Instruction: Generate impression based on findings.

Input: 52Yrs old male with hx of multiple MI; LV dysfunction, admitted for NSTEMI/Chronic Systolic Heart Failure. Referred for cardiac MRI for assessment of viability and ascending aorta aneurysm. Left VentricleThe left ventricle is severely dilated with severely depressed systolic function. The overall LV ejection fraction is 19%. The LVEDV is 348 ml (normal range 142+/-34), the LV end diastolic volume index is 155 ml/m2 (normal range: 74+/-15), the LVESV is 281 ml (normal range 47+/-19) and the LV end systolic volume index is 125 ml/m2 (normal range 25+/-9). The LV mass is 131 g (normal range 164+/-36) and the LV mass index is 58 g/m2 (normal range 85+/-15). The left ventricular function is globally depressed with thinning and severe hypokinesia of the basal to apical inferior and inferoseptal walls. There is non-transmural (50 - 75% thickness) subendocardial late gadolinium enhancement along the basal to apical inferior and inferoseptal walls in the vascular territory of the right coronary artery, indicative of myocardial infarction with intermediate viability. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 20%. The RVEDV is 200 ml (normal range 142+/-31), RV end diastolic volume index is 89 ml/m2 (normal range 82+/-16), the RVESV is 161 ml (normal range 54+/-17), and the RV end systolic volume index is 71 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is moderate central aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial to mild tricuspid regurgitation.AortaThere is a left sided aortic arch with normal branching pattern of the supraaortic branches. The aortic root and sinotubular junction are normal in caliber. There is a fusiform aneurysm of the ascending aorta that measures approximately 49 mm. Tortuous ectatic aortic arch. The descending thoracic aorta is normal in caliber. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are signs of residual interstitial pulmonary edema, improved from prior studies. Bilateral lower lobe subsegmental atelectasis. Abnormal focal hyperintense area in the superior segment of the right lower lobe likely represents small amount of alveolar edema. Small left pleural effusion. 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. Globally depressed left ventricular systolic function (LVEF 19%). Regional wall motion abnormality of the basal to apical inferior and inferoseptal walls.2. Non transmural (50 - 75%) sub endocardial late gadolinium enhancement of the basal to apical inferior and inferoseptal walls consistent with myocardial infarction in the right coronary artery territory; the involved myocardium has intermediate viability. 3. Fusiform aneurysm of the tubular ascending aorta, sparing the sinotubular junction and stable from prior study (49 mm). No signs of acute complication. 4. Moderate central aortic regurgitation. Mild mitral and tricuspid regurgitation. 5. Residual interstitial pulmonary edema and small left pleural effusion.


Instruction: Generate impression based on findings.

Input: Ms. Spearson is a 48 year old female with a family history of breast cancer in her mother, diagnosed at the age of 49. Personal history of left breast excisional biopsy in 2009 for benign papilloma. There is extreme amount of fibroglandular tissue in both breasts. Marked nodular parenchymal enhancement is noted bilaterally, appearing similar to multiple prior examinations.Multiple small cysts are present bilaterally. Multiple bilateral enhancing masses/foci are again identified, appearing similar in appearance when compared to prior examinations. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 29-year-old female patient with pain and soft tissue swelling at the lateral malleolus. Question of bony ligament pathology in the left ankle. TENDONS: There is a small amount of fluid noted within the sheath of the medial tendons, otherwise, the underlying tendons are intact. The Achilles and peroneal tendons are intact.LIGAMENTS: The anterior talofibular and calcaneofibular ligaments appear slightly thickened which may represent a mild sprain, but we see no frank disruption of fibers. The posterior talofibular ligament is intact. The distal tibiofibular syndesmotic complex is intact. The visualized components of the deltoid ligament are intact.ARTICULAR SURFACES AND BONE: There is signal intensity abnormality within the distal fibular diaphysis compatible with a grade 3 stress reaction, which corresponds to the cortical irregularity seen on a recent radiographs. We see no discrete fracture line at this time. Mild edema is noted in the surrounding soft tissues. We see no osteochondral defects.ADDITIONAL

Output: Grade 3 stress reaction ("stress fracture") without discrete fracture line at this time.Findings communicated to A. Hong via telephone at 1004 hrs on 7/10/2015.


Instruction: Generate impression based on findings.

Input: 83 years Female (DOB:10/3/1932)Reason: weakness in BLE, dizziness - w post circ? New stroke? PROVIDER/ATTENDING NAME: DANIEL P. SULMASY DANIEL P. SULMASY MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Patchy T2 and FLAIR hyperintense lesions are present within the brainstem. Multiple T2 hyperintense punctate foci are present within the basal ganglia and thalami which are not associated with substantial FLAIR abnormality.There are several punctate foci of signal loss and susceptibility imaging within the thalami bilaterally.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is mild narrowing of the distal right internal carotid artery at the distal cavernous segment and proximal ophthalmic segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The right vertebral artery is larger than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the right vertebral artery. The left vertebral artery is small and the proximal portion left vertebral artery is not completely identified.

Output: 1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease. Please note the proximal left vertebral artery is not adequately imaged.3.Periventricular and subcortical white matter lesions of a moderate degree and patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 4.Microhemorrhages predominantly in the thalami are suspected to be related to hypertension. Please correlate with clinical history


Instruction: Generate impression based on findings.

Input: 24-year-old female with Crohn's ileocolitis, evaluate for primary sclerosing cholangitis, history of superior mesenteric vein thrombosis ABDOMEN:LIVER, BILIARY TRACT: There is mild irregularity of the intrahepatic bile ducts (segment 5/8) and proximal common bile duct. No abnormal enhancement is present. No dominant stricture or mass is present.Numerous vascular collateral at the porta hepatis compatible with superior mesenteric vein thrombosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter 4 mm nonenhancing renal cyst in the right kidney. No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is thickening of the descending colon which may be exaggerated due to under distention.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Imaging findings compatible with primary sclerosing cholangitis without dominant stricture or mass evident.2.Descending colonic wall thickening compatible with provided history of Crohn's disease.3.Porta hepatis collaterals reflect provided history of superior mesenteric vein thrombosis.


Instruction: Generate impression based on findings.

Input: Ms. Bosby is a 33-year-old female with biopsy-proven left breast cancer presenting for research MRI(I-SPY #3) There is extreme amount of fibroglandular tissue in both breasts. Moderate parenchymal enhancement is noted bilaterally.LEFT BREAST: There has been an interval decrease in size of the known left breast cancer, now measuring 5.7 x 6.1 x 9.8 cm (AP x LR x CC, previously measuring 5.7 x 8.6 x 11.7 cm). In addition, there is an associated decrease in overall enhancement of the tumor, particularly centrally, indicating tumor necrosis. Diffuse edema and skin thickening remains similar to prior examination. A Hydromark clip is identified in the anterior 12:00 position within the known malignancy in the left breast.A known metastatic left axillary lymph node with Hydromark clip now measures 1.4 cm in maximum dimension, previously measuring 1.7 cm.RIGHT BREAST: There is no abnormal enhancement seen in the right breast. Multiple small cysts are present in the right breast. No abnormal axillary lymph nodes are identified in the right axillary region.

Output: Interval decrease in size and enhancement of known left breast cancer and metastatic left axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Diagnosis: Dizziness and giddinessClinical question: please do Dr. Javed pMS protocol on 3 T MRISigns and Symptoms: dizziness, fatigue MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical white matter lesions present which are hyperintense on T2 and FLAIR MRI.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disk dessication present.There is a 12x12mm T2 and T1 hyperintense enhancing lesion within the right anterolateral portion of the C6 vertebral body.There is a 12x12mm T2 and T1 hyperintense enhancing lesion within the right posterolateral portion of the T2 vertebral body.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal. There are small uncovertebral osteophytes present bilaterally associated with disk material and narrowing of the neural foramina bilaterally.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge at this level. There are small left sided uncovertebral osteophytes at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is a left lateral recess disk protrusion at this level associated with small uncovertebral osteophytes.The vertebral artery flow voids appear to be intact.

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.2.No intrinsic cervical spinal cord lesions are detected.3. There are mild degenerative changes in the cervical spine as detailed above worse at C4-5 where there is mild to moderate encroachment of exiting nerve roots bilaterally.


Instruction: Generate impression based on findings.

Input: Reason: eval for labral tear History: shoulder pain and instability with throwing for over a year ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The teres minor tendon is poorly visualized, but the normal muscular attachment is seen inserting on the greater tuberosity. This may represent a normal variant. The subscapularis muscle and tendon appear intact. There is a small cyst within the underlying humeral head.SUPRASPINATUS OUTLET: The distal end of the clavicle is slightly high riding with respect to the acromion process, but we suspect this is a normal variation. There is no fluid or gadolinium within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Note is made of a relatively capacious glenohumeral joint. The glenoid labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears intact.

Output: Somewhat capacious glenohumeral joint, but no labral tear is evident.


Instruction: Generate impression based on findings.

Input: Rule out bleed or acute change. Signs and symptoms: Encephalopathy. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal range for patient's stated age of 69. Large vessel intracranial vascular calcification. Calvarium, paranasal sinuses and mastoid air cells are unremarkable. If clinical concern persist an MRI is recommended.

Output: Negative CT of brain without infusion.


Instruction: Generate impression based on findings.

Input: Cognitive impairment. Evaluate for progressive dementia. The ventricles and sulci are prominent, consistent with global parenchymal volume loss, which is progressed from 1/17/2013 and greater than expected for age. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with minimal chronic small vessel ischemic changes, which is progressed from 1/17/2013. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Moderate global parenchymal volume loss, which is progressed from 1/17/2013 and greater than expected for age. 2. No acute intracranial hemorrhage or mass effect. Minimal chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Female 18 years old with right hip pain. Evaluate for active sacroiliitis. The sacroiliac joints are normal in appearance. There is no ankylosis and no erosions are seen. Bone marrow signal intensity is within normal limits and there is no enhancement on postcontrast images. A small, approximately 8 mm, T2 hyperintense lesion is partially visualized in the right ilium. This may represent a small cyst or possibly an enchondroma and is likely of no clinical significance.A cystic left adnexal lesion measures up to 5.6 x 4.4 cm but is not fully visualized and therefore incompletely characterized.

Output: 1.No evidence of sacroiliitis.2.Incompletely characterized left adnexal cystic lesion.


Instruction: Generate impression based on findings.

Input: History of recurrent hyperparathyroidism. In the mid to superior pole of the right thyroid lobe, there is an enhancing nodule measuring 1.0 x 0.9 cm, correlating with enhancing abnormality seen on the prior MRI study. The lesion also correlates with abnormal uptake in the prior nuclear parathyroid study, and therefore suggests it most likely represents a parathyroid adenoma. More inferiorly and medially in the right thyroid lobe, there are two additional hypodense lesions with the larger one measuring 0.9 x 0 .7 cm, which has nonspecific imaging appearance, but may represent colloid cysts. There are tiny nodular densities in the visceral space around the thyroid glands, and in the superior mediastinum, which may represent small lymph nodes.There is mild atelectasis in the lungs. There is mild degenerative disease of the cervical spine, with minimal anterolisthesis at C4 over C5 and disc space narrowing at C5 - C6 level.

Output: 1. Enhancing nodule in right thyroid lobe, correlating with previous studies, suggesting it likely represents a parathyroid adenoma. 2. No other suspicious nodules in the neck.


Instruction: Generate impression based on findings.

Input: Hemangioma of intracranial structures [D18.02], Reason for Study: ^Reason: 3T scanner, QSM/permeability, CCM Protocol, had pons hemorrhage in 1982, 2008 began having eye/facial nerve problems, HA, 2016 trouble swallowing, cavernous angioma diagnosed. There is about 15.0mm(RL) x 10.8mm(AP) x 6.7mm(CC) T2 low signal intensity, T1 mainly low signal intensity with susceptibility artifacts on the lower pons indicating likely diagnostic possibility of cavernous malformation. There are evidence of craniotomy on the right temporo occipital bone indicating postoperative status.On Gad enhanced images, There is focal enhancing tubular structure especially on the right anterior aspect of the lesion. The lesion is likely represent associated Developmental venous anomaly, however, other vascular malformations such as associated occult AVM cannot be completely excluded.There is no other abnormal enhancement seen on this scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. The right maxillary sinus shows subtle T2 high signal intensity and non enhancing low/iso T1 images at the bottom of the sinus cavity which most likely represent partial volume averaging artifact. Other paranasal sinus appear to be normal.

Output: 1. Cavernous malformation at the lower pons as described above.2. Tubular enhancing lesion on the right anterior aspect of the lesion indicate associated DVA but the possibility of associated occult AVM cannot be completely excluded.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Medial knee pain MENISCI: There is vertically oriented increased signal intensity within the posterior horn of the medial meniscus at its root likely representing a focal tear with mild associated edema in the underlying tibial plateau. There is also blunting and thinning of the free edge of the posterior horn of the medial meniscus likely representing mild chronic attritional tearing. There is an additional small defect within the anterior horn of the medial meniscus at its root; this could represent a small tear or a peculiar anatomic variant. The body of the medial meniscus appears normal.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the articular cartilage of the patella most pronounced centrally where there is near full-thickness to full-thickness articular cartilage loss along with small underlying subchondral cysts. The articular cartilage of the femoral trochlea also appears thinned with a subchondral degenerative lesion noted beneath the medial facet of the trochlea inferiorly and heterogeneity of the overlying articular cartilage which indicates more focal degeneration. There is mild heterogeneity of the articular cartilage of the lateral tibial plateau likely representing relatively mild degeneration. There are small tricompartmental osteophytes.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: There is focal intermediate signal intensity within the distal quadriceps tendon laterally which may reflect focal tendinosis but is of questionable clinical significance, and there is no focal fluid-filled tear. There is mild subcutaneous edema anterior to the patella tendon which is nonspecific.ADDITIONAL

Output: 1. Vertically oriented increased signal intensity within the posterior horn of the medial meniscus at its root suggesting a focal tear.2. Articular cartilage loss further detailed above.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: There is exaggerated lordosis of the lumbar spine. There is a minimal anterolisthesis of L5 on S1. Otherwise, the alignment of the lumbar spine is within normal limits. The vertebral body heights are preserved. There is no evidence of acute fracture. Bilateral L5 pars defects are present without associated edema, and are chronic. There are no other areas of edema-type signal to suggest a stress reaction. No evidence of spinal canal stenosis or neural foraminal narrowing at any level. The conus is normal in signal and morphology and terminates at L1. The visualized intra-abdominal and paraspinal contents are unremarkable.

Output: 1. Chronic bilateral L5 pars defects with minimal anterolisthesis of L5 on S1.2. No evidence of acute fracture, spinal canal stenosis, or neural foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out herniated disc. Signs and symptoms: Back pain with radiculopathy. Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column.The signal intensity of the vertebral column is unremarkable.The lower most visualized thoracic spine and thoracic cord is unremarkable other than minimal degenerative disease.T12-L1 and L2-L3 levels are unremarkableL2-L3 demonstrate mild disc desiccation and mild facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise. No significant change since prior.L3-L4 demonstrate mild disc disease and loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophy changes including minimal facet effusion without significant change since prior exam. There is however interval resolution of previously noted small disc protrusion on the right since prior study. There is no central spinal stenosis however moderate right neural foraminal compromise secondary to degenerative disease is detected. The left neural foraminal remains patent.L4-L5 demonstrate mild to moderate disc disease and loss of disc height, moderate bilateral (L>R) facet degenerative and hypertrophic changes with interval progression since prior exam. No convincing evidence of central spinal stenosis, however mild compromise of the transverse diameter of the spinal canal secondary to ligamentous hypertrophic changes is noted. Additionally at this level note is made of an extruded disc fragment migrating superiorly posterior to the body of L4 vertebrae on the left (sagittal T2, T2 STIR images 13 and 14 and axial T2 series 6 images 25 through 27). The finding results in mass effect and posterior displacement of the thecal sac on the left and significant left lateral recess compromise. There is also significant left neural foraminal compromise secondary to degenerative disease. Mild to moderate right neural foraminal compromise as a result of degenerative disease is also noted.L5-S1 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. No central spinal stenosis or neural foraminal compromise. There is a small immediate right paramedian annular fissure which is best appreciated on axial T2 series 6 image 34 and sagittal T2 STIR image 9.

Output: 1.At L4-L5 examination demonstrate an extruded disc fragment on the left migrating superiorly behind the vertebral body of L4 which in combination with degenerative changes results in significant left neural foraminal and left lateral recess compromise without convincing evidence of central spinal stenosis.2.At L3-L4 level there is interval resolution of a previously noted right sided disc protrusion. Degenerative changes however results in significant right neural foraminal compromise.3.Degenerative changes at other levels with mild progression since prior study however without spinal stenosis or neural foraminal compromise.4.Lower most visualized thoracic spine and thoracic cord is unremarkable with the exception of mild degenerative disease. Please review above detailed report per level.5.


Instruction: Generate impression based on findings.

Input: Other malaise and fatigue [780.79], Reason for Study: ^Reason: possible CVA History: weakness The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Bilateral PCAs are Pcom origin. Acom artery is patent.3D MRA neck post-gadolinium images show no evidence of vascular signal intensity on bilateral carotid arterial system and most of aortic arch vessels except the left vertebral artery. This is a poor quality exam due to the injection of contrast and acquisition time are not well coordinated. Thus, images are non-diagnostic. The neck MRA scan should be repeated without additional charge.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Normal brain MRA3. Non diagnostic neck MRA


Instruction: Generate impression based on findings.

Input: 57 year-old female with ataxia and cerebellar mass. Evaluate for evolution of cerebellar mass. Again noted is a posterior fossa space-occupying hypodense lesion measuring 3.5 x 2.6 cm and appears minimally decreased in size since the previous examination (Image 10; series 4). This previously measured 3.8 x 2.7 cm. There is an adjacent focus of hyperdensity in the right cerebellum measuring 1.9 x 0.8 cm which appears unchanged compared to previous study (Image 7; series 4). This previously measured 1.7 x 0.8 cm. Differential considerations include hematoma versus mass lesion with petechial hemorrhage. Contrast enhanced MRI could be considered for further evaluation of this finding. Again noted is effacement of the fourth ventricle associated with moderate supratentorial ventriculomegaly and transependymal edema which appears unchanged when compared to the previous study. These findings are likely related to obstructive noncommunicating hydrocephalus. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses are normally pneumatized. There is opacification of the left mastoid air cells and thickening of the left external auditory canal which appears unchanged compared to previous study. Incidental noted is made of bilateral lens prosthesis. There is calcification within the left globe.

Output: There is no significant interval change since the previous examination. 3.5 cm space-occupying mass lesion within the left cerebellum with an associated hyperdensity which could represent blood product or mass lesion with mineralization. There is associated effacement of the fourth ventricle and moderate noncommunicating hydrocephalus unchanged since the previous examination. MRI examination for further characterization is recommended.


Instruction: Generate impression based on findings.

Input: Headache No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal enhancement.There are patch high signal intensities on periventricular white matter and scattered white matter high signal intensities indicate minimal nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Minimal nonspecific small vessel ischemic disease.Otherwise unremarkable MRI.


Instruction: Generate impression based on findings.

Input: The seen in the right lobe on ultrasound suspicious for HCC. Elevated alkaline phosphatase. Cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is nodular in contour, compatible with cirrhosis. Within segment 6, there is a T2 hyperintense, enhancing peripheral lesion with washout and restricted diffusion measuring 3.4 x 3.4 cm (series 16, image 89), compatible with hepatocellular carcinoma. There is no capsular retraction or biliary ductal dilatation. The portal vein is patent. Cholelithiasis, without evidence of cholecystitis.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: Upper abdominal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Segment 6 enhancing lesion with washout in a cirrhotic liver, compatible with hepatocellular carcinoma.2.Cholelithiasis, without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: 68-year-old female with a history of lesions in T3, T6, T7 and T12 suspicious for myeloma. Bone marrow biopsy shows less than 10% plasma cells. Evaluation of the left hip and surrounding bone and soft tissue is limited by metallic susceptibility artifact related to the patient's left total hip arthroplasty device. There is mild generalized heterogeneity of the bone marrow of the pelvis which is nonspecific and may simply represent residual red marrow elements. There is a subcentimeter round lesion within the proximal right ischium which has intermediate signal intensity on T1 weighted images and high signal intensity on T2-weighted images and shows enhancement on postcontrast sequences which may represent a small myelomatous deposit. There is a focus of low signal intensity of about 1 cm within the posterior aspect of the right ilium that shows no enhancement and may represent a bone island. There is a 2 cm focus of high signal intensity on fat-saturated T2-weighted images within the L4 vertebral body that appears to enhance following contrast, however, it is intermediate to high signal intensity on T1-weighted images and may represent a hemangioma rather than a myelomatous deposit. There is also a tiny 4 mm round hyperintense lesion within the L5 vertebral body seen on image 16 of series 701 which may represent a myelomatous deposit. Moderate to severe degenerative disc disease affects the lower lumbar spine. There is a small juxtavaginal cyst to the left of midline which may represent a Bartholin's gland cyst. There is atrophy of the gluteus medius and minimus muscles, particularly on the left.

Output: Small subcentimeter round lesions within the right ischium and L5 vertebral body are nonspecific but may represent myelomatous deposits. A larger lesion within the L4 vertebral body is not optimally imaged on this study, but may represent a hemangioma. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with intermittent, stereotactic left upper extremity shaking movements sometimes with spread to the right upper extremity, and headache on the left side. No evidence of any structural abnormality or focal signal parenchymal signal alteration is seen. Diffusion-weighted images are within normal limits. There is no evidence of edema or mass effect. No findings to suggest acute or chronic intracranial hemorrhage are noted. There are no abnormal extra axial fluid collections. The ventricular system is normal in size and morphology. A partially empty sella is demonstrated. No pathologic parenchymal enhancement is seen. However, there is a 10 x 8 x 5 mm extra-axial dural-based enhancing lesion along the left petrous bone within the posterior fossa. This lesion perhaps minimally indents the adjacent parenchyma.

Output: 1.No definite findings are seen to account for the patient's symptoms.2.A small extra-axial mass is demonstrated along the petrous bone within the left posterior fossa which most likely represents a meningioma. Due to the small size of the lesion and the posterior fossa location, it is favored to be an incidental finding.3.A partially empty sella is seen which is nonspecific and can be a normal finding in patients of this age group. Partially empty sella can be associated with conditions of elevated intracranial pressure including idiopathic intracranial hypertension, though there are no other findings on this examination to support that diagnosis.


Instruction: Generate impression based on findings.

Input: Worsening headaches. Atypical connective tissue disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered nonspecific foci of T2 hyperintensity in the cerebral white matter. 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 acute intracranial hemorrhage, mass, or acute infarct.2. Few scattered nonspecific foci of T2 hyperintensity in the cerebral white matter, which may be related to atypical connective tissue disease, although other etiologies are not excluded. Follow up via MRI with contrast may be useful, if clinically warranted.


Instruction: Generate impression based on findings.

Input: History of nausea, vomiting, abdominal pain and concern for obstruction. Crohn's disease involving the terminal ileum, cecum and ascending colon seen on colonoscopy dated 9/25/2015. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and enhancement without a focal lesion. It measures 20 cm in craniocaudal dimension. No intrahepatic or extrahepatic biliary ductal dilatation.Large gallstone within a normally distended gallbladder without evidence of acute inflammation.SPLEEN: The spleen is normal in size signal intensity and without a focal lesion.PANCREAS: The pancreas is normal in morphology, signal intensity and enhancement without a focal lesion or main pancreatic ductal dilatation. Normal variant ductal anatomy. Splenule near pancreatic tail. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach and small bowel is adequately distended with oral contrast.The small bowel fold pattern is maintained.The terminal ileum is well seen and demonstrates a long segment of T2 weighted wall hyperintensity, thickening, restricted diffusion and enhancement with moderate luminal narrowing extending for approximately 6 cm. This is followed by a 2 cm skip segment followed by a long segment of active inflammation involving approximately 7 cm of the ileum with moderate luminal narrowing resulting in severe poststenotic/upstream dilatation up to 4.1 cm involving approximately 22 cm of small bowel. Proximal to this dilated segment is another 6 cm segment of active inflammation with moderate luminal narrowing and mild proximal dilatation. Several additional skip lesions and skip segments extends proximally and involve much of the mid and proximal ileum with associated moderate pre-stenotic dilatation of the jejunum.Note is made of irregular conical contour of the cecum, compatible with chronic inflammation. The colon otherwise demonstrates no specific evidence of active inflammation or a flow-limiting stricture.There is a small amount of interloop fluid and peri-enteric inflammatory changes including fibrofatty proliferation and engorged mesenteric vasculature. No loculated fluid collection to suggest an abscess.No definite fistula is evident.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pleural effusions. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Extensive active inflammation involving long segments of the ileum with intervening skip segments superimposed on persistent moderate luminal narrowing with associated pre-stenotic/upstream dilatation suggestive of underlying fibrostenotic strictures.2. Interloop fluid without a loculated fluid collection to suggest an abscess or definite sinus tract/fistula formation.3. Chronic inflammatory changes of the cecum. No definite active inflammation of the colon otherwise.4. Trace effusions. Gallstone.


Instruction: Generate impression based on findings.

Input: 3-year-old female with history of intermediate-risk neuroblastoma, off therapy evaluation. Please visualize area of consolidation noted on MRI performed 10/20/10. LUNGS AND PLEURA: Nodular pleural thickening posteromedially in the left apex measures 8 x 6 mm (image 14/59, series #4). This is in the previous location of the large left paraspinal mass. Previously seen consolidation in the right lung base on prior MRI is no longer evident. There are no pulmonary consolidations, nodules, or pleural effusions.MEDIASTINUM AND HILA: Soft tissue density mass in the anterior mediastinum with concave margins and conforming to the contour of the aorta is not significantly changed and consistent with normal thymus. No lymphadenopathy. Normal heart size. No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: 1. Consolidation in the right lung base on prior MRI has resolved.2. Residual nodular left pleural thickening in the region of the previously described paraspinal mass.


Instruction: Generate impression based on findings.

Input: 48 year old female with a history of congenital pulmonary stenosis s/p PVR with pulmonic insufficiency and known pulmonary artery aneurysm. She is now referred for cardiac assessment and follow-up of pulmonary artery dimensions. Height: 170cmWt 113kgLeft VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 81 ml/m2 (normal range: 65+/-11), the LVEDV is 188 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 70 ml (normal range 31+/-10), the LV mass index is 59 g/m2 (normal range 67+/-11), and the LV mass is 137g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 106 ml/m2 (normal range 69+/-14), the RVEDV is 245 ml (normal range 110+/-24), the RV end systolic volume index is 60 ml/m2 (normal range 22+/-8), and the RVESV is 138 ml (normal range 35+/-13). Right AtriumThe right atrium is again dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and visually there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is moderate pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. Visually there is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no thoracic aortic aneurysm. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated. Measurements using 3D volumetric data demonstrate the following:Proximal main PA: 32mm x 34mmDistal main PA: 49 x 51 mmLeft PA (proximal): 47 x 38 mmLeft PA (distal): 30 x 31 mmRight PA: 36 x 35 mmThese values are stable when compared to previously obtained measurements. Proximal main PA: 33x33mm Distal main PA: 45mmx43mm (remeasured using the same technique as above as 55 x 49 mm)Left PA (proximal): 35x44mm (remeasured using the same technique as above as 47 x 38 mm)Left PA (distal): 36x36mm (remeasured using the same technique as above as 31 x 30 mm).Right PA: 34x33mm (remeasured using the same technique as above as 34 x 37 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size and systolic function (LVEF 63%).2. Moderately dilated right ventricular size and low normal systolic function (RVEF 44%), slightly worse compared to last study.3. Moderate pulmonary valve regurgitation (visual estimate).4. Dilated right atrium, as before.5. Severe pulmonary arterial dilation, not substantially different compared to previous study. Quantitative differences in measurement are likely related to differences in technique.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: Cord compression; lesion; tumor. Signs and symptoms: Bilateral lower extremity weakness, decreased anal sphincter. Pre- and post enhanced total spine MRI:Cervical MRI demonstrate extensive patchy foci of T2 hyperintensity throughout the cervical cord consistent with patient's known demyelinating disease. None of the lesions demonstrate enhancement. There is no convincing evidence of any definite interval change since prior exam in the extent of disease.Mild to moderate degenerative changes of cervical spine without evidence of spinal stenosis is again noted. There is no evidence of abnormal enhancement of the vertebral column.Thoracic MRI demonstrate multiple foci of T2 hyperintensity in the lower thoracic cord and conus consistent with patient's history of demyelinating disease. There is a demyelinating plaque at T11 level with resultant decreased cord caliber which also demonstrates subtle enhancement on post infused series (sagittal post enhancement series 4401 image 10). There are no prior MRI of thoracic spine for comparison. Mild degenerative changes of the thoracic spine is noted with normal anatomical alignment and without intravenous of central spinal stenosis or abnormal enhancement.Lumbosacral spine study demonstrate lesion within the conus of the cord without convincing evidence of enhancement. The signal intensity and overall morphology of cauda equina is within normal and without abnormal enhancement. Mild to moderate degenerative changes of lumbar spine without evidence of central spinal compromise or stenosis is noted. Incidental note is made of a mild chronic compression deformity of the superior endplate of L3. No compromise of neural foraminal is detected. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination redemonstrates extensive primarily periventricular and corpus callosal findings of chronic demyelinating disease without abnormal enhancement. Similar signal changes in the left cerebral peduncle and pons are also noted and without abnormal enhancement. Precise comparison with prior exam is difficult due to significant technique difference between the 2 studies. Current exam is performed utilizing routine brain MRI with 5 mm slices compared to prior dedicated multiple sclerosis study with 2 mm slices. Within this limitation is no significant interval change to possible mild progression of demyelinating disease since prior exam.New since prior exam from 3-3-2015 however is extensive right hemispheric foci of hemorrhagic encephalomalacia. There is a resolving hematoma in the right inferior frontal lobe with extensive surrounding FLAIR and T2 hyperintensity and widening of the adjacent cortical sulci suggestive of atrophic changes. Large focus of FLAIR/T2 hyperintensity with chronic hemorrhagic changes is also noted in the right anterior, mid and posterior temporal lobe involving the cortex and subcortical white matter. There is resultant ex vacuo dilatation on the temporal horn and trigone of right lateral ventricle. There are regions of heavy cortical hemosiderin position in the right frontal and temporal lobes. The appearance of findings are more suggestive of posttraumatic changes and chronic hemorrhagic ischemic stroke is considered less likely however it cannot be excluded. There is no evidence of enhancement with the above described findings. If there are more recent exams (brain MRI or head CT) since March 2015 and are provided to the radiology department an addendum to this report will be submitted after comparison.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Calvarium demonstrate normal signal intensity and without abnormal enhancement.

Output: 1.Pre and post enhanced MRI of spine demonstrate diffuse chronic nonenhancing lesions of the cervical spine without change since prior study. Findings of demyelinating disease in the lower thoracic cord and conus with evidence of enhancement of a lower thoracic cord lesion which also demonstrate decreased cord caliber as detailed. There are no prior MRI of thoracic spine for comparison. There is no evidence of a spinal canal compromise or stenosis at any level. There is no detectable abnormal enhancement of the vertebral column.2.Pre and post enhanced brain MRI demonstrate extensive chronic nonenhancing findings of demyelinating disease which compared to prior study from March 2015 demonstrate no significant change to possible mild progression. New since prior exam however are extensive regions of hemorrhagic encephalomalacia extensively involving the right inferior frontal, right anterior, mid and posterior temporal lobes as detailed. Findings results in significant interval ex vacuo dilatation of the temporal horn and trigone of right lateral ventricle. Please review detailed repot above. If there are more recent exams (brain MRI or head CT) since March 2015 and are provided to the radiology department an addendum to this report will be submitted after comparison.


Instruction: Generate impression based on findings.

Input: 62 years Female (DOB:3/9/1953)Reason: lumbar radiculopathy spondylolisthesis History: buttock and leg painPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a levocurvature to the lumbar spine associated with right lateral translation of L1 on L2. This was not conspicuous on the prior exam. There is multilevel disc desiccation present. There is a left-sided Tarlov cyst in the sacral spinal canal. This appears to have also been present on the priorAt L5-S1 there is no significant compromise to spinal canal. There is a left lateral disc protrusion present at this level which extends into the left neural foramen and effaces the fat surrounding the left-sided exiting nerve root. This is new since the prior exam. Since the prior exam associated endplate reactive changes developed along the left half of the disc space.At L4-5 there is mild anterior subluxation of L4 and L5 associated with diffuse disc bulge. The subluxation is new since the prior exam. There is associated bilateral facet hypertrophy. There is also associated narrowing of the neural foramina bilaterally at this level with some mild encroachment of the right-sided exiting nerve roots.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge at this level. There are some facet hypertrophic changes present at this level which were also present on the prior exam.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level which extends into the neural foramina bilaterally. The exiting nerve roots are surrounded by fat within the neural foramina. There are new facet hypertrophic changes present at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina. There is mild right lateral translation of L1 and L2 associated with a broad-based disc protrusion extending along the left anterior lateral aspect of the disc space.

Output: 1.Since the prior exam patient has developed more degenerative changes. There is now a levocurvature to the lumbar spine centered at L1-L2 and mild anterior subluxation of L4 on L5 is not present in 2006. There is more disc disease and facet disease on the current exam relative to the prior exam.2.There are degenerative changes present in the lumbar spine with new mild to moderate encroachment of left-sided exiting nerve roots at L5-S1 within the left neural foramen and mild encroachment of the right-sided exiting nerve roots within the right neural foramen at L4-5.


Instruction: Generate impression based on findings.

Input: The thoracic spine is in normal alignment. 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 significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. Disc herniation at the right L5-S1 level is again noted on the sagittal counting sequence and more completely imaged on recent lumbar spine MRI from 9/24/2016.

Output: 1. Unremarkable thoracic spine MRI.2. Disc herniation at the right L5-S1 level is again noted and more completely imaged on recent lumbar spine MRI from 9/24/2016.


Instruction: Generate impression based on findings.

Input: Interval enlargement of polypoid right nasal cavity mass is seen which appears to infiltrate the right inferior nasal turbinate. The mass is difficult to demarcate from the residual normal right inferior turbinate and measures approximately 6.1 cm in the AP dimension, previously approximately 5.4 cm. There is interval increase in extension into the right maxillary sinus with the mass measuring approximately 2.8 cm in the transverse dimension, previously remeasured as 2.2 cm. In the craniocaudal dimension, mass measures approximately 3.3 cm, previously 2.6 cm.There appears to be associated obstruction of the inferior portion of the right nasolacrimal duct with distention of the upper right nasolacrimal duct and sac.In the left orbit, there is an ovoid intraconal mass which involves the left lateral rectus muscle, measuring 1.4 x 2.7 cm in the axial plane and 1.7 cm in the craniocaudal dimension. The left lateral rectus muscle is suspected to be inferiorly displaced although muscle infiltration is not excluded. In retrospect a small lesion in this region can be appreciated on prior MRI where it measures 6 x 12 x 9 mm, measured in a similar plane. There is medial deviation of the left optic nerve without signal abnormality in the optic nerve. Nonspecific subcentimeter cervical lymph nodes are present and can be better imaged with dedicated neck CT or MRI.Partially imaged brain demonstrates no intracranial mass or mass effect or abnormal enhancement to suggest metastasis.

Output: 1. Interval enlargement of right nasal cavity mass which appears to infiltrate the right inferior turbinate and erodes into the right maxillary sinus measuring approximately 6.1 x 2.8 x 3.3 cm, previously 5.4 x 2.2 x 2.6 cm. Findings consistent with tumor progression. 2. Left intraorbital mass is also larger measuring 1.4 x 2.7 x 1.7 cm, previously 0.6 x 1.2 x 0.9 cm, and highly suspicious for enlarging metastasis.


Instruction: Generate impression based on findings.

Input: Male, 2 years old, with recent abnormal movements, status post tethered cord release three months ago, evaluate for tethered cord, syrinx. Also with left eye droop. Brain:The right parietal approach ventricular shunt catheter remains in stable position. Also unchanged is the right-sided subdural catheter. The lateral ventricles remain dilated but the caliber is decreased by several millimeters when compared to the prior MRI. The third ventricle remains mildly dilated and the fourth ventricle is small, similar to prior.Multiple developmental anomalies of the cerebrum and cerebellum are redemonstrated. Briefly, these include absence of the septum pellucidum, dysmorphic contour of the ventricles, a thinned and stretched corpus callosum, and white matter volume loss. T2 hyperintense rimming of the ventricular system appears mildly more conspicuous.Anomalies of the posterior fossa are also redemonstrated including nonvisualization of the cerebral aqueduct and rhomboencephalosynapsis. The posterior fossa is crowded which causes the cerebellum to herniate superiorly through the tentorial incisure, and the left cerebellar tonsil to herniate down through the foramen magnum. The fourth ventricle is partially effaced. Findings have not significantly changed.No evidence for restricted diffusion or parenchymal edema is seen. Scattered foci of parenchymal susceptibility are unchanged. No evidence of acute intracranial hemorrhage is seen.Orbits:The left optic nerve appears to be slightly smaller than the right. However, no abnormal signal abnormality is seen within the nerve or nerve sheath. The globes are slightly flattened bilaterally at the optic nerve heads but otherwise unremarkable. The extraocular muscles are within normal limits. No intraorbital mass or fluid collection is seen.Spine:Postoperative findings are demonstrated centered at L4 compatible with tethered cord release. The cut ends of the fatty filum terminale are visualized on sagittal T1 imaging with a 3 cm gap in between. The superior end appears to have retracted to the L3 level while the inferior end is at L5. However, it should be noted that axial T1-weighted images were inadvertently not acquired through the lumbar region which prevents more detailed assessment. On prone imaging, there is mild anterior shifting of the conus and some of the cauda equina nerve roots relative to supine imaging.Minimal prominence of the central canal of the spinal cord is seen in the lower thoracic region, similar to prior. Otherwise, the spinal cord demonstrates normal signal characteristics. No significant compromise of the spinal canal or neural foramina is detected. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. No epidural lesions are detected.

Output: 1.The shunted lateral ventricles have decreased in caliber. Mild T2 hyperintense rimming of the ventricles appears slightly more conspicuous, but this is a finding of uncertain clinical significance.2.Extensive dysmorphism of the brain and cerebellum is again seen. This includes absence of the septum pellucidum, nonvisualization of the cerebral aqueduct, rhomboencephalosynapsis, and a small posterior fossa which causes superior and inferior cerebellar herniation. All findings are similar to prior.3.No definite orbital lesions are seen. The left optic nerve may be slightly smaller than the right, but this could also be a technical artifact. Slight flattening of the globes at the optic nerve heads is of uncertain significance, but this finding can occasionally be seen in the context of increased intracranial pressure.4.Findings are demonstrated compatible with tethered cord release. The cut ends of the fatty filum terminale are visualized with a gap of several centimeters in between. Furthermore, there does appear to be at least a small amount of conus and cauda equina mobility when prone and supine images are compared.


Instruction: Generate impression based on findings.

Input: T2N0 right oral tongue squamous cell carcinoma treated with CRT completed in 6/2009 with right partial glossectomy for salvage in 10/2009 now with recurrent right oral tongue tumor. There are post-treatment findings in the oral cavity. There is a somewhat ill-defined enhancing lesion in the right oral tongue along the margins of the glossectomy site that measures up to 18 mm. There is no evidence of significant lymphadenopathy in the neck. The salivary glands are unremarkable. The thyroid gland also appears unremarkable. There are upper thoracic spinal rods that produce susceptibility effect in the region. There is a right maxillary sinus retention cyst. The major cervical flow voids appear to be intact. The imaged intracranial structures, orbits, and facial soft tissues appear unremarkable.

Output: Post-treatment findings in the oral cavity with evidence of recurrent tumor in the right oral tongue along the margins of the glossectomy site that measures up to 18 mm.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, with esophageal ulcer and possible exposed bone. Evaluate for osteomyelitis of the vertebral bodies. An ET tube is in place with fluid surrounding the tube within the pharynx. At the level of the C4 and C5 vertebral bodies, this fluid appears to extend posteriorly through a potential defect or ulceration in the hypopharyngeal wall to the level of the anterior vertebral bodies. No definite rim-enhancing or diffusion restricting collection is seen to suggest the presence of an abscess. The mucosa is edematous and enhancing compatible with inflammation. The marrow signal of the adjacent C4 and C5 vertebral bodies demonstrates T1 hypointensity but with little definite T2 signal abnormality and no clear correlating diffusion restriction or pathologic enhancement. No pathologic adenopathy is seen. No compromise of the spinal canal is detected. A scarlike opacity in the right lung apex has been better assessed on dedicated chest imaging.

Output: Findings are seen compatible with ulceration of the posterior hypopharyngeal wall at the C4 and C5 levels, potentially extending to the level of the vertebral bodies. The surrounding mucosa is inflamed but there is no evidence to suggest an adjacent soft tissue abscess. The C4 and C5 vertebral bodies show relatively mild marrow signal abnormality which could indicate early osteomyelitis or perhaps just reactive edema.


Instruction: Generate impression based on findings.

Input: 18 year-old male with weakness, evaluate for possible rotator cuff tear or impingement following MVC ROTATOR CUFF: The muscles and tendons of the rotator cuff are intact.SUPRASPINATUS OUTLET: The AC joint is within normal limits. There is no fluid in the subacromial-subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. The labrum appears intact within the limits of a non-arthrogram exam, although note is made of hypoplasia of the anterior/superior labrum with a thickened middle glenohumeral - normal variant anatomy.BICEPS TENDON: The long head of the biceps tendon is intact normally situated in the bicipital groove.ADDITIONAL

Output: Unremarkable exam without specific finding to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Diagnosis: Hereditary hemorrhagic telangiectasia Arteriovenous malformation, site unspecifiedClinical question: Please evaluate for cerebral AVMsSigns and Symptoms: HHT screening MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular, brainstem and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.

Output: 1.There is no evidence for intracranial arteriovenous malformation.2.Periventricular, brainstem and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with multiple myeloma, status post calibers stem cell transplant with relapsed disease. Signs and symptoms: Nausea and vomiting, central process suspected. Pre-and post-enhanced CT of brain:There is prominence of the supratentorial ventricular system when more apparent in the lateral ventricles and the third ventricle. There is also a paucity of cortical sulci. There is however no detectable cerebral edema and gray -- white matter differentiation is well-preserved. There are no old studies available for comparison. There is however partial visualization of the supratentorial ventricular system on prior CT of soft tissues of neck from 4 to 27 next 2010 which demonstrate similar sized ventricular system.There is no evidence of intracranial hemorrhage, edema or midline shift.Post infusion images demonstrate enhancement of thickened pituitary stalk that measures 6 mm in transaxial dimension. This finding was present on prior CT of soft tissues of neck from 4 -- 27 -- 2010.Examination also demonstrate thickening and enhancement along the left petroclinoid ligament which appears to be continuous with the enhancement of the cavernous sinus. There is no definitive associated bony changes however the dorsum sella on the left side and including the left posterior clinoid appear thinner than the right which may indicate erosive bony changes. The constellation of above findings could represent a metastatic disease or an infectious/granulomatous process. It is highly recommended that this finding to be followed with an enhanced MRI of pituitary and brain which would visualizes all the above regions of abnormal finding.Bony density of calvarial demonstrate multiple well demarcated small lytic lesions within the diploic space. Considering patient's history of multiple myeloma this finding may represent multiple myeloma. MRI examination with further clarified this finding.Above findings were discussed with the referring clinical service Garcia Ima pager number 5251 at the time of interpretation.80 cc of Omnipaque 350 was administered for this study.

Output: 1.Abnormal enhancement of the left cavernous sinus with extension posteriorly along the petroclinoid ligament and left CP angle. Thickened pituitary stalk with enhancement and with possible some thinning of dorsum sella as described above. Follow-up exam with an MRI is recommended. The constellation of above findings can be secondary to a metastatic disease, infectious or a granulomatous process.2.No definitive evidence of parenchymal abnormality of brain.3.Prominent lateral ventricles with only minimal dietitian of temporal horns. This finding may be a normal variation which was also partially visualized on prior CT of soft tissues of neck from 4 -- 27 -- 2010. This finding is not associated with any periventricular edema and I believe this is a normal anatomical variation for patient's age. Follow-up MRI would further assess this finding.4.Multiple well demarcated lytic lesions of calvarial with the largest measuring only 6 mm times 5-mm in the right frontal bone. Findings may also represent multiple myeloma.5.Above findings were discussed with referring clinical service Garcia Ima pager number 5251.


Instruction: Generate impression based on findings.

Input: 25-year-old female patient perirectal pain and drainage. Evaluate for perirectal abscess. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: There are scattered mildly enlarged perirectal lymph nodes. BOWEL, MESENTERY: Redemonstration of a fistula originating at the 11 o'clock position of the distal rectum (to the right), coursing anteroinferiorly, and terminating in the skin of the right labia. No evidence of associated abscess. A fistula originating at the 6 o'clock position of the distal rectum without definite fluid collection also appears similar to the prior study. There is bowel wall thickening, increased T2 signal, restricted diffusion, and enhancement of the rectum compatible with active disease. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a new small amount of presacral fluid. No perirectal abscess is identified.

Output: 1.Rectal bowel wall thickening with signal abnormality and enhancement compatible with active disease. 2.New small amount of presacral fluid, but no definite perirectal abscess.3.Similar appearance of fistulae to prior exam.


Instruction: Generate impression based on findings.

Input: 28 year-old female with fibromatosis status post chemotherapy and preparing for surgery/XRT. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: 1.2-cm hypodense lesion in segment two of the liver may represent hemangioma, unchanged from MRI 1/7/09SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The left kidney continues to demonstrate abnormal infiltrative low density throughout, greatest in the upper pole, with some areas of fat density. Dilatation of the left renal collecting system and ureter extends to the proximal third of the ureter, where ill-defined soft tissue obstructs the ureter, unchanged.Upper pole calculus in the left.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mass in the presacral space as slightly increased in size, measuring 5.8 x 5.0 cm (series 2; image 116), previously 5.4 x 4.7 cm. Another lesion extends into the left perirectal region and ischiorectal fossa, involving the left lateral pelvic side wall and invading the ipsilateral obturator internus muscle. It measures approximately 7.6 x 5.0 cm (series 3; image 124), previously 7.0 x 4.7 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Continued mild increase in size of the known fibrous masses.Unchanged appearance of the left kidney, compatible with xanthogranulomatous pyelonephritis


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for CNS inflammation. Signs and symptoms: Patchy right arm/leg numbness and right leg weakness. Pre and post enhanced cervical MRI:There is normal anatomical alignment of the vertebral column and within normal signal intensity on all MRI sequences. There is no abnormal enhancement of the vertebral column.There is no significant degenerative disease of cervical spine and without evidence of central spinal stenosis or neural foraminal compromise at any level.The signal intensity and caliber of the cervical and upper most visualized thoracic cord is also within normal and without detectable abnormal enhancement.

Output: Unremarkable pre and post enhanced cervical MRI.


Instruction: Generate impression based on findings.

Input: 68-year-old male with prostate cancer. PELVIS:PROSTATE:Prostate Size: 3.2 x 4.3 x 4.3 cm.Peripheral Zone: Mild patchy low T2 signal in the peripheral zone bilaterally, suggestive of inflammation. No definite focal lesion suspicious for prostate cancer.Central Gland: Heterogeneous with hyperplastic nodules. Small prostatic utricle cyst noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No focal lesion suspicious for prostate cancer.


Instruction: Generate impression based on findings.

Input: Worsening dizziness. There is significant interval change in the enhancing mass that extends from the left cerebellopontine angle to the porus acusticus and is associated with the left vestibular nerve. The mass measures up to 19 mm. There is intact fluid signal within the inner ear structures.

Output: No significant interval change in the left vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: 82-year-old male with history of gastric cancer with possible liver lesion seen on recent CT. ABDOMEN:LIVER, BILIARY TRACT: No definite focal hepatic lesion corresponding to previously seen CT finding in the left hepatic lobe. No additional suspicious hepatic lesions. No biliary ductal dilation. SPLEEN: No significant abnormality noted.PANCREAS: Stable atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable thinning and cortical scarring of the left kidney upper pole. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Redemonstration of postsurgical changes from gastrectomy with esophagojejunostomy. Small ventral abdominal wall hernia containing nonobstructed bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No definite focal hepatic lesion corresponding to previously seen CT finding in the left hepatic lobe.


Instruction: Generate impression based on findings.

Input: MRI Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are bilateral prominent perivascular spaces in the basal ganglia. Minimal scattered periventricular and subcortical white matter T2 hyperintensity is nonspecific. 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 Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. 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. No evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. There is a retropharyngeal right internal carotid artery. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion. There appears to be a right thyroid nodule that measures up to 6 mm.

Output: 1.No evidence of an acute infarct.2.Minimal scattered likely chronic small vessel ischemic disease.3.No high-grade stenosis involving the intracranial or neck arteries.4.Apparent right thyroid nodule that measures up to 6 mm. A thyroid ultrasound may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 27 years old with abdominal pain and bleeding and newly diagnosed Crohn's disease with perianal disease, evaluate for small bowel involvement. ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion, biliary ductal dilation, or ascites.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: There is an approximately 30 cm segment of abnormal distal ileum. Asymmetric wall thickening, enhancement and diffusion restriction with associated stranding of the mesentry and prominent vaso vasorum are seen throughout this segment although some skip areas are noted. Similar findings are also present within the sigmoid colon. No abscess, stricture or fistula is identified. There is increased to 2 signal at the 6:00 to 7:00 position of the rectum but no definite collection or fistula. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiple follicles are seen in both ovaries.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is an approximately 30 cm segment of abnormal distal ileum. Asymmetric wall thickening, enhancement and diffusion restriction with associated stranding of the mesentry and prominent vaso vasorum are seen throughout this segment although some skip areas are noted. Similar findings are also present within the sigmoid colon. No abscess, stricture or fistula is identified. There is increased to 2 signal at the 6:00 to 7:00 position of the rectum but no definite collection or fistula. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small amount of pelvic free fluid.

Output: 1.Evidence of active inflammation compatible with Crohn's disease involving an approximately 30 cm segment of distal ileum as well as the sigmoid colon.2.Increased T2 signal at the 6:00 to 7:00 position of the rectum but no definite collection or fistula.


Instruction: Generate impression based on findings.

Input: Pain in perineum, testes, penis, and back. 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. There is no evidence of mass lesions in the lumbar spine. The paravertebral soft tissues are unremarkable.

Output: No evidence of spinal canal stenosis or mass lesions.


Instruction: Generate impression based on findings.

Input: Counting from above, there is a normal complement of vertebrae. Using this counting convention, the most recent kyphoplasty was likely performed at the actual T10 level rather than the reported T11 level, which is in agreement with the bone scan counting convention. T12 does appear to have hypoplastic ribs.Since the prior MRI of the thoracic spine, there has been interval mild to moderate compression deformity of T4, seen on prior CT cervical spine. Interval kyphoplasty changes are seen in T6 with similar mild vertebral body height loss. There is mild vertebral body height loss at T10 with post kyphoplasty changes. Other chronic compression deformities scattered in the mid to lower thoracic spine appear similar. There is no evidence of STIR abnormality to suggest recent fracture or progression of compression. There are scattered levels of trace retropulsion of compressed fracture fragments, most conspicuous at the T12 level where there is mild effacement of ventral CSF space, although unchanged.The thoracic spine is in normal alignment, with exaggerated normal thoracic kyphosis. The spinal cord is of normal caliber and signal.Minimal scattered spondylotic changes. There is persistent moderate-severe narrowing of the right T8-T9 foramen, as well as moderate narrowing of the T9-T10 foramina bilaterally.There is partial visualization of a rounded T2 hyperintense structure off the upper pole of the left kidneyLUMBAR SPINE

Output: 1. Please note that counting convention differs from that of the most recent kyphoplasty. Normal complement of vertebrae with hypoplastic 12th ribs. Using this counting convention, the most recent kyphoplasty is at the T10 level consistent with prior bone scan.2. Other than interval compression deformity and subsequent kyphoplasty changes at the T10 level, and now mild chronic compression deformity of the superior endplate of T4 as seen on prior CT cervical spine, no significant interval change in appearance of thoracic and lumbar multilevel compression deformities with superimposed postprocedural changes. Stable superior endplate of T12 retropulsion of fracture fragments without canal compromise.3. Several levels of foraminal narrowing, including moderate-severe right sided stenosis at T8-T9, although unchanged.


Instruction: Generate impression based on findings.

Input: 46-year-old woman with history of radiculopathy. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Along the anterior inferior endplate of L4, there is a small area of degenerative, edematous signal. Bone marrow signal is slightly heterogeneous but benign. There is disc desiccation at L4/L5 and L5/S1. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a disc bulge without spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge with mild disc desiccation and minimal left neural foraminal narrowing, no right neural foraminal narrowing, and no spinal canal stenosis.L4-L5: There is a disc bulge and disc desiccation. There is minimal right neural foraminal narrowing but no left neural foraminal narrowing or spinal canal stenosis.L5-S1: There is a disc bulge with disc desiccation. There is minimal right neural foraminal narrowing but no left neural foraminal narrowing or spinal canal stenosis.The paraspinous soft tissues are within normal limits.

Output: Mild multilevel degenerative disc disease without significant neural foraminal compromise or spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 76-year-old female with glioblastoma. Three weeks into RT. Decreasing mental status and increasing somnolence. Recent fall. Evaluate for bleed, shift or edema Minimal edema and hemorrhage at the site of patient's known left temporal lobe tumor and postoperative site is noted. Extensive periventricular and subcortical areas of low attenuation is believed to represent advanced small vessel disease of indeterminate age. A very small area of increased density measuring approximately 3 mm in left parietal is concerning for small amount of hemorrhage. No subarachnoid hemorrhage or midline shift or hydrocephalus.Postoperative changes of calvarium are noted in calvarium is otherwise unremarkable.Limited view of paranasal sinuses and mastoid air cells are also unremarkable.

Output: 1.Diffuse a small vessel disease of indeterminate age.2.Small area of hemorrhage edema and postoperative change in the left temporal lobe which were present on prior MRI.3.Very small area of suspected hemorrhage in the parenchyma in the left parietal which is a new finding.


Instruction: Generate impression based on findings.

Input: 47-year-old woman with history of menorrhagia and fibroids. PELVIS:UTERUS, ADNEXA: Multiple large, intramural fibroids are noted. The largest of these is a 83 x 77 mm intramural fibroid in the left lower uterine segment (10/17) which enhances moderately. Additionally, there is a 69 x 60 mm right fundal submucosal fibroid (14/3) which avidly enhances. Multiple additional, smaller fibroids are seen throughout the uterus, both submucosal and intramural. The endometrial canal is distorted by these fibroids.Nabothian cysts are noted.BLADDER: No significant abnormality noted.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: Multiple large enhancing intramural and submucosal uterine fibroids.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer, baseline exam prior to clinical trial. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered nonspecific cerebral white matter T2 hyperintense foci. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 40-year-old female with ulnar-sided wrist pain. LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: TFCC is intact for nonarthrographic technique. TENDONS: Mild intrinsic signal within the extensor carpi ulnaris compatible with tendinosis. BONES: Small cysts within the capitellum, scaphoid, and lunate may be degenerative in etiology. Nonspecific edema type signal in the distal pole of the scaphoid. Type II lunate.ADDITIONAL

Output: 1.TFCC is intact for nonarthrographic technique.2.Extensor carpi ulnaris tendinosis. 3.Nonspecific edema type marrow signal in the distal pole of the scaphoid.4.Minimal osteoarthritis affects the wrist.


Instruction: Generate impression based on findings.

Input: 11-year-old male with glioblastoma multiforme status post recent cycle 10 temozolomide as well as radiation therapy completed, which 11/14/2014, now off therapy. There are postoperative findings related to right transfrontal biopsy of the brainstem. There is persistent and unchanged increased T2 signal in the right aspect of the posterior pons and midbrain, as well as in the medial thalamus. There are punctate foci of intrinsic T1 hyperintensity within the brainstem, which are unchanged. However, there is a newly apparent punctate focus of possible enhancement in the left paramedial pons adjacent to an intrinsically T1 hyperintense focus. 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 and paranasal soft tissues are unremarkable.

Output: A newly apparent punctate focus of possible enhancement in the left paramedial pons adjacent to an intrinsically T1 hyperintense focus is nonspecific and too small to arcuately characterize. Nevertheless, close interval follow up may be useful in case this actually represents incipient tumor progression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 56-year-old female with bilateral hip pain and a sclerotic left hip lesion on CT with a history of lung cancer. There is abnormal signal intensity with the head, neck, and intertrochanteric region of the proximal left femur compatible with metastatic disease, as seen on the recent CT examination. Overall the lesion is multilobulated and is approximately 9 cm in the craniocaudal dimension and is largely isointense to skeletal muscle on T1 weighted images with hypointense components corresponding to sclerosis seen on recent CT examination. The lesion is heterogeneous with hyperintense and hypointense foci on T2-weighted images with heterogeneous enhancement on postcontrast sequences. Penetration of the anterior cortex of the femoral head/neck and intertrochanteric region is visible, but better seen on the recent CT examination. There is mild edema and enhancement of the proximal fibers of the vastus lateralis, but we see no discrete soft tissue mass. There are smaller possible discontinuous lesions noted within the lateral aspect of the intertrochanteric region. The remaining musculature of the left hip is normal. There is a small amount of fluid within the hip joint and perhaps mild enhancement on postcontrast sequences suggesting a mild synovitis. There is a 1 cm focus of intermediate signal intensity within the right acetabular dome with minimal enhancement on postcontrast sequences corresponding to a small focus of sclerosis seen on the recent CT examination, which may represent an additional metastatic focus. There is fluid signal intensity along the left proximal hamstring tendon and sacrotuberous ligament which may reflect small tears, but are not necessarily of any current clinical significance. There is fluid signal intensity along the right hamstring tendons at their insertion suggesting chronic insertional tearing which is not necessarily of current clinical significance. Severe degenerative disc disease affects the lower lumbar spine.

Output: 1. Large metastatic lesion involving the head, neck, and intertrochanteric region of the proximal left femur with probable smaller metastatic focus in the right acetabular dome.2. Degenerative disc disease of the lumbar spine and other findings as described above.


Instruction: Generate impression based on findings.

Input: 32-year-old male. Knee pain. MENISCI: Medial and lateral menisci are intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Patellofemoral and tibiofemoral compartment articular cartilage is intact. Edema type signal in the anterior aspect of the medial femoral condyle consistent with a small contusion.LIGAMENTS: ACL, PCL, MCL, and LCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Small bone contusion of the anterior medial femoral condyle. No evidence of a meniscal tear or ligamentous injury.


Instruction: Generate impression based on findings.

Input: 16 year old female with tetralogy of Fallot s/p repair (transannular patch) and RV to PA conduit, pulmonic valve replacement x2 with last one being a homograft, Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 90 ml/m2 (normal range: 65+/-11), the LVEDV is 207 ml (normal range 109+/-23), the LV end systolic volume index is 50 ml/m2 (normal range 18+/-5), the LVESV is 114 ml (normal range 31+/-10). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The RV shape is elongated. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 103 ml/m2 (normal range 69+/-14), the RVEDV is 237 ml (normal range 110+/-24), the RV end systolic volume index is 58 ml/m2 (normal range 22+/-8), and the RVESV is 134 ml (normal range 35+/-13). The right ventricular outflow tract is aneurysmal with evidence of a patch. Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve is trileaflet, opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a bovine-style brachiocephalic branching pattern. The aortic root is normal in size but with clockwise rotation of the root and the coronary origins. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThere is PA conduit. The proximal portion is normal in size (21x18mm). Distally, there is a narrowing (14x17mm) which extends into the left pulmonary artery (13x12mm) with evidence of flow acceleration. The right pulmonary artery is normal in size (21x17mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires noted. 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. Mild left ventricular dilation with mildly reduced systolic function (LVEF 45%) without evidence of fibrosis, inflammation, or infiltration.2. Mild right ventricular dilation with mildly reduced systolic function (RVEF 44%) with evidence of an aneurysmal RVOT and patch repair. 3. The main PA has evidence of valved conduit. The proximal portion is normal in size. Distally, there is a narrowing which extends into the left pulmonary artery (13x12mm) with evidence of flow acceleration. The right pulmonary artery is normal in size.4. Moderate tricuspid regurgitation. 5. There is clockwise rotation of the aortic root.


Instruction: Generate impression based on findings.

Input: 80-year-old female with leg pain and elevated ESR/CRP. Patient motion artifact limits examination. There is no bone marrow signal abnormality, sinus tract, or osteolysis to suggest osteomyelitis. There is diffuse fatty atrophy affecting the musculature of the legs bilaterally. There is nonspecific subcutaneous edema most pronounced along the lateral aspect of the right leg as well as along lateral aspect of the left leg. There is associated skin thickening along the medial aspect of the ankles. No encapsulated focal fluid collection is identified to suggest abscess formation. No pathologic enhancement is identified on postcontrast sequences. There are small bilateral knee joint effusions which are incompletely imaged on this examination. Severe degenerative changes affect both knees, left greater than right, as seen on the large field-of-view images.

Output: Nonspecific subcutaneous edema along the lateral aspect of the legs, bilaterally, without evidence of osteomyelitis. No encapsulated fluid collection is identified to suggest abscess formation. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with cervicalgia and history of C1 instability. Spinal alignment is anatomic. In particular, no subluxation of C1 relative to the occiput or to C2 is demonstrated. Vertebral body height and morphology are within normal limits. No areas of pathologic marrow replacement or edema are demonstrated.The visualized spinal cord is normal signal intensity and morphology. No epidural abnormalities are suspected. The cerebellar tonsils are mildly ectopic but the criteria for a Chiari I malformation are not met.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Minimal disc osteophyte formation. No significant spinal canal or foraminal stenosis. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.No imaging evidence of C1 subluxation is demonstrated.2.No other specific findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Vomiting in a patient with brain metastases from breast cancer. There are postoperative findings related to right medial cerebellar metastasectomy, with persistent diffuse linear enhancement along the resection cavity and surrounding T2 hyperintensity. There is slight interval decrease in size of a right anterior pons enhancing lesion, measuring up to 11 mm, previously 12 mm. There is slight decrease in size of a medial right occipital lobe lesion, which measures up to 4 mm, previously 5 mm. Likewise, the right corona radiata punctate enhancing and left middle frontal gyrus lesions appear to be slightly smaller. There are postoperative findings in the left anterior frontal lobe with persistent T2 hyperintensity, but no evidence of enhancing lesions. There is scattered cerebral white matter T2 hyperintensity, which is nonspecific. There is no evidence of acute infarct. There is a right frontal lobe developmental venous anomaly. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Postoperative findings related to right medial cerebellar metastasectomy, with persistent diffuse linear enhancement along the resection cavity, which may represent granulation tissue. 2. Slight interval decrease in size of several brain metastases. 3. No evidence of recurrent tumor in the left anterior frontal lobe treatment bed.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Evaluate for epidural hematoma in an anticoagulated patient can't get an MRI. Signs and symptoms: Myelopathy. This examination was performed with contrast to evaluate for possible epidural process (abscess, hematoma). This examination is not the appropriate test and it may not visualize any of these abnormalities on this exam. This exam however was performed due to patient's inability to obtain an MRI. Advanced degenerative disk disease at C3 -- C4 and C4 and C5 levels are again identified. There is grade 1 retrolisthesis of C4 in respect to C5. There is reversal of cervical lordosis into kyphotic deformity centered at C3 -- C4 level.Axial and sagittal reformatted images demonstrate no definitive evidence of any abnormal enhancement within the epidural space in the cervical region from C2 through C7. Images below this level are even further obscured due to shoulder artifacts and nondiagnostic for any of the above clinical question concerns.Foramina magnum.Examination at this level is unremarkable.C2 -- C3. No central spinal stenosis or neural foramina compromise.C3 -- C4.Minimal compromise of bilateral neural foramina. Flattening and posterior displacement of the cord secondary to ventral hypertrophic changes. Borderline central spinal stenosis of 7.9-mm is suspected.C4 -- C5. Advanced degenerative disk disease and retrolisthesis. Central spinal stenosis of 6.6-mm is suspected. Compromise of bilateral neural foramina secondary to degenerative changes.C5 -- C6. Minimal degenerative changes. Suspected minimal left neural foramina compromise. No central spinal stenosis.C6 -- C7.No central spinal stenosis or neural foramina compromise.C7 -- T1.Examination at this level is unremarkable.100 cc of Omnipaque was utilized for the above study.

Output: 1.Extensive degenerative changes of cervical spine with multilevel neural foramina compromise and central spinal stenosis as detailed.2.Limited value examination for detection of epidural hematoma or abscess however no definitive finding to suggest either one of the above suspected clinical questions.A