Instruction: Generate impression based on findings.

Input: 61 years Female (DOB:8/30/1954)Reason: worsened neck and upper and lower back pain in pt w known cspine stenosis and lumbar disc ds History: worsened neck and upper and lower back pain in pt w known cspine stenosis and lumbar disc dsPROVIDER/ATTENDING NAME: DEBORAH L. BURNET JAMES MOON MOK Cervical spine: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 disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild facet hypertrophy present on the right side at this level.At C5-6 there are endplate and uncovertebral osteophytes present associated with a disc bulge and narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots. The neural foramen encroachment appears to be worse on the right when compared to the left side at this level. Overall there is a mild degree of spinal stenosis at this level.At C6-7 there are endplate and uncovertebral osteophytes present associated with a disc bulge and narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is a right thyroid cystic lesion present which is not completely included on this exam.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is some facet hypertrophy present at this level.At L4-5 there is mild anterior subluxation of L4 on L5. There is moderate facet hypertrophy present at this level. There is no significant, minus the spinal canal or exiting nerve roots. The degree of subluxation is mildly progressed since prior exam this level. Overall there is previously subluxation was a couple millimeters currently its several millimeters. The facet hypertrophy is changed character as the facet joints are narrow where on the current exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are some degenerative changes present in the lower lumbar spine worse at L4-5 where there is facet hypertrophy and mild subluxation which has mildly progressed since the prior exam of 7/12/2010.2.There are degenerative changes in the cervical in the cervical spine worse at C5-6 and C6-7 with bilateral neural foramen encroachment of exiting nerve roots at these levels and mild spinal stenosis at C5-6. This has not changed significantly compared to the prior exam.3.A cystic lesion is present in the right thyroid lobe. This is not entirely included on this exam. Please note that MR is not accurate in evaluation of the thyroid gland. Please correlate with clinical symptoms. Please note that the this was obscured on the prior exam due to saturation band and comparison cannot be adequately made.


Instruction: Generate impression based on findings.

Input: Right breast DCIS. Additional left breast calcifications noted on review of outside images. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.At the site of known malignancy in the right outer breast, there is tightly clumped non-mass enhancement measuring 2.2 x 2.1 x 1.6 cm. Artifact compatible with biopsy clip is seen along the medial inferior aspect of the enhancement. Two additional enhancing findings are present in the right breast. Near 10:00 anterior depth, a 5 mm focus with central non-enhancement is present. The finding is probably benign, though a second look ultrasound will be done. Additionally, there is a 2.9 cm area of linear/branching non-mass enhancement in the central breast at mid to anterior depth. This is morphologically suspicious, though less enhancing than the proven malignancy.In the left outer breast extending from anterior to posterior depth there is highly suspicious clumped non-mass enhancement. This measures 11.2 x 1.9 x 3.0 cm. The enhancement extends to within 1 cm of the pectoralis muscle, but the muscle enhances normally. The left nipple enhances normally and symmetrically compared to the right. The immediate retroareolar tissues are also normally enhancing.  No abnormal lymph nodes are identified in either axillary region.

Output: 1. Area of enhancement spanning up to 2.2 cm at the site of biopsy proven malignancy in the right upper outer breast.2. Highly suspicious contralateral enhancement spanning up to 11.2 cm in the left outer breast. Additional magnification views will be performed today to evaluate the left breast calcifications. Two site stereotactic biopsies versus MRI guided biopsies can be considered to establish extent.3. Additional 2.9 cm area of linear/branching non-mass enhancement in the central right breast enhances less than either of the two areas above, but is nonetheless suspicious in morphology. MRI guided biopsy should be performed presuming breast conservation is being considered on the right.4. Probably benign 5 mm focus in the right 10:00 position. Second look ultrasound will be performed today. If that is negative and the patient has breast conservation on the right, then this focus should be followed in 6 months with MRI. The patient will see Dr. Jaskowiak today. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Possible primary biliary cirrhosis. Abnormal LFTs. ABDOMEN:LIVER, BILIARY TRACT: The liver is mildly lobular in contour with patchy reticular T2 weighted hyperintensity suggestive of cirrhosis with fibrotic changes. These regions demonstrate increasing enhancement on delayed phase imaging without a discrete mass lesion, biliary ductal dilatation or capsular retraction.The vessels are patent.The common bile duct measures up to 10 mm, yet tapers smoothly at the level of the ampulla without an obstructive lesion evident. Normally distended gallbladder.SPLEEN: The spleen is normal in size without a focal lesion.PANCREAS: Normal morphology. The main pancreatic duct is normal in caliber. No focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal interpolar intraparenchymal T2-weighted hypointense subcentimeter focus is not clearly a cyst but is too small to characterize otherwise.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. Chronic liver disease morphology with fibrotic changes. No discrete mass lesion.2. Right renal intraparenchymal subcentimeter T2 weighted lesion is not clearly a cyst; dedicated renal CT in 1 year is suggested to confirm stability.


Instruction: Generate impression based on findings.

Input: 51-year-old male, evaluate for slap lesion ROTATOR CUFF: There is contrast noted within the subacromial and subdeltoid bursa compatible with full-thickness tear of the supraspinatus tendon without retraction.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a tear of the superior labrum which extends from posterior to anterior compatible with a SLAP (Superior Labrum Anterior Posterior) type II lesion BICEPS TENDON: The biceps tendon is intact with no evidence of tear or other abnormality.ADDITIONAL

Output: 1. Findings compatible with a SLAP II lesion. 2. Full thickness tear of the supraspinatous tendon.


Instruction: Generate impression based on findings.

Input: 45-year-old female with stage IV ovarian cancer. Evaluate for clinical trial. Is there measurable disease? Is there sites of disease that can be safely biopsied twice?Per outside report, clinical history ofPET avid area to left iliopsoas. Patient with history of recurrent ovarian cancer. ABDOMEN:LIVER, BILIARY TRACT: Within the left lobe of the liver, there is a peripheral enhancing lesion measuring 1.8 x 1.5 cm (series 17 image 27) that demonstrates restricted diffusion and FDG avidity on outside PET. Additional peripheral enhancing lesion lesion along the gallbladder fossa measures 1.1 x 1.1 centimeters (series 17 image 42) also demonstrates restricted diffusion FDG avidity on outside PET. Focus of arterial enhancement in segment 3 likely represents a flash filling hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Omental and mesenteric nodules in the left abdomen compatible with carcinomatosis. Nodule that demonstrated FDG avidity on outside PET measures 1.4 x 0.8 cm (series 19 image 45).BONES, SOFT TISSUES: Enhancing nodule adjacent to the left iliopsoas muscle measures 1.2 x 1.1 cm (series 23 image 47) and is PET avid on outside PET. Additional enhancing nodule lateral to the left iliopsoas muscle (series 23 image 38). OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical changes of hysterectomy and bilateral salpingo-oophorectomy. BLADDER: No significant abnormality noted.LYMPH NODES: Ill defined soft tissue nodularity anterior to the rectum compatible with carcinomatosis. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hepatic lesions suspicious for metastases.2.Omental and mesenteric nodularity in the abdomen and pelvis suspicious for carcinomatosis.


Instruction: Generate impression based on findings.

Input: Large symptomatic uterine fibroids presents for surgical planning. PELVIS:UTERUS, ADNEXA: The uterus is markedly enlarged and distorted by numerous well-defined masses, compatible with numerous fibroids. It measures approximately 18.5 x 8.7 cm in sagittal dimension. Many of these masses are pedunculated and extend into the left and right adnexa. The largest fibroid is a pedunculated fibroid extending to the left adnexa measuring 7.6 x 7.3 cm (series 5 on 1/35). The fibroids demonstrate heterogeneous postcontrast enhancement with some demonstrating partial central necrosis.The endometrial cavity is distorted by the numerous submucosal and intramural fibroids. It does not appear thickened.The endometrial/inner myometrial junction is poorly seen but is otherwise unremarkable.The right ovary measures 2.4 x 1.3 cm (series 501/16) with several physiologic follicles.The left ovary measures 4.0 x 2.9 cm and contains several physiologic follicles and a simple cyst measuring 2.2 x 1.6 cm. Small amount of free fluid in the cul-de-sac and adjacent to the right adnexum is within physiologic limits.The cervical stroma is normal in signal intensity.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild bilateral hydroureters is partially imaged to the level of the pelvic inlet likely related to mass effect from the enlarged uterus.OTHER: No significant abnormality noted.

Output: 1. Markedly enlarged and distorted uterus containing numerous well-defined enhancing masses compatible with leiomyomata.2. Partially imaged mild bilateral hydroureters to the level of the pelvic inlet likely related to mass effect from the enlarged uterus.


Instruction: Generate impression based on findings.

Input: Reason: Changes in Crohn's involvement since last exam. History: Crohn's disease, wall thickening and enhancement of TI in 2010, study to assess evidence of resolution or progression ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See below.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild mucosal hyperenhancement involving the distal 5 cm terminal ileum without significant wall thickening. No fistulas or abscesses. No evidence of obstruction. No fluid collections.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis, likely physiologic.

Output: Mild hyperenhancement suggestive of a prior terminal ileitis. No evidence of active disease.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with mild erosion of the calvarium. An extra-axial mass with a broad base of dural attachment is seen along the left paramedian vertex measuring up to 21 mm in AP length and up to 13 mm in thickness. The lesion is mildly enhancing. The lesion barely contacts the underlying brain parenchyma causing no significant parenchymal edema. It does, however, appear to infiltrate the overlying calvarial bone, permeating through the inner table and thinning but not definitely eroding through the outer table.No additional enhancing lesions are seen intra or extracranially. Scattered nonspecific foci of T2 hyperintensity are seen within the cerebral hemispheres without significant mass effect. No restricted diffusion is seen. No intracranial hemorrhage or abnormal extra-axial fluid collections are detected. The ventricular system is normal in size and morphology.

Output: A small extra-axial mass is seen along the left vertex with invasion into the overlying skull. The differential diagnosis would include meningioma, perhaps an atypical variant given the osseous erosion. Other mesenchymal tumors including hemangiopericytoma and hemangioendothelioma can be considered. Although metastasis would be unusual without a known primary, this would technically be in the differential as well.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate osteo-. Signs and symptoms: Back pain. Nonenhanced lumbar MRI:Examination redemonstrated diffuse marrow signal changes all vertebral bodies of L3 and L4 consistent with edema. There is also redemonstration of increased T2 signal intensity in the severely degenerated disc space at L4-L5. Although the extent of the findings appears similar to prior exam the signal changes appear slightly less conspicuous on T2 STIR sequence which may be technical or could represent subtle interval improvement of edema. Although the T2/T2 STIR signal of disc space at this level remains similar to prior exam there is suggestion of subtle interval decreased height of disc space which conceivably could represent decreased effusion in the disc space and with resultant decreased disc height. Ventral epidural defects of degenerative cause and with resultant central spinal stenosis demonstrate no change.Degenerative changes at L2-L3 and a prominent degenerative ventral epidural defect with resultant moderate central spinal stenosis demonstrate no change.Marrow signal changes suggestive of edema at T11 and T12 vertebral bodies and the intervertebral disc space is again identified and as well suggestive of inflammatory changes/discitis osteomyelitis. Compared to prior exam the signal changes at this level is less conspicuous which again can be technique related or indicate subtle interval improvement. There is no evidence of a spinal stenosis at this level.Significant bilateral neural foraminal compromise secondary to degenerative disease at L3-L4 and L4-L5 levels are again noted. Bilateral neural foraminal compromise at T11-T12 also remains stable and similar to prior exam.There is no evidence of any perispinal or epidural abnormal soft tissue thickening or collection on this non-infused exam.

Output: 1.Redemonstration of L3-L4 disc and vertebral body signal changes suggestive of inflammation/infectious process appears slightly less conspicuous on T2 STIR compared to prior exam which could be technique related or may represent subtle interval improvement.2.Redemonstration of disc space and adjacent vertebral body signal changes at T11-T12 highly suggestive of an inflammatory/infectious process also appears slightly less conspicuous on sagittal T2 STIR which may be technique related or represent subtle interval improvement since prior study.3.Central spinal stenosis secondary to degenerative disease at L4-L5 and L3-L4 levels remains stable since prior exam.4.Significant bilateral neural foraminal compromise at T11-T12, L3-L4 and L4-L5 levels secondary to degenerative disease remains similar to prior exam.5.No detectable perispinal or epidural soft tissue abnormality or collection on this nonenhanced study.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 30 seconds.

Output: Successful arthrogram injection of the right hip.


Instruction: Generate impression based on findings.

Input: 20-year-old female with cramps. Rule out fatty replacement thigh muscle, myopathy. The muscles of the right thigh appear normal without evidence of fatty atrophy or edema. We see no abnormal enhancement. The remaining soft tissues of the right thigh appear normal. Marrow signal intensity of the right femur appears normal.On the large field-of-view coronal images there is an intramedullary lesion centrally within the mid left femoral diaphysis. It measures approximately 7 cm in craniocaudal dimension and approximately 1.5 cm in greatest transverse dimension and results in mild endosteal scalloping and perhaps mild cortical thickening. It has a lobulated margin. It is predominantly isointense to muscle on T1-weighted images, heterogeneously hyperintense on T2-weighted images and shows peripheral and somewhat lobular enhancement on postcontrast images

Output: 1.Normal appearance of the right thigh musculature without evidence of fatty atrophy or myositis.2.Intramedullary lesion of the left femoral diaphysis as described above that we suspect represents a benign enchondroma. However dedicated femur radiographs are strongly recommended for confirmation.


Instruction: Generate impression based on findings.

Input: Strong family history of breast cancer and BRCA carrier. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Biopsy clip artifact again noted in the right posterior central breast.No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 29 year old female with a history of biventricular dilation referred for cardiac MRI for further characterization. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 103 ml/m2 (normal range: 65+/-11), the LVEDV is 174 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 65 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 109 ml/m2 (normal range 69+/-14), the RVEDV is 183 ml (normal range 110+/-24), the RV end systolic volume index is 52 ml/m2 (normal range 22+/-8), and the RVESV is 87 ml (normal range 35+/-13). There is mild extrinsic compression of the RV free wall without hemodynamic compromise.Right AtriumThe right atrium is normal in size. Prominent eustachian valve.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is significant scoliosis and decreased space between the sternum and spine. There is a significant pectus excavatum. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with normal systolic function (LVEF 62%).2. The right ventricle is mildly dilated with normal systolic function (RVEF 52%).3. Compared to cardiac MRI 4/2016 the left ventricle and right ventricle are less dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Morgan is a 57 year old female with a personal history of bilateral breast cancer status post right breast lumpectomy for IDC treated with radiation in 2013 and left breast mastectomy for multifocal IDC/DCIS in 2014. RIGHT BREAST:There is heterogeneous amount of fibroglandular tissue. Mild background parenchymal enhancement is noted in the right breast. Stable postsurgical changes present in the right breast. Benign intramammary lymph node unchanged in the right lateral breast. No abnormal enhancement is seen in the right breast.LEFT BREAST:Patient is status post left breast mastectomy with implant-based reconstruction. There is no abnormal MR enhancement seen in the left reconstructed breast or chest wall. AXILLA:No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: A 41 year old female with hypertension, sickle cell trait, and mildly reduced left ventricular systolic function referred to stress cardiac MRI for evaluation of etiology.MEDICATIONS: Amlodipine, Aspirin, Carvedilol, Dapsone, Plaquenil, Prednisone First Pass PerfusionDuring hyperemia, no perfusion defects were present. A black ring was noted at the base, mid and apex both in stress and rest, thus this finding most probably represents an artefact.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is moderately dilated with mild systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 106 ml/m2 (normal range: 65+/-11), the LVEDV is 185 ml (normal range 109+/-23), the LV end systolic volume index is 55 ml/m2 (normal range 18+/-5), the LVESV is 97 ml (normal range 31+/-10), the LV mass index is 72 g/m2, and the LV mass is 125 g. There is mild global hypokinesis with some regional variation.Left AtriumThe left atrium is mild to moderately dilated. Right VentricleThe right ventricle is normal in size with borderline reduced systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 94 ml/m2 (normal range 69+/-14), the RVEDV is 165 ml (normal range 110+/-24), the RV end systolic volume index is 48 ml/m2 (normal range 22+/-8), and the RVESV is 85 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 no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is probably thyroid enlargement, recommend correlation with exam or ultrasound. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Moderate LV dilation with mildly reduced systolic function (LVEF 48%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.4. Normal RV size and borderline reduced systolic function (RVEF 49%).5. See extra-cardiac findings


Instruction: Generate impression based on findings.

Input: Ear and neck pain. There is a small focus of T2 hyperintensity along the medial aspect of the right occipital condyle-C1 junction favored to represent synovial cyst, but without mass effect on the cervical cord or medulla. Craniovertebral junction appears otherwise within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained aside from minimal anterolisthesis of C3 on C4 and retrolisthesis of C5 on C6. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc osteophyte complex including uncovertebral hypertrophy. There is advanced left-sided facet arthropathy which contributes to moderate to severe left-sided neural foraminal stenosis. No significant compromise to the spinal canal or right neural foramen.C4-5: Disc osteophyte complex including uncovertebral hypertrophy and left facet arthropathy. Mild ligamentum flavum thickening. There is moderate to severe left neural foraminal stenosis. There is mild narrowing of the spinal canal and mild right neural foraminal narrowing. C5-6: Small disc osteophyte complex including uncovertebral hypertrophy as well as ligamentum flavum thickening. There is also left-sided facet arthropathy. There is mild spinal canal stenosis. There is moderate to severe left neural foraminal stenosis. Mild to moderate right neural foraminal stenosis. There is mild effacement of the left lateral aspect of the thecal sac at the C6 level related to a T1 and T2 hyperintense focus which may represent a small bony or perhaps soft tissue spur.C6-7: Minimal disc bulge without significant spinal canal or neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine primarily consisting of left-sided facet arthropathy, worst at the C3-C4 level, and associated with moderate to severe left-sided neural foraminal stenosis at the left C3-C4, C4-C5, and C5-C6 levels.2. Mild spinal canal stenosis at the C4-C5 and C5-C6 levels. No high-grade spinal canal stenosis or evidence of cord signal abnormality.3. Small T2 hyperintense focus along the medial aspect of the right occipital condyle-C1 junction favored to represent synovial fluid/cyst without mass effect on the medulla or cervical cord.


Instruction: Generate impression based on findings.

Input: Left knee instability MENISCI: There is mild intrasubstance degeneration of the posterior horn of the medial meniscus but otherwise there is no evidence of tear in either the medial or lateral menisci.ARTICULAR CARTILAGE AND BONE: There is heterogeneity and moderate articular cartilage loss with partial-thickness defects identified within the femoral trochlea centrally. The articular cartilage of the patella is intact as is the articular cartilage of the medial and lateral compartments. A scattered area of increased T2/low T1 signal intensity is identified within the fibular head/neck which may represent a cartilaginous lesion.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Mild intrasubstance degeneration of the medial meniscus without evidence of discrete medial or lateral meniscal tear.2. Moderate articular cartilage loss of the femoral trochlea centrally with a small joint effusion.


Instruction: Generate impression based on findings.

Input: Male, 44 years old, with cerebral cavernous malformation of the left brainstem, compare to outside images. Clinical symptoms of right arm and face numbness. Since the prior examination, a T1/T2 hypointense lesion within the left aspect of the pontomedullary junction has decreased in size, measuring up to 5 mm in diameter on T2 weighted images, previously over 10 mm. The lesion has lost nearly all of its previously seen bubbly T2 hyperintense characteristics, as well as its T1 hyperintense characteristics. The degree of associated susceptibility has also diminished. No significant surrounding edema is seen. At most, there may be a very subtle blush of associated enhancement which is not convincing for the presence of a developmental venous anomaly.No additional intracranial lesions are seen. No parenchymal edema or mass effect is detected. There are no abnormal extra axial fluid collections and the ventricles are normal in size and morphology.

Output: 1.Interval decrease in size of a hemosiderin stained lesion at the left ponto-medullary junction which, at least on prior imaging, had characteristic features for a cavernous malformation. The lesion is now hypointense on all sequences, having lost its prior T2 and T1 hyperintense features.2.No additional or new intracranial lesions are appreciated.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of prostate [C61] / Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: Pt is a 65 y/o male with met CRPC, right leg weakness, evaluate for progression of disease, cord compression History: met CPRC For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are replacement of normal fatty marrow of lumbar vertebral bodies, sacrum and bilateral iliac bones with evidence of inhomogeneous enhancement indicating diffuse metastatic lesions.In particular, at the level of L5, there are enhancing soft tissue lesions within the spinal canal out side of thecal sac suggesting tumor extensions. In addition, there are multifocal non enhancing lesions within L5, S1 and bilateral iliac bones indicating necrotic portions.There is also grade 1 anterolisthesis of L4 on L5.Comparing to prior scan performed on Dec 23 2015, there have been interval progression of normal fatty marrow replacement of lumbar vertebral bodies. At the level of L5 and Sacrum, interval development of soft tissue lesions and progression of lower sacral involvement indicate interval progression of metastatic lesions at this level. There is normal lumbar lordosis. Although there are STIR high signal intensities at L4, L5 and S1 vertebral bodies may indicate compression fracture. However, the vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. There is no evidence of abnormal enhancement of spinal cord or cauda equina on this scan.Degenerative changes are specified by the intervertebral level as follows: T12-L1: normal fatty marrow has been replaced, no neuroforaminal narrowing or spinal stenosis. L1-L2: normal fatty marrow has been replaced, no neuroforaminal narrowing or spinal stenosis. L2-L3: normal fatty marrow has been replaced, no neuroforaminal narrowing or spinal stenosis. L3-L4: broad based disc bulging toward left side neural foramen which results minimal to mild neuroforaminal stenosis. No evidence of spinal canal stenosis. L4-L5: pseudo bulging of disc with associated central focal protrusion which abuts thecal sac. There is also associated broad based disc protrusion toward right side neuroforamen which results moderate to severe neuroforaminal stenosis. On Gad enhancement, bilateral ligamentum flavum as well as thecal sac appear to show enhancement indicating possible tumor involvement. Spinal canal at this level also shows mild to moderate stenosis. L5-S1: Diffuse enhancement of sacrum and adjacent soft tissues. In particular, thecal sac at this level also appears to show enhancement.

Output: 1. Interval progression of metastatic lesion involvement including lumbar, sacral and bilateral iliac bones since prior scan.2. Grade 1 anterolisthesis of L4 on L5 with moderate degree spinal stenosis.3. Moderate to severe right neuroforaminal stenosis due disc protrusion at the level of L45.4. Bilateral ligamentum flavum and possibly thecal sac enhancements are seen from the level of L5 to sacro-coccygeal area indicate possible tumor involvement of intraspinal content. 5. Spinal cord signal intensity is normal. There is no evidence of abnormal enhancement on spinal cord or cauda equina.


Instruction: Generate impression based on findings.

Input: 69-year-old male with swelling of legs, chronic ulcer, suspicious findings on CT. Evaluate for osteomyelitis. There is soft tissue irregularity along the anterior aspect of the left tibia, consistent with the patient's known history of ulceration. There is diffuse nonspecific subcutaneous edema about the leg. There is associated enhancement of the subcutaneous tissues underlying the aforementioned ulceration which extends to the level of the anterior cortex of the tibial diaphysis. There is associated periosteal reaction affecting the mid diaphysis of the tibia and fibula consistent with with the findings seen on recent CT examination. These findings appear most consistent with chronic osteomyelitis. There is no bone marrow signal abnormality to suggest acute osteomyelitis. There is diffuse fatty atrophy of the imaged musculature of the leg. There is a small to moderate sized knee joint effusion which extends posteromedially into a small Baker's cyst, with associated thick nodular enhancement on postcontrast sequences suggesting a synovitis.

Output: 1. Findings consistent with ulceration and subcutaneous edema along the anterior aspect of the left leg with associated periosteal reaction that appears most consistent with chronic osteomyelitis as described above. No imaging findings to suggest acute osteomyelitis are identified.2. Small to moderate sized joint effusion with associated nodular enhancement suggesting a synovitis.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact.There are postoperative findings related to prior left pterional craniotomy. The left sphenoid wing post treatment changes are not well assessed on this exam. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is an unchanged left cerebellar developmental venous anomaly. There is otherwise 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 midline structures and craniocervical junction are within normal limits.

Output: 1.No evidence of intracranial metastases. 2.The left sphenoid wing post treatment changes are not well assessed on this exam but appear grossly unchanged.


Instruction: Generate impression based on findings.

Input: Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies. There is slight asymmetric increase in enhancement of the left facial nerve from the geniculate ganglion to the level of stylomastoid foramen consistent with provided history of previous left facial paralysis and Ramsey Hunt.

Output: 1.Negative MRI of the internal auditory canals including gadolinium enhancement. Specifically, there are no findings to explain the patient's left are pulsatile tinnitus.2.There is slight asymmetric increase in enhancement of the left facial nerve from the geniculate ganglion to the level of stylomastoid foramen consistent with provided history of previous left facial paralysis and Ramsey Hunt.


Instruction: Generate impression based on findings.

Input: Reason: left foot pain - medial plantar surface, after trauma 1 month ago History: eval plantar fascia - midfoot region source of pain?. Markers were placed along the anterior aspect of the midfoot.The plantar fascia and plantar musculature appears normal.There is a small amount of fluid within the flexor hallucis longus tendon sheath immediately proximal to the knot of Henry as well as a small amount of fluid in the tendon sheath as it courses posterior to the talus. These findings may reflect a mild tenosynovitis, but are of questionable clinical significance. Although the Achilles tendon is not imaged in its entirety, the visualized portions appear normal. Mild edema within the posterior aspect of the calcaneus near the Achilles insertion may reflect enthesopathy, of questionable clinical significance. Small amount of fluid within the posterior tibialis and flexor digitorum longus tendon sheaths within normal limits. The peroneal tendons appear intact. The anterior tendons appear intact.Please note that this study was not protocoled for evaluation of the ankle ligaments. However, the Lisfranc ligament appears intact.The bones of the midfoot are intact. There is mild osteoarthritis affecting the first metatarsophalangeal joint. Edema within the plantar aspect of the first metatarsal head likely is degenerative in etiology.Lobulated collection of fluid signal intensity situated dorsal to the middle cuneiform measures 1.1 x 1.3 x 1.6 cm compatible with a ganglion.

Output: 1.Normal-appearing plantar fascia and plantar soft tissues.2.Small amount of fluid along the flexor hallucis longus tendon may represent mild tenosynovitis, but is of questionable current clinical significance.3.Mild edema within the posterior aspect of the calcaneus at the Achilles insertion may reflect mild enthesopathy, likewise of questionable current clinical significance.4.Mild osteoarthritis of the first metatarsophalangeal joint.5.Dorsal soft tissue ganglion.


Instruction: Generate impression based on findings.

Input: 41-year-old man with history of renal cell carcinoma status post partial nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: The partially visualized liver is normal. The common bile duct is normal.SPLEEN: The spleen is normal. An accessory splenule is noted.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Patient is status post partial left nephrectomy with left mid and lower pole scarring. A 3.8 cm right midpole renal cyst is unchanged. There is a retroaortic left renal vein.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: There is a 15 x 14 mm duodenal diverticulum (series 3, image 28). The partially visualized small bowel and colon are otherwise normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postoperative findings without evidence of recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: Diagnosis: Arnold-Chiari syndrome without spina bifida or hydrocephalusClinical question: Re evaluate right cerebellar signal abnormality and Chiari malformationSigns and Symptoms: headache MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils extend approximately 7 mm below the level of foramen magnum. There is no evidence for ventriculomegaly.No CSF flow abnormalities are appreciated at the level of the foramen magnum.There is redemonstration of a 12 mm x 8 mm axial dimension signal hyperintense lesion located in the deep gray nuclei of the cerebellum on the right side previously measured the same dimensions. This is also unchanged since the exam of 3/28/13 and 1/12/2013The central canal is dilated to approximately 1.5 mm at the C6 vertebral body level for a length of approximately 1 cm. This has not changed since the prior exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine. There is redemonstration of aAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Findings are compatible with Chiari I malformation. There is no convincing evidence for CSF flow abnormality at this time. There is no evidence for ventriculomegaly.2.Small syrinx in the cervical spinal cord at the C6 vertebral level is stable3.A lesion centered in the right dentate nucleus is stable and compared to the prior exam.


Instruction: Generate impression based on findings.

Input: 74-year-old male with non-Hodgkin's lymphoma presents after fall with new onset bilateral lower extremity weakness There is mild compression fracture involving the L2 vertebral body with evidence of prior cement augmentation. The remainder of the vertebral bodies are appropriate in the overall alignment and height. No gross cord signal mobility. No evidence of cord compression or cauda equina compression. There is suggestion of marrow infiltration involving the left lateral aspect of the thoracic vertebra at the T5-T7 levels with suspected small amount of epidural tumor extending into the left lateral aspect of the spinal canal and neural foramina.Large left pleural effusion and extensive lymphadenopathy are partially imaged and better assessed on prior CT.

Output: 1. This is a limited screening exam specific for the exclusion of cord compression only. No acute cord or cauda equina compression is identified.2. There is suggestion of marrow infiltration involving the left lateral aspects of the T5-T7 thoracic vertebrae with small amount of epidural tumor suspected involving the left lateral aspects of the spinal canal and neural foramina. Recommend dedicated thoracic spine MRI with contrast for better assessment.


Instruction: Generate impression based on findings.

Input: Severe neck pain, history of colon cancer. Evaluate for metastasis or abscess. Examination is mildly technically degraded as patient had difficulty tolerating the study. There is mild retro-odontoid soft tissue without mass effect, frequently related to CPPD in this age group. Craniovertebral junction appears otherwise within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from mild anterolisthesis of C4 on C5 and mild retrolisthesis of C6 on C7. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology. No suspicious enhancing lesions are appreciated. There is mild nonspecific edema and enhancement involving the paraspinous musculature and interspinous region at the posterior C1-C2 level. There is also mild fluid involving the lateral atlantoaxial joints. There is no discrete mass to suggest tumor. No evidence of abscess.There is enhancement involving the lung apices and the upper thoracic paravertebral region favored to be related to scarring and better assessed on prior chest CT. There is a 2 cm right thyroid nodule.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy, particularly on the left.C3-4: Small disc osteophyte complex with mild uncovertebral hypertrophy and mild ligamentum flavum thickening. There is facet arthropathy, particularly on the left. There is no spinal canal stenosis. Mild bilateral neural foraminal stenosis.C4-5: Small disc osteophyte complex and mild uncovertebral hypertrophy. There is no spinal canal stenosis. There is moderate right and mild left neural foraminal stenosis. There is facet arthropathy, particularly on the right.C5-6: Small disc osteophyte complex and mild uncovertebral hypertrophy. No significant spinal canal stenosis. There is mild stenosis of the bilateral neural foramina. Bilateral facet arthropathy, greater on the right.C6-7: Small disc osteophyte complex and ligamentum flavum thickening. No significant spinal canal stenosis. There is mild right and minimal left neural foraminal stenosis. There is bilateral facet arthropathy, greater on the right.C7-T1: No significant compromise to the spinal canal or neural foramina.There is a small retropharyngeal fluid collection measuring up to 6 mm in thickness and extending from the C1 to the C6 levels.

Output: 1. No findings to suggest metastatic disease or abscess in the cervical spine, as questioned.2. There are multilevel degenerative changes throughout the cervical spine without significant spinal canal stenosis at any level. There is multilevel facet arthropathy and foraminal stenosis, relatively worse at the right C4-C5 level where there is moderate right neural foraminal stenosis.3. There is mild soft tissue edema and enhancement at the C1-C2 level posteriorly as described above which is nonspecific and may on a degenerative, inflammatory, or traumatic basis.4. Small retropharyngeal fluid collection extending from C1 to C6 which is nonspecific. CT neck with contrast may be considered for further evaluation as clinically warranted.


Instruction: Generate impression based on findings.

Input: 73-year-old female with history of cystic pancreatic tail lesion. Limited due to lack of IV contrast.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion with thick walls and internal septations at the pancreatic tail measures 2.1 x 1.6 cm, previously 2.1 x 1.6 cm (image 19 of series 401). There is no clear communication to the pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Marked atherosclerotic disease of the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Cardiomegaly with small pericardial effusion.

Output: Limited exam secondary to lack of IV contrast. Stable pancreatic tail cystic lesion.


Instruction: Generate impression based on findings.

Input: History of thyroid cancer. Post treatment. Head CT:There is no evidence of intra-axial mass, hemorrhage or infarction. Neck CT:Post-treatment changes are again present at the right masticator space, and parotid space. There is no evidence of interval change of the soft tissues in the surgical bed.An enhancing lesion at the greater wing of right sphenoid bone is again seen, with extension into the orbit. Accounting for differences in imaging techniques, there is no evidence of significant change compared to the more recent MRI study of 3/19/2010. On the CT study, the lesion measures approximately 1.7 x 2 cm on axial plane compared to prior measurement of approximately 2.1 x 2.1-cm on the prior MRI study.There is a heterogeneous nodule in the posterior aspect of the right thyroid lobe, measuring 9 x 9 mm, compared to previous CT measurement of 9 x 8 mm.There is a slightly prominent lymph node at the level 1A region which is still within normal limits in size. There is no evidence of interval change. It demonstrate slightly increased enhancement compared to prior study, but this can be secondary to technical factors. No evidence of adenopathy is seen based on radiological criteria.A developmental venous anomaly is seen in the right cerebellum.There are degenerative changes in the cervical spine. There are numerous nodules in the lungs, consistent with metastatic lung disease.

Output: 1. Metastatic lesion involving right sphenoid bone, with no significant interval change. 2 Stable small lymph nodes in the neck. No evidence of pathological adenopathy.3. Unchanged small right thyroid nodule is nonspecific in imaging appearance but may represent the thyroid cancer as per clinical history.4. Numerous pulmonary metastasis. Please correlate with CT chest.


Instruction: Generate impression based on findings.

Input: Ms. Balling is a 61-year-old female with known left breast cancer status post neoadjuvant chemotherapy. She presents today for needle localization for surgical guidance. The most recent mammogram was performed in March 2013 immediately after biopsy of the left breast. Since then, patient has had multiple MRI and ultrasound examinations to reevaluate the known left breast cancer, but no recent mammograms. Thus, a full field ML and CC views were obtained prior to needle localization in order to confirm exact positioning of the localization wires. Since neoadjuvant chemotherapy administration, the tumor now has a more diffuse appearance on mammogram with biopsy marker clip located centrally within this global asymmetry. Three wires will be placed circumferentially around this global asymmetry.The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, three 9 cm Kopans needle were placed circumferentially around the global asymmetry. On orthogonal mammography, adequate positioning of the needles were confirmed after adjusting depth so the needle tips were approximately 2cm deep to the center of the target. Three spring wires were then deployed. Repeat two view orthogonal mammograms reveal the spring wires to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Sheth performed the procedure.Orthogonal digital specimen radiographs revealed the global asymmetry, three wires and biopsy marker clip to be within the specimen.

Output: Successful needle localization of the left breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Other pulmonary embolism without acute cor pulmonale [I26.99], Reason for Study: ^Reason: Assess brain lesion History: N/A There is 16.3mm (AP) x 15.5mm (CC) and 13.5mm (RL) sized relatively well circumscribed intra axial mainly cystic lesion at the right frontal operculum (right subcentral lobule) with surrounding edema and irregular rim enhancement. There are also a couple of daughter nodules with peripheral enhancement see on post enhanced images. The content of the lesion does not show restricted diffusion. There is no other abnormal enhancing lesion on this scan. Comparing to prior scan obtained outside institution (Sep 15 2015), although overall size of the lesion appears to be decreased and intra lesional fluid fluid level has been not as conspicuous but the enhancing rim has been thickened, peripheral daughter nodules show interval increase in size and the extent of surrounding edema has been increased comparing to the size of the lesion. There is evidence of right fronto-temporal craniotomy.The ventricles, sulci and cisterns are symmetric and unremarkable. Multifocal patchy high signal intensities on bilateral periventricular white matter, bilateral external capsules on FLAIR/T2 images appear to be stable.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Minimal mucosal thickenings on ethmoid sinuses.

Output: 1. Interval progression of the thickness of enhancing rim, increased size of enhancing peripheral daughter nodules and the extent of surrounding edema of the right frontal opercular cystic lesion as described above since prior scan (Sep 15 2015).2. No change of high signal intensity lesions on bilateral periventricular white matter and external capsule.3. No acute ischemic or hemorrhagic lesion. No new abnormal enhancing lesion.


Instruction: Generate impression based on findings.

Input: Neck pain. Postop cervical laminoplasty. There are postsurgical changes of cervical laminoplasty, resulting in overall increase of caliber of the spinal canal from C3 to C7. Small pockets of air, fluid density, and soft tissue edema related to the recent surgery are noted.Residual degenerative disease with disk -osteophyte complexes are again noted at C3 - C4 to C6-C7 level. Neuroforaminal narrowing is again noted at C3 - C4 and C4 - C5 level.

Output: Expected postsurgical changes, and residual degenerative disease of cervical spine as described above.


Instruction: Generate impression based on findings.

Input: 12 years Female (DOB:11/10/2003)Reason: 3T scanner, please assess for cerebral AVMs, hx of pulmonary AVMs (treated w coils and plugs in 2016) History: hx of nosebleeds \T\ pulmonary AVMs, may have HHTPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated. There is artifact emanating from the patient's teeth which obscures some of the pulse sequences such as susceptibility weighted imaging and diffusion-weighted imaging. It also creates distortion along the orbits on MR imaging.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium sized.. The posterior communicating arteries are medium-sized. The vertebral arteries are similar in size.The right posterior inferior cerebellar artery is the dominant vessel and has a prominent vermian branch.

Output: 1.No evidence for cerebrovascular occlusive disease.2.There is no convincing evidence for arteriovenous malformation. The vermian branch of the right posterior inferior cerebellar artery appears relatively prominent. This is a nonspecific finding, however, given the artifacts on this exam emanating from the patient's dental hardware perhaps a CT angiogram may help further assess this.3.No evidence for intracranial aneurysm.4.There is no evidence for intracranial mass lesion.5.The exam is somewhat degraded due to metal artifact from dental hardware which may obscure some abnormalities. The orbits and infratemporal fossa are obscured on almost all pulse sequences. Susceptibility imaging and diffusion-weighted imaging there are significant compromise to by the artifact.


Instruction: Generate impression based on findings.

Input: Male 51 years old with prostate cancer on active surveillance, restaging MRI and biopsy. PELVIS:PROSTATE:Prostate Size: 5.3 x 4.4 cm.Peripheral Zone: There is a 6 x 5 mm focus of restriction diffusion in the left lateral apex (series 43, image 244) and a 1.2 x 7.3 cm focus of T2 signal abnormality in the left base (series 801, image 19) that demonstrates restricted diffusion.There are multiple linear areas of T1 hyperintensity consistent with post biopsy hemorrhage.Note is made of a utricle cyst.Central Gland: The central gland is heterogeneous consistent with benign nodules.Seminal Vesicles: The seminal vessels are unremarkable.Extracapsular Extension: No evidence of extracapsular extension or perineural spread.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 6 x 5 mm area of signal abnormality in the left apex is suspicious for prostate carcinoma. The larger focus of signal abnormality in the left base may represent central zone verses an additional focus of carcinoma.


Instruction: Generate impression based on findings.

Input: 79 year old female with BRCA1 positive mutation. Personal history of ovarian carcinoma diagnosed at age 58. History of breast carcinoma in one paternal aunt and maternal cousins. History of ovarian carcinoma in two paternal aunts. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: 72yo with DM, HTN, CKD, here for large gastric polyp removal. Found to have pancreatic cysts. iGI requesting an MRCP for further evaluation History: anemia, intermittent abdominal pain. Examination is moderately limited by patient motion. Metallic susceptibility artifact likely related to gastric polypectomy clip also obscures surrounding structures and limits evaluation.ABDOMEN:LIVER, BILIARY TRACT: There is an indeterminate T2 hyperintense lesion within hepatic segment 6/7 with reference measurements below. The lesion does not demonstrate restricted diffusion. No additional focal hepatic lesions are identified within the limitations of a noncontrast examination.The gallbladder is collapsed or surgically absent. No biliary ductal dilatation.SPLEEN: Subcentimeter focus of increased T2 signal within the spleen is nonspecific but likely benign.PANCREAS: There is a large, cystic mass associated with the body and tail of the pancreas along the lesser curvature of the stomach with reference measurements below. The mass demonstrates mural thickening and mural nodularity as well as several probable septations and an internal fluid-fluid level. The mass is highly suspicious for neoplasm, though further discrimination is limited by lack of intravenous contrast.There appears to be intact pancreatic parenchyma in the uncinate process and head as well as along the posterior margin of the cystic mass in the body and tail. The pancreatic duct in the pancreatic tail is tortuous and dilated up until the cystic mass where it becomes nondilated and is not well visualized. The pancreatic duct in the head appears within normal limits and is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several bilateral T2 hyperintense structures, likely cysts. There is mild prominence of the bilateral renal collecting systems and ureters.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Metallic susceptibility artifact is present in the region of the gastric antrum likely related to recent polypectomy.BONES, SOFT TISSUES: Degenerative changes affect the spine.OTHER: The urinary bladder bladder is distended.INDEX LESION MEASUREMENTS (Current exam date/time: 9/21/2016 17:31:41)HEPATIC SEGMENT 6/7 LESION: 1.7 x 1.3 cm (Image 20, Series 4).PANCREATIC BODY/TAIL LESION: 5.4 cm (Image 15, Series 3); 4.7 x 10.4 cm (Image 28, Series 4).

Output: 1.Large cystic mass associated with the pancreatic body and tail with features suggestive of neoplasm, though further discrimination is limited by lack of intravenous contrast. Recommend ERCP for further evaluation.2.T2 hyperintense hepatic lesion, incompletely characterized without intravenous contrast.3.Distended bladder and bilateral mild hydroureteronephrosis suggestive of bladder outlet obstruction.


Instruction: Generate impression based on findings.

Input: Radiculopathy. Right lower extremity pain and weakness. Examination quality is suboptimal due to patient's body habitus. 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. The conus medullaris is normal in position.There is mild multilevel disc desiccation with minimal disc bulges. Additional details as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: Minimal disc bulge and mild facet arthropathy. No spinal canal or neural foraminal stenosis.L4-L5: Small Schmorl's node involving the inferior endplate on the right. Mild disc bulge and moderate bilateral facet arthropathy. Mild effacement of the right lateral recess. No significant central spinal canal stenosis. There is mild to moderate bilateral, right greater than left, neural foraminal stenosis.L5-S1: Minimal disc bulge and moderate facet arthropathy. No significant spinal canal stenosis. Mild bilateral neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Mild multilevel degenerative changes in the lumbar spine with no significant spinal canal stenosis at any level. There is mild to moderate bilateral, right greater than left, L4-L5 neural foraminal stenosis and mild bilateral L5-S1 neural foraminal stenosis. No high-grade neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Male, 45 days old, status post fall with abnormal CT findings, evaluate for ligamentous injury. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or marrow edema is seen. The intervertebral discs are intact.The cranio-cervical junction is normally aligned and intact. The retropharyngeal soft tissues appear mildly thickened and edematous centered on C1 and C2. However, no obvious spinal ligamentous injury is detected.The spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are suspected. No significant compromise of the spinal canal or neural foramina is seen.

Output: 1.No evidence of acute osseous or ligamentous injury of the cervical spine.2.The retropharyngeal soft tissues appear mildly edematous which, along with the effect of positioning, may account for the abnormal findings on prior CT and plain films.


Instruction: Generate impression based on findings.

Input: Neck pain and headache Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild straightening as well as mild retrolisthesis of C5 on C6 similar to prior. Alignment is otherwise maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal central protrusion. No significant compromise to the spinal canal or neural foramina.C4-5: Posterior disc osteophyte complex which effaces the ventral thecal sac. Disc bulge component is slightly more prominent than on prior from 10/21/2013. Patent dorsal thecal sac. Overall no significant spinal canal or neural foraminal stenosis.C5-6: Posterior disc osteophyte complex effaces the ventral thecal sac and minimally indents the ventral cord. There is also mild ligamentum flavum thickening. There is overall minimal spinal canal stenosis which appears minimally worse, but this may be related to slight differences in head position. Mild uncovertebral hypertrophy. No significant neural foraminal stenosis.C6-7: Minimal posterior disc osteophyte complex which partially effaces the ventral thecal sac. Mild uncovertebral hypertrophy. No significant spinal canal or neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Tiny left inferior thyroid nodule appears similar to prior.

Output: Mild degenerative changes in the cervical spine which are minimally worse in the interval at C4-C5 and C5-C6 compared to 10/21/2013. There is however no significant spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Brain MRI:There is no restricted diffusion on diffusion weighted images to indicate an infarct. No susceptibility weighted abnormalities to indicate intracranial hemorrhage. Note is made of very mild periventricular and subcortical white matter T2/Flair signal abnormalities which is nonspecific but compatible with very mild chronic small vessel ischemic changes.There is advanced global parenchymal volume loss commensurate with age. The ventricles are somewhat prominent compared to the sulci. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Mild right maxillary and ethmoid opacification. The paranasal sinuses and mastoid air cells are otherwise clear. Mild degenerative changes are noted of the visualized upper cervical spine.Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. There is some narrowing of the left M2/M3 segments which may be due to atherosclerotic disease. No arterial occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. There is a left dominant vertebral artery. A small left A1 segment and small left PICA is noted.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or at the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified. The left vertebral artery is tortuous within the neck but there is no stenosis.

Output: 1. No evidence of acute infarct.2. Global parenchymal volume loss commensurate with patient's age. There is slight prominence of the ventricles compared to the degree of volume loss raising question of communicating hydrocephalus/NPH in the appropriate clinical setting. No significant change since 8/5/2010. 3. No significant steno-occlusive disease of the arteries of the brain or neck.


Instruction: Generate impression based on findings.

Input: Reason: stage IV melanoma with disease left leg getting systemic treatment History: reassess for treatment response. Note is made of multiple enhancing masses along the posteromedial aspect of the left leg consistent with the patient's history of melanoma. There is associated increased signal abnormality on T1 weighted images and intermediate signal abnormality T2 weighted images as well as peripheral enhancement on postcontrast sequences. For reference, the largest confluent mass measures approximately 7.2 x 3.0 cm (image 26; series 21). This mass extends to the level of the fascia of the medial head of the gastrocnemius. There is associated increased signal abnormality on fluid sensitive sequences within the gastrocnemius and soleus muscles. There is lack of enhancement of the medial aspect of the soleus as well as within the medial head gastrocnemius superiorly, which appears to correspond to foci of fatty infiltration of the musculature although this could also represent perfusion abnormalities/multiple foci of myonecrosis. There is a small amount of fluid signal surrounding the gastrocnemius. Multiple additional masses are identified along the posteromedial aspect of the leg also consistent with the patient's history of melanoma. The more anterior of these lesions also appears to abut the medial aspect of the soleus muscle. There is nonspecific skin thickening along the anterior, medial, and posterior aspect of the leg. There is diffuse nonspecific subcutaneous edema about the leg.

Output: Multiple enhancing masses along the posteromedial aspect of the left leg consistent with the patient's history of melanoma as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out myelitis. Signs and symptoms: Paraplegia. Pre-and post-enhanced cervical MRI:The examination demonstrates subtle uniform diffuse T2 hyperintensity of the cervical cord without convincing detectable increase in cord caliber. The finding appears to extend from approximately mid C2 level inferiorly to approximately T1. There is no convincing evidence of enhancement of this finding on post infused images. Findings are suspected for myelitis.The signal intensity of vertebral column is unremarkable other than changes related to degenerative disease and without evidence of abnormal spinal enhancement.Minimal degenerative changes at C3 -- C4 with resultant mild central spinal stenosis is also noted. C4 -- C5 demonstrate moderate disk disease and loss of disk height as well as broad based ventral bulging disk resulting in flattening and posterior displacement of the cord and moderate central spinal stenosis as well as significant right and moderate left neural foraminal compromise. C5 -- C6 demonstrate degenerative changes with resultant mild left neural foraminal compromise.C6 -- C7 degenerative changes also results in mild to moderate left neural foramina compromise.Pre-and post-enhanced thoracic MRI:Examination demonstrate no convincing evidence of cord signal abnormality other than above mentioned changes on MRI of cervical spine. There is also no detectable abnormal enhancement of thoracic cord.T9 -- T10 demonstrate moderate disk disease and loss of disk height and a left lateral and far lateral broad-based disk protrusion which results in mild to moderate left neural foraminal compromise and no central spinal stenosis.Minimal degenerative changes at other levels are also noted however without spinal stenosis or neural foraminal compromise.

Output: 1.Pre-and post-enhanced MRI of cervical spine demonstrate uniform diffuse T2 hyperintensity extending from mid C2 level to approximately T1 and without evidence of change in the cord caliber or abnormal enhancement. Findings are suggestive of myelitis. Degenerative changes of cervical spine results in moderate central spinal stenosis at C4 -- C5 and there is some neural foraminal compromise. Mild central spinal stenosis at C3 -- C4 is also noted. There are multilevel neural foraminal compromise as detailed the level above.2.Pre-and post-enhanced MRI of thoracic spine demonstrates no convincing evidence of cord signal abnormality or enhancement. Degenerative changes and a disk protrusion at T9 -- T10 results in left neural foraminal compromise. No evidence of spinal stenosis or any significant other levels of neural foraminal compromise is detected.


Instruction: Generate impression based on findings.

Input: Clinical question: Incisional drainage. Signs and symptoms: Incisional drainage. Pre and post enhanced brain MRI:Examination demonstrates significant interval increased size of postoperative fluid collection in the soft tissues of lower back extending from L2-L3 disc level inferiorly to L5-S1 level. It measures approximately 106 mm in cranial cephalad compared to prior study measurement of 55. It also measures approximately 45 x 51 mm in transaxial dimensions larger than prior study. Findings demonstrate no mass effect on the thecal sac. There is no associated signal abnormality of displaced musculature or the bony structures adjacent to this collection. On post enhanced images there is expected enhancement of surrounding soft tissues to this collection. Possibility of an infectious process cannot be entirely excluded however the collection is amenable to direct aspiration if clinically an infectious process is suspected. There is redemonstration of tethered cord without definitive evidence of any change since prior exam.Post enhanced images demonstrate dural thickening and enhancement at the point of termination of the cord at S1 and S2 level which also surrounds the tethered cord. This finding highly suggestive of postoperative enhancement.Immediately superior to this level however there is no convincing evidence of left meningeal enhancement. Previously scans were performed without intravenous contrast and comparison cannot be made.

Output: 1.Interval increased extradural fluid collection in the soft tissues of lower back in the midline as measured above. There is enhancement of surrounding soft tissues and including the rim of fluid collection which could be within expected postop changes. If there is clinical concern for infection direct aspiration is recommended.2.Dural thickening and enhancement at the point of termination of the cord at S1-S2 level is believed to represent a postoperative finding and no detectable abnormal enhancement of the leptomeninges superior to this level.


Instruction: Generate impression based on findings.

Input: Ms. Loeher is a 42-year-old female with a personal history of Hodgkin's lymphoma and CML along with a family history of breast cancer in her mother. History of bilateral benign breast biopsies (left breast -- 2010 fibroadenoma surgically excised). She has no current breast related complaints. She is enrolled in the research breast cancer screening study for high risk individuals. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally.Right breast: In the right lower outer breast, 7:00 location, there is an oval enhancing area measuring 0.9 cm in maximal dimension that does not appear mass-like on sagittal or coronal reformations. This appears unchanged dating back to at least 05/16/2013, favoring a benign process (i.e. prominent fibroglandular tissue). There is no suspicious enhancement seen else where in the right breast.Left breast: There is no suspicious enhancement seen in the left breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Follow-up should be as per the research protocol.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Left floor of mouth cancer status post surgery: salivary gland hyalinizing clear cell carcinoma with perineural invasion with initial positive margin and re-resection of floor of mouth. There are post-treatment findings in the left floor of mouth region, including resection of the left sublingual gland with flap reconstruction of the surgical defect and resection of the left submandibular gland along with bilateral neck dissection. There is no evidence of gross measurable tumor or significant lymphadenopathy in the neck. There is herniation of the right sublingual gland via a defect in the mylohyoid muscle. The remaining salivary glands are unremarkable. The thyroid gland is intact. There is mild multilevel degenerative cervical spondylosis. The imaged intracranial structures, paranasal sinuses, and orbits are grossly unremarkable.

Output: Post-treatment findings in the left floor of mouth region, without evidence of gross measurable tumor or significant lymphadenopathy in the neck.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: hx of MS, new right arm paresthesias, electric shock sensationSigns and Symptoms: as above MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are periventricular white matter lesions present which are perpendicularly oriented to the lateral ventricles as well as some corpus callosum lesions especially at the colossal cingulate junction and to some degree some subcortical white matter lesions. These are hyperintense on FLAIR and T2 imaging. There is no associated contrast enhancement. Additionally there are punctate lesions present in the cerebellar hemispheres bilaterally. These also do not enhance following gadolinium administration and they are hyperintense on FLAIR and T2 images. These lesions have not changed since the prior exam of 2/14/2014Normal 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.MRI cervical spine:There is a patchy T2 and FLAIR hyperintense lesion present along the posterior aspect of the cervical spinal cord extending from the C1-2 level down to the C7 vertebral level which has not changed substantially when compared to the prior exam. There is no associated enhancement of this lesion following gadolinium administration. There is no associated mass effect.The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are periventricular and subcortical white matter lesions present as well as lesions in the corpus callosum and cerebellum which are compatible patient's diagnosis of demyelinating disorder. These are stable compared to the prior exam.2.There is redemonstration and no significant change of extensive lesion within the cervical spinal cord. This is compatible with the patient's clinical diagnosis of demyelinating disorder. It is stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Since the prior brain MRI from 9/6/2016 there has been significant increase in size of a subdural hematoma along the left cerebral convexity which measures up to 22 mm in thickness, previously 12 mm. There are areas of T1 hyperintensity indicative of subacute hemorrhage, new since prior. There is increased effacement of the adjacent left frontal and parietal sulci. There is minimal rightward midline shift measuring up to 3 mm.There is no evidence of acute infarct. There is encephalomalacia in the right frontal lobe related to prior trauma. There is mild prominence of the overlying extra-axial CSF space suggesting a small leptomeningeal cyst, with prior study demonstrating heterogeneous extra-axial blood products in this region. There are also foci of T2/FLAIR hyperintensity in the left frontal subcortical white matter which are also compatible with sequela of prior trauma. Punctate chronic blood products in the left posterior left temporal lobe are also again seen. Ventricles remain normal in size. Biparietal skull fractures are better demonstrated on same-day CT.MR venogram demonstrates a normal variant right dominant transverse and sigmoid sinus. Previously seen outpouching involving the midportion of the superior sagittal sinus is no longer discretely appreciated. The superior sagittal sinus is patent. The inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent.

Output: 1. Significant interval increase in size of a left-sided subdural collection with MRI signal features and same-day CT findings suggesting subacute subdural hematoma, with new areas of hyperdensity/T1 shortening indicating new hemorrhage. There is increase in associated mass effect.2.Encephalomalacia in the right frontal lobe with suggestion of a small overlying "leptomeningeal cyst". Mild separation of the right parietal fracture fragment better demonstrated on CT.3.Patent venous system. Focal outpouching involving the mid aspect of the superior sagittal sinus seen on CTA dated 8/27/2016 is no longer discretely perceptible.Dr. Ali discussed findings with Darlene Simkhin (Dr. Frim's nurse) at 1630 hrs on 11/9/2016


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with right base of tongue mass, tongue deviated to the right, throat and tongue pain. Brain:No evidence of parenchymal mass effect or edema is seen. No pathologic parenchymal or extra-axial enhancement is detected. There are a number of scattered small foci of FLAIR hyperintensity including within the anterior temporal lobes and the right superior frontal gyrus which are unchanged and nonspecific. Innumerable foci of susceptibility are redemonstrated with particular involvement of the bilateral frontal lobes, the inferior parietal lobes and the temporal lobes, similar to that seen on the prior examination. No evidence of acute intracranial hemorrhage is seen. No abnormal extra-axial collections are detected. Ventricular size morphology are within normal limits.Neck:Image quality is limited by motion artifact. An enhancing mass is redemonstrated centered on the right tongue base with invasion of the intrinsic tongue musculature and floor of mouth. The lesion does extend across midline to involve the left tongue base to some degree. Compared to the prior examination, it appears that the lesion has increased in size, now measuring up to 38 mm in maximal axial length, previously approximately 28 mm when measured similarly. As before, tumor partially effaces the vallecula.The remainder of the aerodigestive mucosa is within normal limits. No pathologic adenopathy is detected by size criteria. The salivary glands and the thyroid appear to be free of focal lesions. Multilevel cervical spondylosis is demonstrated superimposed on a congenitally slender canal.

Output: 1.Probable increase in size of the right tongue base/floor of mouth tumor.2.No pathologic adenopathy is detected in the neck.3.No evidence of intracranial metastases is seen.4.Numerous scattered foci of brain parenchymal susceptibility are redemonstrated. These lesions are compatible with chronic microhemorrhage, perhaps related to amyloid angiopathy.


Instruction: Generate impression based on findings.

Input: Bus driver with neck injury years ago. There is multilevel degenerative spondylosis and straightening of the cervical spine alignment in the sagittal plane. In particular, there is a prominent posterior disc-osteophyte complex at C4-5 that results in moderate spinal canal stenosis with mild flattening of the spinal cord and moderate right and severe left neural foramen stenosis. A posterior disc-osteophyte complex at C3-4 results in mild spinal canal stenosis and bilateral mild neural foramen stenosis. A posterior disc-osteophyte complex at C5-6 results in mild right and moderate left neural foramen stenosis. A posterior disc-osteophyte complex at C6-7 results in mild spinal canal stenosis and mild left neural foramen stenosis. There is no evidence of abnormal spinal cord signal. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no evidence of intraspinal mass lesions or abnormal enhancement. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative spondylosis, including a posterior disc-osteophyte complex at C4-5 that results in moderate spinal canal stenosis with mild flattening of the spinal cord and moderate right and severe left neural foramen stenosis.


Instruction: Generate impression based on findings.

Input: Ms. Vilenchik is a 58-year-old female with a personal history of right breast mastectomy in 2007 for invasive tubular carcinoma and benign left breast FNA in 2009 and 2014. Family history of breast cancer in sister, diagnosed at the age of 48. Patient is status post right breast mastectomy. There is heterogeneous amount of fibroglandular tissue in the left breast. No abnormal enhancement is seen in the right chest wall and left breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: 82-year-old patient with long-standing pain, rule out degenerative disease or fracture. Signs and symptoms: Back pain. Nonenhanced lumbar MRI:The anatomical alignment of vertebral column is unremarkable. The signal intensity of the vertebral column demonstrate diffuse abnormality consistent with degenerative disease.Unremarkable lower most visualized thoracic spine and thoracic cord from T10 inferiorly.T11-T12 and T12-L1 levels are unremarkable.L1-L2 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum and mild bilateral facet hypertrophy changes. There is a far lateral right-sided broad-based disc protrusion with resultant moderate right neural foraminal compromise. Degenerative changes also results in moderate central spinal stenosis and mild left neural foraminal compromise.L2-L3 demonstrates advanced disc disease and loss of disc height, moderate bilateral ligamentum flavum and to a lesser degree of bilateral facet hypertrophic changes. Constellation of changes results in moderate central spinal stenosis and moderate bilateral (left greater than right) neural foraminal compromise.L3-L4 demonstrate advanced disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease (left greater than right). Constellation of changes results in moderate central spinal stenosis and significant bilateral neural foraminal compromise.L4-L5 demonstrate moderate to advanced disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy, moderate left facet degenerative changes and hypertrophy and to a lesser degree of the right facet. Constellation of changes results in mild to moderate central spinal stenosis, significant bilateral neural foraminal compromise and bilateral recess compromise (right greater than left).L5-S1 demonstrate mild disc disease and loss of disc height, shallow broad-based disc protrusion in the midline and extending to the right, mild bilateral ligamentum flavum hypertrophy, moderate to severe left and mild right facet degenerative/hypertrophic changes. There is evidence of a synovial cyst projecting posterior to the left articulating facet at this level measuring approximately 9 x 14 mm in transaxial dimensions (axial T2 series 601 image 13). Degenerative changes at this level results in mild central spinal stenosis and moderate right neural foraminal compromise.There is spinal soft tissues are unremarkable.

Output: 1.Extensive degenerative changes of lumbar spine results in multilevel central spinal stenosis of varying degrees at L1-L2 through L5-S1 levels as detailed by level.2.Degenerative changes also results in multilevel bilateral neural foraminal compromise (some significantly) as detailed per level.3.Right lateral disc protrusion at L1-L2 with resultant moderate right neural foraminal compromise is also noted.4.Hypertrophic changes of the left articulating facet at L5-S1 and a synovial cyst measuring at 9 x 14 mm projecting posterior to the left facets is present.


Instruction: Generate impression based on findings.

Input: History of right optic meningioma treated with surgery and RT. Orbits: There are postoperative findings related to right optic nerve sheath meningioma subtotal resection with what appears to be residual tumor that measures up to approximately 15 mm in the posteronasal aspect of the orbit, which is difficult to delineate from the adjacent extraocular muscles. There is otherwise soft tissue deficiency in the right orbit with associated enophthalmos. There is metallic artifact of the right orbit, which may represent implanted hardware. There is also diffuse enhancement of the intraorbital structures, which may represent post-treatment inflammation and/or scar tissue. This is difficult to distinguish from adjacent extraocular muscles which are edematous and enhancing. The right optic nerve is markedly atrophic and deformed. The right globe is intact bilaterally. The left orbital structures are unremarkable. Brain: There is atrophy of the right optic nerve, extending to the right optic chiasm. There are a few scattered nonspecific cerebral white matter T2 hyperintense foci. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Postoperative findings related to right optic nerve sheath meningioma subtotal resection with what appears to be residual tumor that measures up to approximately 15 mm in the posteronasal aspect of the orbit and enophthalmos.2. Diffuse patchy enhancement within rest of the right orbital soft tissues may otherwise be treatment-related.3. Extensive right optic nerve atrophy.


Instruction: Generate impression based on findings.

Input: 82 year old gentleman with a history of recent anterior ST-elevation myocardial infarction on 12/21/2014, s/p stent. He is now referred for cardiac MRI to further evaluation LV function and infarct burden. Left VentricleThe left ventricle is dilated with severely reduced systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 136 ml/m2 (normal range: 74+/-15), the LVEDV is 272 ml (normal range 142+/-34), the LV end systolic volume index is 100 ml/m2 (normal range 25+/-9), the LVESV is 199 ml (normal range 47+/-19), the LV mass index is 69 g/m2 (normal range 85+/-15), and the LV mass is 137 g (normal range 164+/-36). There is akinesis with transmural enhancement demonstrated by the apex, apical 2/3 of anterior wall, mid-to-apical septum, apical antero-lateral wall and apical 1/3 inferior wall. The wall thickness of these segments are mildly thinned. The basal-septum and basal antero-lateral wall are hypokinetic. The degree of enhancement is consistent with non viable infarct. There is no intracardiac thrombus.Left AtriumThe left atrium is dilated.Right VentricleThe right ventricle is normal in function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 58 ml/m2 (normal range 82+/-16), the RVEDV is 116 ml (normal range 142+/-31), the RV end systolic volume index is 19 ml/m2 (normal range 31+/-9), and the RVESV is 38 ml (normal range 54+/-17).Right AtriumThe right atrium is normalAortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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 FindingsThere is trace right sided pleural effusion. High signal in the right middle lobe raises question of aspiration. Correlation with chest radiograph is recommended. There is fluid in the superior esophagus.

Output: 1. The left ventricle is dilated with severely reduced systolic function. The overall LV ejection fraction is 27%. Akinesis of the apex, mid-to-apical anterior wall, mid-to-apical septum, apical antero-lateral wall and apical inferior wall . The basal-septum and basal antero-lateral walls are hypokinetic. Nonviable infarct involving the LAD territory.2. No intracardiac thrombus.3. High signal in the right middle lobe raises question of aspiration. Correlation with chest radiograph is recommended. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.