Instruction: Generate impression based on findings.

Input: Hydrocephalus with developmental delay and enlarging head. Status post remote endoscopic third ventriculostomy for aqueductal stenosis. There are postoperative findings related to endoscopic third ventriculostomy. There is no evidence of robust biphasic CSF flow across the third ventriculostomy. There is no significant interval change in the marked dilatation of the lateral and third ventricles with mild mass effect upon the brainstem and cerebellum. There is no significant interval change in the size of the cortical mantle. There is no evidence of acute infarction, hemorrhage, or mass. There is no midline shift. The major cerebral flow voids are grossly intact. The skull and scalp soft tissues are unchanged. There is persistent fluid within the bilateral middle ears and mastoid air cells.

Output: 1. No significant interval change in the hydrocephalus associated with aqueductal stenosis.2. No evidence of robust biphasic CSF flow across the third ventriculostomy.


Instruction: Generate impression based on findings.

Input: Lateral knee pain MENISCI: There is mildly increased signal within the anterior horn of the lateral meniscus with questionable extension to the inferior articular surface. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a small focal full-thickness defect of the articular cartilage of the lateral femoral condyle best appreciated on series 8 image 15/30 and series 5 image 23/31. There is a small amount of underlying reactive marrow edema. The remaining articular cartilage of the knee is otherwise preserved. A small amount of marrow is also noted within the medial tibial plateau posteriorly.LIGAMENTS: The ACL is absent. The PCL is intact as are the remaining collateral ligaments.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Ruptured ACL. 2. Small focal full-thickness cartilage defect of the lateral femoral condyle. The remaining articular cartilage is preserved.3. Increased signal within the anterior horn of the lateral meniscus with possible extension to the inferior articular surface which may reflect a small tear.


Instruction: Generate impression based on findings.

Input: Acute lymphoid leukemia. Headache. No intracranial mass or mass effect. No evidence of acute infarct or hemorrhage. Few scattered T2 hyperintense foci are present in the periventricular and deep frontal white matter, particularly in the right posterior frontal corona radiata, which are nonspecific and may reflect mild chronic microvascular ischemia or post treatment changes. There is no intracranial hemorrhage. Mild global parenchymal volume loss. No hydrocephalus. Major intracranial vascular flow voids are preserved.There is no gross orbital abnormality. Mastoid air cells are clear. There is moderate mucosal thickening in the right ethmoid sinuses. The other paranasal sinuses are clear. There is diffuse heterogeneity of the bone marrow which may be related to known leukemia. No large destructive lesions are appreciated.

Output: 1.No evidence of intracranial mass or mass effect. Few scattered foci of T2/FLAIR hyperintensity in the white matter are nonspecific and compatible with mild chronic small vessel ischemic changes and/or posttreatment related changes. 2.Please note lack of contrast slightly limits evaluation for leptomeningeal disease.3.Diffuse heterogeneity of the bone marrow signal which is nonspecific but may be related to known leukemia.4.Moderate opacification involving the right anterior and posterior ethmoid air cells with minimal mucosal thickening elsewhere in the paranasal sinuses.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Upper back pain and dysphagia with NF1. Postsurgical changes of suboccipital decompression for Chiari I malformation are again seen. Optic pathway gliomas are partially imaged.Multiple enhancing masses are redemonstrated in the spine consistent with neurofibromas.Cervical Spine:Vertebral body heights in the cervical spine are normal. There is dural ectasia with dorsal scalloping of the odontoid process. There is also mild loss of normal cervical lordosis. Small disc bulges are evident in the cervical spine without significant spinal canal or neural foraminal stenosis at any level.There is trace prominence of the central canal at the C5-C7 levels measuring 1 to 2 mm and not significantly changed. Otherwise no intramedullary masses are appreciated. No expansile masses within the cervical neural foramina are appreciated.Left lower neck/paraesophageal enhancing mass measures 2.2 x 3.4 x 4.6 previously 2.2 x 3.1 x 4.6 cm. There is very mild mass effect on the esophagus. Left thyroid lobe is anteriorly displaced as is the left common carotid artery.Thoracic Spine:Thoracolumbar scoliosis with posterior spinal fusion hardware are again seen and better assessed on recent radiographs. Neurofibroma involving the right T4-T5 neural foramen is again seen with paraspinous/right posterior mediastinal extension and measures 4.2 x 2.2 cm in the axial plane and 2.5 cm in the craniocaudal dimension, previously approximatelyA left intercostal neurofibroma at T7-8 is incompletely imaged but appears to have enlarged slightly measuring 1.8 cm in thickness previously approximately 1.3 cm in thickness. Lesion measures at least 3.5 cm in the transverse dimension, previously approximately 2.8 cm.Spinal canal and neural foramina in the thoracic spine are otherwise patent. No evidence of mass effect. Distortion related to susceptibility artifact from hardware limits evaluation however no cord signal abnormality or intramedullary tumor is definitively appreciated.Lumbar Spine:Levoscoliosis at the upper lumbar spine is again seen as seen on recent radiographs. Partial osseous fusion involving the upper lumbar vertebral bodies is noted.There are small bilateral paraspinal neurofibromas situated within and adjacent to the psoas muscles, not appreciably changed. There is a left paraspinous mass at the L2-L3 level measuring approximately 20 x 10 mm and unchanged. Small neurofibroma involving the left L5 nerve root suspected not appreciably changed. No discrete mass within the lumbar spinal canal is appreciated within the limitations of susceptibility artifact. Enhancing mass adjacent to the left renal pelvis measuring approximately 2.2 x 2.4 cm is again seen similar to prior and without evidence of hydronephrosis. There is facet arthropathy at L5-S1 with suggestion of a synovial cyst on the left, measuring approximately 7 mm, and abutting the left dorsolateral aspect of the thecal sac without significant mass effect.

Output: 1. Compared to 4/8/2013 examination, there has been no significant enlargement of the neck, spinous, or paraspinous multiple neurofibromas. Relatively largest one is seen in the left upper para-esophageal region with very mild mass effect on the esophagus.2. No mass effect on the cervical, thoracic, or lumbar spinal canal is appreciated. No intramedullary mass is appreciated although susceptibility artifact related to spinal fusion slightly limits evaluation. There is trace prominence of the central canal in the cervical cord from C5 to C7 which is not significantly changed.3. There is mild enlargement of a left posterior lateral intercostal schwannoma at the T7-T8 level.4. Please refer to separate report for findings in the pelvis.


Instruction: Generate impression based on findings.

Input: Reason: Metastasis to Cerebellum History: Gait instability with known metastatic lung cancer Nonenhanced head CT:There is no detectable abnormality of the cerebellum or the vermis on this non-infused head CT. The fourth ventricle and the cerebellar volume is within normal limits. If concern for metastatic lesion persist recommend contrast MRI.Images through supratentorial space demonstrate no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium is intact.

Output: Negative nonenhanced head CT.


Instruction: Generate impression based on findings.

Input: Per EPIC, patient initially presented on 03/20/15 with left sided ear pain and decreased hearing, found to have a left sided middle ear effusion, now s/p tympanostomy tube placement. CT temporal bone scan incidentally showed some chronic sinusitis with bony erosions with further CT evaluation of the sinuses. Left sphenoid sinusitis with bony dehiscence seen on recent sinus CT. Evaluation is limited by lack of intravenous contrast, motion artifact and an incomplete study. However, there is asymmetric soft tissue prominence in the left posterior nasal cavity extending to the left much greater than right nasopharynx with effacement of the left fossa of Rosenmuller as well as direct extension of soft tissue into the floor of the left sphenoid sinus. There is corresponding diffusion restriction. The focal bony dehiscence, adjacent osseous erosions and partially dehiscent left vidian canal are better evaluated on the prior CT. There is fluid surrounding the focal soft tissue mass in the left sphenoid sinus. Mild mucosal thickening of the bilateral maxillary sinuses, left greater than right, is also present. There is widening of the left sphenopalatine foramen and pterygopalatine fossa with loss of normal fat signal, concerning for perineural tumor spread. There is abnormal marrow signal within the left pterygoid body as well as mildly heterogenous marrow signal of the calvarium. Abnormal marrow signal is also seen basisphenoid. Left masticator space inferiorly is also involved by the mass abnormal appearance of the left medial pterygoid muscle and effacement of adjacent fat plane. The left medial pterygoid plate is not well seen, also noted on CT. There is mild asymmetric effacement of the left parapharyngeal space cranially.There is a bulky appearance along the carotid space bilaterally and partial encasement of the left internal carotid artery by the soft tissue, relating to lymphadenopathy. There is a septated heterogeneous nodule with T2 hyperintense signal measuring approximately 1.4 x 1.3 x 1.4 cm (AP x TR x CC) in the right retropharyngeal space as well as a more inferior nodule measuring 1.0 x 0.6 x 1.0 cm, which are suspicious for necrotic lymph nodes. Overall, there is increased number of prominent lymph nodes along the jugular chain bilaterally. Additional enlarged bilateral level 5 lymph nodes are present, measuring 1.6 x 1.2 cm on the right and 1.7 x 1.3 cm on the left. A left intraparotid node measures 1.3 x 0.8 cm. These all demonstrate some degree of diffusion restriction. There is mild posterior displacement of the right cervical vessels at the level of the retropharyngeal adenopathy.There is minimal scattered opacification of a few left mastoid air cells. Incidentally noted is a 4 mm pineal cyst.

Output: 1. Limited evaluation due to motion, noncontrast and incomplete study. However, prominent soft tissue thickening predominantly at the left greater than right nasopharynx extending into the posterior left nasal cavity with direct extension into the left sphenoid sinus. Additional involvement of the left masticator space and effacement of the left parapharyngeal space, with partial encasement of the left internal carotid artery by soft tissue. Findings are highly suspicious for primary nasopharyngeal neoplasm with perineural tumor spread, and necrotic metastatic right retropharyngeal lymph nodes in addition to other bilateral cervical lymphadenopathy. Evaluation of the full extent of tumor and perineural tumor spread is limited on this noncontrast study. If there are no contraindications, MRI with contrast is recommended.2. Abnormal marrow signal of the left pterygoid body, basisphenoid, and calvarium, suspicious for osseous involvement. Osseous erosive changes and focal dehiscence are better seen on prior CT. Findings discussed with Samantha Zunich, PA of Dr. Pinto's office on 6/11/2015 at 11:10 am by Dr. Wu.


Instruction: Generate impression based on findings.

Input: Stated history of auto-immune sclerosing cholangitis and cirrhosis. Pathology dated 11/30/2012 showed chronic hepatitis with focal bridging fibrosis. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal lesion. No intrahepatic or extrahepatic biliary ductal dilatation. Normally distended gallbladder. The MRCP images demonstrate mild irregular narrowing of the right hepatic duct without a focal lesion or upstream dilatation, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Extrarenal pelvis bilaterally.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: Minimal non-specific irregularity of the right hepatic duct without a focal lesion or biliary ductal dilatation. No specific stigmata of cirrhosis or focal liver lesion.


Instruction: Generate impression based on findings.

Input: There is no acute cord compression.L4-L5 laminectomies are again noted. T1-T2 hyperintense focus in the L2 vertebral body is again compatible with a vertebral hemangioma. Degenerative disc disease is again seen, predominantly affecting the lower lumbar spine with severe bilateral neural foraminal narrowing at the level of L5-S1.Cervical spine MRI:Post surgical changes of cervical laminoplasty with laminectomies from C3 to C7 with spinous process resection is noted. Contrast enhancement and metallic artifact within the posterior soft tissues of the neck are presumably postsurgical. Retrolisthesis of C4 on C5 and C5 on C6 is unchanged. There are no fractures and the marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. No areas of abnormal contrast enhancement are identified.C2/3: No significant neural foraminal or central canal stenosis.C3/4: Diffuse disc bulge results in mild central canal stenosis. Uncovertebral hypertrophy results in moderate left and mild right neural foraminal stenoses. These findings are unchanged from the prior study. C4/5: Disk osteophyte complex and ligamentum flavum hypertrophy results in mild central canal stenosis, improved from the prior study. There is again severe bilateral neural foraminal narrowing.C5/6: Disc osteophyte complex is present without significant central canal stenosis, improved from the prior study. Uncovertebral joint hypertrophy results in mild left and severe right neural foraminal stenoses.C6/7: Disc osteophyte complex causes moderate central canal stenosis, also improved from the prior study. Mildly T2 hyperintense right spinal cord at this level is favored to represent myelomalacia. Severe bilateral neural foraminal narrowing is unchanged.

Output: 1.No acute cord compression.2.Degenerative disc disease is again seen predominantly in the lower cervical spine with improved central canal stenosis from C4/5 through C6/7 when compared with the prior study.


Instruction: Generate impression based on findings.

Input: 50 year old male patient with stage IV rectal cancer. Staging examination. PELVIS:PROSTATE/SEMINAL VESICLES: No definite invasion by tumor.BLADDER: No definite invasion by tumor.LYMPH NODES: There are scattered small mesorectal lymph nodes (image 45, series 601 and 52, series 601). There are non-specific small inguinal lymph nodes.BOWEL, MESENTERY: There is a 2.7 x 3.1 cm (AP x craniocaudal) irregular, circumferential enhancing mass within the upper rectum. Tumor extends beyond the muscularis propria. The tumor appears to infiltrate through the posterior rectal wall and involves the mesorectal fascia posteriorly with signal abnormality extending to the presacral fascia (image 31, series 701 and image 56, series 2001). There is also infiltration of the mesorectal fascia along the right lateral border of the tumor (image 54, series 2001) and abutment of the mesorectal fascia anteriorly. There is no invasion of the bladder. The anal sphincter does not appear to be involved. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Upper rectal mass with extension through the mesorectal fascia as described above.2.Small mesorectal lymph nodes are suspicious for metastatic adenopathy.


Instruction: Generate impression based on findings.

Input: Female, 10 years old, with tract seizures, history of Alpers syndrome. Gyriform T2 hyperintensity seen on the prior examination within the right parietal and occipital lobes is no longer clearly identified. Subtle diffuse T2 hyperintensity of the caudate and putamina bilaterally is unchanged. T2 hyperintensity of the posterior thalami is unchanged on the right, but progressed on the left. Cavitation of the medullary olives is unchanged.No evidence of significant parenchymal mass effect is seen. No restricted diffusion is detected. A right frontal lobe developmental venous anomaly is again seen. No evidence of significant intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricles are normal in size and shape.

Output: Since the prior examination, some fluctuation in areas of parenchymal signal abnormality is detected. For example, regions of gyriform signal abnormality seen previously within the right parietal and occipital lobes seem to have resolved. However, signal abnormality within the left thalamus has progressed.Diffuse signal abnormal involving the basal ganglia, and cavitation of the medullary olives, are stable findings. No entirely new intracranial lesions are detected.


Instruction: Generate impression based on findings.

Input: Multiple myeloma BONE MARROW: A large marrow replacing lesion with soft tissue component is seen involving the left iliac wing. The remaining marrow signal of the pelvis and lower lumbar spine is normal.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Large marrow replacing lesion with soft tissue component involving the left iliac wing. The remaining bone marrow of the pelvis and lower lumbar spine otherwise appears normal.


Instruction: Generate impression based on findings.

Input: Back pain with neurologic symptoms. Motor vehicle accident on 3/22. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is dextro scoliosis at the thoracolumbar junction as seen on prior CT. Alignment of the lumbar spine is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Mild degenerative changes are seen including disc desiccation at the L2-L3, L3-L4, L4-L5, and L5-S1 levels. Individual levels as below:L1-L2: No spinal canal or neural foraminal stenosis.L2-L3: No spinal canal or neural foraminal stenosis.L3-L4: No spinal canal or neural foraminal stenosis.L4-L5: No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or left neural foraminal stenosis. Mild right neural foraminal narrowing. Facet arthropathy is evident, particularly on the right.Paraspinous soft tissues are within normal limits. Patient is noted to be pregnant. Please refer to separate report for findings in the pelvis.

Output: 1. No evidence of compression fracture or hematoma in the spinal canal.2. Dextroscoliosis at the thoracolumbar junction. Mild degenerative changes including multilevel disc desiccation as well as facet arthropathy, particularly at the right L5-S1 level. There is mild right L5-S1 neural foraminal stenosis. No significant spinal canal stenosis at any level.3. Please refer to separate report for findings in the pelvis.


Instruction: Generate impression based on findings.

Input: 67 yo M with HCV, cirrhosis, RVOT PVCs, enlarged RV, chest pain, intermediate CAD. Referred for cardiac stress MRI prior to liver transplant and possible hernia repair. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 68%. The LVEDV is 131 ml (normal range 142+/-34), the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVESV is 42 ml (normal range 47+/-19) and the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9). The LV mass is 82 g (normal range 164+/-36) and the LV mass index is 46 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. 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 67%. The RVEDV is 125 ml (normal range 142+/-31), RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVESV is 41 ml (normal range 54+/-17), and the RV end systolic volume index is 23 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is mild thickening of the tip of the anterior mitral leaflet.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 is normal in size and drains normally into the right atrium. There is a prominent azygous vein which appears dilated and tortuous consistent with the patient's underlying liver disease.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is at least a moderate sized hiatal hernia. 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.No perfusion defects/ "ischemia" present during hyperemia.2.No late gadolinium enhancement. No prior myocardial infarction. The entire myocardium is viable.3.Normal LV size and systolic function (LVEF 68%). No regional wall motion abnormalities.4.Normal RV size and systolic function (RVEF 67%)5.There is a prominent azygous vein which appears dilated and tortuous consistent with the patient's underlying liver disease.6.See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 50-year-old female with history of benign biopsy of the right breast and strong family history of breast cancer in her mother presents for MRI Surveillance. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Multiple cysts are present in both breasts.Focal non-mass enhancement is unchanged at middle 12 o'clock position in the left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Reason: pancreatic mass seen on abd US History: pancreatitis, wt loss, anorexia ABDOMEN:LIVER, BILIARY TRACT: Gallbladder sludge. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: 1.1 cm T2 hyperintense nonenhancing lesion at the pancreatic head just proximal to the ampulla. A branch off the main pancreatic duct appears to communicate with this lesion, and this likely represents a side branch IPMN without evidence of suspicious features. This is best seen on delayed postcontrast imaging. A couple other smaller similar-appearing lesions are also seen. Mild diffuse prominence of the duct measuring up to 3 mm with a beaded appearance. Pancreatic head fullness with no distinct enhancing or hypoenhancing lesion except for what is described immediately above. Infiltrative T2 signal seen throughout the head of the pancreas could be edema related to a component of focal acute pancreatitis on chronic pancreatitis.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.Focal acute on chronic pancreatitis as above. 1.1 cm and smaller nonenhancing lesions in the pancreatic head with apparent communication with the ducts likely represent small side branch IPMN's. Follow-up until resolution is recommended to exclude underlying pancreatic head lesion.


Instruction: Generate impression based on findings.

Input: Known aneurysm: repair scheduled. MRI: There is no evidence of intracranial hemorrhage or acute infarct. There is extensive cerebral and pontine white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is an inferiorly-directed saccular aneurysm arising from the A2 segment of the left anterior cerebral artery near the left pericallosal artery measuring up to 9 mm in diameter, with a 2 mm wide neck. There is no evidence of significant steno-occlusive lesions.

Output: 1. Saccular aneurysm arising from the A2 segment of the left anterior cerebral artery measuring up to 9 mm in diameter, with a 2 mm wide neck.2. Nonspecific extensive cerebral and pontine white matter T2 hyperintensity may represent chronic hypertensive encephalopathy.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 12 seconds

Output: Successful right hip contrast injection for MR arthrogram. Please refer to the subsequent MRI report for further evaluation.


Instruction: Generate impression based on findings.

Input: Redemonstrated are diffuse patchy foci of increased T2 signal within the bilateral basal ganglia, periventricular white matter, the pons, and bilateral cerebral peduncles. These findings are unchanged compared to previous examination. No abnormal enhancement.There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas.The ventricles and sulci are stable in size and configuration with mild cerebral volume loss. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. Bilateral optic nerves appear atrophic, left greater than right. The optic chiasm, and tracts appear unremarkable. There is no optic nerve sheath dilatation. The extraocular muscles are normal and symmetric with physiologic, homogeneous, and intense contrast enhancement. The globes appear normal with physiologic enhancement of the ciliary bodies and choroid. No retinal detachment or vitreous clouding. The lacrimal glands are symmetric and within normal limits for size. No orbital mass lesion. No enhancing pathology.

Output: 1.Stable abnormal nonenhancing T2 signal abnormality within the bilateral basal ganglia and brainstem, which is secondary to presumed neurosarcoidosis.2.Bilateral optic nerves appear atrophic, left greater than right.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute 22 seconds

Output: Successful injection of left hip.


Instruction: Generate impression based on findings.

Input: History of metastatic pancreatic neuroendocrine tumor. Surveillance study. ABDOMEN:LIVER, BILIARY TRACT: Multiple arterially peripherally enhancing metastatic liver lesions are again noted.The index segment 5 lesion measures approximately 2.1 cm x 1.8 cm (series 13/46), compared to 2.1 x 1.8 cm previously.The index segment 6 lesion measures approximately 2.2 x 1.9 cm (series 13/62), compared to 2.0 x 1.9 cm previously.The remaining lesions are not significantly changed in size or number.Susceptibility artifact from CBD stent. No significant intra or extrahepatic biliary ductal dilatation. The hepatic vasculature appears patent. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: There is a poorly defined pancreatic head lesion measuring approximately 1.9 x 1.8 cm (series 13/70), compared to 2.1 x 1.4 cm previously. There is upstream pancreatic parenchymal atrophy without significant ductal dilatation.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.Stable examination with numerous arterial enhancing liver metastases.2.Relatively stable size of the pancreatic head lesion. 3.No new sites of disease.


Instruction: Generate impression based on findings.

Input: Transient cerebral ischemic attack, unspecified [G45.9], Reason for Study: ^Reason: stroke History: dysarthria, left hypoesthesia Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear. Right eye globe shows dystrophic shape with the internal low signal intensities indicating phthisis bulbi.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of flow-limiting arterial luminal stenosis on brain MRA and neck MRA.


Instruction: Generate impression based on findings.

Input: Status epilepticus overnight, EEG showing periods of overactivity not consistent with high dose benzodiazepine therapy. There is vasogenic edema in the bilateral occipital, parietal, superior frontal, and posterior temporal lobes, with a few punctate foci of susceptibility effect in the bilateral parietal lobes. There is minimal T2 hyperintensity in the pons. There is no evidence of mass or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings most compatible with posterior reversible encephalopathy syndrome and associated microhemorrhages.


Instruction: Generate impression based on findings.

Input: 67 years Female (DOB:8/14/1948)Reason: Mets small cell lung cancer, s/p 2 lines of therapy, now with disease progression, pls evaluate CNS status as restaging. History: mets small cell lung cancerPROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 demonstrate partial opacification of the left mastoid air cells. There appears to be some signal hyperintensity on FLAIR imaging within the left jugular vein and sigmoid sinus. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for brain metastases.2.There is fluid in left mastoid air cells. The possibility of mastoiditis cannot be excluded. Some adjacent signal hyperintensity involving the left jugular vein and sigmoid sinus is nonspecific and of uncertain significance however, in theory to could potentially represent inflammatory reaction.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for cervical spine and lumbar spine pathology. Signs and symptoms: Neck pain. LBP and numbness Nonenhanced lumbar MRI:There is normal anatomical alignment of the vertebral column.The signal intensity of vertebral column demonstrate subtle changes secondary to degenerative disease and unremarkable otherwise.T10-T11 is unremarkable.T11-T12 demonstrate mild disc disease and with small anteriorly projecting hypertrophic spur. No spinal stenosis or neural foraminal compromise.T12-L1 demonstrate mild disc desiccation and is unremarkable otherwise.L1-L2 demonstrate mild disc desiccation and unremarkable otherwise.L2-L3 demonstrate mild degenerative changes and unremarkable otherwise.L3-L4 demonstrate mild degenerative disease and unremarkable otherwiseL4-L5 demonstrate mild facet and ligamentum flavum hypertrophy (left greater than right) and unremarkable otherwise.L5-S1 demonstrate mild disc desiccation and mild bilateral facet and ligamentum flavum hypertrophy. Subtle left facet effusion is detected. There is a shallow left lateral and far lateral disc protrusion (axial T2 series 6 image 22 and sagittal T2 series 3 images 6 through 8). Finding results in moderate left neural foraminal and mild left lateral recess compromise without central spinal stenosis. There is no detectable abnormality of the paraspinal soft tissues.Nonenhanced cervical MRI:The signal intensity of vertebral column is unremarkable.The anatomical alignment of the vertebral column is preserved however there is straightening of cervical lordosis which could be secondary to positioning or pain.The signal intensity and caliber of cervical and upper most visualized thoracic cord is unremarkable.C2-C3 is unremarkable.C3-C4 is unremarkable.C4-C5 demonstrates mild disc desiccation and unremarkable otherwise.C5-C6 demonstrate mild disc disease, small anteriorly projecting hypertrophic spur and no significant facet or ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.C6-C7 demonstrate mild disc desiccation and unremarkable otherwise.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord demonstrate no significant degenerative disease and no spinal stenosis or neural foraminal compromise.

Output: 1.MRI of the lumbar spine demonstrate mild degenerative disc disease and hypertrophic changes of facets and ligamentum flavum posteriorly as detailed her level above. There is no spinal stenosis at any level. There is a left lateral and far lateral L5-S1 shallow disc protrusion with resultant moderate left neural foraminal and mild left lateral recess compromise.2.MRI of cervical spine demonstrate mild degenerative disease without spinal stenosis or neural foraminal compromise. Normal signal intensity and caliber of cervical and upper most visualized thoracic cord.


Instruction: Generate impression based on findings.

Input: 55-year-old male with malignant neoplasm of the prostate (3+3 Gleason) PELVIS:PROSTATE:Prostate Size: 4.7 x 5.3 x 2.8 cm.Peripheral Zone: Bandlike T2 hypointensities diffusely throughout the peripheral zone. A focal T2 hypointensity is noted in the left mid gland peripheral zone.Central Gland: Mild degree of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Focal T2 hypointensity is noted in the left mid gland peripheral zone. Otherwise, no discrete nodule/lesion is evident.2.Bandlike T2 hypointensities diffusely throughout the peripheral zone may reflect prostatitis.


Instruction: Generate impression based on findings.

Input: Back pain. There is congenital fusion of the C2 and C3 and C6 and C7 vertebrae associated with straightening of the cervical spine alignment in the sagittal plane, but no spondylolisthesis. The thoracic and lumbar spine alignments are normal. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is a short segment of relatively high T1 signal in the posterior sacral canal that measures less than 2 mm in thickness. The conus medullaris is located at the level of L1-2. The paravertebral soft tissues are unremarkable. There is horseshoe kidney.

Output: 1. Congenital fusion of the C2 and C3 and C6 and C7 vertebrae with straightening of the cervical spine alignment in the sagittal plane.2. The conus medullaris is located at the level of L1-2. 3. A short segment of relatively high T1 signal in the posterior sacral canal may represent a fibrofatty filum terminale.4. Horseshoe kidney.


Instruction: Generate impression based on findings.

Input: 49 year-old female with elevated LFTs, nausea, and vomiting with a history of alcohol use. ABDOMEN:LIVER, BILIARY TRACT: No intra-or extrahepatic biliary ductal dilation. Distended gallbladder without evidence of acute cholecystitis. No evidence of gallstones or common duct stone. There are multiple foci of fluid signal intensity in the liver consistent with simple cysts. No focal mass lesions are identified. There is loss of signal in the liver on out of phase sequences consistent with hepatic steatosis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of intra- or extra-hepatic biliary ductal dilation. No common duct stones are idenitified.2.Fatty infiltration of the liver. Mild hepatomegaly.


Instruction: Generate impression based on findings.

Input: 16-year-old male with Crohn's disease and history of perirectal fistula and abscesses.EXAMINATION: MR enterography without and with IV contrast 1/26/2015 The previously seen left perineal fluid collection has resolved and the anocutaneous fistula has markedly decreased in size, with trace residual T2 hyperintense signal measuring 6 x 4 mm (image 44, series 601), which does not demonstrate appreciable enhancement, but may communicate with a skin surface. No additional sinus tract, fistula or abscess is identified.The T1 hypointense/T2 hyperintense lesion in the right femoral intertrochanteric region is unchanged in size and morphology from the prior examination and stable since 2/20/2014, suggesting a benign etiology.Note is made of a right hydrocele.

Output: 1.Near complete resolution of the previously described anocutaneous fistula and resolution of the perineal abscess, without new abscess, sinus tract or fistula identified.2.Stable osseous lesion in the intertrochanteric region, which is unchanged since 2/20/2014, and likely benign in etiology.3.Right hydrocele, further evaluation with testicular ultrasound is recommended.


Instruction: Generate impression based on findings.

Input: HPV-positive squamous cell carcinoma of the left base of tongue status post chemoradiation. There are post-treatment findings in the neck with mild persistent supraglottic edema. The lingual tonsils appear unchanged, without measurable tumor. There is no cervical lymph node enlargement. Small lymph nodes remain unchanged. The thyroid and major salivary glands are unchanged. There is mild degenerative spondylosis of the cervical spine. The orbits are intact. There are left maxillary sinus retention cysts. The imaged intracranial structures are grossly unremarkable.

Output: 1. Post-treatment findings in the neck without evidence of measurable locoregional tumor recurrence. 2. No evidence of significant cervical lymphadenopathy based on size criteria.


Instruction: Generate impression based on findings.

Input: 63-year-old female with knee buckling and popping sensation. Presents with right knee pain. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is a full-thickness articular cartilage cleft with delamination along the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus. There is a full-thickness articular cartilage cleft along the weightbearing surface of the medial femoral condyle above the anterior horn of the meniscus. The lateral facet of the patella and femoral trochlea are completely devoid of articular cartilage. There is full-thickness articular cartilage degeneration along the medial facet of the patella, centrally, with underlying subchondral cyst formation. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteoarthritis of the right knee with full-thickness articular cartilage clefts and degeneration as described above. 2. Moderate to large joint effusion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Glioblastoma treatment planning. There are postoperative findings related to prior right frontal craniotomy. There is redemonstration of a heterogeneous mass that measures up to approximately 9 cm, centered within the right frontal lobe, with midline shift and extension across the midline and into the basal ganglia. There is effacement of most of the right lateral ventricle, but dilatation of portions of the third and left lateral ventricles. There is also heterogeneous tumor in the left cerebellar hemisphere and vermis with extension into the fourth ventricle, with diffuse surrounding high T2 signal in the cerebellum and brainstem.

Output: Treatment planning MRI redemonstrates a large mass centered in the right frontal lobe, with associated ventricular entrapment, and tumor in the posterior fossa.


Instruction: Generate impression based on findings.

Input: 36-year-old male with history of metastatic renal cell cancer with back pain.EXAM: CT of the thoracic and lumbar spine was performed without IV contrast. Thoracic spine: Alignment of thoracic spine is normal. Mild degenerative changes are seen throughout the thoracic spine. No lesions suspicious for metastases are identified. Nodular opacities at the right lung base are likely due to previously identified consolidation.Lumbar spine:3.3 x 2.9 cm lucent lesion in the L3 vertebral body, with a sclerotic rim, is not significantly changed compared to CT pelvis study from 2/18/08. There is a suggestion of posterior extension of this lesion into the central canal, however, this is equivocal. Additionally, another lucent lesion measuring 1.5 x 0.8 cm in the L1 vertebral body with sclerotic borders is identified. Although these lesions have a benign appearance the etiology of these lesions is unknown, and further evaluation by infused MRI is recommended.

Output: Two lucent lesions in the lumbar vertebral bodies as described above. Extension of the L3 lesion posteriorly into the central canal cannot be excluded. Although they have a benign appearance, the etiology of these lesions is unknown. Further evaluation by contrast-enhanced MRI is recommended.


Instruction: Generate impression based on findings.

Input: 80 year-old woman with right leg numbness x 2 days and headache. There is no evidence of intracranial hemorrhage, mass or edema. In the left, high convex frontal lobe there is a region of dystrophic, cortical calcification. This finding is present on the MRI dated 8/25/2007.The ventricles are normal in size and configuration. There is a mega cisterna magna, a non-pathological finding, noted.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No CT findings of acute process. If stroke is a clinical concern, recommend MRI.


Instruction: Generate impression based on findings.

Input: Right sluggish pupil and eyelid lag. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: Male, 20 years old, with lower extremity paralysis. No acute cord compression is seen. The spinal canal is widely patent throughout. Although image quality is degraded by motion artifact, there does appear to be an area of spinal cord signal abnormality spanning at least the T1 and T2 vertebral body levels if not more. Disc bulge and facet arthropathy are suspected at L5-S1. Fairly extensive edema is seen within the left posterior paraspinal musculature at the cervicothoracic junction. Less intense but still extensive posterior paraspinal edema is seen in the lumbar region as well. A pleural effusion is evident layering along the left upper lobe. Right middle lobe atelectasis is noted.

Output: 1. Image quality is degraded by motion artifact.2. No acute cord compression is seen.3. An area of spinal cord signal abnormality is suspected spanning the T1 and T2 vertebral body levels. This should be further assessed with dedicated pre and postcontrast imaging.4. Fairly extensive paraspinal muscular edema is seen on the left at the cervicothoracic region and bilaterally in the lumbar region.5. Left pleural effusion and right middle lobe atelectasis.


Instruction: Generate impression based on findings.

Input: 35 years Female (DOB:10/18/1980)Reason: assess progression of ischemic disease seen on prior MRI History: altered mental statusPROVIDER/ATTENDING NAME: GINI FLEMING GINI FLEMING The CSF spaces are appropriate for the patient's stated age with no midline shift. There is continued evolution of microinfarcts in the right centrum semiovale which are no longer associated with diffusion restriction. There is no associated hemorrhagic conversion appreciated.A punctate T2 and FLAIR hyperintense focus in the left cerebellar hemisphere has also evolved.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A couple T2 and FLAIR hyperintense foci are present within the basal ganglia and are unchanged since prior exam. These appear to have been more acute stage I 5/5/2016No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There is no evidence for leptomeningeal enhancement on this exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cyst in the right maxillary sinus associated with some mucosal thickening. This is unchanged since prior exam.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Several lesions compatible with microinfarcts are present in the basal ganglia and left cerebellum which evolved since prior exams. 2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. They're suspected to be vascular related.3.There has been continued evolution of lesions in the right centrum semiovale which have been compatible with microinfarcts.


Instruction: Generate impression based on findings.

Input: 70 years Female (DOB:4/21/1946)Reason: s/p srs surgery History: surveillancePROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE There is redemonstration of right frontal craniotomy and encephalomalacia in the right frontal lobe. There is associated T2 and FLAIR signal hyperintensity within the right superior frontal gyrus and part of the right middle frontal gyrus as well as a small portion of the right precentral gyrus and paracentral lobule. There is some associated ex vacuo effect on the right lateral ventricle. The enhancing lesion continues to decrease in size.There is redemonstration of T2 and FLAIR signal hyperintensity within the subcortical white matter extending to the periventricular white matter of the left occipital lobe which was also present on the prior exam and has not changed. There is associated heterogeneous lesion centrally within this as well as susceptibility artifact. Small amount of contrast enhancement is present within the area of susceptibility artifact.There is redemonstration of punctate foci of signal loss on susceptibility imaging within the cerebellar vermis, right cerebellar hemisphere, left cerebellar hemisphere. These are unchanged.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Findings are compatible with previously treated lesions in the right frontal lobe and left occipital lobe. The left occipital lobe lesion continues to decrease in size.


Instruction: Generate impression based on findings.

Input: Mental portion: Rule out hemorrhage. Signs and symptoms: Altered mental status, gaze deviation. Unenhanced head CT:Since prior CT examination from 9 -- 16 -- 2011 and MRI examination from 9 -- 19 -- 2011 there is interval noticeable increase in the size of the supratentorial ventricular system. There is also resultant partial effacement of cortical sulci throughout bilateral cerebral hemispheres. Finding is consistent with acute hydrocephalus. There is no definitive evidence of periventricular low attenuation to suggest transependymal CSF exudate. There is low attenuation and thickening of the posterior aspect of septum pellucidum when compared with prior two studies. This finding appears to extend posteriorly along the roof of the third ventricle and likely in the velum interpositum. Review post shunted the study demonstrate absence of this finding which is suggestive of exudate of CSF into the septum pellucidum and cisternal velum interpositum. This finding is best appreciated on axial images 13 and 14 and coronal reformatted image 32. Findings were discussed with referring clinical physician Dr Hadipour pager # 3068 at the time of review exam.

Output: 1.Interval development of hydrocephalus with resultant partial effacement of bilateral cerebral cortical sulci.2.Low-density soft tissue fullness at the level of septum pellucidum and cisternal velum interpositum likely representing CSF leakage into the cisterns due to patient's hydrocephalus. This finding has resolved on immediate follow-up exam to this study.3.No evidence of periventricular transependymal exudate, hemorrhage or midline shift.


Instruction: Generate impression based on findings.

Input: Female, 28 years old, with one year of low back pain and right-sided sciatica. Assess for disc herniation. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is detected.The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are detected.The intervertebral discs are preserved. No significant disc bulge or herniation is detected. No significant spinal canal or foraminal stenosis is seen. At most, there may be very mild facet arthropathy at L4-5 and L5-S1.Incidental note is made of a multicystic left ovary. The right ovary is perhaps partially visualized and may be cystic as well.

Output: 1.Mild facet arthropathy is seen at L4-5 and L5-S1. No significant disc bulge or herniation is evident. No spinal canal or foraminal stenosis is detected.2.The partially visualized ovaries contain multiple small cysts, more than what would be considered normal for physiologic cysts. Dedicated pelvic imaging by ultrasound or MRI should be considered.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with history of Hodgkin's lymphoma in remission, presenting with left arm numbness and pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement, abnormal enhancement or marrow edema is seen.The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No epidural abnormalities are suspected. No pathologic cord or leptomeningeal enhancement is seen.C2-3: Left facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing C3-4: Left facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C4-5: Bilateral facet hypertrophy. Mild posterior disc-osteophyte complex formation with a small central disc protrusion. No significant spinal canal stenosis. Mild left foraminal narrowing. C5-6: Bilateral facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C6-7: No significant spinal canal or foraminal stenosis. C7-T1: No significant spinal canal or foraminal stenosis. Scattered ligamentum flavum thickening is seen in the upper thoracic spine.

Output: Mild degenerative findings are noted in the cervical spine without significant spinal canal stenosis or evidence of cord impingement. Several left-sided foramina are mildly narrowed, largely due to facet arthropathy.No evidence of any marrow infiltration or other inflammatory process is seen.


Instruction: Generate impression based on findings.

Input: There is mild diffusion hyperintensity along the left corona radiata and centrum semiovale corresponding ADC isointensity rather than T2 shine through. Other subtle areas of mild diffusion hyperintensity are present in the left frontal and parietal subcortical white matter. There are multiple areas of chronic lacunar infarct, including within the left pons. No MR evidence of acute intracranial hemorrhage. There is susceptibility along the left caudate and basal ganglia.There is extensive encephalomalacia involving the left middle cerebral artery territory including frontal lobe, corona radiata, insula, extending to inferior frontal lobe, and extending to the superior left temporal lobe. There is associated ex vacuo dilatation of the left lateral ventricle. Again noted is a small left frontal extra-axial dural based mass measuring 8 x 6 mm (series 7, image 14), most likely a small meningioma as was previously noted to be calcified on CT, without significant mass effect upon the underlying brain parenchyma. There is nonspecific heterogeneous hypointensity on T2/FLAIR with corresponding blooming on SWI in the right frontal lobe which may represent chronic hemosiderin staining. There is no complete T2 hypointense rim.Prominence of the ventricles and sulci, likely age related volume loss. The cerebellar tonsils are in normal position. Flow voids are present within the major vessels indicating patency, although with diminutive left MCA branches consistent with known area of infarct. The paranasal sinuses and mastoid air cells are clear.

Output: 1.Mild diffusion hyperintensity with ADC isointensity scattered along the left corona radiata and centrum semiovale as well as frontal and parietal subcortical white matter upon much more extensive underlying background of chronic small vessel ischemic changes and encephalomalacia in the left MCA territory, suggesting evolving superimposed recent ischemic changes.2.Incidental note is made of the small left frontal dural-based extra-axial mass, most likely a meningioma, without significant mass effect on the underlying brain parenchyma.3. Small area of likely chronic hemosiderin deposition in medial right frontal lobe, not likely felt to relate to an underlying cavernoma.


Instruction: Generate impression based on findings.

Input: Clinical question: New onset of headache. Signs and symptoms: As above. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates normal anatomical morphology of brain and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal limits.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits.All the paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: Unremarkable nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: History of pancreatic head mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. No biliary ductal dilatation or vascular abnormality. Normally distended gallbladder.There are at least 6 punctate subcentimeter mildly restricting, mildly T2 hyperintense, peripherally enhancing lesions in the liver involving both the right and left hepatic lobe, suspicious for metastatic disease.There are numerous predominantly peripheral wedge-shaped arterially enhancing regions which become gradually isointense to the liver on more delayed imaging compatible with perfusion anomalies. SPLEEN: No significant abnormality noted.PANCREAS: Demonstrated again is an approximately 2.7 x 2.4 cm hypoenhancing pancreatic head mass with associated abrupt termination of a markedly distended main pancreatic duct measuring up to 1 cm with associated pancreatic parenchymal atrophy. The mass abuts approximately 90 degrees of the adjacent superior mesenteric artery (series 1501/177). The celiac artery does not appear to be involved. There is severe narrowing of the SMV just proximal to the portal vein confluence. There are prominent peripancreatic/periaortic lymph nodes better characterized on the prior CT. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left interpolar simple cyst. No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion and bibasilar atelectasis.

Output: 1.Pancreatic head mass with features more suspicious for pancreatic adenocarcinoma with 90 degrees of abutment of the adjacent superior mesenteric artery. Peripancreatic and periaortic lymphadenopathy.2.Numerous punctate bilobar hepatic lesions with imaging characteristics highly suspicious for metastatic disease.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, presenting with chronic headaches and vision changes, decreased hearing, waking up from sleep, dizziness. Scattered foci of T2 hyperintensity are demonstrated in the cerebral white matter, a nonspecific finding. No restricted diffusion is seen. No evidence of parenchymal edema or mass effect is detected. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection are seen. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected. The ventricular system is normal in size and morphology.

Output: Scattered small foci of white matter signal abnormality are nonspecific but may represent chronic microvascular ischemic disease, sequelae of migraines, or the sequelae of inflammation or demyelination among other possibilities.No acute intracranial abnormalities are detected, and no additional specific findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: A 60 year old male with diabetes, hypertension, hyperlipidemia, peripheral arterial disease who presented with myocardial infarction 1 week ago and a pseudoaneurysm in the inferior wall was diagnosed in addition to 3 vessel coronary artery disease. The patient refused to have surgery and was referred to cardiac CT for follow-up of the pseudoaneurysmCPT Code: 75572 Left Ventricle: Normal LV size with low normal systolic function. The overall wall thickness is normal; however, a large complex appearing pseudoaneurysm (neck 11x12mm diameter and body with longest diameter 16mm) is noted. It appears to be larger than appreciated on the recent cardiac MRI but about the same size on the cardiac CT performed at outside hospital prior to the cardiac MRI. The aneurysm appears to have a couple of serpiginous extensions into the surrounding myocardium.Right Ventricle: Normal RV size with low normal systolic function.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior vena cava is grossly normal. The inferior vena cava is dilated. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: Normal thoracic aorta and pulmonary artery size.Pericardium: no pericardial effusionCoronary arteries: Coronary artery assessment is limited because beta-blockers and nitrates were not administered as part of this study. The following observations are made within the limits of the study protocol.LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. The left main is without significant stenosis. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. The proximal LAD has an approximately 50% stenosis. There is non-obstructive atherosclerosis in the mid LAD. The distal LAD is not well seen due to severe calcification. LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There is severe calcification in the proximal vessel which prohibits adequate assessment of the lumen.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is a severe stenosis in the proximal vessel. The mid vessel is completely occluded.

Output: 1. Normal LV size with low normal systolic function. A complex appearing pseudoaneurysm is noted in the basal inferior wall.2. Normal RV size with low normal systolic function.3. Mid RCA is occluded. Proximal RCA with severe stenosis. Proximal LAD with stenosis of intermediate severity. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: H/o right frontal meningioma and posterior fossa medulloblastoma. S/p resections. Examination demonstrates postoperative changes status post right frontal craniotomy, including right frontal pneumocephalus, edema and small amount of blood products and extra-axial fluid collection.Imaging through posterior fossa shows postoperative changes status post suboccipital craniotomy and craniectomy. There is a hyperdense mass in the left cerebellum and adjacent meningeal calcification, which is consistent with the finding on the previous MRI. The previously identified lesion in the left cerebellar peduncle is not visualized because of lack of contrast. There is hypoattenuation bilaterally in the periventricular white matter, which likely represents post radiation change. There is no mass effect or midline shift. The ventricles are normal in size and symmetric.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Postoperative changes status post right frontal craniotomy, including right frontal pneumocephalus, edema and small amount of blood products and extra-axial fluid collection.2. Left cerebellar mass. Postoperative changes status post suboccipital craniotomy and craniectomy.3. Postradiation change in the periventricular white matter.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified site of left female breast [C50.912] / Low back pain [M54.5], Reason for Study: ^Reason: 71F breast cancer, new back pain in thoracic/lumbar region, CT showing paraspinal abscess History: back pain, paraspinal abscess. There are multifocal vertebral body and pedicular lesions (T1, T2, T3, T4, T7, T8, T9, T10, and T11) as well as spinous process lesions (T3, T4, T7 and T8) with evidence of enhancement indicating metastatic lesions. Especially T3 vertebral body shows about 20% of compression fracture without evidence of retropulsion.There are paravertebral soft tissue thickening with enhancement especially anterior aspect of the T2 to T4 which also indicate metastatic lesions.There is normal thoracic kyphosis. The spine alignment is anatomic. The signal of the visualized cord is normal. There is no evidence of cord compression, or myelopathy. The conus medullaris terminates at the T12-L1 level. There is no evidence of spinal canal stenosis.There is no evidence of neural foraminal stenosisLeft side renal cyst is seen.Bilateral pleural thickenings are seen.

Output: 1. Multifocal various sized enhancing metastatic lesions of thoracic vertebrae and paravertebral soft tissue as described above.2. About 20% of compression fracture of T3 vertebral body.3. Spinal cord signal intensity is normal. No evidence of spinal stenosis or neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: 51-year-old female with right ankle pain. TENDONS: The tendons of the ankle appear intact.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: The articular cartilage and osseous structures are within normal limits. ADDITIONAL

Output: Inflammation of the subcutaneous fat along the medial malleolus as well as Kager's fat pad, without evidence of associated osseous, tendinous or ligamentous injury.


Instruction: Generate impression based on findings.

Input: Reason: 51 YEAR OLD FEMALE WITH SLE AND CORONARY HEART DISEASE NOW WITH TRANSIENT NEURO SYMPTOMS - SPEECH, NUMBNESS R ARM, HEADACHES The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the left maxillary sinus. The left maxillar ysinus is smaller than the right The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for acute cerebral infarction of intracranial hemorrhage.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 3.Left maxillary sinus is suspicious for silent sinus syndrome.


Instruction: Generate impression based on findings.

Input: Male, 19 years old, behavioral abnormality is hyperactivity, memory problems, assess for progression of toxic leukoencephalopathy/ADEM. Image quality is degraded by motion artifact. In addition, several standard sequences were not obtained including FLAIR and susceptibility weighted imaging as the patient requested to abort the examination early. Within these limitation, the following observations are made.Extensive signal abnormality seen on the prior examination involving the basal ganglia, insulae, midbrain and pons seems to have largely resolved. Some residual signal abnormality in these areas is possible, given the poor quality of the images, but if anything it is mild.No evidence of significant mass effect seen. No abnormal extra-axial collections are detected. Ventricles are normal in size and morphology. No restricted diffusion is seen.

Output: Limited examination due to patient motion and to early termination of the study at the patient's request.Extensive signal abnormality seen on the prior examination involving the bilateral basal ganglia, insulae, midbrain and pons has largely resolved. At most there may be minimal residual signal abnormality in these areas.No evidence of restricted diffusion, mass effect, or any pathologic fluid collections are seen.


Instruction: Generate impression based on findings.

Input: 46-year-old male with history of testicular cancer. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 69 years, Female, evaluate for infarct. Left face and arm weakness with sensory loss. There has been slight evolution of previously seen acute infarct in the right frontal lobe. There are new foci of restricted diffusion with T2/FLAIR hyperintensity adjacent to the aforementioned infarct as well as involving the right posterior temporal and occipital subcortical white matter consistent with acute infarcts. Additional patchy foci of T2/FLAIR hyperintensity involving the bilateral subcortical and periventricular white matter are again seen which are nonspecific but compatible with moderate chronic small vessel ischemic disease and perhaps in part related to the right ICA occlusion. Tiny nonspecific focus of susceptibility compatible with microhemorrhage in the right posterior frontal corona radiata. T2 hyperintense focus involving the left pons is compatible with perivascular space, less likely lacunar infarct.Perfusion images demonstrate prolonged mean transit times and in much of the right cerebral hemisphere compatible with right ICA occlusion. There is asymmetrically increased cerebral blood flow in the right anterior cerebral hemisphere including the basal ganglia.No intracranial mass or mass effect. Ventricles are normal in size. There is a punctate focus of enhancement involving the right paracentral lobule which may be related to subacute infarct, axial series 1201 image 26. There is otherwise no abnormal parenchymal or meningeal enhancement. Absent right internal carotid artery flow-void is again seen. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. Slight evolution of previously seen punctate right frontal subcortical white matter infarct. Compared to 8/19/2016 there are new punctate infarcts in the right cerebral hemisphere including the right posterior frontal, posterior temporal, and occipital white matter. There is also a punctate focus of enhancement likely representing a subacute infarct in the right paracentral lobule.2. Absent right internal carotid artery flow-void consistent with occlusion as seen on prior CTA. Perfusion images demonstrate associated prolonged mean transit time in the right cerebral hemisphere. Areas within the right frontal lobe and right basal ganglia demonstrates relatively increased/preserved cerebral blood flow.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient presents with AMS, global dysfunction without focal deficits. History of renal dysfunction and cannot use IV contrast. Evaluate for potential etiology of AMS. Signs and symptoms: As above. Nonenhanced brain MRI:Examination is severely limited and incomplete due to extensive motion artifacts, repeat exam is recommended.Negative diffusion weighted images.Ventricular system remains within normal size and maintained midline.There is slight prominence of cortical sulci.There are subtle periventricular and subcortical foci of flair/T2 hyperintensity which are nonspecific all are in proper clinical setting could represent chronic changes of microvascular ischemic process.There is no detectable intracranial hemorrhage, mass effect or midline shift. No convincing evidence of a mass on this nonenhanced exam. Calvarium and orbits are unremarkable.Mastoid air cells, middle ear cavities and all paranasal sinuses demonstrate normal pneumatization signal pattern.

Output: 1.Suboptimal and limited exam due to extensive motion artifact.2.Within this limitation no acute intracranial process is detected.3.Minute subcortical and periventricular foci of flair hyperintensity is a nonspecific finding however in proper clinical setting could represent chronic small vessel ischemic strokes.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, with three weeks of persistent headache and visual changes, six months postpartum, family history of aneurysm at young age. MRI brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.A 2 mm focus of enhancement deep within the right internal auditory canal is of uncertain significance. No other pathologic parenchymal or extra-axial enhancement is observed.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.MRA brain:No evidence of any intracranial aneurysm is seen within the limitations of MRA technique. No significant vascular stenosis or occlusion is identified.MRV brain:The dural venous sinuses and deep venous structures of the brain are patent.

Output: 1.A 2 mm focus of enhancement deep within the right internal auditory canal is of uncertain etiology and significance. Correlation with cranial nerve VII or VIII dysfunction is suggested.2.Evaluation of the brain is otherwise within normal limits.3.No intracranial aneurysm is detected.4.The intracranial venous structures are patent.


Instruction: Generate impression based on findings.

Input: 22-year-old woman with right knee pain MENISCI: The medial and lateral menisci are normal in appearance.ARTICULAR CARTILAGE AND BONE: There is marked thinning of the patellar cartilage. The femoral trochlear groove is shallow, and the patella is laterally subluxed.LIGAMENTS: The ACL is not well visualized and is at least partially torn. The PCL appears intact. The MCL and LCL complex appear intact. EXTENSOR MECHANISM: The patellar and quadriceps tendons are normal in appearance.ADDITIONAL

Output: 1. Femoral trochlear dysplasia with lateral subluxation of the patella. 2. The ACL is not well visualized and is at least partially torn.


Instruction: Generate impression based on findings.

Input: 38 years Female (DOB:6/21/1977)Reason: leg numbness History: leg numbnessPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.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 a mild degree of ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Reason: eval posterior heel soft tissues, achilles, subtalar joint, and adjacent soft tissue for swelling History: pain TENDONS: The Achilles tendon is normal in appearance. On fluid sensitive sequences, there is a thin band of increased signal intensity within the soft tissues immediately posterior to the distal Achilles tendon which may reflect mild inflammation of an adventitious retro-Achilles bursa. There is a small amount of fluid within the tendon sheath of the flexor hallucis longus immediately proximal to the talus and proximal to the knot of Henry. The posterior tibialis and flexor digitorum longus tendons appear normal. The anterior tendons appear intact. Small quantities of fluid are noted within the tendon sheaths of the peroneal tendons as they course along the anterior margin of the calcaneus, but this is of doubtful clinical significance.LIGAMENTS: The lateral collateral ligament complex appears intact. There is loss of the normal fatty striations of the deep tibiotalar component of the deltoid ligament which may reflect prior injury or degeneration, but this is not necessarily of any current clinical significance. The distal tibiofibular syndesmotic complex appears intact.ARTICULAR SURFACES AND BONE: There is a small to moderate-sized tibiotalar joint effusion as well as fluid within the posterior recess of the subtalar joint. There is an os trigonum, but there is no edema noted within the ossicle. There is minimal edema type signal within the medial portion of the body of the talus near the insertion of the deltoid ligament which is nonspecific, but may simply be degenerative in etiology. There is also mild edema type signal within the lateral portion of the posterior tuberosity and body of the calcaneus which is nonspecific. This could either represent marrow edema due to enthesopathy at the insertion of the Achilles tendon (although the tendon itself appears normal) or perhaps a stress reaction. There is mild edema within the overlying subcutaneous fat. There is a small defect along the anteromedial aspect of the tibial plafond likely representing a normal variant notch of Harty. We see no fluid-filled osteochondral defect. ADDITIONAL

Output: 1. Mild edema-type signal within the posterolateral calcaneus is nonspecific and could represent a stress reaction or perhaps inflammatory enthesopathic changes at the insertion of the Achilles tendon, although the tendon itself appears normal. There is also mild edema within the overlying subcutaneous fat as well as minimal inflammation posterior to the Achilles tendon which may represent a mild adventitious bursitis.2. Mild to moderate tibiotalar joint effusion as well as fluid within the posterior recess of the subtalar joint. Small amounts of fluid along the flexor hallucis longus tendon, as noted above, are not necessarily of any clinical significance.3. Os trigonum without edema within the ossicle or adjacent bone.4. Nonspecific subcutaneous edema along the medial and lateral aspects of the ankle.


Instruction: Generate impression based on findings.

Input: H/o cervical cancer. The lumbar lordosis is present. The lumbar spine alignment appears within normal limits. Abnormal hyperdensity is seen in the L2, L4, L5 and S1 vertebral bodies, in which there are 30% loss of height in the L2 vertebral body and depression of the right superior endplate of the L5 vertebral body. T12/L1: disc bulge and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L1/L2: disc bulge, vacuum phenomena and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L2/L3: disc bulge and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L3/L4: disc bulge and bilateral facet hypertrophy; no neuroforaminal compromise or spinal canal stenosis. L4/L5: disc bulge, vacuum phenomena and bilateral facet hypertrophy; left neuroforaminal compromise; no spinal canal stenosis. L5/S1: disc bulge, vacuum phenomena with small amount of air in the epidural space and bilateral facet hypertrophy; bilateral neuroforaminal compromise; no spinal canal stenosis. These findings have been stable since prior MRI.

Output: 1. Metastases likely involving the L2, L4, L5 and S1 vertebral bodies with the L2 and L5 compression or pathologic fractures. 2. Degenerative disease of the lumbar spine as detailed above.


Instruction: Generate impression based on findings.

Input: 57 VF arrest, CAD, MI Left VentricleThe left ventricle is severely reduced. The overall LV ejection fraction is 31%, the LV end diastolic volume index is 112 ml/m2 (normal range: 65+/-11), the LVEDV is 211 ml (normal range 109+/-23), the LV end systolic volume index is 77 ml/m2 (normal range 18+/-5), the LVESV is 146 ml (normal range 31+/-10). There are regional wall motion abnormalities present with apical hypokinesis, inferolateral hypokinesis and apical lateral akinesis. . There is late gadolinium enhancement in the endocardial pattern in the basal-mid inferolateral wall and extension in the basal inferior wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern of the enhancement is a distribution which suggests myocardial infarct. In most of the segments the enhancement is approximately 50% which suggests partial viability.Left AtriumThe left atrium is enlarged. Right VentricleThe right ventricle is mild-moderately reduced. The overall RV ejection fraction is 38%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 169 ml (normal range 110+/-24), the RV end systolic volume index is 38 ml/m2 (normal range 22+/-8), and the RVESV is 55 ml (normal range 35+/-13). Right AtriumThe right atrium is enlarged. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsBilateral pleural effusions R > L.. 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 reduced. The overall LV ejection fraction is 31%, There are regional wall motion abnormalities present with apical hypokinesis, inferolateral hypokinesis and apical lateral akinesis.2. There is late gadolinium enhancement in the endocardial pattern in the basal-mid inferolateral wall and extension in the basal inferior wall to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern of the enhancement is a distribution which suggests myocardial infarct. In most of the segments the enhancement is approximately 50% which suggests partial viability.3. Mild-moderate RV dysfunction.


Instruction: Generate impression based on findings.

Input: Ms. Bauer is a 54-year-old female with personal history of bilateral mastectomies with retropectoral silicone implant reconstruction. She has a personal history of LCIS and positive family history of breast cancer in her mother, diagnosed at the age of 46. The patient is status post bilateral mastectomies with retropectoral implants. The implants are intact bilaterally. No residual enhancing glandular tissue is appreciated.No abnormal enhancement is seen in either reconstructed breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 57-year-old male. Evaluate subcentimeter hypodensity seen on CT scan in patient with history of pancreatic cancer, status post resection in 2015. Concern for metastasis. ABDOMEN:LIVER, BILIARY TRACT: Loss of signal intensity on the out of phase imaging compatible with diffuse hepatic steatosis.At the hepatic dome, there are two faintly T2 hyperintense lesions demonstrating restricted diffusion (axial series 9 images 112, 116) and peripheral enhancement consistent with metastases (axial series 13 images 340, 346). These lesions were noted on the 9/23/2016 CT exam, and the sizes have slightly increased in the interval with reference measurements listed below.There are punctate arterially enhancing foci in the inferior peripheral right hepatic lobe that are only seen on the arterial phase and are most compatible with perfusional variants.SPLEEN: No significant abnormality noted.PANCREAS: Stable surgical changes status post Whipple. There is mild dilatation of the pancreatic duct measuring 5 mm in diameter. A 1.1 x 0.8 cm pancreatic tail cyst is unchanged (axial series 600 image 21).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. In the right lower renal pole, there is a 2 x 2 centimeters simple cyst. Other subcentimeter T2 hyperintense foci of the right renal parenchyma are too small to fully characterize.RETROPERITONEUM, LYMPH NODES: Similar mildly prominent periportal lymph nodes.BOWEL, MESENTERY: Surgical changes from Whipple procedure. No acute abnormality.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 10/6/2016 08:59:21)RIGHT HEPATIC LESION 1 - POSTERIOR: 0.9 x 1.0 cm (Image 116, Series 9); (Image 346, Series 13); 0.8 x 0.8 cm on prior (9/23/2016) (Image 66, Series 9).RIGHT HEPATIC LESION 2 - LATERAL: 0.5 x 0.7 cm (Image 112, Series 9); (Image 340, Series 13); 0.4 x 0.4 cm on prior (9/23/2016) (Image 63, Series 9).

Output: Slight interval enlargement of known two hepatic dome lesions, which demonstrate peripheral enhancement consistent with metastases. Reference measurements listed above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Mild cognitive impairment, so statedClinical question: Alzheimer vs alcoholic memory losses vs OSASigns and Symptoms: memory problems, name remembering difficulty The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 79x38mm coronal dimension cyst is centered in the right middle cranial fossa which is associated with remodeling of the adjacent bone. There is a 26x35mm coronal dimension cyst centered in the left middle cranial fossa.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is a punctate T2 and FLAIR hyperintense focus in the pons.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses and ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.There is a defect present along the odontoid process.

Output: 1.Bilateral middle cranial fossa arachnoid cysts. The one on the right is large.2.Periventricular and subcortical white matter changes of a mild degree and a punctate pontine lesions are nonspecific. At this age they are most likely vascular related. 3.There is a defect present along the odontoid process. A chronic fracture cannot be excluded. If clinically appropriate, CT of the cervical spine may help further evaluate this.4.An email was sent to Dr Mastrianni.


Instruction: Generate impression based on findings.

Input: Diagnosis: Postconcussional syndromeClinical question: evaluate for abnormalitySigns and Symptoms: hx of TBI, post concussive symptoms The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the maxillary sinuses - right more than left - and some scattered opacities in the ethmoid air cells and frontal sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for intracranial hemorrhage or diffuse axonal injury to suggest traumatic brain injury.