Instruction: Generate impression based on findings.

Input: Male, 42 years old, with neck pain, left arm to hands. Image quality is degraded by motion artifact. Within this limitation, the following observations are made.Mild straightening of the cervical is seen. Alignment is otherwise unremarkable. Vertebral body morphology and signal characteristics are within normal limits.Except as discussed below, the spinal cord demonstrates normal signal intensity and morphology.C2-3: Unremarkable. C3-4: Mild facet hypertrophy. Otherwise unremarkable. No interval changes.C4-5: Mild facet hypertrophy. Mild left neuroforaminal narrowing. Otherwise unremarkable. No interval changes.C5-6: Mild facet hypertrophy. Posterior disk osteophyte formation with a left central/paracentral disk protrusion. Resultant mild flattening of the left ventral aspect of the cord without cord signal abnormality. Moderate left neuroforaminal narrowing. No significant interval changes. C6-7: Facet hypertrophy. Mild posterior disk osteophyte formation. Moderate left and mild right foraminal narrowing. No significant interval changes. C7-T1: Facet hypertrophy. Otherwise unremarkable. No significant interval changes.

Output: Stable degenerative findings including a disk protrusion at C5-6 which mildly impinges upon the left ventral aspect of the cord.


Instruction: Generate impression based on findings.

Input: 70-year-old woman with history of left upper quadrant pain and normal lipase. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion identified. The gallbladder is normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Partially visualized small bowel and colon appears normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No finding to explain the patient's pain.


Instruction: Generate impression based on findings.

Input: Headaches with eye pain. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There are small retention cysts in the right maxillary and bilateral ethmoid sinuses.

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


Instruction: Generate impression based on findings.

Input: 80 year-old female with left PCA the and left PICA infarctions and possible occluded left vertebral artery. Evaluate for structural changes. There is no evidence of intracranial hemorrhage, mass, extra-axial fluid collection or midline shift. An area of hyperdensity is noted within the left medial temporal lobe. Additionally areas of hypodensity are noted within the left thalamus, the left superior medial cerebellum and the left occipital lobe. There is no volume loss or effacement of the sulci. These findings are consistent with the patient's history of stroke. Additionally, there are multiple areas of hypodensity within the periventricular and deep white matter which are compatible with the MRI findings of chronic small vessel disease.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses are normally pneumatized. There is minimal opacification of the mastoid air cells. Vascular calcifications of the internal carotid and vertebral arteries bilaterally.

Output: Findings consistent with known stroke involving the left medial temporal lobe, left thalamus, left superior medial cerebellum, and the left occipital lobe. There is no mass effect, midline shift, or evidence of hemorrhagic conversion. These findings appear stable since the previous MRI examination on 10/24/2011.


Instruction: Generate impression based on findings.

Input: Female 58 years old with a history of hepatitis C cirrhosis. Assess left lobe liver lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 24.6 cm in length and has a lobular contour. There are innumerable nodules throughout the liver that are slightly T1 hyperintense and T2 hypointense compatible with dysplastic nodules. No enhancing liver lesion is identified.SPLEEN: The spleen measures 17.9 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There a few bilateral subcentimeter T2 hyperintense, circumscribed, nonenhancing renal lesions consistent with simple cysts.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Heterogeneous liver with numerous regenerative nodules consistent with patient's history of cirrhosis. No definite lesions are noted enhancing at the arterial phase and washing out suspicious for hepatocellular carcinoma. Splenomegaly. Severe atherosclerotic disease.1. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Cervical spine:There are no fractures. The marrow signal is benign. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Left uncinate and facet hypertrophy combine to cause moderate to severe left neural foraminal stenosis.C4/5: Left facet hypertrophy causes mild left neural foraminal stenosis.C5/6: Trace anterolisthesis C4 on C5, and severe left facet hypertrophy. There is mild-to-moderate left neural foraminal stenosis.C6/7: Trace anterolisthesis C6 on C7, bilateral uncinate hypertrophy, and moderate left facet hypertrophy. There are no significant stenoses.C7/T1: Posterior osteophyte disc complex, endplate spurring, and left facet hypertrophy. There is moderate left and mild right neural foraminal stenosis.Thoracic spine:There are nodular enhancing foci involving the surface of the conus.Marrow signal intensity is benign throughout. Increased fat intensity in the T9-T12 bodies suggests prior radiation therapy.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates a tiny midline disc protrusion causing slight flattening of the anterior cord surface without intrinsic cord signal abnormality. T5/6 demonstrates a small midline disc protrusion causing slight flattening of the anterior cord surface without intrinsic cord signal abnormality.T6/7 demonstrates a tiny right paramedian disc protrusion without cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates a large central disc extrusion extending above the disc level causing anterior cord flattening without intrinsic cord signal abnormality. T9/10 demonstrates a large central disc extrusion extending above the disc level causing anterior cord flattening without intrinsic cord signal abnormality.T10/11 demonstrates a small left paracentral disc protrusion without cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:There are nodular enhancing foci involving the cauda equina.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign.L1/2: Unremarkable.L2/3:Mild disc bulge without stenosis .L3/4: Mild disc bulge and mild bilateral facet hypertrophy without stenosis.L4/5: Diffuse annular disc bulge, ligamentum flavum thickening, severe left facet hypertrophy, moderate right facet hypertrophy, and a tiny left facet effusion. There is mild to moderate left neural foraminal and mild right neural foraminal stenosis.L5/S1: There is partial sacralization of L5. There are no stenoses.

Output: 1.Nodular enhancing foci are present involving the conus surface as well as cauda equina.2.Degenerative changes of the cervical, thoracic, and lumbar spines including disc protrusions and stenoses as detailed on a level by level basis above.


Instruction: Generate impression based on findings.

Input: A 47 year old male with diabetes, hypertension, hyperlipidemia, coronary artery disease, s/p myocardial infarction in 2011 with PCI and stent placement to the circumflex artery. In a repeat cath, the circumflex stent was occluded and stenosis in the right coronary artery was noted and PCI with stent placement was performed.MEDICATIONS: regadenoson, aminophylline, carvedilol, victoza, losartan, metformin, crestor. Viability/ Myocardial ScarThere is transmural late gadolinium enhancement noted in the basal and mid segments of the infero-lateral wall consistent with prior myocardial infarction. The rest of the myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 71 ml/m2 (normal range: 74+/-15), the LVEDV is 151 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 55 g/m2, and the LV mass is 115 g. There is hypokinesis of the basal infero-lateral wall. Left AtriumThe left atrium is upper limits normal. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 130 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 54 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,two on the RT and two on the left.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. The left ventricle is normal in size with normal systolic function, LVEF is 54%. There is hypokinesis of the basal infero-lateral wall. 2. There is near transmural late gadolinium enhancement noted in the basal and mid segments of the infero-lateral wall consistent with myocardial infarction. The rest of the myocardium is viable.3. The right ventricle is normal in size with normal systolic function, RVEF is 58%. 4. The left atrium is upper limits normal size. 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: Reevaluate cyst. Signs and symptoms: Headache. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination redemonstrates a small left frontal periventricular cyst without appreciable interval change since prior exam.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Postcontrast images demonstrate no abnormal enhancement of brain parenchyma or the leptomeninges and no enhancement of the above detailed cyst. This is a similar observation as prior study.The signal void of all major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and the normal pattern of enhancement.Calvarium, scalp, orbits, paranasal sinuses and mastoid air cells are unremarkable.

Output: Stable small left periventricular frontal cyst since prior exam and unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Reason: ligament injury History: knee is now giving out and locking up multiple times a day MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: Mildly increased signal of the quadriceps tendon, suggestive of tendinosis.ADDITIONAL

Output: Quadriceps tendinosis. No evidence of meniscal or ligament total tear.


Instruction: Generate impression based on findings.

Input: There is slight straightening of the cervical spine which may be positional. Again seen and unchanged is multilevel degenerative changes without significant vertebral body height loss. There is evidence of a previous laminoplasty extending from the C3-C6 levels. The marrow signal is mildly heterogeneous which is nonspecific. The spinal cord is of normal caliber and signal. C2-3: No disc bulge. No significant neuroforaminal or central canal stenosis.C3-4: Moderate disc disease with a mild disc osteophyte complex. No significant neuroforaminal or central canal stenosis.C4-5: Mild to moderate disc disease with a disc osteophyte complex and a focal superimposed central disc protrusion. There is also uncovertebral hypertrophy. There is questionable mild bilateral neural foraminal stenosis but no central canal stenosis.C5-6: Advanced disc disease with a disc osteophyte complex. There is a right paracentral disc protrusion. This results in moderate to severe right and mild left neural foraminal stenosis. No significant central spinal canal stenosis.C6-7: Advanced disc disease and disc osteophyte complex with uncovertebral hypertrophy. There is mild right and moderate left neuroforaminal stenosis. No central canal stenosis.C7-T1: Disc osteophyte complex with left facet hypertrophy. Mild left neural foraminal stenosis. No right neuroforaminal or central canal stenosis.THORACIC SPINE

Output: Multilevel degenerative changes throughout the spine, most severe within the lumbar spine where there is severe central spinal canal stenosis extending from the L2-3 through L4-5 levels but this is not significantly changed compared to multiple previous exams. There is also severe neural foraminal stenosis extending from L2-3 to L5-S1 more severe on the left.


Instruction: Generate impression based on findings.

Input: History of prostate cancer, evaluate for focal laser ablation. PELVIS:PROSTATE:Prostate Size: 4.5 x 3.0 x 3.7 cm.Peripheral Zone: There is diffuse T2 hypointensity of the peripheral zone which somewhat limits evaluation and which may be related to prostatitis. There is an area of decreased T2 and ADC signal within the left mid gland which measures approximately 0.9 x 0.8 cm (series 801, image 114) which is suspicious for neoplasm. There is an additional subcentimeter focus of decreased T2 signal within the right mid peripheral zone which lacks corresponding ADC signal abnormality and which is nonspecific.Central Gland: Multiple well circumscribed nodules compatible with hyperplastic nodules. There is an area of decreased ADC signal in the left transitional zone (series 704, image 404) measuring 1.5 x 1.1 cm which lacks associated T2 signal abnormality and which is nonspecific.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No definite 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: Area of signal abnormality within the left peripheral zone mid gland suspicious for neoplasm. Additional areas of signal abnormality within the right peripheral zone mid gland and left transitional zone which are nonspecific as above.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: 1. No evidence of leptomeningeal metastatic disease. No cord signal abnormality.2. Enhancing lesion involving the T3 vertebral body may represent a benign lesion such as atypical hemangioma but is nonspecific. Examination of the cervical, thoracic, and lumbar spine is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 55-year-old female with right medial knee pain. Prior arthroscopy with possible partial lateral meniscectomy and medial meniscus repair at an outside hospital. MENISCI: There is globular increased signal abnormality within the posterior horn of the medial meniscus likely representing a combination of postsurgical change and intrasubstance degeneration. There is a full-thickness radial tear of the posterior horn of the medial meniscus near its root (image 8; series 8). There is medial extrusion of the body of the meniscus. This tear also extends in a horizontal fashion into the body of the meniscus (image 9; series 8). The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Heterogeneous bone marrow may represent residual islands of red marrow. There is thinning of the articular cartilage along the medial tibiofemoral compartment. There is near full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the posterior horn of the meniscus. There is thinning of the articular cartilage of the patellofemoral joint without evidence of a full-thickness articular cartilage defect. There is a small amount of increased signal abnormality within the medial femoral condyle which may be degenerative in etiology. There are small tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Radial tear of the posterior horn of the medial meniscus, near its root, with extension of the tear in a horizontal fashion into the body of the meniscus with associated medial extrusion of the meniscus. The lateral meniscus appears intact.2. Osteoarthritis of the right knee including near full-thickness articular cartilage degeneration as described above.3. Small joint effusion.


Instruction: Generate impression based on findings.

Input: TFCC tear LIGAMENTS: There is no contrast extravasation through the scapholunate or lunotriquetral ligaments to suggest tears of these intrinsic ligaments. TRIANGULAR FIBROCARTILAGE COMPLEX: There are tiny foci of signal void along the articular disc of the triangular fibrocartilage and dorsal capsular structures which likely reflects artifact from prior surgery. There is a full-thickness defect within the articular disc of the triangular fibrocartilage situated approximately 1 to 2 mm medial to the articular cartilage of the distal radius. The defect is estimated to be 2 to 3 mm in diameter and gadolinium is seen extending from the radiocarpal joint into the distal radioulnar joint as a result. The volar and dorsal radioulnar ligaments appear intact.TENDONS: A small amount of gadolinium within the sheaths of the extensor tendons is iatrogenic in nature. The flexor and extensor tendons are otherwise normal. BONES: The bone marrow signal is normal and we see no frank positive ulnar variance.

Output: Tear of the articular disc of the triangular fibrocartilage as described above.


Instruction: Generate impression based on findings.

Input: Reason: polymyositis History: same. Right Femur:Metallic artifact from right hip arthroplasty device limits evaluation. Previously seen abnormal signal within the distal aspect of the vastus medialis has significantly decreased compared to prior. Previously seen abnormal signal within the adductor magnus has decreased compared to prior. Additional previously seen smaller foci of abnormal signal within the vastus intermedius, gluteus medius and minimus have resolved. No new sites of abnormal signal. No significant fatty muscle atrophy.Left Femur:Metallic artifact from right hip arthroplasty device limits evaluation. Previously seen abnormal signal within the adductor magnus has decreased compared to prior. Previously seen abnormal signal within the biceps femoris has resolved. No new sites of abnormal signal. No significant fatty muscle atrophy.

Output: Interval decrease or resolution of previously seen muscle edema compatible with resolving polymyositis.


Instruction: Generate impression based on findings.

Input: Male 13 years old medial tibial plateau fracture. MENISCI: The medial and lateral menisci appear intact however a small meniscal tear may not be visualized.ARTICULAR CARTILAGE AND BONE: There is a fracture extending from the medial to lateral inferior to the tibial spines. On the sagittal images there is a 4 mm step-off with the fracture fragment elevated relative to the tibial plateau. Edema is present along the lateral articular surface of the femur and in the posterior lateral tibial epiphysis. The articular cartilage appears intact.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The medial collateral ligament and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: ACL avulsion fracture. Large hemarthrosis.


Instruction: Generate impression based on findings.

Input: 46 years year-old BRCA1 mutation carrier. History of right lumpectomy in 2003 for IDC with medullary features. Patient received radiation and chemotherapy. History of breast carcinoma in sister diagnosed at the age of 28 and ovarian carcinoma in a paternal aunt. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Post-operative volume loss and scarring in the right breast again noted. 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: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: There is a 2 mm focus of residual enhancement along the right medial frontal gyrus which is slightly smaller than on the previous exam where it measured 3 mm. There is no significant edema or mass effect. There are no new lesions or new abnormal enhancement in the brain parenchyma. There is diffuse periventricular and subcortical white matter hyperintensities, likely consistent with postradiation changes, slightly progressed from previous exam. There is no midline shift or mass effect. 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. There is mucosal thickening involving the right more than left maxillary sinuses.There is an enhancing focus in the right parietal bone, which was also present on previous MRI from 12/6/2014, likely nonspecific.

Output: Continued interval reduction in the size of the right frontal metastasis. No new lesions seen.Mild interval progression of the periventricular and subcortical hyperintensities related to postradiation changes.


Instruction: Generate impression based on findings.

Input: Female 69 years old Reason: r/o thyroid nodules, adenopathy History: h/o thyroid nodules RIGHT LOBE MEASUREMENTS: 4.1 x 4.2 x 8.9 cmLEFT LOBE MEASUREMENTS: 3.3 x 3.5 x 7.5 cmISTHMUS MEASUREMENTS: 1.3 cmRIGHT LOBE: Diffusely enlarged and heterogeneous thyroid gland. There are multiple complex cystic appearing nodules. Largest measures 2.8 x 2.1 x 2.9 cm in the superior right lobe.LEFT LOBE: Diffusely enlarged heterogeneous thyroid gland. Multiple cystic nodules. Largest measures 9 mm in diameter in the superior aspect of the left lobe of the thyroid.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Diffusely enlarged heterogeneous thyroid compatible with patient's known history of Graves' disease. Multinodular goiter with multiple complex appearing cystic nodules.


Instruction: Generate impression based on findings.

Input: Low back pain. Radiculopathy. 5 lumbar type vertebrae are present. Vertebral body heights are preserved. Endplate degenerative signal is seen at L3-4. There is no worrisome focal bone marrow signal abnormality. The conus medullaris is normal in appearance and terminates at the inferior L2 level. There is grade 1 anterolisthesis of L4 on L5 and L5 on S1. Vacuum disc phenomenon seen at L3-4, L4-5 and L5-S1. Presumed renal cysts are not fully characterized.Individual levels as below:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: Mild disc bulge and facet arthropathy with mild left and minimal right neural foraminal narrowing. No spinal canal stenosis.L3-L4: There is a disc bulge, eccentric to the left with moderate to severe left neural foraminal narrowing and partial effacement of the lateral recess. Mild right neural foraminal narrowing. There is mild central spinal stenosis. There is ligamentum flavum thickening and facet arthropathy. L4-5: There is severe facet arthropathy with fluid in the left facet joint. There is anterolisthesis with uncovering of the disc. There is diffuse disc bulge. There is mild to moderate left and mild right neural foraminal narrowing. There is moderate to severe spinal canal stenosis.L5-S1: There is moderate to severe facet arthropathy, right greater than left. There is anterolisthesis with uncovering of the disc. There is moderate spinal stenosis including effacement of the right lateral recess. There is moderate to severe right neural foraminal narrowing and mild left neural foraminal narrowing.

Output: Advanced degenerative changes in the lumbar spine at L3-4, L4-5 and L5-S1. There is advanced facet arthropathy with grade 1 degenerative spondylolisthesis at L4-5 and L5-S1. There is moderate to severe spinal canal stenosis at the L4-L5 level and to a lesser degree at L5-S1 and L3-L4. There is multilevel neural foraminal narrowing, particularly at the left L3-L4 and right L5-S1 levels. Please see additional details above.


Instruction: Generate impression based on findings.

Input: Female, 78 years old. Reason: swollen lymph node in R submandibular region History: pain RIGHT LOBE MEASUREMENTS: 2.0 by 1.6 x 4.6 cmLEFT LOBE MEASUREMENTS: 1.3 x 1 .0 by 3.1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Mildly heterogeneous echotexture without focal lesion.LEFT LOBE: Mildly heterogeneous echotexture. A 1.2 x 1.1 x 1.4 cm left lower pole spongiform nodule nodule has peripheral vascularity and no significant calcification. ISTHMUS: A 0.7 x 0.5 x 0.7 cm spongiform nodule at the junction of the isthmus and the left lobe has internal vascularity and no significant calcification.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically benign cervical lymph nodes are identified. A right level 2 lymph node measures 0.7 x 0.4 x 1.6 cm, with a fatty hilum. A right level 3 lymph node measures 0.6 x 0.4 x 1.4 cm, with a fatty hilum. A left level 2 lymph node measures 0.8 x 0.4 x 1.8 cm, with a fatty hilum. OTHER: No significant abnormality noted.

Output: 1. The patient's reported area of palpable abnormality corresponds with morphologically benign cervical lymph nodes. 2. Spongiform thyroid nodules are favored to be benign. No regional adenopathy.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: concern for acute ischemic stroke 2/2 to vertebral dissection History: neck pain, ataxia Gradient-echo technique sequences of head was not performed and fat saturated the sequences of neck is nondiagnostic due to poor image quality, thus non-diagnostic. Brain MRI:There is no evidence of acute ischemic stroke.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. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The right vertebral artery is hypoplastic and the left one is dominant.There is no evidence of occlusion, stenosis or any direct evidence of dissection of the vertebrobasilar system.The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic lesion in the brain.2. No direct evidence of vertebrobasilar dissection. Hypoplastic right vertebral artery and dominant left vertebral artery are normal variation. 3. Non diagnostic fat saturated MRI from skull base to neck and gradient echo sequence of the brain were not obtained, thus can be repeated without charge if clinically indicated.


Instruction: Generate impression based on findings.

Input: Prior pT2N0M0 right lateral tongue cancer, resected May 2016 now with intermittent pain evaluate for any submucosal mass in region of right glossotonsillar sulcus. There are post-treatment findings, including partial right glossectomy and neck dissection. There is an infiltrative mass in the posterior right tongue that measures up to approximately 20 mm. There is no evidence of significant lymphadenopathy in the imaged portions of the neck. The remaining salivary glands and thyroid are unremarkable. The osseous structures appear to be intact. The imaged intracranial structures are unchanged. There is a small amount of fluid in the left mastoid air cells.

Output: Post-treatment findings in the neck with an infiltrative mass in the posterior right tongue that measures up to approximately 20 mm, which likely represent recurrent tumor. Otherwise, no evidence of significant lymphadenopathy in the imaged portions of the neck.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction 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.There is redemonstration of small foci of signal hyperintensity on T2 and FLAIR MRI in the cerebellar hemispheres as well as the brainstem which were also present on the prior exam and remain unchangedThe lateral ventricles are fairly large. The biventricular diameter currently measures 44 mm and previously measured the same.Several punctate foci of a signal loss and susceptibility imaging are present along the left temporal lobe subcortical white matter a couple of which were present on the prior examNo 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 demonstrate an opacity in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.The exam is stable compared to the July 2014 exam.2.Punctate periventricular and subcortical white matter as well as cerebellar and brainstem lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Old lacunar infarcts are present in the cerebellar hemispheres4.There are several microhemorrhages present in the left temporal lobe subcortical white matter which are nonspecific


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact.BRAIN: There is an unchanged right frontal lobe chronic infarct with resultant encephalomalacia and volume loss including Wallerian degeneration of the right cerebral peduncle. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. MRA HEAD: There is unchanged severe stenosis of the distal right internal carotid artery with only residual string like flow related signal. There is also further interval reduction in the flow related signal within the arteries throughout the right middle cerebral artery territory. There are unchanged linear foci of flow related signal located at the right internal carotid artery bifurcation compatible with collateral vessels. The left intracranial internal carotid artery is normal in course and caliber. The left middle and bilateral anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of aneurysm.MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is unchanged severe stenosis of the right common and internal carotid arteries with only minimal residual string like flow related signal. There are also unchanged multifocal moderate stenosis (up to 50%) of the right brachiocephalic artery with post-stenotic dilatation of the right subclavian artery. There are also moderate stenoses involving the left common carotid and left subclavian artery origins. The remainder of the left common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent.

Output: 1.Unchanged right frontal lobe MCA distribution chronic infarction.2.Unchanged severe stenosis involving the entire course of the right common and internal carotid arteries with demonstration of string like lumen continued from the level of common carotid artery to the level of supraclinoid segment of the ICA.3.Further interval decrease in anterograde blood flow throughout the right middle cerebral artery distribution although collateral perfusion (centripetal) direction flow) cannot be assessed on this exam using TOF technique. MR perfusion would be helpful on follow-up imaging to assess for changes in blood flow between the two hemispheres. 4.Unchanged moderate relatively long segment stenoses of the brachiocephalic, left common carotid, and left subclavian artery origins, with poststenotic dilatation of the right subclavian artery.


Instruction: Generate impression based on findings.

Input: 32-year-old female with bilateral breast pain, greater on the left. Family history of breast cancer diagnosed in two paternal aunts. Patient underwent diagnostic mammography and left ultrasound the prior day demonstrating left 12 o'clock duct dilatation with possible intraductal mass. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.LEFT:Non-mass enhancement in the left retroareolar breast, predominantly due to ductal wall enhancement, with associated ductal dilatation. Total extent of retroareolar non-mass enhancement measures 5.9 x 6.7 x 9.7 cm (AP x TR x CC). In the 12 o'clock position, there is superimposed more focal rounded peripheral duct enhancement that measures approximately 8 mm, that likely correlates with the 12 o'clock sonographic finding. No definite enhancing mass is identified. Mildly prominent left upper outer breast intramammary and axillary lymph nodes may be reactive in etiology. These maintain fatty hila.RIGHT:No abnormal enhancement is seen in the right breast. No abnormal lymph nodes in the right axillary region.

Output: 1.Left retroareolar non-mass enhancement, predominantly due to ductal wall enhancement with ductal dilatation. Superimposed more focal ductal dilatation in the 12 o'clock position likely corresponds to the sonographic findings in that location. No enhancing mass identified. Findings may be related to a ductal inflammatory process, though malignancy is not excluded. The patient is going to have ultrasound guided biopsy of the left 12 o'clock region. 2.Prominent likely reactive left sided lymph nodes.3.No abnormal enhancement in the right breast or axillary region.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Status post cavernoma resection There are postsurgical changes of laminectomy from C7 to T2 and resection of previously seen intramedullary hemorrhagic lesion.Expected postsurgical changes include intramedullary resection cavity and blood products and edema extending from C7 to T3. No residual lesion is appreciated.Small extradural fluid collection is seen in the surgical bed. No large fluid collections. Artifact slightly limits evaluation however, no abnormal enhancement is seen. Mild degenerative changes including small disk protrusion at C6-C7, T5-T6, and T6-T7 are again seen. Vertebral body heights and alignment are maintained.

Output: Expected postsurgical changes related to resection of intramedullary hemorrhagic lesion compatible with cavernous malformation. No residual lesion.


Instruction: Generate impression based on findings.

Input: Evaluate for Chiari malformation, syrinx, tethered cord: scoliosis. There is upper thoracic levoscoliosis, thoracolumbar dextro scoliosis and lower lumbar levocurvature, but no spondylolisthesis. The spinal cord displays normal signal and morphology. The conus medullaris is positioned at the L1-2 level and shifts in position between prone and supine imaging. There is no evidence of fibrofatty filum. The cerebellar tonsils extend up to 5 mm inferior to the foramen magnum. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Upper thoracic levoscoliosis, thoracolumbar dextro scoliosis and lower lumbar levocurvature. 2. Mildly low-lying cerebellar tonsils without syringohydromyelia. 3. The conus medullaris is positioned at the L1-2 level and there is no evidence of fibrofatty filum.


Instruction: Generate impression based on findings.

Input: Hyperprolactinemia. The pituitary gland enhances somewhat heterogeneously, with an apparent relatively hypoenhancing area in the inferior left lobe. However, the pituitary gland is not enlarged. The pituitary infundibulum is intact. Likewise, the optic apparatus and cavernous sinuses are intact.

Output: The pituitary gland enhances somewhat heterogeneously, with an apparent relatively hypoenhancing area in the inferior left lobe, which may represent a microadenoma.


Instruction: Generate impression based on findings.

Input: Epilepsy, unspecified, not intractable, without status epilepticus [G40.909], Reason for Study: ^Reason: seizure 2 protocol History: seizures The right inferior aspect of temporal lobe shows significant tissue loss. In particular, the right hippocampus head and body tissue losses are significant. The right hippocampal tail and right lingular gyrus appear to be within normal limits. There is also right superior, middle and inferior temporal gyri tissue loss especially anterior aspect.There is extra dural fluid collections on the inferior aspect of right temporal lobe anterior aspect [10.7mm (CC) x 24.4mm (RL) x 30.3mm (AP)]. There is focal encephalomalacia at the left occipital lobe especially distal aspect of the left intra-occipital sulcus.Multiple scattered periventricular white matter FLAIR/T2 high signal intensity lesions indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Mucosal thickenings on bilateral ethmoid and frontal sinuses.

Output: 1. Extensive tissue losses on the anterior aspect of the right temporal lobe including right hippocampal head, body as well as superior, middle and inferior temporal gyri. 2. Infratemporal extra dural fluid collection on the right middle cranial fossa [10.7mm (CC) x 24.4mm (RL) x 30.3mm (AP)]3. Left occipital lobe tissue loss adjacent to distal left intraoccipital sulcus.4. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: There is no intracranial mass or mass-effect. There are no areas of abnormal signal or pathological enhancement. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no evidence of ischemia or hemorrhage. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is interval improvement in previously seen opacification of the paranasal sinus, which are now grossly clear.

Output: No evidence of metastatic disease to the brain or calvarium.


Instruction: Generate impression based on findings.

Input: There are numerous foraminal and extraforaminal lumbar and sacral nerve root tumor that appear to not have significantly changed in size since 2014. Likewise, there are several tumors in the paraspinal soft tissues, which appear to be similar in size as before. There is degenerative spondylosis in the lower lumbar spine. In particular, a disc protrusion at L5-S1 has decreased in size considerably since 2014 and there is now minimal spinal canal narrowing as a result. However, there has been increased loss of disc space height at L5-S1 and increased degenerative bone marrow signal alterations at this level. There is no significant spinal canal stenosis at the other lumbar spine levels. There is no spondylolisthesis and the vertebral body heights are essentially preserved.

Output: 1. The numerous lumbosacral nerve root and paraspinal soft tissue neurofibromas do not appear to have changed significantly since 2014.2. Interval evolution of the degenerative disc disease, with involution of the disc protrusion at L5-S1, with minimal residual spinal canal narrowing, but increased loss of disc space height at L5-S1.


Instruction: Generate impression based on findings.

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

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. In particular, the posterior hypothalamic region is unremarkable. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 80-year-old male disoriented for one day. Evaluate for stroke. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodensity in a periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered. Coarse hyperdensities within the tentorium represent calcifications of no current clinical significance. Focal areas of well delineated CSF attenuation within the region of the anterior left temporal lobe consistent with arachnoid cyst.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: Suspected small vessel disease, otherwise unremarkable. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Aneurysm and cavernous malformation: headache, light flashes. MRI: There is a punctate focus of susceptibility effect in the left parietal lobe white matter with an adjacent developmental venous anomaly. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is a medially-directed outpouching from the right internal carotid artery adjacent to the ophthalmic artery origin that measures up to 5 mm, with a 2 mm wide neck. There is no evidence of significant steno-occlusive lesions.

Output: 1. A punctate focus of susceptibility effect in the left parietal lobe white matter with an adjacent developmental venous anomaly likely represents a cavernous malformation. 2. A right ophthalmic artery saccular aneurysm measures up to 5 mm.


Instruction: Generate impression based on findings.

Input: There are multiple partially enhancing subependymal nodular lesions along the margins of both lateral ventricles. The largest is in the anterior horn of the right lateral ventricle near the right foreman of Monro that measures 10 x 10 mm in transaxial view. There is also a lesion in the anterior horn of the left lateral ventricle near the left foreman of Monro that measures 8 x 7 mm in transaxial view. These nodules demonstrate susceptibility, representing mineralization.There are multiple scattered cortical and subcortical tubers with high T2/FLAIR intensity and with subtle intrinsic T1 hyperintensity on fat-suppressed post-contrast images. The lateral ventricles are mildly prominent, which is nonspecific.There is partial opacification of the paranasal sinuses. Trace fluid is seen in the mastoids.

Output: Multiple subependymal nodules along the margins of the lateral ventricles including ones at the foramen of Monro, with multiple scattered cortical and subcortical tubers, consistent with known diagnosis of tuberous sclerosis.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, history of tuberous sclerosis and epilepsy. Image quality is degraded by motion artifact. Within this limitation, the following observations are made.Redemonstrated are numerous stigmata of tuberous sclerosis, including scattered areas of subcortical T2 hyperintensity and numerous ependymal nodules. Most of these lesions show no significant interval change. Some of the ependymal lesions seem to demonstrate minimal enhancement above their intrinsic T1 hyperintensity, but this has not appreciably changed.One lesion, however, within the left anterior temporal lobe, shows increased T2 signal and enhancement, now measuring up to 8 mm in diameter, previously 5 mm.No entirely new parenchymal lesions are seen. No evidence of significant mass effect is demonstrated. Ventricular size and morphology are unremarkable. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen.Since the prior examination, maxillary sinus inflammation has improved. However, progressive opacification of the mastoid air cells and the left petrous apex is noted.

Output: 1.Interval increase in size of an enhancing lesion within the anterior left temporal lobe, the nature of which is uncertain. Although this would be a very unusual location for a giant cell astrocytoma, the possibility of a neoplastic process cannot be entirely excluded. Correlation with clinical symptomatology and close interval follow-up is suggested.2.The remaining subcortical tubers and subependymal nodules show no significant interval change in size or imaging characteristics.


Instruction: Generate impression based on findings.

Input: Clinical question: Bleed. Signs and symptoms: Acute change in mental status. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and gray -- white matter differentiation is preserved and unremarkable. On sagittal reformatted images there is suggestion of slight ectopia of cerebellar tonsils. Please correlate with history and follow-up with an MRI examination.Calvarium is intact. Visualized paranasal sinuses, middle ear cavities and mastoid air cells are unremarkable

Output: 1.No evidence of acute intracranial findings. 2.Minimally ectopic cerebellar tonsils which may require further follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is a small focus of linear increased signal within the articular surface of the supraspinatus tendon just proximal to its attachment upon the greater tuberosity likely representing a small partial undersurface or interstitial tear. The remaining rotator cuff tendons are intact and the rotator cuff musculature is normal in caliber.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral alignment is normal. There is abnormal signal intensity and contrast extending into the superior labrum from anterior to posterior consistent with a SLAP type tear. This tear does not appear to extend into the biceps anchor. There are no significant osteoarthritic changes of the glenohumeral joint.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Tearing of the superior labrum anteriorly to posteriorly (SLAP tear).2. Mild interstitial or partial articular surface tearing of the supraspinatus tendon just proximal to its attachment upon the greater tuberosity. There is no full-thickness rotator cuff tear in the remaining rotator cuff tendons and muscles are normal.


Instruction: Generate impression based on findings.

Input: 62 years, Male, confusion. History of lung mass and recent embolization for hemoptysis. There is no intracranial mass or abnormal enhancement to suggest metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No evidence of intracranial mass effect, midline shift, or herniation. No hydrocephalus. No extra-axial collections.Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate chronic small vessel ischemic disease. Small lacunar infarcts are suspected including the left thalamus and right external capsule. There is also mild global parenchymal volume loss. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is mild mucosal thickening involving the ethmoid air cells and small left maxillary mucus retention cyst. Skin lesion is noted in the left malar region which can be correlated with direct examination. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial metastatic disease.2. Moderate chronic small vessel ischemic disease.3. Left malar skin lesion, which can be correlated with physical exam.


Instruction: Generate impression based on findings.

Input: Reason: HCC screening History: hep C cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Hyperenhancing focus in the inferior right lower lobe is likely perfusional. No suspicious hepatic lesions. Noncirrhotic morphology. No intrahepatic fracture or hepatic biliary ductal dilatation. The portal venous system is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintensities, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: 37 year old male with a history of non-ischemic cardiomyopathy following viral illness (first diagnosed in 2011) who was admitted for acute decompensated heart failure and ventricular tachycardia with shock/discharge from Life Vest. He is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 13%, the LV end diastolic volume index is 307 ml/m2 (normal range: 74+/-15), the LVEDV is 674 ml (normal range 142+/-34), the LV end systolic volume index is 267 ml/m2 (normal range 25+/-9), the LVESV is 586 ml (normal range 47+/-19), the LV mass index is 70 g/m2 (normal range 85+/-15), and the LV mass is 154 g (normal range 164+/-36). There is global hypokinesis with regional variation. Late gadolinium enhancement images were suboptimal due to artifacts and patient breathing. There is a mid-myocardial stripe of late gadolinium enhancement in the septum. Additionally, there appears to be a small area of late gadolinium enhancement confined to the the mid to apical inferolateral and lateral walls which is subendocardial in nature and could be suspicious for old myocardial infarction versus coronary embolic event. The overall quantity of this late gadolinium enhancement in this region is not enough to explain this patient's cardiomyopathy. In addition, there is significant artifact on late gadolinium enhancement images. T1 mapping could not be performed due to technical challenges. Two thrombi noted in the left ventricle - one at the apex and one at the mid septal wall. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 16%, the RV end diastolic volume index is 170 ml/m2 (normal range 82+/-16), the RVEDV is 373 ml (normal range 142+/-31), the RV end systolic volume index is 144 ml/m2 (normal range 31+/-9), and the RVESV is 316 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is at least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation. There is bileaflet tethering. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is 41 mm at the sinus of Valsalva.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsInterstitial changes noted in the lungs of unclear etiology. 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. Significant motion and breathing artifact throughout the scan that impairs diagnostic quality images. 2. The left ventricle is severely dilated with severely reduced systolic function (LVEF 13%). There is global hypokinesis with regional variation. 3. The right ventricle is severely dilated with severely reduced systolic function (RVEF 16%). 4. There is global hypokinesis with regional variation. 5. There is a mid-myocardial stripe of late gadolinium enhancement in the septum. Additionally, there appears to be a small area of late gadolinium enhancement confined to the the mid to apical inferolateral and lateral walls which is subendocardial in nature and could be suspicious for old myocardial infarction versus coronary embolic event. 5. Two thrombi noted in the left ventricle - one at the apex and one at the mid septal wall. 6. There is at least moderate mitral regurgitation. 7. Severe biatrial enlargement.8. Extracardiac findings as described above. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 43 years old Reason: Crohn's disease 1999, with ileocecectomy. RLQ pain. History: RLQ pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology with patent hepatic and portal veins. No biliary ductal dilatation. No focal hepatic lesions.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: Postsurgical changes of an ileocecectomy. There is mild mucosal hyperenhancement about the level of the anastomosis for approximately 3 cm segment of bowel with subtle bowel wall thickening which is new from prior.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focal area of bowel wall inflammation at the neoterminal ileum anastomosis for a 3 cm segment. This suggests inflammation in this area. Confirmation with a endoscopy can be considered.


Instruction: Generate impression based on findings.

Input: cT2N1 nasopharyngeal squamous cell carcinoma treated with TFHx and XRT. There are post-treatment findings in the nasopharyngeal. There is no residual measurable right nasopharynx mass. There is also no significant upper cervical lymphadenopathy. For example, a right level 2B lymph node measures 6 x 10 mm. The skull base is intact. The submandibular glands are relatively hyperenhancing, which may be attributable to treatment effects. The parotid glands are unremarkable. There are nonspecific scattered foci of T2 hyperintensity in the imaged cerebral white matter. There is mild scattered paranasal sinus mucosal thickening. There is a small amount of fluid within the right mastoid air cells.

Output: No measurable residual treated right nasopharyngeal carcinoma and no significant upper cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Other symptoms and signs involving cognitive functions and awareness [R41.89], Reason for Study: ^Reason: cognitive decline over past few years History: memory decline with visuospatial difficulties There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal scattered FLAIR/T2 high signal intensity lesions on periventricular white matter and centrum semiovale indicate nonspecific small vessel ischemic disease.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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is a bucket-handle tear of the posterior horn of the medial meniscus with the flipped fragment situated in the intercondylar notch. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a small (3 mm) full-thickness articular cartilage defect involving the lateral femoral condyle with slight underlying bone marrow signal abnormality. The remainder of the articular cartilage is intact. There is also mild bone marrow edema involving the mid aspect of the lateral tibial plateau.LIGAMENTS: The anterior cruciate ligament is not visualized, compatible with a complete tear. The PCL is intact. The collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Complete tear of the ACL.2.Bucket-handle tear of the medial meniscus as described above.3.Small focal full-thickness articular cartilage defect of the lateral femoral condyle.


Instruction: Generate impression based on findings.

Input: 34 year old with history of neuroblastoma of the retroperitoneum who presents for cardiac workup prior to planned stem cell transplant. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 56 ml/m2 (normal range: 65+/-11), the LVEDV is 104 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 41 ml (normal range 31+/-10). There are no regional wall motion abnormalities present. There is a small area of mid-wall late gadolinium enhancement in the basal lateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is is normal in size and systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 62 ml/m2 (normal range 69+/-14), the RVEDV is 116 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 56 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. There is a catheter within the right atrium. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drains normally into the right atrium. There is a catheter in the SVC. PericardiumThere is a small pericardial effusionExtracardiac 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. Normal left ventricular systolic function (LVEF 61%)2. Normal right ventricular systolic function (RVEF 52%)3. There is a small area of mid-wall late gadolinium enhancement in the basal lateral wall which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. There is a catheter in the superior vena cava and right atrium.


Instruction: Generate impression based on findings.

Input: Clinical question: Baseline scan prior to starting system the chemotherapeutic treatment. Compared with prior exam and 3 -- 23 -- 15 Pre-and post-enhanced brain MRI: Negative diffusion weighted images.Examination demonstrates significant interval increased size off an enhancing mass involving the splenium of corpus callosum (right greater than left). The largest central and rightward component of the mass measures at 25 x 44-mm compared to prior study measurement of 15 x 32.Component of the tumor immediately to the left of the midline in the splenium of corpus callosum also demonstrate significant change in size. On current exam it measures approximately at 17 x 17.5-mm compared to prior study measurements of 13 x 7.5 mm.Previously noted extension of tumor into the left occipital lobe also demonstrate interval increased size and extent. The tumor extends into the trigone of left lateral ventricle and extends along the ependymal lining of the trigone and the occipital horn of the left lateral ventricle.Multiple previously noted small satellite lesions in the left splenium of corpus callosum also demonstrate interval increased size and with central necrosis as was noted on prior study. Mildly dilated supratentorial ventricular system and ventricular catheters demonstrate no change.There is a developmental venous anomaly in the right frontal lobe similar to prior exam.Diffuse flair hyperintensity of bilateral hemispheric white matter representing peritumoral edema as well as posttreatment changes with interval progression.

Output: 1.Interval progression of an enhancing mass involving the splenium of the corpus callosum ( R > L), left occipital lobe, left trigone and occipital horn of left lateral ventricle as detailed/measured above.2.Stable ventricular size and right frontal approach ventricular catheter.3.Extensive flair hyperintensity of bilateral hemispheric white matter (right greater than left) consistent with peritumoral edema and posttreatment changes also demonstrate progression since prior study.


Instruction: Generate impression based on findings.

Input: 37 year old woman with history of Lupus who presents with suspected cardiac shunt and is referred for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 65 ml/m2 (normal range: 65+/-11), the LVEDV is 105 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 41 ml (normal range 31+/-10), the LV mass index is 53 g/m2 (normal range 67+/-11), and the LV mass is 86 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. No ventricular septal defect is present.Left AtriumThe left atrium is normal in size. The interatrial septum is somewhat aneurysmal. A small patent foramen ovale can not be excluded. No atrial septal defect is seen. The Qp/Qs was within normal range.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 126 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 63 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.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function[LVEF 61%]2. The right ventricle is normal in size with normal systolic function [RVEF 50%]3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. No evidence of a cardiac shunt.5. A small patent foramen ovale can not be excluded. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: R second toe ulcer, r/o osteomyelitis History: R second toe ulcer There is soft tissue irregularity along the distal aspect of the second toe indicating ulceration which extends to the level of the remnant of the middle phalanx of the second toe. There is apparent cortical indistinctness/osteolysis about the distal aspect of the remnant of the middle phalanx of the second toe indicating osteomyelitis. This could be further evaluated with MRI if clinically warranted. There are extensive arterial calcifications in the overlying soft tissues. Osteoarthritis affects the midfoot articulations. The bones appear demineralized. Periosteal reaction along the lateral aspect of the fourth metatarsal is nonspecific but may represent stress reaction.

Output: Findings indicating osteomyelitis of the remnant of the middle phalanx of the second toe. This could be further evaluated with MRI examination if clinically warranted.


Instruction: Generate impression based on findings.

Input: Pulsatile tinnitus with worsening symptoms and abnormal CT. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a nonspecific punctate focus of high T2 signal in the right superior frontal gyrus white matter. 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: 1. No evidence of retrocochlear or inner ear lesions.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 48 year-old female with difficulty speaking and right-sided weakness; evaluate for ICH There is a focus of low attenuation in the left internal capsule/basal ganglia which may indicate early ischemia. Please obtain an MRI for further evaluation as this is a subtle finding. There is no evidence of acute intracranial hemorrhage, mass or edema.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Low-attenuation focus in the left internal capsule/basal ganglia which may indicate early ischemia. Recommend MRI for further evaluation. No evidence of acute intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Epilepsy. Hallucinations and altered mental status. History of left temporal lobe laser ablation for epilepsy. There are post treatment changes related to left hippocampal ablation with associated rim of restricted diffusion. There is also peripheral susceptibility and patchy intrinsic T1 hyperintensity along the ablation cavity, compatible with expected postoperative blood products. There is prominent associated T2/FLAIR hyperintensity. Evidence of trepanation within the left temporal and bilateral occipital bones is again noted, with conspicuous enhancement and T2/FLAIR hyperintensity along the peripheral bilateral occipital and left temporal sites of prior depth electrodes. Faint enhancement is seen along the electrode tracts.There is slight asymmetry of the lateral ventricles left greater than right side, unchanged. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: Expected postoperative findings post left hippocampal ablation, with enhancement and FLAIR parenchymal changes surrounding the ablation site. Additional enhancement and T2/FLAIR hyperintensity along the bilateral occipital and left temporal depth electrode insertion sites.


Instruction: Generate impression based on findings.

Input: 28-year-old woman with lower back pain and irregularity of the sacroiliac joints seen on outside hospital radiographs 5 years ago. Both sacroiliac joints are normal in appearance without specific findings to suggest sacroiliitis. We see no abnormal enhancement of the joints following gadolinium administration.Both hip joints appear normal. There is mild enhancement of the left ischium at the hamstring origin, suggesting mild enthesopathy, but this is of questionable current clinical significance. The visualized musculature otherwise appears normal. A T-shaped intra-uterine contraceptive device is noted. There is a small amount of free fluid in the pelvis, likely physiologic.

Output: 1.Normal appearing sacroiliac joints.2.Mild enthesopathic changes at the left hamstring origin are of questionable current clinical significance.


Instruction: Generate impression based on findings.

Input: 50 years Female (DOB:9/30/1965)Reason: headaches in pt with h/o paraganglioma s/p craniotomy History: headachesPROVIDER/ATTENDING NAME: ANDREA LOUISE AMICO ANDREA LOUISE AMICO The patient status post right frontal craniotomy.There is a small punctate focus of signal hyperintensity in the right pons which is been present on the prior exam to some degree.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 opacification of the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for brain metastases.2.The patient is status post right frontal craniotomy.3.A punctate lesion in the right pons appears to been present on the prior exam. In isolation is probably of little clinical significance. One possibility is that it is vascular related.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for brain inflammation. Signs and symptoms: History of usual snow. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.The anatomical morphology and signal intensity of brain parenchymal remains within normal on all MRI sequences. The cerebral cortex, cortical sulci, ventricular system, CSF spaces in myelination the brain is unremarkable.There is no evidence of cerebral edema as is questioned clinically.Post enhanced images also fail to demonstrate any abnormal parenchymal or leptomeningeal enhancement.Calvarium and soft tissues of the scalp are unremarkable and without abnormal enhancement.Images through the orbits and including axial fat sat post enhanced series are unremarkable.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: Negative pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 19-year-old female with left foot pain for 5 weeks. Markers were placed along the dorsum of the foot.There is a intra-articular fracture through the plantar corner of the base of the second metatarsal with mild displacement. There is edema in the fracture fragment and the adjacent bone. There is also edema within the base of the fourth metatarsal with a thin linear band of low signal intensity representing a nonarticular transverse fracture of the metatarsal. There is further edema within the third metatarsal, but we see no discrete fracture line. There is minimal edema within the tuberosity of the fifth metatarsal, but we see no fracture. The middle and lateral cuneiform bones also show edema, but no evidence of fracture line.Although the Lisfranc ligament is not optimally visualized, a band of low signal intensity extends from the medial cuneiform to the base of the second metatarsal just distal to the fracture line. This is favored to represent the main portion of the Lisfranc ligament, which appears intact.The visualized tendons appear intact. The study was not protocoled for detailed evaluation of the ankle ligaments, but they also appear intact.

Output: 1. Fractures of the bases of the second and fourth metatarsals.2. There is also edema within the third metatarsal, middle cuneiform, lateral cuneiform, and tuberosity of the fifth metatarsal bones, but we see no discrete fracture lines in these bones.Findings were relayed to Dr. Sandoval at the time of dictation.


Instruction: Generate impression based on findings.

Input: 50 year old man with a history of ischemic cardiomyopathy status post heart transplant 4/30/15, referred for evaluation of pericardial disease and rejection. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 79 ml/m2 (normal range: 74+/-15), the LVEDV is 165 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 75 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 116 g (normal range 164+/-36). There is mild abnormal septal wall motion consistent with prior sternotomy. There are no other regional wall motion abnormalities present. The myocardial native T1 time is 1167ms (previously 1231ms on 12/2/15). This is elevated which can suggest the presence of an intra-myocardial process. However, it has decreased since prior MRI. The myocardial to skeletal T2 ratio is mildly elevated (2.2), previously it was less than 2. The cardiac output is 7.59L/min and the cardiac index is 3.62L/min/m2.Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 68 ml/m2 (normal range 82+/-16), the RVEDV is 143 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 60 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.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 trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a combined right innominate and left common carotid or "pseudo-bovine" branching pattern, which is a normal variant. 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.PericardiumThe pericardium is thickened (6 mm maximal). The pericardium is bright on T2-weighted imaging suggesting that it is edematous/ inflamed. There is no obvious pericardial to myocardial tethering noted on the current study. On real-time cine imaging, there is no evidence of interventricular dependence. There is a small loculated pericardial effusion adjacent to the right atrium. There is a significant amount of pericardial fat present.Extracardiac FindingsThere are sternotomy wires present. There is gynecomastia. A catheter is noted in the SVC. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%. The native myocardial T1 time is elevated suggesting that there may be an intramyocardial process present. However the value has decreased since prior MRI on 12/2/15, indicating improvement in the underlying process. The cardiac output has also increased compared to the prior study. 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%. The RVEF has increased compared to the prior study. 3. The pericardium is thickened with evidence of edema/ inflammation. However, based on real-time cine imaging, there does not appear to be interventricular dependence. These finding suggest that there is ongoing pericarditis but the abnormality does not appear to be causing constrictive physiology.4. There is a small loculated pericardial effusion adjacent to the right atrium. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Transient ischemic attack (left-sided weakness). History of sarcoidosis. 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. There is T2 hyperintensity in the mastoid air cells, left more than right. There is moderate mucosal thickening in the maxillary sinuses. The orbits, skull and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial involvement by sarcoidosis. 2. No evidence of intracranial hemorrhage, mass, or acute infarct. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of BRCA mutation. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal morphology, size, signal intensity and enhancement without a focal lesion. No intra or extra hepatic ductal dilatation. Normally distended gallbladder. The vessels are patent.SPLEEN: The spleen is normal in size without a focal lesion.PANCREAS: The pancreas is normal in morphology. Normal pancreatic ductal anatomy and caliber. Normal intrinsic T1-weighted signal intensity of the pancreas. Normal enhancement without a focal suspicious lesion.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: Bilateral breast implants.

Output: Stable examination without evidence of a pancreatic neoplasm.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, dizzy with gait instability. No restricted diffusion is seen. No significant parenchymal signal abnormality, edema or mass effect is detected. No evidence of any intracranial hemorrhage or abnormal extra-axial fluid is seen. Ventricles are normal in size and morphology. Bone marrow signal characteristics are within normal limits. No abnormalities of the paranasal sinuses are suspected.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 54-year-old male with lower back pain. Evaluate for lumbar degenerative changes. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is a mild disc bulge and mild facet hypertrophy causing mild bilateral neuroforaminal stenosis but no significant spinal canal compromise.L4-5: There is a mild disc bulge and mild facet hypertrophy causing mild bilateral neuroforaminal stenosis but no significant spinal canal compromise.L5-S1: There is a mild disc bulge and mild facet hypertrophy causing mild bilateral neuroforaminal stenosis but no significant spinal canal compromise.

Output: Mild stable degenerative changes without significant spinal canal compromise. Mild bilateral neural foraminal stenosis involving the L3-4 through L5-S1 levels levels which is unchanged.


Instruction: Generate impression based on findings.

Input: Worsening headaches, possible absence seizures, evaluate for change in size of cavernoma. There is a 11 x 11 mm lobulated T2 hyperintense lesion with rim of susceptibility involving the inferior left cerebellar hemisphere abutting the inferior cerebellar vermis. Lesion is consistent with a cavernous malformation and unchanged since 1/8/2015 allowing for differences in technique/slice thickness. There is a prominent developmental venous anomaly in the adjacent left cerebellar hemisphere. There is minimal T1 hyperintensity corresponding to mineralization better seen on prior CT. No findings to suggest recent hemorrhage.Remainder of the brain demonstrates no additional cavernous malformations, or other mass or mass effect. There is mild hypoplasia involving the inferior cerebellar vermis. Brain parenchyma is otherwise unremarkable for age. Bilateral hippocampi are unremarkable. No findings to suggest cortical dysplasia or heterotopic gray matter. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. MRA images demonstrate no significant stenosis involving the intracranial internal carotid arteries. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. Right posterior cerebral artery is predominantly fetal in origin which is a normal variant. No evidence of aneurysms or arteriovenous malformation.Sella and orbits are grossly within normal limits. There is mild mucosal thickening throughout the paranasal sinuses. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Compared to 1/8/2015, unchanged left inferior cerebellar cavernous malformation and adjacent developmental venous anomaly. No findings to suggest recent hemorrhage.2. No other lesions, masses or evidence of mass effect.3. Mild diffuse paranasal sinus opacification which is new since prior.


Instruction: Generate impression based on findings.

Input: 62-year-old man with history of Hodgkin's lymphoma, now with right sciatica. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild straightening of the lumbar spine similar to the prior exam. The L4/5 and L5/S1 intervertebral discs appear desiccated with low T2 signal and loss of height, worsened from the prior exam. Decreased T1 signal and slightly increased T2 signal in the endplates surrounding the L5/S1 disc appears similar to study from 7/2008, likely edematous endplate changes. Additionally, there is increased T1 and T2 signal in the anterior portion of T12, also stable and probably fatty endplate changes. There is no new, focal marrow signal abnormality. The conus medullaris is normal in position at mid-L2.Multilevel degenerative changes are seen, progressed from the prior examination as described below:L1-L2: There is a disc bulge, slightly eccentric to the left, new since prior. There is no spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge without significant spinal canal or neural foraminal stenosis.L4-L5: There is a disc bulge with a new right paramedian disc protrusion. Additionally, there is facet arthropathy with ligamentum flavum thickening. This results in mild spinal canal stenosis and significant narrowing of the right lateral recess with impingement of the L5 nerve root. There is minimal bilateral neural foraminal stenosis.L5-S1: There is a disc bulge. Additionally, there is facet arthropathy with ligamentum flavum thickening. There is no spinal canal stenosis. There is mild to moderate right and moderate left neural foraminal stenosis.There are multiple left renal cysts. The paraspinal soft tissues are otherwise within normal limits.

Output: 1.Progressive multilevel degenerative disease in the lumbar spine, worst at L4-5 at which there is a new disc protrusion with effacement of the right lateral recess and suspected impingement on the right L5 nerve root.2.There is also mild to moderate right and moderate left L5-S1 neural foraminal stenosis. Additional details as above.3.Within the limits of noncontrast examination, no findings to suggest active lymphomatous lesions.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Incidental note is made of a partially empty sella. 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. Fluid is present within bilateral mastoid air cells. The paranasal sinuses are clear. Incidental note is made of a small postinflammatory cyst in the midline nasopharynx (aka Tornwaldt cyst). There is no abnormal enhancement within the brain.

Output: Fluid is present within bilateral mastoid air cells which may be causing the patient's severe headaches. Otherwise negativeMRI of the brain including gadolinium enhancement.


Instruction: Generate impression based on findings.

Input: 31-year-old female with known left triple negative breast cancer and metastatic left axillary lymph node. She presents for I-SPY 2 research MRI #3. There is extreme amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally.LEFT BREAST:The index malignancy is significantly reduced in size. A small enhancing mass, measuring 9 x 5 x 9 mm, and several enhancing foci are remaining at the location of the index lesion, which measured 26 x 20 x 43 mm on the prior study.Multiple additional enhancing masses were seen antero-inferiorly from this index malignancy on the prior study. Now, all those masses are smaller and have become foci. The largest focus measures 5 mm, and it is located 18 mm medially from Hydromark clip. The total span of enhancement (index lesion + additional satellite lesions) in the AP oblique dimension measures approximately 51 mm, previously measuring 83 mm. In the left axilla, the biopsy proven lymph node with biopsy marker clip now measures 9 mm, previously measuring 16 mm. RIGHT BREAST:Stable enhancing benign-appearing masses in the right breast. There is no new abnormal enhancement seen in the right breast. No abnormal lymph nodes are identified in right axilla.

Output: 1. Significant reduction in size of the index cancer and additional masses in the left breast.2. No MRI evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Headaches. There is no evidence of intracranial hemorrhage or infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a probable pineal cyst that measures 9 mm in diameter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive mucosal thickening throughout the paranasal sinuses.

Output: 1. No evidence of acute intracranial hemorrhage or ventriculomegaly.2. Pansinusitis.3. A probable pineal cyst measures 9 mm in diameter.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with left-sided lumbar spine mass. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or enhancing marrow lesions are seen.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic spinal cord or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.Apart from some redundancy of the skin in the lower lumbar region, no masslike lesion is identified within the superficial or deep soft tissues. However, inflammation of the left L4-5 facet joint is seen, likely degenerative/osteoarthritic in nature.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet arthropathy. Minimal disc bulging with a small left foraminal annular fissure. No significant spinal canal stenosis. No significant foraminal narrowing. L4-5: Moderate facet arthropathy with edema and enhancement on the left indicating inflammation. Mild disc bulging with bilateral foraminal annular fissuring. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Moderate facet arthropathy. Mild bulging disc with a small central disc protrusion. No significant spinal canal stenosis. No significant foraminal narrowing.

Output: No masslike lesion is evident within the posterior soft tissues of the lumbar region. However, the left L4-5 facet joint appears degenerated and inflamed which may be contributing to the patient's symptomatology. Otherwise, relatively mild degenerative/osteoarthritic findings are seen with no evidence of any high-grade spinal canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Strong family history of breast cancer and BRCA mutation carrier presents for screening. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 61-year-old man with history of chronic wound to the left lateral ankle. TENDONS: The Achilles tendon, tendons of the posterior compartment, tendons of the anterior compartment, and peroneal tendons are intact.LIGAMENTS: The lateral and deltoid ligaments are intact.ARTICULAR SURFACES AND BONE: There is enhancement, loss of cortical signal, and abnormal marrow signal in the lateral talus (axial series, image 22). This abnormal enhancement extends to the level of the posterior subtalar joint.Patient is status post resection of the fifth metatarsal. ADDITIONAL

Output: Osteomyelitis of the lateral talus.


Instruction: Generate impression based on findings.

Input: 43 year old male with DM and right ankle pain with elevated CRP. Rule out osteomyelitis. The great toe appears to been amputated, although this region is not included on the study. There is a large plantar soft tissue defect beneath the remaining first metatarsal extending proximally to beneath the anterior margin of the calcaneus and distally off of the field-of-view of this study. There appears to be blister formation along the adjacent skin of the plantar surface of the foot and there is replacement of the adjacent subcutaneous fat that presumably represents a combination of edema and scarring. There is also edema of the plantar musculature of the foot, indicating inflammation, with small foci of signal void that presumably represent foci of inter/intramuscular gas. The flexor hallucis longus tendon extends to the ulcer, beyond which it cannot be followed. We see no signal abnormality within the bones of the ankle, midfoot, or hindfoot to suggest osteomyelitis. Osteoarthritis affects the midfoot and to a lesser degree the tibiotalar and subtalar joints. There is a subcentimeter focus of low signal intensity within the talus containing a central focus of increased signal intensity, which may represent a benign bone island. There is a small amount of fluid within the posterior recess of the subtalar joint with a linear focus of low signal intensity that may represent a cartilaginous fragment. There are small amounts of fluid also noted within the sheaths of the medial and lateral ankle tendons which may represent mild tenosynovial inflammation, but this is not necessarily of any current clinical significance. There is fatty atrophy of the visualized ankle musculature. There is subcutaneous soft tissue swelling about the ankle.

Output: Extensive plantar soft tissue ulceration and inflammation as described above, but no specific imaging features of osteomyelitis.