Instruction: Generate impression based on findings.

Input: Brain:Asymmetry is noted of the lateral ventricles, right greater than left, which is most likely secondary to anatomic variation.There is a solitary, small, ovoid focus of susceptibility hypointensity within a peripheral posterior right temporal gyrus (series 9, image 46), without other associated signal abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. There is lack of visualization within the distal left vertebral artery. Correlation with the cervical MRI portion of today's studies demonstrates the left-sided transversarium foramina to be small, consistent with a congenitally hypoplastic left vertebral artery. However, portions of the cervical left vertebral artery fail to demonstrate a flow void. It is uncertain if this is due to past dissection or from non-visualization of the tiny lumen.Cervical spine:There is slight reversal normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Other than the aforementioned left vertebral artery findings, the visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: There is a tiny midline disc protrusion, partially effacing the anterior CSF, without associated cord deformation or central stenosis.C4/5: Minimal disc bulge without significant mass effect or stenosis.C5/6: There is a left paracentral disc protrusion which causes anterior left hemicord flattening without intrinsic cord signal abnormality. There is no resulting central stenosis.C6/7: UnremarkableC7/T1: UnremarkableBilateral facet hypertrophy with ligamentum flavum thickening at T2/3 encroachment bilateral neural foramina without significant resulting stenosis.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.L1/2: UnremarkableL2/3: UnremarkableL3/4: There is a small left foraminal/lateral disc protrusion which abuts the adjacent L3 nerve roots. There is also mild left facet hypertrophy without resulting foraminal stenosis.L4/5: Mild bilateral facet hypertrophy without resulting foraminal stenosis.L5/S1:Disc desiccation, disc height loss, asymmetric bulge to the right, small superimposed right paracentral disc protrusion, endplate spurring eccentric to the left, and mild bilateral facet hypertrophy. There is abutment of the right S1 nerve root sheath origin without deformation. There is no central stenosis, although there is mild left neural foraminal and minimal right neural foraminal stenosis.

Output: 1.Asymmetry is noted of the lateral ventricles, right greater than left, which is most likely secondary to anatomic variation. Correlation with prior historical studies could help to determine if there has been interval change.2.There is a solitary, small, ovoid focus of susceptibility hypointensity within a peripheral posterior right temporal gyrus without other associated signal abnormality. This most likely represents a small focus of hemosiderin deposition, of uncertain etiology or clinical significance.3.There is lack of visualization within the distal left vertebral artery. Correlation with the cervical MRI portion of today's studies demonstrates the left-sided transversarium foramina to be small, consistent with a congenitally hypoplastic left vertebral artery. However, portions of the cervical left vertebral artery fail to demonstrate a flow void. It is uncertain if this is due to past dissection or from non-visualization of the tiny lumen.4.C3/4: There is a tiny midline disc protrusion, partially effacing the anterior CSF, without associated cord deformation or central stenosis.5.C5/6: There is a left paracentral disc protrusion which causes anterior left hemicord flattening without intrinsic cord signal abnormality. There is no resulting central stenosis.6.Bilateral facet hypertrophy with ligamentum flavum thickening at T2/3 encroachment bilateral neural foramina without significant resulting stenosis.7.L3/4: There is a small left foraminal/lateral disc protrusion which abuts the adjacent L3 nerve roots.8.L5/S1:Asymmetric bulge to the right with small superimposed right paracentral disc protrusion. There is abutment of the right S1 nerve root sheath origin without deformation. There is no central stenosis, although there is mild left neural foraminal and minimal right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: 58 yo female with hx of dermatofibrosarcoma protuberans to back; please evaluate for recurrence History: back mass Skin markers are placed were placed along the skin of the right mid back. A small vertical fissure is seen, presumably at the site of prior resection. No underlying edema or abnormal enhancement to suggest tumor recurrence. Small foci of susceptibility on gradient echo images are likely posterior surgical. No focal fluid collections. No lymphadenopathy is evident.

Output: No evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. The segment 8 ablation cavity measures approximately 2.8 x 1.6, cm, decreased from prior without evidence of marginal residual or recurrent disease. No new suspicious arterial enhancing and washing out lesion.Hepatic steatosis. The vasculature is patent.No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Heterogeneous bone marrow signal intensity is nonspecific.OTHER: No significant abnormality noted.

Output: Stable post treatment changes of segment 8 without evidence of residual recurrent disease.


Instruction: Generate impression based on findings.

Input: Transient loss of vision in left eye (amaurosis fugax), blurring in right eye. History of lupus. Orbits: The bilateral globes and ocular adnexa, optic nerves, and optic chiasm are unremarkable. There is no evidence of intraorbital mass. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The tiny outpouchings in the region of the left posterior communicating artery are better depicted on the prior CTA. The skull and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral maxillary sinuses.

Output: 1. Unremarkable orbit MRI.2. No evidence of acute intracranial hemorrhage, mass, or acute cerebral infarction.3. Unchanged nonspecific mild cerebral white matter lesions.


Instruction: Generate impression based on findings.

Input: Avascular necrosis, CML MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Serpentine regions of low T1 signal are noted in the distal femur, both the medial and lateral femoral condyles, and proximal tibia. There is associated marrow edema with these changes. There is no evidence of fracture.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Avascular necrosis of the distal femur and proximal fibula.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: There is no evidence of intracranial hemorrhage, mass, or acute infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Delayed gross and fine motor development. Delayed language acquisition. Preserved primitive reflexes. Axial hypotonia. There is no evidence of intracranial hemorrhage, mass, abnormal calcifications, or infarct. The brain parenchyma appears unremarkable, with an appropriate degree of myelination for age. The pituitary gland appears to be intact. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of gross structural abnormalities.


Instruction: Generate impression based on findings.

Input: Brain MRI: Again seen is hemorrhagic lesion in the medial right parietal lobe with linear enhancement corresponding to the previously embolized arteriovenous malformation. There is decrease in size of the hemorrhagic cavity associated with the lesion. No new or enlarging flow-voids within this region are demonstrated to suggest enlargement or persistent arteriovenous shunting. No new surrounding edema.Irregular linear enhancement involving the left lateral central gyrus related to known AVM also remains unchanged. No associated hemorrhage or edema.Previously described subtle area of abnormal linear enhancement/vascularity in the left posterior frontal lobe is not appreciated as a discrete lesion, but the appearance is similar to prior. There are foci of nodular enhancement which are best appreciated on the high-resolution post gadolinium 3-D sequence series 1601 in the left occipital lobe (image 72), right occipital lobe (image 70), right cerebellar hemisphere (image 39), as well as a slightly larger focus in the left cerebellar hemisphere measuring 5 mm (image 57). These are all unchanged since 10/20/2014. No associated susceptibility is seen.There are foci of susceptibility, one in the left anterior temporal lobe image 91, as well as one just lateral to the left thalamus, image 104 of series 1101. These appear to be present on prior study from 10/20/2014 and unchanged.The brain parenchyma demonstrates no evidence of acute infarct, intracranial hemorrhage or new mass effect. Ventricles are normal in size without evidence of hydrocephalus. No extra-axial collections. No midline shift or herniation. Calvarium and extracranial soft tissues are grossly unremarkable. Brain MRA:No definite MRA abnormality is noted in the region of the previously embolized right medial parietal arteriovenous confirmation. Abnormal vasculature is noted corresponding to the small arteriovenous malformation in the left central sulcus similar to prior.Additional areas of enhancement described above demonstrate no clear MRA correlate. There is antegrade flow within the intracranial internal carotid arteries, the bilateral anterior, middle, and posterior cerebral arteries, as well as the distal vertebral and basilar arteries. No significant stenosis or evidence of aneurysm.

Output: 1.Previously seen embolized arteriovenous malformation in the right medial parietal lobe is not associated with new edema, new hemorrhage, or new flow-voids to suggest persistent arteriovenous shunting. Associated hemorrhagic cavity is decreased in size compared to 10/20/2014.2.No significant change in appearance of the abnormal tangle of vascularity demonstrated with both MRI and MRA sequences within the left central sulcus. There is no associated signal abnormality within the adjacent parenchyma.3.Previously described focus of linear enhancement in the left posterior frontal lobe, presumably corresponding to the additional arteriovenous malformation demonstrated on prior angiogram remains unchanged.4.Additional nodules of enhancement are seen in the bilateral occipital lobes and bilateral cerebellar hemispheres as detailed above. No associated susceptibility or abnormal associated flow-voids. These are suspected to represent additional vascular lesions associated with HHT without arteriovenous shunting, although tiny AVMs remain a possibility. These however appear unchanged by MRI.5.Foci of susceptibility in the left anterior temporal lobe and one just lateral to the left thalamus as described above. While nonspecific these may represent additional vascular lesions, possibly cavernous malformations versus unrelated chronic microhemorrhages. These are also unchanged since 10/20/2014.


Instruction: Generate impression based on findings.

Input: 17 year old female with pain and swelling. Rule out ligamentous or meniscal injury. MENISCI: There is deformity and displacement of the posterior horn of the medial meniscus with apparent fragments identified adjacent to the anterior horn of the medial meniscus, consistent with a flipped bucket handle tear. The lateral meniscus appears intact. ARTICULAR CARTILAGE AND BONE: Note is made of serpentine signal abnormality within the medial and lateral femoral condyles consistent with osteonecrosis/bone infarcts. There are subchondral cysts in the intercondylar eminence. No full thickness or near full thickness articular cartilage defects are identified. There is bone marrow signal abnormality within the posterior aspect of the medial tibial plateau.LIGAMENTS: There is edema type signal abnormality within and discontinuity of the midsubstance fibers of the ACL suspicious of a complete rupture. The PCL and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intactADDITIONAL

Output: 1. Bucket handle tear of the medial meniscus.2. Findings suspicious for complete mid ACL rupture.3. Osteonecrosis of the femur.4. Joint effusion and other findings as described above.


Instruction: Generate impression based on findings.

Input: 20 year-old female with pain status post fall and trauma to head and positive loss of consciousness. There is no evidence of intracranial hemorrhage, mass or edema. A nonspecific focus of low attenuation is present within the white matter just adjacent to the right frontal horn which appears to represent encephalomalacia. This is nonspecific and of unknown etiology. Correlation with clinical history and possibly further evaluation with MRI as clinically indicated to further determine etiology.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CERVICAL SPINE: There is minimal straightening of the visualized cervical spine secondary to positioning for the examination. Cervical spine alignment is within normal limits without evidence of spondylolysis or spondylolisthesis. Vertebral body heights and intervertebral disk spaces are within normal limits. The pre-and paravertebral soft tissues are within normal limits. The airway is patent.Within the limits of CT scanning, the thecal sac and spinal cord are preserved with no evidence of spinal canal stenosis. If there is clinical concern for spinal cord or ligamentous injury, an MRI may be considered.

Output: 1. No evidence of fracture or intracranial hemorrhage.2. Normal cervical spine without evidence of fracture or malalignment.3. Focus of low attenuation adjacent to right frontal horn appears to represent encephalomalacia. This is nonspecific and of unknown etiology. Correlation with clinical history and possibly further evaluation with MRI as clinically indicated to further determine etiology.


Instruction: Generate impression based on findings.

Input: 55-year-old female with right shoulder pain. ROTATOR CUFF: Mild intermediate signal within the supraspinatus tendon suggestive of tendinopathy. Otherwise, the rotator cuff appears intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Supraspinatus tendinopathy; otherwise, unremarkable exam of the shoulder.


Instruction: Generate impression based on findings.

Input: [Male, 33 years old. Reason: Ewing's Sarcoma off therapy; completed chemotherapy and radiation therapy] [Again seen is a mass situated between the bladder and the rectosigmoid colon, measuring approximately 6.2 x 5.5 cm in transverse dimension (series 8, image 21) and approximately 5.9 cm in craniocaudal dimension, similar to the prior study. It is predominantly of increased signal intensity on T1 and T2 images with a low intensity rim and no enhancement on contrast images, with the MRI appearance a chronic hematoma. Mild mass effect on the adjacent rectosigmoid colon is unchanged.Mildly enhancing signal abnormality within the anterior aspect of the left sacral wing appears slightly less prominent on the current study than on the prior study and may represent a small focus of bone infarction from prior radiation therapy. An additional small round focus of decreased signal intensity best seen on T1 images in the posterior aspect of the left iliac wing is nonspecific and could represent a treated metastasis. The remaining visualized bones and soft tissues appear normal. The hip joints and sacroiliac joints appear normal.]

Output: [Posttreatment changes of pelvic Ewing's sarcoma appearing similar to the prior study. We see no evidence of disease progression.


Instruction: Generate impression based on findings.

Input: 19 month old female with a history of 7 prior seizures, 3 within the past 24 hours. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. No abnormality is noted within the white matter. An MRI may be considered to look for findings not evident by CT if clinically indicated.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is opacification of the maxillary sinuses and the ethmoid air cells.

Output: No acute intracranial abnormality. MRI may be considered for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: 86 years Male (DOB:1/27/1930)Reason: CSF flow study History: ataxiaPROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE There is redemonstration of ventriculomegaly. Biventricular diameter is 15 mm on the current exam and was 50 mm on the prior exam. The third ventricle width is 11 mm on the current exam and 11 mm on the prior exam.There are subdural effusions present bilaterally which were also present on the prior exam. These are also stable.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate focus of T2 and FLAIR signal hyperintensity is present in the right basal ganglia. Several punctate foci of signal hyperintensity are present in the pons.There is a punctate focus of signal hypointensity on susceptibility imaging in the right cerebellar hemisphere. This most likely represents a microhemorrhage and was also present on the previous exam. Another punctate focus of susceptibility is present in the left insular cortex which was also present on the prior exam. Initial location these microhemorrhages do not establish a particular pattern and are of unknown significance.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. The eyeball lenses are thin.

Output: 1.Stable ventriculomegaly. Possibility of normal pressure hydrocephalus cannot be excluded.2.Periventricular and subcortical white matter lesions of a mild degree and scattered lesions in the brainstem and right basal ganglia are nonspecific. At this age they are most likely vascular related. 3.Subdural effusions are stable compared to prior exam. This could be related to atrophy.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for abnormality. Evaluation of the neural axis. Signs and symptoms: Complains of headaches, numbness and tingling in areas around body (left leg/calf, pelvis). Nonenhanced lumbar MRI:Negative diffusion weighted series.The is normal anatomical development and morphology of brain. There is normal signal intensity of brain on all MRI sequences. The cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination is within normal.The signal void of major intracranial branches are identified. The signal intensity of the venous sinuses are unremarkable.Unremarkable images through the orbits.Calvarium, skull base and scalp are unremarkable.All paranasal sinuses, bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.Nonenhanced thoracic MRI:There is normal anatomical development of the vertebral column.There is normal anatomical alignment of the vertebral column with normal signal intensity on all MRI sequences.There is no clinically significant degenerative disease of the spine and without evidence of spinal canal or neural foraminal compromise at any level.There is normal signal intensity and caliber of the thoracic cord.There is no detectable para spinal soft tissue abnormality.

Output: 1.Negative nonenhanced brain MRI.2.Negative nonenhanced MRI of the thoracic spine.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, history of cancer now with urinary incontinence and back pain. Assess for cord compression. Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow replacement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. The spinal canal is not significantly narrowed at any level. No cord compression is seen. No pathologic epidural lesions are noted.Small disk protrusions are evident at C5-6, T6-7 and T11-12. As above, no areas of high-grade spinal canal stenosis are suspected. No significant neuroforaminal narrowing is seen.The paraspinal and subcutaneous soft tissues, as visualized, are unremarkable.

Output: No evidence of cord compression or any other specific abnormality which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, with paresthesias and muscle wasting in the hands, history of spinal stenosis, assess for degree of stenosis. A reversal of the normal cervical lordosis is evident. In addition, the C4 and C5 vertebral bodies are at least partially fused.Marrow signal characteristics are mildly heterogeneous, but there are no worrisome areas of marrow replacement or marrow edema.Within the limitations of a motion degraded examination, the spinal cord as visualized is free of pathologic signal abnormality. Cord morphology will be discussed by level as follows.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Facet hypertrophy and ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis with some deformation of cord morphology. Moderate left and mild right foraminal narrowing. C4-5: Facet hypertrophy. Posterior disc-osteophyte complex formation with a focal component in the right paracentral zone. No significant generalized spinal canal stenosis, though the focal disc osteophyte may cause some slight impingement of the right ventral cord. Mild left foraminal narrowing. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation. Moderate generalized spinal canal stenosis with questionable slight deformation of cord morphology. Moderate bilateral foraminal narrowing. C6-7: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant generalized spinal canal stenosis. Mild left foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. T1-2: As visualized on sagittal images only, a central disc protrusion is evident without significant spinal canal stenosis or cord impingement.

Output: 1.Fusion of the C4 and C5 vertebral bodies may be congenital, degenerative or postoperative in nature.2.Mild to moderate degenerative findings are seen resulting in a moderate spinal canal stenosis with cord impingement at C3-4, and a moderate spinal canal stenosis at C5-6 with questionable slight cord impingement.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for stenosis. Signs and symptoms: Left-sided weakness. Nonenhanced brain MRI:Diffusion weighted series demonstrate a focus of cortical restriction involving the precentral gyrus of the right frontal lobe consistent with an acute ischemic stroke. This finding is well visualized on FLAIR and T2-weighted images. Finding is nonhemorrhagic and produces very subtle mass effect.Additional examination demonstrate multiple small cortical strokes involving bilateral frontal lobes, bilateral posterior parietal-occipital lobes as well as bilateral posterior temporal lobes. There is ex vacuo dilatation of supratentorial ventricular system with maintained midline. Images through posterior fossa also demonstrate few small chronic cerebellar strokes.Nonenhanced brain MRA:Right internal carotid artery is patent across the skull base in its supraclinoid segment. Mild atherosclerotic smooth narrowing of the supraclinoid carotid caliber is detected. The right anterior and middle cerebral arteries are identified and unremarkable in their proximal portions. Distal arterial atherosclerotic disease of branches of the right anterior and middle cerebral arteries are noted. A prominent right posterior communicating artery is identified.Left internal carotid artery is patent across the skull base and indicate supraclinoid segment. Left anterior and middle cerebral arteries are unremarkable in their proximal segments. The distal branches however demonstrate atherosclerotic disease with multiple foci of moderate to severe stenosis. Bilateral vertebral arteries and basilar artery are widely patent. Superior cerebellar and bilateral posterior cerebral arteries are identified.Enhanced neck MRA:The visualized aortic arch and the origins of major vessels are all unremarkable. Brachiocephalic branching and bilateral subclavian arteries are widely patent. Bilateral common carotid arteries, internal carotid arteries and external carotid arteries and including the origins are unremarkable.

Output: 1.Nonenhanced brain MRI demonstrate a focus of restricted diffusion without evidence of hemorrhage in the right frontal precentral gyrus. Extensive chronic ischemic strokes of bilateral cerebral hemispheres and bilateral cerebellar as detailed.2.Nonenhanced MRA of intracranial circulation demonstrate patency of all major intracranial vasculature. Atherosclerotic disease with regions of moderate to severe stenosis of the distal branches of anterior and middle cerebral arteries are identified.3.Enhanced neck MRA is unremarkable as detailed above.


Instruction: Generate impression based on findings.

Input: Numbness in left arm and leg over the last month. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. However, there appears to be a disc-osteophyte complex at C3-4 with mild indentation of the spinal cord.

Output: 1. No evidence of demyelinating lesions in the brain.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.3. Apparent disc-osteophyte complex at C3-4 with mild indentation of the spinal cord. A dedicated cervical spine MRI may be useful for further evaluation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 15-year-old male with history of Crohn's disease who presents for evaluation of perianal Crohn's disease.EXAMINATION: MR pelvis without and with IV contrast 11/24/2014 PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant interval change in the mildly prominent inguinal lymph nodes measuring up to 2.0 x 0.8 cm.BOWEL, MESENTERY: Again noted is bowel wall thickening and mucosal enhancement involving the terminal ileum. No stricture is identified.BONES, SOFT TISSUES: At approximately 6:00 position, there is a T2 hyperintense, diffusion restricting, and rim-enhancing linear tract measuring up to 3.8 cm and extending to the posterior, inferior anal verge.OTHER: No significant abnormality noted.

Output: 1.Findings as above consistent with perianal fistula at 6:00 position.2.Inflammatory changes involving the terminal ileum suspicious for Crohn's disease.


Instruction: Generate impression based on findings.

Input: 27 year old man with history of LV dysfunction in setting of anthracycline chemotherapy for AML, referred for evaluation of LV function. Study was performed without contrast at the request of the referring clinician.Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 111 ml/m2 (normal range: 74+/-15), the LVEDV is 224 ml (normal range 142+/-34), the LV end systolic volume index is 59 ml/m2 (normal range 25+/-9), the LVESV is 120 ml (normal range 47+/-19), the LV mass index is 56 g/m2 (normal range 85+/-15), and the LV mass is 113 g (normal range 164+/-36). LV systolic dysfunction is global.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 193 ml (normal range 142+/-31), the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9), and the RVESV is 100 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 trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 46%. LV systolic dysfunction is global. Compared to prior MRI on 4/23/14, LV function has slightly increased (from 44% to 46%)2. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%.


Instruction: Generate impression based on findings.

Input: 66 year old male with history of head and neck cancer, found to have severe left ventricular hypertrophy on ECHO. Cardiac MRI done to evaluate for hypertrophic cardiomyopathy and/or infiltrative disease. Left VentricleThe left ventricle is normal in size and systolic function. The anteroseptal wall measures 12 mm and the posterior wall is 10 mm in thickness (i.e. mild left ventricular hypertrophy). A prominent sigmoid septum is noted (normal variant). The overall LV ejection fraction is 61%, the LV end diastolic volume index is 56 ml/m2 (normal range: 74+/-15), the LVEDV is 107 ml (normal range 142+/-34), the LV end systolic volume index is 22 ml/m2 (normal range 25+/-9), the LVESV is 41 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 97 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. No evidence of myocardial iron overload. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 57 ml/m2 (normal range 82+/-16), the RVEDV is 106 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 42 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 trivial mitral regurgitation. The anterior mitral valve leaflet is thickened and somewhat calcified. There is no systolic anterior motion.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (61%)2. The right ventricle is normal in size and systolic function (61%)3. Mild left ventricular hypertrophy with no evidence of outflow tract obstruction. A prominent sigmoid septum (which is a normal variant) is present. The echo measurement is overestimating the severity of left ventricular hypertrophy due to inability to distinguish the endocardial border from adjacent trabeculae, papillary muscles, and RV myocardium. 4. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with left lower extremity weakness and bilateral lower extremity numbness. Cervical:Evidence of instrumented anterior fusion is seen at C5 and C6. There is a grade 1 anterolisthesis of C5 relative to C6. Elsewhere, the cervical lordosis is straightened.There may be some degree of osseous fusion of the C3 and C4 vertebral bodies as there is no clearly recognizable disc space. The C3 and C4 vertebral bodies demonstrate patchy fatty replacement which may be degenerative in nature. Elsewhere, the visualized marrow signal is within normal limits.Due to the spondylolisthesis of C5 relative to C6, there is narrowing of the spinal canal at this level with mild associated impingement and kinking of the spinal cord. There may be slightly increased T2 signal within the cord at this level as well. Elsewhere, cord morphology and signal characteristics are within normal limits.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild facet hypertrophy. Fusion across the disc space without significant disc osteophyte formation. No spinal canal stenosis. Minimal if any left foraminal narrowing. C4-5: Right paracentral and foraminal disc osteophyte formation. The right ventral thecal sac and lateral recess are effaced. Severe right and moderate left foraminal narrowing. C5-6: Spondylolisthesis as above with significant associated spinal canal narrowing and slight kinking of the spinal cord. Moderate bilateral foraminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. The thyroid gland is partially visualized but appears to be nodular bilaterally. Patchy fluid signal is seen within the mastoid air cells.Thoracic:Abnormal T2 signal is again seen within the T9-10 disc space and adjacent marrow. The endplates are severely irregular. Extension of this process is seen into the ventral epidural space with cord impingement and severe spinal canal stenosis. Extension is also seen into the anterior paraspinal soft tissues with adjacent edema. These findings overall appear similar to the prior examination.Relatively mild abnormal T2 signal within the T8-9 and T7-8 intervertebral discs with matching mild abnormal signal in the adjacent vertebral body marrow is seen. These findings are nonspecific and could be either degenerative or infectious/inflammatory in nature. Again, findings are similar to prior. Marrow signal abnormality is also seen within the T11 and T12 vertebral bodies, perhaps in association with small Schmorl's nodes, similar to prior.The spinal cord shows normal signal characteristics throughout.Spinal alignment is within normal limits otherwise. Except where endplate irregularities are seen, the vertebral bodies demonstrate preserved height.Mild edema of the posterior paraspinal musculature is seen on the right in the lower thoracic region.Lumbar:Marrow signal characteristics are extremely heterogeneous with patchy areas of T1/T2 hyperintensity likely representing degenerative endplate signal change. There are multiple scattered Schmorl's node deformities similar to prior. Vertebral body height is nevertheless grossly maintained. Alignment is anatomic. No significant change is noted from the prior examination.The visualized distal spinal cord and conus show normal signal intensity and morphology. No epidural abnormalities are suspected.L1-2: No significant spinal canal or foraminal stenosis.L2-3: No significant spinal canal or foraminal stenosis.L3-4: No significant spinal canal or foraminal stenosis. L4-5: Marked facet hypertrophy with ligamentum flavum thickening. Right-sided disc bulge contributing to a moderate to severe generalized spinal canal stenosis with particular effacement of the right lateral recess, and a severe right foraminal narrowing. The left neural foramen is mildly narrowed. L5-S1: Mild facet hypertrophy with ligamentum flavum thickening. Mild disc bulging asymmetric to the right. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. The kidneys are small and cystic compatible with chronic renal failure.

Output: 1.Evidence of anterior instrumented fusion of C5 and C6. Spondylolisthesis at this level results in a significant spinal canal narrowing and impingement/kinking of the spinal cord. Findings are similar to prior. Significant foraminal narrowing is also evident bilaterally at C4-5 and C5-6. There has been no significant interval change in these findings.2.Findings are again seen highly concerning for discitis osteomyelitis centered at T9-10. There is ventral epidural extension of this process which causes a severe spinal canal stenosis and cord impingement but without frank cord signal abnormality. Relatively mild disc and endplate signal change at T7, T8, T11 and T12 is of uncertain significance and could be degenerative or inflammatory/infectious. Findings have not significantly changed.3.Extensive endplate degeneration through the lumbar spine. Disc degeneration is also seen, most severely affecting the L4-5 level where there is a moderate to severe spinal canal stenosis, particularly affecting the right lateral recess, and a severe right foraminal narrowing. Findings have not significantly changed.


Instruction: Generate impression based on findings.

Input: 33-year-old male with history of right shoulder pain. Evaluate for instability ROTATOR CUFF: The muscles and tendons of the supraspinatus, infraspinatus, teres minor, and subscapularis are unremarkable. There is no evidence of rotator cuff tear.SUPRASPINATUS OUTLET: The supraspinatus outlet is unremarkable. There is no fluid within the subacromial or subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a linear fluid-filled tear of the posterior labrum from approximately the 7 to 9 o'clock positions. The remaining labrum appears unremarkable.BICEPS TENDON: The biceps tendon is unremarkable. ADDITIONAL

Output: 1.Posterior labral tear as above.2.Subcoracoid intraarticular loose body.3.Paralabral cysts with no evidence of nerve impingement.4.Intact rotator cuff.


Instruction: Generate impression based on findings.

Input: 56-year-old female with chest pain and shortness of breath. Evaluate for mediastinal mass. CHEST:LUNGS AND PLEURA: No significant abnormality in the lungs. No pleural effusion or focal pulmonary opacity.MEDIASTINUM AND HILA: There is a large anterior mediastinal mass with predominantly low T2 and T1 signal with scattered linear areas of T2 hyperintensity. This mass demonstrates mild diffuse enhancement on delayed sequences. There is no dropout of signal on in and out of phase sequences to indicate microscopic fat. Mediastinal mass measures 6.0 x 3.3 cm in axial dimensions (series 701, image 19). This mass measures approximately 8.7 cm in craniocaudal dimension (series 801, image 12). Findings related to this mass are nonspecific for benign or malignant features.CHEST WALL: No axillary lymphadenopathy. No significant abnormality.UPPER ABDOMEN: Partially visualized liver demonstrates small hepatic cysts. No significant abnormality.

Output: Large anterior mediastinal mass, concerning for thymic tumor, as noted on recent chest CT.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The patient submitted outside screening mammogram dated 5/10/2014, diagnostic left mammogram and ultrasound dated 5/16/2014, from Silver Cross Hospital. Additionally, images from an MRI guided left breast biopsy and post-procedural mammogram were submitted. MAMMOGRAM AND ULTRASOUND (5/10/2014 and 5/16/2014): Submitted outside study was compared to the current, post-neoadjuvant chemotherapy, mammogram dated 1/28/2015. There has been decrease in size of the irregular asymmetry within the upper outer left breast which now measures 8.0 x 4.9 x 2.6 cm (previously 9.4 x 6.0 x 3.4 cm). Comparison with prior ultrasound is more difficult given differences in measurement techniques. The multiple masses within the left upper outer breast appears slightly smaller on recent ultrasound examination.A 0.4 cm cluster of calcifications is present within the right upper outer breast, without significant change. No dominant mass is present in the right breast. IMAGES FROM MRI GUIDED RIGHT BREAST BIOPSY and POST PROCEDURAL MAMMOGRAM (6/20/2014): Images from MRI guided biopsy of the 0.4 cm enhancing focus at the 11:00 position of the right breast were submitted. Targeting appears appropriate. A clip was placed following biopsy. Post procedural CC and ML views of the right breast demonstrate a clip at the biopsy site. A moderate hematoma is present. PATHOLOGY: Per outside report, pathology from the MRI guided right breast biopsy demonstrated invasive ductal carcinoma, grade 2.

Output: 1. There has been decrease in size of the conglomerate of masses in the left breast following neo-adjuvant chemotherapy. Post treatment measurement is 8.0 x 4.9 x 2.6 cm (previously 9.4 x 6.0 x 3.4 cm. 2. Successful MRI guided biopsy of enhancing focus at the 11 o'clock position of the right breast demonstrating invasive ductal carcinoma.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Worsening LLE weakness, history of breast cancer- determine etiology of weakness Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. T1 hyperintense lesions primarily involving the L1 and L3 levels with additional smaller ones such as at the L2 and S1 levels consistent with hemangiomas. The conus medullaris is normal in position. No suspicious enhancement in the lumbar spine.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy with small subchondral cyst on the right.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.L5-S1: There is disc desiccation with mild bulge. There is also mild bilateral facet arthropathy. There is no significant spinal canal stenosis. There is minimal right and mild to moderate left neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. No evidence of metastatic disease in the lumbar spine.2. Mild degenerative changes in the lumbar spine, relatively worse at the L5-S1 level where there is mild-to-moderate left sided neural foraminal stenosis and possible impingement of the exiting L5 nerve root related to combination of mild disc bulge and facet arthropathy.


Instruction: Generate impression based on findings.

Input: History of gastric carcinoid resection. Evaluate liver lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size.Stable punctate arterial enhancing foci are again noted in segment 2 (series 9/42) measuring approximately 5 mm and in segment 7/8 measuring approximately 6 x 6 mm (series 9/40).Again these lesions retain contrast on delayed imaging. There is faint T2 weighted signal hyperintensity associated with the segment 2 lesion (series 4/13). No restricted diffusion. Hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum. The main pancreatic duct is normal in caliber. The pancreatic parenchyma is normal in signal intensity and enhancement.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. Stable examination with 2 punctate arterial enhancing subcentimeter foci. No new hepatic lesions.2. Liver steatosis.3. Pancreas divisum.


Instruction: Generate impression based on findings.

Input: Male, 31 years old. IBD arthropathy. Pain, stiffness. The sacroiliac joints appear normal, without fluid or edema in the adjacent bone to suggest sacroiliitis. Bone marrow signal intensity is normal. The hip joints are within normal limits. There is mild degenerative disc disease at L5-S1 with a small annular tear posteriorly.The musculature appears normal. Please note, the study was not protocoled for detailed evaluation of the visceral structures, but no gross abnormality is noted.

Output: 1.No evidence of sacroiliitis.2.Degenerative disc disease at L5-S1 with a small annular tear posteriorly.


Instruction: Generate impression based on findings.

Input: Reason: R ilium lesion first identified on outside MRI pelvis from 3/15, s/p needle bx without clear pathology, please evaluate for interval change History: above. BONE MARROW: Right intramedullary and screw fixation device is incompletely imaged.Interval decrease in size of ill defined lesion within the right acetabulum demonstrating T2 hyperintense, T1 hypointense signal and enhancement measures approximately 3.3 x 1.8 x 1.4 cm (series 501 image 25, series 301 image 10), previously measuring 3.3 x 2.4 x 4.3 cm.No new lesions.The remainder of the bone marrow is within normal limits.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Interval decrease in size of right acetabular lesion.


Instruction: Generate impression based on findings.

Input: Pain and swelling of the knee MENISCI: Lateral meniscus: There is complex tearing and maceration of the posterior horn at the junction of the posterior horn and body. There is horizontal tearing of the anterior horn as well.Medial meniscus: The medial meniscus is normal.ARTICULAR CARTILAGE AND BONE: Lateral compartment: There is full-thickness loss of the articular cartilage of the lateral compartment posteriorly with underlying cystic degenerative change. Thinning of the articular cartilage is noted anteriorly. Medial compartment: The articular cartilage of the medial compartment is relatively intact.Patellofemoral compartment: There is full-thickness articular cartilage loss of both the lateral patellar facet and femoral trochlea with associated degenerative marrow signal. Full-thickness articular loss of the medial facet of the femoral trochlea is also noted inferiorly.LIGAMENTS: No significant abnormality noted. Specifically, the ACL is intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tear of the lateral meniscus.2. Intact ACL.3. Osteoarthritis and cartilage loss particularly of the lateral and patellofemoral compartments, further detailed above.4. Moderate size joint effusion with large Baker's cyst with additional findings described above.


Instruction: Generate impression based on findings.

Input: 46-year-old female with left knee pain. Evaluate for medial meniscus tear. MENISCI: The anterior horn of the lateral meniscus is abnormally small consistent with tearing. There is blunting of the posterior horn of the lateral meniscus. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage of the lateral compartment and irregularity of the weightbearing surface of the medial femoral condyle without evidence of full-thickness cartilage defect. There is marked thinning of articular cartilage in the patellofemoral joint with delamination along the lateral patellar facet and multiple partial thickness cartilage defects.Bone marrow signal intensity is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Tearing of the anterior horn of the lateral meniscus and blunting of the posterior horn of the lateral meniscus. The medial meniscus is intact.2.Chondromalacia most severe in the patellofemoral compartment.3.Small Baker's cyst.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to anterior fusion of C5 and C6 with mild anterolisthesis of C5 on C6 and mild impingement upon the spinal cord at this level. There may be associated T2 hyperintensity in the spinal cord at this level versus artifact. There is scattered fatty infiltration in the bone marrow, but no evidence of edema. The vertebral body heights are essentially preserved. There is encephalomalacia in the right pons. There is high T2 signal of the intervertebral disc T9-T10 with erosions of the inferior endplate of T9 and the superior endplate of T10, as well as slight focal kyphosis. There is epidural extension of the disc material and fluid with impingement upon the spinal cord, which displays patchy high signal in this region, and paravertebral extension of the inflammatory process with multiple small fluid collections, particularly on the right side. At the T9 and T10 levels, there is also hypertrophy of the ligamentum flavum, which contributes to severe spinal stenosis. The neural foramina is also severely narrowed bilaterally. There are multiple intravertebral disc herniation in the inferior endplates of T6 through T8 and T10 through T12 and the superior and inferior endplates of T11 and T12, with associated degenerative endplate marrow signal alterations. There is bilateral renal atrophy, with multiple cysts.There are multiple intravertebral disc herniation with associated degenerative marrow changes. At L4-L5 and L5-S1, there are disc bulges, ligamentum flavum hypertrophy, and bilateral facet degenerative changes with effusions and synovial cysts with mild spinal canal stenosis and at least moderate narrowing of the neural foramina bilaterally at both of these levels. There is straightening of the lumbar spine alignment in the sagittal plane.

Output: 1. Discitis-osteomyelitis at the level of T9-T10 with epidural extension that results in spinal cord compression and mild edema. The infectious process also extends into the paraspinal region with what appears to be multiple small abscesses. However, characterization is limited due to the lack of intravenous contrast. 2. Multiple thoracic and lumbar intravertebral disc herniations.3. Degenerative spondylosis at L4-L5 and L5-S1 with at least moderate narrowing of the neural foramina bilaterally and mild spinal canal stenosis.4. Postoperative findings related to anterior fusion of C5 and C6 with mild anterolisthesis of C5 on C6 and mild impingement upon the spinal cord at this level and possible myelomalacia versus artifact. 5. Chronic right pons infarct.


Instruction: Generate impression based on findings.

Input: 73-year-old man with additional history as per chart: PSA of 4.9 on 5/2016 and status post biopsy revealing Gleason 7 disease. PELVIS:PROSTATE:Prostate Size: 42 x 27 mmPeripheral Zone: There is a 12 x 12 x 12 mm focus of T2 hypoattenuation, diffusion restriction, and enhancement seen in the mid left peripheral zone (series 801, image 14). Additionally, there is an approximately 9 x 5 mm area of low T2 signal and diffusion restriction in the right prostatic base (series 801, image 17) and a 4 x 4 millimeter area of low T2 signal and diffusion restriction in the mid right peripheral zone (series 801, image 13).Central Gland: The central gland is unremarkable.Seminal Vesicles: The seminal vesicles appear normal.Extracapsular Extension: There is loss of normal capsular signal along the left posterolateral aspect (series 01, image 14), however the adjacent neurovascular bundle appears uninvolved.BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: Small focus of juxta-articular high T1 signal on postcontrast images in the right sacral ala (series 2301, image 163) is noted, however this area is not covered on the precontrast T1 images. Additionally, there is an area of T1 and T2 hypointensity in the right pubic symphysis (series 501, image 84) which slightly enhances.OTHER: No significant abnormality noted.

Output: 1.Lesion in the mid left peripheral zone with extracapsular extension highly suspicious for adenocarcinoma.2.Additional suspicious areas of signal abnormality in the right peripheral zone.3.Partially imaged lesion in the right sacral ala and right pubic symphysis which are nonspecific but may be further evaluated with nuclear medicine bone scan to exclude metastatic foci.


Instruction: Generate impression based on findings.

Input: History of epilepsy with intractable complex partial seizures, preoperative planning. Limited images for treatment planning. Increased T2/FLAIR signal in the right hippocampus is better assessed on the 5/16/2015 MRI study without evidence of associated hippocampal atrophy. The ventricles and basal cisterns are normal in size and configuration. No intracranial mass or mass effect. No midline shift or herniation. The major cerebral flow voids are intact. There is unchanged mild mucosal thickening within the right frontal sinus and anterior ethmoidal air cells.

Output: Limited sequences for operative planning. Abnormal T2/FLAIR signal within the right hippocampus better demonstrated on 5/16/2015 MRI. No significant hippocampal atrophy.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other musculoskeletal symptoms referable to limbs(729.89)Malignant neoplasm of other specified sites of female breastClinical question: unexplained weakness in her armSigns and Symptoms: arm weakness bilateral. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature centered at C5-6.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge and disc desiccation at this level. There are small uncovertebral osteophytes present at this levelAt C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are mild degenerative changes present in the cervical spine without significant compromise to spinal canal or exiting nerve roots.2.Mild reversal of the normal cervical curvature could be related to patient positioning or muscle spasm.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:2/11/1963)Reason: 1 month of headache, visual change, R tongue sensation change, ? L facial droop History: as abovePROVIDER/ATTENDING NAME: MURRAY J KEENE RICHARD G KRAIG There is subtle gyral enhancement and some leptomeningeal enhancement present along the right occipital lobe. There is associated T2 and FLAIR hypointensity along the adjacent subcortical white matter and some mild diffusion restriction.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is gyral enhancement along the right occipital lobe. Differential considerations include subacute infarction as well as an inflammatory or infiltrating process such as meningoencephalitis or granulomatous disease or lymphomatous disease.2.Findings were discussed with Dr. Burns at the time of this dictation


Instruction: Generate impression based on findings.

Input: Paresthesias, urinary frequency, and diplopia. There is linear branching enhancement with associated susceptibility effect and mild T2 hyperintensity in the right pons. There are also punctate foci of patchy enhancement and associated susceptibility effect within the right inferior frontal lobe. The brain parenchyma otherwise appears unremarkable. 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, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. Linear branching enhancement with associated susceptibility effect and mild T2 hyperintensity in the right pons is compatible with a developmental venous anomaly.2. Punctate foci of patchy enhancement within the right inferior frontal lobe may also represent developmental venous anomalies or telangiectasias.3. No evidence of intracranial demyelinating lesions.


Instruction: Generate impression based on findings.

Input: MRI brain: There is a large intracerebral hematoma involving the right temporal, parietal and frontal lobes measuring 8.8 x 5.2 cm in maximum axial dimensions. There is intraventricular hemorrhage with layering hemosiderin levels in the occipital horns as well as blood in the third and fourth ventricle. There is extensive T2 hyperintensity surrounding the lesion consistent with vasogenic edema. There is mass effect with effacement of the right lateral ventricle and subfalcine herniation. There is mild dilatation of the left lateral ventricle. There is midline shift to the left of approximately 9 mm. There is effacement of the cortical sulci on the right side. There are foci of restricted diffusion with associated T2 hyperintensity involving the right paramedian frontal lobe, as well as along the left cingulate gyrus indicating small areas of acute ischemia.In addition there are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with chronic small vessel ischemic changes.The midline structures and craniocervical junction are within normal limits.There is minimal mucosal thickening and small air-fluid levels in the maxillary and sphenoid sinuses, including mucosal thickening in the bilateral ethmoid and left frontal sinuses. MRA brain: There is no evidence of any vascular malformation in the vicinity of the large right cerebral hematoma. There is reduced caliber of the right middle cerebral artery branches likely secondary to mass effect. No aneurysms are detected within the limitations of technique.The intracranial internal carotid arteries are normal in course and caliber. The left middle cerebral artery and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber.

Output: 1. Large intracerebral hematoma in the right temporal, parietal and frontal lobes, with extensive intraventricular hemorrhage as demonstrated on previous CT, showing no significant interval change.2. Mass effect on the right ventricle, subfalcine herniation and 9 mm leftward midline shift.3. Small areas of acute ischemia involving the right paramedian frontal lobe and the left cingulate gyrus.4. Periventricular and subcortical hyperintensities compatible with chronic small vessel ischemic disease. 5. No evidence of any vascular malformation is seen in the vicinity of the large hematoma. Reduced caliber of the right middle cerebral artery branches is likely secondary to mass effect.


Instruction: Generate impression based on findings.

Input: There is a subtle focus of apparent diffusion restriction in the anterior aspect of the left thalamus without a correlate on the T2 sequence. There is no restricted diffusion elsewhere. Extensive periventricular and subcortical white matter T2/FLAIR hyperintensity is present throughout the cerebral white matter as well as in the pons likely reflective of advanced chronic small vessel ischemic disease. In particular, there is FLAIR signal abnormality involving the bilateral anterior temporal lobes. Areas of T2 hyperintensity are also evident in the bilateral cerebral hemispheres and vermis. Focal area of encephalomalacia is present in the right external capsule with susceptibility signal compatible with chronic hemorrhagic infarct. No intracranial mass or mass effect. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Bilateral maxillary sinus retention cysts, left larger than the right.

Output: 1. Subtle focus of apparent diffusion restriction in the left anterior thalamus without a definite correlate on the T2 sequences. This finding may represent a small focus of hyperacute infarct, with artifact a less likely possibility. A follow-up study can be considered for confirmation. There is otherwise no clear evidence of acute infarct in the brain. 2. Extensive periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but favored to represent advanced chronic small vessel ischemic disease. Given the particular signal abnormality involving the bilateral anterior temporal lobes, CADASIL may also be a consideration in the appropriate clinical setting. There is also particular T2/FLAIR signal abnormality involving the bilateral cerebellum which is uncommon with chronic small vessel ischemic disease and therefore this finding and perhaps also component of the brainstem and supratentorial signal abnormality may be related to PRES. Other inflammatory processes/encephalitis can also be considered.3. Chronic hemorrhagic infarct involving the right external capsule.Findings were discussed with APN Stefanie Blummer by phone on 12/22/2016 at 11:05 AM.


Instruction: Generate impression based on findings.

Input: History of elevated PSA and family history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 5.0 x 3.9 x 4.6 cm.Peripheral Zone: There is a 5 x 8 mm focus of decreased T2 and ADC signal within the lateral aspect of the right mid peripheral zone (series 801, image 17) suspicious for neoplasm. There is a 4 x 5 mm focus of decreased T2 and ADC signal within the medial aspect of the left mid peripheral zone (series 801, image 16) suspicious for neoplasm.There is a 4 x 5 mm focus of decreased T2 and ADC signal within the lateral aspect of the left apex (series 801, image 11) suspicious for neoplasm. There are a few additional smaller foci of decreased T2 signal within the peripheral zone which are nonspecific.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Several subcentimeter foci of signal abnormality in the bilateral peripheral zone suspicious for neoplasm. No specific evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: 44-year-old female patient with right shoulder pain, limited abduction, known stage IV metastatic breast cancer, right scapular pain. Evaluate for right rotator cuff injury. ROTATOR CUFF: There is increased signal intensity and thickening of the distal supraspinatus tendon consistent with tendinopathy but no full thickness tear. The muscle and tendons of the subscapularis, infraspinatus, and teres minor appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. No fluid is identified in the subdeltoid/subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. The glenoid labrum is grossly intact.BICEPS TENDON: The long head of the biceps tendon is intact. ADDITIONAL

Output: Tendinopathy of the supraspinatus tendon without full thickness rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 49 year old male with a history of chemotherapy induced cardiomyopathy, presenting with acutely reduced LVEF. Referred for cardiovascular MRI to evaluate for myocarditis vs. CAD. Left VentricleThe left ventricle is normal in size with severely reduced systolic function. There is severe hypokinesis of the lateral wall and near-akinesis of all other regions, as well as diffusely thinned myocardium. An apical thrombus is noted, measuring 18mm x 10mm, with a thick stalk which appears affixed to the subendocardial apical wall. The overall LV ejection fraction is 22%, the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVEDV is 103 ml (normal range 142+/-34), the LV end systolic volume index is 67 ml/m2 (normal range 25+/-9), the LVESV is 158 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 95 g (normal range 164+/-36). There is no late gadolinium enhancement of myocardial infarct, fibrosis or inflammation.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 23%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 66 ml/m2 (normal range 31+/-9), and the RVESV is 157 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal 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. There is no evidence of central pulmonary embolus.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac Findings1. Large loculated right pleural effusion which has increased in size and become more organized when compared to CT on 12/4/14. There is also a small left pleural effusion.2. Multiple large lymph nodes in the right axilla, stabe size of partially calcified lymph nodes in the anterior mediastinum.3. A 1.5 cm low-signal lesion is seen in the lateral spleen, more conspicuous than on prior CT, raising question of a metastasis.4. T2 high signal of two vertebral bodies which are new, suggestive of osseous metastases. One at approximately T3 is punctate left of midline, the second is also left of midline, of approximately 40% of the L1 vertebral body.Findings were discussed with resident caring for the patient at 1307hrs.

Output: 1. Left ventricle is normal in size with global, severely reduced systolic function, with regional variation as described above (LVEF 22%). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The appearance is suggestive of a dilated cardiomyopathy, possibly secondary to chemotherapy.2. An apical thrombus measures 18mm x 10mm with a stalk affixed to the apical subendocarium. 3. Right ventricle is normal in size with severely reduced systolic function (RVEF 23%).4. Mild tricuspid regurgitation and mild to moderate mitral regurgitation.5. High signal within two vertebral bodies which are new, suggestive of osseous metastases.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, 24 years old, 22 weeks gestation, twins, with brain abnormalities detected on ultrasound of the male twin. Please note that assessment is limited to fetus1 which is on the maternal right in cephalic presentation.The corpus callosum is absent with an expected colpocephalic pattern of lateral ventricular prominence. In addition, there is a gap of at least 8 mm within the right cerebral hemisphere which allows communication between the extracerebral CSF and the ventricular system. The choroid plexus appears to dangle through this defect. Severe parenchymal thinning or encephalomalacia affects the bilateral paramedian parietal lobes. Frank parenchymal loss is seen in the bilateral occipital lobes, right side more than left.The third and fourth ventricles are within normal limits. The posterior fossa structures are normal. Apart from the above-mentioned parenchymal lesions, the overall pattern of parenchymal development is appropriate for age.

Output: Multiple intracranial abnormalities are identified in fetus 1 (cephalic, maternal right) including agenesis of the corpus callosum, a parenchymal defect in the right cerebral hemisphere which may represent schizencephaly, and bilateral parenchymal defects involving the parietal and occipital lobes. The posterior fossa structures are spared.


Instruction: Generate impression based on findings.

Input: The study is motion degraded and nearly nondiagnostic. Given this caveat:Soft tissue edema with ill-defined enhancement is noted involving the soft tissues overlying the right posterior sacral region and sagittal STIR images fail to demonstrate osseous edema, thus there is no gross evidence of osteomyelitis.Redemonstrated are small disc bulges at L4/5 and L5/S1 with mild to at most moderate facet hypertrophy from L3/4 through L5/S1. There is no gross central or neural foraminal stenosis. The cauda equina is grossly unremarkable and terminates at an appropriate level.

Output: The study is motion degraded and nearly nondiagnostic. Given this caveat, no gross evidence for osteomyelitis. Soft tissue edema with ill-defined enhancement is noted involving the soft tissues overlying the right posterior sacral region and sagittal STIR images fail to demonstrate osseous edema.


Instruction: Generate impression based on findings.

Input: 70 year-old female with altered mental status. Evaluate for hematoma. The small area of low attenuation in the left cerebellum seen on axial image number 7 is suspicious for an old small stroke. The age is unable to be determined due to the small size of the hypodense region. MRI may help further evaluate if indicated. There are no noted supratentorial abnormalities.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small area of low attenuation in the left cerebellum likely representing an old stroke. MRI may help further evaluate if indicate.


Instruction: Generate impression based on findings.

Input: 76-year-old male with bleeding, left hepatic mass status post embolization, assess for rebleed. ABDOMEN:LIVER, BILIARY TRACT: The reference heterogeneous exophytic left hepatic mass measures 3.5 x 3 .3 cm, previously 3.3 x 2.3 cm. There is no washout on postcontrast sequences. There is progressive heterogeneous nodular enhancement on delayed sequences, which measures approximately 2.5 x 1.6 cm (29; series 15). No additional enhancing lesions are noted. There is a small adjacent simple cyst, which appears similar to the prior study. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in size of the reference exophytic left hepatic mass, which is incompletely characterized given the history of embolization, but may represent a hemangioma. Further evaluation with percutaneous biopsy could be considered for further characterization.


Instruction: Generate impression based on findings.

Input: Evaluate for left temporal parietal lesion: Right hand weakness, speech apraxia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Patient states that he was struck with 7200 volts of electricity and flung. There are depression deformities involving the superior endplates of T5, T6, T7, and T10. There is patchy high T2 signal in the superior aspects of these vertebral bodies. There is mild loss of anterior anterior vertebral body height at T6. There also high T2 signal within the T9-10 intervertebral disc. There is a small bulge at T7, but no spinal canal or neural foraminal stenosis throughout the thoracic spine. There is no abnormal signal in the thoracic spinal cord. There are multiple prominent mediastinal lymph nodes. There is a partly imaged hiatal hernia.

Output: 1. Multiple endplates deformities involving T5-T7 and T10 due to intravertebral disc herniations with bone marrow edema in the some of the thoracic vertebrae, which can be related to intravertebral disc herniations, although traumatic fractures are also potential consideration.2. Small bulge at T7, but no spinal canal or neural foraminal stenosis throughout the thoracic spine. 3. Multiple nonspecific prominent mediastinal lymph nodes. Refer to the prior chest imaging may be useful for further evaluation.4. Hiatal hernia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of decreased rectal tone and back pain, evaluate for lumbar compression. There are apparently size lumbar vertebrae based on the position of the iliolumbar ligament. There is mild retrolisthesis of L5 on L6. The vertebral body heights are preserved. There is loss of disc space height at L5-L6 and L6-S1 with corresponding disc desiccation and bulges, which appear to have decreased in size. In conjunction with bilateral facet arthropathy, there is mild bilateral neural foraminal stenosis, but no significant spinal stenosis. The vertebral bone marrow signal is unremarkable. The distal spinal cord and conus medullaris display normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: There are apparently size lumbar vertebrae. Degenerative spondylosis at L5-L6 and L6-S1 results in mild bilateral neural foraminal stenosis, but no significant spinal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Acute cerebrovascular accident. Redemonstration of multifocal supra and infratentorial bihemispheric acute ischemic infarctions without evidence of hemorrhagic transformation. No change since prior scan.Extensive nonspecific small vessel ischemic disease and left cerebellar encephalomalacia seen do not show any interval change either.Multifocal susceptibility artifacts are again seen, no change since prior exam.Although there are significant motion artifacts for post contrast scans which degraded diagnostic accuracy, there is no definitive evidence of abnormal enhancement.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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal various degree narrowing of intracranial vessels especially on bilateral M2 and 3 of middle cerebral artery as well as bilateral P2 and PCA segments of posterior cerebral arteries.However, these lesions are nonspecific since the resolution of MR angiogram is limited. In addition, these findings are difficult to differentiate from atherosclerotic changes from intracranial vasculitis. To clarify the nature of intracranial arterial narrowing, diagnostic catheter angiogram is highly recommended if clinically indicated.There is no intracranial aneurysm on this MR angiogram. 3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate slightly ectatic and tortuous but maintaining normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No interval change of multifocal ischemic infarctions without hemorrhagic transformation since prior scan.2. No definitive evidence of abnormal enhancement.3. Multifocal various degreed intracranial arterial luminal irregularities and narrowings especially medium sized vessels as described above. These findings are non specific especially based on MR angiography. Differential diagnosis include atherosclerotic changes or intracranial vasculitis. If clinically suspicious for intracranial vasculitis as described on clinical history section, a diagnostic catheter angiography is highly recommended for the clarification and differential diagnosis.4. Some atherosclerotic changes of cervico-carotid arterial system without evidence of significant luminal stenosis.


Instruction: Generate impression based on findings.

Input: Signs and symptoms: 51-year-old male with right mouth droop. Clinical question: Right mouth through Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Fairly acute strokes can be missed on nonenhanced head CT. Recommend follow with an MRI considering patient's presenting symptoms.Cortical sulci, ventricular system and all CSF cisterns remain within normal limits. The gray -- white matter differentiation remains normal.There is extensive opacification of left ethmoid air cells and significant rightward nasal septum deviation this limited view of paranasal sinuses.

Output: Negative nonenhanced head CT. Considering provided clinical data recommend follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: MRI brain: The study is degraded by motion. There is a large confluent area of restricted diffusion, T2 hyperintensity, and mild swelling involving the right precentral gyrus. There are also punctate foci of restricted diffusion and T2 hyperintensity in the right middle frontal gyrus. There is a background of diffuse cerebral white matter T2 hyperintensity without restricted diffusion. There is encephalomalacia in the right pons. There is diffuse cerebral volume loss. There is no midline shift or evidence of acute intracranial hemorrhage. MRA brain: There are atherosclerotic steno-occlusive lesions of the M1 segments of the middle cerebral arteries bilaterally. The middle cerebral arteries are patent up to the level of the bifurcation. The anterior cerebral arteries appear to be patent. However, there are also atherosclerotic irregularities of the internal carotid arteries bilaterally. There are also atherosclerotic irregularities of the V4 segments of the bilateral vertebral arteries. The basilar artery appears patent. The posterior cerebral arteries are patent. The anterior cerebral arteries are patent.

Output: 1. Early subacute infarct involving the right precentral gyrus and to a lesser degree the right middle frontal gyrus, without evidence of hemorrhagic transformation or midline shift.2. Chronic right pontine infarct and diffuse chronic small vessel ischemic disease of the cerebral white matter.3. Atherosclerotic steno-occlusive lesions of the M1 segments of the middle cerebral arteries bilaterally and V4 segment of the vertebral arteries bilaterally.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 67 years Female (DOB:8/15/1948)Reason: Primary CNS lymphoma status post treatment. History: Primary CNS lymphoma status post treatment.; please compare with previous MRI done here and the outside MRI images.PROVIDER/ATTENDING NAME: CHADI NABHAN CHADI NABHAN There is some exact effect on the frontal horn of the left lateral ventricle. There is a T2 and FLAIR signal hyperintense focus present adjacent to the frontal horn of the left cerebellar ventricle measuring 13 x 32 mm in axial dimensions which is unchanged compared to prior exam. There is no associated contrast enhancement. Signal hyperintensity along the left corticospinal tract and atrophy of the left cerebral peduncle suggest Wallerian degeneration. There is a burr hole present along the left frontal calvarium.There is a T2 and FLAIR hyperintense focus present in the left parietal bone which was also present on the prior exam and has not changedNormal 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: There is no interval change. There is no evidence for recurrence of the patient's known lymphoma. The appearance of the bed of the lesion in the left frontal periventricular white matter is stable. There are findings which are compatible with a wallerian degeneration.


Instruction: Generate impression based on findings.

Input: Female, 15 years old, with history of NF1 and worsening headaches and neck pain. Brain:Multiple scattered areas of cortical and subcortical T2 hyperintensity are demonstrated involving the high left frontal lobe, both parietal lobes and questionably along the right medial temporal lobe. All of these lesions are new when compared to the prior MRI examination from 2012. The largest lesion, within the right parietal lobe, also demonstrates several small foci of susceptibility suggesting minimal blood product. This lesion also seems to exert a slight local mass effect.A punctate nonspecific focus of T2 hyperintensity within the right centrum semiovale is unchanged. Small foci of T2 hyperintensity seen within the thalami on the prior examination are not distinctly appreciated on today's study. A focus of nonspecific T2 hyperintensity within the left restiform body is new, as is a focus slightly lower at the right posterior cervico-medullary junction.No evidence of restricted diffusion is seen. No significant generalized mass effect is detected. No large intracranial hemorrhage or abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology.Although this is not a dedicated examination of the optic pathways, the orbital structures appear to be within normal limits and no optic pathway masses are suspected.C-spine:Apart from the cervico-medullary signal abnormality discussed above, the cervical spinal cord shows normal signal intensity and morphology. No intraspinal masses are appreciated.The spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow signal abnormality is detected.No evidence of significant spinal canal or neuroforaminal stenosis is seen.Soft tissue neck:The soft tissue structures of the neck are within normal limits. No pathologic adenopathy is detected in the cervical region. There may be some mildly prominent lymph nodes in the upper mediastinum but these are nonspecific. No convincing evidence of any large neurofibroma or other mass lesion is seen.

Output: Multiple areas of new pathologic T2 signal are seen within the cerebrum and brainstem. Some of these could reflect FASI of neurofibromatosis, particularly the brainstem lesions and perhaps also the lesion along the right medial temporal lobe, as these are fairly characteristic locations.Many of the lesions, however, show morphology and distribution which are atypical for FASI. In particular, the dominant lesion in the right parietal lobe seems to exert some degree of local mass effect and is associated with small quantities of blood product, which are not typical features of FASI. The imaging features of these lesions are, however, fairly characteristic for a PRES-like vascular phenomenon, and based on review of the medical record, the patient does appear to have risk factors for this condition.Assessment of the cervical spine and soft tissues of the neck is within normal limits. No specific lesions are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Recent resection of an extradural dorsal fibrous mass at T11. Some small dorsal aspects are very adherent to the dura and were left. There are postoperative findings related to recent T11 extradural mass resection. There is are prominent areas of hypointensity in the posterior epidural space at the T10-11 level, which likely represent thickening of the ligamentum flavum, which result in mild spinal canal stenosis. Although no large mass is otherwise apparent, evaluation for tumor is limited due to the lack of contrast. There is persistent diffuse T2 hyperintensity and mild swelling of the lower spinal cord. The vertebral body heights are preserved. The thoracic spine alignment is anatomic. There are multiple foci of T1 and T2 hyperintensity in the vertebral white matter, which likely represent hemangiomas or focal fat.

Output: Postoperative findings related to recent T11 extradural mass resection with prominent areas of hypointensity in the posterior epidural space at the T10-11 level that likely represent thickening of the ligamentum flavum and result in mild spinal canal stenosis. Although no large mass is otherwise apparent, evaluation for tumor is limited due to the lack of contrast. However, diffuse edema in the lower spinal cord persists.


Instruction: Generate impression based on findings.

Input: 64-year-old male with abdominal pain and ampullary lesion seen on outside CT. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Gallbladder surgically absent. No biliary ductal dilation (see below).SPLEEN: No significant abnormality noted.PANCREAS: No focal pancreatic lesions. Previously seen mild dilation of the common bile duct and pancreatic duct appears resolved with the common bile duct measuring up to 5 mm, previously 7 mm, and the pancreatic duct measuring up to 4 mm, previously 8 mm. No ampullary mass is evident. No choledocholithiasis. The findings may be related to benign stricture at the level of the ampulla.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: Interval decreased caliber of the common bile duct and pancreatic duct. No ampullary mass is evident. The findings may be related to benign stricture at the level of the ampulla.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. Mild mucosal thickening is present within the bilateral maxillary sinuses, sphenoid sinuses, and ethmoid air cells. The midline structures and craniocervical junction are within normal limits.

Output: 1.Brain MRI is within normal limits without evidence of intracranial mass or mass effect.2.Paranasal sinus mucosal thickening which may represent sinusitis.


Instruction: Generate impression based on findings.

Input: 55 year old female with sarcoidosis and palpitations, referred for cardiovascular MRI to evaluate for cardiac sarcoid involvement. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVEDV is 126 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 81 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 75 ml/m2 (normal range 69+/-14), the RVEDV is 139 ml (normal range 110+/-24), the RV end systolic volume index is 35 ml/m2 (normal range 22+/-8), and the RVESV is 66 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch. There is anomalous right subclavian artery originating from the descending aorta (i.e. Lusoria Artery). The artery travels posterior to the esophagus which does not appear to be dilated proximally. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 56%). There is no evidence of cardiac sarcoid involvement.2. The right ventricle is normal in size and systolic function (RVEF 53%)3. Anomalous origin of the right subclavian artery from the descending aorta (i.e. Lusoria Artery), normal variant. The artery travels posterior to the esophagus which does not appear to be dilated proximally. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of parotid gland Disorder of brain, unspecified Abnormal findings on diagnostic imaging of other specified body structuresClinical question: h/o HNC and CRTSigns and Symptoms: new brain lesions as found on last CT scans The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 23x 19 mm homogenously enhancing mass with intermediateT2 signal, located in the right precuneus associated with vasogenic edema.There is a14x15 mm axial dimension homogenously enhancing mass with highT2 signal, located in the right basal ganglia.There is a 24x25 mm axial dimension homogenously enhancing mass with heterogeneous T2 signal, located in the posterior aspect of the right gyrus rectus and medial orbital gyrus extending to the posterior orbital gyrus. It is associated with vasogenic edema.There is a12x11 mm axial dimension homogenously enhancing mass with high T2 signal, located in the right cerebral peduncleThere is a11x11 mm axial dimension homogenously enhancing mass with lhighT2 signal, located in the left middle temporal gyrus next to the left inferior temporal sulcus. It is associated with vasogenic edema.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.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Incidental note is made of partial empty sella.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.The visualized portions of parotid glands are asymmetric.

Output: 1.Multiple enhancing masses within the supratentorial brain as detailed above. The possibility of metastatic disease cannot be excluded.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: work related back injury ? History: severe low back pain, unresponsive to one year of physical therapy. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are localized high signal intensities of L4 and L5 vertebral body on T2 images adjacent to Schmorl's nodes. On Gad enhanced scan, there are localized enhancement around the Schmorl's nodes. The L45 disc shows diffuse bulging of disc which is extending toward left side neural foramen which abuts the left L4 root.Other intervertebral discs from T12-L1 to L5S1 appear to be normal.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level. The paraspinal soft tissues are unremarkable.

Output: 1. Diffuse bulging of disc with slight extension toward left side neural foramen at the level of L45 which abuts left L4 root as described above.2. Schmorl's nodes with enhancements at the inferior endplate of the L4 and superior endplate of the L5 vertebral bodies.3. Otherwise unremarkable.