Again seen are four tubular fixation devices within the medial femoral condyle extending to the articular surface. The most anterior device appears to penetrate the anteromedial cortex with its end lying just deep to the medial patellofemoral ligament, but this is unchanged from the prior study. Marrow edema along these fixation devices appears less prominent on the current study than on the prior study. There is minimal heterogeneity of the articular cartilage as well as slight thinning of the cartilage along the anteriormost fixation device, but we see no full thickness fluid-filled defect. The articular cartilage of the lateral and patellofemoral compartments appears normal. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: Again seen is thickening of the proximal patellar tendon, although signal abnormality within this portion of the tendon has normalized. This may reflect healing tendinosis or postsurgical changes. The quadriceps tendon is normal in appearance. ADDITIONAL

Output: Surgical changes of osteochondral defect fixation as described above with improving bone and soft tissue edema. Although there is minimal heterogeneity and thinning of the articular cartilage of the medial femoral condyle, we see no fluid-filled cartilage defect or other complication. Other findings as above.


Instruction: Generate impression based on findings.

Input: Muscle weakness Right: There is severe fatty atrophy of the gluteus minimus muscle with mild fatty atrophy of the gluteus maximus and relative sparing of the gluteus medius. There is moderate to severe fatty atrophy of the tensor fascia lata. There is moderate fatty atrophy of the hamstring musculature which most severely affects the semimembranosus and relatively spares the short head of the biceps femoris. There is mild fatty atrophy of the adductor musculature. There is moderate fatty atrophy of the sartorius muscle distally with mild fatty atrophy of the vastus lateralis, medialis, and intermedius muscles. Additionally, there is moderate fatty atrophy of the visualized medial head of the gastrocnemius proximally. On fat suppressed T2-weighted images, there is minimal edema type signal within the vastus lateralis and perhaps vastus medialis but this may simply reflect a component of subacute atrophy as opposed to true inflammation. Mild osteoarthritis affects the knee and hip but the marrow signal of the femur is otherwise normal.Left: There is severe fatty atrophy of the gluteus minimus muscle with mild fatty atrophy of the gluteus maximus and relative sparing of the gluteus medius. There is moderate to severe fatty atrophy of the tensor fascia lata. There is severe fatty atrophy of the semimembranosus with moderate fatty atrophy of the semitendinosus and mild fatty atrophy of the long head of the biceps femoris. There is mild fatty atrophy of the adductor musculature. There is mild to moderate fatty atrophy of the sartorius with mild fatty atrophy of the vastus lateralis, medialis, and intermedius. On fat suppressed T2-weighted images, there is minimal edema type signal within the vastus lateralis and perhaps vastus medialis but this may simply reflect a component of subacute atrophy as opposed to true inflammation. Thee marrow signal of the femur is normal.

Output: Bilateral and symmetrical fatty atrophy of the gluteal and thigh musculature as detailed above.


Instruction: Generate impression based on findings.

Input: Developmental delay and short stature. History of intrauterine growth restriction. No parenchymal structural abnormality is appreciated. Myelination is appropriate for age. No findings to suggest cortical developmental malformation. Gray-white differentiation is preserved. T2/FLAIR-hyperintense signal in the parietal white-matter likely represents zona terminalis, which is within normal limits. The ventricles and the other CSF-containing spaces are normal in size. Midline structures including the corpus callosum as well as posterior fossa structures appear within normal limits.The mastoid air cells and the middle ear cavities are clear. There is partial opacification of the partially pneumatized sinuses which is nonspecific. Calvarium and extra cranial soft tissues are unremarkable.

Output: No brain parenchymal structural abnormalities are appreciated.


Instruction: Generate impression based on findings.

Input: 64 year old with proven right IDC grade 3 and high grade DCIS. MRI (10/13/14) demonstrated extensive non-mass enhancement in the right breast, suggesting extensive DCIS. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There has been significant interval decrease in right breast enhancement. At this point, only a few enhancing foci remain in the right breast. There are a few left breast foci which are stable to slightly less enhancing compared to the prior study. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.A port-a-cath is present in the medial left chest wall superiorly.

Output: Nearly complete response to therapy on MRI since the prior study in October. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 29-year-old woman with history of Rasmussen's encephalitis status post right hemispherectomy at age 7, complicated by hydrocephalus status post drainage and multiple revisions ultimately removed 11/1/2016. These procedures have also been complicated by wound dehiscences. There are extensive postoperative changes of right craniectomy and hemispherectomy, similar to the prior examination. A dominant extra-axial fluid and air collection appears minimally smaller compared to the prior examination (701/22). A second, smaller extra-axial fluid collection along the anterior craniectomy margin (701/23) is stable in size. Multiple left cerebral CSF signal cysts are not appreciably changed in the interval. There is extensive T2 hyperintense signal within the posterior left cerebral white matter, similar in distribution and extent to the prior examination and likely reflect gliosis. Additional foci of T2 hyperintense signal in the left cerebral peduncle and left thalamus appears similar to prior examinations. Volume loss with increased T2 signal in the right posterolateral partially imaged cervical cord also appears unchanged.There is no restricted diffusion to suggest acute ischemia. There is no acute intracranial hemorrhage. No new mass or mass effect.The orbits and paranasal sinuses are unremarkable. The bone marrow signal is unremarkable. The soft tissues overlying the right craniectomy appear intact.

Output: Extensive remote postoperative changes of right craniectomy and hemispherectomy with minimally decreased size of right-sided extra axial air and fluid collection. Otherwise, underlying parenchymal findings are not significant changed from 11/4/2016 including intraparenchymal cysts and extensive surrounding T2/FLAIR hyperintensity in the left cerebral white matter which at least predominantly reflect gliosis, although a small component of vasogenic edema not entirely excluded.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 82 year old female who presents with signs and symptoms of stroke. Rule out CVA. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.Multiple age indeterminate scattered hypodensities are noted in the periventricular white matter bilaterally, which are nonspecific, and may represent small vessel ischemic disease. There is a linear hypodensity at the left basal ganglia extending into the internal capsule. This finding likely represents chronic infarction. However, if acute infarct remains a clinical concern further evaluation with MRI could be considered. Additionally, a foci of encephalomalacia is noted within the left cerebellar hemisphere.The calvaria and skull base are radiographically normal. There is mild mucosal thickening of the right maxillary sinus. These findings likely represent chronic mucosal sinus disease.

Output: 1. There is a linear hypodensity at the left basal ganglia extending into the internal capsule. These findings likely represent chronic infarction. However, if acute infarct remains a clinical concern further evaluation with MRI could be considered. 2. Multiple age indeterminate scattered hypodensities are noted in the periventricular white matter bilaterally which are nonspecific and may represent small vessel ischemic disease. 3. Focus of encephalomalacia within the left cerebellar hemisphere from prior small infarct.4. Right maxillary sinus mucosal disease.


Instruction: Generate impression based on findings.

Input: 59 year old man with history of DM1, CAD referred for stress cardiac MRI to evaluate for ischemia. MEDICATIONS: ASA, Lipitor, Bumex, Eplerenone, labetalol First Pass PerfusionDuring hyperemia, no perfusion defects were present. A prominent dark rim artifact was noted. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 101 ml/m2 (normal range: 74+/-15), the LVEDV is 233 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 65 g/m2, and the LV mass is 150 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 69%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 183 ml (normal range 142+/-31), the RV end systolic volume index is 24 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 65%) without evidence of underlying fibrosis, inflammation, or infiltration. 4. Normal RV size and systolic function (RVEF 69%).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, 21 years old, with relapsed neuroblastoma and lower leg pain and weakness. Diffuse osseous marrow replacing lesions are seen. In addition, bulky dorsal epidural tumor is seen spanning from approximately T5-T8. This produces a severe narrowing of the spinal canal and cord compression most notably at T6. The neural foramina are also likely invaded by this tumor at least at T6-7. Elsewhere, no significant compromise of the spinal canal is seen. Vertebral body heights are preserved. Spinal alignment is anatomic. Mediastinal adenopathy is partially visualized, as is nodularity along the posterior chest wall. There appears to be a left pleural effusion.

Output: 1.Diffuse osseous metastatic disease.2.Bulky dorsal epidural metastatic involvement from T5 through T8 which results in severe spinal canal narrowing and cord compression at T6.


Instruction: Generate impression based on findings.

Input: Evaluate intracranial hemorrhage. Found down, unresponsive. MRI brain: There is stable to slight interval increase in size of a right frontal lobe intraparenchymal hematoma measuring 3.2 x 2.7 cm (AP x TR), previously 3.1 x 2.4 cm, with surrounding edema and mild mass effect. There is a homogeneously enhancing lesion measuring 1.2 x 1.5 x 2.5 cm (AP x TR x CC) at the paramedian right frontal lobe along the cortical surface with questionable associated mineralization hyperostosis on recent CT. This lesion is favored to be extra-axial but possibility of intra-axial location along the cortical surface not entirely excluded. There are foci of susceptibility which may be related to hemorrhage or mineralization.There is restriction diffusion in the right thalamus and the right posterior medial cerebellar hemisphere with corresponding FLAIR hyperintensity.There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with chronic small vessel ischemic changes. No hydrocephalus. There are multiple foci of susceptibility effect within the supratentorial compartment predominantly in a lobar distribution, consistent with hemosiderin deposition from chronic microhemorrhage. Few foci within the left thalamus and bilateral basal ganglia are also noted which may be related to chronic hypertension. There is trace fluid in the right maxillary sinus and nasopharynx. An endotracheal and oroenteric tube are partially imaged. Partial bilateral mastoid air cell opacification also noted.MRA brain: The intracranial internal carotid arteries are normal in course and caliber. No significant stenosis is seen involving the anterior or middle cerebral arteries. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRV brain: MRV images are limited by motion degradation. In combination with the postgadolinium sequences there is no convincing evidence of venous sinus thrombosis. The left transverse sinus appears hypoplastic. Cervical spine: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. There is moderate loss of disc height and disc desiccation throughout the cervical spine. No worrisome focal marrow signal abnormality is appreciated. No definite cord signal abnormality is appreciated. Degenerative changes are seen as described below:C2-C3: Mild posterior disc osteophyte complex. No significant spinal canal or foraminal stenosis.C3-C4: Posterior disc osteophyte complex, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to moderate spinal canal stenosis and moderate left and mild right foraminal stenosis.C4-C5: Posterior disc osteophyte complex, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to moderate spinal canal stenosis and moderate left greater than right foraminal stenosis.C5-C6: Posterior disc osteophyte complex, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to mild to moderate spinal canal stenosis and moderate to severe right and moderate left foraminal stenosis.C6-C7: Posterior disc osteophyte complex with superimposed central disc extrusion with cranial migration of 10 mm, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to moderate spinal canal stenosis and mild left worse than right bilateral foraminal stenosis. There is mass effect on the cord.C7-T1: No significant disc bulge, spinal canal or foraminal stenosis. Disc extrusion is also seen at the T1-T2 level on the sagittal sequences with effacement of the ventral thecal sac.

Output: 1. There is stable to slight interval increase in size of a right frontal lobe hematoma measuring up to 3.2 cm with surrounding edema and mild local mass effect. No associated enhancement is definitively appreciated.2. There is a 2.5 cm homogeneously enhancing lesion along the paramedian right frontal lobe which may represent an extra-axial enhancing lesion such as meningioma. However, the possibility that this is a enhancing intra-axial lesion at the cortical surface cannot be entirely excluded. There is associated susceptibility effect which may be related to mineralization versus chronic blood products. Motion degraded postcontrast sequences do not demonstrate additional enhancing masses within the brain. If clinically warranted, the postgadolinium sequences may be repeated with perhaps inclusion of a 3-D T2 sequence to better delineate if this mass is extra-axial or intra-axial in location.3.Multiple foci of susceptibility effect consistent with chronic microhemorrhages involving the bilateral cerebral hemisphere. These are predominantly in the lobar distribution favoring amyloid angiopathy. This may be the etiology of the right frontal lobe hemorrhage. 4. Restriction diffusion in the right thalamus as well as the right posterior medial right cerebellar hemisphere with corresponding FLAIR hyperintensity favored to represent acute to subacute infarcts. There is also evidence of moderate chronic small vessel ischemic disease.5. No evidence of intracranial aneurysm or flow-limiting limiting stenosis. No definite evidence of venous sinus thrombosis.6. Advanced degenerative changes of the cervical spine with moderate spinal canal stenosis and mild cord deformity at C3-4, C4-C5, and C6-C7. No definite cord signal abnormality is appreciated.  I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 35 years old, with bacteremia and neurologic changes, concern for septic emboli. No restricted diffusion is seen. Areas of encephalomalacia are present within the right frontal and right parietal lobes. Elsewhere, the morphology and signal characteristics of the brain are within normal limits. No pathologic intracranial enhancement is detected. There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology.

Output: 1.Chronic infarcts of the right frontal and right parietal lobe.2.Otherwise, the examination is unremarkable. There are no specific findings to indicate acute embolic or septic embolic disease.


Instruction: Generate impression based on findings.

Input: 30-year-old pregnant (31 weeks and 5 days) female who presents with nausea, vomiting and right-sided tenderness. Evaluate for appendicitis. LUNG BASES: Partially visualized bilaterally basilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral mild hydroureteronephrosis, likely related to mass effect from intrauterine pregnancy.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.PELVIS:UTERUS, ADNEXA: Intrauterine pregnancy is noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is not well visualized; however, no discrete evidence of inflammatory changes in the right mid/lower quadrant to suggest appendicitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Although, the appendix is not well-visualized, no discrete evidence of inflammatory changes to suggest appendicitis.2.Intrauterine pregnancy.3.Mild bilateral hydroureteronephrosis likely related to mass effect from intrauterine pregnancy.


Instruction: Generate impression based on findings.

Input: 81 year old female with history of paroxysmal atrial fibrillation, carotid atherosclerosis, essential hypertension, coronary artery disease and mitral regurgitation presenting for evaluation of possible cardiac amyloid. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 53 ml/m2 (normal range: 65+/-11), the LVEDV is 83 ml (normal range 109+/-23), the LV end systolic volume index is 18 ml/m2 (normal range 18+/-5), the LVESV is 28 ml (normal range 31+/-10), the LV mass index is 31 g/m2 (normal range 67+/-11), and the LV mass is 48 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely enlarged.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 75 ml/m2 (normal range 69+/-14), the RVEDV is 118 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 58 ml (normal range 35+/-13). Right AtriumThe right atrium is severely enlarged. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. There is aortic valve calcification. Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation. There is mitral valve calcification.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 66%2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%3. Severe biatrial enlargement4. Severe tricuspid regurgitation, at least moderate mitral regurgitation. 5. No evidence of amyloid. 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, 10 years old, left-handed, with drug resistant epilepsy, planning for epilepsy surgery. Functional MRI requested for localization of speech, vision and motor areas. As discussed above, excessive motion artifact renders the finger tapping paradigm unreliable. Sensorimotor cortical activation of the foot and face, however, is well visualized and maps as expected along the pre- and post-central gyri. The passive visual stimulation paradigm produces robust cortical activation within the bilateral occipital lobes at the level of the calcarine sulci.Of the tested language paradigms, only one of the sentence completion exercises and two verb generation exercises produce reliable language related cortical activation. The cleanest language related cortical activation is seen with the sentence completion paradigm, where language related cortical activation is seen bilaterally. Broca's area activation is noted within the inferior frontal lobe (primarily pars opercularis and pars triangularis), and Wernicke's area activation is seen within the posterior superior temporal gyri. On the verb generation paradigms, Broca's area activity is again seen though with a slight predominance on the right. Wernicke's area activation is seen bilaterally but without a consistent hemispheric dominance. Of note, on each of the language paradigms, there is bilateral activation along the lower aspect of the precentral gyrus which likely reflects facial motion during the paradigm.

Output: Motion degradation prevents accurate demonstration of the hand sensorimotor cortical area. However, sensorimotor cortical activation of the foot and face maps as expected along the pre and post-central gyri. Visual stimulation likewise produces cortical activation in the expected location of the bilateral occipital lobes.Language related cortical activation is reliably visualized on only three of the numerous paradigm attempts. Broca's area is evident within the inferior frontal gyrus, and Wernicke's area is seen within the posterior superior temporal gyrus, each in their customary locations. Broca's area activation is seen bilaterally, with a slight right-sided predominance on two of the paradigms. Wernicke's area activation is also bilateral, but not consistently right or left dominant. Overall findings suggest that language function is shared between the hemispheres, with perhaps a slight right-sided predominance during certain language tasks.


Instruction: Generate impression based on findings.

Input: Pseudotumor cerebri. Recent visual changes. Evaluate for mass or stroke. There is interval removal of the right transfrontal shunt catheter. The left lateral ventricle has slightly re-expanded, while the right lateral, third and fourth ventricles are otherwise unchanged. There is persistent linear T2 hyperintensity along the prior right transfrontal lobe catheter tract and associated focal thinning involving the anterior body of the corpus callosum. A non-enhancing focus of high T2 signal and apparent mild volume loss in the posterior right temporal lobe is unchanged. The pituitary gland appears to be slightly re-expanded. There is no midline shift or herniation. There is no acute intracranial hemorrhage. There is mild unchanged enlargement of the Meckel's caves and the arachnoid granulations in the right transverse/sigmoid sinuses. There is a extra-axial, dural-based, left frontal convexity enhancing lesion that measures 4 mm in width.

Output: 1.There is no intracranial mass. In contrast enhancing right frontal signal abnormality related to previous shunt catheter is improved while the nonspecific T2 hyperintensity in the right temporal lobe is unchanged.2.Interval removal of the right transfrontal shunt catheter, such that the left lateral ventricle has slightly re-expanded, while the right lateral, third and fourth ventricles are otherwise unchanged. 3.A subcentimeter extra-axial left frontal convexity mass likely represents a meningioma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 52-year-old male patient with right knee pain status post fall. Evaluate for lateral meniscus tear. MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There are bone contusions in the weightbearing portion of the lateral femoral condyle and the posterior aspect of the lateral tibial plateau. There is mild compression of the surface of the lateral femoral condyle overlying the contusion, compatible with a lateral notch sign. There are also nonspecific reactive marrow changes along the medial aspect of the medial femoral trochlea.There is partial thickness chondral fissuring in the apex of the patella.LIGAMENTS: There is at least a partial tear of the anterior cruciate ligament. Posterior cruciate ligament, medial collateral ligament, lateral collateral ligament complex, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: At least partial anterior cruciate ligament tearing with characteristic bone contusions involving the lateral femoral condyle and posterior aspect of the lateral tibial plateau.


Instruction: Generate impression based on findings.

Input: 60 year-old male with atrial fibrillation and obstructive sleep apnea found to have new pulmonary hypertension. Right heart cath revealed ASD with Qp:Qs 1.55. CMR ordered to further evaluate. Patient polish-speaking. Did not speak any English. Translator present but patient frequently not able to follow commands. Patient had a significant amount of difficulty holding his breath during the study and especially during the short axis sequences and axial stack. LV and RV volumes are estimates at best. Endocardial borders were difficult to delineate with accuracy. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 44%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 195 ml (normal range 142+/-34), the LV end systolic volume index is 49 ml/m2 (normal range 25+/-9), the LVESV is 110 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. Poor quality late gadolinium enhancement images due to inability to follow breathing instructions.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with moderately reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 264 ml/m2 (normal range 82+/-16), the RVEDV is 587 ml (normal range 142+/-31), the RV end systolic volume index is 183 ml/m2 (normal range 31+/-9), and the RVESV is 406 ml (normal range 54+/-17). Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is at least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely. Unable to assess degree of mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThe aortic root measured 39 mm in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated. The main PA size is 50 mm, the right PA size is 32 mm, and the left PA size is 38 mm.Venous AnatomyThe SVC and IVC drain normally into the right atrium. ShuntsThere is a large secundum ASD present measuring ~30 mm in the 4-chamber view with evidence of both right to left and left to right shunting. Qp:Qs could not be calculated as the software for calculation was not functional. Images were suboptimal for rim assessment.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. Technically challenging study due to language barrier and patient difficulty with breath-holds2. The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 44%. Largely non-diagnostic late gadolinium images.3. The right ventricle is severely dilated with moderately reduced systolic function. The overall RV ejection fraction is 31%4. There is a large secundum ASD present measuring ~30 mm in the 4-chamber view with evidence of both right to left and left to right shunting. 5. At least moderate tricuspid regurgitation


Instruction: Generate impression based on findings.

Input: Left optic neuritis with scotoma. Orbits: The globes and optic nerves appears unremarkable. The ocular adnexa are intact. There is no evidence of mass lesions or abnormal intraorbital enhancement.Brain: There is a T2 hyperintense enhancing lesion in the right pituitary lobe that measures up to 6 mm. There is also a non-enhancing focus in the right lateral pituitary lobe that measures up to 4 mm. There is no mass effect upon the optic apparatus. There is no evidence of intracranial hemorrhage or acute infarct. There are a few punctate foci of T2 hyperintensity in the cerebral white matter, without associated 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, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1. An enhancing lesion in the right pituitary lobe that measures up to 6 mm may represent a microadenoma. A non-enhancing focus in the right lateral pituitary lobe that measures up to 4 mm may represent a cystic microadenoma.2. A few punctate foci of T2 hyperintensity in the cerebral white matter are nonspecific.3. The orbits are unremarkable.Discussed with Dr. Reder at 8:40 AM on 1/9/15.


Instruction: Generate impression based on findings.

Input: Invasive squamous cell carcinoma of the supraciliary ridge with chemoradiation treatment started recently. There are post-treatment findings in the left supraciliary region. There is a persistent infiltrative enhancing lesion in the left supra-orbital subcutaneous tissues with extension into the left orbital roof, traversing the frontal bone along the lateral aspect of the left frontal sinus with slight epidural extension and extraconal left orbital extension. Overall, the lesion appears to have decreased in size, measuring up to 15 mm, previously 20 mm. The right orbit is unremarkable. There is a subcentimeter left maxillary sinus retention cyst.

Output: Interval decrease in size of the squamous cell carcinoma centered in the left supraciliary ridge region.


Instruction: Generate impression based on findings.

Input: 54 year old male with EKG with ST elevations, normal coronary arteries on recent coronary angiogram, concern for myocarditis. Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 55%. The LVEDV is 206.8 ml (normal range 142+/-34), the LV end diastolic volume index is 86.8 ml/m2 (normal range: 74+/-15), the LVESV is 94 ml (normal range 47+/-19) and the LV end systolic volume index is 39.4 ml/m2 (normal range 25+/-9). The LV mass is 177 g (normal range 164+/-36) and the LV mass index is 74.3 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time not obtainable as image sequences for measurement are not present due to MRI software issues. Left AtriumThe left atrium is normal in size. Right VentricleRV function is qualitatively normal. However,the right ventricle is normal in size with mildly reduced function quantitatively. The overall RV ejection fraction is 30%. The RVEDV is 209 ml (normal range 142+/-31), RV end diastolic volume index is 87.7 ml/m2 (normal range 82+/-16), the RVESV is 146.6 ml (normal range 54+/-17), and the RV end systolic volume index is 61.5 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely; mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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. Normal left ventricular systolic function at 55%.2. Qualitatively normal RV ejection fraction. Quantitatively, right ventricular ejection fraction is mildly reduced.3. No late gadolinium enhancement noted in myocardium. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 22 year-old female with elevated INR and dilated pupils. Evaluate for brain hemorrhage, status post cardiac arrest. Focal hypodensity in the right cerebellar hemisphere is of unclear etiology. There is no evidence of intracranial hemorrhage, mass, or midline shift. Gray-white differentiation is preserved. The ventricles and basal cisterns are normal in size and configuration.The skull and other osseous structures are diffusely thickened and heterogeneous in appearance, which was noted on 2009 MRI. Maxillary sinuses, sphenoid sinuses, ethmoid air cells, and mastoid air cells are opacified bilaterally. Stranding in the soft tissues of the face is consistent with anasarca. Linear calcifications scattered throughout the scalp likely represent vascular calcifications.ET tube is noted.

Output: 1.No evidence of intracranial hemorrhage, hydrocephalus, mass effect or edema.2.Bilateral paranasal sinus and mastoid air cell opacification.3.Focal hypodensity in the right cerebellum is of unclear etiology or significance; MRI is recommended for further characterization if clinically indicated.4.Diffuse thickening and heterogeneity of osseous structures is nonspecific but may be related to systemic process such as renal osteodystrophy, hyperparathyroidism, or chronic severe anemia.


Instruction: Generate impression based on findings.

Input: Female 54 years old Reason: stage IV uveal melanoma s/p hepatic embo/RFA History: assess for disease status ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Segment 6 lesion with peripheral discontinuous enhancement and progressive fill in is unchanged in size measuring 1.9 x 1.1 cmThere is hyperenhancement of the medial aspect of the caudate lesion possibly reflecting post therapy changes.There are 2 subtle subcentimeter lesions in segment 4A and B suspicious a small new metastatic deposits.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.2 new subcentimeter lesions in segment 4 of the liver suspicious for small new metastatic foci.2.Post therapy changes in the caudate.


Instruction: Generate impression based on findings.

Input: VHL with presumed hemangioblastomas. There is a subcentimeter enhancing lesion in the left superior cerebellar hemisphere. There is no evidence of enhancing mass lesions within the spine. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There are postoperative findings related to C5-6 anterior fusion, with possible narrowing of the right neural foramen due to uncovertebral hypertrophy, although assessment is limited by the metal artifact. There is no evidence of significant spinal canal or neural foraminal stenosis in the cervical spine. Aside from the postoperative findings in the cervical spine and a few scattered areas of focal fat, the vertebral bone marrow signal is unremarkable. There are prominent areas of ligamentum flavum thickening in the right upper thoracic spine and small posterior disc-osteophyte complexes in the mid thoracic spine, but no associated significant spinal canal stenosis. There is a small disc bulge at L4-5 with annular fissuring and a slight disc bulge at L3-4, but no significant spinal canal or neural foraminal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a subcentimeter left renal cyst and a partially imaged right renal lesion.

Output: 1. A subcentimeter enhancing lesion in the left superior cerebellar hemisphere is compatible with a hemangioblastoma in the setting of VHL syndrome. Please refer to the prior brain MRI for additional details.2. No evidence of hemangioblastomas in the spine.3. Postoperative findings related to C5-6 anterior fusion, with possible narrowing of the right neural foramen due to uncovertebral hypertrophy, although assessment is limited by the metal artifact.4. Mild degenerative spondylosis at multiple levels of the thoracic and lumbar spine without significant spinal canal stenosis.5. Subcentimeter left renal cyst and a partially imaged right renal lesion. Please refer to the prior body MRI for additional details.