Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There is a complete tear of the supraspinatus tendon with approximately 2 cm of retraction. This is superimposed upon thickening and increased signal of the retracted tendon indicating tendinosis. The tearing extends posteriorly to include much of the infraspinatus tendon which also shows moderate to severe tendinosis. There is additional tearing of the infraspinatus tendon at the myotendinous junction more posteriorly. There is mild fatty atrophy of the supraspinatus and infraspinatus muscles. The teres minor muscle and tendon are normal. There is moderate tendinosis of the subscapularis with mild interstitial and perhaps undersurface tearing of the tendon. There is mild atrophy of the superior portions of the subscapularis muscle.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint. A small amount of fluid is present within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild osteoarthritis of the glenohumeral joint. Attenuation of the glenoid labrum is likely secondary to age-related degeneration.BICEPS TENDON: Evaluation of the intra-articular portion of the long head biceps tendon is limited given the internal rotation of the arm. The extra-articular portion of the biceps tendon appears small but otherwise intact.

Output: Rotator cuff tear with additional findings described above.


Instruction: Generate impression based on findings.

Input: 37 years Male (DOB:9/16/1979)Reason: stroke protocol History: as abovePROVIDER/ATTENDING NAME: TERESITA M HOGAN TERESITA M HOGAN There is a large volume of diffusion restriction involving the all the right basal ganglia, the entire right insular cortex, almost all the right frontal lobe and small portions of the right parietal and temporal lobe.

Output: 1.Large acute ischemic cerebral infarction involving ACA and MCA territories as described above. Endovascular intervention is not indicated here.2.Findings were discussed with Dr Ardelt at the time the exam was obtained.


Instruction: Generate impression based on findings.

Input: Hearing loss. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is an expected degree of myelination. There is persistent mild prominence of the lateral ventricles. The cerebral aqueduct is patent. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is mild plagiocephaly.Internal auditory canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is small amount of fluid signal in the bilateral mastoid air cells and middle ears.

Output: 1. A small amount of fluid signal in the bilateral mastoid air cells and middle ears is nonspecific.2. No gross inner ear abnormalities.3. Persistent mild ventriculomegaly.4. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is moderate loss of disc height at L3-L4 and mild loss of disc height at L4-L5. The vertebral bone marrow signal is heterogeneous. There is a Schmorl's node at L5. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is a small Tarlov cyst at the S3 level incidentally noted. The paravertebral soft tissues are unremarkable.L1-L2: Mild facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis.L2-L3: Disc bulge, thickening of the ligamentum flavum and mild bilateral facet arthropathy. No significant spinal canal or foraminal stenosis. L3-L4: Disc bulge eccentric to the left and extending into the neural foramen as well as effacing the left lateral recess. There is also thickening of the ligamentum flavum and mild bilateral facet arthropathy, contributing to mild spinal canal stenosis and moderate left foraminal stenosis. L4-L5: Mild disc bulge eccentric to the right. There is also thickening of the ligamentum flavum and mild bilateral facet arthropathy, contributing to mild spinal canal and mild right foraminal stenosis. L5-S1: No significant disc bulge, spinal canal or foraminal stenosis.

Output: 1. Degenerative changes of the lumbar spine, most severe at L3-L4, with disc bulge eccentric to the left extending into the neural foramen and effacing the left lateral recess with thickening of the ligamentum flavum and mild bilateral facet arthropathy. There is resulting mild spinal canal stenosis and moderate left foraminal stenosis. 2. At L4-L5, there is mild disc bulge eccentric to the right with thickening of the ligamentum flavum and mild bilateral facet arthropathy, contributing to mild spinal canal and mild right foraminal stenosis at this level.


Instruction: Generate impression based on findings.

Input: 63-year-old female with rectal gist status post radiation and Gleevec There is MRI artifact limiting evaluation.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: None.Lymph nodes outside the mesorectal fascia: 11 mm right external iliac lymph node slightly increased in size compared to the prior exam.BOWEL, MESENTERY: Circumferential thickening of the sigmoid and rectal wall may be related to postradiation changes.Rectal Tumor:Size: 2.4 x 2.2 x 3.3 cm (image 40/series 8) previously the tumor measured 4.6 x 3.8 x 5.3 cm there is also decreased enhancement.Tumor appearance on T2-weighted images: T2 hyperintenseTumor location: Right lower rectal wall with intraluminal extension.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 2.0 cm.Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Abuts the right levator ani muscle.Circumference of the rectum involved: Approximately 270 degrees along the right lateral wall and posterior wall.Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): Not involved. Tumor Distance to Mesorectal Fascia: Minimal invasion of the right medial rectal fascia (image 42/series 8).BONES, SOFT TISSUES: Probable left S3 perineural cyst.OTHER: No significant abnormality noted.

Output: 1.Decrease in the size of the rectal mass with decreased enhancement.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, 72 years old, with weakness and gait problems. Brain:Since the prior examination, foci of restricted diffusion within the left thalamus and right pons have resolved. However, there is a new 6 mm focus of restricted diffusion along the right postcentral sulcus.Extensive patchy periventricular and subcortical T2 hyperintensity is seen, appearing similar to prior. Also noted are numerous scattered lacunar infarcts involving the basal ganglia, midbrain and pons. Numerous small cortical strokes are also seen in the cerebellum. Overall, these findings have not substantially changed from prior.Numerous scattered small foci of stability are seen relating to the areas of prior ischemic injury. No evidence of acute intracranial hemorrhage is seen. No abnormal extra axial fluid collections are detected. The ventricles remain normal in size and morphology.C-spine:Please note that most sequences are degraded by motion artifact, and in particular, the axial sequences are of poor quality and offer little diagnostic information. T2 axial images were not acquired as the patient requested to terminate the exam.The cervical lordosis is straightened but alignment is otherwise unremarkable. Vertebral body morphology is normal. No concerning marrow replacement or marrow edema is seen.The spinal cord shows normal signal intensity and morphology, as assessed on sagittal images only.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Right foraminal/subarticular disk osteophyte complex. Mild right neuroforaminal narrowing. Otherwise unremarkable.C5-6: Unremarkable. C6-7: Unremarkable. C7-T1: Unremarkable.

Output: 1. A new small focus of acute ischemia is seen along the right postcentral sulcus.2. Evidence of extensive chronic microvascular and lacunar ischemia in the brain.3. Limited evaluation of the cervical spine but without obvious findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Tinnitus since February. Normal audiogram. Normal ENT evaluation. Normal neurological exams. Perhaps increased dizziness with exercise. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, mastoid air cells, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. If symptoms persist, perhaps dedicated temporal bone imaging may be useful, including associated vascular imaging.


Instruction: Generate impression based on findings.

Input: 29-year-old woman with history of diarrhea, weight loss, and abdominal pain. Please assess for small bowel enteritis or Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: There is a T2 hyperintense, nodular enhancing 15 mm lesion in segment 8 (14/16), otherwise the liver is normal in signal and morphology. The gallbladder is normal and there is no intra or extrahepatic biliary ductal dilatation. The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The bowel appears normal without evidence of wall thickening or abnormal enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral breast implants noted.

Output: 1.No evidence of small bowel inflammation to suggest enteritis.2.Hemangioma in the liver.


Instruction: Generate impression based on findings.

Input: 63-year-old male. History of pancreas mass. Please evaluate for changes and/or abnormalities. ABDOMEN:LIVER, BILIARY TRACT: Scattered hepatic cysts, unchanged. Hepatic steatosis. Multiple arterially enhancing small foci throughout the liver that become isointense on later phases are likely perfusion abnormalities. No suspicious hepatic mass.SPLEEN: No significant abnormality noted.PANCREAS: Nonenhancing pancreatic tail cystic lesion in the distal body of the pancreas measures 2.5 x 2.2 cm (series 1101, image 40, previously 2.5 x 2.4 cm. Thin septation in this lesion is unchanged. It communicates with the pancreatic duct consistent with a sidebranch IPMN. No main pancreatic ductal dilatation or pancreatic atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, including a mildly complex cyst in the right upper pole with thin septations, unchanged.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: Unchanged 2.5 cm cystic lesion in the distal pancreatic body consistent with a sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: History of perianal fistula. Evaluate for evidence of Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: The liver dome is not included in the field of view. The visualized portions of the liver are normal without focal lesion biliary ductal dilatation or vascular abnormality. Normally distended gallbladder without cholelithiasis.SPLEEN: Normal splenic size and morphology without focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Partially duplicated right renal collecting system with fusion of the ureters at the mid abdomen. No hydronephrosis. No focal suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is well-distended with oral contrast. There is no wall thickening, abnormal enhancement or adjacent inflammatory changes. The terminal ileum is well seen and is normal in appearance. No fluid collections. No focal persistent stricture is evident. Portions of the colon are underdistended limiting evaluation for bowel wall thickening which is not suspected. No abnormal postcontrast enhancement of the colonic wall.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postcontrast images were not performed of the perineal soft tissues limiting evaluation. There is a fistulous tract extending from approximately the 12:00 location of the anal canal which progresses inferiorly and extends to the left gluteal cleft. No associated fluid collection. No evidence of extension through the outer sphincter.OTHER: No significant abnormality noted.

Output: 1.No specific evidence of inflammatory bowel disease.2.Perianal intersphincteric fistula extending from the 12:00 location of the anal canal without an associated fluid collection.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: eval for cauda equina History: L spine tenderness, difficulty ambulating, incontinence For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Vertebral bone marrow signal on T1-weighted images show diffuse low signal intensity. At this age group, this diffuse low signal intensity on T1 weighted image indicate possible normal fatty marrow replacement such as chronic anemia, diffuse metastasis or other chronic illness, thus clinical correlation is indicated.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: Diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L3-L4: Diffuse bulging of disc which abuts thecal sac, no neuroforaminal narrowing or spinal stenosis. L4-L5: Broad-based disc bulging towards left side neural foramen results mild left neuroforaminal stenosis. Focal enhancement of L4 inferior endplates may indicate possibility of focal end plate fracture, disc protrusion or focal Schmorl's node. CT scan can be considered for further imaging evaluation.L5-S1: The left side L5S1 facet joint shows bulky nature with linear and somewhat nodular signal voids indicate possible osteophytes formation likely due to localized facet arthritis which results left lateral recess stenosis associated with broad based disc bulge. Prominent epidural fat are seen at the level of L45 and L5S1 with mild to moderate spinal canal narrowing indicating epidural lipomatosis.

Output: 1. Diffuse decrease in bone marrow signal intensity on T1 weighted image may suggest associated systemic lesion such as chronic anemia, diffuse metastatic disease, or other bone marrow replacing lesions. Clinical correlation is recommended.2. Left side neuroforaminal stenosis as well as spinal canal narrowing likely due to epidural lipomatosis at the level of L45 and L5S1.3. Possible disc herniation or L4 inferior endplate fracture as well as possible left L5S1 facet hypertrophy, lumbar spine CT scan can be considered for further imaging evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: History of sclerosing cholangitis. Evaluate for gallbladder carcinoma or cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Mildly cirrhotic liver morphology.Multifocal bilobar left greater than right strictures are again noted with focal stricture and irregularity of the proximal common bile duct appearing similar to the prior study.Scattered filling defects in the intrahepatic bile ducts likely represent hepatolithiasis.No dominant stricture or discrete mass is evident.Heterogenous T2 signal near the porta hepatis with restricted diffusion but no definite delayed enhancement - this is stable from 2010, and likely fibrotic change vs periportal lymph node, as it has been measured on prior exams. The measurement is below.SPLEEN: No significant abnormality noted.PANCREAS: Linear cystic lesion in the pancreatic tail communicates with the main pancreatic duct and is unchanged, compatible with a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable periportal lymphadenopathy. The reference lymph node measures approximately 2.0 x 1.4 cm (series 3/18).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multifocal intrahepatic and extrahepatic biliary strictures appearing similar to the prior without a new dominant stricture or focal lesion.2.Stable subcentimeter IPMN in the pancreatic tail without suspicious features.3.Stable periportal lymphadenopathy/fibrotic change near the porta hepatis as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 40 year old with newly diagnosed right breast high grade IDC with DCIS presents for breast MRI There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the right breast, there is a regional non-mass enhancement measuring 34 x 24 x 17 mm (AP x LR x CC) at the central aspect, consistent with biopsy proven malignancy. Biopsy changes are present at the anterior and posterior aspects of the non-mass enhancement.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Non-mass enhancement at the central aspect of right breast, corresponding to the biopsy proven malignancy2. No MRI evidence of malignancy in the left breast or either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: There is a punctate focus of restricted diffusion within the left periatrial white matter. There is no evidence of intracranial hemorrhage. There are no additional areas of abnormal parenchymal signal. 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 midline structures and craniocervical junction are within normal limits. There is a 9 mm thick caput succedaneum over the vertex.

Output: Punctate focus of diffusion restriction within the left periatrial white matter without susceptibility, consistent with a small area of recent ischemic change. Otherwise unremarkable MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: cervical radiculopathy to explain neck pain and posterior headacheSigns and Symptoms: headache, neck painComments: 77 yo male with severe neck pain and posterior headache, although with DJD of thoracic, lumbar spine | The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is reversal of the normal cervical curvature present. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. Small uncovertebral osteophytes are present at this level.At C4-5 there is no significant compromise to the spinal canal. There is loss of disc space height at this level. There are endplate and uncovertebral osteophytes present at this level associated with encroachment of the exiting nerve roots within the neural foramina bilaterally. There are large anterior osteophytes present at this level.At C5-6 there is is loss of disc space height at this level. There are endplate and uncovertebral osteophytes present at this level associated with encroachment of the exiting nerve roots within the neural foramina bilaterally. There is ligamentum flavum hypertrophy present at this level There is effacement of spinal fluid ventral and posterior the spinal cord at this level with partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild to moderate degree of spinal stenosis at this level. There are large anterior osteophytes present at this level.At C6-7 there is no significant compromise to the spinal canal. There is loss of disc space height at this level. There are endplate and uncovertebral osteophytes present at this level associated with encroachment of the exiting nerve roots within the neural foramina bilaterally. At C7-T1 there is no significant compromise to the spinal canal. There is loss of disc space height at this level. There are endplate and uncovertebral osteophytes present at this level associated with mild encroachment of the exiting nerve roots within the neural foramina bilaterally. The vertebral artery flow voids appear to be intact.

Output: 1.There are are degenerative changes present in the cervical spine with multilevel encroachment of exiting nerve roots bilaterally at C4-5, C5-6 and C6-7 and mild to moderate spinal stenosis present at C5-6.


Instruction: Generate impression based on findings.

Input: History of cholecystectomy with increasing CBD dilation to 1.4 cm, nonspecific abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver enhances homogeneously. No focal hepatic lesion is identified. Patient is status post cholecystectomy. There is extrahepatic biliary ductal dilatation, with the common duct measuring up to 15 mm in diameter. Minimal central intrahepatic ductal dilatation is seen. No choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is atrophic. No pancreatic ductal dilatation is identified. No suspicious pancreatic lesion is identified.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: No focal renal lesion.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Large colonic stool burden. Correlate for history of constipation.BONES, SOFT TISSUES: Partially imaged posterior spinal stabilization of the lower lumbar spine. There is lateral listhesis of the lumbar vertebra superior to the orthopedic hardware.OTHER: No significant abnormality noted.

Output: Extra hepatic biliary ductal dilatation likely attributable to cholecystectomy in absence of other identifiable cause. No pancreatic head lesion or choledocholithiasis.


Instruction: Generate impression based on findings.

Input: Aphasia. Brain MRI: There is no evidence of intracranial hemorrhage or acute infarct. There is moderate patchy cerebral white matter T2 hyperintensity. There is a subcentimeter lesion within the right internal auditory canal. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere, which may represent a chronic microhemorrhage. There is diffuse prominence of the sulci and ventricles due to cerebral volume loss. There is cavum septum pellucidum and vergae, which represents an anatomic variant. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions or retention cyst formation in the right maxillary sinus. Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There is a two vessel aortic arch, in which the left common carotid artery arises from the brachiocephalic trunk, which is an anatomic variant. The ascending aorta appears to be enlarged, measuring at least 4.5 cm in width. There is no evidence of significant steno-occlusive lesions in the neck.

Output: 1. Probable chronic small vessel ischemic disease and diffuse cerebral volume loss, but no evidence of acute intracranial hemorrhage or acute infarct.2. An incompletely characterized subcentimeter right internal auditory canal lesion may represent a schwannoma.3. No evidence of significant steno-occlusive arterial lesions in the head or neck.4. The ascending aorta appears to be enlarged, measuring at least 4.5 cm in width.


Instruction: Generate impression based on findings.

Input: Female 49 years old with biliary colic. Evaluate for choledocholithiasis. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 20 cm in length. Small stones are present within the gallbladder. There is a filling defect within distal common bile duct compatible with an impacted stone. No intra or extrahepatic biliary ductal dilatation.There is a 1.0 x 0.6 cm segment 7 lesion which is bright on T2 with peripheral, nodular discontinuous enhancement consistent with hemangioma. SPLEEN: Splenomegaly.PANCREAS: The pancreas enhances homogeneously. The pancreatic duct is mildly dilated near the ampulla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant ostomy is noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Choledocholithiasis with no significant biliary ductal dilatation. The distal pancreatic duct is mildly dilated near the ampulla.Findings discussed with Dr. Anyane-Yeboa by phone at 11:22 on 11/28/2016.


Instruction: Generate impression based on findings.

Input: Anterior knee pain for 2 years, evaluate for patellar cartilage MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Mild thinning of the medial aspect of the patellar cartilage. No focal defect.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: Mild thickening and increased signal in the patellar tendon suggestive of tendinopathy.ADDITIONAL

Output: Mild thinning of the medial aspect of the patella cartilage without focal defect. Mild patellar tendinopathy.


Instruction: Generate impression based on findings.

Input: Reason: abnormality History: spinal stenosis with radiculopathy Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level. There is right-sided facet hypertrophy with narrowing of the right neural foramen at this level.At C3-4 there is a diffuse disk bulge present There are endplate and uncovertebral osteophytes present associated with loss of disk space height, disk desiccation and endplate reactive changes. There is effacement of spinal fluid ventral and to a lesser degree posterior to the spinal cord creating a mild/moderate degree of spondylostenosis. There is narrowing of the neural foramina right worse than left with encroachment of right-sided exiting nerve roots at this level.At C4-5 there is no significant compromise to the spinal canal. There is loss of disk space height, disk desiccation and uncovertebral osteophytes at this level associated with encroachment of the left-sided exiting nerve roots in the neural foramenAt C5-6 there is a diffuse disk bulge present There are endplate and uncovertebral osteophytes present associated with loss of disk space height, disk desiccation and endplate reactive changes. There is effacement of spinal fluid ventral and to a lesser degree posterior to the spinal cord with a mild degree of spondylostenosis. There is narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots bilaterally at this level and a mild to moderate encroachment of the exiting nerve roots.At C6-7 there is disk desiccation and diffuse disk bulge associated with uncovertebral osteophytes and encroachment of the exiting nerve roots bilaterally.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal. There is loss of disk space height, disk desiccation, diffuse disk bulge and some endplate reactive change at this level. There is narrowing of the neural foramina as a result of disk bulge with encroachment of the exiting nerve roots within the neural foramina bilaterally. There is also some partial effacement of the fat at the left lateral recess with some mild encroachment of the nerve roots of the left lateral recess at this level .At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, disk desiccation and diffuse disk bulge at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild disk desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes in the cervical spine with mild to moderate spinal stenosis at C3-4 and neural foramina encroachment of exiting nerve roots bilaterally at C5-6 and C6-7 , the left side at C4-5 and on the right side at C3-4.2.There are degenerative changes present in the lower lumbar spine with some encroachment of the exiting nerve roots bilaterally at L5-S1


Instruction: Generate impression based on findings.

Input: The patient is a 44-year-old male who presents for a pulmonary vein CT prior to planned atrial fibrillation ablation by catheter-based pulmonary vein isolation. The quality of the study is suboptimal. There is a relatively low contrast opacification of the left atrium pulmonary veins. Within the limits of this study the pulmonary vein dimensions are as follows:Left superior pulmonary vein: 19.3 x 12.8mmleft inferior pulmonary vein 11.4 x 20.1 mmright superior pulmonary vein 26.6 x 17.2 mmright inferior pulmonary vein 19.5 x 15.6 mmLeft atrial volume 123 cc

Output: 1. Increased left atrial volume. 2. Mildly enlarged pulmonary vein diameter. 3. Poor opacification of the left atrium and pulmonary veins.Interpretation of the lungs and other soft tissues of the thorax and upper abdomen will be included in the radiologist report.


Instruction: Generate impression based on findings.

Input: Back pain. Postoperative changes of a posterior laminectomy at L4 and L5.L1-2: Disk disease with posterior disk bulge. Bilateral facet hypertrophy. No significant central canal stenosis. L2-3: Posterior disk bulge, bilateral facet hypertrophy and thickening of the ligamentum flavum with mild narrowing of the spinal canal. Bilateral neuroforaminal narrowing. L3-4: Grade 1 retrolisthesis of L3 on L4. Degenerative disk disease is present. There are severe endplate changes and multiples lytic foci, very suspicious for a diskitis/osteomyelitis or metastatic disease. There is extensive soft tissue abnormality in the spinal canal and in paravertebral region, with involvement of neuroforamina. There is likely impingement of nerve roots within the spinal canal and right neuroforamen. Please correlate with a dedicated MRI of the lumbar spine.L4-5: Grade 1 retrolisthesis of L4 on L5 with degenerative disk disease including loss of disk height and posterior disk bulge / herniation. There is bilateral spinal canal and neuroforaminal narrowing, and likely nerve impingement.L5-S1: Grade 1 retrolisthesis of L5 on S1 with posterior disk bulge and bilateral neural foramen narrowing. There is extensive soft tissue abnormality in the spinal canal and neuroforamina, probably causing encasement or impingement of nerve roots.A small sclerotic lesion is seen in the left ilium. This likely represents an enostosis, but blastic bone metastasis can have similar appearance.

Output: 1.Degenerative disease of the lumbar spine as described above. Postoperative changes of posterior laminectomy extending at L4 and L5 level.2.There is extensive L3-L4 disk disease and endplate destruction with multiple lytic lesions, and extensive soft tissue abnormality within the spinal canal, neuroforamina and paravertebral region, very suspicious for discitis/osteomyelitis versus metastatic disease.3.Spinal canal and neuroforaminal narrowing at multiple levels.4.Small sclerotic lesion in the left ilium. This likely represents an enostosis, but blastic bone metastasis can have similar appearance.5.Findings were discussed with Dr. Pettit at time of final reporting of the study.


Instruction: Generate impression based on findings.

Input: Left-sided neck pain with radicular symptoms to all 5 fingers, status post radiation for head and neck cancer. Evaluate for stenosis. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from minimal retrolisthesis of C4 on C5 and C5 on C6. Bone marrow signal is benign with diffuse T1 shortening related to prior radiation.The cervical spinal cord has normal signal characteristics and overall morphology.There is developmental narrowing of the cervical spinal canal with superimposed degenerative changes as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex eccentric to the right with prominent right-sided uncovertebral hypertrophy. There is also a small right central disc protrusion and ligamentum flavum thickening. Mild spinal canal stenosis. There is mild to moderate right-sided neural foraminal stenosis. Left neural foramen is patent.C4-5: Disc osteophyte complex eccentric to the right with right-sided uncovertebral hypertrophy. There is also mild ligamentum flavum thickening. There is mild to moderate spinal canal stenosis, relatively greater involving the right aspect of the spinal canal. There is mild to moderate right-sided neural foraminal stenosis. Left neural foramen is patent.C5-6: Disc osteophyte complex and bilateral uncovertebral hypertrophy. There is also mild ligamentum flavum thickening. There is moderate degree of spinal canal stenosis. There is moderate to severe left and, to a slightly lesser degree, right neural foraminal stenosis. C6-7: Mild disc bulge eccentric to the right and mild bilateral uncovertebral hypertrophy. There is also mild ligamentum flavum thickening. There is moderate right and mild left neural foraminal stenosis. Mild spinal canal narrowing.C7-T1: Minimal disc bulge eccentric to the right without significant compromise to the spinal canal or left neural foramen. Minimal right neural foraminal narrowingThe vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine, worst at the C5-C6 level where there is moderate degree of spinal canal stenosis and moderate to severe left neural foraminal stenosis. The left-sided neural foramina are grossly patent at the other levels. Additional details as above.2. No cord signal abnormality. No suspicious osseous lesions.


Instruction: Generate impression based on findings.

Input: Ms. Argeropolos is a 62 year old female with a personal history of bilateral lumpectomies (right breast-2012, left breast-2004) for DCIS. Patient received radiation and tamoxifen therapy. Family history of breast cancer in sister, maternal aunt, and paternal aunt. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal background parenchymal enhancement is noted bilaterally.Mild architectural distortion is seen in both breasts, at sites of bilateral lumpectomies. However, there is no abnormal enhancement present in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Worsening back pain. Check construct. Postoperative day # 2. For the purpose of labeling, 5 lumbar vertebral bodies are assumed to be present.There are postsurgical changes, with air within L2 -- L3 and L3 -- L4 intervertebral disk spaces, and within the spinal canal. There are interspinous device, extending from L2 to L4 spinous processes. The surgical hardware appears intact. There are streak artifacts in the vicinity of the hardware, which limits evaluation of these areas. Soft tissue stranding and a small amount of fluid density are seen in the posterior subcutaneous soft tissues, which are compatible with expected postsurgical changes. There is effacement of epidural fat at the level of L2 -- L3 to L3 -- L4 levels, likely related to the postsurgical change, but given this, the spinal canal cannot be assessed adequately. At L4 -- L5 intervertebral level, there is residual disk bulging, facet arthropathic change and ligamentum flavum hypertrophy, resulting in residual spinal canal narrowing. These findings may be further evaluated with MRI of the lumbar spine.No acute fracture is identified.There is air in dilated small bowel loops, suggesting ileus.

Output: 1. Post surgical changes, with interspinous device extending from L2 to L4 levels. 2. Due to effacement of the epidural fat, and presence of streak artifacts, spinal canal from L2 -- L3 to L3 -- L4, cannot be adequately evaluated.3. Residual degenerative changes.4. MRI of lumbar spine may be helpful for further correlation.5. Dilated small bowel loops suggestive of ileus.


Instruction: Generate impression based on findings.

Input: History of enlarging pancreatic cyst. ABDOMEN: Artifact from aortic stent graft limits evaluation of the retroperitoneum and distorts many of the imaging sequences.LIVER, BILIARY TRACT: Mildly prominent common bile duct up to 10 mm tapering smoothly at the ampulla without a filling defect or discrete mass lesion. This may be related to the patient's postcholecystectomy state.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic distal body well-defined cystic lesion measures 2.4 x 2.3 cm (series 12/29), compared to 2.6 x 2.3 cm previously. Additional punctate pancreatic tail foci are also unchanged. The main pancreatic duct is normal in caliber. There is no mural nodularity of the lesion. Otherwise limited nonenhanced evaluation of these cysts is unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited study due to artifact and lack of intravenous contrast shows a stable pancreatic body 2.4 cm cystic lesion without mural nodularity. It is essentially unchanged from 5/5/2015, but increased in size since 08/13/2013 CT.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:2/8/1958)Reason: h/o R acoustic neuroma History: tinnitusPROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mass present in the right internal auditory canal measuring 15 x 6 mm axial dimensions which is also identified on prior examsNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Right internal auditory canal mass is stable since the February exam. Examination is obtained for stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: No significant interval changes are seen from the prior exams. The trigone of the right lateral ventricle remains mildly expanded representing the site of a previously fenestrated intraventricular cyst. Minimal linear transparietal encephalomalacia is seen representing the operative tract.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and pattern of myelination are otherwise unremarkable. Normal visualization of signal voids of the major intracranial arterial branches is noted.

Output: 1. No acute or new findings.2. No detectable interval expansion of previously fenestrated right intraventricular cyst.3. Stable linear encephalomalacia along the course of the right parietal surgical tract.


Instruction: Generate impression based on findings.

Input: Ulcer on right lateral malleolus. Osteo-? Markers were placed along the lateral aspect of the lower leg and ankle denoting the area of interest. Please note that the field-of-view was adjusted accordingly, and the inferior margins of the talus and calcaneus are not included on the field-of-view of this study. There is ulceration of the soft tissues along the lateral aspect of the distal fibula. A collection of nonenhancing tissue, perhaps representing pus, extends from the skin defect to the underlying fibular cortex. There is edema and enhancement surrounding this collection indicating inflammation, but I see no signal abnormality within the underlying fibula to indicate osteomyelitis. The nonenhancing collection continues tracks deep to the peroneal tendons along the posterior margin of the fibula. The peroneal tendons themselves, however appear intact and I see no tenosynovitis. There is diffuse subcutaneous edema, as well as mild edema and enhancement of the musculature of the ankle indicating inflammation, but I see no discrete rim-enhancing fluid collection to indicate a drainable abscess.

Output: Soft tissue ulceration and inflammatory changes of the right ankle as described above, including a sinus tract/phlegmon that extends from the skin surface to the fibula; however, I see no bone marrow signal abnormality to indicate osteomyelitis.


Instruction: Generate impression based on findings.

Input: Clinical question:? Intracranial hemorrhage. Signs and symptoms: Status post blunt head trauma and loss of consciousness. CT of brain without infusion:Diffuse periventricular and subcortical foci of decreased attenuation in bilateral cerebral hemispheres are not specific however more likely diagnosis of small vessel disease and multiple sclerosis should be considered. Please correlate with history. There are no old studies available. There is no associated mass effect with the above findings. The cortical sulci and ventricular system remain within normal. There are no old studies for comparison and please correlate with clinical findings and history and if clinically desired follow-up with an MRI is recommended. No evidence of any post traumatic finding is detected.Calvarium is intact. Mastoid air cells, middle ear cavities and limited view of paranasal sinuses are unremarkable. No abnormality of the scalp is detected.CT of the maxillofacial region:Paranasal sinuses are well pneumatized and with no evidence of acute or chronic sinus disease. The ostiomeatal units of maxillary sinuses are patent bilaterally. Images through the nasal cavity demonstrate minimal nasal septum deviation to the left and a very small approximately 3 mm bony septal spur projecting to the left.Images through the orbits demonstrate no evidence of adenopathy.The minimal soft tissue thickening of the right cheek is present.

Output: 1.No evidence of post traumatic finding on CT of brain.2.Findings highly suspect that of advanced small vessel disease or demyelinating disease as described. Follow-up with an MRI is recommended.3.With the exception of minimal soft tissue thickening/edema of the right cheek the CT of maxillofacial region remains within normal.


Instruction: Generate impression based on findings.

Input: Patient with L5-S1 discogenic DJD and now with new low back pain not responding to conservative measures. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are grossly within normal limits. Again seen is dextroscoliosis of the lumbar spine centered at the L3 level. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: Mild disc bulge and mild facet arthropathy. Spinal canal and right neural foramen are patent. Left neural foramen is narrowed with mild to moderate neural foraminal stenosis similar to prior.L2-L3: Mild disc bulge eccentric to the left, bilateral facet arthropathy, and ligamentum flavum thickening. There is partial effacement of the left lateral recess as before. Central spinal canal remains patent. There is moderate left-sided neural foraminal stenosis as before. Right neural foramen is patent. L3-L4: Mild disc bulge eccentric to the left, ligamentum flavum thickening, and advanced facet arthropathy. There is distention of the left facet joint which was present previously. There is mild to moderate left neural foraminal stenosis. Right neural foramen is patent. Mild effacement of the left lateral recess. Minimal narrowing of the spinal canal similar to prior. L4-L5: Mild disc bulge and advanced bilateral facet arthropathy. Mild effacement of the right lateral recess. There is no significant central canal stenosis. There is moderate degree of right-sided neural foraminal stenosis. Mild left neural foraminal narrowing. Noted is clumping and peripheral displacement of the cauda equina nerve roots particularly on the right suggestive of arachnoiditis which is new since prior. L5-S1: Severe disc height loss particularly in the right aspect of the disc space and similar to prior. Mild disc bulge. Advanced right-sided facet arthropathy. There is severe right neural foraminal stenosis which was present previously. Left neural foramen is patent. Spinal canal is patent.Lower lumbar posterior paraspinous musculature demonstrates asymmetric atrophy on the right similar to prior.

Output: 1. Degenerative changes throughout the lumbar spine with significant dextroscoliosis centered at the L3 level similar to prior. There is no significant central spinal canal stenosis at any level. There is multilevel neural foraminal stenosis as detailed above, which is severe at the right L5-S1 level. Please see additional levels of neural foraminal stenosis as detailed above.2. There is advanced facet arthropathy at the bilateral L3-L4, bilateral L4-L5, and right L5-S1 levels, which may be contributing to patient's low back pain.3. There is clumping and peripheral displacement of the cauda equina nerve roots in the lower lumbar spine particularly on the right, which is new since prior MRI from 12/23/2014. Findings suggest arachnoiditis. Correlate with history for possible spine procedure in the interval as a potential etiology.


Instruction: Generate impression based on findings.

Input: Cirrhosis, evaluate for HCC recurrence status post TACE/RFA ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology. Segment 5 ablation zone measures 3.2 x 1.0 cm (series 11, image 61), previously 3.7 x 1.2 cm. No evidence of surrounding enhancement to suggest residual or recurrent tumor. Scattered foci of parenchymal arterial enhancement without washout. The hepatic and portal veins are patent. Conventional hepatic arterial anatomy. Status post cholecystectomy. 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: Focus of blooming artifact in the region of the greater curvature of the stomach is new and may represent ingested material versus postsurgical change in the appropriate clinical context.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Segment V ablation zone without surrounding enhancement to suggest residual / recurrent tumor.2.Special attention should be given to scattered foci of arterial enhancement on future exams.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (5/15/15), ultrasound images of left breast(5/15/15), images from ultrasound guided biopsy of both breasts and post-procedural mammographic images (5/22/15), breast MRI (6/2/15) performed at Advocate South Suburban Hospital. DIGITAL MAMMOGRAPHIC IMAGES (5/15/15):The breast parenchyma is heterogeneously dense. There is an oval mass with pleomorphic calcifications and an ill-defined anterior density in the left retroareolar region, measuring 45 x 22 mm (AP x LR) on CC view. Just posterior to the above-mentioned calcified mass, there is a circumscribed mass, measuring 33 x 18 mm. There are several benign appearing masses at lateral and medial aspect in the left breast.No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREASTS(5/15/15):In the left breast, there is a bilobed mass with calcifications in the posterior part of the mass, measuring 36 x 16 mm, corresponding the retroareolar mass on the mammogram. The distance between nipple and the anterior part of this mass is about 4 mm.Labeled as "Left Breast Areolar Area Long Lat/Med," visualized is a benign appearing hypoechoic mass measuring 22 x 11 mm, likely corresponding to the circumscribed mass located just posterior to the calcified mass.Benign appearing oval masses are detected at 3:00 position (9 x 5 mm), 9:00 position (14 x 8 mm), and 1:00 position (23 x 11 mm) in the left breast. The 1:00 mass is likely the same lesion as one that labeled "Left Breast Areolar Area Long Lat/Med."There is a hypoechoic mass measuring 19 x 15 mm in the left axilla, suspicious for metastatic lymph node.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF BOTH BREASTS AND POST-PROCEDURAL MAMMOGRAPHIC IMAGES (5/22/15):In the right breast, multiple benign appearing oval hypoechoic mass are detected; 10:00 position (13 x 6 mm, 9 x 6 mm and 6 x 3 mm), 12:00 position (6 x 3 mm), and 11:00 position (6 x 4 mm). A few benign appearing lymph nodes are detected in the right axilla.Ultrasound guided biopsy and clip placement was performed for the following lesions with appropriate needle placement;1. Benign-appearing mass at 9:00 position in the left breast2. Suspicious mass at subareolar region in the left breast3. Benign-appearing mass at 3:00 position in the left breast4. Suspicious left axillary mass5. Benign-appearing mass at 10:00 position in the right breastPer outside pathology report, the pathology result of suspicious mass at subareolar region and left axillary mass was malignant (IDC grade 3 with DCIS grade 3), and that for other masses was benign.Post-procedural mammograms show 3 marker clips in the left breast, including the one in the proven carcinoma, a clip in the left metastatic axillary lymph node, and a clip in the right 10:00 position.BREAST MRI (6/2/15):Breast MRI was performed with a protocol outlined in the outside radiology report.There is an enhancing bilobed mass measuring 41 x 20 x 28 mm (AP x LR x CC) at the left retroareolar region, consistent with proven carcinoma. Posterior portion of this mass shows rim-enhancement. Just posterior to this bilobed mass, there is a slowly enhancing mass, likely fibroadenoma. There are several slowly enhancing masses in the left breast, consistent with multiple fibroadenomata.In the left axilla, there are two enlarged lymph nodes, measuring 23 mm and 13 mm. A marker clip is present at immediately anterior to the larger lymph node.In the right breast, a hematoma is present at 10:00 position. No suspicious enhancement is seen in the right breast.No abnormal lymph node in right axilla.

Output: 1. Biopsy proven carcinoma in the left breast with metastatic left axillary lymph node2. Multiple fibroadenomata in both breasts (the mass located posterior to the proven carcinoma in left breast also appears like a fibroadenoma)BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Back pain. Elevated ESR/CRP For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: There is a broad-based disc protrusion central to right which abuts thecal sac. Disc desiccation is also noted. No neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.There are multiple renal cysts is on bilateral kidneys. Right-sided lesion is about 4.5 mm left side lesion is the smallest one is about 2 mm the the largest one on the inferior pole is about 31.6 mm x 24.3 mm.

Output: Focal disc protrusion, at the level of T12-L1 central to right abuts thecal sac as described above.Multiple bilateral renal cysts as described above.


Instruction: Generate impression based on findings.

Input: Female, 6 years old, with seizures and developmental delay. Assess for structural abnormality. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The rostrum of the corpus callosum may be slightly blunted, but the remainder of the corpus callosum is normally formed. The region of the pituitary is within normal limits. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. The pattern of white matter myelination is appropriate. No evidence of any cortical dysplasia or migrational anomaly is seen.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: History of metastatic melanoma with brain metastasis status post resection for SRS treatment planning. This is a limited stealth MRI of the brain for treatment planning. There are post-operative findings related to a right frontal craniotomy for tumor resection with more conspicuous rim enhancement of the surgical cavity. There remains dural thickening and enhancement with interval decrease in size of a fluid collection subjacent to the craniotomy flap. There is decreased mass effect on the right frontal horn without significant midline shift. There is evidence of a remote left frontal craniotomy with redemonstration of a resection cavity at the left frontal lobe convexity, which appears unchanged. Redemonstrated is a 9 mm lesion in the right precuneus with associated susceptibility artifact, which is unchanged in size. There is interval progression in size of a punctate 4 mm enhancing lesion in the left precuneus, which in retrospect was present on prior MRI's but more punctate. There is ill-defined, patchy enhancement in the right temporal lobe, which is likely artifactual. Again seen are multiple areas of susceptibility artifact throughout the bilateral cerebral hemispheres, consistent with hemosiderin deposition.

Output: 1. Limited stealth MRI of the brain for treatment planning.2. Expected post-operative findings related to a right frontal craniotomy for tumor resection with increased conspicuity of rim enhancement surrounding the resection cavity margin, which is compatible withe evolution of post-surgical change. Attention on follow-up is suggested.3. Punctate 4 mm enhancing lesion in the left precuneus, which is slightly increased in size compared to prior exams. Ill-defined patchy enhancement in the right temporal lobe is likely artifactual. 4. No significant interval change in the appearance of the right parietal precuneus hemorrhagic lesion as well as left posterior frontal resection cavity.


Instruction: Generate impression based on findings.

Input: T2N0 right oral tongue squamous cell carcinoma treated with CRT completed in 6/2009 with right partial glossectomy for salvage in 10/2009 with recurrent right oral tongue tumor treated with chemoradiation. Neck: There are post-treatment findings in the oral cavity, including radiation effects and partial right glossectomy and neck dissection with radial forearm flap reconstruction. There is residual measurable lesion in the oral cavity. There is also no evidence of significant lymphadenopathy in the neck. The remaining salivary glands are unremarkable. The thyroid gland also appears unremarkable. There are upper thoracic spinal rods that produce susceptibility effect in the region. There is a right maxillary sinus retention cyst. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Post-treatment findings without residual measurable lesion in the oral cavity or evidence of significant lymphadenopathy in the neck.2. No evidence of acute intracranial metastases.


Instruction: Generate impression based on findings.

Input: Female, 17 years old, 31 weeks gestational age with IUGR and suspicion for absence of the septum pellucidum on US. The cavum septum pellucidum is present, as is the corpus callosum.Cavitation with mild ex vacuo expansion of the left lateral ventricular atrium is seen. In addition, the margins of the left atrium are rimmed with a band of abnormal signal which is T1 hyperintense, T2/gradient-echo hypointense, and hyperintense on DWI. Similar periventricular signal abnormality is also seen but to a lesser degree elsewhere around the lateral ventricles, particularly along the right occipital and temporal horns. In addition, the right anterior temporal horn is either dilated or cystically cavitated. The third and fourth ventricles are within normal limits for size. The cerebral aqueduct is patent. In fact, the lateral ventricles are not frankly dilated except for those areas of cavitary/cystic expansion discussed above. The cerebellar vermis and hemispheres are hypoplastic. The inferior outflow pathway of the fourth ventricle is widened. The right cerebellar hemisphere is somewhat more truncated than the left with thin T2/gradient hypointense rimming along its inferior surface.Pattern of sulcation is appropriate for the presumed gestational age. No definite evidence of any cortical clefting, dysplasia or other migrational anomaly is seen.The fetal spleen appears to be somewhat enlarged, though this is difficult to assess with accuracy as images were tailored for evaluation of the brain.Maternal findings include a subjective paucity of amniotic fluid. Also noted is mild prominence of the maternal renal collecting system which can be physiologic.

Output: 1.The cavum septum pellucidum and corpus callosum are identified and appear within normal limits.2.A pattern of largely periventricular abnormalities is identified including areas of cavitation and/or cystic dilatation. Associated periventricular signal abnormality is suggestive of the presence of necrosis and blood product with or without calcification.3.The posterior fossa structures are hypoplastic and, in addition, there are findings to suggest tissue injury and loss within the right cerebellar hemisphere. Prominence of the inferior fourth ventricular outflow pathway may reflect inferior vermian hypoplasia, less likely a mild Dandy-Walker spectrum variant.4.The above findings, and particularly the periventricular abnormalities, in the context of an otherwise normally formed brain, suggest an acquired process. Congenital infection could produce all of the imaging findings noted above. CMV would be the favored agent given the pattern, though other infectious agents are not excluded. Alternately, these abnormalities could be primarily ischemic in nature.


Instruction: Generate impression based on findings.

Input: Female, 67 years old. Pain MENISCI: There is marked fragmentation of the posterior horn of the medial meniscus. A horizontal component of tearing extends into the anterior horn, with extension to the femoral articular surface and an associated 6 mm parameniscal cyst (series 5, image 9). The lateral meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: There is diffuse cartilage thinning of the medial compartment, with irregularity and areas of complete cartilage loss involving the medial femoral condyle. There is extensive cartilage loss of the patellofemoral articulation, with underlying marrow reactive changes and cyst formation involving the undersurface of the patella and the lateral femoral trochlea. Tricompartmental osteophytes are noted.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Osteoarthritis, with significant cartilage loss involving the medial tibiofemoral articulation and the patellofemoral articulation as above.2.Marked fragmentation of the posterior horn of the medial meniscus.3.Horizontal tear of the anterior horn medial meniscus with a small parameniscal cyst.


Instruction: Generate impression based on findings.

Input: 50 year-old man with Hodgkin's lymphoma status post chemotherapy now with altered mental status, focal neurologic deficits. Rule out CVA and increased intracranial pressure. There is no evidence of intracranial hemorrhage, mass or edema. There are no CT findings of stroke. If stroke remains a clinical concern, MRI is more accurate for detection of acute ischemia.The ventricles are normal in size and configuration. The suprasellar, basilar, and quadrigeminal cisterns are normal appearance.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: Anesthesia of skin [R20.0], Reason for Study: ^Reason: eval plaques / other lesions History: R hand numbness, previous transverse myelitis Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There are multifocal FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and deep white matter including left frontal white matter lesion. Grossly unchanged since prior scan. There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-Spine MRI Post laminectomy status are seen from C4 to C5.Previously seen operation site extradural fluid collections are not seen anymore.However, there are focal T2/STIR increased signal intensity at the level of C2 level just below the foramen magnum level. The lesion is mainly located on the right side but reaches to the midline. Comparing to prior cervical spine MRI, this is a new lesion.There is relatively well circumscribed T2/STIR high signal intensity lesion at the C4 level cervical spinal cord posterior column area which indicate postoperative (cervical spinal cord biopsy) changes. There is subtle T2 high signal intensities on the posterior right lateral aspect of the C5 level (series 1601, image 24/45). This lesion is also new lesion comparing to prior scan (Apr 11/2014).  There is subtle kyphotic angulation of cervical spine at the level of C56. Vertebral body heights are normal.

Output: 1. Interval development of new T2/STIR high signal intensity cervical spinal cord lesions at the level of C2 and possibly C5 level as described above.2. Unchanged FLAIR/T2 high signal intensity periventricular white matter and deep white matter lesion.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with history of von Hippel-Lindau with history of cerebellar and spinal hemangioblastomas. Evaluate for new lesions. Brain:Findings are seen compatible with prior suboccipital craniotomy. Mild distortion of the cervicomedullary junction may be related to the prior surgery and is unchanged.No evidence of any significant parenchymal edema or mass effect is detected in the brain or cerebellum. No reliably detectable enhancement is seen within the cerebrum or cerebellum. A few scattered punctate foci of enhancement noted in the cerebellum on the prior MRI have either resolved or are not detected due to technical differences.No significant parenchymal edema or mass effect seen. No abnormal extra-axial fluid or evidence of intracranial hemorrhage is noted. The ventricular system is within normal limits.Spine:Image quality is degraded by motion artifact. Within this limitation, the following observations are made.The posterior arch of C1 has been resected likely in combination with suboccipital craniotomy. Also noted is evidence of prior C4 and C5 laminectomy. Surgical changes appear similar to prior.A 4 mm focus of enhancement along the right posterior spinal cord at the C3-4 level, and a 5 mm focus of T2 hyperintensity and enhancement along the right posterior aspect of the cord at C4-5 both appear similar to the prior examination allowing for differences in technique.A 4 mm focus of T2 hyperintensity and enhancement along the left posterior cord at the C7-T1 level is unchanged. Likewise small foci of enhancement along the right posterior cord at T5, and two small enhancing lesions along the left posterior cord at T9 are unchanged. Mildly prominent vascularity is seen along the dorsal surface of the distal spinal cord and conus.A 2 mm focus of enhancement is evident along the proximal cauda equina at the L2 level. The prior lumbar spine MRI was performed without contrast so comparison is not accurate. No other reliably detectable intrathecal lesions are seen. Reversal of the cervical lordosis is seen with mild disc osteophyte formation at C3-4, C4-5 and C5-6. No areas of significant spinal canal or foraminal stenosis are seen in the cervical region.In the thoracic region, spinal alignment is anatomic. Vertebral body morphology is within normal limits allowing for mild concavity of the T12 superior endplate. No significant disc herniations or spinal canal or foraminal stenosis are seen.In the lumbar region, spinal alignment is anatomic and vertebral body morphology is within normal limits. Mild disc degeneration is seen at L4-5 with a small central protrusion and mild generalized disc bulging. No significant spinal canal or foraminal stenosis is seen.Multiple cystic renal lesions are noted incidentally.

Output: 1.Findings are seen compatible with suboccipital craniotomy, presumably for prior resection of a posterior fossa tumor.2.No definite evidence of any intracranial enhancing lesions are seen. Several punctate enhancing foci were present in the cerebellum on the prior outside MRI, but these are not seen on today's study which could reflect interval resolution or technical differences.3.Postoperative findings are seen compatible with C4 and C5 laminectomy, again presumably for intraspinal tumor resection.4.Multiple small foci of enhancement are noted predominantly along the dorsal surface of spinal cord involving the cervical and thoracic levels as well as the proximal cauda equina. None of these lesions shows evidence of significant interval change, and no definite new spinal lesions are noted.


Instruction: Generate impression based on findings.

Input: 60-year-old male with history of liver kidney transplant The patient is status post amputation the distal phalanx of the great toe. The distal 1 cmof the proximal phalanx has been replaced by a soft tissue mass, which is hypointense onboth T1 and T2 sequences, appearing similar to the prior exam. The there is low T1 marrow signal within the distal first phalanx with associated marrow edema consistent with ongoing osteomyelitis. Soft tissue swelling surrounding the distal first phalanx has increased from the prior exam.

Output: Osteomyelitis involving the distal first phalanx with interval increase in associated soft tissue swelling.


Instruction: Generate impression based on findings.

Input: Brain metastasis status post surgery and radiation. Surveillance exam. There are postoperative findings related to frontal craniotomy. There is a persistent punctate focus of enhancement in the anterior right superior frontal gyrus with surrounding vasogenic edema. There is no definite evidence of additional enhancing lesions, although the images are degraded by motion artifact. There is no evidence of intracranial hemorrhage or acute infarct. 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 a small right sphenoid sinus retention cyst.

Output: Post-treatment findings with a persistent nonspecific small area of enhancement in the anterior right superior frontal gyrus with surrounding vasogenic edema. There is no definite evidence of additional enhancing intracranial lesions, although the images are degraded by motion artifact.


Instruction: Generate impression based on findings.

Input: Male, 51 years old. Reason: Evaluate for osteomyelitis, soft tissue necrosis History: Abscess/cellulitis of L foot in pt with PVD, DM TENDONS: The imaged portions of the flexor and extensor tendons are intact. There is mild tenosynovitis of the extensor tendons.LIGAMENTS: Image portion of the Lisfranc ligament is intact.ARTICULAR SURFACES AND BONE: Degenerative changes affects the first metatarsophalangeal joint with moderate osteoarthritic changes. There is mild hallux valgus deformity.No marrow signal abnormalities noted on the T1 weighted image to suggest acute osteomyelitis. Erosive changes at the tufts of the second third digits are unchanged.. ADDITIONAL

Output: Soft tissue swelling and some muscle edema but no specific evidence of osteomyelitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Elevated transaminases. Transjugular liver biopsy demonstrated mild portal and lobular inflammation and minimal hemosiderosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and enhancement. There is minimal decrease in signal intensity on in-phase images relative to out-of-phase images suggesting mild iron deposition. No focal suspicious lesion. Status post cholecystectomy. No intrahepatic biliary ductal dilatation. The common bile duct measures 7 mm and tapers smoothly to the level of the ampulla without a stone or discrete mass.SPLEEN: The spleen measures 12 cm in length, at the upper limits of normal. No focal lesion.PANCREAS: The pancreas is normal in morphology and signal intensity. Normal enhancement. No focal lesion. No pancreatic ductal dilatation.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. Possible mild iron deposition.2. No biliary ductal dilatation or other specific findings to account for the patient's elevated LFTs.


Instruction: Generate impression based on findings.

Input: 59-year-old female with pain and limited mobility of the shoulder, rule out tear in the shoulder area ROTATOR CUFF: There is marked thinning of the anterior fibers of the supraspinatus tendon reflecting both articular and bursal surface tearing. At its thinnest, the tendon measures only 1 mm in thickness. This high-grade partial-thickness tear is approximately 1 cm in AP dimension. There appears to be delamination resulting in approximately 1 cm of proximal retraction of the articular and bursal surface fibers. More posteriorly, there is less pronounced articular surface tearing and bursal surface fraying with underlying tendinosis. There is fatty infiltration along the myotendinous junction of the supraspinatus, but more proximally the muscle appears normal. Mild tendinosis affects the infraspinatus tendon without a discrete tear. The subscapularis and teres minor tendons are intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint with spurring along the undersurface of the acromion. A trace amount of fluid is present in the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthrosis affects the glenohumeral joint. There is deformity of the posterior superior labrum which likely represents degenerative tearing. There is also mild degenerative tearing of the anterior inferior labrum. A small amount of fluid is present in the glenohumeral joint, but no large effusion is present.BICEPS TENDON: There is mild increased signal intensity along the long head of the biceps at its transition into the intertrabecular groove, suggesting mild tendinosis.

Output: 1.High-grade partial-thickness tearing of the supraspinatus tendon involving both articular and bursal surfaces.2.Osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: Patient with history of metastatic NSCLC with known brain mets now with wobbly gait. Please eval for worsening mets or leptomeningeal disease History: Wobbly gait Diffuse non nodular leptomeningeal enhancement is seen on today' scan which is non specific but may indicate leptomeningeal inflammation or metastatic involvement. Previously seen multiple enhancing metastatic nodules were redemonstrated with some lesions such as left inferior parietal lobule, right frontal deep white matter and right occipital lobe show interval increase in size and enhancement degree. The left parietal lobe, mainly superior parietal lobule but involving inferior parietal lobule acute/subacute ischemic stroke lesion shows increased extent of restricted diffusion areas and shows intra lesional susceptibility artifacts on gradient echo images indicating hemorrhagic transformation. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval increase of the extent of acute/subacute ischemic infarction on the left parietal lobe with evidence of hemorrhagic transformation.2. Interval increase in size and the degree of enhancement on some metastatic brain parenchymal lesions since prior scan.3. Diffuse non nodular enhancement of leptomeninges indicating possible leptomeningeal inflammation or metastasis.


Instruction: Generate impression based on findings.

Input: 16-year-old male with history of redness and warmth in the right lower extremity. Evaluate for osteomyelitis or joint effusion. There is high T2 signal diffusely within the right lower leg musculature. There is generalized atrophy of the musculature as well. There are also mild inflammatory changes within the subcutaneous fat. These areas also demonstrate mild enhancement after contrast administration. No evidence of drainable fluid collections. The underlying tibia and fibula are normal. There is no knee joint effusion.There is a small right hip joint effusion. Development of dysplasia of the right hip again noted. Once again, marked atrophy and increased T2 signal present within the upper leg musculature. There is a postoperative longitudinally oriented high T2 linear defect within the right lateral thigh with adjacent foci of susceptibility likely representing gas density. This tract extends to the lateral mid femur surface. Mild heterogeneous enhancement is appreciated within the tract. There is chronic periosteal reaction about the mid femur however the underlying bone marrow signal intensity appears normal with no evidence of acute osteomyelitis. Skin thickening with moderate enhancement of the subcutaneous tissues of the thigh.Fluid filled rectum. The right testes is located within the inguinal canal. Left hip dysplasia.

Output: 1. Postoperative changes in the right thigh of hardware removal with a residual thin fluid filled tract extending to the femur surface. This likely represents a combination of granulation tissue and fluid, however given the presence of gas density, an infected tract is favored. While there is chronic periosteal reaction of the femur in this area, the underlying bone signal abnormality is normal with no evidence of acute osteomyelitis.2. Skin thickening and inflammation of the subcutaneous fat of the lateral right femur likely represents a cellulitis.3. Diffuse muscular atrophy of the upper and lower legs with increased T2 signal abnormality which is likely the result of denervation.4. Small right hip joint effusion.5. Right testis is located within the inguinal canal.6. Fluid filled sigmoid and rectum.


Instruction: Generate impression based on findings.

Input: 29-year-old man with history of pancreatic pseudocyst. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal. Gallbladder is normal.SPLEEN: Spleen is normal.PANCREAS: A cystgastrostomy is again seen. Persistent small amount of fluid immediately anterior to the stomach has decreased. Additionally, there is a fluid collection in the pancreatic tail (series 3, image 17) that measures 14 x 14 mm, previously 29 x 25 mm. There is stable, mild prominence of the pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Decreased size fluid focus in pancreatic tail and decreased perigastric fluid.


Instruction: Generate impression based on findings.

Input: A9 year old female with history of multiple myeloma. Presenting with two months history of bilateral neck pain. No vertebral tendinous or neurological findings. Exaggerated lordosis of cervical spine is noted. Extensive lytic lesions of the skull base in particular the clivus is noted. These changes are consistent with patient's diagnosis of multiple myeloma.Multiple lytic lesions involving the entire vertebral body of C2 including the dens, C3, C4 is also noted. There is no evidence of collapse of any of the vertebral bodies and no evidence of malalignment is detected. No definitive evidence of abnormality of the posterior elements is detected. Reformatted images with wide window settings demonstrates no definitive evidence of a soft tissue abnormality within the spinal canal. The caliber of the cord appears unremarkable and subarachnoid space is visualized. If clinical concern persists further evaluation with an MRI would be most helpful. No definitive evidence of bony neural frontal compromise or central spinal stenosis is present.

Output: Extensive lytic changes of skull base and upper cervical spine consistent with multiple myeloma as detailed above.


Instruction: Generate impression based on findings.

Input: Male 39 years old Reason: pt with concern for ?metal in eyes (is sheet metal worker). Needs MRI pre-screening History: concern for metal in eyes We see no metallic density overlying the orbits or intracranially. Punctate density is present within the soft tissues of the forehead, which would not preclude MRI examination.

Output: No metallic density overlying the orbits or intracranially.


Instruction: Generate impression based on findings.

Input: 52 years, Female, Reason: Hx of metastatic breast cancer, new left adrenal nodule on CT scan, please evaluate History: above. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 7-mm left adrenal nodule appears to lose signal on out of phase imaging.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Vertebral body lesion in L5, seen on coronal images is hypermetabolic on prior PET on suspicious for a metastases.OTHER: No significant abnormality noted.

Output: 1.Subcentimeter left nodule appears to lose signal on out of phase imaging, which would suggest an adenoma, however this is not definite due to the small size of this lesion. Follow up is recommended. 2.L5 lesion, hypermetabolic on prior PET, it is suspicious for an osseous metastases.


Instruction: Generate impression based on findings.

Input: 51-year-old male with metastatic lung cancer presenting with worsening lower extremity weakness and AMS. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. Unchanged disc herniation at the level of L4-L5. Few osseous metastatic lesions are redemonstrated from previous exam.

Output: This is a limited exam specific for the exclusion of cord compression only. No cord compression is identified. Few osseous metastatic lesions are redemonstrated.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: 40 year old male with a history of bicuspid aortic valve, aortic pseudocoarctation and aneurysm with perforated ulcer who is status-post hemasheild graft placement in 10/2013. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 194 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 63 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 98 g (normal range 164+/-36). 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 normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 94 ml/m2 (normal range 82+/-16), the RVEDV is 207 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 78 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.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Hemashield graft noted in the descending thoracic aorta with surrounding post-operative changes, not changed in size.  The aortic dimensions are as follows: (Previous two dimensions in parentheses)  Sinus of valsalva 30x30mm (33x32mm, 31 x 31mm)Sinotubular junction 29x27mm (28x27mm, 30 x 27mm)Ascending aorta 29x31mm (32x32mm, 31 x 31mm)Proximal aortic arch 30x31mm (30x30mm, 32 x 32mm)Distal aortic arch 27x23mm (27x23mm, 25 x 24mm)Aortic graft measurements essentially unchanged. 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 FindingsSternal wires present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 67%). 2. The right ventricle is normal in size with normal systolic function (RVEF 63%). 3. Aortic measurements as above, not substantially changed compared to previous study.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer. There is interval decrease in size of the right perirolandic enhancing lesion with susceptibility effect, which now measures 17 x 11 mm, previously 25 x 14 mm. In addition, the surrounding vasogenic edema has diminished. The left occipital lobe lesion has also decreased in size and is nearly resolved. There is a small developmental venous anomaly in the right paracentral lobule. There is unchanged scattered nonspecific cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval decrease in size of the intracranial metastases.


Instruction: Generate impression based on findings.

Input: History of left knee venous malformation with pain, evaluate low flow versus high flow. Grayscale images demonstrate several tubular hypoechoic structures within Hoffa's fat pad likely corresponding to the vessels described on recent MRI.DOPPLER

Output: Vessels within Hoffa's fat pad corresponding to those seen on recent MRI with minimal to no blood flow.


Instruction: Generate impression based on findings.

Input: There is mild enhancement and slight thickening of the lower cervical and thoracic ventral and dorsal nerve roots, although evaluation of the thoracic spine is somewhat limited due to lack of axial T1 precontrast images. There is no evidence of abnormal cord enhancement.There is redemonstration of a right thyroid mass which appears heterogeneous with diffuse enhancement. There is also again seen a large left adrenal mass with heterogeneous appearance.

Output: 1. Somewhat limited exam due to lack of axial T1 precontrast images through the thoracic spine. Mild enhancement and slight thickening of lower cervical and thoracic nerve roots symmetrically which would be compatible with CIDP.2. Redemonstration of right thyroid mass with diffuse but slightly heterogeneous enhancement.3. Redemonstration of a large left adrenal mass with heterogeneous appearance. Consider MRI or CT.


Instruction: Generate impression based on findings.

Input: A 28 year old male with history of congenital HIV, s/p chemotherapy for lymphoma, EtOH abuse. Now hospitalized and found to have decreased left ventricular systolic function with an apical thrombus. Referred to cardiac MRI for further evaluation. MEDICATIONS: none First Pass PerfusionDuring hyperemia, no perfusion defects were present. A dark rim artifact was noted.Viability/ Myocardial ScarThere is a focal area of late gadolinium enhancement noted at the mid-to-apical segment of the infero-septal wall. This pattern is atypical for myocardial infarction and could represent fibrosis, inflammation, or infiltration. The rest of the myocardium is viable.Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 139 ml/m2 (normal range: 74+/-15), the LVEDV is 294 ml (normal range 142+/-34), the LV end systolic volume index is 120 ml/m2 (normal range 25+/-9), the LVESV is 252 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 107 g (normal range 164+/-36). There is severe global hypokinesis. Highly trabeculated myocardium noted extending form the apex to mid LV wall along the anterior, lateral and inferolateral walls. Maximum ratio of trabeculated to non-trabeculated myocardium in diastole on short-axis views (mid-myocardium level) is 21mm/6 mm = 3.5. The compacted myocardium is thin. This ratio is in keeping with a diagnosis of LV noncompaction.An apical thrombus was seen (22X11mm).Left AtriumThe left atrium is severely dilated (169ml). Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 19%, the RV end diastolic volume index is 121 ml/m2 (normal range 82+/-16), the RVEDV is 254 ml (normal range 142+/-31), the RV end systolic volume index is 97 ml/m2 (normal range 31+/-9), and the RVESV is 205 ml (normal range 54+/-17). Right AtriumThe right atrium is severely dilated. Dilated coronary sinus.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate 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 (27 mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumModerate-sized pericardial effusion. Extracardiac FindingsBilateral pleural effusions (right>left). Changes noted in the lung fields better described on dedicated lung imaging performed today (see report). This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.A dark rim artifact was noted.2. There is a focal area of late gadolinium enhancement noted in the mid-apical inferoseptum. This pattern is atypical for myocardial infarction and suggests underlying fibrosis, inflammation, or infiltration. The rest of the myocardium appears viable.3. the LV is severely dilated with severely reduced systolic function (LVEF 14%). Ratio of non-compacted to compacted myocardium measures 3.5. This is in keeping with a diagnosis of LV noncompaction.4. The RV is mildly dilated with severely reduced systolic function (RVEF 19%).5. Severe biatrial dilation.6. Severe mitral regurgitation.7. Mild to moderate tricuspid regurgitation.8. Moderate-size pericardial effusion. Suggest follow-up with echocardiogram.9. See extracardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Redemonstrated is an intraparenchymal hematoma centered within the right parietal lobe with extensive edema. Postcontrast images reveal an enhancing nodular component anteriorly measuring up to 32 x 17 mm in transverse dimension, as well as a collection of enhancing foci posteriorly (the largest of which measures up to 15 x 15 mm). The collection of hemorrhage, enhancing material, and edema measures approximately 8 x 8 x 8 cm. Significant mass effect includes leftward midline shift measuring 22 mm, right uncal herniation, deformation of the midbrain and pons, and downward transtentorial herniation. Also redemonstrated is a subdural fluid collection along the right frontal convexity which appears to contain a nonenhancing curvilinear (perhaps membranous) component measuring up to 11 mm in thickness which is overall slightly more T1 hyperintense than CSF, T2 hyperintense, and CT hypodense, most suggestive of proteinaceous material within a collection of CSF. As before, there is dilatation of the right temporal horn compatible with trapped ventricle and dilatation of the left lateral ventricle compatible with developing obstructive hydrocephalus.

Output: Large 8-cm space-occupying lesion centered within the right parietal lobe containing hemorrhagic components, enhancing material, and edema. Given the patient history of neuroblastoma, this is most consistent with a heterogeneous hemorrhagic metastasis from neuroblastoma. Significant associated mass effect with herniations as well as a right frontal subdural primarily fluid collection are described in detail above.


Instruction: Generate impression based on findings.

Input: Confusion. There is mild scattered cerebral white matter T2 hyperintensity. There is a small area of susceptibility effect and faint enhancement in the right caudate nucleus, which may represent a telangiectasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Nonspecific mild scattered cerebral white matter T2 hyperintensity may represent chronic small vessel ischemic disease and/or perivesicular spaces. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: 17-year-old with Chiari malformation. Signs and symptoms: Headache. Nonenhanced thoracic MRI:Examination demonstrate normal anatomical development, signal intensity and alignment of the vertebral column.There is also normal signal intensity and caliber of thoracic cord and in particular without evidence of syrinx.There is normal termination of the cord at the lower L1 level.There is no evidence of spinal canal compromise or neural foraminal stenosis at any level.There is no detectable. Spinal soft tissue abnormalities.Nonenhanced lumbar MRI:There is normal anatomical development, signal intensity and alignment of the lumbosacral spine. No evidence of spinal canal or neural foraminal compromise at any level.There is a punctate size fatty signal intensity of the filum terminale in an interrupted fashion and extending from approximately lower L3 level inferiorly. The signal intensity and overall anatomical morphology of the cauda equina is otherwise unremarkable.Prone sagittal T2 sequence is degraded due to motion artifact and is nondiagnostic, recommend repeat prone sagittal sequence.

Output: 1.Unremarkable nonenhanced thoracic MRI.2.Nonenhanced MRI of lumbar spine demonstrate normal anatomical development and alignment of vertebral column. There is normal termination of the cord at the lower L1 level. There is a tiny noncontiguous fatty signal intensity of the filum terminale extending from L3 inferiorly and unremarkable cauda equina are otherwise. The prone sagittal T2-weighted images are nondiagnostic due to extensive motion artifact and recommend repeat of the sequence.


Instruction: Generate impression based on findings.

Input: Headaches that send tinglings down the body. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is a mega cisterna magna, which is an anatomic variant. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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