Instruction: Generate impression based on findings.

Input: Headache, back pain, and lower extremity weakness. History of IV drug use and HIV. Brain: There is no evidence of abscess, intracranial hemorrhage, or acute infarct. There are a few scattered foci of nonspecific T2 hyperintensity in the cerebral white matter. There are small globular extra-axial areas of low T2 and high T1 signal with susceptibility effect along the frontoparietal convexity, adjacent to the superior sagittal sinus. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Lumbar Spine: There is no evidence of epidural abscess in the lumbar spine. There has been interval evolution of the bone marrow signal in the L4 and L5 vertebrae, with predominantly fatty marrow characteristics. There is extensive irregularity of the inferior L4 and superior L5 endplates. There is minimal fluid signal within the intervening disc space. There is underlying degenerative spondylosis at L4-5 and L5-S1, with mild bilateral L4-5 neural foraminal stenosis and at least moderate bilateral L5-S1 neural foraminal stenosis, but no significant spinal canal stenosis. There has been interval evolution of the bone marrow signal in the left sacrum and iliac bone, with predominantly fatty marrow characteristics and persistent irregularity of the left sacroiliac joint. The lumbar spine alignment is nearly anatomic. The imaged portions of spinal cord and cauda equina appear unremarkable.

Output: 1. No evidence of intracranial abscess or acute infarct. Small globular extra-axial areas of low T2 and high T1 signal with susceptibility effect along the frontoparietal convexity, adjacent to the superior sagittal sinus may represent dural ossification versus less likely subarachnoid hemorrhage. A head CT may be useful for follow up. 2. Sequela of prior discitis-osteomyelitis at L4-5 with considerable irregularity of the adjacent endplates, but no evidence of epidural abscess.3. Degenerative spondylosis at L4-5 and L5-S1, with mild bilateral L4-5 neural foraminal stenosis and at least moderate bilateral L5-S1 neural foraminal stenosis, but no significant spinal canal stenosis. 4. Sequela of prior left sacroiliitis.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain and spinal cord. Cerebral infarction. Altered mental status. Cerebral artery occlusion. MRI of the brainThere is diffusion restriction involving both left and right middle cerebral artery territories with more prominent FLAIR abnormality in the right MCA territory. Most of the MCA territory on each side is involved however, there are some exceptions. The right basal ganglia are involved whereas the left basal ganglia are relatively spared. The right anterior temporal artery territory is involved whereas the left anterior temporal artery territory is relatively spared. There is more involvement of the left orbital gyrus and left middle frontal gyrus than the right orbital gyrus and right middle frontal gyrus.There is 41x31nm axial dimension focus of diffusion restriction with greater FLAIR signal hyperintensity than those in the MCA territories centered in the left fusiform gyrus but involving adjacent brain in the occipital lobe.There are multiple punctate foci of diffusion restriction in the cerebellar hemispheres.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The patient is status post posterior fossa craniotomy with a mesh placement for removal of a fourth ventricular mass. There is some FLAIR signal hyperintensity in the medulla adjacent to the tumor bed. There is a fluid collection 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 and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Flow voids of the MCAs are not readily identified.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are opacified. The patient is status post intubation. The visualized portions of the orbits are intact.Patient motion degrades the exam.MRA brain:There is occlusion of the right and left MCA at their origins.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is obscured by artifact. The left posterior communicating artery is medium size. The right posterior cerebral artery has fetal origin. The right p1 segment is large. The left vertebral artery is larger than the right vertebral artery. Left PICA is dominant. Right AICA is dominant.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the right carotid bifurcation. Findings raise the question of (but do not confirm) partially occlusive intraluminal thrombus at the left internal carotid artery origin with 70% stenosis by NASCET criteria. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Bilateral MCA territory acute cerebral infarctions (right more extensive than left as detailed above). There are findings suggesting the right MCA territory infarction preceded the left MCA territory infarction.2.Bilateral MCA proximal occlusions. (Given that the left MCA occlusion is more proximal than the territories involved would imply it is suspected that further progression of the left MCA territory infarction may occur.)3.Subacute infarction in the left occipital lobe (posterior circulation)4.Multiple punctate foci of acute or subacute infarction in the cerebellum.5.Findings raise the question of (but do not confirm) partially occlusive intraluminal thrombus at the left internal carotid artery origin with 70% stenosis by NASCET criteria. An ultrasound or CTA may be helpful to help confirm or assess further.6.Status post recent posterior fossa surgery for removal of a mass. Although no residual mass is identified, a contrast enhanced exam would be more sensitive for its detection. Additionally, motion artifact could obscure a subtle residual tumor. There is a fluid collection at the craniotomy site.7.Exam is degraded by patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: Eval for MS vs Transverse myelitis History: b/l LE numbness after travel to puerto rico Brain MRIThere scattered FLAIR/T2 high signal intensities at bilateral corpus callosum, bilateral frontal white matter (left more than right) and the left temporal periventricular white matter. The lesion is somewhat perpendicular toward the axis of corpus callosum suggesting possible demyelinating lesions such as multiple sclerosis.There is however patchy enhancement at the left hippocampus especially at the hippocampal head and amygdala with subtle increase in T2 signal intensity but no particular abnormal signal intensity seen on FLAIR. On gradient echo image, the lesion shows susceptibility artifacts indicating blood products within the lesion. There is no definitive mass formation on this scan, nor mass effects toward surrounding structures. Constellation of above findings suggest diagnostic possibility of capillary telangiectasia. Possibility of cavernous malformation may need to be excluded but low possibility. Other possibilities such as tumorous condition or gliotic changes are unlikely. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Whole spine MRIThere is focal T2/STIR high signal intensity lesion of spinal cord especially dorsal column area at the level of C5 which does not show any evidence of enhancement. There is another T2 high signal intensity lesion at the level of T5 with evidence of subtle enhancement but without evidence of local mass effects indicating possible active multiple sclerosis plaque.Other areas of spinal cord appear to be normal.The cervical spine shows subtle kyphotic angulation at the level of C34 with diffuse minimal bulging of disc at the level of C34 and C45.There is no evidence of spinal canal stenosis. No neuroforaminal stenosis at Cervical, Thoracic and Lumbar spines.

Output: 1. Multiple FLAIR/T2 high signal intensity lesions at bilateral white matter indicate possible diagnosis of multiple sclerosis.2. Multifocal (C5 and T5 level) spinal cord T2/STIR high signal intensity lesions suggesting spinal cord involvement of multiple sclerosis. The T5 lesion shows enhancement implying possible active lesion.3. Enhancing lesion with susceptibility artifacts at the left hippocampus head, indicating possible diagnosis of capillary telangiectasia.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: There is small near full-thickness to full-thickness tear of the distal fibers of the supraspinatus upon its insertion upon the greater tuberosity. This is superimposed upon diffuse tendinopathy. The remaining rotator cuff tendons are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. A trace amount of fluid is noted in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Within the limits of a non-arthrographic exam, there is no evidence of gross labral detachment. A small amount of fluid is noted within the subcoracoid recess with a possible small loose body.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Small near full-thickness to full-thickness tear of the distal insertional fibers of the supraspinatus tendon. The remaining rotator cuff tendons are intact.2. Osteoarthritis of the acromioclavicular joint with possible small loose body in the subcoracoid recess.


Instruction: Generate impression based on findings.

Input: Reason: patient w/ ulcer on left great toe, elevated inflammatory markers, eval for osteomyelitis. History: toe ulceration Evaluation is limited due to patient motion artifact. There appears to be bandage material along the medial aspect of the forefoot. There is abnormal signal intensity within the medial soft tissues of the forefoot extending to the great toe and also extending along the dorsal and plantar aspect of the first MTP joint, likely reflecting a combination of edema and scar tissue. This has perhaps progressed slightly beneath the first MTP joint, with what appears to be additional soft tissue ulceration. There is a chronic appearing erosion along the medial aspect of the first metatarsal head that was present on the prior MRI examination and is nonspecific. There is a bipartite medial sesamoid bone, but we see no imaging features to suggest acute osteomyelitis. There is a hallux valgus deformity with osteoarthritis of the first MTP joint and interphalangeal joint of the great toe. We see no fluid collection to suggest abscess formation. There is atrophy of the musculature of the foot.

Output: Limited evaluation due to patient motion artifact. Soft tissue ulceration and subcutaneous signal changes likely reflecting a combination of inflammation and scarring with chronic erosion of the first metatarsal head, but no findings to suggest acute osteomyelitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: History of olfactory neuroblastoma treated with surgery and CRT. There are postoperative findings related to sinonasal surgery and bifrontal craniotomy. There is unchanged diffuse enhancement within the obliterated frontal sinus bed and along the right fovea ethmoidalis. There is unchanged minimal distortion of the right medial rectus muscle, which may be due to scar tissue formation. Otherwise, the orbital contents are unremarkable, without evidence of mass lesions. There is also scattered mucosal thickening and enhancement within the remaining portions of the paranasal sinuses and secretions within the left sphenoid sinus. There is also fluid within the left sphenoid sinus. The right pterygopalatine fossa, foramen rotundum, Vidian canal, and foramen ovale appear intact. The left orbit is unremarkable. There is mild encephalomalacia in the bilateral straight gyri.

Output: 1. Post-treatment findings in the sinonasal region without convincing evidence of recurrent olfactory neuroblastoma.2. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: Male, 40 years old. Polyneuropathy. H/O cutaneous amyloid. There is mild to moderate muscle atrophy diffusely which more prominently affects the gluteus musculature and appears to be symmetric bilaterally. Otherwise, the soft tissue structures of the right thigh are unremarkable, without soft tissue edema, solid mass lesion, or discrete fluid collection. The imaged neurovascular structures are grossly intact. The underlying osseous structures are unremarkable, with normal cortical thickness and marrow signal. Nondedicated images of the right hip are grossly unremarkable.

Output: Bilateral muscle atrophy without other significant MR abnormality to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 26-year-old BRCA1-positive woman enrolled in a MRI screening study. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a subcentimeter cyst in the right breast 12:00 position.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: Subcentimeter cyst in the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 49-year-old female with right shoulder pain. Rule out rotator cuff tear. ROTATOR CUFF: There is a partial thickness undersurface tearing of the anterior fibers of the supraspinatus tendon at the level of its insertion on the greater tuberosity, involving greater than 50% of the tendon width, measuring approximately 15 mm in the AP dimension, without significant retraction. There is interstitial tearing of the infraspinatus tendon proximal to its insertion on the greater tuberosity. There is thickening and intermediate signal abnormality of the supraspinatus suggestive of mild to moderate tendinosis. The subscapularis and teres minor muscles and tendons appear intact. SUPRASPINATUS OUTLET: Mild degenerative changes affect the acromioclavicular joint. No significant fluid is identified within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate degenerative changes affect the glenohumeral joint with subchondral cyst formation. There is heterogeneity and increased intermediate signal abnormality within the anterior glenoid labrum suggestive of degenerative tearing. Note is made of subchondral cyst formation within the humeral head. No large glenohumeral joint effusion is evident.BICEPS TENDON: There is circumferential fluid within the tendon sheath of the long head of the biceps which may reflect fluid extension from the glenohumeral joint versus a very mild tenosynovitis. ADDITIONAL

Output: Rotator cuff tearing involving the supraspinatus and infraspinatus tendons as described above. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Cirrhosis. Hepatolithiasis with secondary biliary fibrosis. ABDOMEN:LIVER, BILIARY TRACT: Mildly cirrhotic morphology.No focal liver lesion.Demonstrated again is mild central intrahepatic ductal dilatation, greater on the left with narrowing near Klatskin's point. Mild wall thickening of the common bile duct near the porta hepatis, unchanged. No focal lesion.No cholelithiasis or choledocholithiasis.The vessels are patent.SPLEEN: Stable borderline splenomegaly. Stable small splenic cyst anteriorly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic mass.2.Stable mild intrahepatic biliary ductal dilatation without a focal lesion. No hepatolithiasis or choledocholithiasis.


Instruction: Generate impression based on findings.

Input: Frequent headaches. There is a partially empty sella. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal mucosal thickening in the paranasal sinuses.

Output: A partially empty sella may be a manifestation of pseudotumor cerebri. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Clinical question: History of pituitary cyst. Signs and symptoms: Surveillance scan. Pre-and post-enhanced pituitary MRI:Examination demonstrate a mass within the sella with solid and cystic components without significant change since prior exam. There is resultant enlargement of the sella similar to prior study. The solid component of mass demonstrate enhancement and there is no detectable enhancement of cystic portion of tumor. There is extension of tumor superiorly into the basal cistern and is in contact with the optic chiasm with resultant subtle elevation of the chiasm. This appearance is also similar to prior study. The pituitary stalk demonstrate normal caliber and terminates along the left paramedian dome of the pituitary mass similar to prior exam.Cavernous sinuses demonstrate normal signal intensity and pattern of enhancement.

Output: 1.Partially solid enhancing and partially cystic nonenhancing pituitary mass with resultant expansion of sella and extension into the basal cisterna with subtle elevation of chiasm remains stable since prior exam. No evidence of extension into the cavernous sinuses.


Instruction: Generate impression based on findings.

Input: History of pancreatic cyst. 03/24/2015 EGD/EUS FNA Non-diagnostic. EGD/EUS on 6/19/2014 with a 3 x 2 cm pancreatic tail cyst without worrisome sonographic findings except for size (no mural nodules no wall thickening). Cytology negative, cyst fluid CEA low 3.4, fluid amylase high 444,400. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Bilobed/septated lesion in the distal pancreatic body measures 1.8 x 1.2 cm (series 5/53), compared to 1.8 x 0.6 cm previously. Enhancing thin-walled septations are present. Demonstrates no solid internal or mural enhancement. The remainder of the pancreas is unremarkable. It does not appear to communicate with the main pancreatic duct which is located anteroinferior to the lesion. The duct is normal in caliber. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval increase in size of the bilobed/septated pancreatic tail cystic lesion. Mild thin-walled enhancement of the septations. No internal mural nodularity or solid enhancement. The appearance is similar to the 2013 MRI, prior to FNA. The lesion does not distinctly appear to communicate with the normal caliber main pancreatic duct. Given the patient's age and the interval increase in size a cystic neoplasm, specifically a mucinous neoplasm should also be considered in addition to an IPMN.


Instruction: Generate impression based on findings.

Input: 87-year-old woman with history of pancreatic mass on CT. ABDOMEN:LIVER, BILIARY TRACT: Scattered foci of calcification are seen in the liver, otherwise the liver is normal in signal and morphology. The gallbladder appears and there is no intra or extra hepatic biliary ductal dilatation.SPLEEN: The spleen appears normal.PANCREAS: Within the tail of the pancreas (series 3, image 11) there is a lobulated 39 x 32 mm, T2 hyperintense lesion with thin, mildly enhancing septae. The majority of these fluid locules are homogenous in signal intensity on both T2 and T1 sequences and similar in signal intensity to one another on T1 and T2 sequences. There is a similar lesion seen in the neck of the pancreas (series 3, image 8) measuring 14 x 14 mm. Finally, there is a subcentimeter area of T2 hyperintense signal in the body of the pancreas (series 3, image 12). The latter lesions appear to communicate with the pancreatic duct which is nondilated. The larger size of the lesion located in the pancreatic tail makes assessment for a definitive connection to the pancreatic duct difficult. The distal pancreatic parenchyma is normal without atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts are noted, the largest of which is a right midpole cyst measuring 47 x 46 mm (series 9, image 9).RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Corresponding to lesion seen on earlier CT is 39 mm lobulated pancreatic tail lesion containing enhancing septations. Additional smaller pancreatic head and body lesions seen that appear to communicate with the pancreatic duct are seen, consistent with sidebranch IPMNs. The larger size of the pancreatic tail lesion makes definitive identification of a pancreatic ductal connection difficult. However, given the lobulated and multicystic appearance of the dominant lesion and the presence of sidebranch IPMNs elsewhere, another sidebranch IPMN is favored. Although the location is atypical, a serous cystic neoplasm is another differential consideration.


Instruction: Generate impression based on findings.

Input: Biopsy proven right breast foci of ADH diagnosed in January 2014. History of breast cancer in paternal grandmother and maternal great aunt. Mild parenchymal enhancement is noted bilaterally. Heterogeneous fibroglandular densities are present bilaterally.Right breast: In the lateral aspect of the right retroareolar region, multiple ring enhancing masses are present, corresponding to calcifications seen on mammography. In addition, a discrete 6-mm enhancing mass is present in the mid depth of the right breast at 9 o'clock. MRI directed ultrasound of the right retroareolar region and right 9 o'clock position is recommended for further evaluation. No abnormal enhancement is present at the site of biopsy proven ADH.Left breast: Two discrete low suspicion enhancing masses are present in the left breast, one in the left upper outer quadrant measuring 8 mm in diameter. The second lesion is located inferior and posterior to the larger lesion measuring 5 mm in diameter. MR directed ultrasound of both of these lesions is also recommended.No abnormal axillary lymph nodes are identified in either axillary region.

Output: Multiple bilateral enhancing masses, the most suspicious in the right retroareolar region. MR directed bilateral breast ultrasound is recommended for evaluation. Any suspicious ultrasound findings could be biopsied under ultrasound guidance.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: 47-year-old female with a history of large B cell non-Hodgkin's lymphoma status post 6 cycles of chemotherapy. Evaluate left scapula mass/lesion. There is heterogeneous signal abnormality affecting the scapula. Again seen is deformity and fragmentation of the scapula, particularly along the inferior and medial aspect of the glenoid, consistent with the patient's history of osseous destruction complicated by pathologic fracture. Note is made of a 9 mm focus of pathologic enhancement along the lateral border of the body of the scapula suspicious for residual osseous disease (image 15; series 15). Additionally, note is made of multiple subcentimeter foci of enhancement within the subscapularis muscle belly which are also suspicious for residual tumor/disease. There is a 3.1 x 1.8 x 2.7 cm left axillary mass/lymphadenopathy with thin peripheral enhancement. There is nonenhancing increased signal abnormality within the deltoid, subscapularis, supraspinatus, and infraspinatus which is nonspecific and may reflect post therapy change versus subacute denervation. The visualized musculature is otherwise within normal limits. There is a small amount of fluid within the glenohumeral joint with associated thick enhancement suggesting a synovitis.

Output: Enhancing scapular lesion suspicious for residual osseous disease as described above. Persistent left axillary mass as well as enhancing foci within the subscapularis muscle which are also suspicious for residual disease. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 4 month old female, ex-32 weeker, with history of hypothalamic, tectal and fourth ventricle masses and congenital hydrocephalus for follow up. There is interval resolution of pneumocephalus within the frontal horns and the previously identified post-surgical changes. There is a right frontal approach ventriculostomy catheter placement, with tip near the foramen of Monro just to the right of midline. There is significant interval decrease in dilatation of the lateral ventricles. The third and lateral ventricles appear normal in size. There is interval decrease in the prominence of subarachnoid space along the medial occipital lobes bilaterally. There is mild prominence of the subarachnoid spaces along the bilateral frontal lobes. There are foci of susceptibility artifact in the ventricles, particularly the occipital horns and right temporal horn.There is interval enlargement in T2 hypointense mass along the right lateral aspect of the vermis (image 20, series 901) with associated subtle diffusion restriction, which measures approximately 18 x 15 mm, previously 11 x 7 mm. There is no associated enhancement. There is again distortion of the contour of the posterior right cerebellum, with asymmetric prominence of the extra-axial space posteriorly.There is redemonstration of a subtle mass along the ventral aspect of the lower tectum resulting in aqueductal obstruction. This lesion measures 7 mm in AP dimension, previously 6 mm, likely without significant interval change allowing for differences in technique. There is no corresponding enhancement. The previously seen small thumb-like soft tissue mass just anterior and superior to the mammillary bodies projecting into the third ventricle along the floor is not as well delineated due to the resolved third ventricle dilatation, but is grossly similar to the prior study. There is also no corresponding enhancement in this location.

Output: 1. Redemonstration of previously identified hypothalamic region, tectal, and vermian masses with interval enlargement in the vermian mass, but grossly stable size of the hypothalamic region and tectal masses. No corresponding enhancement.2. Right frontal approach ventriculostomy catheter, which is unchanged in position. Interval decrease in size of the lateral ventricles with normal size of the third ventricle. Fourth ventricle remains partially effaced and aqueduct obstructed.3. Focal prominence of extra-axial space posterior to the right cerebellum, which may relate to right cerebellar dysplasia and/or mega cisterna magna vs. retrocerebellar cyst.


Instruction: Generate impression based on findings.

Input: Severe abdominal pain. Evaluate migraine. The cerebellar tonsils extend up to 9 mm inferior to the foramen magnum, where there is crowding of the soft tissues. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered punctate foci of T2 hyperintensity within the subcortical white matter. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The skull and extracranial soft tissues are unremarkable.

Output: 1. Low-lying cerebellar tonsils are suggestive of Chiari I malformation.2. No evidence of intracranial hemorrhage, mass, or acute infarct.3. A few scattered punctate foci of T2 hyperintensity within the subcortical white matter, which are non-specific.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: concern for seronegative spondyloarthropathy History: young man with back stiffness and inflammatory back pain There is no evidence of SI joint ankylosis or erosion. Signal intensity along the SI joints on T1, T2 and STIR imaging sequences is within normal limits.The imaged soft tissues all appear within normal limits. No fractures are evident.

Output: No MR evidence of spondyloarthropathy, as clinically queried.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for growth of AA. Signs and symptoms:AA. Pre and post enhanced brain MRI :Negative diffusion-weighted images.Postoperative and treatment changes of a right frontal tumor evident by increased FLAIR/T2 hyperintensity and an irregular surgical cavity demonstrate no evidence of interval change in its signal pattern or extent. There is subtle underlying parenchymal volume loss similar to prior study. There is thin linear mineralization of the cortex in the surrounding region similar to prior exam. Post enhanced images demonstrate very thin linear and minimally nodular enhancement along the surgical cavity wall without appreciable change since prior study.New since prior exam however is interval increased size of 2 foci of subtle FLAIR hyperintensity however with distinct enhancement in the right anterior temporal and right basal ganglia. The focus of enhancement in the right anterior temporal measures approximately at 10 x 4.5 mm in transaxial dimensions (axial post enhanced series 1/3/2001 image 14) compared to prior study measurement of 3.5 mm. The second nodular focus of enhancement under the right insular cortex posteriorly has increased in size since prior exam and measures at 10 mm in AP and 5 mm in transverse dimensions compared to prior study measurement of approximately 4 mm in AP. Findings likely representing posttreatment change however further follow-up is recommended to exclude tumor progression.

Output: 1.Post surgical/treatment changes of a right frontal tumor with evidence of adjacent cortical mineralization and a thin and minimally irregular rim of enhancement suggestive of post posttreatment changes. Findings demonstrate no convincing evidence of interval change since prior study.2.Interval increased size of 2 remote small foci of Flair hyperintensity and enhancement since prior exam in the right anterior temporal (superior temporal gyrus) and right basal ganglia under right external capsule as detailed/measured above. Findings although suggestive of posttreatment change follow up with imaging is recommended to exclude possibility of tumor progression.


Instruction: Generate impression based on findings.

Input: Patient History: low back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. The patient is status post laminectomies at L3, L4 and L5 with a posterior fusion at L3, L4, L5 and S1 with pedicle screws and interconnecting rods as well as bone graft. There is a cross bar present centered at L4-5. There is mild anterior subluxation of L4 on L5.There is a septated fluid collection present at the laminectomy sites of L3, L4 and L5 which surrounds the posterior crossbar. This associated with the peripheral contrast enhancement and appearance of infiltrating margins.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is anterior subluxation of L4 and L5 by approximately 4 mm.At L3-4 there is no significant compromise to spinal canal or neural foramina. There are some endplate reactive changes present at L3-4At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild disc bulge at this level associated with disc desiccation and facet hypertrophy. There is narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots within the right neural foramen.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 16 mm right parapelvic cyst of the right kidney and a 12 mm cortical cyst along the superior aspect of the left kidney.

Output: 1.The patient is status post posterior fusion and laminectomies. There is a fluid collection present at the surgical site which abuts the thecal sac. Differential considerations may include seroma as well as CSF leak and even infection in the appropriate clinical circumstances. Please correlate with the timing of surgery.2.There is no significant compromise to spinal canal or neural foramina.3.There is mild subluxation of L4 and L5.4.There is some encroachment of the exiting nerve roots at the right L4-5 neural foramen due to facet hypertrophy


Instruction: Generate impression based on findings.

Input: 76-year-old male with low back pain and bilateral lower leg pain worsened by ambulation. The bony density and the alignment the vertebral column in the lumbosacral region remains within normal limits.Incidental note is made of heavy calcification of the abdominal aorta.Mild degenerative disk disease and hypertrophic changes of posterior elements for patient's age is noted. No definitive evidence of central spinal stenosis or neural frontal compromise on this non-infused CT of the lumber spine is detected. Considering provided clinical data further follow-up with an MRI would be significantly more useful.

Output: 1.Mild degenerative changes of lumber spine with no definite evidence of neuroforamina compromise or central spinal stenosis.2.Normal density and the alignment of the vertebral column.


Instruction: Generate impression based on findings.

Input: Reason: eval extent of infection including ankle/hindfoot/midfoot/forefoot History: left foot wound Left midfoot/forefoot:Extensive signal void related to multiple foci of gas within the subcutaneous and soft tissue tissues along the plantar and dorsal aspect of the midfoot and forefoot limits evaluation of the underlying bone marrow signal, particularly along the second and third digits of the foot. There is apparent increased signal abnormality within the proximal phalanx of the second digit on fluid sensitive sequences which demonstrates decreased signal abnormality on T1-weighted images, suspicious for osteomyelitis, although evaluation is limited secondary to patient motion artifact. No focal fluid collection is identified to suggest abscess formation. There is increased signal abnormality within the imaged musculature of the foot on fluid sensitive sequences as well as nonspecific diffuse subcutaneous edema.Left ankle/midfoot:No bone marrow signal abnormalities are identified within the bones of the ankle or midfoot to suggest osteomyelitis. There is no frank osteolysis or cortical destruction identified. There is increased signal abnormality within the navicular bone about the talonavicular articulation, likely degenerative in etiology. There is increased signal abnormality and fluid sensitive sequences within the plantar musculature of the left foot. Again seen are numerous foci of signal void within the subcutaneous and soft tissues along the plantar and dorsal aspect of the left foot corresponding to gas seen on recent radiographs, extending from the level of the plantar aspect of the calcaneus to the level of the distal tufts of the seconds and third phalanges. No focal fluid collection is identified to suggest abscess formation.

Output: 1. There is signal abnormality within the proximal phalanx of the second digit which is suspicious for osteomyelitis, particularly if there is skin ulceration in the surrounding area, although evaluation is limited secondary to patient motion artifact and extensive gas within the surrounding area. 2. Nonspecific subcutaneous and soft tissue edema with extensive gas intensity along the plantar and dorsal aspect of the foot consistent with the findings seen on recent radiographs. A necrotizing infection/fasciitis cannot be excluded by this examination. No evidence of abscess formation.


Instruction: Generate impression based on findings.

Input: 64-year-old male with respiratory failure pre-lumbar puncture evaluation. Provided further history of vascular malformation. There is no evidence of intracranial hemorrhage or edema. Right frontal mass-like lesion overlying right frontal cortex with internal coarse popcorn calcifications measuring approximately 3.4 x 2 .4 cm (series 3 image 21). This lesion exerts a mass effect on underlying right precentral and postcentral gyri with minimal sulcal effacement and an about one to 2 mm of midline shift to the left. This is unchanged compared to prior MRI. The right ventricle appear slightly asymmetrically thinner than the left likely from minimal mass effect of the extra-axial mass.The basal cisterns, third and fourth ventricles are normal in size and configuration. The calvaria and skull base unremarkable. The orbits are unremarkable. The visualized paranasal sinuses are well pneumatized. There is partial opacification of bilateral mastoid air cells.

Output: 1. No acute intracranial hemorrhage. 2. Right frontal mass like lesion is compatible with vascular malformation seen on an outside MRI. The associated minimal mass-effect and midline shift have been stable. Further evaluation with brain MRA and MRI is recommended.


Instruction: Generate impression based on findings.

Input: History of tuberous sclerosis and seizures of increased frequency. There is an unchanged 7 mm wide avidly enhancing lesion at the grey-white matter junction along the anterior right superior frontal sulcus with associated surrounding T2 hyperintensity. There are postoperative findings in the right parietal lobe with unchanged associated scattered punctate foci of susceptibility effect and linear T2 signal abnormality surrounding the resection cavity, which likely represents gliosis and encephalomalacia. There is also unchanged linear T2 hyperintensity in the right forceps minor region. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Unchanged enhancing lesion in the right superior frontal sulcus grey-white matter junction, which may represent a hamartoma or perhaps less likely a neoplasm superimposed upon transmantle dysplasia.2. Unchanged postoperative findings in the right parietal lobe.3. Unchanged signal abnormality in the right right forceps minor region, which likely represents transmantle dysplasia with radial migration band.


Instruction: Generate impression based on findings.

Input: 62 year-old female with lower abdominal, hip, and back pain.IMAGE ACQUISITIONS: Lumbar spine CT without contrast Vertebral column alignment and density are normal. There is posterior disk bulge, bilateral facet joint hypertrophy, and ligamentum flavum thickening at L5-S1 causing mild spinal stenosis and bilateral neuroforaminal narrowing. No other significant lumbar degenerative disease is noted. MRI of the lumbar spine would provide a more detailed evaluation.

Output: Degenerative disk disease at L5-S1 causing mild spinal stenosis


Instruction: Generate impression based on findings.

Input: Male, 17 years old, with history of germinoma status post chemotherapy. Off therapy evaluation. A right transfrontal surgical tract is redemonstrated. The pineal region appears unchanged from prior with no evidence of recurrent tumor. The remainder of the brain is also within normal limits. No evidence of parenchymal signal abnormality, edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is observed. No abnormal extra-axial collections are present. The ventricular system is normal in size and morphology.

Output: Stable examination with no evidence of recurrent tumor in the pineal region.


Instruction: Generate impression based on findings.

Input: 74-year-old woman with history of endometrial hyperplasia seen 5 years ago, now with uterine wall abnormalities seen on ultrasound. PELVIS:UTERUS, ADNEXA: There is a large, masslike area of decreased T2 signal in the transitional zone of the uterus measuring approximately 48 x 47 mm (series 601, image 26) and involving greater than 50% of the myometrium. There is portion of this lesion which appears to extend through the serosal surface and abuts the sigmoid colon (series 601, image 20), however the sigmoid colon does not appear to be invaded. This masslike area demonstrates mild enhancement. The endometrial stripe is obliterated towards the fundus.The cervix and vagina appear normal.The ovaries appear normal.BLADDER: Bladder appears normal.LYMPH NODES: Multiple, mildly enlarged pelvic and retroperitoneal lymph nodes are noted (series 701, images 31/50/58) and enhance on postcontrast sequences.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mass of the uterine fundus which obliterates the endometrial canal, extends through the serosa, and abuts the sigmoid colon.2. Mild lymphadenopathy in the pelvis and retroperitoneum.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges [D32.0] / Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: h/o right frontal meningioma and also a pons lesions; please add spectroscopy. History: fatigue, weakness, elevated parathyroid hormone. There is 7.6mm x 11.3mm x 15.1mm extra-axial dural based enhancing lesion along the high right vertex at the level of the superior frontal sulcus. This lesion causes no significant mass effect upon the adjacent parenchyma and there is no evidence of parenchymal invasion or parenchymal edema. Allowing for differences in technique, no change is detected when compared to the prior examination.As on the prior examination, a 4 mm focus of somewhat ill-defined enhancement is evident within the right upper pons. On 3-D postcontrast images, there also appears to be a small linear vascular structure just below the area of enhancement. The lesion is associated with susceptibility effect, and a barely detectable punctate focus of FLAIR hyperintensity. No edema or mass effect is seen. No restricted diffusion is evident. Single voxel spectroscopy of this lesion shows no findings to suggest an aggressive or proliferative process. If anything, the level of choline at the lesion is reduced relative to an adjacent normal area of the pons.No additional enhancing lesions are seen. Brain parenchymal morphology and signal characteristics are otherwise unremarkable. No evidence of any parenchymal edema or mass effect is seen. No abnormal fluid collections are detected. The ventricular system is normal in size and morphology.

Output: 1.A small extra-axial mass compatible with meningioma is evident along the high right vertex at the level of the superior frontal sulcus. This lesion causes no significant mass effect upon or edema within the adjacent brain parenchyma.2.A small somewhat ill-defined focus of enhancement is evident within the right aspect of the upper pons with associated susceptibility effect and perhaps a small adjacent vascular structure. Spectroscopic findings do not suggest an aggressive or proliferative process. The imaging features and location of this lesion favor a benign vascular process such as a capillary telangiectasia. If clinical concern warrants, at least one follow-up examination can be considered to ensure stability.


Instruction: Generate impression based on findings.

Input: 81 yo w known T8-9 vertebral lesion involving spinal canal s/p palliative XRT. Please eval for extent of disease for consideration of surgical debulking. Abdominal pain, back pain, mild lower extremity weakness. PET/CT 12/4/2015, CT chest 11/20/2015 There is an expansile enhancing mass involving the T8 vertebral body and posterior elements with diffuse low T1 signal and increased STIR signal. Mild endplate deformities of the T8 vertebral body are seen. There is mild right and moderate left compression deformity. The tumor extends into the epidural space diffusely, surrounding the spinal cord and causing severe spinal stenosis. There is no definite abnormal cord signal. The epidural component of the lesion extends from T7 to T9 levels. Additionally, there is involvement of the superior endplate of the T9 vertebral body with small area of enhancement. Tumor extension into the neural foramina results in severe bilateral foraminal stenosis at T8-T9, as well as severe left and moderate to severe right neuroforaminal stenosis at T7-T8. There is extension in the costovertebral junctions bilaterally at T8, with poor visualization of the left T8 proximal rib.The left anterior aspect of the T3 vertebral body demonstrates mild enhancement without additional corresponding signal abnormality.There is an approximately 5 cm right upper lobe mass, partially visualized.

Output: 1. There is an expansile T8 holovertebral metastatic lesion with diffuse epidural extension between the T7 and T9 levels, with severe central spinal canal stenosis. No definite abnormal cord signal at this time. Up to moderate associated compression deformity.2. Tumor extension into the neural foramina results in severe bilateral neuroforaminal stenosis at T8-T9, as well as severe left and moderate to severe right foraminal stenosis at T7-T8. 3. Likely additional metastatic involvement of the superior T9 endplate.4. The left anterior aspect of the T3 vertebral body demonstrates mild enhancement without additional corresponding signal abnormality. Continued close follow-up is recommended.5. Partially visualized right lung mass.


Instruction: Generate impression based on findings.

Input: 72-year-old male with abnormal PSA. According to the patient, multiple biopsies have revealed prostatitis. PELVIS:PROSTATE:Prostate Size: 6.3 x 6.8 x 3.8 cm.Peripheral Zone: There is no abnormal intrinsic T1 signal within the peripheral zone. There is a focus of low signal on ADC without reliable corresponding T2 abnormality in the left apex peripheral zone measuring 5 x 4 mm. No early arterial enhancement is present. Central Gland: There is severe degree of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted..Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered bilateral inguinal lymph nodes are not pathologically enlarged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Indeterminate focus in the left apex peripheral zone as described above. 2.Severe degree of benign prostatic hypertrophy.


Instruction: Generate impression based on findings.

Input: Signs and symptoms: MVC. No neck pain. Clinical question: 71-year-old.? Fracture. Nonenhanced head CT:Findings of small vessel disease of indeterminate age is present and evident by few small patchy periventricular and subcortical white matter low attenuation.No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable. Limited view of the orbits are unremarkable.Nonenhanced CT of cervical spine:No evidence of fracture or subtle change is detected. The alignment of the vertebral column is unremarkable. Advanced degenerative disk disease at C6 -- C7 level and to a lesser degree at other levels are present. Sagittal reformatted images demonstrate significant bulge of disk material at C3 -- C4 which appears to be in contact with the ventral aspect of the cord. Possibility of a herniated disk cannot be ruled out. Please correlate with neurological exam and if needed follow-up with an MRI is recommended. Examination also demonstrated degenerative changes of posterior elements from C3 -- C4 inferiorly.Degenerative changes of cervical spine results in right neural foramina compromise at C5 -- C6 and left neural foramina at C6 to C7 level.

Output: 1.Nonenhanced head CT demonstrates minimal findings of small vessel disease of indeterminate age and otherwise unremarkable.2.CT of cervical spine demonstrates no evidence of fracture or malalignment. Extensive degenerative disk disease and hypertrophic changes of posterior elements are present. Significant bulge of disk material at C3 there C4 is best a patient on sagittal reformatted images and possibility of a herniated disk cannot be rule out.


Instruction: Generate impression based on findings.

Input: 69-year-old female with a history of right basal ganglia stroke now with lethargy and confusion. Evaluate for hemorrhagic conversion. There is no evidence of intracranial hemorrhage, extra-axial fluid collection or mass. There is no mass effect or midline shift. There is a focal area of hypoattenuation in the right MCA perforator distribution in the right basal ganglia and right anterior limb of the internal capsule which appears more well defined and correlates to a subacute infarction previously demonstrated on MRI. There is no significant associated vasogenic edema.Redemonstration of nonspecific moderate periventricular and deep white matter hypoattenuation. These findings are most consistent with age indeterminate small vessel ischemic disease.The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized mastoid air cells are within normal limits. Again seen is a moderate mucosal thickening of the maxillary sinuses which appears unchanged when compared to the previous study.

Output: 1. Focal area of hypoattenuation in the right MCA perforator distribution in the right basal ganglia and right anterior limb of the internal capsule which correlates to a subacute infarction previously demonstrated on MRI. There is no evidence of hemorrhagic conversion.2. Nonspecific moderate periventricular and deep white matter hypoattenuation. These findings are most consistent with age indeterminate small vessel ischemic disease.3. Mild mucosal thickening of the maxillary sinuses bilaterally, unchanged.


Instruction: Generate impression based on findings.

Input: 76 years Female (DOB:8/8/1939)Reason: History of systemic and CNS lymphoma. Please restage History: memory lossPROVIDER/ATTENDING NAME: KENNETH STUART COHEN KENNETH STUART COHEN The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a burr hole present along the left frontal bone. A prior ventriculostomy tract extends into the left lateral ventricle from the burr hole.There is T2 signal hyperintensity and FLAIR signal hyperintensity along the anterior aspect of the corpus callosum where the patient's prior CNS lymphoma was.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Metal artifact partially obscures imaging on some of the pulse sequences affected by susceptibility artifact in the region of the right frontal lobe and right temporal lobe especially.

Output: 1.No abnormal enhancing lesions are appreciated intracranially to suggest CNS lymphoma.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.The patient status post left frontal bone burr hole placement.


Instruction: Generate impression based on findings.

Input: Unable to perform physical therapy. Left shoulder pain. Specifically difficulty with abduction and flexion ROTATOR CUFF: Only minimal signal abnormality along the undersurface of the distal supraspinatus near the insertion is observed compatible with mild fraying. Intact fibers are observed throughout and changes are only observed in the distalmost centimeter just prior to attachment. Remaining rotator cuff is otherwise intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Minimal degenerative changes of the AC joint and the remaining shoulder is otherwise grossly intact. Marrow signal unremarkable. Labrum remains grossly intact given limitations of the technique.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Minimal tendinopathy with mild changes at the distal most supraspinatus tendon compatible with undersurface fraying. See detail provided


Instruction: Generate impression based on findings.

Input: 51 year old male with post operative LV dysfunction after liver transplant in June 2016. MRI for evaluation of possible cause. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 46%. The LVEDV is 258 ml (normal range 142+/-34), the LV end diastolic volume index is 144 ml/m2 (normal range: 74+/-15), the LVESV is 139 ml (normal range 47+/-19) and the LV end systolic volume index is 78 ml/m2 (normal range 25+/-9). The LV mass is 154 g (normal range 164+/-36) and the LV mass index is 86 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.The native T1 myocardial relaxation time is 1100-1125 ms which is mildly elevated and can represent the presence of underlying myocardial interstitial fibrosis or edema.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 54%. The RVEDV is 224 ml (normal range 142+/-31), RV end diastolic volume index is 125 ml/m2 (normal range 82+/-16), the RVESV is 103 ml (normal range 54+/-17), and the RV end systolic volume index is 58 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 mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are bilateral moderate sized 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.Severe left ventricular dilation with mildly reduced systolic function (LVEF 46%). There is no evidence of myocardial scar/ replacement fibrosis or infiltration based on late gadolinium enhancement; however, the native myocardial T1 relaxation time was mildly elevated suggesting the presence of underlying myocardial interstitial fibrosis or edema). 2.Mildly dilated right ventricle with normal systolic function (RVEF 54%). 3.Severely enlarged left atrium4.Bilateral moderate sized pleural effusions5.Small pericardial effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Radiculopathy, lumbar region [M54.16], Reason for Study: ^Reason: eval for cause of lumbar radiculopathy History: LE fasciculations/spasms For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: Mild disc desiccation. No neuroforaminal narrowing or spinal stenosis. L3-L4: Minimal diffuse bulging of disc. Mild disc desiccation. No neuroforaminal narrowing or spinal stenosis. L4-L5: Minimal diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: Minimal diffuse bulging of disc facet the level of L3-4 and L4-5 without evidence of spinal canal stenosis or neural foraminal stenosis. Otherwise unremarkable lumbar spine MRI.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial mass or enhancing lesions. No evidence of a bleed, mass effect, or edema. There is normal ventricular size with normal gray-white matter differentiation and no midline shift.Punctate nonspecific high signal lesions on T2 and FLAIR is seen in the corona radiata, likely chronic ischemic small vessel disease. There are no restricted diffusion abnormalities. There are no susceptibility abnormalities.A lobulated mucosal retention cyst is seen in the left maxillary sinus. A small mucosal retention cyst is seen also in the right maxillary sinus. The left middle turbinate has been resected. Along the left antrostomy, there is an area of abnormal soft tissue with cerebriform pattern. The lesion has heterogeneous high signal in T2 and FLAIR and is enhancing. A nonspecific soft tissue nodule is seen along the musculature in the left suboccipital region. Flow voids of the anterior intracranial vascular structures are present.

Output: 1. No definite evidence of metastatic lesions in the brain.2. Abnormal soft tissue is seen at the left antrostomy, with imaging characteristics suggestive of possible inverted papilloma, although correlation with previous surgical history is recommended. Differential diagnosis would also include a metastatic lesion or other primary sinus neoplasm.3. A nonspecific heterogeneous small soft tissue nodule is seen along the posterior musculature in the left suboccipital region. Recommend correlation with physical examination and with any history of trauma. Different diagnosis would include hematoma or possible metastasis.Dr. Lauren Feld was notified by Dr. Arie Franco on 8/6/2015 at 4:00 p.m.


Instruction: Generate impression based on findings.

Input: History of glioblastoma with left-sided weakness and in a 56-year-old female. Now with right facial droop x 4 days since anesthesia for colonoscopy. Very large area of encephalomalacia involving the right frontal lobe with ex vacuo dilatation of the right frontal horn and right lateral ventricle is identified. There is evidence of an extra-axial high density mass abutting the right temporal and parietal bone with mass effect and medial deviation of brain parenchyma. There is extensive surrounding calcification. This finding was noted on prior MRI examination dated 2 -- 15 -- 2008 and with no definitive evidence of interval change. The finding may represent a meningioma or an organized old calcified hematoma.No evidence of hemorrhage, midline shift is detected. The overall appearance of this is study is similar to the prior MRI exam.

Output: No evidence of acute findings.Stable exam since prior MRI.


Instruction: Generate impression based on findings.

Input: Limited sequences per demyelinating disease protocol. Again seen are multiple T2/FLAIR hyperintense lesions in the periventricular and subcortical supratentorial white matter with morphology and distribution consistent with known demyelinating disease. Multiple brainstem and cerebellar lesions are also again seen, which are predominately along the dorsal midbrain and pons similar to prior. No new lesions are identified. Mild to moderate burden of T1 hypointense lesions again seen similar to prior. Mild parenchymal volume loss including mild thinning of the corpus callosum similar to prior. No evidence of intracranial mass effect, midline shift, or herniation.

Output: Compared to 5/22/2015, there are no new lesions in the brain to suggest progression of demyelinating disease.


Instruction: Generate impression based on findings.

Input: 58 year old female with syncope and history of TIA. Evaluate for any neurologic disease Non-enhanced CT of brain:No evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Cortical sulci, ventricular system and all CSF cisterns remain within normal range for patient's stated age of 78. The gray -- white matter differentiation is preserved.Calvarium, visualized orbits, paranasal sinuses and mastoid air cells are unremarkable. Considering significant provided clinical data and unremarkable prior CT examination from 11 -- 27 -- 10 follow-up with an MRI is recommended.Minimal suspected a small vessel disease that was reported on prior study is not identified on this exam however the quality of this exam is suboptimal compared to prior study which may explain this difference.

Output: No evidence of acute intracranial process, mass effect, midline shift or hydrocephalus. Recommend follow-up with an MRI examination considering lack of any definitive finding on two CT examination of brain.


Instruction: Generate impression based on findings.

Input: Reason: Outside Request: pt with bilateral periosteal changes in the distal femurs. ? Of chronic hemorrhages in the bones vs hypertrophic bone. Pt with chronic pain History: Right femur:There is serpentine signal abnormality within the distal femur affecting the diaphysis, metaphysis, and distal diaphysis indicating chronic bone infarction. There is also avascular necrosis of the femoral head. There is a focus of susceptibility artifact within the medial subcutaneous soft tissues of the upper thigh which may represent a foreign body. The musculature of the right thigh appears normal. Aside from mild enhancement of the aforementioned bone infarction, we see no abnormal enhancement.Left femur:There is serpentine signal abnormality within the distal femur affecting the epiphysis, metaphysis and extending to the mid diaphysis. There is also serpentine signal abnormality in the intertrochanteric region and femoral head. There is a small amount of synovial enhancement about the left knee which may represent a mild synovitis, but this is of questionable clinical significance. There is no large joint effusion. The musculature of the left thigh appears normal. Aside from mild enhancement of the bone infarction, we see no abnormal enhancement.

Output: 1. Bilateral femoral osteonecrosis.2. Focus of metallic susceptibility in the soft tissues along the medial aspect of the upper thigh may represent a foreign body. This could be further evaluated with dedicated radiographs if clinically warranted.


Instruction: Generate impression based on findings.

Input: Thoracic spine:Marrow signal abnormality is noted throughout all osseous elements providing MRI evidence for diffuse metastatic disease.Osseous expansion causes left T6/7, bilateral T7/8, and left T8/9, foraminal narrowing.There has been collapse of the T11 vertebral body with retropulsion of fragments 5 mm posteriorly in a right paramedian direction causing slight flattening of the anterior right hemicord, however without cord signal abnormality or compression. Associated osseous expansion results in T10/11 and T11/12 foraminal narrowing bilaterally, worse on the right. Associated soft tissue extends beyond the vertebral body cortices anteriorly from T9 through T12.There are bilateral pleural effusions as demonstrated previously, right much greater than left.Lumbar spine:Marrow signal abnormality is noted throughout all osseous elements providing MRI evidence for diffuse metastatic disease.There has been near complete central collapse of L4, with MRI findings consistent with prior vertebroplasty as better demonstrated on the x-ray dated 4/24/2014. This is associated with approximately 4 mm retropulsion of fragments in the left paramedian direction which results in moderate left lateral recess and neural foraminal stenosis.At L3/4 there is mild bilateral neural foraminal stenosis from diffuse annular disc bulge. Degenerative changes are noted elsewhere in the lumbar spine, however without significant resulting associated stenosis.

Output: 1.Marrow signal abnormality is noted throughout the thoracic spine, lumbar spine, and visualized pelvis, providing MRI evidence for diffuse metastatic disease.2.Osseous expansion causes left T6/7, bilateral T7/8, and left T8/9, foraminal narrowing.3.There has been collapse of the T11 vertebral body with retropulsion of fragments 5 mm posteriorly in a right paramedian direction causing slight flattening of the anterior right hemicord, however without cord signal abnormality or compression. Associated osseous expansion results in T10/11 and T11/12 foraminal narrowing bilaterally, worse on the right. Associated soft tissue extends beyond the vertebral body cortices anteriorly from T9 through T12.4.There has been near complete central collapse of L4, with MRI findings consistent with prior vertebroplasty as better demonstrated on the x-ray dated 4/24/2014. This is associated with approximately 4 mm retropulsion of fragments in the left paramedian direction which results in moderate left lateral recess and neural foraminal stenosis.5.At L3/4 there is mild bilateral neural foraminal stenosis from diffuse annular disc bulge.6.There are bilateral pleural effusions as demonstrated previously, right much greater than left.


Instruction: Generate impression based on findings.

Input: 75 year old with hypertension and suspected cardiac amyloidosis presenting for repeat evaluation after treatment. Left VentricleThe left ventricle is normal in size with normal systolic function. There is left ventricular hypertrophy, most prominent in the basal septum. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 79 ml/m2 (normal range: 65+/-11), the LVEDV is 145 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10), the LV mass index is 51 g/m2 (normal range 67+/-11), and the LV mass is 92 g (normal range 114+/-24). There is patchy late gadolinium enhancement in the basal lateral, inferolateral and inferior walls both subendocardial and midmyocardial suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern appears to be consistent with previous LGE images (unchanged). Native T1 times are 1015 ms. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 82 ml/m2 (normal range 69+/-14), the RVEDV is 151 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 67 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 trace mitral regurgitation. The valve leaflets are notably thickened. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac Findings: Multiple left renal cysts. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. There is left ventricular hypertrophy, most prominent in the basal septum. The overall LV ejection fraction is 67%. There is patchy late gadolinium enhancement in the basal lateral, inferolateral and inferior walls both subendocardial and midmyocardial suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern appears to be consistent with previous LGE images. Native T1 times are 1015 ms (normal). 2. The right ventricle is normal in size with normal systolic function (RVEF 56%). Compared to previous study, the left ventricular, size, function and LGE are similar.


Instruction: Generate impression based on findings.

Input: Biopsy proven malignancy in the right breast and axilla. First I Spy research MRI is performed. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In most of the right superior breast is extensive clumped nonmass enhancement measuring approximately 4.7 x 8.2 x 3.9 cm (AP x ML x SI). Within this region of clumped non-mass enhancement are again seen three irregular masses, which correspond to the masses identified on recent ultrasound exam in the right breast 1:00, 3:00 and 9:00 positions. Post biopsy changes related to the two research core biopsies is identified in the medial aspect of this clumped nonmass enhancement (adjacent to the right 3:00 mass). In addition, there is diffuse skin thickening present of the entire right breast, measuring up to 8 mm in thickness.There is no abnormal MR enhancement identified in the left breast.There are multiple enlarged right axillary lymph nodes identified, the largest of which measures approximately 1.9 cm. One of these enlarged axillary lymph nodes has susceptibility artifact from a biopsy marker clip and adjacent hematoma formation, compatible with recently biopsy proven lymph node. There are no abnormal axillary lymph nodes in the left axillary region.Dual lumen port-a-cath noted in the left chest wall.

Output: Extensive abnormal enhancement in the right breast and axilla as previously seen. Only biopsy related changes in the breast are new since the prior MRI. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 85 years, Female, Reason: assess for bladder cancer recurrence History: h/o bladder cancer. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nonenhancing T2 hyperintense lesions are unchanged and likely represent benign cysts. Centripetally enhancing lesion in the left hepatic lobe likely represents a hemangioma and is unchanged. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic right upper pole simple renal cyst is unchanged. Additional renal cysts are unchanged. No suspicious renal lesions. A 4-cm nonobstructing calculus in the right renal pelvis is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileal conduit. Small right abdominal ventral hernia containing a loop of bowelBONES, SOFT TISSUES: Mild degenerative changes and scoliosis of the visualized spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomyBLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Lipoma adjacent to the right lesser trochanter is unchanged.OTHER: Numerous collateral vessels in the anterior subcutaneous tissues.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Chronic post-traumatic headache, intractable [G44.321], Reason for Study: ^Reason: post traumatic headache History: headache No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Assess for thyroid nodule RIGHT LOBE MEASUREMENTS: The right lobe measures 3.9 x 1.3 x 0.8 cmLEFT LOBE MEASUREMENTS: The left lobe measures 6.7 x 6.2 x 3.2 cmISTHMUS MEASUREMENTS: The isthmus there measures 0.5 cmRIGHT LOBE: Multiple nodules on the right which appear complex. The largest is located inferiorly and measures 1.0 x 0.7 x 0.8 cmLEFT LOBE: Dominant complex nodule on the left measures 5.7 x 4.9 x 3.1 cmISTHMUS: Small nodule measures 1.3 x 1.1 x 0.7 cm and appears complexPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral complex thyroid nodules with the largest located on the left


Instruction: Generate impression based on findings.

Input: 40 years Female (DOB:5/7/1975)Reason: patient with mild cervical-thoracic scoliosis with worsening thoracic back pain and new heaviness/clumsiness of the right arm - evaluate for nerve compression, spinal stenosis or other History: back painPROVIDER/ATTENDING NAME: GEORGE W WEYER GEORGE W WEYER Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature present.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. There is a disc bulge at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is mild loss of disc space height, endplate osteophyte formation or disc bulge 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.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Some small foci of T1 signal hyperintensity within the thoracic spine are present which could represent focal fatty replacement or hemangioma.There is a mild dextrocurvature to the thoracic spine.

Output: 1.There are some degenerative changes present in the cervical spine without significant compromise to spinal canal or neural foramina.2.There is no significant compromise to the thoracic spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 22-year-old male with knee pain. Assess for lateral meniscal injury. MENISCI: There is linear signal abnormality within the body of the lateral meniscus which extends to the femoral articular surface consistent with a horizontal tear which extends to the posterior horn of the meniscus. There is linear increased signal abnormality which extends to the tibial and femoral articular surface consistent with a radial tear within the anterior horn of the lateral meniscus. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is increased signal abnormality within the posterior aspect of the lateral tibial plateau which may represent a bone contusion. There is also increased signal abnormality within the medial aspect of the medial femoral condyle which may represent a contusion. There is heterogeneous bone marrow signal abnormality consistent with residual islands of red marrow. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is slight thickening of the patellar tendon. There is also increased intermediate signal abnormality within the proximal fibers of the patellar tendon indicating mild tendinosis. The Insall Salvati ratio measures 1.3 suggesting patella alta.ADDITIONAL

Output: 1. Horizontal and radial tears of the lateral meniscus as described above.2. Findings suggestive of patellofemoral instability as described above.3. Nonspecific fluid signal abnormality along the posterior aspect of the knee may represent the sequela of a ruptured Baker's cyst.4. Mild patellar tendinosis.


Instruction: Generate impression based on findings.

Input: 56-year-old male. Rule out stroke. Images through posterior fossa are unremarkableimages through the supratentorial brain parenchyma demonstrates no definitive evidence of any hemorrhage, mass-effect, edema, midline shift or hydrocephalus. Focal area of low-attenuation in the periventricular white matter with ex vacuo dilatation of the right lateral ventricle is noted. This has the appearance of an old finding and further evaluation with an MRI is recommended.

Output: No evidence of acute findings. Follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Reason: knee injury History: knee injury MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Normal MRI right knee.


Instruction: Generate impression based on findings.

Input: 2-year-old female with pain Moderate joint effusion with apparent enhancing synovium suggestive of synovitis. A portion of this fluid extends along the medial aspect of the humeral metaphysis in between the humerus and heterotopic bone formation measuring 10 x 4 mm. No loose bodies are evident.Heterotopic bone formation is present circumferentially around the proximal humeral metaphysis with surrounding T1 hypointense and T2 hyperintense heterogeneous signal. The humeral cortex at this level is preserved. The underlying marrow at this level demonstrates increased T2 signal with appreciable enhancement, nonspecific. No soft tissue or osseous mass is evident.The biceps tendon is within the bicipital groove. Mildly enlarged axillary lymph nodes measuring up to 13 x 7 mm (series 4, image 19) may be reactive in etiology. At the elbow, there is also displacement of the posterior fat pad without joint effusion or abnormal signal.

Output: Near circumferential heterotopic bone formation around the proximal humeral metaphysis with surrounding heterogeneous enhancement and edema type signal may represent myositis ossificans. Moderate right shoulder joint effusion with apparent enhancing synovium is suggestive of synovitis that may be related to direct extension of the aforementioned process. Follow-up radiographs in 2-4 weeks are recommended.


Instruction: Generate impression based on findings.

Input: History of migraine. Comment a history of cerebral aneurysm. Nonenhanced CT of brain:A there is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. Considering multiple normal prior CT examinations recommend an MRI examination to exclude possibility of pathology not appreciated on an not infused head CT.Calvarium, limited field paranasal sinuses and mastoid air cells are also within normal limits. No change since prior examinations.CTA of intracranial circulation:There is normal visualization of bilateral intracranial vertebral arteries, bilateral pica branches, basilar artery, posterior cerebrals and superior cerebellar arteries.Normal appearing bilateral cavernous internal carotid arteries and their supraclinoid components. There is no visualization of posterior communicating arteries. This is a normal anatomical variation. Bilateral anterior cerebral arteries and including anterior communicating artery remains within normal. Both middle cerebral arteries and their branches are within normal.

Output: 1.Normal nonenhanced CT brain and calvarium. Stable since prior study from 2009.2.Negative CTA of intracranial vasculature.


Instruction: Generate impression based on findings.

Input: 34 years, Male, GBM. Most recently underwent resection w/ intratumoral injection of Ad-RTS-hIL12. Compared to 1/4/2016 and 3/7/2016, there is slight gradual increase in size of the heterogeneous nodular enhancement along the inferior aspect of the left frontal resection cavity which now appear to extend to the surface of the left frontal horn. There was a small ovoid peripherally enhancing lesion in the inferior left frontal lobe which appeared separate from the larger area of enhancement on 1/4/2016 and now demonstrates coalescence into the relatively larger area of enhancement. The cystic/peripherally enhancing areas slightly more laterally in the left anterior frontal lobe also demonstrates slight enlargement. Expansile FLAIR hyperintensity involving the left anterior frontal cortex also demonstrates subtle gradual increase in prominence when compared to the prior studies. There is mild associated restricted diffusion. These findings are suspicious for tumor progression. Overall no major change in the degree of FLAIR hyperintensity in the left frontal lobe extending into the right frontal lobe. No significant new mass effect, midline shift, or herniation is appreciated. No evidence of acute ischemia or new hemorrhage. Chronic blood products associated with the left frontal resection cavity are again seen, which also limit perfusion sequence. No hydrocephalus.

Output: Compared to 3/7/2016 and 1/4/2016, there are findings suspicious for gradual tumor progression involving the left frontal lobe inferior to the left frontal resection cavity. Posttreatment change while possible seems less likely, especially given the masslike cortical thickening with mild restricted diffusion. Suggest continued close follow-up.


Instruction: Generate impression based on findings.

Input: 55 year old man with history of non-ischemic cardiomyopathy, cardiac sarcoid who presents with new drop in EF. Patient presents for cardiac MRI to evaluate cardiac function and extent of sarcoid involvement Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 12 %, the LV end diastolic volume index is 180 ml/m2 (normal range: 74+/-15), the LVEDV is 337 ml (normal range 142+/-34), the LV end systolic volume index is 157 ml/m2 (normal range 25+/-9), the LVESV is 327 ml (normal range 47+/-19), the LV mass index is 77 g/m2 (normal range 85+/-15), and the LV mass is 160 g (normal range 164+/-36). There is severe diffuse hypokinesis. There is midwall basal to mid septal late gadolinium enhancement not consistent with myocardial infarction. This is likely secondary to underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated and severely reduced in systolic function. The overall RV ejection fraction is 20%, the RV end diastolic volume index is 129 ml/m2 (normal range 82+/-16), the RVEDV is 269 ml (normal range 142+/-31), the RV end systolic volume index is 104 ml/m2 (normal range 31+/-9), and the RVESV is 216 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is reduced excursion of the mitral valve with moderate 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 is mediastinal lymphadenopathy present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function (LVEF 12%)2. There is a mid-wall stripe of basal to mid septal late gadolinium enhancement. The pattern is atypical for prior myocardial infarction and represents underlying myocardial fibrosis, inflammation, or infiltration. Given the patient's history of sarcoidosis, the underlying mechanism of the late gadolinium enhancement is likely due to sequelae of cardiac sarcoidosis. Would recommend FDG-PET to determine whether active inflammation is present and to guide potential immunosuppressive therapy.3. The right ventricle is mildly dilated and severely reduced in systolic function (RVEF 20%)4. Moderate mitral regurgitation5. Severe left atrial enlargement6. Extra-cardiac findings as above7. In comparison to the cardiac MRI performed 7/14/10, there has been a substantial decrease in systolic function.


Instruction: Generate impression based on findings.

Input: Knee pain following injury Note that the examination is suboptimal secondary to patient motion artifact on all sequences.MENISCI: There is vertically oriented linear increased signal intensity noted within the posterior horn of the lateral meniscus with extension laterally from the interface of the meniscus with the ligament of Wrisberg highly suggestive of a longitudinal tear ("Wrisberg rip"). Additionally, there is increased signal intensity along the undersurface of the peripheral fibers of the posterior horn of the medial meniscus which may represent a tear in the red zone; however this is equivocal.ARTICULAR CARTILAGE AND BONE: There are bone contusions within the lateral tibial plateau posteriorly and the lateral femoral condyle above the anterior horn of the lateral meniscus. Small contusions are also present within the medial tibial plateau posteriorly and medial femoral condyle above the body of the medial meniscus. There is edema within the proximal fibula at the tibiofibular articulation.Evaluation of the articular cartilage is limited by motion artifact however within these limits, there are no fluid-filled cartilage defects identified.LIGAMENTS: There is a full-thickness rupture of the ACL. The PCL, MCL, and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Limited examination secondary to motion artifact which demonstrates the presence of a ruptured ACL, longitudinal tear of the lateral meniscus, and possible undersurface tear of the medial meniscus as detailed above.


Instruction: Generate impression based on findings.

Input: 68 year old with altered mental status. Patchy areas of periventricular and subcortical lucencies are consistent with small vessel disease of undetermined age. No evidence of hemorrhage, mass effect, midline shift or hydrocephalus is detected. Additional clinical history of metastatic colon cancer was relayed to the radiology resident on call. If concern for metastatic process or acute stroke is suspected an MRI is recommended.

Output: Small vessel disease of undetermined age. Please see above comments.


Instruction: Generate impression based on findings.

Input: Evaluate for lumbar spine spondylolisthesis and nerve compression. Bilateral hip arthroplasties. Now with left-sided hip and posterior buttock pain radiating down to anterior thigh. Five lumbar type vertebral bodies are presumed to be present as previous. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5 similar to prior as well as minimal retrolisthesis of L5 on S1, also similar to prior in the supine position. Bone marrow signal is benign. The conus medullaris is at the lower limits of normal at the L2-L3 level.Multilevel degenerative changes are seen, as described below:Again seen are disc bulges at T10-T11 and T11-T12 which are imaged only on the sagittal sequences and are associated with mild spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis.T12-L1: There is a disc bulge with bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.L1-L2: Mild disc bulge and facet arthropathy. No significant spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge and facet arthropathy. No significant spinal canal or neural foraminal stenosis.L3-L4: There is disc bulge eccentric to the right which partially effaces the right lateral recess and extends to the neural foramen. There is mild central canal stenosis and mild to moderate right neural foraminal stenosis. Left neural foramen is patent.L4-L5: Grade 1 anterolisthesis as above. There is disc height loss and vacuum phenomena. There is advanced facet arthropathy as well as ligamentum flavum thickening. There is moderate right neural foraminal stenosis which is slightly worse. There is also mild left neural foraminal stenosis which is also slightly worse. There is moderate degree of spinal canal stenosis similar to prior. L5-S1: Severe disc height loss, bilateral facet arthropathy, and mild disc bulge. There is no significant central spinal canal stenosis. There is moderate to severe left and moderate right neural foraminal stenosis similar to prior. Endplate osteophytes involving the neural foramina, worse on the left, are better seen on CT.

Output: Multilevel degenerative changes in the lumbar spine which are stable to minimally worse compared to prior MRI from 11/14/2011. There is degenerative grade 1 spondylolisthesis at L4-L5 which is similar to prior and can be further assessed with dynamic radiographs. There is moderate degree of spinal canal stenosis at L4-5 level. There is also moderate to severe left L5-S1 neural foraminal stenosis. Additional levels of stenoses as detailed above.


Instruction: Generate impression based on findings.

Input: Patient with history of squamous cell carcinoma of ethmoid sinus with recurrence.Please evaluate for disease. Metastases. CT of soft tissues of the neck.Images through the skull base and including cavernous sinuses remain within normal limits.Revisualization of extensive opacification of left ethmoid air cells which also demonstrated a small bony defect along its anterior aspect. In comparison with the prior examination there is evidence of reduction in the amount of soft tissue density that was immediately anterior to the bony defect of the lamina procedure and anterior aspect of the floor of the orbit on the left. This may be result of interval improvement of post therapy changes. Two entirely exclude possibility of residual tumor MRI examination in this case would be most helpful.The bony density of the area of the exam demonstrates no evidence of any new area of bony erosion. Images through the rest of the soft tissues of the neck demonstrate a few small nonpathologic lymph nodes which are stable since prior study. No pathologically enlarged lymph node is detected.Limited images through the apices of the lungs demonstrate extensive findings of multiple pulmonary emphysematous bulla (right greater than left. No definitive metastases is detected.CT of brain with infusion.Notice of metastatic disease to the brain, calvarial or leptomeninges is detected. This is study is essentially within normal limits.75 cc of Omnipaque was utilized for these studies.

Output: 1.Negative CT of brain with infusion.2.Reduction in the amount of soft tissue density at the level of the left ethmoid air cells and left orbit since prior study. Further evaluation to exclude residual tumor with an MRI is recommended.3.No areas of pathologic adenopathy in the neck and stable multiple small bilateral lymph nodes.


Instruction: Generate impression based on findings.

Input: Female, 56 years old. Left leg sarcoma. Evaluate for response/progression. A lobulated, heterogeneous solid mass lesion within the anterior subcutaneous soft tissues of the thigh measures 4.5 x 2.6 x 4.7 cm (series 7, image 20; series 12, image 23), with increased signal on T2 images, diffuse enhancement, and mild surrounding soft tissue edema. The mass appears entirely located within the subcutaneous fat and does not appear to extend into the deep fascial spaces. The underlying muscles and tendons are unremarkable.The visualized osseous structures are unremarkable, with normal cortical thickness and marrow signal.

Output: A 4 to 5 cm mass within the anterior subcutaneous soft tissues of the thigh is compatible with a known history of sarcoma.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis [Q85.1] / Neoplasm of uncertain behavior of brain, unspecified [D43.2], Reason for Study: ^Reason: Evaluate SEGA, cortical tubers for change. Compare with previous History: Tuberous sclerosis. SEGA s/p cortical resection. Prior right frontal craniotomy with partial resection of anterior aspect of corpus callosum are redemonstrated. Multiple bihemispheric subcortical white matter T2/FLAIR high signal intensity lesions are again seen, unchanged since prior scan.Multiple subependymal nodules which most of them show susceptibility artifacts indicating calcifications are seen, unchanged.Enhancing lesions one on the right side foramen of Monroe, another on the left side foramen of Monroe and the other on the left lateral ventricular ependymal surface are seen, no significant interval change since prior scan.Calcified lesions on bilateral cerebellar hemispheres do not show any interval change since prior scan. The ventricles size appears to be stable since prior scan.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Known Tuberous Sclerosis patient with prior right frontal craniotomy for the resection of anterior corpus callosum lesion.No significant interval change of multiple cortical tubers and subependymal nodules as well as SEGAs since prior scan.Ventricle size also appears to be stable.


Instruction: Generate impression based on findings.

Input: Reason: S/P L breast lumpectomy for Phyllode's/ADH. There is a heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. There is asymmetrically increased background parenchymal enhancement in the left lower outer breast, at the site of previous surgical excision. No seroma cavity is seen. No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Slightly increased background enhancement in the surgical bed in the left lower outer breast, compatible with postsurgical change. No MRI evidence for malignancy. If clinical examination remains benign, the patient may continue routine high risk screening with annual mammogram and MRI, presuming she has >20% lifetime risk.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.