Instruction: Generate impression based on findings.

Input: Male, 3 months old, status post head trauma with intracranial hemorrhage, post evacuation of hematoma. MRI brain:Postoperative findings are seen compatible with right frontal convexity subdural hematoma evacuation. The underlying brain parenchyma is edematous and contains a few foci of parenchymal hemorrhage, but the previously seen local mass effect has largely been relieved. A relatively thin layer of subdural hemorrhage is seen along the remainder of the right cerebral hemisphere and to a lesser degree along the left posterior cerebral hemisphere. Sulcal T1 and FLAIR hyperintensity within the right cerebral hemisphere is seen which may reflect slow flow in the leptomeningeal vessels over perhaps trace subarachnoid blood product.Diffuse restricted diffusion is seen involving both cerebral hemispheres with slight relative sparing of the perirolandic tissues and the basal ganglia. The cerebellum is affected to a much lesser degree. There may be some crowding of sulci. However, no frank brain herniation is seen. The right lateral ventricle has reexpanded and the ventricular system is in general relatively normal in size.Brain MRV:No definite evidence of venous sinus thrombosis is seen. Postcontrast images demonstrate leptomeningeal enhancement in the right cerebral hemisphere.C-spine MRI:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow edema is seen. The cervical ligamentous structures appear to be intact. There may be some mild posterior paraspinal edema in the upper neck. The spinal canal is not compromised and the spinal cord demonstrates normal signal intensity and morphology throughout. Mild expansion of the dorsal epidural space in the upper thoracic region is favored to represent prominence of the venous plexus.A large fluid collection is seen involving the fascial planes of the left neck extending into the mediastinum with associated rightward displacement of the airway. A left subclavian central venous catheter is in place. The left IJ vein demonstrates rim T1 hyperintensity which could reflect slow flow or partial thrombosis.

Output: 1.Evidence of subdural hematoma evacuation at the right frontal convexity. Thin residual subdural blood product is seen along the right cerebral hemisphere and to a lesser degree along the left cerebral hemisphere.2.Findings compatible with diffuse hypoxic ischemic injury of the cerebral hemispheres. Slight relative sparing of the perirolandic and basal ganglia structures is seen. The cerebellum is also affected but to a much lesser degree.3.No definite dural venous sinus thrombosis is seen.4.No evidence of acute posttraumatic cervical spine injury. Note is made, however, of a fluid collection extending from the left neck into the mediastinum with associated rightward displacement of the airway. This finding could reflect a hematoma or an effusion. Findings suggestive of slow flow or partial thrombosis of the left IJ vein are seen.Findings discussed with the pediatric ICU service at 12:45 PM on 11/9/16.


Instruction: Generate impression based on findings.

Input: Evaluate cyst at the level of the nasopharynx and oropharynx. There is a non-enhancing T2 hyperintense lesion that measures up to approximately 20 mm in the midline of the posterior oropharynx with associated obliteration of the airway. The lesion communicates with the spinal canal via a narrow channel through the dysmorphic basiclivus, which may represent a form of canalis basilaris medianus. In addition, the upper spinal cord, brainstem, and cerebellum are markedly dysmorphic. There are also extensive segmentation anomalies of the upper cervical spine with associated scoliosis. There is no evidence of solid mass lesion or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is fluid within the bilateral mastoid air cells and middle ears. A tracheostomy is in position.

Output: 1. A midline posterior pharyngeal cystic lesion measuring up to 20 mm that communicates with the intracranial compartment via a narrow defect in the clivus likely represents a developmental meningocele or neurenteric cyst, perhaps as a manifestation of split notochordal syndrome associated with the cervical spine segmentation anomalies and hindbrain malformation. A cervical spine CT may be useful for further delineation of the abnormal bony anatomy.2. Nonspecific fluid within the bilateral mastoid air cells and middle ears.Findings discussed with Dr. Baroody on 3/2/2015 at 2:30pm by Dr. Wu.


Instruction: Generate impression based on findings.

Input: 69-year-old male with persistent diarrhea. Evaluate for pancreatitis. ABDOMEN: Motion artifact partially degrades image quality, specifically postcontrast images.LIVER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. There is no evidence of suspicious hepatic lesion.SPLEEN: Splenic granulomata are again noted.PANCREAS: Morphologic changes of the pancreas with evidence of diffuse calcifications compatible with chronic pancreatitis. There is no evidence of increased T2 signal or diffusion restriction to suggest acute pancreatitis. The pancreatic duct is irregular. No peripancreatic fluid collections.There is increased fluid within the bowel after secretin administration, however, no change in the caliber of the duct size to suggest adequate response to secretin.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.Morphologic changes of chronic pancreatitis without evidence of acute pancreatitis.2.Increased fluid within the bowel after secretin administration; however, no change in caliber of the duct size to suggest adequate response to secretin.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The imaged spinal cord displays normal signal and morphology with the conus terminating at the upper third of the L2 body. While the filum terminale is not thickened, measuring 2 mm, there is abnormal T1 hyperintensity extending from mid L3 through S1 with associated chemical shift artifact on the T2 weighted sequence indicating fibrofatty infiltration, a finding that can be seen in tethered cord. The paravertebral soft tissues are unremarkable.

Output: Fibrofatty infiltration of an otherwise unremarkable filum terminale. The exam is otherwise normal.


Instruction: Generate impression based on findings.

Input: Reason: Spinal Stenosis? History: Pain in low back radiating to both thighs. There is unchanged 4 mm of retrolisthesis of L5 relative to both L4 and S1. This subluxation is associated with degenerative disc disease at L4-5 and L5-S1, loss of height and T2 signal. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable, including multifocal hemangiomas or focal fat deposits. The lower spinal cord and conus medullaris show normal signal and morphology. There are multiple T2 hyperintense lesions in both kidneys that are probably cysts.

Output: Multilevel degenerative disease is most pronounced at L4-5, where it results in severe spinal narrowing. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male; 57 years old. Reason: 57 yo M with h/o hereditary paraganglioma syndrome at risk for neck/mediastinum/retroperitoneal paragangliomas and RCC; baseline screening eval; has h/o lymphoma History: 57 yo M with h/o hereditary paraganglioma syndrome at risk for neck/mediastinum/retroperitoneal paragangliomas and RCC; baseline screening eval; has h/o lymphoma ABDOMEN:LIVER, BILIARY TRACT: Hepatic cyst in segment 4a. No suspicious hepatic lesion.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: Thin, round T2 hyperintense left subdiaphragmatic lesion measuring up to 1 cm and without enhancement, of unclear clinical significance but likely benign (series 301/21)BONES, SOFT TISSUES: Mild S-shaped scoliosis thoracolumbar spine.OTHER: No significant abnormality noted.

Output: No significant abnormality.


Instruction: Generate impression based on findings.

Input: 71-year-old female status post resection of a left thigh atypical lipomatous tumor on 3/1/2013. Evaluate for recurrence of posterior thigh lipomatous mass. BONE MARROW: No bone marrow signal abnormality is identified.SOFT TISSUES: The previously described lobulated predominantly fatty mass within the soft tissues of the posterior thigh has been resected. There is associated heterogeneity in the soft tissues along the posterior thigh which presumably represents postsurgical change. Note is made of multiple foci of metallic susceptibility artifact in the surrounding area. No definitive residual pathologic enhancement is visualized. No evidence of residual or recurrent soft tissue mass/lipoma.JOINTS: No significant abnormality noted.ADDITIONAL

Output: Postsurgical changes without definitive evidence of residual or recurrent tumor/lipoma.


Instruction: Generate impression based on findings.

Input: 72-year-old female with history of pancreatic cysts. Evaluate for any abnormalities. ABDOMEN:LIVER, BILIARY TRACT: Gallbladder sludge and stones. Few small hepatic cysts. No suspicious hepatic mass. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Scattered T2 hyperintense foci throughout the pancreas, some of which appear to connect to the pancreatic duct, likely side-branch IPMNs. No appreciable enhancement in these lesions on the limited post-contrast sequences. The largest lesion in the neck measures 1.4 x 1.9 cm (series 9, image 16).No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large T2 hyperintense foci in the left kidney, one in the upper pole is mildly complex with thin septations, presumably cysts. No definite enhancement is seen in the visualized portions of these lesions not obscured by metal artifact on the limited post-contrast sequences.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 8 mm nonspecific enhancing nodule in the right lateral breast (series 12, image 10).Rods and screws throughout the thoracolumbar spine produces significant metal artifact that variably degrades MRI sequences.OTHER: No significant abnormality noted.

Output: 1. Scattered cystic foci throughout the pancreas, largest is 1.4 x 1.9 cm, most suggestive of side-branch IPMNs.2. Nonspecific 8 mm enhancing nodule in the lateral right breast, correlation with mammogram/ultrasound as clinically warranted.


Instruction: Generate impression based on findings.

Input: Change in stool caliber bloating and left lower quadrant tenderness. PELVIS:UTERUS, ADNEXA: Retroflexed retroverted uterus. The endometrial thickness is normal. The inner myometrium/junctional zone is normal in thickness. There are small uterine fibroids. The bilateral adnexa are normal in morphology and size without a focal lesion. Small cervical nabothian cysts are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes of the spine.OTHER: No significant abnormality noted.

Output: No specific findings to account for the patient's left lower quadrant tenderness.


Instruction: Generate impression based on findings.

Input: Male, 34 years old, with new onset daily headache. Two punctate nonspecific foci of T2 hyperintensity are seen within the right inferior frontal and subinsular white matter. No edema or mass effect is detected. There are no diffusion restricting lesions identified. Cerebral and cerebellar morphology is within normal limits. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: No acute intracranial abnormality or other specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Right neck mass status post biopsy on 5/2015 with pathology as cyst. There is a T2 hyperintense, enhancing, right palatine tonsillar mass measuring 3.9 x 3.4 x 2.7 cm with extension into the soft palate and mild oropharyngeal airway narrowing. There may also be slight extension of tumor across the glossotonsillar sulcus. There is a conglomerate of what appears to be three right level 2 lymph nodes. A cystic lymph node with layering debris or hemorrhage measures 2.2 x 2.6 cm, a lymph node with a small enhancing nodular component and septations measures 2.4 x 1.6 cm, and a more solid lymph node measures 2.0 x 1.2 cm. The salivary glands are unremarkable. There are right temporomandibular joint degenerative changes with an associated small effusion and subluxation. There is mild scattered paranasal sinus mucosal thickening. There is mild scattered periventricular and subcortical white matter T2 hyperintensity compatible with chronic small vessel ischemic disease. There is multilevel degenerative cervical spondylosis. The orbits are unremarkable.

Output: 1. A mass in the right palatine tonsil with extension into the soft palate likely represents a squamous cell carcinoma.2. Right suprahyoid lymphadenopathy likely represents metastatic disease.3. Advanced degenerative changes involving the right temporomandibular joint.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 49-year-old female with left mastectomy and sentinel biopsy in 2004 with reconstruction for invasive ductal carcinoma with tamoxifen with left silicone implant. History of benign right breast MR guided biopsy 2010. RIGHT BREAST:On postcontrast images, mild parenchymal enhancement is seen.No abnormal enhancement is seen in the right breast. A few nonspecific enhancing areas in the central right breast are stable compared to the prior exams, especially prior 3T studies. RECONSTRUCTED LEFT BREAST:No abnormal enhancement is present within the reconstructed left breast. Status post left mastectomy. Left breast silicone implant is intact. Stable skin irregularity is likely post surgical in etiology. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with chronic polypoid sinusitis with lamina papyracea and skull base erosion, presenting with eye pain and severe headaches, status post FESS and Lothrop procedure. As on the prior examinations, extensive heterogeneous polypoid opacification is seen involving the frontal sinuses, frontoethmoidal recesses, and the ethmoid cavities. Mucosal thickening is also seen in the sphenoid sinuses, right side more than left. The opacifying material in the left ethmoid cavity is relatively T2 hypointense which can indicate inspissated secretions or fungal elements.Postoperative findings are seen compatible with both the prior reported functional endoscopic sinus surgery and Lothrop procedure. The maxillary sinuses are clear with only trace peripheral mucosal thickening and the neo-antra are widely patent. Osseous thinning and/or deficiency of the laminae papyraceae and right ethmoid roof is better appreciated on prior CT. The polyps encroach upon the orbits, right side more than left. In addition, polypoid material seems to pass through the right ethmoid roof and approaches close to the right gyrus rectus, but without gyral edema.Portions of the brain are not visualized as the examination was tailored for assessment of the paranasal sinuses and the skull base/orbits. However, no areas of parenchymal edema or mass effect are detected. No pathologic parenchymal or extra-axial enhancement is seen. Scattered foci of white matter T2 hyperintensity are demonstrated, a nonspecific finding which likely reflects chronic microvascular ischemia. The ventricles are normal in size and morphology.

Output: Evidence of sinonasal surgery is seen with extensive persistent polypoid opacification involving the frontal sinuses, frontoethmoidal recesses and ethmoid cavities. Some of the opacifying material is T2 hypointense which can indicate inspissated secretions or fungal elements.Osseous thinning and deficiency involving the laminae papyraceae and the right ethmoid roof is better assessed on prior CT. Polypoid tissue does encroach upon the right orbit more than the left, and a small amount of polypoid tissue encroaches through the right ethmoid roof adjacent to the right gyrus rectus. No brain parenchymal edema is identified.


Instruction: Generate impression based on findings.

Input: MRI CARDIAC W/FLOW QUANT WWO, 3/23/2016 12:26 PM Left VentricleThe left ventricle is severely dilated with moderate to severely reduced systolic function. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 139 ml/m2 (normal range: 74+/-15), the LVEDV is 250 ml (normal range 142+/-34), the LV end systolic volume index is 97 ml/m2 (normal range 25+/-9), the LVESV is 176 ml (normal range 47+/-19), the LV mass index is 65 g/m2 (normal range 85+/-15), and the LV mass is 117 g (normal range 164+/-36). The LV dysfunction appears global. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process, however the viability imaging quality is poor due to motion artifact and poor gadolinium uptake. Left AtriumThe left atrium is normal appearing (though RA bowing into LA). Right VentricleThe right ventricle is borderline dilated with severely reduced systolic function. The overall RV ejection fraction is 25%, the RV end diastolic volume index is 114 ml/m2 (normal range 82+/-16), the RVEDV is 205 ml (normal range 142+/-31), the RV end systolic volume index is 151 ml/m2 (normal range 31+/-9), and the RVESV is 273 ml (normal range 54+/-17).Right AtriumThe right atrium is severely enlarged.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a mild pericardial effusion.Extracardiac FindingsThere is a massive right sided pleural effusion and left sided pleural effusion. Large degree of ascities. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with moderate to severely reduced systolic function. The LV dysfunction appears global. There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process; however, the viability imaging quality is poor due to motion artifact and low amount of gadolinium administered (renal dysfunction). 2. The right ventricle is borderline dilated with severely reduced systolic function. The overall RV ejection fraction is 25%3. Right atrium is severely dilatedI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 15 year old female with with NF-1 and subcutaneous tumor on the proximal portion of the right index finger. Please define the extent of the tumor of her index finger. BONE AND MARROW: Bone marrow signal is within normal limits.MUSCULATURE: The muscles are within normal limits.ADDITIONAL

Output: 2nd and 5th digit plexiform neurofibromas.


Instruction: Generate impression based on findings.

Input: 41 years, Female, Reason: Rule out biliary obstruction History: elevated bilirubin, hepatomegaly, fever, abdominal pain. ABDOMEN: Please note that there is significant artifact from Dobbhoff tube tip within the duodenum.LUNG BASES: Small bilateral pleural effusions, new from the prior CT.LIVER, BILIARY TRACT: Mild hepatomegaly. Gallbladder is mildly distended with adjacent fluid but no wall thickening or stones.Common bile duct is normal in caliber measuring 4 mm. No intrahepatic biliary ductal dilatation. No choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Small cystic foci adjacent to the main pancreatic duct within the head of the pancreas (401/12) and body of the pancreas (701/61) appear to communicate with the main pancreatic duct and likely represent small side branch IPMN's.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small broad-based fat containing umbilical hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Likely Tarlov cyst partially visualized. Mild scattered ascites. Anasarca.

Output: 1.No evidence of biliary obstruction.2.Two small side branch IPMN's.3.Small bilateral pleural effusions and anasarca.


Instruction: Generate impression based on findings.

Input: Advanced HIV and acute altered mental status. Evaluate for opportunistic infection. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Within the periventricular distribution is a mild T2/FLAIR signal abnormality which is nonspecific but likely from small vessel ischemic disease. There is no evidence of infection or abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. There is thickening of the sphenoid sinus with mixed debris and fluid centrally.

Output: 1.No evidence of intracranial infection are abnormal enhancement.2.Thickening of the sphenoid sinus with mixed debris and fluid centrally. 3.Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 84-year-old female with left hip pain, metastatic lung adenocarcinoma There are small subchondral cysts within the acetabulum about the left hip consistent with mild degenerative arthritis. The marrow signal of the femoral head and pelvis appears within normal limits.Again seen is a T2 bright, enhancing lesion involving the left aspect of the L4 vertebral body with extension into the pedicle, disk space, superior L5 vertebral body and adjacent soft tissues as described in the prior lumbar spine MRI. Refer to dedicated lumbar spine report for further detail.

Output: 1. Mild degenerative arthritis of the left hip without evidence of metastasis to the hip.2. Findings consistent with an L4/5 metastatic lesion as described above. Please see dedicated lumbar spine report for further detail.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (7/16/15), MR-directed right ultrasound images (7/28/15), images from MRI guided right breast biopsy and postprocedural right mammographic images (7/28/15) performed at Palos community hospital. For comparison, digital mammographic images (6/25/15, 7/9/15) are available. BREAST MRI (7/16/15):Breast MRI was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is an enhancing spiculated mass measuring 23 x 18 x 21 mm (AP x LR x CC) at middle 1:00 position in the left breast. This lesion corresponds to the proven carcinoma. A marker clip is identified at the medial aspect within this lesion.No other abnormal findings are present within the left breast.In the right breast, there is a benign-appearing circumscribed focus measuring 4 mm, at posterior central aspect.No abnormal lymph nodes are identified in either axillary region.MR-DIRECTED RIGHT ULTRASOUND IMAGES (7/28/15):Ultrasound study for the right breast was performed and failed to detect a sonographic correlate with an enhancing focus.IMAGES FROM MRI GUIDED RIGHT BREAST BIOPSY AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (7/28/15):MR-guided biopsy of the benign-appearing circumscribed focus at right posterior central aspect was performed. A needle placement appears appropriate. A marker clip is located at the expected location on the post-procedural mammogram.The pathology result was fibroadenoma, which is concordant.

Output: 1. Unifocal cancer in the left breast on MRI.2. Biopsy proven fibroadenoma in the right breast. No MR evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Hepatomegaly. 1.6 cm left hepatic lobe mass seen on CT suspicious for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver measures 18.2 cm in craniocaudal dimension. There is mild left hepatic and caudate lobe hypertrophy.The study is somewhat limited by motion. The left hepatic lobe lesion is not definitively seen or characterized.The common bile duct measures up to 14 mm which tapers somewhat abruptly at the level of the ampulla without a discrete mass lesion or filling defect.Cholelithiasis within a partially contracted gallbladder. No evidence of gallbladder inflammation.SPLEEN: No significant abnormality noted.PANCREAS: Near the ampulla there is mild soft tissue prominence which may represent a combination of sphincter and pancreatic parenchyma without a definite lesion. Minimal main pancreatic ductal prominence without parenchymal atrophy or focal lesion. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal scarring. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Cardiomegaly. Left basilar compressive atelectasis.

Output: 1. The study is somewhat limited by motion. The left lobe lesion is not well seen or characterized. Percutaneous ultrasound-guided biopsy should be considered as this lesion was clearly seen on CT and ultrasound.2. Common bile duct dilatation with somewhat abrupt tapering at a minimally prominent ampulla. Correlate with LFTs and consider ERCP/EUS evaluation as clinically warranted to exclude an obstructing lesion.


Instruction: Generate impression based on findings.

Input: 44-year-old female with left knee pain, evaluate for internal derangement MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: Moderate degeneration of articular cartilage of the patella is noted, particularly along the median eminence. There is also degeneration of the articular cartilage along the inferior aspect of the medial facet of the femoral trochlea. Articular cartilage of the tibiofemoral compartments is within normal limits. There is mild edema-type signal within the tibial plateau near the attachment of the PCL, which is not necessarily of any current clinical significance. Note is made of tiny tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Patellofemoral osteoarthritis. We see no meniscal or ligamentous injury.


Instruction: Generate impression based on findings.

Input: Female, 36 years old. Reason: left thyroid nodules with left neck lymph node History: as above RIGHT LOBE MEASUREMENTS: 4.3 x 1.5 x 1.1 cmLEFT LOBE MEASUREMENTS: 4.2 x 1.7 x 1.1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Minimally heterogeneous echotexture, without focal lesion.LEFT LOBE: Minimal heterogeneous echotexture. A left superior pole nodule measures 0.4 by 0.3 x 0.2 cm, cystic with a small echogenic focus, unchanged from prior.ISTHMUS: Minimally heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right level 2 lymph node measures 0.9 x 0.8 x 0.3 cm. A left level 2 lymph node measures 1.0 x 0.5 x 2.1 cm. A left level 4 lymph node measures 0.8 x 0.4 x 1.3 cm, unchanged.OTHER: No significant abnormality noted.

Output: 1. Subcentimeter left colloid nodule, unchanged.2. Unchanged cervical lymph nodes.


Instruction: Generate impression based on findings.

Input: Slurred speech [R47.81], Reason for Study: ^Reason: POST TPA, L M1/M2 OCCLUSION - PLEASE INCLUDE PERFUSION History: right arm weakness Brain MRIThere is restricted diffusion on the left external capsule without evidence of hemorrhagic transformation.Scattered somewhat patchy T2/flair high signal intensity lesions on periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.Several lacunar infarcts involving bilateral basal ganglia and thalami are seen.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 90% occlusion of the left MCA distal M1 segment.Hypoplastic left distal vertebral artery with a possible long segment stenosis.There are luminal irregularities with various degree stenosis of intracranial arteries including right MCA M2 segment, basilar artery and bilateral PCAs indicating atherosclerotic changes.There is no evidence of intracranial arterial aneurysm.

Output: 1. Acute ischemic infarction involving the left external capsule without evidence of hemorrhagic transformation.2. More than 90% stenosis of the left MCA M1 segment.3. Multifocal various degree intracranial arterial luminal irregularities and stenosis indicating intracranial atherosclerosis.


Instruction: Generate impression based on findings.

Input: History of vertigo, numbness, and weakness. HTN, POAG, Retinal detachment OS status post laser who presents for follow-up for optic disc pallor versus cupping. Orbits: There is volume loss and high T2 signal in the posterior orbital segment and canalicular segment of the right optic nerve. The right globe, extraocular muscles, and lacrimal gland are unremarkable. There is no evidence of intraorbital mass or abnormal enhancement. The left orbit is unremarkable.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white mater 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 skull and scalp soft tissues are unremarkable. There is a small right maxillary sinus retention cyst.

Output: 1. Right optic nerve atrophy may be secondary to a prior ischemic event.2. No evidence of demyelinating lesions, mass, or acute infarction.


Instruction: Generate impression based on findings.

Input: Male, 48 years old, with headaches, history of meningioma the right cavernous sinus. Evaluate for changes. A smoothly marginated, very T2 hyperintense homogeneously enhancing lesion is present within the right cavernous sinus. The lesion causes bowing of the lateral cavernous sinus wall as well as anterior displacement of the ICA, but no ICA narrowing is observed. Minimal if any interval growth is seen of the lesion which measures 16 x 14 mm in the coronal plane (image 21 series 901), previously 16 x 12 mm when measured similarly.Two or three scattered punctate foci of white matter T2 hyperintensity are seen in the cerebral hemispheres, unchanged and nonspecific. No evidence of parenchymal edema or mass effect is seen. No pathologic parenchymal enhancement is observed. The ventricles are normal in size and morphology. No abnormal intracranial fluid collections are detected. Maxillary sinus mucosal thickening and a fluid level on the right are noted.

Output: No definite interval change in the size or morphology of a right cavernous sinus lesion. The slight interval change in measurements could represent differences in technique. This lesion could represent a meningioma, though a hemangioma would also be in the differential diagnosis.


Instruction: Generate impression based on findings.

Input: Reason: Mass palpable along the left lower shin. Tender and growing. Edema of the LLE >> right. Please evaluate etiology. History: As above 2 markers were placed along the anterior skin surface of the lower leg, presumably denoting the site of the patient’s palpable mass. There is thickening and enhancement of the skin underlying the markers, with enhancement and reticulation of the underlying subcutaneous fat, but we see no focal mass. There is also mild enhancement of the peripheral deep fascia anteriorly. The underlying musculature and bone signal is normal. There is also mild enhancing reticulation along the medial and lateral subcutaneous fat of the ankle. Additional non-enhancing edema is seen within the subcutaneous fat along the tibial diaphysis.

Output: Enhancement of the skin, subcutaneous fat and peripheral deep fascia of the lower leg and ankle without a discrete mass, as described above. These findings may reflect cellulitis.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: restaging lung cancer with brain mets History: na There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.Patchy bihemispheric periventricular white matter and centrum semiovale T2/flair high signal intensity lesions are seen, indicating nonspecific small vessel ischemic disease, unchanged since prior scan.Left caudate nucleus chronic lacunar infarct is again seen, unchanged.Multiple supra and infra tentorial susceptibility lesions are seen, indicating either mineralization or chronic hemorrhage, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.No lens signal are seen bilaterally indicating postoperative status.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.2. Unchanged extensive nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: view for flow through ETV History: s/p ETV. Mid cerebral aqueductal stenosis and surgical third ventriculostomy defect appear similar to the prior exam. Significantly dilated lateral and third ventricles remain unchanged in size. Fourth ventricle is stable. Robust CSF flow ithrough the third ventriculostomy defect into the prepontine cistern is again identified. Scattered foci of intraparenchymal and intraventricular susceptibility is unchanged. A small amount of gliosis again is again identified along the previous right frontal lobe ventriculostomy catheter tract.No midline shift or mass effect. No diffusion abnormality. Incidental note is again made of a small focal area of prominent CSF signal the along the left paramedian posterior fossa, likely a small retrocerebellar cyst. Normal flow voids within the major intracranial vascular structures. Partial empty sella is unchanged.

Output: Continued stable exam with no significant change in lateral and third ventriculomegaly, status post third ventriculostomy which is patent.


Instruction: Generate impression based on findings.

Input: Male; 77 years old. Reason: assess for recurrent disease h/o of urothelial carcinoma ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter left hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: Stable 5-mm cyst connecting to the main pancreatic duct within the uncinate process compatible with an IPMN, previously 5 mm (series 7/22).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy, cystoprostatectomy, and ileal conduit formation. Stable left inferior pole hemorrhagic/proteinaceous cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes from ileal conduit formation. No evidence of obstruction.BONES, SOFT TISSUES: Multiple T1 and T2 bright nonenhancing lesions within the spine are unchanged and compatible with benign hemangiomas.OTHER: No significant abnormality noted.

Output: Postoperative changes without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Myositis, elevated CPK Femur: The muscles of the right thigh are normal in signal intensity and caliber. The underlying marrow signal of the femur is normal. On the limited views of the right thigh, the signal intensity of the muscle is also normal.Tibia/fibula: The exam is slightly limited by motion artifact. The muscles of the right leg are normal in signal intensity and caliber. The underlying marrow signal of the tibia and fibula is normal. On the limited views of the left lower extremity, the signal intensity of the muscle is also normal.

Output: Normal signal intensity and caliber of the right lower extremity musculature.


Instruction: Generate impression based on findings.

Input: Left knee pain. MENISCI: There is attenuation of the body and horns of the medial meniscus that we suspect reflects interval partial meniscectomy. There is horizontally oriented intermediate signal within the anterior horn of the medial meniscus that extends to the femoral articular surface. While we cannot exclude the possibility of a tear, this may simply reflect residual intrasubstance signal following partial meniscectomy. There is also mild deformity of and signal abnormality along the undersurface of the posterior horn of the medial meniscus, but it is difficult to determine to what degree this represents sequela of meniscectomy versus degenerative undersurface tearing. We see no unstable meniscal fragment. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is now severe loss of cartilage affecting the medial compartment with much of the weightbearing surface of the medial femoral condyle and medial tibial plateau devoid of articular cartilage. There is slight focal depression of the weightbearing articular surface of the medial femoral condyle and mild underlying marrow edema. The articular cartilage of the lateral compartment appears relatively spared. Moderate osteoarthritis affects the patellofemoral joint and appears similar to the prior study. Cysts within the tibial plateau anterior to the PCL attachment appear similar to the prior study.LIGAMENTS: There is a small amount of fluid and edema along the medial collateral ligament that we suspect is associated with underlying medial compartment osteoarthritis although this could conceivably represent sprain if there is a history of recent trauma. The lateral collateral ligament complex is intact although there is mild nonspecific edema superficial to the iliotibial band extending into the subcutaneous fat of the lower leg.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Marked progression of cartilage loss affecting the medial compartment with osteoarthritis of the patellofemoral joint appearing similar to the prior study.2.Findings suggestive of partial meniscectomy as described above.3.Other findings as described above.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mucosal thickening of the ethmoid and left maxillary sinuses.MRA HEAD

Output: 1. Unremarkable MRI of the brain.2. Unremarkable MRA of the head and neck.3. There is mucosal thickening of the ethmoid and left maxillary sinuses.


Instruction: Generate impression based on findings.

Input: 71-year-old female with history of kidney 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: Redemonstrated is a nonenhancing interpolar right kidney lesion that is predominantly T2 hypointense, T1 hyperintense with fluid fluid levels measuring approximately 2.3 x 3.8 cm at the prior partial nephrectomy site. This lesion is not significantly changed when compared to the prior examination. The left kidney is within normal limits.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right anterior abdominal wall fluid collection compatible with a postoperative hematoma is unchanged.OTHER: No significant abnormality noted.

Output: 1.Nonenhancing T1 hyperintense cystic lobulated focus in the left partial nephrectomy site is favored to represent postoperative blood product. No specific evidence of residual recurrent disease.


Instruction: Generate impression based on findings.

Input: 62-year-old female with right foot cellulitis. Evaluate for abscess or osteomyelitis. Questionable low T1 signal, increased STIR signal, and mild enhancement is present at the base of the fourth proximal phalanx. These findings are suspicious for osteomyelitis.Soft tissue abnormality is noted along the plantar aspect of the second and third MCP joints. This lesion demonstrates increased STIR signal and slight peripheral enhancement and thus may represent phlegmon or a developing abscess. An additional fluid collection is also noted dorsal to the second and third MCP joints. Adjacent to this collection, slight enhancement is noted within the second and third metatarsal heads, and thus osteomyelitis cannot be excluded at this site.

Output: 1.Findings suspicious for osteomyelitis at the base of the fourth proximal phalanx as described above. Extension of infection to the second and third metatarsal heads cannot be excluded.2.Probable phlegmon or developing abscess within the plantar soft tissues adjacent to the second and third MCP joints.


Instruction: Generate impression based on findings.

Input: Redemonstrated a small enhancing lesion measuring involving the left cavernous sinus which enters somewhat into the sella displacing normal pituitary as well as the pituitary stalk rightward. It abuts the cavernous left internal carotid artery without narrowing. Laterally it demonstrates a broad-based dural attachment. Although there is no associated osseous hyperostosis, there is some osseous remodeling however no aggressive lytic features. Given the constellation of these findings including comparison to the prior studies dating back to 2005, the most likely consideration is meningioma.Foci of hypodensity are seen in the periventricular white matter without mass effect which correlates with previous MRI demonstrated chronic small vessel ischemic disease. The ventricles are unchanged in size or shape without evidence of obstruction or hydrocephalus. There are no other masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. There is no other abnormal enhancement within the brain.

Output: Evidence for meningioma involving the left cavernous sinus extending into the sella as well as laterally without evidence of cavernous carotid narrowing. Given differences in technique, there is been no significant change since the comparison MRI dated 3/3/2012. This lesion was present on the comparison CT from 2005, and although it has demonstrated increase in size since that study, given the long 7 year interval, a benign process such as meningioma is the most likely etiology.


Instruction: Generate impression based on findings.

Input: Female, 25 years old, with history of HSV encephalitis. Compare to prior exam. Since the prior exam, encephalomalacia has developed in the left anterior temporal tip, amygdala and hippocampal head. The surrounding tissue demonstrates FLAIR hyperintensity compatible with gliosis which extends up into the insula. Ex vacuo dilatation of the left temporal horn is seen. The remainder of the brain is unremarkable. No new signal abnormality is seen. No pathologic parenchymal enhancement is detected. There is no evidence of intracranial hemorrhage or any abnormal collection. Except as above, the ventricles are within normal limits.

Output: Findings compatible with chronic evolution of HSV encephalitis of the left temporal lobe. No new or active intracranial lesions are suspected.


Instruction: Generate impression based on findings.

Input: 16 years Female (DOB:8/26/1999)Reason: Need to be on a 3T Scanner please evaluate structural abnormalities History: headaches, weakness, previous scans with asymmetric ventricles,PROVIDER/ATTENDING NAME: PATRICIA OGDEN MICHAEL H KOHRMAN The CSF spaces are appropriate for the patient's stated age with no midline shift. The right lateral ventricle is slightly larger than the left lateral ventricle.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 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.


Instruction: Generate impression based on findings.

Input: Cervical tenderness, right upper extremity weakness There are postsurgical changes of cervical laminectomies and posterior spinal fusion extending from the C3 to the C7 levels. Spinal canal is well decompressed throughout. No abnormal cord signal is appreciated, within the limitations of susceptibility artifact from patient's spinal hardware. Vertebral body heights are maintained. There is straightening of the cervical spinal curvature. Post gadolinium images demonstrate no abnormal enhancement. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or right neural foramen. There is mild left-sided neural foraminal stenosis related to facet arthropathy.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Small disc osteophyte complex. No significant compromise to the spinal canal. There is mild to moderate right and mild left neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: Small disc osteophyte complex. No significant compromise to the spinal canal. There is moderate to severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy. C7-T1: Minimal disc bulge. No spinal canal stenosis. There is up to moderate right neural foraminal narrowing. Left neural foramen is patent.Paraspinous soft tissue structures appear within normal limits aside from postsurgical changes. No masses or fluid collections.

Output: 1. Postsurgical changes of laminectomy and posterior spinal fusion from C3 to C7. Spinal canal remains patent. No cord signal abnormality is evident.2. Suboptimal evaluation of the neural foramina due to susceptibility artifact from hardware. There are multilevel degenerative changes with neural foraminal stenosis at the C6-C7 and to a lesser degree C5-C6 and C7-T1 levels on the right. If clinically indicated, CT may be helpful to assess the hardware and the bony neural foramina given the mild limitations due to the hardware. Please see additional details above.


Instruction: Generate impression based on findings.

Input: Female 2 years old Reason: re-evaluation of cortical tubers, SEN History: tuberous sclerosis, refractory epilepsy, focal onset Redemonstration of numerous cortical/subcortical T2 hyperintense lesions throughout both hemispheres of the supratentorial brain. These are not significantly changed from prior. In addition there are multiple enhancing subependymal nodules, also not significantly changed.No new or growing lesions are seen. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.Scattered paranasal sinus mucosal thickening, otherwise the paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Stable exam with findings of tuberous sclerosis including scattered subcortical tubers and ependymal nodules.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for shoulder pain etiology History: left shoulder pain ROTATOR CUFF: There is increased signal intensity within the anterior fibers of the distal supraspinatus tendon at its insertion on the greater tuberosity indicating a tear that involves the undersurface fibers, which we suspect extends through the entire thickness of the tendon, measuring approximately 1 cm in the AP dimension. There is no significant retraction. More proximally within the supraspinatus tendon, there is focal intermediate signal intensity that involves the majority of the thickness of the tendon including the articular surface fibers, which we believe spares the bursal surface fibers, likely representing a high-grade partial-thickness tear with less than 1 cm of retraction of the deep fibers of the tendon. The margins of the suspected tear are difficult to discern due to adjacent tendinosis, which also extends posteriorly to involve the anterior fibers of the infraspinatus. There is mild fatty atrophy at the level of the myotendinous junction of the supraspinatus and infraspinatus. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial/subdeltoid bursa which supports an anterior full thickness rotator cuff tear. The acromioclavicular joint is normal for age.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is degeneration of the articular cartilage of the glenoid, anteriorly, with underlying subchondral cyst formation indicating mild osteoarthritis. There is linear intermediate signal intensity traversing the mid anterior labrum which likely represents a tear of questionable significance. There is increased signal intensity within the joint that likely represents a combination of a mild synovitis as well as a small amount of fluid within the joint.BICEPS TENDON: The tendon of the long head of the biceps appears intact.

Output: 1. Supraspinatus tears and tendinosis as described above.2. Mild osteoarthritis of the glenohumeral joint and other findings as described above.


Instruction: Generate impression based on findings.

Input: History of hepatitis C and liver lesions. ABDOMEN:LIVER, BILIARY TRACT: Mildly prominent fissures and mild caudate and left hepatic lobe hypertrophy suggestive of chronic liver disease.In the right hepatic dome centrally there is a 5.1 x 3.0 x 4.3 cm heterogeneously T2 hyperintense well-defined lesion (series 9/38). 1.7 cm T2 hyperintense lesion in segment 4A (series 9/25). Poorly defined mildly T2 hyperintense lesion adjacent to the gallbladder fossa measuring 2.1 x 2.1 cm (series 9/23).These lesion demonstrate very gradual peripheral nodular enhancement with slow centripetal filling, suggestive of hemangiomas.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings suggestive of mild chronic liver disease.2.Three discrete T2-weighted mildly to moderately hyperintense lesions do not meet imaging criteria for HCC. Rather, they appear to demonstrate very gradual peripheral nodular enhancement with slow centripetal filling, suggestive of atypical hyalinized and/or sclerosed hemangiomas. A tagged RBC scan or short interval 6-month follow-up imaging should be considered given the history of chronic liver disease.


Instruction: Generate impression based on findings.

Input: Paresthesias, evaluate for progression of demyelinating disease. Brain: Again seen are scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter not appreciably changed compared to 6/12/2015. No new lesions. There is subtle focus of enhancement in the right posterior frontal lobe, series 4 image 12 with enhancement not present on the 3-D SPGR sequences likely related to differences in technique and contrast timing. There is corresponding T2 FLAIR hyperintensity which was present on prior study from 6/12/2015 but did not demonstrate enhancement. As such this may represent new enhancement within pre-existing lesion versus chronic enhancement which was not appreciable previously due to technique. Subtle focus of enhancement is also suspected in the right ventral pons, series 3 image 130 also not appreciated on prior.Brain parenchymal volume is preserved. No evidence of intracranial mass or mass effect. No hydrocephalus or extra-axial collections. Evidence of prior left parietal burr hole placement for biopsy with gliosis involving the adjacent cortex again seen. Visualized extracranial soft tissues are unremarkable.Cervical spine: There is minimal patchy T2 signal abnormality throughout the cervical cord without findings to suggest a new discrete lesion. No discrete/large lesion with enhancement is appreciated. There are subtle foci of enhancement which are again questioned in the cervical cord, such as at the C1 level sagittal series 9 image 8 and at the left C4 level, sagittal series 9 image 9. Previously described foci of enhancement at the C2 level and right lateral C6 level are no longer appreciated.Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow signal abnormality or enhancement is seen. No significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are unremarkable.

Output: Compared to 6/12/2015, there are small scattered T2/FLAIR hyperintense lesions in the white matter which are not appreciably changed since 6/12/2015. There are tiny foci of enhancement, such as in the right posterior frontal lobe and right ventral pons which were not appreciated on prior. Similarly in the cervical cord, there are tiny T2 hyperintense lesions which overall are not appreciably changed. There are subtle foci of enhancement in the cervical cord which appear new, while subtle enhancing foci present on prior study which are no longer appreciated on the current study. Overall, these tiny areas of enhancement in the brain and cervical cord suggest ongoing inflammation/demyelination. Given their small size (1-3 mm) it is possible that they represent chronic subtle enhancing foci with apparent fluctuation possibly related to differences in technique/contrast timing.


Instruction: Generate impression based on findings.

Input: 43-year-old male with knee pain, evaluate for medial meniscal tear. MENISCI: There is branching signal abnormality within the posterior horn of the medial meniscus indicating a complex tear, which consists of a longitudinal component extending to the tibial articular surface and perhaps the femoral articular surface along the inner half of the meniscus as well as a more vertical component extending to the tibial articular surface within the periphery. Increased signal intensity extends into the body of the medial meniscus which likely reflects intrasubstance degeneration. The anterior horn of the medial meniscus appears normal. There is prominence of the body of the lateral meniscus, suggesting a mild discoid morphology, which contains mildly increased signal intensity suggesting intrasubstance degeneration, but no discrete tear is evident.ARTICULAR CARTILAGE AND BONE: There is focal degeneration of the articular cartilage along the trochlea. The remainder of the articular cartilage is normal. No abnormal marrow signal within the bone.LIGAMENTS: The ACL and PCL are intact. The MCL and lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Complex tear of the posterior horn of the medial meniscus and other findings as described above.


Instruction: Generate impression based on findings.

Input: 20 years Male (DOB:1/8/1996)Reason: Transient right monocular visual loss History: abovePROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated.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 are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are small. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.No evidence for intracranial mass.2.No evidence for intracranial aneurysm3.No evidence for intracranial or extracranial cerebrovascular occlusive disease


Instruction: Generate impression based on findings.

Input: Worsening back pain. There is multilevel degenerative spondylosis. At L1 through L3, there is minimal disc bulging without significant spinal canal stenosis and perhaps minimal neural foraminal narrowing. However, at L3-4, there is left neural foraminal disc protrusion superimposed upon a small disc bulge and facet hypertrophy, which impinges upon the exiting nerve roots. There is also at least mild right neural foraminal narrowing at L3-4. At L4-5, there is bilateral facet hypertrophy and ligamentum flavum hypertrophy, as well as a disc bulge, with mild bilateral neural foraminal narrowing, but no significant spinal canal stenosis. At L5-S1, there is disc bulging and bilateralfacet and ligamentum flavum hypertrophy with mild spinal canal narrowing and severe right, but mild left neural foraminal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The spinal cord displays normal signal and morphology. However, there is persistent clumping of the right cauda equina nerve roots at the L5 level. There is an unchanged high T1 signal focus within S1, which likely represents a hemangioma. The paravertebral soft tissues are unremarkable.

Output: 1. Multilevel degenerative spondylosis. In particular, a left neural foraminal disc protrusion superimposed upon a small disc bulge and facet hypertrophy impinges upon the exiting nerve roots at L3-4 and disc bulging and bilateral facet and ligamentum flavum hypertrophy results in mild spinal canal narrowing and severe right, but mild left neural foraminal stenosis at L5-S1. 2. Persistent clumping of the right cauda equina nerve roots at the L5 level may represent arachnoiditis.


Instruction: Generate impression based on findings.

Input: Neoplasm of uncertain behavior of meninges, unspecified [D42.9], Reason for Study: ^Reason: Page 6876 for fiducials: Pt has hx of allergic reaction with dye- Please do T2 \T\ Flair.No contrast History: headaches, seizures... preop planning Multiple fiducial markers attached on the skull for the preparation of preoperative scanning.Redemonstration of postop changes of left frontal lobe and about 30mm sized falcine meningioma, 7mm sized left temporal meningioma and 5mm sized left frontal meningioma unchanged.Bilateral frontal lobe vasogenic edema are seen, unchanged.Ventricle size is stable and unchanged.The paranasal sinuses and mastoid air cells are clear.

Output: 1. Preop planning MR scan without contrast enhancement are obtained.2. Multiple extra axial masses representing multifocal meningiomas as described above, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: Male 21 years old Reason: eval meniscus . and cyst History: knee pain MENISCI: Radial tear of the anterior horn/body of the lateral meniscus with a large, complex, multiloculated, parameniscal cyst which measures approximately 6.7 x 2.2 x 4.0 cm and extends into the lateral gutter and Hoffa's fat pad.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Radial tear of the anterior horn/body of the lateral meniscus with a large 6.7-cm, multiloculated para-meniscal cyst.


Instruction: Generate impression based on findings.

Input: New diagnosis of endometrial cancer (grade 1 endometrial cancer status post D&C, IUD placement). Evaluate size and depth of invasion. PELVIS:UTERUS, ADNEXA: An IUD is present within the endometrial cavity. There is homogenous enhancement of the endometrium. The junctional zone is intact. There is no evidence of myometrial invasion. The right ovary is enlarged and contains a T1 hyperintense, T2 hypointense lesion measuring 2.0 x 1.7 cm, probably endometrioma versus hemorrhagic cyst (series 701, image 13). There is a right para ovarian cyst. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Homogenous enhancement of the endometrium with no myometrial invasion or lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 66-year-old female. Liver cirrhosis. HCC status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Ablation defect in the right hepatic lobe is 3.1 x 1.6 cm (series 10, image 47), which is superior to the unchanged HCC measuring 2.4 x 2.4 cm, previously 2.3 x 2.3 cm (series 10, image 59).Cirrhotic liver morphology. Patent hepatic vasculature. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Cystic T2 hyperintense lesion in the pancreatic head measures 0.9 x 1.3 cm, unchanged (series 3, image 22), likely an IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: Prominent periportal and gastrohepatic lymph nodes, likely related to cirrhosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: RFA ablation cavity is superior to the location of the HCC, which has not significantly changed from prior study.


Instruction: Generate impression based on findings.

Input: Reason: CCM Protocol, QSM, Permeability, 3T Scanner; s/p resection of brainstem lesion History: Weakness, speech problems The patient has undergone a right temporal lobe surgery. Since the prior exam or extra-axial fluid collection and a additional postoperative findings have regressed. Since the prior exam the patient has evolved to encephalomalacia along the anterior aspect of the right temporal lobe. There is associated vacuum effect on the temporal horn of the right lateral ventricle.There is redemonstration of multiple popcorn-like lesions with a dark surrounding rim and a heterogeneous central portion on the T2 image and located in the region of the right cerebral peduncle and adjacent deep gray nuclei, the left temporal lobe and the right frontal lobe. There is redemonstration of multiple punctate lesions scattered throughout the brain parenchyma. The right cerebral peduncle lesion is somewhat smaller on the current exam when compared to the prior. The left temporal lobe lesion and the right frontal lobe lesion remain relatively stable. The right frontal lobe lesion currently measures 14 x 10 mm axial dimensions previously measured approximately the same there the left temporal lobe lesion previously measured 11 x 11 mm currently measures approximately the same.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 demonstrate elongation of the AP dimension of the eyes similar to the prior exam.

Output: 1.A right frontal lobe in the left temporal lobe cerebral cavernous malformation are stable.2.The patient has undergone right-sided craniotomy. Since the prior exam cavernoma occupying the right cerebral peduncle and adjacent gray matter has decreased in overall size.3.There is encephalomalacia along the anterior aspect of right temporal lobe.4.Multiple punctate hemorrhagic lesions are scattered throughout the brain parenchyma which also present on previous exams and suspected to be related to the patient's cerebral cavernous malformations.


Instruction: Generate impression based on findings.

Input: 56-year-old male with history AV malformation, seizure disorder who presents with altered mental status. There is no evidence of intracranial hemorrhage, mass or edema. Vascular calcifications are noted. The region of encephalomalacia within the posterior temporal occipital region with high density clip/coils presumably from the prior AVM repair. No evidence of hemorrhage. Multiple patchy low low attenuation is nonspecific and likely represents small vessel disease, age determinate. If there is clinical concern for acute ischemia an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Chronic changes as described above. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 46-year-old woman with history of liver adenomas. ABDOMEN:LIVER, BILIARY TRACT: Multiple well circumscribed arterially enhancing masses are seen in both lobes of the liver. For reference, the largest left hepatic lesion (4/12) measures 65 x 36 mm, previously 69 x 36 mm. The largest right hepatic lesion (4/80) measures 37 x 29 mm, previously 38 x 31 mm. There is no definite signal loss on opposed phase imaging. The background liver morphology is normal and none of these lesions appears to washout on delayed phase. No intrinsic T1 hyperintensity or susceptibility artifact within these lesions.The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation. The portal vein is patent.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: Stable hepatic adenomas.


Instruction: Generate impression based on findings.

Input: 58-year-old female with diagnosis of anal cancer. A large perianal ulcer on left periaortic region consistent with recurrent anal cancer and firm and indurated left inguinal region highly suspicious for recurrent nodal involvement with cancer. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Enhancing left inguinal lymph node measuring 3.3 x 3.3 x 5 cm (series 401 image 26, coronal series 501 image 8).BOWEL, MESENTERY: The anal tumor measures 1.9 x 1.4 cm and is located between the 3:00 and 5:00 position (series 701 image 21). The necrotic mass extends inferiorly from the anus to the left medial perineal soft tissues. Some tumor extends anteriorly along the skin to the level of the vagina. No intrapelvic involvement of the vagina is noted.BONES, SOFT TISSUES: Post radiation changes of the regional bones.OTHER: No significant abnormality noted.

Output: Necrotic mass extends from the anus to the left medial peritoneal tissues with anterior extension along the skin to the level of the external vagina.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: Pt with hx of seizures History: see above 43 years Female (DOB:3/14/1973)Reason: Pt with hx of seizures History: see abovePROVIDER/ATTENDING NAME: MAHESH PADMANABAN THOMAS J. KELLY No evidence of acute ischemic or hemorrhagic lesion.Scattered T2/FLAIR high signal intensity lesions on periventricular white matter indicate nonspecific small vessel ischemic disease.There is about 7mm thin focal thickening with enhancement of right frontal lobe meninges indicating possible meningioma (series 1201, image 29; series 1301, image 58).The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion2. Nonspecific small vessel ischemic disease3. Small focal thickening with homogeneous enhancement on the right frontal meningioma (about 7 mm) most likely indicating small meningioma.


Instruction: Generate impression based on findings.

Input: 66 years Male (DOB:5/5/1950)Reason: Stroke work up History: R side sensory deficitPROVIDER/ATTENDING NAME: KATIE TATARIS KOUROSH A REZANIA MRI of the brainThere is a small focus of diffusion restriction present along the inferior and posterior lateral aspect of the left thalamus. This associated with vague T2 and FLAIR signal hyperintensityThere are punctate foci of T2 and FLAIR signal hyperintensity located in the basal ganglia, thalami and brainstem.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is 90% stenosis at the origin of the right posterior cerebral artery.There is 50% stenosis of the right pericallosal artery at the proximal A4 segment.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are very very small.. The right vertebral artery is smaller than the left vertebral artery.There is extracranial and extradural origin of the right posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the left vertebral artery. There is a 75% stenosis at the origin of the right vertebral artery.The right vertebral artery is smaller than the left vertebral artery.

Output: 1.Findings are compatible with acute lacunar infarct located in left thalamus.2.There is a 75% stenosis at the origin of the right vertebral artery.3.There is 90% stenosis at the origin of the right posterior cerebral artery4.Punctate lesions in the basal ganglia, thalami and brainstem are most likely related to prior lacunar infarcts5.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: For the purposes of numbering of the lumbar levels, a partially sacralized L5 vertebral body is identified and the last discernible disc space is labeled L5-S1 disc. Grade 1 L4-L5 anterolisthesis. The lumbar spine is otherwise in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are maintained with mild disc desiccation throughout. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is diffuse congenital narrowing of the lumbar spinal canal with superimposed prominence of the epidural fat and degenerative changes as described below:T12-L1: Minimal disc bulge and moderate bilateral facet degeneration, contributing to mild bilateral foraminal stenosis. No significant central spinal stenosis.L1-L2: Minimal disc bulge, thickening of the ligamentum flavum and moderate bilateral facet degeneration, contributing to mild bilateral foraminal stenosis. No significant central spinal stenosis.L2-L3: Mild disc bulge, thickening of the ligamentum flavum and moderate to severe bilateral facet degeneration, contributing to mild to moderate right and mild left foraminal stenosis. No significant central spinal stenosis.L3-L4: Disc bulge, thickening of the ligamentum flavum and moderate to severe bilateral facet degeneration, contributing to severe spinal canal stenosis and moderate bilateral foraminal stenosis. Findings are slightly progressed from prior study.L4-L5: Minimal anterolisthesis of L4 on L5. Disc bulge, thickening of the ligamentum flavum and moderate to severe bilateral facet degeneration, contributes to severe spinal canal stenosis and moderate bilateral foraminal stenosis. Findings are slightly progressed from prior study.L5-S1: No significant disc bulge, spinal canal or foraminal stenosis.There is partial ankylosis involving the sacroiliac joints right relatively greater than left. There are anterior bridging osteophytes.

Output: 1. There is congenital narrowing of the lumbar spinal canal with superimposed epidural lipomatosis and advanced degenerative changes. Degenerative changes are slightly progressed since 2005. There is severe L3-L4 and L4-L5 spinal canal stenosis and moderate bilateral neural foraminal stenosis, as detailed above.2. There is partial ankylosis involving the sacroiliac joints, right greater than left, which may be on a degenerative basis given associated anterior bridging osteophytes. Correlate however for any history of inflammatory spondyloarthropathy. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Images are somewhat limited by patient motion. No abnormal mass or abnormal enhancement is seen. Specifically, a discrete choroidal mass is not identified. There is bilateral symmetric enhancement of the choroid and sclera bilaterally posteriorly, as well as the uvea. No abnormal signal intensity or inflammatory change is evident. The optic nerves appear diminutive in size with questioned STIR hyperintensity distally on the axial images. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.There is partial visualization of the previously seen thin smooth dural thickening and enhancement especially along the frontal and temporal regions.

Output: 1. No overt evidence of a discrete choroidal mass. Symmetric thin enhancement of the choroid, sclera, and uvea bilaterally consistent with patient's history.2. Symmetric atrophy of the optic nerves with questioned abnormal signal in the distal portions of the nerve which may relate to chronic neuritis, versus artifact.3. Partial visualization of grossly similar smooth dural enhancement along the frontal and temporal lobes.


Instruction: Generate impression based on findings.

Input: 67-year-old male with a history of of hepatocellular carcinoma with lower back pain. Evaluate for metastatic lesion. MRI C-Spine:There is diffuse heterogeneity of the bone marrow which is nonspecific. No evidence of osseous edema or abnormal enhancement to definitively indicate tumor. The craniovertebral junction appears within normal limits. There is mild reversal of cervical lordosis of the cervical spine. The cervical vertebral bodies are appropriate in height. There is multilevel disc height loss, most prominently involving the C3-4, C4-5, and C5-6 levels. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. There is a subcutaneous lipoma involving the posterior subcutaneous soft tissues at the C4-C5 level. The paraspinous soft tissue structures appear otherwise within normal limits.Interspace observations:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex and uncovertebral and facet hypertrophy. There is effacement of the ventral thecal sac, otherwise no significant spinal canal stenosis. Mild bilateral neural foraminal narrowing. C4-5: Disc osteophyte complex and uncovertebral and facet hypertrophy. There is effacement of the ventral thecal sac, otherwise no significant spinal canal stenosis. Mild to moderate bilateral neural foraminal stenosis.C5-6: Disc osteophyte complex, uncovertebral and facet hypertrophy and ligamentum flavum thickening. Mild spinal canal stenosis. Moderate to severe right neural foraminal stenosis. Left neural foramen is patent.C6-7 and C7-T1: No significant compromise to the spinal canal or neural foramina.MRI T-Spine:There is diffuse heterogeneity of the bone marrow which is nonspecific. There is STIR hyperintensity and enhancement involving the right T3 transverse process may represent an osseous metastatic lesion but nonspecific. There is questionable intrinsic T1 hyperintensity.The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. The spinal cord is of normal caliber and signal. There is no pathological intramedullary or epidural enhancement. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1.Focal STIR hyperintensity and enhancement involving the right T3 transverse process may represent a hemangioma versus a small osseous metastasis. There is questionable intrinsic T1 shortening which would favor the former. This could be further evaluated with a bone scan if clinically warranted. Otherwise no definite evidence of metastatic disease within the visualized cervical or thoracic spine. 2.Multilevel degenerative changes involving the cervical and thoracic spine without high-grade spinal canal stenosis at any level. Additional details regarding degenerative findings in the cervical spine as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 25-year-old female with history of antineoplastic chemotherapy who presents for coronary artery CTA. Coronary arteries: 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. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD.LCx: The left circumflex coronary artery is dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches, posterior descending artery, and posteriolateral branch. There are no significant stenoses in the LCx.RCA: The right coronary artery is large and arises normally from the right sinus of valsalva. There are no significant stenoses in the right coronary artery.Please note, streak artifact from ICD lead limits evaluation of the cardiac apex.Left Ventricle: The left ventricle is moderately dilated without evidence of thrombus.Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrium is mild to moderately dilated. 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 and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.CHEST:LUNGS AND PLEURA: Visualization of the lung parenchyma is limited by the field of view and length of scan which excludes a substantial amount of the lungs. No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted in the extra cardiovascular portions of the mediastinum.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted.

Output: There are no significant coronary artery stenoses present.


Instruction: Generate impression based on findings.

Input: 17 year-old female with knee pain for 3 to 4 years. MENISCI: No significant abnormality noted. The menisci are intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. No abnormal thinning or defects of the articular cartilage. No abnormal bone marrow signal. No evidence of osteochondritis dissecans within the patella or elsewhere as clinically questioned.LIGAMENTS: The ACL, PCL, MCL, and lateral collateral complex are normal in appearance.EXTENSOR MECHANISM: The extensor mechanism is intact. No visible abnormal patella plica.ADDITIONAL

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: 61 year old man with history of 5V CABG in 2011. He had a recent VT arrest. Subsequent angiogram with patent grafts. Patient referred to assess for myocardial fibrosis, etc. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. There is hypokinesis of the basal inferolateral and anterolateral walls, severe hypokinesis of the mid inferior and inferolateral walls, there is hypokinesis of the apical inferior wall. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 171 ml/m2 (normal range: 74+/-15), the LVEDV is 338 ml (normal range 142+/-34), the LV end systolic volume index is 115 ml/m2 (normal range 25+/-9), the LVESV is 227 ml (normal range 47+/-19), the LV mass index is 96 g/m2 (normal range 85+/-15), and the LV mass is 189 g (normal range 164+/-36). There is a predominantly transmural myocardial infarction associated with almost all of the above dysfunctional segments. The majority of this region is non-viable. The remainder of the myocardium is free of myocardial infarction and likely to be viable. No LV thrombus is noted. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 83 ml/m2 (normal range 82+/-16), the RVEDV is 164 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated (SOV 43mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The LV is severely dilated with moderately reduced systolic function (LVEF 33%). There is a large wall motion abnormality with a transmural myocardial infarction as described above. The dysfunctional segments are predominantly non-viable. The remainder of the myocardium is free of myocardial infarction and is likely to be viable.2. Normal RV size and systolic function (RVEF 61%).3. Moderate left atrial dilation.4. The aortic root is mildly dilated. When the echocardiogram from 3/23/2015 was re-reviewed, it is evident that the LV ejection fraction was previously significantly over-estimated due to poor visualization of the endocardial border due to technically limited images. There has probably been no significant change in ejection fraction from the prior echo to today's MRI.


Instruction: Generate impression based on findings.

Input: Unspecified papilledema [H47.10], Reason for Study: ^Reason: increased IOP History: optic disc swelling. The globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. There is no evidence of signal abnormality, mass, or abnormal contrast enhancement.  The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection, hemorrhage, restricted diffusion/acute ischemia or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There is a retention cyst on the right maxillary sinus.

Output: 1. Normal brain MRI.2. Normal orbit MRI.


Instruction: Generate impression based on findings.

Input: Right-sided posterior scalp and neck pain There is T2/STIR hyperintensity and enhancement involving the right lateral mass of C1 as well as the right aspect of the dens extending posteriorly into the C2 right lateral mass. Edema and enhancement also noted within the intervening joint space.Alignment the craniocervical junction is maintained. Vertebral body heights and cervical spine are normal. There is mild anterolisthesis of C4 on C5 and minimal retrolisthesis of C5 on C6. No abnormal signal in the cervical cord. Degenerative changes include significant loss of disc height at the C5-6 level as well as multilevel facet arthropathy, relatively worse at the right C4-C5 and right C7-T1 levels. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Mild anterolisthesis and disc uncovering. Right-sided facet arthropathy. No significant spinal canal or neural foraminal stenosis. C5-6: Disc osteophyte complex, mild retrolisthesis, and ligamentum flavum thickening result in mild spinal canal narrowing. There is mild left and minimal right neural foraminal narrowing related to uncovertebral hypertrophy.C6-7: Small disc osteophyte complex, uncovertebral hypertrophy, and ligamentum flavum thickening result in minimal spinal canal narrowing. There is mild left and minimal right neural foraminal narrowing. C7-T1: No significant compromise to the spinal canal or neural foramina. Prominent right-sided facet arthropathy with surrounding enhancement.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Edema and enhancement involving the right lateral mass of C1 as well as the right aspect of the C2 vertebra. Finding is nonspecific and may be related to prior trauma, advanced degenerative changes, or inflammatory arthropathy. Suggest noncontrast CT cervical spine to better assess the osseous anatomy in this region.2. Multilevel degenerative changes in the cervical spine relatively worse at the C5-C6 and C6-C7 levels with up to mild spinal canal and mild neural foraminal stenosis as detailed above. No high-grade spinal canal or high-grade neural foraminal stenosis at any level.3. Facet arthropathy relatively worse at the C4-C5 and right C7-T1 levels. There is enhancement surrounding the right C7-T1 facet joint which may be on a degenerative versus inflammatory basis.


Instruction: Generate impression based on findings.

Input: There are scattered foci of T2 hyperintensity within the subcortical and periventricular white matter, primarily subcortical in location. Many of these were present on the 2006 study, with a few that are new. None demonstrate mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is unremarkable. 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. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Scleroderma, right head tilt, developed right-sided torticollis over a few days in November. Craniovertebral junction appears grossly within normal limits, with head tilt better seen on recent radiographs. There is reversal of cervical lordosis with kyphotic angulation centered at the C5 level. There is loss of height involving the C6 vertebral body and to a milder degree involving the C4 and C5 levels which appear minimally worse since 10/8/2015. There is diffuse osteopenia which is better assessed on recent radiographs. There is anterolisthesis of C3 on C4 which appears minimally worse since prior. There is mild retrolisthesis of C4 on C5 which is similar to prior. There is minimal C2-C3 anterolisthesis similar to prior.Compared to 10/8/2015 there has been interval increase in fluid within the C3-C4 disc space. There is also interval development of bone marrow edema involving the C3, C4, C5, and C6 vertebral bodies. Edema in the interspinous region is noted at the C5-C6 level and to a lesser degree more superiorly in the posterior paraspinous soft tissues. There is also small amount of prevertebral fluid which is new since prior. There is fluid distention involving the left C2-C3 facet joint which was present previously.No abnormal signal within the cervical cord is definitively appreciated. There is deformity in the cord contour related to the vertebral malalignment, which appears worse and in part related to differences in position.Degenerative changes in the cervical spine including disc osteophyte complexes and significantly diminished disc space at the C3-C4, C4-C5, C5-C6, and C6-C7 levels, worst at the C5-C6 and C6-C7 levels. Individual levels as described below:C2-3: Small central disc protrusion and ligamentum flavum laxity without significant spinal canal or neural foraminal stenosis.C3-4: Small central disc protrusion and ligamentum flavum thickening with moderate spinal canal stenosis. There is mild to moderate left and no significant right neural foraminal stenosis. There is prominent facet arthropathy on the left.C4-5: There is disc osteophyte complex and ligamentum flavum thickening with moderate spinal canal stenosis. There is mild to moderate left and mild right neural foraminal stenosis related to uncovertebral hypertrophy and left-sided facet arthropathy. C5-6: There is disc osteophyte complex with moderate spinal canal stenosis. There is mild left and no significant right neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: Small disc osteophyte complex with minimal spinal canal stenosis. There is uncovertebral hypertrophy with mild bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Advanced multilevel degenerative changes in the cervical spine are again seen including moderate degree of spinal canal stenosis at C3-C4, C4-C5, and C5-C6 levels similar to prior 10/8/2015. There is however interval increase in fluid involving the C3-C4 disc space with suggestion of minimal worsening of anterolisthesis at this level. There is also more pronounced increase in bone marrow edema involving the C3 to C6 vertebral bodies. There is moderate loss of height involving the C6 vertebral body and to a milder degree involving the C4 and C5 levels which appears mildly worse; osteopenia is more evident on radiographs. There is also interval increase in edema at the interspinous level at the C5-C6 level and to a lesser degree more superiorly in the posterior paraspinous soft tissues. There is also development of mild prevertebral fluid collection.Overall the new findings may all be related to trauma if there is history, including interspinous ligamentous injury at the C5-C6 level. The increased fluid in the C3-C4 disc space is likely related to instability although infection cannot be entirely excluded.