Instruction: Generate impression based on findings.

Input: Neck pain radiating down to left arm. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. Minimal degenerative spondylosis of significant spinal canal stenosis or neural foraminal narrowing. The imaged spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. The visualized intracranial structures are unremarkable. The cerebellar tonsils are normal in position.

Output: No spinal canal stenosis, neural foraminal narrowing, or other findings to the patient's neck and left arm pain.


Instruction: Generate impression based on findings.

Input: Neck pain, neck muscle weakness, left side Examination is slightly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex which partially effaces the ventral thecal sac with minimal narrowing of the spinal canal. There is mild narrowing of the left neural foramen. Minimal right neural foraminal narrowing.C4-5: No significant spinal canal stenosis. Uncovertebral hypertrophy and facet arthropathy resulting in moderate left neural foraminal stenosis. No significant right neural foraminal narrowing.C5-6: Minimal disc osteophyte complex without spinal canal stenosis. Mild bilateral neural foraminal stenosis related to uncovertebral hypertrophy. C6-7: Small disc osteophyte complex without significant spinal canal or neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal. There is mild bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. There is a lobulated mass involving the involving the left parotid gland measuring 17 x 21 x 28 mm in the AP, transverse, and craniocaudal dimensions with T2 hyperintensity.

Output: 1. Multilevel degenerative changes in the cervical spine without significant spinal canal stenosis at any level. There is up to moderate left neural foraminal stenosis at the C4-C5 level related to uncovertebral hypertrophy and prominent left-sided facet arthropathy at this level. Please see additional levels as above.2. Incidentally noted is a lobulated mass involving the left parotid gland measuring 17 x 21 x 28 mm. Finding may represent a benign neoplasm such as pleomorphic adenoma but is incompletely evaluated. Dedicated parotid imaging with contrast or comparison with priors is suggested if available.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are small scattered foci of T2 hyperintensity within the subcortical white matter bilaterally. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Small foci of T2 hyperintensity in the subcortical white matter are nonspecific, but are likely related to chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 69-year-old male with acutely painful edematous left knee and personal history of prostate cancer. Evaluate for pathology. MENISCI: There is globular increased signal abnormality within the posterior horn of the medial meniscus which extends to the tibial articular surface consistent with a complex degenerative tear. There is globular signal abnormality within the posterior horn of the lateral meniscus consistent with mucoid degeneration.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. No pathologic enhancement to suggest metastatic disease. There is articular cartilage degeneration along the medial and lateral facets of the patella. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. ADDITIONAL

Output: 1. Complex degenerative tearing of the medial meniscus as described above.2. Findings suggestive of a partially ruptured large Baker's cyst.3. No findings to suggest metastatic disease.


Instruction: Generate impression based on findings.

Input: Yearly follow up to evaluate change in meningioma size. There is no appreciable interval change in the well-defined homogeneously enhancing dural based mass situated in the left aspect of the sella and cavernous sinus that measures up to 15 mm. There is no significant narrowing of the left internal carotid artery flow void, although the structure is surrounded by the mass. There is also mild mass effect upon the otherwise atrophic pituitary gland and deviation of the infundibulum to the right. There is no mass effect upon the optic apparatus. There is encephalomalacia in the right parietal, occipital, and temporal lobes with areas of cortical laminar necrosis. There is otherwise unchanged mild to moderate cerebral white matter T2 hyperintensity, which likely represents chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There are bilateral lens implants.

Output: 1. No appreciable interval change of the mass situated in the left aspect of the sella and cavernous sinus.2. Chronic right middle cerebral artery territory infarcts.


Instruction: Generate impression based on findings.

Input: Reason: Stroked w/u History: R face and arm weakness MRI brain: There are patchy foci of diffusion restriction along the left basal ganglia with corresponding decrease in ADC signal. There is subcortical and periventricular nonspecific white matter T2 hyperintensities, which may represent chronic small vessel ischemic disease. Chronic appearing infarcts of the right basal ganglia and left cerebellar cortex. There is generalized volume loss with prominence perivascular space, ventricles, and sulci.No acute intracranial hemorrhage is identified. No evidence of intracranial mass or midline shift. No extra-axial fluid collections. Nonspecific mucosal thickening of the ethmoid air cells. Mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable. MRA brain: There is normal flow voids of the circle of Willis vessels. The distal left vertebral artery is small in caliber and appears nonpatent proximal to the V4 segment. No evidence of aneurysm or dissection. MRA neck: Conventional anatomy of the great vessels. Left common carotid shows mild narrowing at the level of the thyroid gland. Otherwise bilateral carotid arteries are patent. Left vertebral artery is occluded at the origin with no opacification until V3/V4 junction where very small artery is evident. Normal opacification of the right vertebral artery. No evidence of aneurysm or dissection.

Output: 1.Acute ischemia of the left basal ganglia.2.Occlusion of the left vertebral artery beginning at the origin and extending to the V3/V4 junction. 3.The intracranial vessels are free of significant stenosis.4.Findings discussed with Dr. Xiao pager 4174 on 2/27/16 at 9:13AM.


Instruction: Generate impression based on findings.

Input: Radiculopathy, cervical region [M54.12], Reason for Study: ^Reason: lumbar radiculopathy History: radiating pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1 level. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: diffuse minimal disc bulging with disc dessication, no neuroforaminal narrowing or spinal stenosis. L5-S1: central focal bulging of disc, no neuroforaminal narrowing or spinal stenosis.

Output: 1. Diffuse bulging of disc at the level of L45 and focal central bulging of disc at the level of L5S1. 2. No evidence of neuroforaminal stenosis.3. No evidence of spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Neck pain. Evaluate for progression of cervical stenosis. Overview: There is reversal of the normal cervical lordosis, but no significant spondylolisthesis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable accounting for minimal degenerative signal subjacent to the inferior C4 and C5 endplates. There is multilevel degenerative spondylosis. At C2-C3, there is a small central disc-osteophyte complex, but no significant spinal canal or foraminal stenosis. At C3-C4, there is a small central disc-osteophyte and mild uncovertebral arthropathy, but no significant spinal canal or foraminal stenosis. At C4-C5, a disc-osteophyte complex slightly indents the spinal cord without signal abnormality. Left greater than right uncovertebral arthropathy results in moderate bilateral right foraminal stenosis. At C5-C6, a disc-osteophyte complex mildly indents the spinal cord without cord signal abnormality. Bilateral uncovertebral arthropathy results in mild-to-moderate left spinal canal stenosis and mild-to-moderate bilateral foraminal stenoses. At C6-C7, a disc-osteophyte complex mildly indents the spinal cord without cord signal abnormality. There is also uncovertebral arthropathy that results in moderate bilateral neural foraminal stenoses. At C7-T1, there is no significant spinal canal stenosis. However, uncovertebral arthropathy result in moderate to severe right and moderate left neural foraminal stenoses. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative cervical spondylosis, which overall appears similar in degree as in July 2014.


Instruction: Generate impression based on findings.

Input: 43 year old male with history of recent viral illness and LV dysfunction, referred for possible myocarditis. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 94 ml/m2 (normal range: 74+/-15), the LVEDV is 215 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 106 ml (normal range 47+/-19). There is hypokinesis of the basal-mid inferior and inferolateral walls. There is no evidence for myocardial edema (T2 STIR myocardial:skeletal ratio<2). There is a mid-myocardial focus of late gadolinium enhancement in the basal inferolateral wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. It is atypical for myocardial infarction.There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 194 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 94 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function (EF = 51%). There is mild inferior / inferolateral hypokinesis.2. There is a midmyocardial focus of late gadolinium enhancement in the basal inferolateral wall which is atypical from previous myocardial infarction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function (EF 52%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Wrist swelling and pain. Per Epic note, soft tissue swelling along medial aspect of distal forearm. LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: There is increased fluid signal surrounding the flexor digitorum superficialis tendons (series 6, image 17) and flexor pollicis longus tendon (series 6, image 23) suggestive of tenosynovitis. No associated definite tendon thickening or tendon tears.BONES: Signal changes compatible with small cysts present in the proximal aspect of the hamate and ulnar aspect of the lunate. Bone marrow signal is otherwise within normal limits without evidence of fracture.ADDITIONAL

Output: 1.Findings suggestive of tenosynovitis of the flexor digitorum superficialis and flexor pollicis longus tendons.2.Mild degenerative changes of the carpal bones. 3.Please note that this examination only includes the distal most 3 cm of the radius; if there is suspicion for more proximal pathology a dedicated forearm examination can be considered.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma and TSH: surveillance. There has been interval evolution of postoperative findings related to transsphenoidal surgery, in which the sellar fat graft is no longer apparent. There is an enhancing sellar mass with suprasellar extension that measures up to 19 mm in height and 24 mm in width. The tumor exerts mild mass effect upon the overlying optic apparatus and also extends into the bilateral cavernous sinuses. The internal carotid artery flow voids are grossly intact, however. The pituitary infundibulum is intact, but deviated to the left. There is scattered paranasal sinus mucosal thickening.

Output: Interval evolution of postoperative findings related to transsphenoidal surgery and a residual pituitary adenoma that measures up to 24 mm with extension into the cavernous sinuses and with mass effect upon the optic apparatus.


Instruction: Generate impression based on findings.

Input: Proximal tibia lesion Again seen is abnormal marrow signal within the proximal diaphysis of the right tibia the extent of which is similar to the prior exam. No discrete fracture line is evident. The abnormal signal appears to be centered near the insertions of the semitendinosis, gracilis, sartorius and tibial collateral ligament.There is diffuse soft tissue edema particularly along the posteromedial and anterior portions of the lower extremity. There is surrounding muscular edema at the level of the abnormal marrow signal as well. The marrow signal of the fibula is normal.

Output: Abnormal marrow signal within the proximal diaphysis of the right tibia, appearing similar to the prior exam. The abnormal signal appears to be centered along the insertions of multiple muscles and the tibial collateral ligament.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with left arm and leg weakness, history of a right hemispheric cystic lesion in 1994 status post removal by neurosurgery. Evidence of right parietal craniotomy is seen. A cystic lesion is present situated within the parenchyma of the posterior right frontal lobe measuring up to 6 cm in maximal diameter. The lesion consists of a large primary cystic component with two or three small adjacent cystic locules medially and superiorly. There is no evidence of edema in the surrounding parenchyma.Posteriorly, the lesion appears to extend into the precentral gyrus with compression of the central sulcus. Inferiorly and medially, the lesion extends to the lateral ventricular margin but is separated from the margin by a thin membrane of soft tissue. The signal characteristics of the lesion follow CSF on all sequences. No associated pathologic enhancement is observed.At most, there may be one small focus of nonspecific subcortical FLAIR hyperintensity within the left frontal lobe. Otherwise, no significant parenchymal signal abnormality is seen. No restricted diffusion is demonstrated. There are no findings to suggest acute intracranial hemorrhage. Ventricular size and morphology are within normal limits apart from mild mass effect on the right lateral ventricle caused by the overlying cyst. No pathologic parenchymal or extra-axial enhancement is observed.

Output: A large cystic lesion is evident occupying the posterior aspect of the right frontal lobe. The lesion extends from the brain surface peripherally to the ventricular margin at its deep surface but it does not appear to communicate directly with the ventricular system. Given the appearance and location of the lesion, the differential would include a neuroglial cyst or arachnoid cyst as the most likely entities. There are no findings to suggest that this lesion is neoplastic or associated with a neoplasm.


Instruction: Generate impression based on findings.

Input: Macroadenoma status post resection and XRT in 2008. There are postoperative findings related to transsphenoidal surgery. There is tumor within the bilateral cavernous sinuses with encasement of the cavernous carotid arteries and tumor along the floor of the sella. There is also enhancing globular enhancing material just inferior to the sella within the sphenoid sinuses. Overall, the tumor spans approximately 4.0 cm in width and 2.5 cm in height. However, there is no significant narrowing of the carotid arteries. Tumor abuts the bilateral optic canals and the bilateral supraclinoid carotid arteries abut the prechiasmatic optic nerves. The infundibulum is intact, but deviated to the right.

Output: Residual tumor within the bilateral cavernous sinuses with encasement of the cavernous carotid arteries and tumor along the floor of the sella. Globular enhancing material just inferior to the sella within the sphenoid sinuses may represent tumor extension or a nasoseptal flap.


Instruction: Generate impression based on findings.

Input: CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: New, almost isodense to minimally hypodense lesions in the liver. An index lesion near the dome measures 2.3 x 2.1 cm on image number 74, series number 3. A second lesion is smaller and best seen image number 94, series number 3. MRI of the liver may be helpful for better detection of these lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland is enlarged.BLADDER: Bladder thickening suggestive of cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New hepatic lesions suspicious for metastatic disease. MRI of the liver may be helpful for better understanding the extent of these lesions and 40 are follow since they are very subtle on CT.


Instruction: Generate impression based on findings.

Input: Numbness and severe pain to the upper right brachial plexus area. There is no significant asymmetry or abnormal signal involving the roots of the brachial plexus on the right. There is no mass or abnormal signal along the course of the right brachial plexus. Specifically, there is no definite impingement in the interscalene triangle, costoclavicular space or retropectoral. Incompletely imaged is advanced osteoarthritic changes of the right glenohumeral joint associated with subarticular marrow edema in addition to subarticular and paralabral cysts. A well-circumscribed 1.5 cm T2-hyperintense, T1 isointense lesion, compared to muscle, is attached or just deep to the skin in the right upper back. It shows no definite contrast enhancement and may represent a sebaceous cyst.

Output: 1.No definite abnormality along the right brachial plexus.2.Advanced osteoarthritic changes of the right glenohumeral joint.


Instruction: Generate impression based on findings.

Input: 34-year-old female with back pain, evaluate SI joints The SI joints appear unremarkable, with normal signal intensity on T1 and T2-weighted images. There is no abnormal enhancement. Moderate pelvic ascites is noted.

Output: Normal SI joints and additional findings as described above.


Instruction: Generate impression based on findings.

Input: 40 year-old female with calvarial abnormality. Surveillance scan. There is no evidence of intracranial hemorrhage, mass or edema. Bilateral basal ganglia calcifications particularly involving the lentiform nucleus. The ventricles and basal cisterns are normal in size and configuration.In the left frontal calvarium is a multiloculated lesion that involves the inner table of the calvarium with a remodeled, but well-defined surrounding border. The internal contents of the lesion demonstrate spiculations and water/soft tissue density without evidence of expansion or compression of the adjacent brain parenchyma. The lesion measures approximately 2.6 cm in widest dimension, (series 80486, image 11). The lesion was present on previous MRI dated 6/2010 and while accounting for differences in modalities, the lesion does not appear to have changed in size when compared to the previous examination. A smaller similar appearing lesion is present in the right frontal calvarium measuring approximately 4 mm in widest dimension, also unchanged, (series 6, image 17). The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Left frontal calvarial lobulated lesion, not significantly changed in size when compared to MRI dated 6/2010. The morphology, signal characteristics and lack of significant change over time are suggestive of a benign lesion, possibilities of which include hemangioma.2. Bilateral basal ganglia calcifications.


Instruction: Generate impression based on findings.

Input: 85 year-old female with sudden onset of aphasia. Acute stroke. Extensive small vessel disease of indeterminate age is noted. No meniscal hemorrhage, edema, mass-effect, midline shift or hydrocephalus is seen. Images through posterior fossa demonstrate the foci of low-attenuation in the right paramedian pons believed to represent an old focal infarct. Follow-up with an MRI is recommended.

Output: Advanced small vessel disease.


Instruction: Generate impression based on findings.

Input: Reason: h/o chronic pancreatitis with pseudocyst, new onset fever, tachycardia; eval for edema/infection/necrosis ABDOMEN:LUNG BASES: Moderate left pleural effusion, increased from prior with associated left basilar atelectasis/consolidation.LIVER, BILIARY TRACT: No focal hepatic lesions. The hepatic vasculature appears patent. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is somewhat enlarged and demonstrates decreased T1 signal with associated peripancreatic edema compatible with acute pancreatitis. There are several discrete fluid collections which were also present on the prior examination. These include a rounded collection with a well-defined wall within the pancreatic body measuring 6.2 x 6.9 cm, increased from approximately 4.3 x 4.5 cm previously. There are several smaller additional contiguous fluid collections extending superiorly along the greater curvature of the stomach the largest of which measures approximately 2.8 x 3.1 cm (401/38). Though these were poorly visualized on the 3/10/2016 noncontrast examination, there were present on the 2/12/2016 exam but appear to have increased in size. The collections along the greater curvature demonstrate peripheral enhancement and restricted diffusion raising the possibility of superinfection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Pancreatic and peripancreatic fluid collections as described above with left greater than right retroperitoneal fat stranding.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Acute pancreatitis with several pancreatic and peripancreatic fluid collections overall increased in size from prior. Collections along greater curvature of stomach demonstrate peripheral restricted diffusion and enhancement raising the possibility of superinfection.2.Increased left pleural effusion with basilar consolidation/atelectasis compatible with pneumonia.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of unspecified siteClinical question: pt with met melanoma and slurred speech please eval for brain metsSigns and Symptoms: met melanoma The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of status post left-sided craniotomy. A focus of encephalomalacia is redemonstrated in the left temporal lobe. There is associated ex vacuo effect along the adjacent left lateral ventricle.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post left temporal craniotomy and left temporal lobe surgery.2.No evidence for brain metastases at this time.


Instruction: Generate impression based on findings.

Input: Reason: Eval for progression of GBM. Pt on TMZ. History: GBM. The patient is status was right sided ventriculostomy tube placement and ventriculostomy tube course the right frontal lobe into the right lateral ventricle across the midline with tip in the frontal horn of left lateral ventricle. There is metal artifact associated with the reservoir of the ventriculostomy tube along the scalp tissues which distorts the appearance of the right hemisphere.Another drainage tube courses to the left temporal lobe across the temporal horn of the left lateral ventricle and has its tip just anterior to the basilar artery. Is in stable positionThere is an irregularly enhancing mass present along the splenium of the corpus callosum which extends across the midline. There is greater enhancement along the right half of the splenium of the corpus callosum versus the left. Enhancement mildly surrounds the left lateral ventricle occipital horn compared or several satellite lesions are compared to the prior exam the degree of enhancement has progressed into the degree of infiltration into the right hemisphere has progressed. There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This has progressed since the prior exam.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam there is been interval progression of the lesion involving the splenium of the corpus callosum especially on the right side.2.Since the prior exam white matter signal changes have also progressed. These are likely treatment related.


Instruction: Generate impression based on findings.

Input: 12-year-old male with shoulder pain with throwing. Evaluate for impingement. ROTATOR CUFF: No evidence of abnormal signal within the supraspinatus, infraspinatus, teres minor, or subscapularis musculature.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No abnormality of the biceps tendon. ADDITIONAL

Output: No specific findings to suggest impingement.


Instruction: Generate impression based on findings.

Input: 52 year old with strong family history of breast cancer. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Preop planning. Signs and symptoms: Preop planning. Nonenhanced head CT:Stealth nonenhanced head CT for surgical planning is performed. Halo is secured to patient's calvarium.Examination demonstrates a well demarcated cystic lesion in the right cerebellum measuring approximately 33.3 x 15-mm in size.There is no appreciable interval change since prior exam in the size or density of this is. The overall mass effect on the fourth ventricle with slight deviation across the midline to the left is also similar to prior study.Images through supratentorial space demonstrate small less ischemic disease of indeterminate age as was noted on prior MRI study.

Output: 1.Steath enhanced preoperative surgical planning CT the reidentifies a stable right cerebellar cyst.2.Small vessel ischemic disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Subcutaneous nodules, evaluation for neurofibromatosis Right forearm:There is mild reticulation of the subcutaneous fat within the posterior forearm which also demonstrates slight enhancement suggesting mild inflammation. There are numerous tiny (2 mm) foci of enhancement within the medial subcutaneous fat of the elbow particularly at the level of the radiocapitellar joint. These foci are poorly seen on T1 sequences as they are only slightly hypointense to fat signal and are mildly hyperintense on STIR sequences. Additional slightly larger foci are seen more proximally in the subcutaneous fat both medially and laterally. A tiny nodule is also noted in the volar aspect of the forearm which is best appreciated on the sagittal sequence. Due to the location and size of the foci, it is difficult to determine the origin of these lesions or their relation to the nerves in particular. The musculature of the forearm demonstrates no abnormal signal. The bone marrow signal is also normal.Left forearm:There are similar scattered enhancing subcutaneous nodules although several appear slightly larger than the right forearm. These demonstrate similar signal characteristics on T1 and STIR. One lesion in particular within the radial subcutaneous tissues (axial postcontrast series 15, image 17/28) appears contiguous with surrounding vasculature however again, it is difficult to determine the relation to nerves. The musculature of the forearm demonstrates no abnormal signal. The bone marrow signal is also normal.

Output: Multiple tiny enhancing subcutaneous foci within both forearms. The findings are nonspecific however several appear in close proximity or associated with vasculature and are slightly hypointense on T1 signal raising the question of multiple subcutaneous angiolipomas. Given their small size and location, we cannot determine their relationship to nerves.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, history of left intraventricular and right frontal meningioma, surveillance imaging. An enhancing mass is redemonstrated within the trigone of the left lateral ventricle, unchanged in size when compared to multiple prior examinations and measuring approximately 32 x 29 mm in the axial plane.A small dural based enhancing lesion along the right frontal lobe is also unchanged in size measuring approximately 12 x 7 mm in the axial plane.Also stable is a subcentimeter enhancing lesion within the right parietal bone. No new enhancing parenchymal or extra-axial lesions are detected. No evidence of new parenchymal signal abnormality is seen. A few small scattered foci of white matter T2 hyperintensity are nonspecific and stable.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Allowing for tumor expansion of the left ventricular trigone and mild dilatation of the left temporal horn, the ventricular system is stable and otherwise unremarkable.

Output: 1.Stable presumed left intraventricular meningioma.2.Stable presumed right frontal meningioma.3.No new intracranial lesions.


Instruction: Generate impression based on findings.

Input: Staging for lung cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few non-enhancing punctate foci of T2 hyperintensity scattered within the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable. However, there is an enhancing 6 mm diameter nodule in the right lateral scalp.

Output: 1. No evidence of intracranial metastases. 2. A few non-enhancing punctate foci of T2 hyperintensity scattered within the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease.3. An enhancing 6 mm diameter nodule in the right lateral scalp may represent a metastatic deposit, among other possibilities.


Instruction: Generate impression based on findings.

Input: Status post right partial nephrectomy. Back pain. Presents for surveillance imaging. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal morphology, size and signal intensity. No suspicious enhancing lesion. Normally distended gallbladder. Small gallstones. No biliary ductal dilatation or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes of a right renal superior pole partial nephrectomy. Postsurgical changes in the surgical bed without specific evidence of local tumor recurrence.Right inferior pole subcentimeter minimally complex cyst with a thin septation but no suspicious enhancing foci colored., Unchanged.Left renal simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of local tumor recurrence or metastatic disease. Stable Bosniak 2F septated cystic lesion in the inferior pole of the right kidney.


Instruction: Generate impression based on findings.

Input: 58 years, Female, Reason: LIVER lesions History: Liver lesions, Diarhhora. Cardinoid. ABDOMEN:LUNG BASES: A punctate T2 hyperintensity in the hepatic dome which does not correspond to any enhancing lesion in the CT is nonspecific. No significant T2 abnormality is seen within the location of enhancing foci on CT.LIVER, BILIARY TRACT: Cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: Prominent pancreatic duct.ADRENAL GLANDS: Subcentimeter left adrenal nodule loses signal on out of phase images, likely an adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Posterior spinal fusion of L4-L5.OTHER: No significant abnormality noted.

Output: 1.Limited exam comment discontinued by patient. Postcontrast images were not obtained.2.No significant abnormality is seen on precontrast images, however these lesions are incompletely evaluated without contrast. Recommend completion of exam with postcontrast images.


Instruction: Generate impression based on findings.

Input: This is a motion degraded exam affecting multiple sequences limiting the sensitivity of the study. The ventricles and sulci are mildly prominent compatible with age-appropriate volume loss. There is mild patchy abnormal T2/FLAIR hyperintensity within the periventricular white matter which is nonspecific. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. 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. There is minimal right maxillary and trace bilateral ethmoid sinus mucosal thickening.MRI neck: This is a significantly motion degraded exam. There is a large lobulated oval lesion in the right posterior upper back soft tissues involving the subcutaneous fat causing mass effect upon the adjacent trapezius muscle. There is extension to the skin surface. This lesion approximately measures 34 x 19 mm in maximum axial dimensions. This lesion is slightly hyperintense on T1-weighted sequence and homogeneously T2 hyperintense. No definite enhancement is associated with this lesion. The lesion demonstrates restricted diffusion.PHARYNX/LARYNX: The nasopharynx, oropharynx, and hypopharynx are grossly unremarkable. The larynx is grossly unremarkable The upper trachea and esophagus are unremarkable.GLANDS: The noncontrast appearance of the submandibular, sublingual, and parotid glands bilaterally is unremarkable. There are multiple T2 hyperintense enhancing nodules in the bilateral thyroid gland left more than the right, largest left thyroid nodule measures up to 15 x 12 mm. ORAL CAVITY: The oral tongue and the floor of mouth are grossly unremarkable.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.OTHER: There is a pulmonary opacity involving the posterior segment of the right upper lobe. In addition, there are coarse linear and nodular opacities in the right upper lobe.

Output: 1. Motion degraded exam. No evidence of intracranial mass. 2. 34 x 19 mm lobulated cystic structure in the subcutaneous fat in the right upper posterior soft tissue with corresponding restricted diffusion most compatible with epidermoid cyst. 3. Bilateral thyroid nodules, left more than the right. Recommend further evaluation with dedicated ultrasound neck.4. Nonspecific pulmonary opacity in the right upper lobe mostly involving posterior segment which is confluent and concerning for possible focal consolidation, although there may be some degree of atelectasis. Also scattered areas of linear and nodular opacities. Clinical correlation will be helpful.


Instruction: Generate impression based on findings.

Input: PSA recurrence 5 years after radical prostatectomy for PT3N0 Gleason 4+4 disease with extracapsular extension. PELVIS:PROSTATE: Status post prostatectomy. The cystourethral anastomosis is unremarkable. No findings to suggest tumor recurrence in the prostatectomy bed.BLADDER: The cystourethral anastomosis is unremarkable. Partially distended urinary bladder is unremarkable.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: Heterogeneous signal intensity of the osseous structures without an enhancing lesion.OTHER: No significant abnormality noted.

Output: No findings to suggest tumor recurrence in the prostatectomy bed. No enlarged pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: History of prostate cancer (Gleason 8). 11/12 cores with prostate cancer, Gl 8 in 1, Gl 4+3 in 2, Gl 3+4 in 6, Gl 3+3 in 2 cores PELVIS:PROSTATE:Prostate Size: 5.7 x 4.4 x 5.3 cm.Peripheral Zone: There are several areas of decreased T2 and ADC signal within the bilateral apex, mid gland, and base, suspicious for neoplasm. The largest discrete area of signal abnormality is in the left apex (series 401, image 29) measuring 1.1 x 1.3 cm.Central Gland: No significant abnormality noted.Seminal Vesicles: No frank invasion of the seminal vesicles is identified.Extracapsular Extension: There is extracapsular extension on the left at the level of the mid gland (series 801, image 12) without definite involvement of the adjacent neurovascular bundle.BLADDER: No significant abnormality noted.LYMPH NODES: No frank lymphadenopathy is identified.BONES, SOFT TISSUES: There is a 1.6 x 1.6 cm lesion within the left femoral head which demonstrates sclerotic borders, heterogeneously increased T2 signal, intermediate T1 signal, and enhancement. Elsewhere, bone marrow signal intensity is mildly heterogeneous.OTHER: No significant abnormality noted.

Output: 1.Diffuse prostate cancer involving the bilateral peripheral zones with extracapsular extension at the left mid gland without definite associated involvement of the adjacent neurovascular bundle.2.Lesion within the left femoral head, nonspecific but favor benign given imaging characteristics. However, correlation with nuclear medicine bone scan is recommended.


Instruction: Generate impression based on findings.

Input: Obesity too soon after eating disorder, unexplained swelling. There is no evidence of pituitary mass lesions. The pituitary gland is normal in size. The pituitary infundibulum is intact and situated in the midline. The posterior pituitary bright spot is intact. The cavernous sinuses and optic apparatus are unremarkable.

Output: No evidence of pituitary lesions.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness, evaluate for cord compression The vertebral bodies are appropriate in the overall alignment and height. Minimal degenerative changes are seen throughout. No findings to suggest cord compression. No findings to suggest compression of the cauda equina nerve roots in the lumbar spine. Linear T2 signal is noted at the level of the conus on the sagittal T2/STIR images which may be artifactual.

Output: This is a limited exam specific for the exclusion of cord compression only. There is no evidence of cord compression or high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine. If there is suspicion for intrinsic cord lesion, suggest dedicated study tailored to a particular level.


Instruction: Generate impression based on findings.

Input: 23 years, Female, Reason: r/o retained stone in cbd History: h/o biliary colic s/p lap chole two weeks ago p/w severe N/V and epigastric abd pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy with a small amount of unorganized fluid in the gallbladder fossa. Small amount of focal fat along the ligamentum teres.Common bile duct is mildly prominent measuring 6 mm in diameter, tapering at the ampulla. No choledocholithiasis or obstructing lesions. Mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild intrahepatic biliary ductal dilatation, likely related to recent cholecystectomy.2.No choledocholithiasis or other obstructing lesions.


Instruction: Generate impression based on findings.

Input: 67 year old man with history of ischemic cardiomyopathy s/p CABG, LV aneurysm and mitral valve repair and atrial fibrillation with dual chamber ICD referred for cardiac MRI to evaluate for scar burden. Left VentricleThere is severe LV dysfunction. There is thinning of the basal to mid lateral, inferolateral and inferior wall with associated akinesis of these segments. The apex was not visualized due to significant artifact. There was late gadolinium enhancement in the basal to mid lateral, inferolateral and inferior walls which was transmural. This territory is not viable. The presence of late gadolinium enhancement in the apical segments could not be evaluated. Right Ventricle:There is an ICD lead in the right ventricle. The RV is not well visualized.Left Atrium: Severely dilated.Mitral ValveMorphology is consistent with history of repair. There is mitral regurgitation, but quantification on this study was not possible.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Extracardiac FindingsThere is a left chest wall defibrillator with significant associated artifact. There are sternotomy wires present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dysfunction. The basal to mid lateral, inferolateral and inferior walls are thinned and akinetic. There is transmural late gadolinium enhancement seen in these segments, which suggests no viability. 2. The apical segments could not be visualized to evaluate wall function or late enhancement.3. Severe left atrial dilation. 4. Mitral valve morphology consistent with history of repair. 5. There is significant artifact present due to the patient's indwelling cardiac device. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 36 year old with known right breast cancer and metastatic right axillary lymph node presents for research MRI of I-SPY protocol (2nd time point). There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.A known cancer is again identified at posterior 11 o'clock position, measuring 18 x 16 x 19 mm (AP x LR x CC, previous measurement: 24 x 26 x 23 mm). There is a linear non mass enhancement extending inferior and anterior from the known cancer measures 31 x 6 x 8 mm (previously 50 x 22 x 25 mm), and the overall size of the mass with non mass enhancement is 31 x 6 x 25 mm (previously 50 x 22 x 45 mm). An enlarges lymph node is again seen in the right axilla, with maximum diameter of 15 mm (previously 17 mm). No abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in left axillary region.

Output: Mild decrease in size of known cancer in the right breast and metastatic right axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Images are somewhat limited by patient motion. There is a background of severely heterogeneous marrow signal, scattered superimposed mildly expansile discrete metastatic osseous lesions which demonstrate STIR hyperintensity and T1 hypointensity, including posterior element involvement. There has been further progression of the now moderate-severe compression deformity involving T4. The most conspicuous lesions are again noted at the T9, T11, and T12 levels. There has been interval mild-moderate compression deformity involving T12. Dorsal epidural fat encroachment by tumor is suggested at T3, T9, T12, and possibly L1 levels. However, there is no evidence of acute cord compression. There is no significant retropulsion of fracture fragments any level, with mild to moderate scattered predominantly lumbar and to a lesser degree cervical spondylotic changes. There is likely most mild-moderate central spinal canal stenosis along the lumbar spine.In addition, metastatic lesions are seen at the C5-C7 levels within the cervical spine, as well as involving all the lumbar vertebrae. There is interval pathologic compression deformity of mild-moderate degree along the superior endplate of L5 where there is focal concavity compared to prior MRI, although this likely was present on the most recent CT chest.Scattered multilevel disc narrowing is present. The spine is in normal alignment. The spinal cord is grossly of normal caliber and signal.Due to the compression deformity of the T4, there appears to be mild-moderate bilateral foraminal narrowing at at T4-T5. There is moderate bilateral foraminal narrowing at L3-4 on the left as well as moderate right foraminal narrowing at L4-L5. At L5-S1, there is suggestion of mild bilateral foraminal narrowing.There is partial visualization of diffuse or hyperintensity throughout the pons, which is nonspecific.

Output: 1.Compared to prior available spine imaging, interval development of multiple discrete cervical and predominantly lumbar lymphomatous lesions, with redemonstration of several stable scattered thoracic lesions from lymphomatous involvement. Diffuse background of heterogeneous abnormal signal throughout the marrow.2.No acute cord compression. At most mild/moderate central spinal canal stenosis at several levels along the lumbar spine, with scattered dorsal epidural tumor as detailed above.3.Interval further collapse of the T4 vertebral body which is now moderate-severe in degree. Stable mild to moderate chronic compression deformity of T12 and more recent compression deformity of L5. No significant retropulsion of fracture fragments at any level.


Instruction: Generate impression based on findings.

Input: 18 year-old female with history of astrocytoma of the posterior fossa, off therapy evaluation. Redemonstrated are postoperative findings within the posterior fossa. Surgical deformation of the fourth ventricle is unchanged as is the degree and extent of T2 hyperintensity along the roof of the fourth ventricle, extending into the vermis, is also unchanged. This tissue also redemonstrates mild intrinsic T1 hyperintensity. As before, there is no abnormal enhancement.Elsewhere, parenchymal signal intensity and morphology are within normal limits. No edema or mass effect is seen. No pathologic enhancement is detected. No evidence of intracranial hemorrhage or any new fluid collections are seen. Ventricles are stable in size and morphology. A small left sphenoid sinus mucous retention cyst is unchanged. The remaining paranasal sinuses and mastoid air cells are clear. Expected vascular flow voids are demonstrated.

Output: Redemonstration of postoperative findings in the cerebellum with no evidence to suggest progressive or recurrent disease.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Rule-out intracranial process. Signs and symptoms: Seizure. Prominence of cortical sulci and ventricular system for patient's stated age is again identified and the great normal change.A nonspecific small new area of low-attenuation in the subcortical white matter of left frontal lobe is noted. The finding may represent edema. There is however no detectable mass effect with this finding. The exact etiology of finding is not clear. Further evaluation with an infused MRI is recommended. This examination is otherwise unremarkable. Calvarium, paranasal sinuses and mastoid vessels are also unremarkable.

Output: 1.Prominence of cortical sulci and ventricular system for patient's stated age as was noted on prior examination from 2007.2.Nonspecific focal area of low-attenuation in the subcortical white matter of left frontal lobe which needs further evaluation with an infused MRI examination.3.Unremarkable calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: MRI T-Spine:There is diffuse enhancement of the exiting thoracic spine nerve roots. There is no abnormal cord signal or enhancement involving the spinal cord. The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There are is a small disc bulge at the T1-T2 level, small right paracentral disc protrusion, T2-3 level, tiny central disc protrusion at the T5-6 level but there is no significant spinal canal stenosis or neural foraminal narrowing. There are additional degenerative changes involving the T6-7 posterior T11-12 with variable disc height loss and Schmorl's nodes but no significant spinal canal or neural foraminal stenosis at these levels. MRI L-Spine:Within the thecal sac there is diffuse abnormal enhancement of the cauda equina nerve roots. The visualized lower spinal cord/conus is of normal signal intensity and enhancement.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 a small disc bulge at L3-4 and L5-S1 with at most mild bilateral neuroforaminal stenosis at L5-S1 and no significant spinal canal stenosis at any level in the lumbar spine.

Output: Diffuse enhancement of the cauda equina and thoracic spinal nerve roots. Given the patient's history, the possibility of lymphomatous involvement should be considered. An infectious or post-infectious-autoimmune process would also be in the differential.


Instruction: Generate impression based on findings.

Input: 73-year-old female with draining pus from foot There are inflammatory changes in the soft tissues about the calcaneus and dorsally in the mid foot. No definite evidence of osteomyelitis. There is abnormal signal intensity involving the sinus tarsus which is dark on T1-weighted images and bright on T2-weighted images compatible with synovitis. There is a rounded lesion within the navicular bone distally abutting the articular surface with the cuneiform bones which demonstrates low signal intensity on T1-weighted images and mild enhancement on postcontrast images. It is associated with degenerative changes about the adjacent joint most consistent with a degenerative cyst. There are patchy tubular foci in the calcaneus which most likely represent vascular remnants. The bone marrow signal of the visualized bones is otherwise within normal limits.

Output: 1. Inflammatory changes within the soft tissues dorsally in the midfoot and about the calcaneus with no definite evidence of osteomyelitis. 2. Synovitis of the sinus tarsus.3. Degenerative cyst in the navicular bone at its articulation with the cuneiform bones.


Instruction: Generate impression based on findings.

Input: Evaluate for CVA or hemorrhage. Examination demonstrates infarcts in the left parietal lobe. Since prior brain MRI, the infarcts have increased in size. No intracranial hemorrhage, mass, midline shift or abnormal extraaxial fluid collection is identified. The periventricular small vessel ischemic disease and right cerebellar encephalomalacia are again identified. The ventricles are normal in volume and are symmetric.The visualized paranasal sinuses mastoid air cells are normally pneumatized.

Output: 1.Interval increase in size of the left parietal stroke with no evidence of intracranial hemorrhage.2.Small vessel ischemic disease and right cerebellar encephalomalacia.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. There are numerous supratentorial and to a lesser extent infratentorial white T2 hyperintense matter lesions, which appear to be unchanged. The majority of the lesions are T1 hypointense, but there is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are mild secretions or mucosal thickening in the right sphenoid sinus.

Output: The demyelinating lesions are grossly unchanged and there is no evidence of associated acute inflammation.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, with neck pain after falling down six stairs. Spinal alignment is slightly straightened but is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or evidence of marrow edema is seen. The cervical spinal cord shows normal signal intensity and morphology throughout the field-of-view. No epidural abnormalities are suspected.There may be a very small central or paracentral disc protrusion at T3-4 which causes no significant spinal canal stenosis. Elsewhere in the cervical spine, no significant disc osteophyte formation is seen. The spinal canal and the neural foramina remain patent.

Output: No evidence of any acute posttraumatic abnormality in the cervical spine.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with metastatic breast cancer to the lungs, presenting with pain in the neck up into the bottom of the skull. Assess for metastatic disease. Extensive metastatic infiltration of the C3 and C4 vertebral bodies and posterior elements is noted with minimal infiltration of C5. Extraosseous extension is also seen into the left lateral paraspinal soft tissues.The affected vertebral bodies are mildly expanded and along with nearly circumferential involvement of the neural arch, there is a resulting severe spinal canal stenosis with cord impingement but no definite cord signal abnormality. Tumor extensively infiltrates the left C2-3, C3-4 and C4-5 neural foramina. The left vertebral artery is encased by tumor but the flow void appears to be preserved throughout indicating patency.Elsewhere, the vertebral bodies demonstrate normal signal characteristics and pattern of enhancement. Spinal alignment is straightened. Vertebral body heights are grossly preserved, even those affected by metastatic disease.C2-3: Posterior disc-osteophyte complex formation with a superimposed right paraspinal osteophyte or disc protrusion causing minimal impingement upon the spinal cord. At the disc space, only a mild generalized spinal canal stenosis is seen, though below the disc space, canal stenosis related to metastatic disease begins and is severe. No significant right foraminal narrowing. Tumor infiltration of the left neural foramen is seen. C3-4: Severe spinal canal stenosis and cord impingement secondary to a combination of circumferential tumor with osseous expansion and superimposed degenerative disc disease. The left neural foramen is extensively tumor infiltrated. The right neural foramen is moderately narrowed by degenerative disease. C4-5: Moderate spinal canal stenosis due to a combination of expansile tumor and some superimposed disc degeneration. The cord is impinged to a mild degree. The left neural foramen is tumor infiltrated. The right neural foramen is mildly narrowed by degenerative disease. C5-6: Posterior disc-osteophyte complex formation. Effacement of the ventral thecal sac with a mild generalized spinal canal stenosis but no significant cord deformation. Moderate to severe bilateral foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant generalized spinal canal or foraminal stenosis. C7-T1: Left facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal or neuroforaminal stenosis. Left supraclavicular adenopathy is partially imaged on this examination. Abnormal signal within the posterior sphenoid bone extending to involve the clivus may simply represent chronic sphenoid sinus mucosal thickening or a mucous retention cyst, but it is nonspecific.

Output: 1.Extensive tumor infiltration is seen affecting the C3 and C4 vertebral bodies and posterior elements, and to a lesser degree the C5 vertebral body. There is substantial left lateral extraosseous tumor spread as well which engulfs the left vertebral artery. 2.The above findings result in a severe stenosis of the spinal canal at the C3 and C4 levels with cord impingement, as well as tumor infiltration of the left-sided neural foramina from C2 through C5.3.Relatively mild degeneration of the disks and posterior elements is seen at the remaining cervical levels.4.Signal abnormality within the posterior sphenoid bone and clivus, partially imaged on this examination, is nonspecific. Dedicated imaging of the head, at least by CT, would likely help to clarify the nature of this finding.


Instruction: Generate impression based on findings.

Input: History of seizure disorder diagnosed 1 year ago who presents with increased seizure frequency. There are unchanged linear subcortical T2 hyperintense bands in the left superior frontal gyrus that extend towards the lateral ventricle with associated blurring of the grey-white matter junction, which may represent a radial migration band. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Bands of subcortical T2 hyperintensity in the left superior frontal gyrus may indicate underlying malformation of cortical development.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with known cavernous malformation, speech and motor assessment for surgical planning. Sensory motor cortical activity maps as expected along the pre- and post central gyri. Cortical activation related to facial/tongue movement maps immediately anterior to the known left parietal opercular lesion.Reliable language-related activation was achieved with all the attempted language paradigms. Language is left dominant. Putative Broca's area activity is seen within the pars opercularis and pars triangularis on the left. Putative Wernicke's area activity is seen within the posterior superior left temporal gyrus.

Output: 1. Sensory motor cortical activation related to the face/tongue maps immediately anterior to the known lesion within the left parietal operculum.2. Language functional activation is left dominant. Broca's and Wernicke's areas are identified and found to be well separated from the lesion.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with aneurysms. Chronic infarcts of the left parietal and occipital lobes are seen appearing similar to prior. Also noted is extensive patchy periventricular and subcortical T2 hyperintensity. No restricted diffusion is detected. No evidence of parenchymal edema or mass effect is noted. Two or three scattered small foci of susceptibility are seen, similar to prior and compatible with chronic microhemorrhage. No acute intracranial hemorrhage is seen. The ventricles are stable and normal in size. No abnormal extra-axial fluid collections are detected. Multiple known intracranial aneurysms are not well visualized on this study.

Output: 1.No acute intracranial abnormality.2.Chronic ischemic lesions of the left parietal and occipital lobes.3.Moderate chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Female 84 years old with swelling, pain, pus right second toe. Evaluate for osteomyelitis. There is abnormal signal intensity replacing the subcutaneous soft tissues about the distal phalanx of the second toe. The distal phalanx is replaced with high T2 signal on the fat-suppressed T2-weighted images. Although there is relatively mild signal abnormality within the distal phalanx on the sagittal T1 weighted images, abnormal low signal intensity within the tuft on the long axis sequences as well as more diffusely on the short axis T1 sequence is suggestive of osteomyelitis, particularly in light of the cortical irregularity seen on recent radiographs. There is mild enhancement of soft tissues of second toe suggesting inflammation. There are also small foci of signal void within the subcutaneous soft tissues dorsal to the proximal phalanx that may represent foci of gas, but this is equivocal. The distal phalanx of the fourth toe is abnormally small and there is increased signal within the remaining base of the distal phalanx on the fat-suppressed T2-weighted images with preservation of fat signal intensity on T1-weighted images. These findings are more suggestive of reactive osteitis than acute osteomyelitis but radiographs of the toe may be obtained for further evaluation.Mild enhancement of the soft tissues adjacent to the fifth metatarsal head likely represents a soft tissue callus.Mild osteoarthritis affects the first metatarsophalangeal joint and moderate to severe osteoarthritis affects the midfoot articulations. There is fatty atrophy of the musculature.

Output: 1.Findings suggestive of osteomyelitis of the distal phalanx of the second toe.2.Abnormality of the distal phalanx of the fourth toe may reflect sequela of prior surgery or chronic erosion but radiographs may be considered for further evaluation to evaluate for osteomyelitis.


Instruction: Generate impression based on findings.

Input: 45 year old female patient with well differentiated liposarcoma of the retroperitoneum. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Post-surgical changes adjacent to the left adrenal gland.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No evidence of disease recurrence. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of disease recurrence.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for ischemia and etiology of seizures, possible epidermoid cyst in right anterior temporal lobe? Signs and symptoms: Left MCA syndrome status post TPA and seizure. Nonenhanced brain MRI:Examination is severely degraded due to extensive motion artifact in particular on axial T2-weighted series.No acute intracranial findings and negative diffusion weighted series.Within limitation of exam compromised secondary to motion artifact there is no evidence of an epidermoid cyst on this study. Examination demonstrates numerous scattered foci of FLAIR and T2 hyperintensity throughout bilateral hemispheric white matter concerning for chronic small vessel ischemic strokes. Similar findings are also present to a lesser degree in bilateral basal ganglia (R>L). There are no detectable similar signal changes in the thalami or the pons. Tiny foci of T2 hyperintensity in the inferior left cerebellum could represent a chronic cerebellar infarct. There is no detectable cortical signal abnormality and the cortical sulci remain within normal. Ventricular system are within normal size for patient's age and with maintained midline.

Output: 1.Suboptimal exam due to extensive motion artifact.2.No acute intracranial process and no evidence of an epidermoid cyst as is questioned clinically.3.Findings of chronic small vessel ischemic stroke as detailed above.


Instruction: Generate impression based on findings.

Input: Left arm and leg numbness.. The study is mildly limited by patient body habitus and motion.Sagittal spinal alignment is anatomic. Vertebral bodies are preserved in height. There is a T1-hypointense, T2-hyperintense somewhat elongate and lesion within the spinous process C7. Marrow signal shows no suspicious lytic and otherwise.The spinal canal is preserved other than mild mild narrowing as described below. The spinal cord shows normal signal accounting for artifact. C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: Small central disc protrusion/osteophyte indents the thecal sac. There is no spinal canal or foraminal stenosis.C4-C5: There is no spinal canal stenosis and mild to moderate right foraminal stenosis.C5-C6: Disc-osteophyte complex along with ligamenta flava thickening result in mild spinal canal stenosis. There is also right more than left uncovertebral and facet proliferative change resulting in moderate right foraminal stenosis and mild-to-moderate left foraminal stenosis.C6-C7: Disc-osteophyte complex mildly narrows the spinal canal. Left uncovertebral facet proliferative change present within moderate left foraminal stenosis.C6-C7: Disc-osteophyte complex indents the anterior aspect of the thecal sac but without significant stenosis. There is also no significant foraminal stenosis.C7-T1: Minimal disc osteophyte complex without stenosis.T1-T2 and T2-T3 (on sagittal imaging alone): There is no spinal canal foraminal stenosis.

Output: 1.Examination is limited motion and patient's body habitus.2.Multilevel cervical spondylosis is associated with mild spinal canal narrowing at C5-C6. 3.There is moderate right C5-C6, mild to moderate left C5/C6, and moderate and left C6-7 foraminal stenoses.


Instruction: Generate impression based on findings.

Input: Malignant melanoma of skin, unspecified [C43.9], Reason for Study: ^Reason: metastatic melanoma concern for mets to brain History: metastatic melanoma There is no evidence of acute ischemic or hemorrhagic lesion. There is no abnormal enhancement.There is a 13 mm x 14 mm sized well-circumscribed subcutaneous lesion at the right occiput which shows low signal intensity on T2 and low signal intensity T1 with the minimal peripheral enhancement. In addition, there is evidence of patchy enhancement on surrounding subcutaneous tissues. The MR characteristics of this lesion is nonspecific but may indicate the lesion contains calcification, fibrosis or hemosiderin with some inflammatory changes. Differential diagnosis include epidermal inclusion cyst, inflammatory changes of subcutaneous lymph node. Possibility of metastatic lesion is less likely.The ventricles, sulci and cisterns are unremarkable. There is no intracranial 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: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Well-circumscribed subcutaneous lesion which is nonspecific in terms of MR characteristics.


Instruction: Generate impression based on findings.

Input: 57 years Female (DOB:3/1/1959)Reason: cervical stenosis History: neck and arm painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG 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. The patient is status post anterior fusion at C4-C7 with anterior plate and screws as well as bone plugs at the disc space levels. Overall the cervical spinal canal is small on a congenital basis.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present this level. There is mild narrowing of the left neural foramen at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present this level. There are some mild narrowing of the left neural foramen at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is some ligamentum flavum hypertrophy present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.The patient is status post anterior fusion from C4 through C7. The prior exam there is some further narrowing of the left neural foramen at C3-4 and C2-32.Exam is mildly degraded patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:11/15/1943)Reason: evaluate for stroke History: L-sided weakness, extensive aneurysmal burdenPROVIDER/ATTENDING NAME: JAMES J WALTER RICHARD J KRAIG MRI of the brainThere is a small focus of diffusion restriction present in the right centrum semiovale measuring approximately 10 mm in size which is high signal on FLAIR and T2 imaging.There is a focus of encephalomalacia present in the left inferior parietal lobule and adjacent precuneusThere is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Some patchy T2 and FLAIR signal hyperintensities are present in the thalami, brainstem and basal gangliaA subdural effusion the posterior fossa is likely related to atrophy.Punctate foci of signal loss are identified on susceptibility weighted imaging within the cerebellar hemispheres approximately 2 or 3 in each cerebellar hemisphere. These were also present on the prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 a 10 mm x 9 mm aneurysm present along the left internal carotid artery originating from the posterior aspect of the clinoidal segment with any 2.5-mm in neck and suprasellar extension which abuts the optic nerve. There is fusiform ectasia of the left internal carotid artery at the distal cavernous segment where it dilates up to 7 mm in diameter. Immediately distal to this ectasia the internal coronary narrows down to 2.5 mm after which the aneurysm originates. The aneurysm abuts the left optic nerve. The aneurysm appears stable when compared to the prior exam. There is 40% narrowing of the left internal carotid artery at the distal cavernous segment.The right vertebral artery functionally appears to and in the right posterior inferior cerebellar arteryThere is a stenosis present at the distal left vertebral artery at the vertebrobasilar junction where there is approximately 80% stenosis over a 10 mm segment. There is 40% narrowing basilar artery along its midportion.The right P1 segment appears be occluded approximately 4 mm from its origin and the left P1 segment is stenotic approximately 7 mm from its origin where it narrows down to 1 mm diameter.There is a short segment 80% stenosis at the proximal left middle cerebral artery at the M1 segment with associated poststenotic dilation. This was also present on the prior exam. It does not appear to have progressed significantly.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.There is an acute lacunar infarct present in the right centrum semiovale.2.A 10 mm left internal carotid artery aneurysm at the clinoid segment is stable compared to the prior exam. This is associated with suprasellar extension. The aneurysm abuts the left optic nerve.3.There is 80% stenosis at the distal left vertebral artery near the V-B junction associated with milder narrowing of the basilar artery. The LVA appears to be effectively the sole supply to the basilar artery. It is associated with tandem foci of narrowing in the basilar artery.4.80% stenosis at the proximal left M1 segment.5.There is occlusion of the right P1 segment.6.There is a high-grade stenosis along the proximal left P1 segment.7.There are multiple old lacunar infarcts present in the brainstem and thalami. These were also present on the prior exam.8.There is a focus of encephalomalacia in the left parietal lobe. This was also present on the prior exam.9.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 10.Cerebellar microhemorrhages are stable.


Instruction: Generate impression based on findings.

Input: Reason: pain, concern for meniscus and LCL History: pain MENISCI: There is linear increased signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial articular surface indicating a longitudinal tear. The anterior horn appears intact. The medial meniscus appears intactARTICULAR CARTILAGE AND BONE: There is a focal full-thickness articular cartilage defect along the lateral facet of the femoral trochlea with underlying degenerative subchondral signal abnormality (image 13; series 501). This defect extends to involve the femoral trochlea centrally and a small portion of the medial facet of the femoral trochlea as well.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Longitudinal tear of the posterior horn of the lateral meniscus.2. Focal full-thickness articular cartilage defects along the femoral trochlea as described above. Other findings as described.


Instruction: Generate impression based on findings.

Input: 19-year-old female patient with right knee pain and concern for right medial meniscus tear. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There are no fluid-filled cartilage defects. LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament complex, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Right knee within normal limits. Specifically, no meniscal tear is present.


Instruction: Generate impression based on findings.

Input: Right cervical radiculopathy: pain in neck and right arm. There is multilevel degenerative spondylosis with considerable bilateral neural foraminal stenosis at C5-6 and C6-7, as well as mild spinal canal stenosis at these levels. There is mild bilateral neural foraminal narrowing at C4-5 and C7-T1, but no significant spinal canal narrowing. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Multilevel degenerative spondylosis with considerable bilateral neural foraminal stenosis at C5-6 and C6-7, as well as mild spinal canal stenosis at these levels.


Instruction: Generate impression based on findings.

Input: 83 year old with history of coronary artery disease requiring multiple percutaneous coronary interventions and three vessel coronary artery bypass grafting (LIMA to LAD, SVG to RCA and SVG to OM) and valvular heart disease s/p recent repeat aortic valve replacement and mitral valve repairMEDICATIONS: Amiodarone, aspirin, clopidogrel, triamterene-hydrochlorothiazide First Pass PerfusionDuring hyperemia, extensive perfusion defects involving the entire basal left ventricle, all but the inferolateral wall of the mid left ventricle, and all but the anterior wall of the apical left ventricle. Viability/ Myocardial ScarThere is a small transmural late gadolinium enhancement noted in the mid inferior wall that is consistent with transmural myocardial infarction. This small area (<5% of the myocardium) is unlikely to be viable. The basal septum has a mid-ventricular stripe pattern of late gadolinium enhancement, which is atypical for prior myocardial infarction and suggests the presence of myocardial fibrosis due to a non-ischemic etiology. This segment has an indeterminate probability of viability. The remaining myocardium does not show evidence of myocardial infarction, fibrosis, inflammation, or infiltration and is likely to be viable. Left VentricleThe left ventricle is normal in size and with severely reduced systolic function. The overall LV ejection fraction is 23%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 205 ml (normal range 142+/-34), the LV end systolic volume index is 78 ml/m2 (normal range 25+/-9), the LVESV is 158 ml (normal range 47+/-19), the LV mass index is 66 g/m2, and the LV mass is 132 g. There is global hypokinesis with additional severe akinesis of the entire inferior wall.. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 28%, the RV end diastolic volume index is 108 ml/m2 (normal range 82+/-16), the RVEDV is 217 ml (normal range 142+/-31), the RV end systolic volume index is 78 ml/m2 (normal range 31+/-9), and the RVESV is 156 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThere is a bioprosthetic aortic valve presentMitral ValveThe mitral valve has posterior leaflet restriction with severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are small bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large burden of ischemia, as described above, in a multivessel coronary distribution. 2. There is a small transmural myocardial infarction in the mid inferior wall. This small area (<5% of the myocardium) is unlikely to be viable. The basal septum has a mid-ventricular stripe pattern of late gadolinium enhancement, which is atypical for prior myocardial infarction and suggests the presence of myocardial fibrosis due to an additional non-ischemic etiology. This segment has an indeterminate probability of viability. The remaining myocardium does not show evidence of myocardial infarction or fibrosis and is likely to be viable. 3. Normal LV size with severely reduced systolic function (LVEF 23%). There is global hypokinesis but the entire inferior wall is clearly worse.4. Normal RV size with severely reduced systolic function (RVEF 28%).5. Mild biatrial dilation.6. Severe mitral regurgitation, likely due to an "ischemic" etiology causing tethering of the posterior leaflet. 7. Small bilateral pleural effusions.


Instruction: Generate impression based on findings.

Input: 64-year-old female with metastatic renal cell carcinoma and possible metastases ABDOMEN:LUNG BASES: Small left-sided pleural effusion and dependent atelectasis. Calcified mediastinal lymph nodes.LIVER, BILIARY TRACT: Bilateral extensive liver metastases. An index lesion in the left lobe measures 3.3 x 2.7 cm, image number 51, series number 3.Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: The tail of the pancreas is diffuse the hypodense. A solid neoplasm in the distal body and tail cannot be excluded. Further evaluation with MRI of the pancreas is recommended. Splenic vein is not well seen. There are venous collaterals around the stomach.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys.Small hypodense lesions in the left kidney which are too small to accurate characterize.Right kidney is very heterogeneous with multiple scars. Multiple cysts in the upper pole. Lower pole of the right kidney has lobulated contours with ill-defined heterogeneous density. These findings may represent postsurgical changes, however, a solid lesion cannot excluded with this single phase study.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. Index portacaval node measures 15 by 11 mm on image number 55, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Not well visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Extensive hepatic metastatic disease.Diffusing hypodense tail of the pancreas. A solid neoplasm cannot be excluded. Further evaluation with MRI of the pancreas is recommended.Cholelithiasis.Bilateral atrophic kidneys. Lower pole of the right kidney is heterogeneous with lobulations. Possibility of a solid lesion in the lower pole of the right kidney cannot be excluded. Follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: 55 years, Male, metastatic lung cancer with history of brain metastases. Additional history per chart, patient has history of gamma knife, whole brain radiation, and chemotherapy. Again seen are multiple enhancing lesions in the brain consistent with known intracranial metastases.The right temporal enhancing lesion, axial image 99, measuring 18 x 14 mm is not significantly changed. 4 mm focus of enhancement in the left thalamus not definitively seen previously and appears new. A 3 mm enhancing lesion involving the right cingulate gyrus, axial image 181, not clearly seen on the immediate prior but appears present on 7/10/2015. Multiple foci of enhancement along the cortex in the left posterior frontal lobe, such as axial images 240 and 227 are grossly similar to prior allowing for slight differences in technique although a 2 mm lesion, axial image 209 appears more conspicuous.Enhancing lesion in the left paramedian cerebellum measures 10 x 7 mm, image 78, is not significantly changed. There are 2 subcentimeter enhancing lesions in the left cerebellar hemisphere, axial image 52; the more anterior one measures 3 x 5 mm, previously 2 x 3 mm; the more posterior punctate lesion is not significantly changed. A punctate right cerebellar enhancing nodule, image 74, not significantly changed.There is patchy FLAIR hyperintensity throughout the bilateral supratentorial white matter which is gradually increased across prior studies from 3/14/2016 and 7/20/2015 and likely represents posttreatment change. FLAIR signal associated with some of the lesions such as in the right temporal lobe similar to prior. There may be slight increase in FLAIR signal abnormality associated with the left paramedian cerebellar lesion. No evidence of acute ischemia. There are foci of susceptibility effect such as in the right temporal lobe and left cerebellum associated with the lesions compatible with blood products. These are not evident on prior outside gradient sequences which were acquired with a less sensitive technique and therefore not necessarily new.No significant intracranial mass effect, midline shift, or herniation. No hydrocephalus.In review of the earlier study from 7/10/2015, there are multiple enhancing lesions such as in the left and right aspect of the pons which are no longer present.

Output: 1. Multiple foci of supra and infratentorial intracranial metastatic disease some of which appear new or slightly larger when compared to 3/14/2016. Please see details above.2. No significant intracranial mass effect associated with the lesions.


Instruction: Generate impression based on findings.

Input: Known left triple negative breast cancer on research protocol for I-Spy 2. MRI #3 There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left upper outer breast, there has been an interval decrease in size of known malignancy, now measuring 4.7 x 1.8 x 1.2 cm previously 5.3 x 3.5 x 3.1 cm (AP x ML x SI), and originally 7.4 x 3.9 x 6.0 cm. The degree of enhancement is significantly decreased and just above the level of background parenchyma. Susceptibility artifact from biopsy marker clip is seen within the central aspect of this malignancy. There is no additional abnormal enhancement identified in the left breast.There is continued interval decrease in the lymph nodes in the left axilla and normalization of their morphology, with the reference node now measuring approximately 1.2 cm, previously 2.4 cm, and originally 3.6 cm. Susceptibility artifact from biopsy marker clip is seen within one of these lymph nodes, compatible with biopsy-proven metastatic left axillary lymph node.RIGHT BREAST: No abnormal enhancement is seen in the right breast.No abnormal axillary lymph nodes are identified in the right axillary region. .

Output: (1) Interval decrease in size and degree of enhancement of the biopsy proven malignancy of the left breast. Continued decrease in size of metastatic left axillary lymph nodes. (2) No MRI evidence of malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 42yo female with history of biopsy proven pulmonary sarcoidosis, newly diagnosed non-ischemic cardiomyopathy with EF of 22% who was referred for cardiac MRI to evaluate for possible cardiac involvement of her sarcoid. Left VentricleThe left ventricle is dilated with severely reduced systolic function. There is global hypokinesis with regional variation. There is increased T2-STIR signal in the septum and inferolateral wall with an elevated myocardium: skeletal muscle ratio (2.2-2.9) which is consistent with myocardial edema. There are multiple areas of late gadolinium enhancement. There is patchy diffuse late gadolinium enhancement throughout the septum which spares the endocardium and is atypical for myocardial infarction, and suggests an infiltrative, inflammatory or fibrotic process. There is a small focus of late gadolinium enhancement in the apical anterior wall which spares the endocardium, also suggestive of an infiltrative, inflammatory or fibrotic process. There is a transmural area of late gadolinium enhancement in the basal inferolateral and inferior wall with preserved wall thickness, atypical for myocardial infarction and more suggestive for infiltrative, inflammatory or fibrotic process. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is qualitatively normal size with mildly reduced systolic function.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsBilateral lower lobe infiltrates. Lymphadenopathy 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. Cardiac volumes could not be quantified at this time; an addendum will be generated tomorrow with specific cardiac volumes and function. 2. Severe LV systolic dysfunction with several areas of atypical late gadolinium associated with increased myocardial T2-signal. These findings support the diagnosis of cardiac sarcoidosis in the inflammatory stage. 3. Normal RV size with mildly reduced systolic function.4. Mild mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left unilateral hearing loss, dizziness. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of T2 hyperintensity in the cerebral white matter. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. There is minimal extension of the cerebellar tonsils inferior to the foramen magnum, with an otherwise unremarkable morphology of the tonsils. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is moderate mucosal thickening and secretions within the right maxillary sinus.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. A few scattered foci of T2 hyperintensity in the cerebral white matter are non-specific, but may represent a demyelinating process, small vessel ischemic disease, or vasculitis, for example. 3. Evidence of right maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: History of base of tongue cancer second primary, status post induction chemotherapy, evaluate response. Please see seen enhancing mass centered at the right lateral tongue base has decreased in size with suggestion of development of an ulceration in this region. The lesion measures up to 2 cm in diameter including the central ulcerated portion and 5 mm in thickness if measuring the peripheral enhancing tissue adjacent to the ulceration. Edema and enhancement extending posteriorly along the right lateral pharyngeal wall and glossotonsillar sulcus is similar in extent. No new lesions or new mass is appreciated. There is mild edema involving the supraglottic larynx consistent with post treatment change. Airway is patent. No significant cervical lymphadenopathy is appreciated.There are mild to moderate multilevel degenerative changes in the cervical spine with multiple disc osteophyte complexes without high-grade spinal canal stenosis. The imaged portions of the intracranial structures and orbits are unremarkable. Bone marrow signal is benign.

Output: 1. Compared to MRI dated 6/24/2016, there is suggestion of treatment response with mild decrease in size and development of ulceration at the site of the previously seen solid lesion centered at the right lateral tongue base.2. No significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: There are 2 punctate foci of subtle diffusion restriction and T1 hyperintensity within the deep right frontal white matter and an additional punctate focus within the right inferior parietal lobule. There is no additional evidence of intracranial hemorrhage or acute infarct and no additional areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. The midline structures and craniocervical junction are within normal limits. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable.

Output: Three punctate foci of diffusion restriction and T1 hyperintensity within the right cerebral deep white matter, which may represent foci of subacute petechial hemorrhage with possible underlying minimal ischemia, of unlikely clinical significance. Otherwise unremarkable MRI.