Instruction: Generate impression based on findings.

Input: History of Crohn's disease with obstructive symptoms. Evaluate for stricture. 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: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is unremarkable. There is abnormal moderate circumferential wall thickening, post-contrast enhancement and restricted diffusion involving approximately 16 cm of the distal through terminal ileum. There may be a mild stricture at the terminal ileum without significant proximal/upstream dilatation. There is an approximately 2 cm fixed stricture of this loop as the distal ileum extends into the pelvis (series 4, image 21) with mild proximal/upstream dilatation. In the right lower quadrant there is a 3 cm fixed mild stricture with mild prestenotic dilatation involving the distal small bowel (series 5 image 23). This segment also demonstrates mild wall thickening and postcontrast enhancement.An additional 5 cm fixed mild stricture with mild prestenotic/upstream dilatation (series 5/19) is noted of the distal small bowel with associated mild wall thickening and postcontrast enhancement.There are no significant adjacent mesenteric inflammatory changes. No free or loculated fluid collection.The large bowel is collapsed and otherwise unremarkable.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: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is unremarkable. There is abnormal moderate circumferential wall thickening, post-contrast enhancement and restricted diffusion involving approximately 16 cm of the distal through terminal ileum. There may be a mild stricture at the terminal ileum without significant proximal/upstream dilatation. There is an approximately 2 cm fixed stricture of this loop as the distal ileum extends into the pelvis (series 4, image 21) with mild proximal/upstream dilatation. In the right lower quadrant there is a 3 cm fixed mild stricture with mild prestenotic dilatation involving the distal small bowel (series 5 image 23). This segment also demonstrates mild wall thickening and postcontrast enhancement.An additional 5 cm fixed mild stricture with mild prestenotic/upstream dilatation (series 5/19) is noted of the distal small bowel with associated mild wall thickening and postcontrast enhancement.There are no significant adjacent mesenteric inflammatory changes. No free or loculated fluid collection.The large bowel is collapsed and otherwise unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Acute small bowel inflammation involving approximately 16 cm of distal terminal ileum with a possible non-obstructive stricture at the terminal ileum and a mild stricture of the distal ileum with mild prestenotic/upstream dilatation. 2.Two additional mild strictures measuring approximately 3 and 5 cm with active inflammation representing skip lesions involving the distal small bowel with mild prestenotic/upstream dilatation.


Instruction: Generate impression based on findings.

Input: History of metastatic renal cell carcinoma with dizziness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Unchanged punctate defects in the left inferior cerebellar hemisphere may represent chronic infarcts and mild nonspecific periventricular white matter T2 hyperintensity. The brain parenchyma and pituitary gland otherwise appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. There cerebellar tonsils extend up to 4 mm inferior to the foramen magnum, but otherwise display rounded morphologies. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is extensive subcortical and periventricular white matter abnormal T2 signal along with additional foci within the pons and bilateral basal ganglia. This is consistent with chronic small vessel ischemic disease and old lacunar infarcts. Of note, there are no significant cerebellar lacunar infarcts. There are no diffusion-weighted abnormalities to suggest acute ischemia. There is no abnormal enhancement within the brain. There is trace focal ectasia of the left anterior cerebral artery just prior to its first bifurcation, which was present on prior CT. The ventricles and sulci are normal in size. The cerebellar tonsils are normal in position. There is no mass effect or midline shift. There are no extra-axial fluid collections. There is a small mucous retention cyst in the left maxillary sinus.The left mid to distal parotid duct is significantly dilated, measuring up to 12 mm in greatest diameter, and beaded in appearance proximally within the glandular tissue. Within the dilated portion, there is no definite filling defect or enhancing lesion. No obstructing hyperdense stone is noted on prior CTA. The left parotid gland is slightly atrophic compared to the right with areas of minimal fatty replacement.

Output: 1. No evidence of acute ischemia or mass within the brain.2. Extensive white matter T2 signal abnormality involving the brainstem, basal ganglia, and periventricular and subcortical white matter which represents chronic lacunar infarcts and extensive chronic small vessel ischemic disease. 3. Dilated left Stensen duct without definite obstructing lesion within the dilated portions and slightly atrophic left parotid gland; correlate with history of chronic sialadenitis. Otherwise, MRI of the face with contrast may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Diagnosis: Benign neoplasm of pituitary glandClinical question: Yearly surveillance for previously operated pituitary microadenomaSigns and Symptoms: high prolactin levels, managed by endocrinology MRI pituitary:The patient is status post pituitary surgery. The infundibulum of the pituitary is shifted towards the left and is mildly thickened but unchanged since the previous exam. The general configuration of the pituitary gland is stable.There is a 2mm hyperintense T1 focus present within the infundibulum and mid portion of the pituitary gland which is stable compared with prior exams and may represent a Rathke's cleft cyst.A small nonenhancing focus along the superior aspect of the left pituitary gland is approximately 3 mm in size and is stable.The cavernous sinuses are intact bilaterally.

Output: 1.Status post pituitary surgery. The appearance of the pituitary gland is stable when compared to prior exams. Small nodule along the superior aspect of the left pituitary gland remains stable.2.Findings are consistent with a Rathke's cleft cyst which appears stable when compared to prior exams.


Instruction: Generate impression based on findings.

Input: History of cirrhosis. Presents for HCC screening. Also history of endometrial cancer. Evaluation of the solid organs is limited by lack of intravenous contrast.ABDOMEN:LUNG BASES: There is a partially imaged 2.2 x 2.2 cm nodule within the right lung base.LIVER, BILIARY TRACT: Cirrhotic liver morphology. There are several new small lesions in both lobes of the liver which demonstrate decreased T1 signal, mildly increased T2 signal, as well as restricted diffusion which are incompletely characterized but suspicious for metastases. An example lesion is in hepatic segment 5 with reference measurements below. Additional example lesions are in hepatic segment 2/3 (series 9, image 69).No biliary ductal dilatation. Normally distended gallbladder. Small volume perihepatic ascites. Upper abdominal varices. SPLEEN: Mildly prominent spleen measuring 13 cm in craniocaudal dimension. Note is made of a 2.3 splenic artery pseudoaneurysm, not significantly changed.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal simple cyst.RETROPERITONEUM, LYMPH NODES: IVC filter is noted.BOWEL, MESENTERY: The stomach is distended with debris. There is a new soft tissue mass which appears to arise from the wall of the first portion of the duodenum with reference measurements below, highly suspicious for neoplasm. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/20/2016 08:25:19)HEPATIC SEGMENT 5 LESION: 1.7 x 1.1 cm (Image 51, Series 9).DUODENAL MASS: 4.6 x 5.2 cm (Image 27, Series 8).

Output: 1.Exam limited by lack of intravenous contrast.2.New soft tissue mass which appears to arise from the proximal duodenum highly suspicious for neoplasm. 3.Several new lesions within both lobes of the liver which are suspicious for metastases.4.New right lower lobe pulmonary nodule, suspicious for metastases. Dedicated thoracic imaging is recommended.5.Cirrhotic liver with sequelae of portal hypertension6.Approximately 2.3 cm splenic artery pseudoaneurysm, not significant changed. Endovascular evaluation for possible treatment is recommended.Findings discussed with Dr. Helen Te by Dr. Thomas at 4:00 p.m. on 9/20/2016.


Instruction: Generate impression based on findings.

Input: Reason: spinal cord astrocytoma s/p RT and TMZ. History: spinal cord astrocytoma. CERVICAL SPINE:T2 hyperintense expansile mass within the right aspect of the cord extending from the C3-C4 level to C7-T1 is not appreciably changed in size measuring approximately 1.5 x 1.2 cm in the transverse and AP dimensions in the axial plane at the mid C6 level. T2 hyperintensity involving the left lateral aspect of the cord at these levels is also again seen and not significantly changed. There are faint small foci of ill-defined enhancement involving the left lateral aspect of the cervical cord at the C5 and C7 levels and also present previously.There is mild reversal of the normal cervical lordosis. Vertebral body heights are maintained. Mild multilevel disc desiccation with mild degenerative disc disease at C5-C6 and C6-C7 is unchanged. Diffuse T1 hyperintensity throughout the vertebral bodies likely related to radiation. Postsurgical changes along the posterior cervical spine with laminectomies at C5 and C6 are unchanged.THORACIC SPINE:T2 hyperintense expansile mass centered on the left aspect of the cord extending from the T2-T3 level to the T8 level is unchanged in size and overall distribution, measuring 11 x 10 mm in the axial plane at the mid T4 level similar to prior. Cord signal abnormality involving the right lateral aspect of the cord is also not significant changed. There is faint diffuse enhancement of the lesion which less conspicuous than on 6/8/2016 with artifacts and differences in contrast timing somewhat limiting comparison. There is however no new suspicious enhancement to suggest progression.No significant spinal or neural foraminal narrowing throughout the thoracic spine. Central disc protrusion at T7-T8 as well as additional mild multilevel degenerative changes are not significantly changed. Vertebral body heights and alignment are normal. T1 hyperintensity in the marrow likely reflects post radiation change.

Output: Compared to 9/7/2016 and 6/8/2016, there is no evidence of interval progression cervical and thoracic astrocytomas.


Instruction: Generate impression based on findings.

Input: Male, 39 years old. Knee instability MENISCI: There is complex tearing of the posterior horn of the medial meniscus associated with an intrameniscal cyst. When compared to the previous study, the intrameniscal cyst appears much more conspicuous. The anterior horn of the medial meniscus and the lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: A broad-based exostosis extending posteriorly from the proximal tibia is again noted, with normal bone marrow signal characteristics. The previously described small cartilage cap is not included in the field-of-view of this study. Remaining bony and articular cartilage is within normal limits, without bone marrow signal abnormality or focal cartilage defect.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Complex tear of the posterior horn of the medial meniscus with an associated intrameniscal cyst.2.Benign-appearing exostosis extending from the posterior tibia is not significantly changed.


Instruction: Generate impression based on findings.

Input: 87-year-old female status post fall with an elevated INR. Please evaluate for acute intracranial hemorrhage. There is no evidence of intracranial hemorrhage. As a parafalcine high attenuation mass with a broad based dural connection measuring 2.9 x 2.0 cm transaxial at the posterior superior aspect of the right lateral ventricle consistent with a meningioma.Scattered areas of periventricular and subcortical low attenuation consistent with small vessel ischemic disease of indeterminate age.There is asymmetry in the size and configuration of the lateral ventricles, larger on the left. The possibility of a arachnoid cyst at the level of the left foramen of Monroe is a consideration further evaluation with MRI is recommendedThe calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Right posterior parafalcine meningioma as detailed above.2. Possible intraventricular arachnoid cyst at the level of the left foramen of Monroe. Further evaluation with MRI is recommended.2. Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Female, 40 years old, with abnormal CT this morning and decreased strength in the right upper extremity, otherwise healthy female with pain in the right neck and arm for two weeks. Straightening of the cervical lordosis is likely positional. Alignment is otherwise unremarkable. Vertebral body heights are preserved. No pathologic marrow replacement, edema or enhancement is seen. The spinal cord demonstrates normal signal intensity and is free of abnormal enhancement. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left uncovertebral hypertrophy. No spinal canal stenosis. Mild left foraminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Right paracentral disc protrusion which indents the right ventral spinal cord. No generalized spinal canal stenosis. No significant foraminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: A right paracentral disc protrusion is evident at C5-6 which impinges on the right ventral spinal cord.


Instruction: Generate impression based on findings.

Input: History of multiple myeloma and shoulder subluxation, evaluate for progression of myeloma. Redemonstration of a large, lytic expansile lesion arising from the scapular spine with extension into the surrounding soft tissues appearing similar to prior compatible with myeloma. Additional small lucent lesions within the proximal humerus not significantly changed. The glenohumeral joint maintains normal alignment.

Output: Myelomatous lesions without significant change.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with Parkinson's disease, pre-DBS evaluation. Scattered nonspecific white matter T2 hyperintense lesions are seen. No edema or mass effect is detected. Nonenhancing lesions are identified. There is no evidence to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are within normal limits.

Output: No edema, mass effect or pathologic enhancement is seen on this examination which was tailored for surgical navigation.


Instruction: Generate impression based on findings.

Input: History of left lumpectomy for tubular cancer and DCIS in 2005.Patient received radiation therapy and tamoxifen. History of benign right breast biopsies. History of breast cancer in mother and maternal great-grandmother. Breast screening. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. Few round benign morphology foci in the right central breast are unchanged given the difference between the 1.5T and 3T magnet. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Low back pain for 4 to 6 weeks with arching and in school, plays volleyball, has spina bifida occulta S1. 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. No evidence of filar lipoma or other lesions within the spinal canal. Incomplete posterior arch of S1 is incidentally noted and is a common developmental variant.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. There are findings suggestive of mild facet arthropathy at L4-L5 and L5-S1. Paraspinous soft tissues are within normal limits.

Output: 1. No significant disc disease or spinal canal or neural foraminal stenosis at any level.2. No evidence of tethered cord, filar lipoma, or other lesions within the spinal canal.3. If there is specific suspicion for a pars fracture, oblique radiographs or CT would be helpful. There is however no evidence of spondylolisthesis or edema involving the posterior elements.4. There is mild facet arthropathy at L4-L5 and L5-S1.


Instruction: Generate impression based on findings.

Input: There is increased T2/STIR signal involving the thoracic cord from the T9 to T10 levels, without associated enhancement. This finding was present on the prior exams, though the most recent study was severely motion degraded. On sagittal T2 counting image including the cervical spine, there is subtle increased T2 signal from C3 to C5, grossly similar to the prior study but significantly improved from 7/14/2010.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Again seen is T2 signal abnormality in the thoracic cord from the T9 to T10 levels without associated abnormal enhancement and compatible with transverse myelitis. Finding is not significantly changed since 1/19/2016. No earlier thoracic comparison study is available.2. Partially imaged abnormal signal in the cervical cord is grossly similar to prior but significantly improved from 7/14/2010, when it also demonstrated enhancement. Finding is consistent with sequela of remote cervical transverse myelitis.


Instruction: Generate impression based on findings.

Input: Female, 25 years old, with history of traumatic brain injury five years ago, cervicothoracic syrinx with increased ICP, presenting with worsening muscle spasms following spinal tap on 7/6. A very extensive T2 hyperintense epidural collection is seen within the spinal canal beginning at the C3 level and continuing caudally to at least the mid lumbar region. The fluid follows CSF signal characteristics and is predominantly located posteriorly. The collection effaces the thecal sac through most of the spine. Apart from crowding due to the epidural collection, the spinal cord itself appears relatively unremarkable. No clear evidence of any focal signal abnormality or syrinx is seen.The spinal alignment is anatomic allowing for some positional straightening of the cervical lordosis. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is detected. The intervertebral discs are preserved with no areas of degenerative spinal canal encroachment or foraminal narrowing.

Output: A very extensive epidural CSF collection is seen beginning at C3 and continuing down to at least the mid lumbar region. This collection effaces the thecal sac and may exert a mild compressive force on the spinal cord. No evidence of any cord edema or focal cord lesion is seen. In particular, no clear evidence of the reported syrinx is demonstrated.These findings were discussed with Dr. Satzer at 10:10 AM on 07/08/16.


Instruction: Generate impression based on findings.

Input: History of base of tongue cancer. Status post chemo/RT finishing 8 -- 12 -- 2004 CT of the soft tissues of the neck.Images through the skull base and cavernous sinuses demonstrate prominence of the lateral ventricles stable since prior study. New since prior examination is erosive changes of the posterior aspect of dens and body of C2 vertebrae. There is also associated soft tissue thickening and enhancement along the ventral aspect of the spinal canal at this level. This soft tissue also appears to extend between the dens and inferior tip of the clivus. The finding is concerning for metastatic disease and a follow-up with an MRI examination is recommended. There is slight compromise of the AP diameter of thecal sac at this level due to epidural soft tissue mass which causes slight flattening and posterior displacement of the cord and borderline central spinal stenosis of 7.5 mid. These findings are best appreciated on the reformatted sagittal images and also axial post infusion image 28 through 32.No evidence of recurrence of tumor at the level of base of tongue is detected. There is also no evidence of any pathologic adenopathy in the neck. No evidence of any additional osseous abnormality is detected. Extensive degenerative changes of cervical spine are noted. Limited images through the apices of the lungs demonstrate apical scarring. No evidence of metastatic nodules within the lung or limited view of mediastinum is detected.CT of brain with infusion:Visualization of ventral epidural soft tissue at the level of foramen magnum as detailed above.No evidence of hemorrhage, edema, mass effect or midline shift. Prominent supratentorial ventricular system remains stable since prior study. Normal density of brain parenchyma and no evidence of abnormal enhancement.The above new findings where discussed with Dr. Nwizu, Tobenna with pager number 2703 at the time of interpretation.70 cc of Omnipaque was utilized for this exam.

Output: 1.Stable CT of brain with infusion.2.Erosive changes along the dorsal aspect of C2 vertebral body with extra osseous enhancing soft tissue as detailed. Follow-up with a dedicated MRI of cervical spine is recommended to rule out metastatic lesions.3.No evidence of recurrence of tumor at the tongue base or any pathologic adenopathy in the neck.


Instruction: Generate impression based on findings.

Input: 44-year-old woman with right breast cancer status post enlargement was present for follow-up. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Right breast: There is no appreciable enhancement in the lower inner quadrant of the right breast near the 4:00 position at the site of biopsy-proven carcinoma. Previously described non mass enhancement lateral to this area has also completely resolved. A few cysts are present within the right breast. No abnormal enhancement is seen elsewhere in the right breast.Left breast: There is no abnormal enhancement.Axilla: No abnormal enhancement in either axillary region.Other: A port catheter is seen in the left chest wall.

Output: Resolution of abnormal enhancement in the right breast at the sites of biopsy proven malignancy consistent with complete treatment response.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Planning for SRS. Signs and symptoms: Left-sided weakness. Pre and post treatment planning brain MRI:Examination demonstrates an enhancing intra-axial right high convexity superior frontal gyrus metastatic mass measuring at 19.5 x 19.5 x 17.5 mm with slight interval increased size since prior exam from 4-2-15. Extensive surrounding vasogenic edema results in regional mass effect.There is no detectable additional parenchymal or leptomeningeal enhancement.Since prior MRI exam a large left anterior frontal bone enhancing metastatic lesion has been surgically removed and without evidence of recurrence on this limited exam (surgical planning study and not a true diagnostic MRI).Additional small calvarial 5/4/2015 lesions without definitive interval change since prior exam are again noted. Ventricular system remains within normal size and with maintained PICC line. Periventricular white matter Flair hyperintensity (right greater than left) consistent with residual edema, treatment changes as well as overlapping chronic small vessel ischemic strokes are again noted.

Output: 1.Right superior frontal gyrus metastatic lesion measuring 19.5 x 19.5 x 17.5 mm and with slight interval increased size since prior exam.2.Interval removal of left anterior frontal skull metastatic lesion.3.Stable multiple additional small calvarium metastases.


Instruction: Generate impression based on findings.

Input: MRI CARD W/VASODILATOR STRESS WWO CNTRST, 12/7/2016 10:30 AM First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. LV wall thickness is upper limits of normal (IVSd=10mm). The overall LV ejection fraction is 70%, the LV end diastolic volume index is 63 ml/m2 (normal range: 74+/-15), the LVEDV is 123 ml (normal range 142+/-34), the LV end systolic volume index is 19 ml/m2 (normal range 25+/-9), the LVESV is 37 ml (normal range 47+/-19), the LV mass index is 31 g/m2, and the LV mass is 61 g. There are no regional wall motion abnormalities present. Native T1 myocardial relaxation time is normal (<1100ms).Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 134 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 55 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and hyperdynamic systolic function (LVEF 70%). Wall thickness is upper limits of normal. 4. Normal RV size and systolic function (RVEF 60%).5. Mild left atrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: r/o stenosis or occlusion History: transient right sided weakness MRI of the brainNo diffusion weighted abnormalities are appreciated.T2 and flair MR images demonstrate high signal foci in the brainstem associated with some loss of volume of the brainstem. There is interval appearance of focal signal hyperintensity in the left medulla which was not present on the prior exam.There is a moderate degree of periventricular and subcortical predominantly confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Susceptibility images there the grated by patient motion. There is a gyral signal loss from susceptibility in a small focus of encephalomalacia located in the left middle frontal gyrus anteriorly this was also present on the prior examThe CSF spaces are appropriate for the patient's stated age with no midline shift. 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 mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left A1 segment is larger than the right A1 segment. The right posterior communicating artery is not readily identified. The left posterior cerebral artery has fetal origin. The left P1 segment is a very small. There is narrowing of the left posterior cerebral artery in the P2 segment compared to the also appears to be some mild narrowing at the right A3 segment. The vertebral arteries are similar in size.MRA neck:The proximal portions of the great vessels from the aortic arch are not adequately opacified. There is no gross evidence for stenosis at the origins of the great vessels from the aortic arch. There is antegrade flow present along the carotid and vertebral arteries in the neck . On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the visualized course of the vertebral arteries. The origins of the vertebral arteries do not appear to be stenotic but are not well imaged

Output: 1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusion or high-grade stenosis. Some of the peripheral vasculature intracranially appears narrowed.3.There is no evidence for acute ischemic infarction appreciated.4.Signal changes are present in the brain stem and is suspected to be vascular related.5.Small focus of encephalomalacia is present in the left frontal lobe which is most likely vascular related. It is stable compared to the prior exam.6.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 40-year-old male with heterogeneous cystic mass in the tail of the pancreas ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology. No focal liver lesions. No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is within normal limits.SPLEEN: No significant abnormality noted.PANCREAS: Cystic lesion in the tail of the pancreas is again noted demonstrating peripheral enhancement and mild surrounding inflammation. No definitive connection to the main pancreatic duct is noted. No restricted diffusion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cystic lesion in tail of pancreas as described above. Differential includes cystic pancreatic neoplasm, cystic neuroendocrine tumor, or pseudocyst. Correlation with endoscopic ultrasound is recommended.


Instruction: Generate impression based on findings.

Input: 70 years Female (DOB:1/10/1946)Reason: eval cva History: L hand weaknessPROVIDER/ATTENDING NAME: DANIEL W ROBINSON MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Patchy T2 and FLAIR hyperintense lesions are present in the pons and lower midbrain..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 size. There is fetal origin of the left posterior cerebral artery. The right posterior communicating artery is very large. There is an infundibulum at the origin of the posterior communicating arteries bilaterally. The left vertebral artery is larger than the right vertebral artery. The right vertebral artery predominantly supplies the right posterior inferior cerebellar artery and is hypoplastic distal to that.

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


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There are minimal degenerative changes including small disc bulges at the C4-C5 and C5-C6 levels. There is however no significant spinal canal stenosis or neural foraminal stenosis at any level. THORACIC SPINE

Output: No evidence of lymphomatous involvement of the spine. Specifically no suspicious osseous lesion or epidural or leptomeningeal enhancement in the spine.


Instruction: Generate impression based on findings.

Input: Left sided facial pain: sinuses to lower jaw, left cheek, and left ear. There are numerous focal infratentorial and supratentorial focal T2 hyperintense lesions, particularly Involving the corpus callosum, periventricular and subcortical white matter and left inferior pons. The lesions do not appear to enhance. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. There is no convincing evidence of vascular loop phenomenon affecting the trigeminal nerves. There is no evidence of acute infarct or hemorrhage. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.

Output: Extensive supratentorial and infratentorial white matter lesions, including in the region of the left trigeminal nucleus are compatible with multiple sclerosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis with diplopia and fatigue. There are numerous supratentorial and infratentorial T2 hyperintense lesions. There has been interval appearance and increase in size of a few lesions, particularly in the centrum semiovale of the frontal lobes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There are postoperative findings related to endoscopic sinus surgery.

Output: Numerous supratentorial and infratentorial T2 hyperintense lesions are compatible with multiple sclerosis with interval appearance and increase in size of a few demyelinating lesions since February 2013.


Instruction: Generate impression based on findings.

Input: There is mild retrolisthesis of C3 relative to C4 and C4 relative to C5 unchanged. There is multilevel degenerative marrow signal abnormality. Bone marrow signal is heterogenous without suspicious lesions. Vertebral body heights are preserved. The cervical cord is again severely compressed at C3-4 with severe reduction in cord volume and abnormal increased T2 signal consistent with myelomalacia, overall appearing similar to the prior study. There is severe multilevel loss of disk height. Additional level specific findings are as follows:C2-C3: Moderate right facet hypertrophy results in moderate right neuroforaminal stenosis. No significant left neural foraminal or spinal canal narrowing.C3-C4: Large posterior disk osteophyte complex and facet and uncovertebral joint hypertrophy results in severe spinal stenosis with flattening of the cord and abnormal cord signal consistent with myelomalacia. There is moderate right and moderate to severe left neuroforaminal narrowing.C4-C5: Posterior disk osteophyte complex results in moderate spinal stenosis and mild cord deformity. Again seen is severe bilateral neuroforaminal stenosis.C5-C6: Posterior disk osteophyte complex asymmetric towards the right without significant central canal stenosis. There is severe right and moderate left neuroforaminal narrowing.C6-C7: Mild posterior disk osteophyte complex without significant central stenosis. Moderate bilateral neuroforaminal narrowing.C7-T1: Mild posterior disk osteophyte complex without significant central canal stenosis. Moderate left and mild right neuroforaminal narrowing.Mild degenerative changes affect the upper thoracic spine appearing similar to the prior study. Again noted is a hemangioma of the T4 vertebral body. The craniocervical junction and paraspinal soft tissues are unremarkable.

Output: Chronic severe spinal stenosis at C3-C4 and moderate stenosis at C4-C5 with myelomalacia. Findings are not significantly changed since 2012. Moderate to severe neural foraminal stenosis at multiple levels as detailed above.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass, or cerebral edema. There is a 10 x 5 mm thickening and enhancement of the left anterior frontal convexity dura on series 1001 image 19 presumably representing a small meningioma without adjacent mass effect. There are periventricular and subcortical white matter T2 hyperintensities which are nonspecific, likely representing mild chronic microvascular ischemic changes. There is a small old right cerebellar hemispheric infarct. There is a punctate focus of susceptibility effect in the right occipital lobe likely representing chronic microhemorrhage. There is diffuse ventricular and sulcal prominence advanced for patient age consistent with moderate global volume loss, also including the bilateral hippocampi. There is no midline shift or herniation. There is nonspecific opacification of posterior left ethmoid air cells. The skull and extracranial soft tissues are unremarkable.

Output: 1.Moderate global volume loss (advanced for patient age) and mild chronic microvascular ischemic changes with no acute infarct.2.Left frontal convexity dural thickening with enhancement presumed to be a tiny 10 x 5 mm meningioma without mass effect on the adjacent brain.


Instruction: Generate impression based on findings.

Input: 55-year-old male with history of elevated PSA and prior biopsy demonstrating right prostate gland base ASAP. PELVIS:PROSTATE:Prostate Size: 4.1 x 6.2 x 6.6 cm.Peripheral Zone: Single 4 mm focus of low T2 signal with questionable restricted diffusion in the right posterolateral base (series 100 1/20), equivocal for prostate cancer. Otherwise, no suspicious foci.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Single subcentimeter focus in the right base equivocal for prostate cancer, as described above. No definite prostate cancer.


Instruction: Generate impression based on findings.

Input: Lower back pain, left hip pain, rule-out new myeloma this lesion Five lumbar type vertebral bodies are presumed to be present. Multiple compression fractures are seen including T12, L3, L4, and L5, worst at T12 where there is approximately 50% loss of height. These are new since 4/29/2013 but do not demonstrate significant marrow edema to suggest recent loss of height. There is mild anterolisthesis of L4 and L5 and minimal retrolisthesis of L5 on S1. Alignment of the lumbar spine is otherwise maintained. Bone marrow signal is heterogeneous compatible with history of multiple myeloma. There is enhancing lesion involving primarily the posterior elements of the T12 vertebra which is significantly decreased in size from 4/29/2013. Numerous additional smaller enhancing lesions have also regressed compared to 4/29/2013. No new lesion is definitively appreciated. No evidence of epidural tumor.Multilevel degenerative changes are seen, as described below:T12-L1: T12 compression fracture with up to approximately 50% loss of height as mentioned above. No significant disk disease. There is mild bilateral neural foraminal stenosis. No significant spinal canal stenosis.L1-L2: No significant spinal canal or neural foraminal stenosis.L2-L3: No significant spinal canal or neural foraminal stenosis.L3-L4: There is mild bilateral neural foramina narrowing, relatively worse on the right related to mild disk bulge and facet arthropathy. No significant spinal canal stenosis.L4-L5: There is mild spinal canal stenosis related to mild anterolisthesis, small disk bulge, advanced bilateral facet arthropathy, and ligamentum flavum thickening. There is moderate right neural foramina stenosis and mild left neural foramina stenosis.L5-S1: There is mild to moderate right and moderate left neural foramina stenosis related to diffuse disk bulge and advanced facet arthropathy. No significant spinal canal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. No recent MRI is available for comparison. Compared to 4/29/2013, there is been regression of numerous enhancing lesions with residual enhancing lesion involving the posterior elements of T12 again identified.2. Multiple compression fractures involving the T12, L3, L4, and L5 vertebral bodies, worst at T12 where there is up to 50% loss of height. These appear to be chronic but are new since 2013. 3. Multilevel degenerative changes including mild spinal canal stenosis at L4-5 and variable neural foraminal narrowing as detailed above.4. Multilevel facet arthropathy, worst at L4-L5 and L5-S1, which may be contributing to low back pain. There is mild L4-L5 anterolisthesis.


Instruction: Generate impression based on findings.

Input: Acromegaly, failed previous surgery, transsphenoidal surgery in 2013. There is evidence of prior transsphenoidal surgery. There is soft tissue with low T1 and low T2 signal and minimal enhancement along the inferior aspect of the sella where it measures approximately 6 mm in the craniocaudal dimension, 15 mm in the AP dimension, and 18 mm in the transverse dimension. Soft tissue extends laterally on the right and partially fills the right cavernous sinus with the right cavernous sinus portion measuring 11 x 10 mm in the craniocaudal and transverse dimensions. No narrowing of the cavernous internal carotid arteries. Homogeneously enhancing tissue within the upper aspect of the sella is consistent with residual normal pituitary tissue. Infundibulum remains in the midline. No suprasellar extension or evidence of mass effect on the optic chiasm is appreciated.Evaluation of the remainder of the brain demonstrates no intracranial mass or mass effect. No evidence of acute ischemia or hemorrhage. No abnormal parenchymal or meningeal enhancement. No hydrocephalus. No extra-axial collections. Brain parenchyma appears within normal limits. Major flow-voids are preserved. Mild diffuse calvarial thickening is noted and compatible with known acromegaly.

Output: Extensive lobulated soft tissue involving the inferior aspect of the sella and extending into the right cavernous sinus is highly suspicious for residual tumor. The tumor is very mildly enhancing which is somewhat unusual but of uncertain significance. Preoperative MRI would be helpful for comparison.


Instruction: Generate impression based on findings.

Input: 60 year old man with history of coronary artery disease s/p left main BMS in 2011 and proximal LAD DES in 2015 with left circumflex CTO, referred for cardiac stress MRI to evaluate for inducible ischemia and viability. MEDICATIONS: ASA, Plavix, Lipitor, diltiazem, enalapril. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is a small area of focal late gadolinium enhancement noted in the basal antero-septal wall. It appears intra-myocardial which is an atypical pattern for infarct. This pattern may be due to prior inflammation, infiltration or other non-ischemic fibrotic process. Potentially it may be due to injury in the septal perforator territory. The remainder of the myocardium is viable.Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. There is hypokinesis and associated thinning of the basal to mid anterolateral and infero-lateral walls. Otherwise, there is mild to moderate concentric hypertrophy. The overall LV ejection fraction is 42%, the LV end diastolic volume index is 100 ml/m2 (normal range: 74+/-15), the LVEDV is 181 ml (normal range 142+/-34), the LV end systolic volume index is 59 ml/m2 (normal range 25+/-9), the LVESV is 106 ml (normal range 47+/-19), the LV mass index is 43 g/m2, and the LV mass is 79 g. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 133 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 69 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a bovine arch brachiocephalic branching pattern (innominate artery and left carotid artery sharing a common ostium).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia; however, there is clearly a resting wall motion abnormality and relative myocardial thinning in the left circumflex territory that does not have any evidence of myocardial infarction. This wall motion abnormality likely represents hibernating myocardium with a high probability of viability despite the absence of demonstratable ischemia on the stress perfusion images (the sensitivity of stress CMR is ~85-90%). 2. There is a small area of late gadolinium enhancement noted in the basal antero-septal wall. It appears intra-myocardial which is an atypical pattern for infarct. This pattern may be due to prior inflammation, infiltration or other non-ischemic fibrotic process. The finding may also represent a myocardial scar in the septal perforator territory.3. Normal LV size and mildly reduced systolic function (LVEF 42%). Aside from the above mentioned region of relative myocardial thinning, there is mild to moderate concentric left ventricular hypertrophy.4. Normal RV size and mildly reduced systolic function (RVEF 48%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Scoliosis is better characterized on previous x-ray dated 6/11/2015.There are no osseous dysplasias such as hemivertebrae or butterfly vertebrae.Cervical spine:There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. Thoracic spine:There are no fractures or subluxations. The marrow signal is benign. The thoracic cord is normal in signal. The visualized paraspinal contents are unremarkable.Lumbar spine:There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at the inferior aspect of L2. There are no findings of fatty filum. Upon prone maneuvering, the conus and cauda equina slightly translate anteriorly. The visualized intra-abdominal and paraspinal contents are unremarkable.

Output: 1.Normal cord signal without evidence of syrinx.2.No MRI evidence of fatty filum.3.No MRI evidence of cord tethering.


Instruction: Generate impression based on findings.

Input: 48-year-old female with right leg pain. Evaluate for a right-sided lumbar radiculopathy. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. Mild disc dessication and mild disc bulges are again seen involving the L3-4 and L4-5 levels. Schmorl's nodes are again seen involving the superior endplate of L5 and involving the upper lumbar and lower thoracic spine but these are unchanged. There is no significant neuroforaminal or spinal canal stenosis. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology and terminates at the L2-3 level. The paravertebral soft tissues are unremarkable.

Output: Mild degenerative changes without findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Peri-orbital and sclera swelling. Relapsed preB ALL s/p MRD SCT on blinatumimab. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is mild diffuse prominence of the sulci and ventricles, which may represent treatment-related pseudoatrophy. There is no midline shift or herniation. The major cerebral flow voids are intact. There is moderate mucosal thickening within the left maxillary and sphenoid sinuses and mild mucosal thickening within the right maxillary sinus. There is diffuse hypointense of the bone marrow on T1 and T2-weighted sequences.Orbits: There is left preseptal soft tissue swelling and and enhancement and to a lesser extent right preseptal swelling and enhancement. There is no evidence of abscess or postseptal inflammation. There is no evidence of intraorbital tumor. Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Nonspecific left greater than right preseptal swelling, without evidence of abscess or postseptal cellulitis.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.3. No evidence of leptomeningeal tumor in the spinal canal.4. The diffusely abnormal bone marrow signal may be related to leukemia and/or associated treatment effects.


Instruction: Generate impression based on findings.

Input: Headaches, ventriculomegaly, and neck pain with history of motor vehicle accident. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged dilatation of the bilateral lateral ventricles, particularly in the region of the trigones with associated paucity of periventricular white matter. The third and fourth ventricles are not enlarged. The corpus callosum is intact. There is a right cerebellar hemisphere developmental venous anomaly and mild prominence of the regional sulci, indicating volume loss. There is also prominence of the extra-axial cerebrospinal fluid space medial to the right cerebellar hemisphere that measures up to 9 mm in width. The pituitary gland appears unremarkable. There is no midline shift or herniation. The major cerebral artery flow voids are intact, including a hypoplastic right vertebral artery. There is a small retention cyst within the alveolar recess of the right maxillary sinus. There is a small amount of persistent fluid within the right mastoid air cells. The skull, orbits, and scalp soft tissues are grossly unremarkable.Cervical Spine: There is degenerative spondylosis with small posterior disc-osteophyte complexes and diminished fluid signal at C5-6 and C6-7, but no significant spinal canal or neural foramen stenosis. The vertebral column alignment is anatomic. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The imaged cervical artery flow voids are grossly intact, including a hypoplastic right vertebral artery. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or cerebral edema.2. Unchanged dilatation of the bilateral lateral ventricles, particularly in the region of the trigones with associated paucity of periventricular white matter, which is compatible with colpocephaly. 3. Right cerebellar developmental venous anomaly.4. Prominence of the cerebrospinal fluid space medial to the right cerebellar hemisphere that measures up to 9 mm in width may represent an arachnoid cyst versus an asymmetric mega cisterna magna. 5. Small amount of persistent fluid within the right mastoid air cells.6. Degenerative spondylosis with small posterior disc-osteophyte complexes at C5-6 and C6-7, but no significant spinal canal or neural foramen stenosis.


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 family, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left 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. Unfortunately, the patient was claustrophobic and could not tolerate the MRI examination. The patient was therefore escorted to CT, where his left hip was scanned.Exposure time: 0:16

Output: Successful intra-articular injection of contrast material for CT arthrogram of the left hip. The patient could not tolerate MRI due to claustrophobia.


Instruction: Generate impression based on findings.

Input: Clinical question: Orbital cellulitis?. Signs and symptoms: Right eye pain with movement. Enhanced MRI of orbits:120 cc of Omnipaque 350 was administered.The retro-orbital fat is well preserved and with no evidence of stranding or abnormal enhancement. The extraocular musculature has normal morphology and size and no abnormal enhancement.The optic nerves are well visualized and with no abnormal enhancement.There is normal morphology and density of bilateral globes and with no abnormal enhancement.The adjacent paranasal sinuses demonstrate minimal sinus disease of the ethmoids and otherwise unremarkable.Cavernous sinuses and sella are normal and no abnormal enhancement. No evidence of preseptal soft tissue swelling or abnormal enhancement.

Output: Negative enhanced CT of orbits.


Instruction: Generate impression based on findings.

Input: 37 year old female with history of brain tumor. Evidence of a bifrontal high convexity frontal craniotomy which extends across the midline. Some soft tissue density with central enhancement appears to be along the inner table of the craniotomy flap. This finding could represent epidural thickening as result of surgery. Due to high positioning of the craniotomy it is not possible to determine with certainty whether there is residual tumor in this location. The brain parenchyma immediately inferior to the flap however appears normal and demonstrates no evidence of any edema, encephalomalacia or any abnormal enhancement. Although this exam does not demonstrate any definitive evidence of tumor, further evaluation with MRI would be more definitive. The findings in this exam are believed to be entirety post operative change. Multiple thick dural based calcification in the area of surgery is noted which are believed to represent dural calcific plaques.

Output: No definitive evidence of recurrence of tumor. Follow up exam and MRI is recommended.


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 left 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, 12 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: 19 seconds.

Output: Successful fluoroscopic-guided injection of dilute gadolinium into the left hip for subsequent MR arthrogram examination.


Instruction: Generate impression based on findings.

Input: 47 year old woman with recent diagnosis of diffuse large B-cell lymphoma, family history of coronary disease, found to have reduced LV function on pre-chemotherapy echocardiography. She was referred for cardiac stress MR to evaluate for possible etiologies of her cardiomyopathy.MEDICATIONS: albuterol, Zyrtec, multivitamin First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is a small amount of epicardial late gadolinium enhancement involving the basal inferolateral wall which is atypical for myocardial infarction and suggests prior fibrosis, inflammation, or infiltration. The remainder of the myocardium is viable.Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 81 ml/m2 (normal range: 65+/-11), the LVEDV is 171 ml (normal range 109+/-23), the LV end systolic volume index is 43 ml/m2 (normal range 18+/-5), the LVESV is 85 ml (normal range 31+/-10), the LV mass index is 21 g/m2, and the LV mass is 45 g. There is global hypokinesis.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 63 ml/m2 (normal range 69+/-14), the RVEDV is 131 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 62 ml (normal range 35+/-13). Right AtriumThe right atrium is mild-moderately dilated. 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. There is a right chest wall port with catheter in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac Findings 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. There is a small amount of epicardial late gadolinium enhancement involving the basal inferolateral wall which is atypical for myocardial infarction and suggests prior fibrosis, inflammation, or infiltration.3. Normal LV size and low normal systolic function (LVEF 50%).4. Normal RV size and mildly reduced systolic function (RVEF 47%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Generalized abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. It measures 14.2 cm in the craniocaudal dimension. Note is made of a septated cyst in segment 8 and additional subcentimeter cysts. No suspicious liver lesion.Cholelithiasis within a distended gallbladder with mild gallbladder wall thickening.The common bile duct measures up to 1.4 cm, dilated. There are several dependent filling defects within the common bile duct consistent with choledocholithiasis. There is mild central intrahepatic biliary ductal dilatation.SPLEEN: The spleen is normal in size and signal intensity without a focal lesion.PANCREAS: The pancreas is normal in morphology, signal intensity and enhancement. No evidence of acute pancreatitis. The main pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple and minimally complex septated renal cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Tortuous abdominal aorta. No retroperitoneal lymphadenopathy measuring greater than 1 cm in short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Rightward thoracolumbar scoliosis.OTHER: No significant abnormality noted.

Output: 1.Choledocholithiasis with biliary ductal dilatation.2.Cholelithiasis within a distended gallbladder with mild gallbladder wall thickening/pericholecystic fluid, suspicious for acute cholecystitis.


Instruction: Generate impression based on findings.

Input: Left lumbar sciatica and positional paresthesias involving the left calf and foot. Five lumbar type vertebral bodies are presumed to be present. There is transitional morphology of L5 with pseudoarticulation involving the right L5 transverse process with the sacrum. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign with fatty marrow signal changes involving the anterior inferior endplates of the T11 and L3 vertebrae. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described 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: Disc desiccation and mild disc bulge. There is moderate right-sided facet arthropathy and to a mild degree on the left and appears minimally progressed in the interval. There is no spinal canal stenosis. There is mild to moderate right-sided and minimal left neural foraminal stenosis which has mildly progressed in the interval.L4-L5: Disc desiccation again seen as well as moderate bilateral facet arthropathy. Small right posterior lateral annular fissure. No spinal canal stenosis. There is mild left and minimal right neural foraminal stenosis which is slightly progressed in the interval. L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes as described above which have mildly progressed since 4/24/2008. There is no significant spinal canal stenosis at any level. Neural foraminal narrowing is relatively worse at the L3-L4 level where there is mild to moderate right-sided stenosis. There is also mild left L4-L5 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a distal left M1 aneurysm at the bifurcation, measuring approximately 4 x 4 mm in diameter. There is also a 2 x 2 mm posterosuperiorly directed outpouching from the mid-left M1 segment which was present on the prior MRI and is unchanged. Along the distal right M1 segment at the bifurcation is a third aneurysm directed superiorly, measures 2 x 2 mm, was present previously, and is unchanged.The intracranial internal carotid arteries and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. The bilateral PComA are not visualized. There is no evidence of flow-limiting stenosis.

Output: 1.Unchanged appearance of the 4 mm distal left M1 segment aneurysm at the bifurcation.2.Two additional smaller aneurysms, including a posterosuperiorly directed 2 mm aneurysm along the left mid-M1 segment and a superiorly directed 2 mm aneurysm along the distal right M1 segment at the bifurcation are also not significantly changed.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Evaluate for progression. There is minimal retrolisthesis of C4 on C5 and C5 on C6. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal morphology. There are scattered foci of T2 hyperintense signal within the cervical spinal cord at multiple levels as follows: at the C2 level, in the slight right paramidline posterior aspect; at the C3-4 level, in the right lateral aspect; at the C5 level, in the posterior midline; at the C6-7 level, in the left lateral aspect; at the C7-T1 level, in the right lateral aspect. There is minimal degenerative spondylosis in the lower cervical spine without significant spinal canal or neural foramen stenosis. There is a subcentimeter left adenoid retention cyst. The paravertebral soft tissues are unremarkable.

Output: Multiple lesions within the cervical cord may represent a demyelinating process. No prior cervical spine MRI is available to evaluate for progression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 20-year-old male patient with ulcerative colitis and likely primary sclerosing cholangitis. Nausea, abdominal cramping, frequent bowel movements. ABDOMEN:LIVER, BILIARY TRACT: There is minimal intrahepatic biliary ductal dilatation. While this may be an early sign of primary sclerosing cholangitis, the ducts do not appear irregular and there is no dominant stricture. No suspicious hepatic lesion is identified. The common bile duct is normal in diameter. The gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction. The distal transverse and descending colon are decompressed.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Minimal intrahepatic biliary ductal dilatation which could represent early disease although there is no irregularity of the bile ducts or dominant stricture or suspicious hepatic lesion.2.Otherwise, no acute abnormality identified within the abdomen.


Instruction: Generate impression based on findings.

Input: Status post L4-S1 laminectomy on 3/21/16. A new low back pain with right lower extremity radiation. Suspicion of infection. The examination is limited by patient body habitus and motion.Sagittal alignment is anatomic. Vertebral body heights are further preserved except for suggestion of minimal height loss at L5. There are changes of the recent L4-S1 laminectomies. Extensive inflammatory changes are present in the subcutaneous fat and the paravertebral soft tissues, including a well-circumscribed subcutaneous fluid collection, which measures transaxially 3.7 cm x 2.0 cm and craniocaudally 5.2 cm. There is no definite deep extension of fluid towards the spinal canal. The abnormal signal and enhancement in the paraspinal muscles is asymmetrically more pronounced on the left side and may represent a correlation of postoperative change and/or inflammatory tissue.Posterolateral at L4-L5 which is best seen on image #24 of series #12, there is asymmetrically increased focal T2 signal which may reflect asymmetric distribution of the CSF related to the compression of the thecal sac. At the same level, there is a focus of T1/T2-hyperintensity at the left L5 laminotomy defect and with similar though more poorly defined change in the overlying soft tissue. This may represent proteinaceous fluid or even minimal postoperative blood products but causes no significant mass-effect on the thecal sac. There is central fluid signal intensity within the mildly expanded L5-S1 disc with peripheral contrast enhancement with infiltrative inflammatory changes including the adjacent soft tissue. This is associated with osseous endplate erosion and irregularity with poor delineation of the cortex, most pronounced along the central portion of upper endplate of S1. The immediately subjacent marrow surrounding L5-S1 show hypointense T1/T2 signal, probably reflecting sclerosis suggesting some degree of chronicity. The adjacent marrow in the superior part of L5 vertebral body and the inferior part of minimally S1 segment as well as the upper part of the left greater than right sacral ala show contrast enhancement.There is also extensive inflammatory change involving the epidural space circumferentially from the lower L4 level to the upper S2 level which shows fairly solid contrast enhancement. This moderately narrows the thecal sac at L5-S1. The inflammatory change also extends along the L5 and S1 nerve roots, again greater on the left side. There is also asymmetric inflammatory change and contrast enhancement involving the left L2-L3 neural foramen with loss of the foraminal fat, extending into the adjacent left pedicle and facet, with adjacent epidural fat resulting in minimal mass-effect on the thecal sac. There is also involvement of the adjacent paraspinal soft tissues though no drainable fluid collection. There is also inflammatory change along the anterior-superior aspect of L2 vertebral body but the adjacent disc shows relative desiccation at this time. This L2-L3 involvement may represent cranial extension of the above-described inflammatory/infectious process in the lower lumbar spine through involvement of the prevertebral soft tissues.Otherwise, there is multilevel degenerative change manifested by disc bulges at L2-L3, L3-L4 and L4-L5 along with facet arthropathy and ligamenta flava thickening resulting in multilevel spinal canal stenosis which is severe at L3-L4, moderate at L4-L5, and mild-to-moderate at L2-L3. This is in addition to the moderate spinal canal stenosis at L5-S1 due to the epidural process.

Output: 1.The examination is limited by patient body habitus and motion.2.Extensive inflammatory changes at the L5-S1 disc as well as the L4-S1 laminectomy site with involvement of the epidural space, resulting in moderate compression of the thecal sac and involvement of the L5 and S1 nerve roots. This is probably a combination of postoperative change and an ongoing infectious process. The exact details of previous surgery are not available, however. The involved epidural space shows solid contrast enhancement, compatible with phlegmon with persistent L5-S1 discitis/osteomyelitis. Also, there is a superficial fluid collection in the subcutaneous fat at the surgery site which is nonspecific.3.Contrast enhancement in relation to the left L2-L3 neural foramen and adjacent pedicle and facet likely represents additional early osteomyelitis through involvement of the prevertebral soft tissues. Alternatively, this may represent a separate focus of inflammatory/infectious process. A CT scan of the lumbar spine with provide more details regarding osseous structures, specifically regarding cortical integrity. 4.Multilevel degenerative disease as associated with multilevel spinal canal stenosis, most pronounced at L3-L4 where it is severe.Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Javed Khader-Eliyas (from Neurosurgery) over the phone on 4/26/2016 12:33 PM.


Instruction: Generate impression based on findings.

Input: Left arm mass A vitamin E marker was placed in the region of interest overlying the posteromedial soft tissues of the proximal forearm.There is a mild amount of increased signal intensity within the region which may be secondary to the compressive effect a marker. Otherwise there is no discrete mass appreciated. The underlying marrow and muscle signal intensity is normal.

Output: Within the limits of this exam, there is no mass identified although there is a mild amount of increased signal intensity in the region of interest which may be secondary to compression from the vitamin E marker. If there is persistent clinical concern for mass or soft tissue lesion, repeat MRI with contrast can be obtained.


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 left 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, 12 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: 1 minute and 38 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium into the left hip for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: Reason: 56 yo female with abnormal CT scan suggesting hypodense lesion in the head of pancreas; please evaluate for any abnormalities History: pancreas lesion ABDOMEN:LIVER, BILIARY TRACT: There is a stone in the gallbladder neck without evidence of cholecystitisSPLEEN: No significant abnormality noted.PANCREAS: Lesion in the uncinate measures 1.3 x 0.7 cm (701/17) and appears to communicate with the main pancreatic duct, which is not dilated. No enhancement is evident. This lesion appears to contain a small septation (901/13). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Subcentimeter right axillary lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cystic lesion in the uncinate with a small septation likely represents a side branch IPMN.2.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: 48-year-old female with prior left temporal lobe resection. There are stable findings related to left temporal craniotomy with unchanged T2/FLAIR hyperintensity surrounding the left temporal resection cavity. Unchanged areas of FLAIR hyperintensity extending to the adjacent left temporal cortex. No new mass or evidence of mass-effect. No evidence of recent ischemia or hemorrhage. No extra-axial collections. No hydrocephalus. No abnormal parenchymal meningeal enhancement. Unchanged area of T1 hyperintensity in the right parietal calvarium which may represent hemangioma. No suspicious osseous lesions.

Output: Stable appearance of the left temporal resection cavity and areas of adjacent FLAIR hyperintensity which most likely represent gliosis. No new mass or signal abnormality to suggest recurrence.


Instruction: Generate impression based on findings.

Input: 41-year-old female patient with cirrhosis, hemosiderosis, hepatolithiasis status post biliary drain. HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Post-surgical findings of a hepaticojejunostomy and cholecystectomy. A percutaneous biliary drain enters the left hepatic lobe biliary system and terminates in the jejunum. Moderate left hepatic lobe central biliary ductal dilatation extending to the hilum is similar to the prior exam. There is a geometric configuration of foci of signal void with corresponding T1 hyperintensity in the biliary ducts of the left hepatic lobe, which is suspicious for stones; these appear similar to the prior study. There is only mild upstream biliary ductal dilatation, unchanged from earlier exam. Intermediate signal around the biliary catheter may represent debris.There is reticular T2 hyperintensity in the right hepatic lobe consistent with fibrosis. Diffusely decreased T2 signal in the liver with paradoxical shift on in/out of phase images is compatible with iron deposition. Of note, the arterial phase images are suboptimal due to timing. Two ill-defined non-enhancing T2 hypointense hepatic lesions with signal dropout on in phase images are consistent with siderotic nodules, appearing similar to the prior study. A reference segment 7 lesion measures 1.5 x 1.3 cm (image 46, series 9), unchanged. A previously noted nodule within the inferior right hepatic lobe is not well seen on today's examination, which may be technical. No new suspicious hepatic lesion is identified.Portal vein and hepatic veins are patent.SPLEEN: Autoinfarcted spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild T2 hypointensity within the renal cortex bilaterally is suggestive of iron deposition given clinical setting of sickle cell disease.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large stool burden.BONES, SOFT TISSUES: Partially imaged fluid containing ventral wall abdominal hernia.OTHER: No significant abnormality noted.

Output: 1.Stable hepatic lesions compatible with siderotic nodules. No new suspicious hepatic lesion is identified. 2.Dilated central left intrahepatic ducts with multiple stones, appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: 18 year-old female with paresthesias and multiple sclerosis. Redemonstrated are numerous T2 hyperintense lesions within the subcortical and periventricular white matter as well as corpus callosum. One definite new lesion is present within medial left frontal subcortical white matter. The majority of lesions are stable, although a view with increased/decreased in size. Previously demonstrated pontine abnormality is less apparent, however axial FLAIR imaging includes phase artifact through this region, and no conventional T2 sequence was acquired. There is questionable involvement of the right superior cerebellar peduncle.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, or intra- or extra-axial fluid collection. The midline structures and cranial-cervical junction are normal.

Output: MRI evidence for multiple sclerosis which appears primarily stable, although one definite new lesion is present within the medial left frontal subcortical white matter.


Instruction: Generate impression based on findings.

Input: Reason: concern for rotator cuff tear History: pain x 6-7 mo. ROTATOR CUFF: Complete full-thickness tear of the supraspinatus tendon with approximately 1.7 cm of retraction in a background of moderate tendinosis. Mild fatty atrophy of the supraspinatus muscle.Undersurface tearing of the infraspinatus tendon without discrete full-thickness tear in a background of mild tendinosis. Mild fatty atrophy of the infraspinatus muscle.The teres minor tendon and muscle are intact.The subscapularis tendon and muscle are intact. SUPRASPINATUS OUTLET: Moderate AC joint osteoarthritis. Small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Small amount of joint fluid. Irregularity of the glenoid labrum compatible with degeneration.BICEPS TENDON: Complete or near complete tear of the intraarticular biceps tendon in a background of tendinosis. Fluid within the sheath compatible with tenosynovitis. ADDITIONAL

Output: 1.Complete full thickness tear of the supraspinatus tendon with retraction and muscle atrophy.2.Undersurface tearing of the infraspinatus tendon with muscle atrophy.3.Moderate AC joint osteoarthritis.4.Intraarticular rupture of the biceps tendon in background of tendinosis. Mild tenosynovitis. 5.Glenoid labral degeneration without discrete tear.6.Small joint effusion.


Instruction: Generate impression based on findings.

Input: 45-year-old female with history of cervical cancer, residual disease in the vaginal cuff on exam PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy. Limited evaluation due to incomplete distention of the vaginal canal. There is submucosal edema of the vaginal wall. No enhancing measurable disease is identified in the region of the vaginal cuff.BLADDER: No significant abnormality noted.LYMPH NODES: 11 mm left inguinal lymph node. Additional scattered bilateral inguinal lymph nodes. No significant internal obturator, or pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Submucosal edema of the vaginal wall without enhancing mass.


Instruction: Generate impression based on findings.

Input: Diagnosis: CervicalgiaClinical question: evaluate for degenerative change, disk herniationSigns and Symptoms: neck and L shoulder pain, radicular The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of normal cervical curvature present. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There are small left-sided endplate and uncovertebral osteophytes present associated with some disc material and mild encroachment of left-sided exiting nerve roots.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this level. There is partial effacement of spinal fluid ventral to the spinal cord at this level. Overall there is a mild degree of spinal stenosis at this level.At C5-6 there is no significant compromise to the neural foramina. There is a disc bulge present at this level as well as some very small uncovertebral osteophytes. There are some mild posterior ligamentous hypertrophy at this level Overall there is a mild to moderate degree of spinal stenosis at this level. There is partial effacement of spinal fluid ventricle. There is loss of disc space height at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this There is loss of disc space height at this level.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 multilevel degenerative changes present in the cervical spine with a mild to moderate degree of spinal stenosis at C5-6.


Instruction: Generate impression based on findings.

Input: For the purposes of this dictation, the last fully formed disk space will be termed L5-S1. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The imaged spinal cord displays normal signal and morphology with the conus terminating at the inferior L2 endplate. There is no evidence of filar thickening or fibrofatty infiltration. There is no significant anterior translation of the conus upon prone positioning. The paravertebral soft tissues are unremarkable.

Output: Unremarkable lumbar spine MRI without evidence for tethered cord.


Instruction: Generate impression based on findings.

Input: Redemonstrated is posterior spinal fusion at L4-S1, utilizing posterior fusion rods, bilateral pedicle screws, interbody spacer devices and bone graft material. There is unchanged mild anterolisthesis of L4 on L5. The vertebral body heights are maintained. There is moderate loss of disc height at L5-S1 with disc dessication and endplate degenerative changes. There is degenerative spondylosis of the lower lumbar spine. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is edema at the posterior subcutaneous soft tissues. T12-L1: No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: Bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis. L2-L3: Bilateral facet degeneration, and thickening of the ligamentum flavum. No significant disc bulge, spinal canal or foraminal stenosis. L3-L4: Disc bulge, thickening of the ligamentum flavum and bilateral facet degeneration. No significant spinal canal or foraminal stenosis.  L4-L5: Bilateral facet degeneration. No significant disc bulge, spinal canal or foraminal stenosis. L5-S1: Bilateral facet degeneration and marginal osteophytes, contributing to mild bilateral neural foraminal narrowing. No significant spinal canal stenosis.

Output: 1. Posterior spinal fusion at L4 through S1.2. Degenerative spondylosis with bilateral mild neural foramen narrowing at L5-S1. No significant spinal canal stenosis. This is stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with left temporal GBM status post resection. A wide left-sided craniotomy is seen involving portions of the left frontal, parietal and temporal bones with scalp edema and scalp fluid. Pneumocephalus is present, as well as epidural and subdural collections most likely representing a mixture of proteinaceous and hemorrhagic fluid measuring up to 11 mm in thickness subjacent to the craniotomy. A small amount of this mixed subdural fluid tracks along the left frontal lobe and posteriorly along the interhemispheric falx.The previously seen small left temporal resection cavity has been significantly enlarged to encompass a majority of the large ring-enhancing mass which previously occupied the left anterior temporal lobe and the insula. Resection of the anterior temporal lobe is complete with the exception of a residual island of superior temporal gyrus which contains a focus of hemorrhage. The surgical cavity margins demonstrate a thin coating of T1 hyperintense material likely representing evolving blood product. Along the posterior superior edge of the cavity, there is an ill-defined area of enhancement extending to the left ventricular atrium (see image 16 series 1101) which correlates with an area of restricted diffusion. Nonspecific curvilinear enhancement is also seen within and along the margins of the residual island of superior temporal gyrus (see image 15 series 1101, and adjacent slices). Nonenhancing thickened parenchyma remains evident along the posterior aspect of the left mesial temporal lobe, extending into the splenium of the corpus callosum.Restricted diffusion is seen along the posterior inferior margin of the surgical cavity, and as above, more superiorly extending to the left ventricular atrium. Generalized left cerebral mass effect is seen with sulcal effacement, partial effacement of the left lateral ventricle, and a 7 mm midline shift to the right. The left ambient cistern is narrowed but not effaced. The left uncus is displaced medially. Mild rightward mass effect persists upon the midbrain.No new enhancing or masslike lesions are seen. The right lateral ventricle is not dilated. Mild ill-defined periventricular FLAIR hyperintensity is nonspecific.

Output: Findings are seen compatible with extensive left anterior temporal and insular tumor resection. Resection of the structures is complete with the exception of a residual island of superior temporal gyrus which contains focal hemorrhage.The previously seen large ring-enhancing tumor involving the left anterior temporal lobe has been nearly completely resected. Curvilinear enhancement within the residual left superior temporal gyrus is nonspecific and could represent tumor or surgical change. Ill-defined enhancement along the posterior superior surgical cavity margin is seen, but this correlates with restricted diffusion and may therefore represent parenchymal injury rather than residual tumor. Nonenhancing thickened parenchyma, presumably reflective of infiltrative tumor, is seen along the posterior most aspect of the left medial temporal lobe, extending into the splenium of corpus callosum.Generalized left cerebral mass effect is seen with sulcal effacement, left ventricular effacement, midline shift to the right and mild rightward shift of the midbrain.


Instruction: Generate impression based on findings.

Input: No evidence of acute infarct. T2/FLAIR images demonstrates moderate hyperintensity in the periventricular and the subcortical white matter as well as in the pons, most consistent with chronic small vessel ischemic disease. Few foci of susceptibility are seen in the basal ganglia bilaterally, which may be related to chronic microhemorrhages or mineralization. No evidence of acute hemorrhage. No evidence of intracranial mass effect. No hydrocephalus or extra-axial collections.MR angiography demonstrates patent internal carotid arteries, bilateral ACAs, MCAs, and bilateral PCAs. Left A1 segment is hypoplastic. A 2 mm aneurysm is seen in the anterior communicating artery, projecting posteriorly and to the left. Basilar artery and distal vertebral arteries are patent. Note is made that the right internal carotid artery has a retropharyngeal course.

Output: 1. No evidence of acute infarct.2. Moderate chronic small vessel ischemic disease.3. No significant stenosis in the intracranial circulation.4. A 2 mm anterior communicating artery aneurysm is noted projecting posteriorly and to the left.


Instruction: Generate impression based on findings.

Input: Female, 57 years old, with metastatic renal cell carcinoma to L2 status post prior RT, kyphoplasty and recent debulking. Evaluate for extent of disease now five weeks postop. Postoperative findings are redemonstrated at L2 including resection of the left lamina, pedicle, transverse process and facet complex. Fluid and edema within the epidural operative bed are similar to the prior examination. A new fluid collection is also noted within the superficial soft tissues of the operative bed measuring up to 4 cm in diameter. The caliber of the thecal sac at L2 is similar to the immediate prior examination and improved relative to the older preoperative examination. The left L1-2 neural foramen remains narrowed. The left L2-3 neural foramen is surgically decompressed. Extraosseous tumor involving the left lateral extraosseous tissues at L2 is similar to the prior examination.Again seen is evidence of kyphoplasty at L2 and L5 with findings appearing similar to prior. A moderate compression deformity of the L1 vertebral body is also unchanged. Diffuse fatty marrow infiltration of the lumbar spine is compatible with prior radiotherapy. Abnormal STIR signal and enhancement involving the right L4 pedicle and inferior articulating facet have become more conspicuous. No other areas of new or progressive signal abnormality are seen. Degenerative findings are unchanged. No significant compromise of the spinal canal is seen at any level.

Output: Evolving postoperative findings are seen compatible with tumor debulking at L2. The caliber of the thecal sac at L2 is similar to the immediate prior examination and improved relative to preoperative studies. A fluid collection within the superficial operative bed is new.Abnormal signal and enhancement involving the right L4 pedicle and inferior articulating facet are concerning for metastatic involvement. These findings have become more conspicuous when compared to prior examinations. No additional new lesions are seen.