Instruction: Generate impression based on findings.

Input: 17-year-old male patient with history of injury eight days prior and the examination concerning for medial meniscus tear. Due to the patient's body habitus and HD coil could not be utilized. An alternative coil was used instead resulting in slightly suboptimal image quality.MENISCI: There is branching signal abnormality within the outer one half of the posterior horn of the medial meniscus that extends to both the femoral and tibial articular surface indicating a complex tear. The body of the medial meniscus appears slightly attenuated relative to the lateral meniscus which may reflect additional tearing. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is edema within the posterior aspect of the medial tibial plateau that may represent a contusion associated with the aforementioned medial meniscal tear. There is also edema within the posterior aspect of the medial femoral condyle which may represent an additional contusion. No fluid-filled articular cartilage defects are identified.LIGAMENTS: The ACL and PCL are intact. The superficial band of the MCL is intact. There is bandlike low signal intensity seen within the medial gutter between the medial femoral condyle and superficial band of the MCL which is of uncertain etiology and could represent a torn meniscofemoral coronary ligament or displaced meniscal flap. The LCL appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus as described above. Bandlike low signal intensity within the medial gutter could represent a displaced meniscal flap or sprain/tear of the meniscofemoral coronary ligament.2. Bone contusions of the medial tibial plateau and medial femoral condyle.


Instruction: Generate impression based on findings.

Input: History of metastatic breast cancer. Please evaluate liver lesions. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. No intrahepatic biliary ductal dilatation. The vessels are patent. Normally distended gallbladder.There are 2 segment 8 lesions compatible with metastatic disease. The peripheral lesion measures 3.1 x 1.8 cm. The more cranial lesion measures 2.5 x 2.2 cm with a small adjacent subcentimeter satellite nodule anteriorly. Both demonstrate a bull's-eye configuration. They demonstrate mild if any peripheral thick-walled enhancement with central nonenhancement reflecting necrotic/cystic components.There is a 6 mm segment 3 lesion which is too small to definitely characterize but does not appear to be a simple cyst or hemangioma.Right hepatic dome segment 7 simple cyst.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: Focal bone marrow signal abnormalities compatible with known osseous metastases.OTHER: No significant abnormality noted.

Output: Segment 8 lesions compatible with metastatic disease. Subcentimeter segment 3 lesion is too small to definitively characterize but does not appear to be a simple cyst or hemangioma. It has imaging characteristics similar to the other metastatic lesions and probably reflects a metastatic deposit.


Instruction: Generate impression based on findings.

Input: Female, 12 years old, with hydrocephalus, VP shunt, yearly follow-up examination. An ill-defined, T2 hyperintense, partially cystic lesion is redemonstrated involving the right basal ganglia, thalamus, hypothalamus, anteromedial temporal lobe, and left hypothalamus. As before, this lesion demonstrates patchy intrinsic T1 hyperintensity and patchy susceptibility effect. No definite pathologic enhancement is seen above and beyond the intrinsic T1 signal. There has been no significant interval change in these findings.A right parietal approach ventricular catheter is redemonstrated and appears to be in stable position. Ventricular size and morphology are unchanged. The left lateral ventricle is nearly completely collapsed. The right lateral ventricle is normal in caliber with stable trace T2 hyperintensity along the ependyma of the atrium and occipital horn. The third and fourth ventricles are normal.The right cerebral peduncle is thinner than the left likely reflecting degeneration. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. An incidental pineal cystic lesion is unchanged.

Output: No change in the heterogeneous T2 hyperintense, cystic lesion affecting the right thalamus, basal ganglia, hypothalamus and medial temporal lobe.


Instruction: Generate impression based on findings.

Input: Clinical question: Lung cancer with history of treated brain metastases. Please reassess disease. Signs and symptoms: Same. Enhanced head CT:No additional contrast is given for this exam. This examination was performed immediately post enhanced CT of chest abdomen and pelvis.There is no evidence of metastatic disease of brain parenchyma, leptomeninges or the calvarium. Aexamination demonstrates a developmental venous anomaly of the left anterior temporal lobe as was noted on prior enhanced brain MRI examination.The cortical sulci, ventricular system and CSF cisterns remain operating normal. Very subtle subcortical and periventricular low attenuation of white matter as was noted on prior brain MRI history to represent small vessel ischemic disease of indeterminate age.

Output: 1.No evidence of metastatic disease.2.Minimal small vessel ischemic strokes of indeterminate age.3.Revisualization of the left anterior temporal lobe development of venous anomaly.


Instruction: Generate impression based on findings.

Input: The diffusion and susceptibility images are normal. Nonspecific scattered FLAIR hyperintense foci are seen in the cerebral white matter. No abnormalities are seen in the T1 postcontrast images.There is a thickening and heterogenous appearance of the calvarium. Mucosal thickening and partial opacification of the left maxillary sinus is seen.The right aspect of the clivus demonstrates a lobulated T1 hypointense and T2/FLAIR hyperintense lesion with mild enhancement, corresponding to a focal lucency in this area on CT. This is unchanged in size comparing the most recent CT to that dated 5/7/2013.There is extensive bilateral cervical and left greater than right parotid lymphadenopathy.

Output: 1. No acute findings in the brain.2. Cervical and parotid lymphadenopathy, consistent with history of CLL.3. T2/FLAIR hyperintense lesion in the right aspect of the clivus with mild enhancement, with corresponding geographic lucency which has been stable since the CT of 5/7/2013, of uncertain etiology.


Instruction: Generate impression based on findings.

Input: 69-year-old female with numbness and tingling with a left C6 radiculopathy. Mild straightening and minimal retrolisthesis of C5 on C6. Alignment is otherwise anatomic. Vertebral body heights are maintained. Minimal end plate degenerative signal changes and multilevel disk desiccation. No cord signal abnormality. Visualized intracranial structures are unremarkable.Individual levels as below:C2-C3: No spinal canal or neuroforaminal stenosis.C3-C4: No spinal canal or neuroforaminal stenosis. C4-C5: No spinal canal or neuroforaminal stenosis.C5-C6: Disk osteophyte complex, uncovertebral hypertrophy, and ligamentum flavum buckling. There is partial effacement of the ventral and dorsal thecal sac. There is moderate to severe right and moderate left neural foraminal stenosis. C6-C7: Disk osteophyte complex, uncovertebral hypertrophy, and ligamentum flavum buckling. There is partial effacement of the ventral and dorsal thecal sac. There is mild to moderate bilateral neuroforaminal stenosis. C7-T1: No spinal canal or neuroforaminal stenosis.

Output: Degenerative changes in the cervical spine particularly at C5-6 and C6-7 without significant spinal canal stenosis. There is moderate to severe right and moderate left neural foraminal stenosis at C5-6 which may be impinging on the C6 nerve roots.


Instruction: Generate impression based on findings.

Input: Male, 49 years old, with numbness, Chiari seen on previous MRI. Brain:The right cerebellar tonsil is peglike in morphology and descends 7-8 mm below the level of foramen magnum. The left cerebellar tonsil maintains a more normally rounded configuration but still distends 5 to 6 mm below the level of the foramen magnum. However, the CSF space at the level of foramen magnum is not particularly crowded, and on CSF flow imaging, fairly robust biphasic flow is demonstrated both anteriorly and posteriorly.Elsewhere in the brain, a few scattered small foci of nonspecific FLAIR hyperintensity are seen within the cerebral parenchyma. No edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. Bone marrow signal characteristics are within normal limits. A defect of the nasal septum is noted incidentally.Thoracic spine:As assessed on sagittal T2-weighted images, the spinal cord demonstrates normal signal intensity and morphology. No focal lesions are seen. No evidence of any syrinx is detected. Spinal alignment is anatomic. Vertebral body heights are preserved. Mild endplate degenerative changes are seen with small scattered disc protrusions. No high-grade spinal canal or foraminal stenosis is suspected.

Output: 1.Findings are seen compatible with Chiari I malformation. However, the CSF space at the foramen magnum is not particularly crowded, and CSF flow imaging shows robust biphasic flow both anteriorly and posteriorly.2.No additional significant intracranial findings are seen.3.On limited imaging of the thoracic spine, no additional spinal cord abnormalities are detected.


Instruction: Generate impression based on findings.

Input: Evaluate portal vasculature. Cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No discrete lesion.The main portal vein appears chronically thrombosed with reconstitution of the left portal vein distally by small collaterals. Cholelithiasis without evidence of cholecystitis.No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Mild splenomegaly measuring 14.5 cm without a focal lesion. Perisplenic hilum collateral vessel formation with splenorenal shunt. The splenic vein is patent. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive right-sided retroperitoneal and mesenteric collateral vessel formation.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate right-sided pleural effusion with adjacent compressive atelectasis.

Output: 1.Cirrhosis without a focal lesion. Stigmata of portal hypertension. Extensive porto-systemic collateral vessels.2.Chronically thrombosed main portal vein with reconstitution of the left portal vein by small collateral vessels in the porta hepatis. 3.Moderate right-sided pleural effusion.


Instruction: Generate impression based on findings.

Input: 57-year-old female with hyperbilirubinemia, right upper quadrant pain, myeloproliferative infiltrate into the liver. Evaluate for biliary obstruction. ABDOMEN:LIVER, BILIARY TRACT: The liver measures approximately 22 cm and demonstrates capsular nodularity consistent with cirrhosis. The liver is heterogeneous in echotexture.No intra or extrahepatic biliary ductal dilatation. At the level of the confluence of the right and left biliary duct, there is nonopacification of the common bile duct measuring approximately 5 mm and caudal dimension (series 9, image 102). Mild stricture is not excluded; however, there is no upstream biliary dilatation.SPLEEN: The spleen is heterogeneous in appearance with multiple heterogeneous lesions with the largest measuring 2.2 x 4.3 cm (series 6, image 20).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: Small volume ascites is present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis and hepatosplenomegaly.2.Heterogeneous hepatic parenchyma, most likely related to the myeloproliferative process.3.Multiple splenic lesions likely related to myeloproliferative process.4.Non-opacification at the biliary confluence apparent only on MRCP images nonspecific but likely related to technique given that there is no significant upstream dilatation; however, very mild stricture is not entirely excluded.


Instruction: Generate impression based on findings.

Input: 64 year old female with a history of hyperlipidemia, former smoker who was recently discovered to have pulmonary sarcoidosis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 71%, the LV end diastolic volume index is 73 ml/m2 (normal range: 65+/-11), the LVEDV is 121 ml (normal range 109+/-23), the LV end systolic volume index is 21 ml/m2 (normal range 18+/-5), the LVESV is 35 ml (normal range 31+/-10), the LV mass index is 39 g/m2 (normal range 67+/-11), and the LV mass is 64 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native T1 times were normal (<1050ms). Left AtriumThe left atrium is normal in sizeRight 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 92 ml/m2 (normal range 69+/-14), the RVEDV is 151 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are right lung abnormalities consistent with patient's known sarcoid (refer to dedicated imaging). Indeterminate but well-defined T2 hyperintense lesion within the right lobe of the liver measuring 1.2 cm, which was present on previous CT studies from late 2015 but was not definitely present on the study from 2014. Patient status post left nephrectomy. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 71%. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native T1 times were normal (<1050ms). 2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%. 3. Indeterminate well-defined T2 hyperintense lesion within the right lobe of the liver measuring approximately 1.2 cm. This is unlikely to represent a cyst given its appearance on previous CT scans. This may represent a focus of sarcoidosis given recent diagnosis of this condition. This can be reevaluated on imaging follow-up in 6-12 months as clinically indicated.


Instruction: Generate impression based on findings.

Input: 72-year-old man with history of Gleason 6 prostate adenocarcinoma in the right lateral base on biopsy from 6/15/2016. PELVIS:PROSTATE:Prostate Size: 56 x 37 mm.Peripheral Zone: In the peripheral zone of the right prostatic base (901/22) there is a 11 x 5 mm area of T2 hypointensity and diffusion restriction (408/424). This area also appears to extend from the capsule and abuts the right seminal vesicles (1002/95).Additionally in the peripheral zone of the left mid gland (501/76) there is a 9 x 8 mm area of T2 hypointensity and diffusion restriction without extension to the capsule.Central Gland: Nodular hypertrophy.Seminal Vesicles: Previously described tumor appears to abut the right seminal vesicles which otherwise appear normal.Extracapsular Extension: Apparent extracapsular extension from the right base as described above.BLADDER: No significant abnormality noted.LYMPH NODES: Small external iliac nodes noted without significant lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Right lateral base tumor suspicious for adenocarcinoma with extension beyond the capsule and questionable involvement of the right seminal vesicles.2.Additional focus of abnormal signal in the left mid gland also suspicious for adenocarcinoma.


Instruction: Generate impression based on findings.

Input: left side numbness No evidence of acute ischemic or hemorrhagic lesion.There is linear tissue defect with high signal intensity on FLAIR images on the right cerebellar hemisphere indicating prior infarction.Scattered multiple subcortical white matter high signal intensities on FLAIR on bilateral hemispheres are non specific.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Bilateral maxillary sinuses, ethmoid sinuses, frontal sinus and sphenoid sinus show mucoperiosteal thickening indicating pansinusitis.

Output: No evidence of acute ischemic or hemorrhagic lesion.Pansinusitis.


Instruction: Generate impression based on findings.

Input: Ms. Ksiazek is a 58-year-old female with a personal history of left breast lumpectomy in 2015 for IDC/DCIS treated with radiation and chemotherapy. Personal history of benign left breast MR-guided biopsy for UDH/sclerosing adenosis in 5/2015 and right breast mastopexy in 5/2016. She has no current breast complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable post-lumpectomy changes are identified in the left breast. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: Stable postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 24-year-old female with lacrimal gland pain and enlargement. Evaluate for lacrimal gland enlargement/inflammation The lacrimal glands are symmetrically enlarged and uniformly enhancing. No discrete masses are seen. The pituitary gland is slightly prominent but still within normal limits for age. The globes are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact.

Output: Bilateral symmetric enlargement of the lacrimal glands without focal lesions. Findings may represent an underlying autoimmune or collagen vascular disease process.


Instruction: Generate impression based on findings.

Input: 47 year male with history of CAD, s/p PCI to RCA CTO, here for evaluation after procedure Left VentricleThe left ventricle is normal in size with mildly decreased ejection fraction. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 209 ml (normal range 142+/-34), the LV end systolic volume index is 53 ml/m2 (normal range 25+/-9), the LVESV is 108 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 131 g (normal range 164+/-36). There is mild basal inferoseptal tardokinesis. There is small area of late gadolinium enhancement in the basal inferior myocardial wall involving the subendocardium. This pattern of late gadolinium enhancement is consistent with prior myocardial infarction and is likely not viable. The remainder of the ventricular myocardium is viable. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 231 ml (normal range 142+/-31), the RV end systolic volume index is 57 ml/m2 (normal range 31+/-9), and the RVESV is 116 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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are several left sided axillary nodes. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly decreased systolic function at 48%. 2. The right ventricle is normal in size with mildly decreased systolic function at 50%.3. There is mild basal inferoseptal tardokinesis. There is small area of late gadolinium enhancement in the basal inferior myocardial wall involving the subendocardium. This pattern of late gadolinium enhancement is consistent with prior myocardial infarction and is likely not viable. The remainder of the myocardium is viable. 4. Mild biatrial enlargement.5. See extracardiac findings


Instruction: Generate impression based on findings.

Input: Male, 36 years old, with multiple sclerosis and paresthesias. Vague periventricular T2 hyperintensity is unchanged. Also unchanged is a focus of T2 hyperintensity along the right midbrain at the level of the superior cerebellar peduncle, and several clustered T2 hyperintense lesions in the juxtacortical left anterior temporal lobe. Minimal T2 hyperintensity at the caudal aspect of the tectum, best appreciated on sagittal images, is also unchanged. Mild T1 hypointensity corresponding to these lesions is also unchanged. No new parenchymal lesions are detected. Brain volume is preserved. The ventricles remain normal in size and morphology.

Output: Relatively mild parenchymal signal abnormality is unchanged when compared to the prior examination.


Instruction: Generate impression based on findings.

Input: Stage IV melanoma with two brain metastases, status post resection of a large left frontal lesion and SRS for a cerebellar lesion. Re-evaluate disease status following immunotherapy and hold due to elevated enzymes. There are postoperative findings related to left frontal craniotomy for metastasectomy. There is a subcentimeter focus of susceptibility effect without associated enhancement in the left inferior frontal gyrus resection cavity. There is more prominent enhancement on the 3D T1 sequence associated with the right lateral cerebellar hemisphere lesion, but no significant interval change in size of the lesion, measuring up to 3 mm. Previously, the 3D post-contrast sequence was obtained earlier during the scan. There is no evidence of other intracranial mass lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Post-treatment findings related to left frontal lobe metastasectomy without evidence of recurrent metastasis at this site. 2. Unchanged size, but more pronounced enhancement of the small right cerebellar metastasis, which may be due to differences in timing of the contrast material.3. No evidence of new intracranial metastases.


Instruction: Generate impression based on findings.

Input: 64-year-old female with diarrhea, nausea, vomiting and abdominal pain. History of see differential colitis with abnormal guaiac two days ago. Evaluate for colitis. Previous history of multiple myeloma. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatic hypodensities in the right lobe at axial image 31/162 and 38/162 were present in 2005 and most likely represent benign cysts. However, the lesion at image 31/162 has a larger size and may be better characterized for staging, if needed, with dedicated CT or MRI. This lesion now measures 12 mm in diameter. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cortical hypodensities are present compatible with simple cysts. These are stable since 2005. Punctate calcifications in the renal pelves are most likely vascular. No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Focal right eighth anterior rib expansion at axial image 38/162 is stable since 2005 and most likely represents changes of multiple myeloma.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a 4-cm segment of thickened narrowed sigmoid colon at axial image 107/162 with sharp zones of transition has appearance consistent with colon cancer. The remainder of the colon wall thickness and lumen diameter are normal.BONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis. Multiple stable lesions in the pelvis and hip compatible with history of multiple myeloma. These are stable since 2/5.OTHER: No significant abnormality noted

Output: 4 cm lesion in sigmoid with appearance suggesting colon cancer. Right hepatic lobe hypodensity was present in 2005, but appears larger. Bony changes compatible with stable multiple myeloma.


Instruction: Generate impression based on findings.

Input: Back pain and lower extremity weakness. There is no evidence of abscess in cervical or thoracic spine regions. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is lack of the usual cervical lordosis, but no spondylolisthesis and the thoracic spine alignment is anatomic. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is no abnormal enhancement in the cervical or thoracic spine regions. The paravertebral soft tissues are unremarkable.

Output: No evidence of abscess in cervical or thoracic spine regions.


Instruction: Generate impression based on findings.

Input: Back pain. Evaluate for herniated lumbar disc. The vertebral column alignment is within normal limits. There is loss of disc height, disc desiccation and endplate degenerative changes at L4-5. There is a small subcentimeter subchondral cysts at the inferior endplate of L4. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.T12-L1 through L3-4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is a mild disc bulge, with superimposed right lateral recess disc protrusion. There is mild facet hypertrophy. There is mild to moderate right neural foraminal narrowing. There is no significant spinal canal narrowing. L5-S1: There is no significant compromise to spinal canal or neural foramina.

Output: Spondylosis with right lateral recess disc protrusion and mild/moderate right neural foraminal narrowing at L4-5.


Instruction: Generate impression based on findings.

Input: 82 year old woman with dyspnea, referred for evaluation of underlying ischemia. MEDICATIONS: Toprol XL, gemfibrozil, Crestor, nifedipine. First Pass PerfusionDuring hyperemia, there is a perfusion defect (ischemia) in the basal to mid inferior wall and the basal inferoseptum. Viability/ Myocardial ScarThere probably a nontransmural myocardial infarction involving the basal inferior and inferoseptal walls which has an intermediate probability of viability. The mid inferior wall has no evidence of prior myocardial infarction and is viable. The remainder of the coronary territories are free of myocardial infarction and viable.Left VentricleThe left ventricle is normal in size with normal systolic function. There is hypokinesis of the basal to mid inferior wall. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 71 ml/m2 (normal range: 65+/-11), the LVEDV is 126 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 49 ml (normal range 31+/-10), the LV mass index is 50 g/m2, and the LV mass is 88 g. 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 64%, the RV end diastolic volume index is 48 ml/m2 (normal range 69+/-14), the RVEDV is 85 ml (normal range 110+/-24), the RV end systolic volume index is 17 ml/m2 (normal range 22+/-8), and the RVESV is 31 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe ascending aorta is mildly dilated (43mm). 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 FindingsTrace 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. In the typical territory of the RCA, there is evidence of hypokinesis associated with a non-transmural myocardial infarction with residual peri-infarct ischemia and an intermediate probability of viability. 2. There is no ischemia or myocardial infarction in the typical territory of the LAD and LCx.3. Normal LV size and systolic function (LVEF 61%).4. Normal RV size and systolic function (RVEF 64%).5. Mild dilation of the ascending aorta.6. Mild aortic 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: Persistent sciatica, left-sided Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L2 on L3 and L3 on L4. Alignment is otherwise within normal limits. Bone marrow signal is benign with T1 hyperintense focus at the L4 vertebral body compatible with hemangioma. Mild edematous changes are evident involving the left aspect of the L5-S1 endplates. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge and bilateral facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge and mild facet arthropathy. There is associated mild right-sided neural foraminal stenosis. No spinal canal or left neural foraminal stenosis.L4-L5: Mild disc bulge with small right paracentral annular fissure. There is moderate bilateral facet arthropathy and ligamentum flavum thickening. There is effacement of the right lateral recess as well as mild bilateral, right greater than left, neural foraminal stenosis. There is also fairly mild central spinal canal stenosis. These findings are progressed since 8/28/2009.L5-S1: There is moderate disc height loss at this level with suggestion of vacuum phenomena. There is mild disc bulge which is eccentric to the left with a left foraminal component. There is mild right and mild to moderate left neural foraminal stenosis. There is contact of the left L5 nerve root. These findings are progressed since 8/28/2009.Paraspinous soft tissues are within normal limits.

Output: Mild progression of multilevel degenerative changes compared to 8/28/2009, which are relatively worse at the L4-L5 and L5-S1 levels.


Instruction: Generate impression based on findings.

Input: Reason: eval lesion in anterior pons History: BLE weakness. Again seen is a lesion with increased T2 signal in the anterior pons, left greater than right, without associated diffusion restriction, susceptibility or significant mass effect that measures approximately 2.0 x 1.5 cm. There may be some subtle speckled enhancement along the anterior aspect of the lesion, which may represent prominent vascularity. No masslike enhancement is identified.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: T2 hyperintense lesion within the pons without masslike enhancement. There is some subtle speckled enhancement along the anterior aspect which is suspected to represent prominent vasculature. This lesion remains nonspecific with differential including demyelinating, inflammatory and metabolic etiologies. A neoplastic process is considered less likely, as there is no significant mass effect or alteration of the contour of the pons.


Instruction: Generate impression based on findings.

Input: Visual changes and metastatic melanoma on immunotherapy - numbness/tingling in left hand ring and middle finger. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of non-enhancing T2 hyperintensity in the cerebral white matter, which are nonspecific. The pituitary gland appears unremarkable. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbit, and scalp soft tissues are unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No evidence of intracranial metastases of acute infarction.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for intracranial hemorrhage. Signs and symptoms: Altered mental status status post concussion two months ago with CLL and thrombocytopenia Nonenhanced CT of brain:There is no it is of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. A very subtle area of low attenuation in the right basal ganglia at the level of genu of internal capsule may represent a lacunar infarct of indeterminate age. Please correlate with history and if needed follow-up with an MRI is recommended for detection of acute lacunar infarct.Cortical sulci, ventricular system and all CSF cisterns remain within normal for patient stated age of 77.There is also a small extra-axial collection of CSF density which measures approximately 36 mm in AP axis and 12-mm in thickness at the level of sylvian fissure on the left. This is associated with subtle bony remodeling of calvarium. This finding is believed to represent a small arachnoid cyst and is best appreciated on axial images 15 through 17.

Output: 1.Small low-attenuation in the genuine of right internal capsule may represent a small lacunar infarct of indeterminate age. Please correlate with history and follow-up with an MRI.2.Small extra-axial left temporal arachnoid cyst as detailed.3.Unremarkable CT examination of brain otherwise.


Instruction: Generate impression based on findings.

Input: Clinical question: demyelinating lesions. Signs and Symptoms: optic neuritis/myelitis The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.There is a cystic lesion in the left thyroid gland measuring 4mm diameter. There is a 1 mm cystic lesion present immediately posterior to it.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is no abnormal lesion appreciated within the cervical spinal cord to suggest myelitis.2.There is no compromise of the cervical spinal canal or exiting nerve roots.3.A couple tiny cystic lesions are present in the left thyroid gland. These are nonspecific. Please correlate with patient's clinical history and symptoms.


Instruction: Generate impression based on findings.

Input: 56 show male with osteoarthritis of the knee MENISCI: There is increased signal within the anterior horn of the lateral meniscus near its root with fraying of the free edge, which may represent intrasubstance degeneration or degenerative tearing. There is a complex tear of the posterior horn extending into the body of the medial meniscus with mild medial extrusion of the body of the medial meniscus. A 4 mm parameniscal cyst is present adjacent to the medial meniscal posterior horn.ARTICULAR CARTILAGE AND BONE: There is edema along the far medial tibial plateau and anterior lateral femoral condyle which is likely reactive. There is mild thinning of the articular cartilage in the medial and lateral there is focal full-thickness cartilage loss along the lateral aspect of the trochlea with underlying reactive marrow signal changes. The patellar cartilage is intact without full-thickness cartilage loss. Small tricompartmental osteophytes are present.LIGAMENTS: The ACL and PCL are intact. There is mild fluid surrounding the MCL which may indicate a mild sprain. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The quadriceps tendon as intact. There is mild thickening of the patellar tendon without clear internal signal.ADDITIONAL

Output: 1.Large complex medial meniscal tear.2.Increased signal within the lateral meniscus with fraying of the free edge may represent intrasubstance degeneration or degenerative tearing.3.Mild MCL sprain.4.Mild osteoarthritis.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There is gyriform restricted diffusion and T2 hyperintensity involving the left middle and inferior frontal gyri with mild swelling. There are two additional punctate foci of restricted diffusion and T2 hyperintensity in the left inferior cerebellar hemisphere. There are scattered punctate foci of susceptibility effect in the left superior cerebellar hemisphere, and right frontal periventricular white matter and left middle frontal gyrus, which may represent chronic microhemorrhages. There is periventricular and subcortical nonspecific white matter T2 signal abnormality with additional patchy T2 signal abnormality in the central pons. There is a defect in left basal ganglia. The ventricles and sulci are diffusely prominent suggesting cerebral volume loss. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. MRA BRAIN: The anterior and posterior circulations show no evidence of high-grade steno-occlusive disease or aneurysm. MRA NECK: There is suboptimal depiction of the great vessel origins due to technical factors. Otherwise, the bilateral common carotid arteries, cervical internal carotid arteries, and vertebral arteries are without evidence of high grade stenosis.

Output: 1.Acute nonhemorrhagic cortical infarction involving the left middle and inferior frontal gyri, as well as punctate acute left inferior cerebellar hemispheric infarcts.2.No evidence of significant steno-occlusive disease in the head or neck].3.Chronic left basal ganglia infarct.4.Chronic microvascular ischemic changes as described above.Findings were discussed with Dr. Andrew Beaser (CCU Fellow) over the telephone at 4:06 PM today.


Instruction: Generate impression based on findings.

Input: Again seen is a T2 hyperintense, T1 hypointense, enhancing right paraspinal mass at the L1-L2 level which measures 3.2 x 2.8 x 7.9 cm and unchanged when remeasured on study from 12/3/2014. It completely fills and expands the right L1-L2 neural foramen but does not compress the thecal sac. It causes mild mass effect upon the smaller right kidney and mild remodeling of the right L2 transverse process.There is also unchanged additional enhancing mass in the right paraspinal muscles along the anterior lateral and lateral aspect of the L3 vertebral body which measures approximately 11 mm in thickness previously 10 mm. There is a component involving the right psoas muscle which is also similar. There is mild extension to involve the right lateral aspect of the L3-L4 neural foramen and abut the foraminal/extraforaminal L3 nerve root.There is also no significant change in mass along the right lateral aspect of the T12 vertebral body measuring 9 mm in thickness and approximately 3.7 cm in its long dimension.There is unchanged rightward displacement of the conus with suggestion of a CSF signal intensity rounded filling defect central to the surrounding slightly displaced nerve roots. There is also a thin linear focus of T1 hyperintensity anteriorly at the L2 level in a location where the cauda equina is displaced peripherally. These findings may be related to an arachnoid cyst versus adhesions/mild arachnoiditis.Additionally, there is T1 hyperintensity within the distal filum at the L5 level compatible with fibrofatty infiltration of the distal filum measuring less than 2 mm in thickness. The conus terminates normally at the L1-L2 level.The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is heterogenous but unchanged and may be related to post treatment change. There is an unchanged small central disc protrusion with associated disc desiccation at the L5-S1 level without spinal canal or neural foramen stenosis. Additionally, at L1-L2, there is disc desiccation, mild loss of disc height, and a mild disc bulge without spinal canal stenosis. Minimal narrowing of the right L3-L4 and L4-L5 neural foramina is also noted without clear evidence of impingement.

Output: No significant change in size or appearance of the right paraspinal masses at T12, L1-L2, and L3 levels. Again seen is the L1-L2 mass extending to fill the right L1-L2 neural foramen, where there may be impingement of the right L1 nerve root. The extra foraminal right L2 and right L3 nerve roots are also noted to contact the above mentioned masses.Rightward displacement of the conus which may be related to an adjacent arachnoid cyst or adhesions. Finding is unchanged since at least 12/28/2010.


Instruction: Generate impression based on findings.

Input: Female, 37 years old, history of neurofibromatosis type I with back pain. Thoracic:An area of plaque-like enhancement spanning the right lateral aspect of the vertebral bodies and T10 and T11 is seen. This enhancing tissue enters the right T10-11 neural foramen but does not frankly invade the spinal canal.A small STIR hyperintense nodule along the left anterior paraspinal tissues at T1 is of uncertain significance. Likewise, a tiny STIR hyperintense nodule posterior to the left kidney at the T12 level is of uncertain significance.No other large or significant paraspinal, foraminal or intracanalicular masses are identified in the thoracic region. The visualized spinal cord is unremarkable.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No worrisome marrow signal replacement or enhancement is detected.Minimal degenerative disc disease is seen at T10-11. No significant spinal canal or neuroforaminal stenosis is identified.Lumbar:No convincing evidence of any paraspinal, foraminal or intracanalicular mass is seen. The visualized conus and cauda equina are unremarkable.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No worrisome marrow signal replacement or enhancement is detected.Mild facet arthropathy is evident most notably affecting L3-4 and L4-5. Mild degenerative disc disease is seen with loss of disc T2 signal at lower lumbar levels. No significant spinal canal or neuroforaminal stenosis is detected.

Output: 1.Plaque-like soft tissue thickening along the right aspect of the T10 and T11 vertebral bodies, with involvement of the intervening neural foramen, is suspicious for the presence of a neurofibroma.2.Small paraspinal nodules in the thoracic region as above are of uncertain significance and could represent lymph nodes or neurofibromas.3.No definite evidence of any neurofibroma is seen in the lumbar region.4.No areas of significant spinal canal or neuroforaminal stenosis are detected.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with metastatic lung cancer, EGFR positive, status post SRS, status post four cycles of Erlotinib and MPDL3280A. Also with history of prior surgery for meningioma. A 2 mm focus of enhancement within the right cerebellar hemisphere is unchanged. No other parenchymal enhancing lesions are seen.A small area of nodular and plaque-like extra-axial enhancement is seen at the left anterior clinoid process with tapering extension along the left planum sphenoidale and into the left aspect of the sella and cavernous sinus (see image 15 and image 14, series 1201). This finding is unchanged over both prior MRI examinations.Encephalomalacia of the left inferior frontal lobe is unchanged. Metallic artifact obscures a portion of the left frontal calvarium and left frontal lobe similar to prior.A slitlike fluid space is evident within the left basal ganglia, stable from prior, perhaps simply representing a perivascular space. A few additional scattered small foci of white matter T2 hyperintensity are redemonstrated, nonspecific and unchanged.No parenchymal edema or significant parenchymal mass effect is detected. No intracranial hemorrhage or any abnormal extra-axial collections are seen. The ventricular system is normal in size and morphology.

Output: 1. No significant change is seen in the size of a 2 mm focus of enhancement within the right cerebellum. No new parenchymal enhancing lesions are detected on this exam.2. A region of nodular and plaque-like extra-axial enhancement is seen centered at the left anterior clinoid process with extension along the left planum sphenoidale and into the left sella and cavernous sinus. This lesion has not changed significantly over the two prior examinations and is favored to represent a meningioma. Encephalomalacia within the adjacent left frontal lobe likely relates to prior surgical treatment of this lesion.


Instruction: Generate impression based on findings.

Input: Ms. Loeher is a 44-year-old female with a personal history of Hodgkin's lymphoma and CML along with a family history of breast cancer in her mother. History of bilateral benign breast biopsies (left breast -- 2010 fibroadenoma surgically excised). She has no current breast related complaints. She is enrolled in the research breast cancer screening study for high risk individuals. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate background parenchymal enhancement is noted bilaterally.Right breast: There is no suspicious enhancement seen in the left breast. The previously described subcentimeter enhancement at the 7 o'clock position is not visualized on today's examination. No abnormal lymph nodes are identified in the right axillary region.Left breast: There is no suspicious enhancement seen in the left breast. No abnormal lymph nodes are identified in the left axillary region.

Output: No MRI evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:2/18/1972)Reason: ccm protocol/qsm/permeability 3 t scanner s/p Temporal lobe hemorrhagic cerebrovascular malformation with prior hemorrhage. History: surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is a punctate focus of signal hypointensity in the right cerebellar hemisphere.Since prior exam patient's undergone left-sided craniotomy and cranioplasty for removal of a left temporal lobe lesion known to represent a cerebral cavernous malformation. There is no small focus of encephalomalacia at the surgical site. There is dural thickening and enhancement adjacent to the craniotomy site.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The cerebellar tonsils appear to be low lying.

Output: 1.A previously noted left temporal lobe cerebral cavernous malformation not identified on the current exam. The patient status post left-sided craniotomy and cranioplasty associated with postsurgical change..2.The cerebellar tonsils are low lying


Instruction: Generate impression based on findings.

Input: There is syringohydromyelia throughout the spinal cord extending from the C3 level to the conus that has minimally decreased in diameter. For example, at the level of T5 it measures 3 x 3 mm, previously 2 x 2 mm. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The conus terminates at L1. The paravertebral soft tissues are unremarkable. There is mild dependent atelectasis. The craniocervical junction is unremarkable.

Output: Syringohydromyelia throughout the spinal cord has minimally increased in diameter.


Instruction: Generate impression based on findings.

Input: 57-year-old female with right lower quadrant abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Several hypodense lesions in the liver are incompletely evaluated with this single phase contrast enhanced CT. ultrasound or liver MRI may be helpful for further evaluation. An index lesion in the left lobe measures two by 1.2-cm image number 25 of series number 3.SPLEEN: 1.2-cm cyst in the spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral benign-appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is dilated with thick walls and periappendiceal fat stranding consistent with acute appendicitis. No evidence of abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 4.6 x 3 cm cystic lesion involving the right ovary. Pelvic ultrasound is recommended for further evaluation. Left ovary contains at 1.4 cm cyst.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: Acute appendicitis.Right ovarian cystic mass . further evaluation with transvaginal ultrasound is recommended.Several hypodense lesions within the liver. Their etiology is unknown. Ultrasound or MRI of the liver may be helpful for further evaluation and characterization of these lesions.


Instruction: Generate impression based on findings.

Input: 50 year old female with cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Note is made of a cirrhotic liver morphology. There are linear bands of increased T2 signal abnormality consistent with fibrosis. No focal enhancing mass lesions are identified. No intra-or extrahepatic biliary ductal dilation. Postoperative changes of prior cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple cyst in the interpolar region of the right kidney.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: Cirrhotic liver morphology without evidence of focal mass lesion.


Instruction: Generate impression based on findings.

Input: Biopsy proven invasive carcinoma in the left upper outer breast. Additionally, a stereotactic biopsy of the left breast at a central site showed ADH. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.At the site of known malignancy in the left upper outer breast, the Hydromark biopsy clip is well seen with mild surrounding enhancement measuring up to 8 mm. This probably represents a combination of the residua of the small mass and post biopsy change.In the left central breast at the location of the stereotactic biopsy with pathology resulting in focal ADH, there is focal enhancement with a few foci of enhancement projecting anterior to the biopsy site in a linear distribution. Overall AP extent is about 4 cm. There is also an area of lateral to medial enhancement corresponding to the biopsy track near this site. No abnormal enhancement is seen in the right breast. There are a few scattered enhancing foci in the right breast that appear similar to scattered enhancing foci on the left that are not at the areas described above.No abnormal enlarged lymph nodes are identified in either axillary region. Symmetric small nodes are present. Incidental note of a lipoma within the right serratus anterior is made.

Output: 1. Mild enhancement surrounding the biopsy clip of the known invasive cancer in the left upper outer breast measures up to 8 mm, and could relate to the residua of the mass and post biopsy change. 2. At the site of focal ADH from stereotactic biopsy, there is enhancement with a few linear distribution enhancing foci extending anteriorly. Excisional biopsy should be considered given this appearance and the ADH known from prior biopsy. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Ms. Young is a 28 year old female with personal history of Castleman disease diagnosed at age 20 status post radiation and chemotherapy. Family history of breast cancer in paternal grandmother. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Male, 60 years old, history of L1-2 diskitis with bilateral psoas abscesses. Assess for improvement on IV antibiotics. Redemonstrated is destruction and replacement of the L1-2 disk space with T2 hyperintense signal along with destruction of the adjacent endplates and significant collapse of the L1 vertebral body. Moderate retropulsion of the L1 vertebral body continues to result in narrowing of the spinal canal this level. Findings are not changed since prior. Extension of inflammation into the ventral epidural space at L2 casuses tenting of the dura and some narrowing of the thecal sac, also unchanged.Additional patchy areas of largely T1 hyperintense marrow signal are stable in the remaining vertebral bodies. No new or concerning marrow space lesions are seen.Extensive edema persists within the bilateral psoas musculature. Loculated collections within the right psoas are definitely smaller than on the prior examination. Loculated collections within the left psoas muscle are also probably slightly smaller but the change is less dramatic than on the right.The kidneys are atrophic and contain numerous cysts compatible with renal failure.T12-L1: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.L1-2: Moderate facet hypertrophy and ligamentum flavum thickening. Disk destruction and vertebral body retropulsion result in a moderate generalized canal stenosis with crowding of the cauda equina. The neural foramina are mildly narrowed as well. No significant interval changes. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Prominence of the epidural fat and ventral epidural inflammation as above. Mild thecal sac narrowing. No significant foraminal narrowing. No significant interval changes.L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Prominence of the epidural fat. Mild thecal sac narrowing. No significant neuroforaminal narrowing. No significant interval changes.L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Prominence of the epidural fat. Mild thecal sac narrowing. No significant neuroforaminal narrowing. No significant interval changes.L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. No significant interval changes.

Output: 1. Findings of osteomyelitis diskitis at L1-2 show no significant interval change. This includes destruction of the disk and adjacent endplates with significant collapse of the L1 vertebral body. The overall process results in narrowing of the spinal canal at the L1 and L2 levels which is also unchanged.2. Significant edema persists within the bilateral psoas musculature. However, loculated collections compatible with abscess have significantly improved on the right, with probable mild improvement on the left.


Instruction: Generate impression based on findings.

Input: 42 years Male (DOB: 10/28/1973)Reason: Eval for progression of c-spine stenosis History: cervical radiculopathyPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The cervical vertebral bodies are appropriate in overall alignment and height. There is mild reversal of the normal cervical curvature present.There is a small T2 hyperintense focus in the right hemicord at the C6-7 disc space level which is not readily appreciated on sagittal imaging. It is seen on a single slice and likely represents artifact.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is a left lateral recess disc protrusion present at this level which extends into the left neural foramen at this level and encroaches on the left-sided exiting nerve roots. There are endplate reactive changes present this level. These findings are stable compared to the prior exam.At C4-5 there is no significant compromise to the spinal canal . There is a left lateral broad-based disc protrusion present at this level which extends into the left neural foramen and encroaches on the left-sided exiting nerve roots. There are endplate reactive changes present this level. These findings are stable compared to the prior exam.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a diffuse disc bulge present this level associated with some disc desiccation and mild narrowing of the neural foramina. There are endplate reactive changes present this level. These findings are stable compared to the prior exam.At C6-7 there is no significant compromise to the spinal canal. There is loss of disc space height and disc desiccation and diffuse disc bulge at this level associated with endplate and uncovertebral osteophytes and encroachment of the exiting nerve roots within the neural foramen at this level. There are endplate reactive changes present this level which are high signal on T2 and T1. These endplate reactive changes were not present on the prior exam. The neural foramen encroachment is unchanged compared to the prior exam.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are degenerative changes present in the cervical spine with associated encroachment of exiting nerve roots within the neural foramina bilaterally at C6-7 and on the left side at C5-6. These findings are stable when compared to the prior exam though there are more endplate reactive changes present at C6-7 on the current exam when compared to the previous.2.There is no convincing evidence for demyelinating lesion within the cervical spinal cord on the basis of this exam.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out bleed. Signs and symptoms: Confusion, altered mental status. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal. A very small subtle foci of subcortical -- periventricular low attenuation in the left frontal lobe is noted. There is no associated mass effect or parenchymal volume loss. The finding may represent minimal small vessel disease. Please correlate with history and follow up grade a post infusion CT exam or an MRI is recommended. There are no old studies for comparison.

Output: Small nonspecific foci of left frontal subcortical low attenuation as described. The finding may represent minimal small vessel disease of indeterminate age. Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Multiple CCM: Turner's syndrome, right arm numbness, right foot and leg numbness, nausea/sensitivity to light/migraines, trouble walking, trouble writing, dizziness, vision changes. There is a lesion in the pons with susceptibility effect and patchy enhancement that measures up to 25 mm. There is an associated developmental venous anomaly and left hypertrophic olivary degeneration. There are several other lesions with susceptibility effect ad enhancement, including within the left cerebellar hemisphere, bilateral cingulate gyri, bilateral peripheral frontal lobes, and right parietal lobe, some of which are also associated with developmental venous anomalies. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. A lesion in the pons with susceptibility effect and patchy enhancement that measures up to 25 mm is compatible with a cavernous malformation associated with a developmental venous anomaly and left hypertrophic olivary degeneration.2. Multiple punctate supratentorial and infratentorial lesions are also compatible with cavernous malformations, some of which are associated with developmental venous anomalies.


Instruction: Generate impression based on findings.

Input: 48 year old with plasma cell neoplasm presenting for evaluation of possible amyloidosis. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 228 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 104 ml (normal range 47+/-19), the LV mass index is 54 g/m2 (normal range 85+/-15), and the LV mass is 138 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The T1 times were 1000 ms and lower, including in the basal segments. This is inconsistent with the diagnostic threshold of amyloidosis. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%, the RV end diastolic volume index is 85 ml/m2 (normal range 82+/-16), the RVEDV is 217 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 110 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly enlarged.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 drains normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%. There is no enhancement or prolonged T1 times, thus this study is inconsistent with the diagnosis of amyloidosis. 2. The right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 49%


Instruction: Generate impression based on findings.

Input: CT head 9/10/2015 and 9/10/2013. MRA BRAIN: There is a saccular aneurysm arising from the anterior communicating artery that is inferiorly-directed and measures 9 mm in length, 7 mm in width, and a neck that measures approximately 5 mm in width. There appears to be mild mass-effect upon the prechiasmatic optic nerves. There is no evidence of significant steno-occlusive lesions. The left vertebral artery terminates are the PICA, which is an anatomic variant.MRI BRAIN: There is no evidence of intracranial hemorrhage or acute infarct. There are scattered subcortical and confluent periventricular hyperintensities, which may be nonspecific most likely related to chronic small vessel ischemic changes. The ventricles are unchanged. There is no midline shift or herniation. There are left orbital floor fracture and lamina papyracea blow out fractures associated with enophthalmos. The left maxillary sinus contains mucosal thickening and is smaller in size compared to the right. There is torus palatinus. There is a large lipoma overlying the right occipital scalp, grossly unchanged from previous.

Output: 1. A saccular aneurysm arising from the anterior communicating artery measures up to 9 mm.2. No evidence of acute intracranial hemorrhage or acute infarct.3. Moderate periventricular white matter hyperintensities likely related to chronic small vessel ischemic disease.4. Chronic left orbital floor fracture and lamina papyracea blow out fractures associated with enophthalmos.


Instruction: Generate impression based on findings.

Input: Ms. Nichols is a 60-year-old female presenting for breast cancer screening MRI. BRCA1 positive. Personal history of breast surgery in 1978 and 1981 to remove fibroadenomas. Family history of breast cancer in mom, sister, and paternal grandmother. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.Few scattered foci of enhancement are seen in both breasts, none of which are more suspicious than the rest. There is no abnormal enhancement seen in either breast. No abnormal axillary 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: Headache. Rule out bleed/mass. Areas of high-density line the ependyma of the frontal horns of the lateral ventricles bilaterally with associated edema that crosses the corpus callosum. The lateral ventricles appear enlarged while the third and fourth ventricle are normal in appearance indicating mass effect at the level of the foramen of Monro. There is prominence of the pineal gland. These findings are highly suspicious for lymphoma. A germ cell tumor is in the differential but less likely. An MRI is recommended for further evaluation.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.These findings were discussed with Dr. Glickman at the time of interpretation.

Output: Lateral ventricular enlargement with high density lining the ependyma and edema crossing the corpus callosum is highly suggestive of lymphoma, with a germ cell tumor also in the differential. An MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 13-year-old male with hip pain for 6 months. Evaluate for labral tear. ACETABULAR LABRUM: The acetabular labrum appears intact.ARTICULAR CARTILAGE AND BONE: No articular cartilage defects are identified. There is increased signal abnormality within the right iliac bone about the right sacroiliac joint which is incompletely imaged and characterized on this examination. No additional bone marrow signal abnormality is identified.SOFT TISSUES: The imaged musculature of the right hip is normal in appearance. ADDITIONAL

Output: Bone marrow edema within the right iliac bone, about the right sacroiliac joint, is nonspecific and may represent an occult fracture or stress reaction, although sacroiliitis remains as a differential consideration. Further evaluation with dedicated SI joint radiographs is recommended. No evidence of an acetabular labral tear.


Instruction: Generate impression based on findings.

Input: 62-year-old female with pain and locking. Evaluate for meniscus tear. MENISCI: There is branching linear signal abnormality within the posterior horn of the medial meniscus extending to the body of the meniscus indicating a complex tear, seen on multiple sequential sagittal images. The tear predominantly involves the inner two thirds of the meniscus with fragmentation of meniscal tissue, but does appear to extend to the peripheral one third as well. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There are full-thickness clefts of the articular cartilage of the femoral trochlea, centrally and along its medial facet. There is perhaps mild degeneration of the articular cartilage of the medial facet of the patella, but this is equivocal. There is full-thickness degeneration of the articular cartilage of the medial femoral condyle above and anterior to the posterior horn of the medial meniscus. There is also moderate degeneration of the articular cartilage along the posterior aspect of the medial femoral condyle with subchondral cyst formation. There are small cysts within the posterior aspect of the tibia, near the attachment of the posterior cruciate ligament, which are not necessarily of any clinical significance.LIGAMENTS: The anterior cruciate ligament is markedly thinned, and on the sagittal images is indistinct, compatible with a chronic tear, although we suspect some fibers extend from the femur to the tibia based on evaluation of the ligament in all 3 planes. There is band-like low signal intensity extending along the intercondylar eminence which may represent torn ACL fibers or less likely a displaced meniscal fragment. The PCL, MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the medial meniscus.2. Cartilage degeneration as described above.3. Poor visualization of the anterior cruciate ligament on sagittal images with thinning of the ligament on the remaining pulse sequences suggestive of a chronic tear.4. Mild pes anserine bursitis and moderate size joint effusion.


Instruction: Generate impression based on findings.

Input: 54 year old male with history of atrial fibrillation s/p 2 ablations, recurrent atrial fibrillation; scheduled for repeat ablation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%. The LVEDV is 119 ml (normal range 142+/-34), the LV end diastolic volume index is 53 ml/m2 (normal range: 74+/-15), the LVESV is 53 ml (normal range 47+/-19) and the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9). The LV mass is 176 g (normal range 164+/-36) and the LV mass index is 78 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no LV thrombus. Left AtriumThe left atrium is normal in size. All four pulmonary veins drain normally into the left atrium. There is additionally a right middle pulmonary vein. The dimensions are as below. The esophagus runs posterior to the left superior and inferior pulmonary veins and also near the ostium of the right inferior pulmonary vein. No obvious left atrial appendage thrombus is noted. Left atrial volume: 53mlLeft superior pulmonary vein: 15x13mmLeft inferior pulmonary vein: 23x15mmRight superior pulmonary vein: 12x11mmRight middle pulmonary vein: 8x10mmRight inferior pulmonary vein: 16x12mmRight VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%. The RVEDV is 146 ml (normal range 142+/-31), RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVESV is 71 ml (normal range 54+/-17), and the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is 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 ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left atrial size.2. Pulmonary vein anatomy as above. Specifically a right middle pulmonary vein with relatively small ostium is noted.3. Esophagus located posterior to left superior and inferior pulmonary veins but also posterior to right inferior pulmonary vein. 4. Normal left ventricular size and systolic function (LVEF 56%)5. Normal right ventricular size and systolic function (RVEF 51%)6. Image quality was somewhat limited due to patient difficulty with lying still and also with breath holds.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Disorder of brain, unspecifiedClinical question: Preoperative planning for biopsy of intracranial massSigns and Symptoms: weakness There is a 17x20 mm axial dimension ring enhancing mass present in the left parietal lobe subcortical white matter. There is marked amount of vasogenic edema. There is mass effect associated with the vasogenic edema with compression of the right lateral ventricle and sulcal effacement There is a 9mm focus of contrast enhancement located in the posterior aspect of the left insular cortex.The ventricles are enlarged. There are periventricular confluent and patchy white matter T2 and FLAIR signal hyperintense lesions of a mild to moderate degree. There are patchy signal T2/FLAIR signal hyperintense foci in the brainstem.Normal vascular flow voids are present in the distal carotid arteries, the left vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery flow void is not readily appreciated.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.Examination was performed for purpose of stereotactic guidance during surgery. It is therefore limited exam. Overall there is no significant change when compared to the previous exam2.There is a left parietal lobe ring enhancing mass present associated with minor hemorrhage and diffusion restriction. Differential considerations include infection (abscess) as well as neoplasia (metastasis or possibly primary brain tumor).3.There is a hemorrhagic lesion along the posterior aspect of the left insular cortex.4.Marked ventriculomegaly. The possibility of normal pressure hydrocephalus cannot be excluded. Alternatively this could represent communicating hydrocephalus. 5.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 6.Lesions in the brainstem are most likely vascular related.


Instruction: Generate impression based on findings.

Input: H/o breast cancer. Examination demonstrates a focal hypodensity lateral to the left insular fissure, corresponding a metastatic lesion on the previous MRI. The brain is otherwise normal in attenuation and morphology. There is no intracranial hemorrhage, mass effect, edema, midline shift or abnormal extra-axial fluid collection.There is a focal area of lytic change in the left frontal bone. The visualized paranasal sinuses are well cells are normally pneumatized.

Output: 1. Left temporal metastatic lesion. An infused exam is suggested for further evaluation. 2. Metastatic lesion in the left frontal bone.


Instruction: Generate impression based on findings.

Input: Pain in leg with negative response to physical therapy. Negative compartment test and normal radiographs. Reevaluation of the right lower leg is again observed without abnormality in the field-of-view. Distortion and limited evaluation of the most proximal aspect and knee, however this area was recently evaluated on an alternate exam. In particular the soft tissues and muscular compartments are normal throughout the study. Specifically no abnormal fluid collections or signal abnormality. No abnormal areas of enhancement.The osseous structures are also intact and unremarkable. Marrow signal is normal throughout. Visualized portions of the tendons and insertions are unremarkable. Vasculature is also unremarkable, however please correlate with recent prior MR and MRA exam given greater sensitivity.

Output: Normal


Instruction: Generate impression based on findings.

Input: Left thigh mass Note that a vitamin E marker was placed along the lateral aspect of the thigh which represents the area of palpable abnormality.There is no evidence of mass or abnormal signal/enhancement in the region of concern. The underlying vastus lateralis muscle is normal in caliber and signal. Within the superior portion of the rectus femoris is an ill-defined area of low T1/T2 signal intensity measuring approximately 2.1 x 1.2 x 4.5 cm in the greatest transaxial and craniocaudal dimensions. There is minimal enhancement and increased T2 signal surrounding this focus within the rectus musculature at this level. There is no discrete mass and no additional enhancing foci.

Output: 1. No evidence of mass or abnormal enhancement within the region of interest along the lateral thigh.2. Ill-defined area of low T1/T2 signal within the anterior rectus femoris superiorly. There is a mild amount of enhancement following contrast administration however this is nonspecific in nature and there is no discrete mass lesion. The significance of this finding is unclear and may be unrelated to the current clinical question but may represent an intramuscular hemangioma or other vascular lesion.


Instruction: Generate impression based on findings.

Input: 43 year old woman with PH, RHF, referred for evaluation of underlying infiltrative disease or fibrosis. Left VentricleThe left ventricle is small in size with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 45 ml/m2 (normal range: 65+/-11), the LVEDV is 91 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 50 ml (normal range 31+/-10). LV dysfunction is global. There is septal flattening consistent with elevated RV pressures.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is enlarged with severely reduced systolic function. The overall RV ejection fraction is 23%, the RV end diastolic volume index is 87 ml/m2 (normal range 69+/-14), the RVEDV is 175 ml (normal range 110+/-24), the RV end systolic volume index is 67 ml/m2 (normal range 22+/-8), and the RVESV is 136 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There at least moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a psuedo-bovine 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 small pericardial effusion.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. The left ventricle is small in size with mildly reduced systolic function. The overall LV ejection fraction is 45%. LV dysfunction is global. There is septal flattening consistent with elevated RV pressures.2. Delayed enhancement imaging was not able to be obtained today due to contrast extravasation at IV insertion site. Recommend repeat administration/imaging in following day when better IV access available.3. The right ventricle is enlarged with severely reduced systolic function. The overall RV ejection fraction is 23%. RV dysfunction is global.4. Severe right atrial dilation.5. At least moderate tricuspid regurgitation.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for right paramedian HNP explain right radicular symptoms. Signs and symptoms: Right radiating leg pain. Nonenhanced lumbar MRI:T11 -- T12 is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 demonstrate minimal bilateral facet effusion/fluid signal intensity and unremarkable otherwise.L2 -- L3 demonstrate mild disk desiccation, moderate right and mild left ligamentum flavum hypertrophy and mild (right greater than left) facet hypertrophic changes. There is no spinal stenosis. However a symmetric right-sided hypertrophic changes of posterior elements results in moderate right neural foraminal compromise.L3 -- L4 demonstrate moderate disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy, mild left facet effusion. There is a central and right-sided broad-based disk protrusion with resultant mass-effect and posterior displacement of the right exiting nerve root within the lateral aspect of the spinal canal however without extension into the right neural foramina. This finding also results in moderate central spinal stenosis. Patent left neural foramina.L4 -- L5 demonstrate moderate disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is no evidence of central spinal stenosis in the AP axis however mild decrease caliber of thecal sac secondary to mass effect by hypertrophied ligamentum flavum is noted. There is no central spinal stenosis however mild compromise of the lateral recess of the canal bilaterally is noted.L5 -- S1 demonstrate minimal degenerative disk disease, mild bilateral facet and ligamentum flavum hypertrophy. There is a central and left lateral and far lateral broad-based disk protrusion which results in moderate left neural foraminal compromise. Mild right neural foraminal compromise is also present.

Output: 1.At L3 -- L4 there is a central and rightward broad based disk protrusion with resultant mass-effect and posterior displacement of the exiting right nerve root at this level and moderate central spinal stenosis.2.At L5 -- S1 there is a shallow broad-based disk protrusion on the left and extending far laterally with resultant moderate left neural foraminal compromise without central spinal stenosis.3.At L4 -- L5 there is mild decreased caliber of thecal sac in transverse axis secondary to ligamentum flavum hypertrophy changes.4.Please see above comments per level for degenerative disk disease, hypertrophic changes of posterior elements including facet effusion.


Instruction: Generate impression based on findings.

Input: H/o AML. S/p intrathecal methotrexate. There is a redemonstration of bilateral hemispheric subcortical and white matter edema. In comparison with prior brain MRI, the extent of the edema has been grossly unchanged. A right frontal Omaya catheter is in place with its tip in the left lateral ventricle. Air is present in bilateral frontal horns. There is no intracranial hemorrhage, mass, midline shift or abnormal extraaxial fluid collection. The ventricles are normal in volume and are symmetric. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Grossly stable subcortical and white matter edema likely represent drug related change in light of clinical history provided.


Instruction: Generate impression based on findings.

Input: 81-year-old male with 1.4 cm lesion in the pancreatic body. ABDOMEN: Limited examination due to respiratory motion.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Redemonstrated is a T2 hyperintense cystic lesion in the body of the pancreas measuring 7 x 7 mm with communication to the main pancreatic duct, previously 11 x 8 mm, compatible with a side branch type IPMN. Main pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense lesions within bilateral upper poles are unchanged, compatible with cysts, minimally complex on the left. There is no hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stabilization hardware at lower lumbar spine, incompletely imaged.OTHER: No significant abnormality noted.

Output: 1.Relatively stable to slight decrease in size of a cystic lesion compatible with a side branch type IPMN in the body of the pancreas.


Instruction: Generate impression based on findings.

Input: 72 years, Female, progressive left-sided weakness. Evaluate for CNS demyelinating disease.. Brain: There are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter which have slightly increased in number since prior study from 6/11/2009. For example, T2 hyperintense lesion in the right parietal periventricular white matter, coronal T2 image 22, is not definitively seen previously. Patchy left posterior frontal deep white matter hyperintensity, axial FLAIR image 20, also not definitively seen previously. No restricted diffusion to suggest acute ischemia. No evidence of hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are grossly within normal limits. Thoracic spine: There is subtle T2 hyperintensity involving the left ventral aspect of the cord at the T12 level (axial T2 image 7, sagittal T2 image 8 and sagittal STIR image 8) which has decreased in prominence when compared retrospectively to prior lumbar spine MRI dated 6/21/2013. There is also a subtle T2 hyperintensity involving the left dorsal aspect of the cord at the T9 level (axial T2 image 22, sagittal T2 image 8 and sagittal STIR image 8). There is otherwise no large lesion in the thoracic cord or evidence of cord edema. Cord parenchymal volume also appears grossly maintained.Thoracic vertebral body heights are maintained. Alignment is maintained. Bone marrow signal is benign with no suspicious lesions. Scattered foci of T1 hyperintensity in the vertebral bodies are compatible with foci of fat or hemangiomas. There is tubular soft tissue in the midline extending inferiorly from the T12-L1 to the mid L1 levels which likely represent a central disc extrusion with inferior migration, and slightly decreased in size since prior lumbar spine MRI from 6/21/2013. There is no significant spinal canal or foraminal stenosis.

Output: 1. No recent prior brain MRIs available for comparison. There are multiple T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter which have slightly increased in number since brain MRI from 6/11/2009. No abnormal enhancement. These lesions are nonspecific with differentials including prior inflammation, demyelination, as well as ischemia. 2. Subtle, nonenhancing T2 hyperintense lesions in the thoracic cord at the left T9 and T12 levels which may represent chronic demyelinating plaques. The T12 lesion is decreased in prominence since prior lumbar spine MRI dated 6/21/2013 compatible with evolution. No significant spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 69-year-old male with pain. Evaluate for rotator cuff tear. ROTATOR CUFF: Intermediate to high signal intensity is noted within the supraspinatus tendon with laxity of the fibers indicating a partial thickness tear. The remaining rotator cuff tendons appear normal. There is mild fatty atrophy of the supraspinatus and infraspinatus muscles. The subscapularis and teres minor muscles appear normal. SUPRASPINATUS OUTLET: Moderate osteoarthritic changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate osteoarthritic changes affect the glenohumeral joint, which is otherwise in anatomic alignment. There are subchondral cysts in the humeral head.BICEPS TENDON: The long head of the biceps tendon appears normal.ADDITIONAL

Output: 1. Findings compatible with a partial-thickness tear of the supraspinatus tendon.2. Mild fatty atrophy of the supraspinatus and infraspinatus muscles.3. Osteoarthritic changes affect the glenohumeral and acromioclavicular joints.


Instruction: Generate impression based on findings.

Input: 35-year-old male with continued pain in shoulder after subacromial injection and physical therapy. ROTATOR CUFF: The supraspinatus, infraspinatus, and teres minor muscles and tendons appear normal. There is a small, 4-mm focus of increased signal intensity at the insertion of the subscapularis tendon on the lesser tuberosity, compatible with tendinosis or perhaps a tiny insertional tear. Additional linear increased signal intensity along the subscapularis myotendinous junction is compatible with additional mild tendinosis or mild interstitial tearing. The subscapularis muscle otherwise appears normal.SUPRASPINATUS OUTLET: There is mild capsular hypertrophy along the undersurface of the acromioclavicular joint, as well as a small spur along the distal aspect of the clavicle. However no fluid in the subacromial or subdeltoid bursae is present.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. No joint effusion is present. There is a small paralabral cyst along the anterior-inferior labrum that we suspect arises from a small nondisplaced tear of the underlying labrum. The significance of this finding is uncertain. The remainder of the labrum is normal within the limitations of a non-arthrogram study. BICEPS TENDON: Tendon of the long head of the biceps appears normal.

Output: 1.Tendinosis and/or small tears involving the subscapularis tendon. Remainder of the rotator cuff appears normal.2.Probable small nondisplaced anteroinferior labral tear associated with a small parameniscal cyst.3.Other findings as above.


Instruction: Generate impression based on findings.

Input: Reason: r/o meniscal or ligamentous injury History: pain Due to to the patient's body habitus, a high-resolution coil could not be used. An alternative coil was used instead resulting in suboptimal image quality.MENISCI: There is enlargement of the body of the lateral meniscus with intrasubstance increased signal intensity indicating mucoid degeneration. This mucoid material extends through the peripheral fibers of the meniscus into the adjacent soft tissues resulting in a parameniscal cyst that extends along the periphery of the body and posterior horn of the lateral meniscus. Relatively mild intrasubstance degeneration is noted within the posterior horn of the medial meniscus. Despite the degree of intrasubstance degeneration, we see no definite communication with the articular surface. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: We see no articular cartilage defects. There is slight lateral translation of the patella relative to the femoral trochlea. Bone marrow signal intensity is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons appear intact. The tibial tuberosity trochlear groove distance measures 19 mm, which is borderline abnormal. The Insall-Salvati ratios is within normal limits.

Output: 1. Extensive mucoid degeneration of the body of the lateral meniscus with parameniscal cyst formation, although we see no definite extension to the articular surface.2. Borderline elevated tibial tuberosity trochlear groove distance with slight lateral translation of the patella.