Instruction: Generate impression based on findings.

Input: 42 female with history of lumbar laminectomy for lipomatosis last March, experiencing left lumbar pain and paresthesia Redemonstrated is congenital spinal canal stenosis. The vertebral body heights are preserved. The bone marrow signal is benign. Note is made of bilateral ovarian cysts and a small amount of pelvic fluid. Otherwise the paraspinal soft tissues are unremarkable. Disc desiccation with mild disc height loss is present at L4/5 and L5/S1, unchangedT12/L1: Mild bilateral facet hypertrophy without stenosis, unchanged.L1/2: Mild bilateral facet hypertrophy without stenosis, unchanged.L2/3: Mild bilateral facet hypertrophy without stenosis, unchanged.L3/4: Minimal bilateral facet hypertrophy without stenosis, unchanged.L4/5: Redemonstrated is a central to right paracentral protrusion, superimposed mild disc bulge, and mild bilateral facet hypertrophy. There has been interval left hemilaminectomy with resection of epidural fat and ligamentum flavum thickening resulting in decompression of the central canal. As before, there is no significant neural foraminal stenosis.L5/S1:There is been slight interval progression of a previously demonstrated left paracentral disc protrusion, with further posterior displacement of the left S1 nerve root sheath. There has also been interval left hemilaminectomy with resection of epidural fat, decompressing the central canal. As before there is bilateral mild facet hypertrophy and no significant neural foraminal stenosis.

Output: 1.L4/5: Redemonstrated is a central to right paracentral protrusion, superimposed mild disc bulge, and mild bilateral facet hypertrophy. There has been interval left hemilaminectomy with resection of epidural fat and ligamentum flavum thickening resulting in decompression of the central canal. As before, there is no significant neural foraminal stenosis.2.L5/S1:There is been slight interval progression of a previously demonstrated left paracentral disc protrusion, with further posterior displacement of the left S1 nerve root sheath. There has also been interval left hemilaminectomy with resection of epidural fat, decompressing the central canal. As before there is bilateral mild facet hypertrophy and no significant neural foraminal stenosis.3.Note is made of bilateral ovarian cysts and a small amount of pelvic fluid.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 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: 22 seconds

Output: Successful right hip arthrogram injection.


Instruction: Generate impression based on findings.

Input: New nocturnal headaches. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift or hydrocephalus.There is also noted definitive evidence of small vessel ischemic disease as was noted on prior MRI exam.There is prominence of cortical sulci and supratentorial ventricular system similar to prior study. This may be begin or more range for patient's stated age of 89.Calvarium is intact. Visualized mastoid air cells and middle ear cavities are unremarkable. Limited view of the orbits demonstrate evidence of prior bilateral cataract surgery.

Output: 1.No evidence of acute intracranial process.2.Stable exam since prior MRI study from 8 -- 20 -- 10.3.Normal pneumatization of paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: 23 years, Male, status post tumor resection. History of central neurocytoma. There are postsurgical changes of right parietal craniotomy for resection of mass involving the mid to posterior aspect of the cingulate gyrus. There is restricted diffusion along the margins of the surgical cavity involving the bilateral parietal lobes. Blood products are also noted along the frontoparietal sulci in a paramedian distribution. Encephalomalacia related to presumed prior surgical tract involving the left superior frontal gyrus noted.There is thinning involving the posterior callosal body and isthmus. Expected postsurgical changes also include extra-axial air and blood products. No large hemorrhage, infarct, or mass effect is appreciated. No hydrocephalus. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Expected postsurgical changes of resection of midline tumor along the posterior cingulate gyrus. No evidence of residual tumor.


Instruction: Generate impression based on findings.

Input: Seizure x1, evaluate for structural abnormality No diffusion restriction is seen to suggest acute infarction. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. The brain parenchyma is of normal signal intensity without mass lesion. The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the visualized intracranial vasculature.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Reason: Left foot infection, rule out osteomyelitis or abscess History: left foot swelling, erythema There is decreased T1 signal and increased STIR signal of the second metatarsal. A transverse band of decreased T1 signal and increased STIR signal is seen in the proximal diaphysis of the second metatarsal (series 601 image 15). There is also decreased enhancement of the second metatarsal, suggestive of hyperacute/acute osteomyelitis.Swelling of the skin and subcutaneous soft tissue of the dorsum with enhancement. Inflammatory changes of the dorsal and plantar foot muscles with loss of fat plane and enhancement. No evidence of abscess.

Output: 2nd metatarsal acute osteomyelitis with inflammatory changes of the surrounding muscle, subcutaneous tissue, and skin.


Instruction: Generate impression based on findings.

Input: 30 year-old history of bilateral breast implants who sustained a work-related injury 2 weeks ago presents for further evaluation and follow-up to breast MRI. MAMMOGRAM: Three standard and implant displaced views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. The collapsed right retropectoral implant is similar in appearance to the MRI. A left retropectoral implant is intact with contours maintained.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae.LEFT AXILLA ULTRASOUND:On physical exam, there is no visible abnormality of the left breast.A targeted left axillary grayscale and color Doppler ultrasound was performed enlarged left axilla lymph nodes identified on MRI 12/24/2015. Two lymph nodes are identified deep in the left axilla. The largest lymph node measures 1.6 x 0.5 cm. Both lymph nodes demonstrate normal morphology with hilar flow.

Output: Bilateral breast implants with collapse of the right implant similar to the findings on MRI. No sonographic or mammographic evidence of malignancy. Normal morphology lymph nodes in the left axilla. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually starting at age 40. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Pre-treatment planning MRI for a left cerebellar tumor. There is a heterogeneous mass that measures up to 20 mm in the left medial cerebellar hemisphere. There also appears to be a punctate satellite lesion or exophytic component anterolateral to the dominant mass. There is slight effacement of the left lateral aspect of the fourth ventricle, but no evidence of obstructive hydrocephalus. There appears to be a punctate focus of T2 hyperintensity in the splenium of the corpus callosum, which may be artifactual. There is a right parietal lobe developmental venous anomaly. There is a cavum septum pellucidum.

Output: Pretreatment planning MRI demonstrates a mass that measures up to 20 mm in the left medial cerebellar hemisphere with an adjacent punctate satellite lesion or exophytic component.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarction. There are a couple punctate foci of increased T2/FLAIR signal within the right frontal subcortical white matter which are thought to be artifactual. Subtle confluent increased T2/FLAIR signal within the bilateral periatrial white matter is compatible with terminal zones of myelination. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: No acute intracranial abnormalities or specific findings to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: 36 year old BRCA2 positive with strong family history of breast cancer and ovarian cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of Crohn's disease. Presents with abdominal pain. 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 patient is status post ileocecectomy with end to end neoterminal ileum.At the level of the neoterminal ileum there is a 2.4 cm segment of circumferential wall thickening, luminal narrowing, or restricted diffusion and postcontrast enhancement. No significant prestenotic dilatation.No evidence of a flow-limiting stricture. No free fluid or loculated fluid collection.There are discontinuous areas of descending colonic wall thickening, luminal narrowing, restricted diffusion, arterial enhancement and pericolonic fat induration without significant upstream dilatation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted. T-shaped IUD device.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above. The rectum is suboptimally distended without definite inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Active inflammation involving an approximately 2.4 cm narrowed segment of the neoterminal ileum. Several skip lesions of active inflammation involving the descending colon. No evidence of a flow-limiting stricture. No drainable fluid collection.


Instruction: Generate impression based on findings.

Input: Encephalomalacia with gliosis and a rim of susceptibility hypointensity is present involving the posterior right frontal lobe (precentral gyrus). There is no associated restricted diffusion or enhancement.There are scattered punctate foci of T2 hyperintensity within periventricular and subcortical white matter without restricted diffusion, mass effect, or enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within posterior right ethmoid air cells and the left sphenoid sinus. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Remote right MCA territory infarct.2.Mild chronic small vessel ischemic disease.3.No MRI evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate tumor. Signs and symptoms: Ataxia Enhanced CT of brain:Examination demonstrate a low attenuation mass in the left cerebellum with significant mass-effect on the fourth ventricle however made no complete collapse of the ventricle. The mass appears to be partially within the fourth ventricle and left lateral recess of the fourth ventricle. There is only questionable subtle enhancement of this mass along its anterior aspect which projects into the left cerebellopontine angle.There is evidence of remodeling of the Petrus bone on the left at the level of its contact with the mass. This is best appreciated on axial image 6 on bony density. This appearance is suggestive of long-standing presence of mass at this location. For better characterization of this mass an MRI exam is recommended.Images through supratentorial space are essentially within normal limits. The ventricular system remain within normal size. There is no abnormal enhancement.

Output: Left inferior cerebellar partially enhancing tumor measuring approximately 36 x 40 mm in transaxial dimensions. Severe mass effect on the fourth ventricle without resultant hydrocephalus. There is mass causes bony remodeling of the petrous bone on the left. Findings were discussed with the referring clinical physician Dr. Sophia Shakur at the time of review of study.


Instruction: Generate impression based on findings.

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

Output: No evidence of intracranial abscess or abnormal leptomeningeal enhancement.


Instruction: Generate impression based on findings.

Input: Male; 56 years old. Reason: elevated psa History: elevated psa PELVIS:PROSTATE:Prostate Size: 3.7 x 5 x 3.8 cm.Peripheral Zone: Large ovoid lesion with low T2 signal, restricted diffusion, and increased enhancement in the right anterior mid gland measuring up to 1.6 x 2.7 cm (series 704/224), compatible with prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Right anterior mid gland prostate cancer causes bulging of the anterior capsule with mild extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Prostate cancer in the right anterior mid gland with extracapsular extension.


Instruction: Generate impression based on findings.

Input: Abdominal pain. Evaluate for retained stone in the pancreatic duct. History of internal pseudocyst drainage. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. No focal lesion. Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation. No filling defect in the common bile duct to suggest a retained stone. There is minimal non-loculated fluid in the gallbladder fossa, improved from the prior.SPLEEN: No significant abnormality noted. Minimal perisplenic and perihepatic fluid.PANCREAS: Susceptibility artifact from a cystogastrostomy catheter in the main pancreatic duct at the level of the distal pancreatic body is noted within a tiny intraparenchymal fluid collection (series 901/22). Distal to the catheter there is moderate pancreatic ductal dilatation. There is no definite communication with the more down-stream pancreatic duct, suggestive of a stricture without a discrete filling defect or mass lesion. Evaluation is limited by lack of intravenous contrast. The distal pancreatic body and tail demonstrates mild increase in restricted diffusion, decreased intrinsic T1-weighted signal and mild T2-weighted hyperintensity compatible with mild inflammation. There is an adequate pancreatic excretion response from the downstream pancreatic duct to secretin administration.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: Moderate bilateral pleural effusions with adjacent compressive atelectasis.

Output: 1. Limited non-enhanced study demonstrates a suspected stricture at the level of the cystogastrostomy catheter with upstream pancreatic ductal dilatation and mild pancreatic parenchymal inflammation. There is no definite communication with the more down-stream pancreatic duct which is normal in caliber. No filling defect or discrete mass lesion, within the limitation of an unenhanced study. 2. Tiny residual fluid collection at the level of the distal pancreatic body.


Instruction: Generate impression based on findings.

Input: 59-year-old man with history of orthotopic heart transplant. Reduced ejection fraction. Left VentricleThe left ventricle is grossly normal in appearance. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 76.1 ml/m2 (normal range: 74+/-15), the LVEDV is 143 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 81 ml (normal range 47+/-19), the LV mass index is 59 g/m2 (normal range 85+/-15), and the LV mass is 111 g (normal range 164+/-36). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.T1 value: 1108T2 value: 216Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is grossly normal in appearance. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 130 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 73ml (normal range 54+/-17).Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings6.5 x 4.7 x 3.2 cm fluid collection just inferior to the right atrium, likely representing a chronic postoperative fluid collection. Probable renal cysts. 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: No late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Intermediate LV T1 measurement, as above.Mildly reduced biventricular function.6.5 x 4.7 x 3.2 cm fluid collection just inferior to the right atrium, likely representing a chronic postoperative fluid collection.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils again extend to the level of C1.Redemonstrated is focal syringohydromyelia, which measures up to a maximal 17 x 9 mm in width and length at the mid C2 level, previously 14 x 7 mm when measured at the same location as utilized on the current study). There is minimal retroflexion of the dens and loss of the usual cervical lordosis, unchanged. There is no evidence of vertebral subluxation. The vertebral body heights are preserved. There is no significant spinal canal or neural foraminal stenosis. Postoperative findings from decompressive surgery are stable.

Output: Redemonstrated is focal syringohydromyelia, which measures up to a maximal 17 x 9 mm in width and length at the mid C2 level, previously 14 x 7 mm when measured at the same location as utilized on the current study).


Instruction: Generate impression based on findings.

Input: History of hepatitis C cirrhosis. Prior nonspecific lesions on CT. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. The liver measures 17.6 cm in craniocaudal dimension. Trace perihepatic ascites.Best seen on the T2-weighted images is a 2.8 x 2.5 cm lesion adjacent to the gallbladder fundus (series 4/69) demonstrating very mild heterogeneous T2 weighted hyperintensity (series 3/30) and subtle arterial enhancement (series 9/29 and corresponding subtraction images). The lesion is mildly heterogeneous. No definite relative washout of the lesion.No additional suspicious lesion.The examination is at least partial portal vein thrombosis. The hepatic artery and hepatic veins are patent.Right hepatic lobe segment 6 subcentimeter cyst.No intrahepatic or extrahepatic biliary ductal dilatation.Normally distended gallbladder.SPLEEN: The spleen measures 9.3 cm in length without a focal lesion. Perisplenic collaterals. Abdominal wall collateral vessels.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuation of a segment of the right renal inferior pole compatible with an infarct.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small incisional fat and fluid containing hernias. Right lateral lower abdominal wall lipoma measuring 6.3 x 4.7 cm.Mild infrarenal abdominal aortic ectasia and atherosclerotic disease. OTHER: No significant abnormality noted.

Output: 2.8 cm lesion adjacent to the gallbladder fossa demonstrates subtle heterogeneous arterial enhancement, restricted diffusion and T2-weighted hyperintensity; no definite washout. Although lesion does not meet strict imaging criteria for an HCC, findings remain suspicious, continued follow-up and/or tissue sampling recommended.Cirrhosis, small volume perihepatic ascites and collateral vessel formation. At least partial portal vein thrombosis. Demonstrated again is a right renal segmental infarct.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with right-sided weakness and right hand tingling, history of multiple sclerosis. Please note that the patient declined to complete all postcontrast views. Complete postcontrast imaging of the cervical spine was performed, but only sagittal views of the thoracic spine were obtained, and no postcontrast images of the brain were obtained.Brain:Scattered foci of predominantly periventricular T2 hyperintensity are redemonstrated without significant interval change in size or number. The brainstem and cerebellum are preserved. Cerebral morphology is otherwise unremarkable. Brain parenchymal volume is preserved. No evidence of any edema or mass effect is seen. No abnormal extra axial fluid collections are detected. A small focus of susceptibility at the pontomedullary junction is unchanged and probably represents a benign vascular anomaly.Cervical spine:The previously seen signal abnormality within the right lateral cord at C2-3 has become less conspicuous. Whereas the cord in this area was slightly edematous on the prior examination, there is now slight volume loss. Scattered smaller questionable focus of signal abnormality are seen elsewhere in the cervical cord without significant interval change. No pathologic cord enhancement is seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. Minimal posterior disc-osteophyte complex formation is seen at C4-5, C5-6 and C6-7 without significant spinal canal compromise. Moderate narrowing of the left neural foramen at C5-6 is demonstrated.At least one T2 hyperintense nodule is evident within the right thyroid lobe, non-specific but probably unchanged and likely benign.Thoracic spine:The previously demonstrated T2 hyperintense lesions within the thoracic spinal cord are not as clearly seen on the present examination. However, there does appear to be some minimal residual signal abnormality within the spinal cord at T5-6, potentially at T8, and also at T9. No new lesions are seen. Only sagittal postcontrast images could be obtained, but within this limitation, no pathologic spinal cord enhancement is seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is observed. A small right paracentral disc extrusion is evident at T12-L1, similar to prior. No significant compromise of the spinal canal or neural foramina is detected.

Output: 1.Stable scattered lesions in the brain compatible with demyelinating disease.2.Scattered spinal cord lesions as noted on the prior examination are either stable or less conspicuous. No new spinal cord lesions are seen.3.Scattered mild degenerative findings are noted without significant compromise of the spinal canal.


Instruction: Generate impression based on findings.

Input: 38-year-old male with continued pain 12 weeks postop. Evaluate patellar tendon repair. MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is focal blistering of the articular cartilage along the medial facet of the patella. The articular cartilage of the medial and lateral compartments appears normal. We see no bone contusions.LIGAMENTS: There is intermediate signal intensity within the proximal half of the PCL which may reflect degeneration or perhaps prior injury. The ACL appears intact. The LCL and MCL appear intact.EXTENSOR MECHANISM: There are tubular foci of abnormal signal intensity extending vertically through the patella, compatible with the patient's history of patellar tendon repair, with mild edema-type signal abnormality within the remainder of the patella that is nonspecific. The patellar tendon itself is markedly thickened with heterogeneous low to intermediate signal intensity with multiple foci of signal void. These findings likely represent a combination of tendinosis, scarring, and prior surgical intervention, but we see no fluid signal intensity within the tendon to confirm a tear. The quadriceps tendon also appears thickened and heterogeneous indicating tendinosis with small foci of increased signal intensity within the tendon at its patellar insertion, suggesting small interstitial insertional tears. There is thickening of the medial and lateral retinacular structures, presumably reflecting prior injury/scarring.ADDITIONAL

Output: 1. Thickened and heterogeneous patellar tendon indicating tendinosis and scarring, but we see no fluid-filled tear.2. Quadriceps tendinopathy and retinacular thickening.3. Blistering of the articular cartilage of the medial facet of the patella and other findings as above.


Instruction: Generate impression based on findings.

Input: 49 year old man with cryptogenic cirrhosis and possible cardiomyopathy here for cardiac MRI evaluation. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 168 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 48 ml (normal range 47+/-19), the LV mass index is 34 g/m2 (normal range 85+/-15), and the LV mass is 60 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of a focal underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is mildly elevated at 1110ms, which is mildly elevated. This could suggest an underlying diffuse myocardial infiltrative or fibrotic process. Gadolinium kinetics are not consistent with cardiac amyloidosis.There is no myocardial iron overload. Left AtriumThe left atrium is mild-moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 153 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 54 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly 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.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The sinus of Valsalva measures upper normal (35mm).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 FindingsRecanalization of the umbilical vein consistent with elevated portal pressures. Nodular contour of liver consistent with cirrhosis. Splenomegaly. Extensive peri-gastric varices. Ascites is present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with hyperdynamic systolic function (EF 72%). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is mildly elevated at 1110ms. 2. Normal size right ventricle with normal systolic function (EF 65%.)3. Biatrial enlargement.4. Findings consistent with cirrhosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Right facial droop, right arm/face numbness. Signs and symptoms: As above. Nonenhanced brain MRI:Negative diffusion weighted images. No evidence of acute intracranial process.Examination demonstrate normal anatomical development and morphology brain. There is normal signal intensity brain parenchyma on MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF and spaces and brain myelination.The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses appear within normal.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Unremarkable calvarium and soft tissues of the scalp. Nonenhanced cervical MRI:There is normal anatomical alignment the vertebral column. There is however mild straightening of cervical lordosis which could be positional. There is no significant degenerative changes of the cervical spine present.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 is unremarkable.C4 -- C5 demonstrate mild degenerative changes and unremarkable otherwise.C5 -- C6 demonstrate mild degenerative changes and unremarkable otherwise.C6 -- C7 is unremarkable.C7 -- T1 is unremarkable.Uppermost visualized thoracic spine and thoracic cord to T4 level is unremarkable.

Output: 1.Negative nonenhanced brain MRI.2.Unremarkable nonenhanced MRI of cervical spine.


Instruction: Generate impression based on findings.

Input: 57 year old male with known CAD, found to have chronic total occlusion of OM and diagonal coronary artery, stress being done to evaluate for ischemic tissue and myocardial viabilityMEDICATIONS: amlodipine, aspirin, atorvastatin, isosorbide mononitrate, metoprolol Stress PerfusionDuring dobutamine infusion, no wall motion abnormalities were present. Viability/ Myocardial ScarThere was presence of late gadolinium enhancement in the basal inferolateral wall of the left ventricular myocardium, suggestive of prior myocardial infarction. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and global function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 107 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 80 ml (normal range 47+/-19), the LV mass index is 78 g/m2, and the LV mass is 150 g. There are no regional wall motion abnormalities present. . Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is %, the RV end diastolic volume index is 107 ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 80 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall hepatic and left renal cysts. 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. There are no wall motion abnormalities seen during dobutamine stress. The entire myocardium is viable.2. There is presence of late gadolinium enhancement in the basal inferolateral wall of the left ventricular myocardium, suggestive of prior myocardial infarction. 3. Normal LV size and systolic function (LVEF 61%).4. Normal RV size and systolic function (RVEF 60%).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: Eval astrocytoma. Pt on TMZ. History: astrocytoma. There is redemonstration of postoperative changes of previous left frontal craniotomy for tumor resection, with slight increased posterior extent of T2/FLAIR hyperintensity along the posterior aspect of the left superior frontal gyrus abutting lateral margin of the anterior body the left lateral ventricle. There is stable ex vacuo dilatation of the left lateral ventricle.Areas of extra-axial enhancement along the surgical bed again are unchanged. Previously seen faint nodular enhancement along the margins of the resection cavity appears similar to the most recent comparison. This includes the area of subtle nodular enhancement along the anterior aspect of the resection cavity as seen on current 1203/2015.The ventricles and sulci are stable. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Stable postoperative changes from previous left frontal lobe mass resection. No definite evidence of tumor recurrence or progression. Stable subtle areas of nonspecific nodular enhancement along the resection cavity margins.2. Stable extent of T2/FLAIR hyperintensity along the left superior frontal gyrus white matter extending to the left frontal horn may represent post-treatment changes.


Instruction: Generate impression based on findings.

Input: 91-year-old female status post fall without loss of consciousness. Evaluate for bleed or fracture. There is no evidence of intracranial hemorrhage, mass or edema. Multiple diffuse hyperdensities in a periventricular distribution consistent with advanced small vessel disease, age indeterminate. There is a focus of hyperdensity within the right frontal horn which may represent calcification but we cannot rule out the remote possibility of hemorrhage. If further evaluation is clinically warranted MRI may be considered. Small lacunes are noted within the bilateral basal ganglia consistent with chronic ischemic changes.Prominent sulci in proportion to ventricles are within normal limits for age. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Advanced small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.2. A small focus of hyperdensity within the right frontal horn is likely due to calcification but a focus of hemorrhage cannot be ruled out.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:1/5/1961)Reason: evaluate for stroke History: transient bilateral leg and L arm weakness, L ICA stenosis 50 - 69% per US at OSHPROVIDER/ATTENDING NAME: SARAH E PAYNE MADHU C YARLAGADDA MRI of the brainNo diffusion weighted abnormalities are appreciated. The cerebellar tonsils extend below the level of the foramen magnum by approximately 10 mm.The 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 some mild mucosal thickening. The visualized portions of the mastoid air cells demonstrate minor opacities along the right mastoid air cells. 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. The right posterior communicating artery is medium-sized. The left posterior cerebral artery has fetal origin. The left P1 segment is medium-sized. There is infundibulum at the origin of the posterior communicating arteries bilaterally. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The cerebellar tonsils extend below the level of the foramen magnum by approximately 10 mm.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. There is a perineural cyst present on the left at T1-2 lateral to the neural foramen. This is not entirely exam.

Output: 1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.3.There is no evidence for acute cerebral infarction.4.There is no compromise of the cervical spinal canal or exiting nerve roots appreciated.5.Chiari I malformation without associated syrinx or ventriculomegaly.


Instruction: Generate impression based on findings.

Input: 30-year-old female with optic neuritis, evaluate for demyelinating lesions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. Mild mucosal thickening of the bilateral maxillary sinuses.The optic nerves demonstrate no abnormal enhancement or increased T2 signal to suggest optic neuritis. There is ectasia of the optic nerve sheaths bilaterally as well as optic nerve sheath dilatation. In addition, there is questionable mild flattening of the left posterior globe and a slitlike appearance of the frontal horns of the lateral ventricles. The retro-orbital fat appears normal. No intraconal or extraconal lesions are identified.

Output: 1.Normal MR brain without findings to suggest multiple sclerosis.2.Findings supportive of radiographic intracranial hypertension (a.k.a. pseudotumor cerebri) in the correct clinical setting.3.No evidence of optic neuritis.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for ACL tear, meniscus injury and possible MCL injury History: left knee pain MENISCI: There is curvilinear signal abnormality within the peripheral half of the posterior horn of the medial meniscus extending to the tibial articular surface indicating an undersurface tear that extends into the body of the meniscus. Additionally, there is blunting of the free edge of the posterior horn of the medial meniscus likely representing a radial tear in the absence of prior partial meniscectomy. The anterior horn appears intact. The body of the lateral meniscus is abnormally prominent suggesting a discoid morphology, but we see no tear.ARTICULAR CARTILAGE AND BONE: We see no focal articular cartilage defects. The bone marrow signal intensity is normal.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Abnormal signal intensity and morphology of the medial meniscus suggesting tearing in the absence of prior partial meniscectomy.2. Discoid lateral meniscus and other findings as described above.3. The MCL is normal in appearance.


Instruction: Generate impression based on findings.

Input: 34 years Female (DOB:4/27/1982)Reason: hx L sphenoid dehiscence w CSF leak History: hx L sphenoid dehiscence w CSF leakPROVIDER/ATTENDING NAME: JAYANT M PINTO JAYANT M PINTO There is a T2 hyperintense lesion present adjacent to the left middle cranial fossa and anterior to it but behind the pterygopalatine fossa. It measures approximately 23 x 19 mm coronal dimensions and 23 x 14 mm axial dimensions. It appears to communicate with the left middle cranial fossa. This communication is better depicted on the recent CT of the paranasal sinuses. It bulges into the left sphenoid sinus. There is communication with the left sylvian fissure. Soft tissue within the encephalocele extends from the left temporal lobe through the defect.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts in the maxillary sinuses as well as the bulging lesion from the left middle cranial fossa. There is an air-fluid level in the sphenoid sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are suspicious for an encephalocele extending from the left middle cranial fossa into the infratemporal fossa just behind the pterygopalatine fossa. It bulges into the left sphenoid sinus where there is an air-fluid level raising the question of CSF leak. Please refer to CT of the paranasal sinuses for further comments.


Instruction: Generate impression based on findings.

Input: Male, 66 years old, with altered mental status, status post corrected hyponatremia, assess for demyelination. Patchy, nearly confluent periventricular T2 hyperintensity is again seen without significant interval change from prior. Scattered foci of signal abnormality are also redemonstrated within the left thalamus and pons without significant interval change. Chronic lacunar infarcts in the bilateral basal ganglia are likewise unchanged.No restricted diffusion, parenchymal edema or mass effect is detected. No abnormal extra-axial fluid collections are seen. Mild ex vacuo dilatation of the frontal horns is noted. Otherwise, the ventricular system is unremarkable. A large left frontal scalp lipoma is unchanged.

Output: 1.No acute abnormality or any significant interval change is seen.2.Extensive periventricular white matter signal abnormality is favored to represent chronic microvascular ischemic disease, given the evidence of multiple prior basal ganglia lacunar infarcts.3.As before, no specific findings are seen to suggest osmotic demyelination.


Instruction: Generate impression based on findings.

Input: 71-year-old female with fracture, evaluate for interval change Pelvis: There is a cortical step-off of the left superior pubic ramus near the pubic symphysis which corresponds to the fracture seen on recent MRI study. The previously described fracture of the right ischium is not well seen on current study. There is a linear lucency at the right superior pubic ramus compatible with a nondisplaced fracture. The aforementioned fractures appear subacute in appearance with no evidence of displacement. Right elbow: Again seen is a supracondylar fracture of the humerus involving both condyles with slight ulnar displacement of the distal fracture fragment without interval change from prior study.

Output: 1.Rright elbow supracondylar fracture without interval change.2.Pelvis fractures as described above which appear subacute in appearance.


Instruction: Generate impression based on findings.

Input: Diagnosis: Generalized nonconvulsive epilepsy without mention of intractable epilepsyClinical question: Evaluate for epileptic focusSigns and Symptoms: Staring spells; EEG demonstrates generalized and focal dischargesComments: Patient will try without sedation first. Seizure II protocol to be performed. | The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There is no evidence for diffusion restriction 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.The visualized nasopharyngeal tissues are thick. This is not unusual at this age.

Output: MRI of the brain is within normal limits. There is no evidence for intracranial mass, congenital brain abnormality or mesial temporal sclerosis on the basis of this exam


Instruction: Generate impression based on findings.

Input: Reason: evaluate for disk disease History: bilateral shoulder pain with paresthesias in both middle fingers (c7 distribution) Postsurgical findings related to anterior fusion of C5-C7 are noted. There is mild grade 1 anterolisthesis of C7 on T1. Compared with the prior MRI, there has been progressive osteoarthritic changes at the C4-5 disc space, as evidenced by anterior osteophytes, facet hypertrophy, and bilateral bony neuroforaminal narrowing.

Output: Anterior fusion of C5-C7. Progressive degenerative changes at C4-5, as above.


Instruction: Generate impression based on findings.

Input: Preop planning for deep brain stimulation stage I on May 26. This is a limited MRI for preoperative planning. There is mild global parenchymal volume loss commensurate with age. There is no enhancing intracranial lesion, mass, or mass effect. No hydrocephalus. Incidentally noted is a developmental venous anomaly along the right superior frontal gyrus. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening in the paranasal sinuses.

Output: Limited examination for operative planning demonstrates no lesions along the expected trajectories of the DBS leads.


Instruction: Generate impression based on findings.

Input: 2-year-old girl with history of NF1 with multiple plexiform fibromas. CHEST:LUNGS AND PLEURA: The lungs appear normal.MEDIASTINUM AND HILA: The heart and pericardium appear normal. The aortic arch is normal. The infiltrative mass described below extends into the anterosuperior mediastinum and displaces the left common carotid and internal jugular veins anteriorly. The arch vessels and tributaries to the left brachiocephalic vein are patent.CHEST WALL: A large, infiltrative T1 and T2 hyperintense mass is seen involving the left neural foramina from C5 to T5. Intradural tumor is identified on the left with slight displacement of the lower cervical/upper thoracic spinal cord to the right. The mass involves the entire left lateral neck and chest wall, extending into the pleural space and laterally into the left axilla beyond the field-of-view.Prominence of the anterior extra-axial CSF space and stenosis in the lower cervical spine is likely postoperative. Please see concurrent MR T-spine for further details.An additional 19 x 12 mm T1 and T2 hyperintense mass is seen arising from the right T7 neural foramen (series 601, image 25) with possible extension through the chest wall.No significant enhancement of this tumor is identified.No muscular atrophy is identified. Skeletal deformities are better characterized on the prior CT.UPPER ABDOMEN: The partially visualized liver and spleen are normal.OTHER

Output: 1.Large, infiltrative plexiform neurofibroma involving the left C5-T5 neural foramina, lateral neck, chest wall, and mediastinum.2.Smaller neurofibroma arising from the right T7 neural foramen and probably extending through the chest wall.3.Partially visualized lesion in the right parotid gland which can be further characterized with dedicated imaging if clinically warranted.4.Please see concurrent thoracic spine MR for additional details.


Instruction: Generate impression based on findings.

Input: For the purposes of this dictation, the last well formed disk space is referred to as L5-S1.There is mild high T2 signal in the T12 through L3 vertebral bodies, with minimal superior end plate cortical disruptions, consistent with acute compression fractures. There is mild anterior wedge deformities at these levels. The abnormal signal is relatively subtle at the T12 level, surrounding an area of focal sclerosis noted on CT along the anterior/superior endplate, likely representing focal fracture rather than more diffuse compression. There is no significant change in affected vertebral body heights compared to outside CT. There is no significant retropulsion into the spinal canal, or epidural hematoma. There is no significant cord signal abnormality. There is mild disk height loss at T11-T12.Elsewhere, the osseous marrow shows low T1 signal diffusely without focal lesion, within normal limits for patient's age.There is no significant disk herniation or spinal stenosis in the thoracic spine. There is normal alignment of the thoracic spine with preserved disk heights.There is normal alignment of the lumbar spine. The conus terminates at L1-2. There is high T1 signal in the posterior intradural space extending from L2 to L4 level distal to the conus, measuring up to 3 mm at the L1-L2 level, possibly representing filum lipoma. At L5-S1, the filum terminale is not fatty infiltrated or thickened.L5-S1: Mild disk bulge, ventral epidural fat. There is a left L5 pars interarticularis defect better visualized on the outside CT.There is no significant disk herniation or spinal stenosis at any other level in the lumbar spine.There is partial visualization of uterus with fluid signal within the endometrial canal which likely is physiologic. There is also a rounded fluid signal intensity structure within the left hemipelvis, likely related to the left ovary. This measures 1.7 cm and likely represents a functional cyst.

Output: 1.Mild superior end plate cortical acute compression fractures of L1 through L3 without retropulsion or epidural hematoma. Slightly more focal fracture along the anterior/superior endplate of T12. Mild disk height loss at T11-T12. 2.No spinal stenosis or cord signal abnormality.3.Minimal disk degenerative changes in the lumbar spine. Incidental left L5 pars interarticularis defect without spondylolisthesis.4.Likely incidental filar lipoma extending from L2 to L4 level measuring up to 3 mm at the L1-L2 level with normal conus termination.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for hemorrhage. Signs and symptoms: Status-post grids in for seizure focus resection. Non-infused CT of brain:There is evidence of a large right temporal and frontal -- parietal craniotomy. Expected extra axial (epidural) air and fluid collection under the craniotomy flap is noted. There is overall increase mass effect in the right hemisphere with effacement of sulci and approximately 1 to 2-mm midline shift. There is evidence of a placement of epidural electrodes extending from the level of the floor of the right middle cranial fossa superiorly to above the level of lateral ventricles. Electrodes cover part of the right temporal lobe and extends superiorly into the parietal lobe. There is medial extension of electrodes which is best appreciated on axial image 11. The cortical sulci are not well visualized due to technique however I believe this component of electrodes are within the right sylvian fissure. There is no evidence of any parenchymal edema or hemorrhage. There is no evidence of ventriculomegaly. There is a focal area of CSF density within the expected level of right sylvian fissure noted on axial image 13. This corresponds with focal area widening of the sylvian fissure that was present on prior MRI examination. This is believed to represent a focal area of encephalomalacia of the operculum of right temporal lobe deep within the sylvian fissure. This is best appreciated on coronal T2 weighted images 15 through 17. No evidence of hemorrhage, edema, hydrocephalus is noted.

Output: 1.Expected postoperative changes of right craniotomy for placement of epidural electrodes over the right temporal and frontal lobes.2.Focal area of encephalomalacia believed to be within the operculum of right temporal lobe deep within the right sylvian fissure.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, history of breast cancer with brain metastases treated with whole brain radiation therapy and subsequent leptomeningeal carcinomatosis. Receiving intrathecal chemotherapy. Brain:Since the prior examination, a right sided ventricular catheter has been placed which traverses the right frontal lobe and terminates in the right frontal horn. Also new is a right sided subdural collection measuring up to 6 mm in thickness extending along the frontal and parietal lobes. This collection follows CSF signal on all sequences and is free of susceptibility artifact.Significant diffuse bilateral T2 hyperintensity has progressed within the white matter of the frontal and parietal lobes and to a lesser degree the temporal lobes. There was some white matter signal abnormality evident on the prior examination, but it is now more extensive and confluent. Only mild scattered white matter hyperintensities were seen on the prior examination from May 2014.Supratentorially, scattered areas of pathologic enhancement are seen, for example within the left hypothalamus and along the tectum. Relative to the prior exam, these areas are less well defined. A 3-mm focus of enhancement within the posterior right temporal lobe is unchanged. Enhancement of the cisternal segment of the right fifth cranial nerve, and the canalicular segments of the seventh/eighth nerve complexes, as well as of the temporal bone segments of the seventh cranial nerves, appear slightly more prominent though this could be technical. Infratentorially, numerous patches of enhancement throughout the cerebellar hemispheres and vermis are demonstrated. These lesions are slightly less well defined and as a result some measure smaller than before. No definite new lesions are seen. The degree of parenchymal T2 hyperintensity in the cerebellum has probably improved. No definite evidence of parenchymal hemorrhage is seen. No significant mass effect is detected. The ventricles have increased in caliber by 2 to 3 mm but they are not frankly dilated. Spine:Patchy leptomeningeal enhancement along the surface of the cervical spinal cord is more conspicuous on the present study. This apparent difference may be due to technique and the presence of motion artifact on the prior exam, but disease was certainly present in a similar distribution before. Likewise, leptomeningeal enhancement along the surface of the thoracic cord, particularly the upper thoracic region, appears slightly more conspicuous. Patchy T2 signal alteration is also seen correlating to the upper thoracic disease.Patchy enhancement along the conus and nerve roots of the cauda equina is seen. No bulky intrathecal tumor deposits are suspected. This finding is progressed from the prior examination of April 2014 but at that time there was evidence of some mild leptomeningeal disease.Small foci of enhancement within the T9 vertebral body and left T9 pedicle are unchanged and nonspecific. An enhancing lesion within the T11 vertebral body is seen measuring up to 17 mm in diameter showing some degree of enhancement, T2 hyperintensity and T1 hypointensity. This lesion also has not significantly changed.Relatively mild degenerative disk disease is seen in the cervical and lumbar spine. This results in stenosis of the lower left sided cervical neural foramina. In the lumbar spine, there is scattered disk bulging and loss of disk height at L4-5 with scattered mild to moderate foraminal narrowing.Incidental note is made of a large lamellated infrarenal abdominal aortic aneurysm which measures 71 x 65 mm in maximal dimension. Cystic lesions are evident in the kidneys.

Output: 1. Interval placement of a ventricular catheter on the right. There is also a new right-sided subdural collection which follows CSF signal on all sequences. No findings are seen to suggest that this fluid is hemorrhagic and it may therefore reflect a subdural effusion or hygroma. This collection exerts mild mass effect on the right cerebral hemisphere.2. Since the prior examination, extensive confluent signal abnormality has progressed within the cerebral white matter. There is no associated mass-effect or enhancement. As such, these findings may represent a leukoencephalopathy related to chemotherapy and/or radiation. Findings are not typical for demyelination or infection and as such these are considered less likely possibilities.3. Leptomeningeal enhancement compatible with carcinomatosis is seen both supra- and infratentorially. The majority of this disease affects the cerebellum, but there are few scattered foci supratentorially and some of the cranial nerves are involved as discussed above. Overall, these lesions appear less well defined and some are smaller. Enhancement of the cranial nerves seems more intense, but this could be technical. No definite evidence of any new lesion is seen. Associated edema in the cerebellum has probably improved.4. Leptomeningeal disease along the surface of the spinal cord and cauda equina is seen. A similar pattern of disease was present on prior examinations, though the intensity of enhancement is increased on today's study. This may very well be due in part to technical differences, but some component of disease progression cannot be excluded.5. Enhancing foci within the T9 vertebral body are unchanged and nonspecific but could represent small metastases. A larger enhancing lesion within the T11 vertebral body is also nonspecific and unchanged, possibly representing an atypical hemangioma or a metastatic lesion.6. A very large infrarenal abdominal aortic aneurysm is noted incidentally.


Instruction: Generate impression based on findings.

Input: Evaluate for brainstem infarct. Confusion, aphasia, and bilateral leg weakness, all persistent since seizure in October. Per chart patient has history of left frontal oligodendroglioma resected in 1983. BrainDiffusion images are slightly motion degraded however no evidence of acute infarct is appreciated. Again seen is evidence of left frontal craniotomy and extensive encephalomalacia in the left frontal lobe, compatible with history of prior tumor resection. There is also encephalomalacia involving the left basal ganglia which appears to be present on remote study from 2003. There is moderate global parenchymal volume loss. There is moderate degree of confluent T2/flair hyperintensity involving the bilateral periventricular and subcortical white matter. More focal area of FLAIR hyperintensity and volume loss is noted within the left occipital lobe involving the cuneus compatible with chronic infarct. Symmetric T2 flair hyperintensity is also noted within the central pons bilaterally. T2/flair hyperintensity and volume loss along the left midbrain and pons is compatible with Wallerian degeneration.No intracranial mass or mass-effect is appreciated although evaluation for small lesions is limited due to motion artifact and absence of gadolinium. Major flow-voids are preserved. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are grossly unremarkable.Cervical SpineExtensive motion artifact severely limits evaluation for cord signal abnormality. Multiple apparent T2 hyperintense foci in the cervical cord may be artifactual. Mild degenerative changes are seen without evidence of extrinsic cord compression. Vertebral body heights and alignment are within normal limits.Lumbar SpineVertebral body heights in the lumbar spine are within normal limits. There is mild retrolisthesis of L4 on L5 and minimal retrolisthesis of L5 on S1. Mild disk bulges are seen without significant spinal canal stenosis at any level in the lumbar spine. Mild bilateral neural foramina stenosis at L4-L5 and mild to moderate bilateral neural foramina stenosis at L5-S1 is seen. T2 hyperintensity at the L5-S1 disk this may be on a degenerative basis. No surrounding fluid collections to suggest abscess.Partially imaged is a multiloculated cystic mass in the pelvis, possibly adnexal in origin. Mass measures more than 5 cm in the AP dimension.

Output: 1. Motion artifact limits evaluation; however, no evidence of acute infarct is seen.2. Encephalomalacia in the left frontal lobe and basal ganglia compatible with remote history of left frontal tumor resection. No intracranial mass or mass-effect is appreciated although evaluation for small lesions is limited due to motion artifact and absence of gadolinium. 3. Mild encephalomalacia in the left occipital lobe may be related to small chronic infarct. Moderate global parenchymal volume loss. 4. Confluent T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter as well as pons is nonspecific but compatible with moderate chronic small vessel ischemic disease. Evidence of Wallerian degeneration along the left corticospinal tract in the brainstem.5. Examination is inadequate to evaluate for cord signal abnormality in the cervical spine. No evidence of extrinsic cord compression.6. No significant spinal canal stenosis in the lumbar spine. There are degenerative changes with mild to moderate neural foraminal stenosis at L5-S1 which may be impinging on the L5 nerve roots.7. Multiloculated cystic mass in the pelvis measuring at least 5 cm in the AP dimension. Mass is incomplete visualized but may be adnexal in origin. Recommend dedicated imaging with ultrasound or CT.


Instruction: Generate impression based on findings.

Input: Hypersomnia, unspecified [G47.10], Reason for Study: ^Reason: Evaluate for hypothalamic lesion History: Excessive daytime sleepiness Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Pituitary MRIThe pituitary gland is normal in size, morphology, signal intensity and enhancement. There is no hypo-enhancement or signal abnormality suggestive of neoplasm. The pituitary stalk is located at midline without deviation, and is normal in caliber, signal intensity and enhancement. The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. The orbits and contents are unremarkable. A small high signal intensity on the left cerebral peduncle (series 901, image 17) is likely represent prominent CSF space.

Output: 1. Normal brain MRI2. Normal pituitary MRI.


Instruction: Generate impression based on findings.

Input: 49 old female with history of multiple myeloma with cord compression. Rule out cord compression. Diffuse low T1 signal throughout the cervical, thoracic and lumbar vertebral bodies consistent with multiple myeloma involvement of spinal column. There is remaining fat within T7 vertebral body unchanged. There is a new extra-medullary lesion posterior aspect of extradural space at the T4-T5 level measuring 1.1 cm in thickness and 2.8 cm in the craniocaudal dimension (series 401, image 7) which compresses the cord at this level; there is subtle increased STIR signal within the cord at this level however grossly the remaining spinal cord signal is unremarkable. There is an additional new right paraspinal mass lesion at T2 level measuring 19 mm x 13 mm (series 1601, image 21) which demonstrates intermediate T2 and low T1 signal. There is progressing compression fracture deformity of T12 vertebral body which demonstrates diffuse STIR signal; vertebral body height currently measures 16 mm, previously 19 mm. Increased STIR signal in the superior endplate of L2 vertebral body appearing more conspicuous on the current exam with an associated Schmorl's node. There is a new extramedullary lesion posterior to the L4 vertebral body measuring up to 9 mm in thickness (series 801, image 7) demonstrating intermediate T1 and STIR signal intensity. The lesion shows mild mass effect toward the spinal canal and cauda equina nerve roots. There is increased STIR signal within S1 vertebral body as well as a partially imaged known right sacroiliac mass. There is a focal rounded lesion posterior to the L1 vertebral body and anterior to the cord measuring 12 mm x 6 mm (series 701, image 7) which demonstrates low T1 and STIR signal and is new from prior study however of unclear etiology; this demonstrates no significant mass effect on the spinal cord. Multilevel degenerative changes not significant change from prior study including mild indentation of the spinal cord at multiple levels most prominent within the upper cervical spine.

Output: 1. Findings most likely represent new extra medullary plasmacytomas at T2 (paraspinal), T4-T5 level (extradural intraspinal) and L4 (retro corporeal extradural) level. 2. There is associated marked compression of the cord with subtle increased STIR signal of the spinal cord at T4-5 level which could represent cord edema however grossly the spinal cord signal is unremarkable throughout its course. 3. Progressing compression fracture at T12 with associated marrow edema.4. The lesion at L4 level demonstrates mild mass effect on the thecal sac and cauda equina nerve roots. 5. Increased STIR signal within S1 vertebral body appearing more conspicuous on the current exam and could represent myelomatous disease; known right sacroiliac mass is partially imaged. 6. New focal rounded lesion posterior to the L1 vertebral body and anterior to the cord of unclear etiology and demonstrates no significant mass effect on the spinal cord; this may be artifactual or could represent an additional tumor deposit. Comment: Dedicated lumbar MRI WWO can be considered for further imaging investigation for above #4, #5, and #6 findings.Findings were discussed with Dr. Linda Zhu by phone on 1/7/2016 at 5:10 PM.


Instruction: Generate impression based on findings.

Input: 10 years, Female, seizures. Rule out structural abnormality. No appreciable evidence of cortical dysplasia, gray matter heterotopia or other abnormalities to suggest seizure focus. Bilateral hippocampi are symmetric in size and signal characteristics with preserved internal architecture. No intracranial mass or mass effect. No evidence of infarct or hemorrhage. Ventricles and sulci appear within normal limits. Major flow-voids are preserved. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: MRI of the brain appears within normal limits. No findings to suggest seizure focus are appreciated.


Instruction: Generate impression based on findings.

Input: Metastatic NSCLC to brain treated with WBRT and growing left frontal lesion s/p resection. There are post-treatment findings in the left middle frontal lobe resection cavity. There is unchanged diffuse, confluent cerebral white matter T2 hyperintensity. There is no midline shift. There is no evidence of acute infarction or hemorrhage. There is fluid signal within the bilateral mastoid air cells and ethmoid sinuses. The orbits appear unremarkable.

Output: Stable post-treatment findings without evidence of intracranial tumor recurrence.


Instruction: Generate impression based on findings.

Input: 49-year-old male with bilateral burning in the knees in the setting of known diabetic peripheral neuropathy. Lack of sensation out of proportion to diabetes. Evaluate for cause of the neuropathy. C-Spine MRI:There is a peg-like configuration of the right cerebellar tonsil which lies 6 mm below the foramen magnum and is suspicious for a type I Chiari malformation. However, the foramen magnum does not otherwise appear to be significantly crowded. There is abnormal T2 hyperintense and T1 hypointense signal within the central spinal cord at the C4-5 level suspicious for a small syrinx. This lesion measures 2 x 2 millimeters in the axial plane and extends for approximately 13 mm in the craniocaudal dimension.The cervical spine alignment is maintained and the cervical vertebral bodies are appropriate in height. The bone marrow signal is within normal limits. There is mild disc height loss involving the lower cervical spine levels. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Degenerative changes are seen in the cervical spine as described below:C2-3: Left facet arthropathy. Minimal disc bulge without significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is a left paracentral and foraminal disc osteophyte and bilateral facet hypertrophy which causes moderate left neural foraminal narrowing. There is no right neural foraminal narrowing or central spinal canal compromise.C6-7: There is a left paracentral and foraminal disc osteophyte and bilateral facet hypertrophy which causes moderate left neural foraminal narrowing. There is no significant right or central spinal canal stenosis.C7-T1: There is a small left greater than right disc osteophyte complex with facet hypertrophy but without spinal canal or neuroforaminal compromise.L-Spine MRI:The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is variable disc desiccation and mild disc height loss involving the T12-L1, L1-L2, and L4-5 levels. 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. Degenerative changes are seen in the cervical spine as described below:T12-L1: Sagittal view only shows small disc bulge without significant compromise to spinal canal or neural foramina.L1-L2: Small disc bulge without significant compromise to spinal canal or neural foramina.L2-L3: Unremarkable.L3-L4: Disc bulge and bilateral facet hypertrophy and ligamentum flavum thickening, which contribute to mild bilateral neuroforaminal narrowing and moderate spinal canal stenosis with particular narrowing of the right subarticular recess.L4-5: Prominent left greater than right disc bulge with a subarticular and foraminal protrusion which, along with facet arthropathy and ligamentum flavum thickening, contributes to moderate left neuroforaminal narrowing, and mild to moderate spinal canal stenosis with marked left subarticular narrowing.L5-S1: There is no significant compromise to spinal canal or neural foramina.

Output: 1. Findings suggestive of Chiari 1 malformation although the CSF space at the level of the foramen magnum is not particularly crowded. 2. A central cord lesion suspected to represent a small syrinx is evident located at the C4-5 level.3. Additional mild spondylotic changes are visualized within the cervical spine without significant spinal canal or neural foraminal compromise.4. Multilevel spondylotic changes involving the lumbar spine most prominent at the L3-L4 and L4-5 levels there is at least some degree of spinal canal compromise


Instruction: Generate impression based on findings.

Input: 33-year-old female with worst headache of her life x 3 days There is no evidence of intracranial hemorrhage, mass or edema. A small focus of mildly increased attenuation in the posterior cranial fossa with possible slight effacement of the right posterior border of the fourth ventricle is seen on a single slice in multiple planes. The remainder of the ventricular system is normal. This is a nonspecific finding and may be artifactual. Recommend MRI if clinically indicated. Slight focal irregularity and waviness of the right lateral ventricle lateral border is nonspecific and may be artifactual or represent isolated remote ischemic event. The remainder of the periventricular white matter is normal. There is a well-demarcated expansile lesion in right supraorbital ridge measuring 2 x 1 x 1.7 cm with no cortical erosion and preservation of the adjacent soft tissue planes. This appearance favors a benign process such as a hemangioma or ossifying fibroma. Left maxillary sinus mucus rentention cyst measuring 1.5 x 1.5 cm is incompletely visualized. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1) No intracranial hemorrhage. 2) Foci of increased attenuation adjacent to the 4th ventricle may represent artifact. Recommend MRI if there is clinical suspicion for mass. 3) Right supraorbital expansile bone lesion, likely benign, such as a hemangioma or ossifying fibroma.


Instruction: Generate impression based on findings.

Input: 67-year-old male with history of 8-foot fall complaining of headache, loss of consciousness. Rule out hemorrhage or cervical fracture. In the right high parietal convexity, seen in image 27/36, is a high density focus within the cortex. Inferior to this, on image 21/36 there is an additional focus of high density which could lie on the surface of the cortex or be within the subarachnoid space. These findings are likely cortical hemorrhage given the history. Continued follow up is recommended, and MRI may be helpful. No associated extra-axial hemorrhage. Otherwise, there is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CERVICAL SPINE

Output: 1. Focal cortical high density is likely hemorrhage given the history (though calcification could potentially have this appearance). Additional small focus of high density inferior to this could be with in the subarachnoid space or in the surface of the cortex. Continued follow-up is recommended, and MRI should be considered.2. Unremarkable examination of the cervical spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out stenosis. Signs and symptoms: Neck pain. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild left uncovertebral hypertrophy with resultant mild left neural foraminal compromise.C4 -- C5 demonstrate moderate disk disease, loss of disk height and minimal hypertrophy changes of posterior elements. No spinal stenosis. Mild bilateral neural foraminal compromise however is present.C5 -- C6 demonstrate moderate disk disease and loss of disk height, mild bilateral ligamentum flavum hypertrophy and mild facet disease (right greater than left). No spinal stenosis however moderate right neural foraminal compromise is detected.C6 -- C7 demonstrate moderate disk disease and loss of disk height, mild to moderate bilateral ligamentum flavum hypertrophy and mild degenerative facet disease. There is a ventral hypertrophic spur with resultant partial effacement of ventral subarachnoid space which in combination with hypertrophic changes of ligamentum flavum results in mild central spinal stenosis. Moderate bilateral neural foraminal compromise is also detected. There is a well demarcated CSF signal intensity within the right neural foraminal laterally likely representing a prominent nerve sheet/Tarlov cyst.C7 -- T1 demonstrate minimal degenerative disk disease and mild bilateral ligamentum flavum and facet (left greater than right) hypertrophic changes. No spinal stenosis or convincing there is some neural foraminal compromise. A well-demarcated small focus of marrow signal change in the dorsal aspect of body of C7 is consistent with a skeletal capillary hemangioma.Degenerative changes all cervical spine at C4 -- C5 to C6 there C7 levels results in mild reversal of cervical lordosis.There is no convincing evidence of cord signal abnormality.Uppermost visualized thoracic spine demonstrate a small disk protrusion at T3 -- T4 level. The finding results in effacement of the ventral subarachnoid space and the status of subtle flattening deformity of the thoracic cord with ultrasound for spinal stenosis or cord signal abnormality.

Output: 1.Examination demonstrates moderate degenerative changes of cervical spine with resultant mild reversal of cervical lordosis at C4 -- C5 through C6 -- C7 levels.2.There is mild central spinal stenosis only at C6 -- C7.3.Multi-level neuroforaminal compromise of varying degrees as detailed per level above.4.Sagittal images demonstrate a central disk protrusion at T3 -- T4 level with subtle flattening deformity of the cord however without spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: 22 year old woman with long QT and abnormal EKG referred to evaluate for structural heart disease. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 93 ml/m2 (normal range: 65+/-11), the LVEDV is 179 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 62 ml (normal range 31+/-10), the LV mass index is 47 g/m2 (normal range 67+/-11), and the LV mass is 90 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 95 ml/m2 (normal range 69+/-14), the RVEDV is 183 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 85 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Normal origins of the coronary arteries.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. Mild LV dilation with normal systolic function (LVEF 65%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 53%).


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: The medial and lateral meniscus appear intact. ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. No bone marrow signal abnormality is seen.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Nonspecific edema within Hoffa's fat pad which is of questionable clinical significance. Otherwise no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 26-year-old female with right wrist pain. Evaluate for scapholunate ligament tear. LIGAMENTS: Gadolinium remains confined within the mid carpal joint without extension into the radiocarpal joint. No findings to suggest scapholunate ligament disruption. Contrast extends partially into the membranous portion of the lunotriquetral ligament which may represent a partial thickness tear, but we see no full-thickness defect.TRIANGULAR FIBROCARTILAGE COMPLEX: The triangular fibrocartilage complex is unremarkable.TENDONS: The flexor and extensor tendons appear intact.BONES: No bone marrow signal abnormality is identified.ADDITIONAL

Output: 1. No evidence of scapholunate ligament tear.2. Possible partial thickness tear of the membranous portion of the lunotriquetral ligament which is of questionable significance.3. Ganglion deep to the tendons of the fourth compartment and superficial to the scaphotriquetral ligament as described above.


Instruction: Generate impression based on findings.

Input: 35-year-old female with a history of CVA x 2, now with dysarthria. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. An area of encephalomalacia in the right frontal lesion appears unchanged from the prior study. High density within this region likely represents calcification. No findings to indicate acute ischemia are noted. However, if there is concern for an acute stroke, an MRI is recommended for further evaluation. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. The patient is status post enucleation of the left eye.

Output: No findings to indicate acute ischemia. Areas of encephalomalacia appear unchanged. However, if there is concern for an acute stroke, an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 54-year-old female with history of ventral hernia and hematuria ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule, enlarged from previous study now measuring 9 by 9 mm on image number 43, series number 7. MRI of the adrenal gland it helpful for further evaluation.KIDNEYS, URETERS: No focal lesions in both kidneys. No evidence of stones. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the lower anterior abdominal wall. There is a midline tissue defect through a short segment of midline incision. No evidence of herniating bowel segments. Small amount of fat indenting the fascia however no obvious evidence of herniation. OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Heterogeneous uterus with possible multiple fibroids.BLADDER: Wall thickening of the bladder. This may represent cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes involving the bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Midline tissue defect along incision. Post surgical changes in the anterior abdominal wall. No evidence of obvious herniation.Mild wall thickening of the bladder suggestive of cystitis.MRI of the adrenal may be helpful for further evaluation of small left adrenal nodule, which is increased in size compared to previous study. Clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: Reason: R knee lateral meniscus tear History: R knee pain and swelling MENISCI: There is a complex tear of the lateral meniscus which consists of a flap of tissue from the posterior horn displaced posteriorly beneath the periphery of the posterior horn of the meniscus. Additional horizontally oriented signal abnormality extends into the body of the meniscus extending to both the femoral and tibial articular surfaces indicating additional tearing. There is also globular increased signal intensity within the anterior horn of the lateral meniscus indicating intrasubstance degeneration which extrudes through the peripheral fibers into multiple parameniscal cysts anteriorly.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness defect of the articular cartilage of the weightbearing portion of the lateral femoral condyle just above the free edge of the torn posterior horn of the lateral meniscus. The defect measures just under 1 cm in diameter and is associated with underlying degenerative subchondral signal changes. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is focal intermediate signal intensity within the proximal fibers of the patellar tendon at its insertion suggesting focal tendinosis. ADDITIONAL

Output: 1. Complex tear of the lateral meniscus as described above.2. Focal defect of the articular cartilage of the lateral femoral condyle.3. Focal patellar tendinosis.


Instruction: Generate impression based on findings.

Input: Male 53 years old Reason: Please follow protocol IRB # 14-0288. Rectal cancer, please assess extent of disease state post consolidation therapy with Chemo and radiation, RECIST compare to previous MRIs, prior to planned potential surgery History: As above Overall image quality: FairPELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: No measurable lymph nodes.Lymph nodes outside the mesorectal fascia: No measurable lymph nodes.BOWEL, MESENTERY: Rectal Tumor:Size: No measurable tumor identified.Tumor appearance on T2-weighted images: No discrete tumor visualized.Tumor location: N/A(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): N/ADistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): N/ACircumference of the rectum involved: N/ARelationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): N/AMRI T-stage: N/ATumor Distance to Mesorectal Fascia: N/ABONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No measurable tumor or suspicious lymph nodes.


Instruction: Generate impression based on findings.

Input: 50 year-old male please evaluate for edema and acute bleed. There is no evidence of intracranial hemorrhage, mass or edema. Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No intracranial hemorrhage. Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Renal cell carcinoma with bone metastases. Study is obtained to evaluate for osseous metastatic disease and is thus limited for evaluation of solid organs.Demonstrated again is the large exophytic mass involving the inferior left kidney measuring 7.6 x 6.6 cm in the cranial plane, essentially unchanged.There is diffusely abnormal bone marrow signal intensity and diffusion restriction within the axial skeleton and bilateral proximal femurs and humeri compatible with metastatic disease, appearing similar to the prior study.

Output: No significant change in the large left renal mass.Extensive metastatic osseous disease affecting the axial and proximal appendicular skeleton appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: Reason: s/p ex lap, now with AMS History: AMS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the prior exam.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: 46-year-old with strong family history of breast cancer presents for a screening MRI. Personal history of right breast benign cyst aspiration. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement and multiple high T2 signal cysts are seen in both breasts.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: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 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: 31 seconds

Output: Successful right hip arthrogram injection.


Instruction: Generate impression based on findings.

Input: Male 60 years old Reason: s/p prostatectomy assess for residual tissue to radiate PELVIS:PROSTATE:Prostate : Status post prostatectomy. No abnormal soft tissue in the prostate bed.BLADDER: No significant abnormality noted.LYMPH NODES: There are bilateral inguinal lymph nodes. The reference left inguinal lymph node measures 1.5 x 1.2 cmBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Bilateral inguinal lymph nodes. No definite soft tissue in the prostate bed to suggest residual disease.