Instruction: Generate impression based on findings.

Input: Patient with history of migraines, evaluate. Patient has previous history of left parietal meningioma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma is unremarkable. There is persistent flattening of the pituitary gland. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.Patient is status post left parietal craniotomy. Posttreatment signal abnormality is again seen within and adjacent to the left parietal calvarium. No gross residual or recurrent tumor is noted within the limitations of a noncontrast study. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Persistent flattening of the pituitary, likely secondary to known intracranial hypertension.3.Status post left parietal craniotomy for resection of meningioma, without evidence of gross recurrent tumor.


Instruction: Generate impression based on findings.

Input: 71-year-old female with numbness. Evaluate expansion of subdural fluid collection. Redemonstrated are the findings from a previous left-sided craniotomy for aneurysm clip placement along the anterior communicating artery region. A previously demonstrated hypodense focus in region of the anterior limb of the left internal capsule, into aspect of the left lentiform nuclei and the left globus pallidus is again seen. There is associated ex vacuo dilatation of the anterior horn of the left lateral ventricle. Note is made of a small hypodensity within the anterior limb of the right internal capsule, unchanged. Note is made of a mixed density fluid collection along the right frontoparietal region, most consistent with an extra-axial hematoma. Note is made of mass effect with associated sulcal effacement of the right hemisphere in the surrounding area. No evidence of intraparenchymal hemorrhage. The remainder of the CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially.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. Redemonstrated is a hyperdense, bone density lesion along the inner table underlying left-sided periorbital gyri, without significant parenchymal mass effect.

Output: 1. Mixed density fluid collection overlying the left frontoparietal lobes consistent with a extra-axial hematoma, corresponding to the findings seen on recent MRI performed on 4/15/2013. No evidence of intraparenchymal hemorrhage.2. Status post aneurysm clipping of anterior communicating artery region aneurysm. 3. Expected evolution of prior infarct in region of the anterior limb of the left internal capsule with development of encephalomalacia and associated ex vacuo dilatation of the anterior horn of the left lateral ventricle.4. Small hypodensity within the anterior limb of the right internal capsule may represent prior remote lacunar infarct.5. Stable calvarial osteoma.


Instruction: Generate impression based on findings.

Input: Clinical question: History of narcolepsy. New diagnosed generalized epilepsy, rule out brain pathology. Seizure two protocol. Signs and symptoms: As above. Nonenhanced brain MRI:No diffusion weighted abnormalities.There is normal anatomical morphology and signal intensity of brain parenchyma on all MRI sequences.The unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination. There is no detectable abnormality on dedicated coronal images through the temporal lobes. The signal voids of major intracranial arterial branches are identified and unremarkable.The signal intensity of intracranial venous sinuses are normal.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.

Output: Negative nonenhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 80 years Male (DOB:5/30/1935)Reason: memory loss History: memory lossPatient History: pt c/o headaches, dizziness, memory loss, patient moving on some scansPregnancy Assessment: Patient signed.PROVIDER/ATTENDING NAME: TIA R KOSTAS TIA R KOSTAS The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.On susceptibility imaging there are punctate signal hyperintensities along the hippocampi bilaterally but more on the right versus the left side.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.Microhemorrhages are suspected to be present along the hippocampi bilaterally - right more than left.


Instruction: Generate impression based on findings.

Input: 65-year-old female with lateral joint line tenderness. Rule out meniscus tear. MENISCI: There is linear increased signal abnormality and blunting of the body of the lateral meniscus which extends to the tibial articular surface, near the free edge of the meniscus, consistent with a horizontal tear. There is increased globular signal abnormality within the anterior horn of lateral meniscus which likely represents intrasubstance degeneration. There is extension of this signal abnormality to the tibial articular surface likely representing degenerative tearing/fraying. There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. This signal abnormality extends to the tibial articular surface consistent with degenerative tearing/fraying. The body and anterior horn of the meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is partial-thickness articular cartilage degeneration along the posterior aspect of the lateral femoral condyle posterior to the posterior horn of the meniscus. No full-thickness or near full-thickness articular cartilage defects are identified. No bone marrow signal abnormality is identified. There are small tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the lateral meniscus.2. Degenerative tearing/fraying of the medial meniscus. 3. Small joint effusion with a moderate-sized Baker's cyst. 4. Degenerative osteoarthritic changes of the knee.


Instruction: Generate impression based on findings.

Input: There are a few scattered foci of T2 hyperintensity primarily in subcortical white matter locations without restricted diffusion, mass effect, susceptibility and amount, or enhancement. There is diffuse volume loss with a specific lobar predominant atrophy pattern. The ventricles are unremarkable in size or shape without evidence of hydrocephalus.. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. 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 are clear. Fluid is noted within a few bilateral mastoid air cells (left greater than right). There is no abnormal enhancement within the brain.

Output: 1.Mild chronic small vessel ischemic disease.2.Mild diffuse volume loss with a specific lobar predominant atrophy pattern.3.Fluid is noted within a few bilateral mastoid air cells (left greater than right).


Instruction: Generate impression based on findings.

Input: Myelopathy. Shoulder pain. ROTATOR CUFF: There is a near full-thickness bursal surface tear of the supraspinatus involving greater than 50% of the tendon with at the level of its insertion on the greater tuberosity measuring approximately 12 mm in AP dimension. There is no significant retraction. There is thickening and intermediate signal intensity within the supraspinatus indicating moderate tendinosis. There is extension of this tearing to involve the anterior fibers of the infraspinatus. There is marked fatty atrophy of the infraspinatus muscle. There is interstitial tearing of the subscapularis at the level of its insertion. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Note is made of an os acromiale. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is thickening and intermediate signal intensity within the posterior superior labrum likely representing a combination of degeneration and degenerative tearing. There is also heterogeneity of the anterior labrum which also likely represents a combination of degeneration and degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps appears intact. The tendon appears perched upon the lesser tuberosity at its transition into the rotator interval suggesting minimal subluxation. There is fluid within the tendon sheath which may represent fluid extension from the joint versus a mild tenosynovitis. ADDITIONAL

Output: 1. High-grade insertional tear of the bursal surface fibers of the supraspinatus without significant retraction. There is extension of this tear to involve the anterior fibers of the infraspinatus. Interstitial tearing of the subscapularis.2. The tendon of the long head of the biceps appears perched upon the lesser tuberosity suggesting minimal subluxation.3. Osteoarthritis of the shoulder. Other findings as described.


Instruction: Generate impression based on findings.

Input: Arm pain and neck pain. History of cervical radiculopathy, now with worsening pain and weakness. Evaluate for progression. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis. Alignment is otherwise maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal. Minimal right neural foraminal narrowing. Left neural foramen is patent. C3-4: Disc osteophyte complex including uncovertebral hypertrophy, particularly on the left. There is mild right and moderate left neural foraminal stenosis. No significant spinal canal stenosis.C4-5: Disc osteophyte complex and uncovertebral hypertrophy. There is effacement of the ventral thecal sac and subtle left ventral cord deformity. No significant stenosis however overall, with widely patent dorsal thecal sac. There is moderate left and mild to moderate right neural foraminal stenosis, which appears minimally worse since 2/23/2015.C5-6: Small disc osteophyte complex and uncovertebral hypertrophy on the left result in mild to moderate left neural foraminal stenosis. No significant spinal canal or right neural foraminal narrowing.C6-7: Right paracentral disc osteophyte complex. No significant spinal canal stenosis or left neural foraminal stenosis. Minimal right neural foraminal narrowing. C7-T1: Disc osteophyte complex and uncovertebral hypertrophy result in mild to moderate right and moderate left neural foraminal narrowing, and appears minimally worse since prior. No significant spinal canal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Small scattered perineural cysts are incidentally noted.

Output: Compared to MRI cervical spine dated 2/23/2015, there is stable to minimal interval worsening of the multilevel degenerative changes in the cervical spine. There is minimal contact and deformity of the left ventral cord at the C4-C5 level related to disc osteophyte complex which is similar to prior. Otherwise there is no significant spinal canal stenosis at any level or cord signal abnormality. There is multilevel neural foraminal stenoses as detailed above.


Instruction: Generate impression based on findings.

Input: There is moderate volume loss involving the bilateral hippocampi with abnormal FLAIR signal involving the left amygdala extending to the left hippocampal head. There is suggestion of cystic change without definite mass effect. Multiple foci of white matter T2 hyperintensity is most compatible with age indeterminate small vessel ischemic disease. There is no restriction diffusion or susceptibility weighted imaging abnormality. There is no midline shift or mass effect. 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. Mucosal thickening is noted in the left maxillary sinus.

Output: 1.Abnormal FLAIR signal involving the left medial temporal including the amygdala and left hippocampal head. There is suggestion of cystic change without clear evidence of mass-effect. Finding is favored to represent gliosis related to chronic injury (including prior ischemia or infection). Suggest obtaining prior studies for comparison if available or consider high-resolution imaging of the hippocampi at 3T with intravenous contrast to exclude other less likely etiologies including neoplasm. 2.There are no findings to suggest frontotemporal degeneration. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Male, 46 years old, with multiple sclerosis presenting with weakness. Evaluate for progression. Brain:Several small scattered foci of T2 hyperintensity are seen within the juxtacortical and periventricular white matter of the cerebral hemispheres. The corpus callosum is also involved. No definite lesions are seen in the brainstem or cerebellum. Since the prior examination, mild rim T2 hyperintensity along the lateral ventricles appears slightly increased, but this could be due to differences in technique. Scattered focal lesions appear grossly unchanged in size and number.No edema or mass effect is observed. No abnormal extra-axial collections are seen. Ventricular size and morphology remain within normal limits. Volume of the brain and corpus callosum remains within normal.Cervical spine:No definite focal cord signal abnormality is seen in the cervical region. No epidural lesions are detected. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow replacement is seen. Minimal degenerative findings are evident without significant spinal canal stenosis. Mild foraminal narrowing is seen on the left at C3-4 and on the right at C4-5.Thoracic spine:Very subtle areas of cord T2 signal abnormality are seen for example at T4 centrally and at T6-7 dorsally. Both of these lesions appear less conspicuous than on the prior exam. Prominence of the central canal of the spinal cord is seen spanning from T5 through T8 with very slight prominence continuing more inferiorly. This finding is grossly unchanged from prior.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement is seen. Mild facet edema is seen at T8-9 on the left likely related to joint arthropathy. The intervertebral discs are relatively well preserved with only minimal degenerative changes seen. No significant compromise of the spinal canal is demonstrated. Foraminal narrowing is present bilaterally at T8-9.

Output: 1.A relatively small number of scattered T2 hyperintense lesions are seen in the brain compatible with multiple sclerosis. Slight apparent increased conspicuity of rim T2 hyperintensity along the lateral ventricles may be technical. Scattered discrete lesions are unchanged in size and number.2.No definite spinal cord lesions are seen in the cervical region. Two small areas of very mild cord signal abnormality are suspected in the thoracic spine. In both cases, the prior examination showed larger, more conspicuous lesions in these locations.3.Prominence of the central canal of the spinal cord is seen in the mid to lower thoracic spine without significant interval change.


Instruction: Generate impression based on findings.

Input: Clinical question: Urinary incontinence, gait instability. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrate several small foci of flair/T2 hyperintensity entirely in the subcortical white matter of cerebral hemispheres. Findings are more extensive in bilateral frontal lobes and with lesser degree in the parietal lobes. There is normal signal intensity and morphology of cerebral cortex, bilateral basal ganglia, thalami, midbrain, pons, medulla and cerebellum/vermis. There is slight prominence of vermian and to a lesser degree cerebellar folia for patient of stated age of 48. Possibility of mild underlying parenchymal volume loss cannot be entirely excluded. Post enhanced images demonstrate no detectable abnormal enhancement of brain parenchyma, leptomeninges, barium, tissues of the scalp or the orbits.There is visualization of the signal void of major intracranial arterial branches. The signal intensity of the intracranial venous sinuses is within normal and with normal pattern of enhancement.

Output: 1.No acute intracranial process.2.Several nonspecific foci of flair hyperintensity only in the subcortical white matter of bilateral frontal and to a lesser degree bilateral parietal lobes. A proper clinical setting this finding could represent mild chronic small vessel ischemic strokes however considering patient's stated age possibility of a demyelinating process cannot be entirely excluded. The signal intensity of brain otherwise remains within normal in all MRI sequences and without detectable abnormal enhancement. 3.Slight prominence of the vermian and to a lesser degree cerebellar folia for patient's stated age of 48 is noted.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: MS; eval for progression History: paresthesias There are multiple new FLAIR/T2 high signal intensity white matter lesions comparing to prior scan. Those lesions are located at the left inferior frontal lobe, left posterior inferior subinsular white matter and left periventricular white matter especially along the occipital horn of the left lateral ventricle.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Other bihemispheric white matter lesions including periventricular white matter and bilateral corpus callosum consistent with demyelinating disease such as multiple sclerosis appear to be stable, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval development of new white matter lesions especially on the left hemisphere as described above comparing to prior scan.2. Grossly unchanged other white matter lesions which are consistent with multiple sclerosis.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Reason: Rule out internal derangement History: left knee swelling, popping, buckling MENISCI: There is a horizontal cleavage tear through the posterior horn of the lateral meniscus. The medial meniscus appears grossly intact.ARTICULAR CARTILAGE AND BONE: There are focal full-thickness defects of the articular cartilage of the medial facet of the trochlea with underlying increased T2 signal, consistent with a degenerative subchondral cyst. There are similar changes along the articular surface of the lateral tibial plateau. There is T1 hypointense signal throughout the distal femoral and proximal tibial metaphysis, consistent with residual red marrow.LIGAMENTS: The ACL, MCL, PCL, and LCL are intact. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Horizontal cleavage tear of the posterior horn of the lateral meniscus and degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: 79 year old female with metastatic breast cancer to bone. CVA with left hemiparesis. Hydronephrosis in the past and a stage IV decubitus ulcer presenting with altered mental status. Nonenhanced head CT:Examination demonstrate no evidence of gross intracranial metastatic disease. To entirely exclude possibility of metastatic lesions enhanced MRI or CT exam is recommended. Finding highly suspected of advanced small vessel disease of indeterminate age are noted.There is no evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus.Multiple poorly defined lytic bony changes with no definitive evidence of breakthrough of cortex are suspected for metastatic lesions.

Output: 1.Limited value examination for metastatic disease due to lack of intravenous contrast. No gross evidence of metastases no disease to the brain. Small osseous lytic skull metastases.2.Small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: 69-year-old male with a history of Crohn's disease status post ileocecectomy with multiple subsequent small bowel obstructions. Intermittent abdominal pain. Scout radiograph showed a nonobstructive bowel gas pattern and scattered surgical clips.Transit time to the colon was approximately 30 minutes. Fluoroscopic evaluation showed postoperative changes of prior ileocecectomy normal mucosa throughout the small bowel, with no ulcers, sinus tracts, or fistulae. The ileocolonic anastomosis appears widely patent without evidence of significant stenosis, obstruction, or fistula formation. No separation of bowel loops was present to suggest fibrofatty proliferation. There are angulated loops of small bowel in the left and right lower quadrant which may represent mild nonobstructive adhesive disease. This corresponds to the findings seen on prior CT examination dated 7/26/2014, although this was not seen on the subsequent CT examination dated 2/9/2015 or MRI enterography dated 8/2/2014. No internal hernias or ventral hernias were evident. The ascending colon was otherwise grossly normal. Air augmentation to the level of the proximal to mid ileum demonstrates a widely patent ileocolonic anastomosis without evidence of ulceration or definitive mucosal lesion.TOTAL FLUOROSCOPY TIME: 5 minutes and 45 seconds.

Output: 1. Postsurgical changes of prior ileocecectomy. The ileocolonic anastomosis appears widely patent without evidence of significant stenosis or obstruction. No findings to suggest active ulcerative or fibro-stenotic disease. 2. There are loops of mildly angulated bowel in the left and right lower quadrant, likely representing mild nonobstructive adhesive disease.


Instruction: Generate impression based on findings.

Input: Female, 19 years old, with back pain and sciatica. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable.The visualized distal spinal cord, conus and cauda equina nerve roots are unremarkable. No epidural abnormalities are suspected.The L5-S1 disc demonstrates loss of height and loss of T2 signal. There is mild disc bulging and a small central disc protrusion. No significant spinal canal or foraminal compromise is noted.The remaining lumbar disc levels are free of significant degenerative disease. No spinal canal or foraminal stenosis is seen.

Output: 1.Degenerative disc findings are evident at L5-S1 with loss of disc height, mild disc bulging and a small central disc protrusion. There is no significant associated spinal canal or foraminal stenosis.2.The remaining disc levels are within normal limits. No osseous or intrathecal lesions are seen.


Instruction: Generate impression based on findings.

Input: 48-year-old male with medial ankle pain and pain with bearing weight since crushing injury. Evaluate for posterior tibial tendon rupture/injury. TENDONS: There is a circumferential fluid about the posterior tibialis tendon which is suspicious for tenosynovitis. There is also fluid about the flexor digitorum longus tendon also suggestive of tenosynovitis. The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is within normal limits.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. There is increased signal abnormality and thickening of the deep layer of the deltoid ligament.ARTICULAR SURFACES AND BONE: There is increase signal abnormality in the medial malleolus and medial aspect of the talar dome likely representing reactive osteitis secondary to the aforementioned tenosynovitis. There is mild narrowing of the medial aspect of the tibiotalar joint with associated subchondral cyst formation in the medial malleolus suggestive of degenerative changes. There is a benign appearing focal lesion in the posterior aspect of the distal tibial metadiaphysis, incompletely imaged, most consistent with a healing nonossifying fibroma.ADDITIONAL

Output: 1. Findings suggestive of posterior tibialis tendon tenosynovitis and associated reactive osteitis of the underlying bone.2. Chronic appearing changes of the deep layer of the deltoid ligament which may represent prior trauma. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 74 years Female (DOB:9/1/1941)Reason: evaluate for ischemic infract, mass History: AMSPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is encephalomalacia involving the left temporal lobe along the fusiform gyrus and parahippocampal gyrus which extends towards the lingual gyrus.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 3.5 mm protrusion of the posterior bend of the left internal carotid artery cavernous segment.There is no evidence for cerebrovascular occlusion. There is some mild narrowing at the distal right M1 segment.The anterior communicating artery is identified and is small. The left A1 segment is larger than the right A1 segment. The posterior communicating arteries are small. The left vertebral artery is significantly smaller than the right vertebral artery. The left middle cerebral artery has a proximal m1 bifurcation. The right middle cerebral artery has a distal m1 bifurcation.

Output: 1.No evidence for intracranial cerebrovascular occlusive disease.2.There is encephalomalacia involving the left temporal lobe centered at the fusiform and lingual gyri.3.There is a small aneurysm along the posterior bend of the left internal carotid artery cavernous segment.4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.Exam is somewhat limited due to the patient's inability to cooperate as detailed by the technologist performing the exam.


Instruction: Generate impression based on findings.

Input: Diagnosis: Encounter for examination for normal comparison and control in clinical research programClinical question: metastatic melanoma to brain, eval for disease, baseline for txSigns and Symptoms: as above There is redemonstration of multiple enhancing foci associated with susceptibility effect scattered in both hemispheres of the brain. One located in the right caudate nucleus currently measures 8 x 7 mm improved slightly measured 10 x 9 mm axial dimensions on the October exam, however, it measured 8 x 9 mm on the August 7 exam. One in the left inferior parietal lobule measuring 3 mm on the August 7 exam currently measures 6 x 6 mm and on the 10/2 exam measured 5 x 6 mm to the extent of visualization. Many of the hemorrhagic foci on the susceptibility images are not seen on the postcontrast images.There is redemonstration of diffuse periventricular and subcortical white matter confluent signal changes which were also present on the previous exams to a similar extent.The patient is status post right-sided craniotomyNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.

Output: 1.There are multiple lesions scattered throughout the supratentorial brain which although larger than the August exam appear relatively stable and compared to the October exam and perhaps a couple of them are smaller. Please note however, that slice thickness on the current exam was 2 mm whereas slice thickness on the prior exam from Highland Park was 5 mm on the postcontrast images as a result minor discrepancies in size could be related to differences in sampling in addition to differences in technique.2.Extensive and diffuse white matter signal changes have been present on prior exams and are most likely treatment related.


Instruction: Generate impression based on findings.

Input: A 64 year old female with history of heart and kidney transplant on 6/23/2011. Referred for stress cardiac MRI for follow up.MEDICATIONS: insulin, famotidine, fluticasone, folic acid, levothyroxine, cellcept, pravastatin, prednisone, tracrolimus, triamcinolone First Pass PerfusionDuring hyperemia, no perfusion defects were present. A mild "dark rim" was seen reflecting most probably an artefact and not a real perfusion defect.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 55 ml/m2 (normal range: 65+/-11), the LVEDV is 105 ml (normal range 109+/-23), the LV end systolic volume index is 18 ml/m2 (normal range 18+/-5), the LVESV is 34 ml (normal range 31+/-10), the LV mass index is 56 g/m2, and the LV mass is 105 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 122 ml (normal range 110+/-24), the RV end systolic volume index is 24 ml/m2 (normal range 22+/-8), and the RVESV is 46 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (32mm) in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsPost surgical findings. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 67%).4. Normal RV size and systolic function (RVEF 63%).5. The main pulmonary artery is mildly dilated (32mm) in size. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate cord compression, epidural abscess. Signs and symptoms: LLE weakness, back pain and fever. Nonenhanced compared to spine MRI:Examination demonstrate no evidence of cord compression. The signal intensity and caliber of cord remains within normal.Signal intensity and alignment the vertebral column is unremarkable. Mild degenerative changes of cervical spine are noted.No convincing evidence of perispinal soft tissue abnormalities. No convincing evidence of epidural collection.

Output: No evidence of cord compression.


Instruction: Generate impression based on findings.

Input: Status post distal pancreatectomy and splenectomy for IPMN May 2011. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Status post splenectomy. Hypertrophied splenule.PANCREAS: The patient is status post partial pancreatectomy with only the pancreatic head and uncinate process remaining. The pancreatic duct is minimally irregular with punctate cystic foci which are not significantly changed in size and are compatible with side-branch IPMNs.ADRENAL GLANDS: Stable left adrenal subcentimeter lipid rich adenoma. 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: Postsurgical changes with multiple stable subcentimeter cystic foci in the pancreatic head, compatible with IPMNs.


Instruction: Generate impression based on findings.

Input: Reason: assess liver for HCC History: cirrhosis and chronic hepatitis B. Evaluation mildly limited by motion. ABDOMEN:LIVER, BILIARY TRACT: There is relative hypertrophy of the left hepatic lobe, widening of the hepatic fissures, and mild nodular hepatic contour compatible with cirrhosis.There is a lesion within hepatic segments 6/7 with reference measurements below. The lesion demonstrates increased T2 signal, decreased T1 signal, restricted diffusion, and arterial enhancement with washout and is compatible with hepatocellular carcinoma. The lesion mildly attenuates the adjacent segmental branches of the right portal vein.There is an additional smaller lesion within segments 7/8 at the dome with reference measurements below. This lesion demonstrates increased T2 signal, decreased T1 signal, restricted diffusion, probable arterial enhancement, and probable washout centrally although the small size somewhat limits evaluation.There is an additional subcentimeter lesion along the periphery in segment 4A with reference measurements below. The lesion demonstrates increased T2 signal, decreased T1 signal, and arterial enhancement without washout may reflect a benign flash filling hemangioma.The gallbladder is nondistended. Mild diffuse gallbladder wall thickening is nonspecific but likely related to ascites and/or chronic liver disease. No significant biliary ductal dilatation.SPLEEN: The spleen is mildly enlarged measuring up to 13.3 cm in the cranial caudal dimension. Normal variant splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal cyst.RETROPERITONEUM, LYMPH NODES: Mildly prominent gastrohepatic and para-aortic lymph nodes which are nonspecific but may be related to chronic hepatic disease.BOWEL, MESENTERY: Mild diffuse wall thickening of the visualized small bowel nonspecific but likely related to ascites/chronic liver disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Marked abdominopelvic ascites.INDEX LESION MEASUREMENTS (Current exam date/time: 9/15/2016 14:22:00)HEPATIC SEGMENT 6/7 LESION: 1.9 x 1.6 cm (Image 17, Series 3).HEPATIC SEGMENT 7/8 DOME LESION: 0.9 x 0.6 cm (Image 8, Series 3).SEGMENT 4A LESION: 0.6 x 0.7 cm (Image 11, Series 3).

Output: 1.Cirrhosis and sequelae of portal hypertension including marked abdominal ascites.2.Hepatic lesion within segment 6/7 highly suspicious for hepatocellular carcinoma.3.Subcentimeter hepatic lesion within segment 7/8 suspicious for hepatocellular carcinoma, although subcentimeter size somewhat limits characterization.4.Subcentimeter hepatic lesion within segment 4A with features suggestive of a benign flash filling hemangioma.Discussed with Dr. Andrew Aronsohn at 4:34 PM on 9/22/2016.


Instruction: Generate impression based on findings.

Input: There is no diffusion abnormality. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific. 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 or pathological enhancement. 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.

Output: 1.No evidence of intracranial hemorrhage, edema or mass effect.2. Mild scattered periventricular and subcortical white matter T2/FLAIR hyperintensities are nonspecific, and a partial differential would include sequelae of demyelination, prior inflammation, migraine headache, or vasculitis.


Instruction: Generate impression based on findings.

Input: 72 year old female patient with history of liver mass with negative biopsy. Follow up imaging. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic morphology with a nodular contour. Interlacing T2 hyperintensity is compatible with fibrosis. No suspicious hepatic lesion is identified. The gallbladder is absent. Prominence of the biliary system is likely secondary to a post-cholecystectomy state. The hepatic vasculature 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: Esophageal varices are noted.

Output: 1. Cirrhotic morphology of the liver without suspicious focal hepatic lesion. 2. Patent hepatic vasculature.3. Esophageal varices.


Instruction: Generate impression based on findings.

Input: Altered mental status and possible right-sided weakness. There are few T2-hyperintense, diffusion-restricted lesions in the left cerebral white-matter, the largest of which involve the subcortical left parietal white-matter and measures up to 8 mm. A smaller subcortical diffusion-restricted lesion involves the left precentral gyrus and may account for patient symptoms. There is at least one additional small focus of diffusion restriction involving the right frontal lobe. Foci of susceptibility effect are also present in some of the these diffusion-restricted lesions in addition to bilaterally in the deep gray nuclei regions. There is no territorial cortical diffusion restriction. The ventricles and the other CSF-containing spaces are minimally enlarged, reflecting underlying mild brain volume loss. There is no mass-effect, midline shift or brain herniation. Linear, nonanatomic T2-hyperintense signal overlying the left prior to occipital region relates to artifact.There is no destructive skull lesion. The orbits are grossly unremarkable. There is fluid signal in both mastoid air cells. There is fluid and mucosal thickening in the sphenoid sinuses.

Output: 1.Small foci of white-matter diffusion restriction are present in the left cerebral hemisphere, with one involving the precentral gyrus and probably accounting for patient's symptoms, and are compatible with acute infarcts. There is at least one additional lesion on the right side, in the right frontal lobe. Punctate hemorrhages are present in some of these lesions. The distribution of the lesions is non-territorial and may reflect tiny emboli or, less likely, watershed infarcts from hypoperfusion.2.The foci of susceptibility artifact involving the the deep gray nuclei regions bilaterally may represent hemosiderin staining, for example from chronic hypertension, or mineral deposition/calcifications. Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Parita Patel over the phone on 3/30/2016 9:34 AM.


Instruction: Generate impression based on findings.

Input: 50 years Female (DOB: 5/17/1966)Reason: left arm pain History: left arm painPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is a right lateral recess disc extrusion present with disc material extending behind the C6 vertebral body and encroaching on the nerve roots of the right lateral recess. There is mild displacement of the right hemicord posteriorly.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a right lateral recess disc extrusion present at C6-7 encroaching on the right-sided exiting nerve roots at this level.


Instruction: Generate impression based on findings.

Input: Female; 58 years old. Reason: CT shows ill defined lesion, capsular retraction History: cirrhosis ABDOMEN:LUNG BASES: Previously seen left basilar opacity has decreased and was likely due to subsegmental atelectasis.LIVER, BILIARY TRACT: Large, geographic area in the posterior right hepatic lobe with low T1 signal, slightly increased T2 signal, and slight increased enhancement without washout, unchanged in extent since prior CT. There is associated capsular retraction. The findings are compatible with confluent hepatic fibrosis.Mild perihepatic ascites.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: Findings most compatible with confluent hepatic fibrosis in the right hepatic lobe. No focal liver lesions which meet the criteria for hepatocellular carcinoma.


Instruction: Generate impression based on findings.

Input: 42 years Female (DOB:7/31/1973)Reason: nerve impingement? History: back pain and progressive weakness/numbnessPROVIDER/ATTENDING NAME: TERESITA M HOGAN TIPU S PURI Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. He T1 signal hyperintense 10 mm lesion is present within the L3 vertebral body which was also present on the prior exam and most likely represents a vertebral body hemangioma.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a disc bulge at this level. There is partial effacement of the fat at the lateral recess bilaterally at this level.At L4-5 there is loss of disc space height, disc desiccation, diffuse disc bulge as well as facet and ligamentum flavum hypertrophy. There is a narrowing of the thecal sac with effacement of spinal fluid surrounding the nerve roots within the thecal sac and effacement of the fat at the lateral recesses bilaterally. There is mild narrowing of the neural foramina at this level. Overall there is a moderate to severe degree of spinal stenosis at this level. This has not changed significantly since the prior exam from 4/9/2014.At L3-4 there is loss of disc space height, disc desiccation and a broad-based central disc protrusion with disc material extending behind the adjacent endplates. There is associated facet and ligamentum flavum hypertrophy at this level. There is effacement of the fat at the lateral recess bilaterally. There is crowding of the nerve roots with partial effacement of spinal fluid surrounding the nerve roots. Overall there is a moderate degree of spinal stenosis at this level. This has not changed significantly since the prior exam from 4/9/2014.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a partially visualized large expanded fluid collection in the abdomen. There is a prior CT of the abdomen from 5/7/2013 which seems to indicate this represents a partially cystic mass and possibly ovarian in origin. It is only partly imaged on this exam.

Output: 1.There are multilevel degenerative changes present lumbar spine with moderate to severe spinal stenosis at L4-5 and moderate spinal stenosis at L3-4. This was also present on the prior exam from 2014.2.There is a large cystic type lesion the abdomen which is not evaluated on this exam. There is a CT of the abdomen from 2013 which at that time suggested that an ultrasound would help resolve it. Please correlate with patient's clinical history.


Instruction: Generate impression based on findings.

Input: Male 75 years old Reason: 75 yo male with hx of pancreas lesion; please eval for changes History: pancreas lesion ABDOMEN:LIVER, BILIARY TRACT: Status-post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Clustered cystic lesions again noted in the region of the pancreatic head and uncinate process. The largest measures 1.3 x 1.5 cm (series 3, image 31) and contains a solid focus on the nondependent wall. While this may represent debris a solid nodule cannot be excluded, particularly in the absence of intravenous contrast.Cranial to this there is a second 1.7 x 1.4 cm lobulated cystic lesion without evidence of internal nodule. Both lesions demonstrate interval decrease in size of the cystic component compared to prior study. The solid component in the more caudally located lesion is unchanged in size.Additional tiny cystic lesions are not significantly changed compared to prior study.The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable appearance on renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Clustered cystic lesions predominantly in the pancreatic head and uncinate process. There has been an interval decrease in size of the cysts compared to prior study. One of the lesions contains a solid component. While this may represent a complex IPMN, the possibility of malignant degeneration cannot be excluded, particularly in the absence of intravenous contrast. Correlation with results of endoscopic sonography recommended.


Instruction: Generate impression based on findings.

Input: 49-year-old male with history of bladder cancer, status post partial cystectomy. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Contour deformity from prior partial cystectomy. No focal wall thickening.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Interval resolution of the previously described nonenhancing fluid collection of the right inguinal region.

Output: 1.No evidence of metastatic disease.2.Interval resolution of the previously described right inguinal fluid collection.


Instruction: Generate impression based on findings.

Input: 83 year old woman referred for evaluation of LV function and fibrosis. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 83 ml/m2 (normal range: 65+/-11), the LVEDV is 140 ml (normal range 109+/-23), the LV end systolic volume index is 41 ml/m2 (normal range 18+/-5), the LVESV is 70 ml (normal range 31+/-10), the LV mass index is 65 g/m2 (normal range 67+/-11), and the LV mass is 110 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 58 ml/m2 (normal range 69+/-14), the RVEDV is 99 ml (normal range 110+/-24), the RV end systolic volume index is 19 ml/m2 (normal range 22+/-8), and the RVESV is 33 ml (normal range 35+/-13). A pacemaker lead is in the RV.Right AtriumThe right atrium is moderately dilated. A pacemaker lead is in the RA. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. Pacemaker leads are noted in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA pacemaker is noted in the left chest. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 66 year old female with non-ischemic cardiomyopathy status-post cardiac transplant with DeVega tricuspid valve repair in 2015 admitted for shortness of breath, referred for cardiac MRI to evaluate for pericarditis or rejection. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 101 ml/m2 (normal range: 74+/-15), the LVEDV is 200 ml (normal range 142+/-34), the LV end systolic volume index is 46 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 54 g/m2 (normal range 85+/-15), and the LV mass is 39 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Gadolinium was not administered due to the patient's renal status. The native pre-contrast T1 myocardial relaxation time ranges 1000-1080 ms (normal). T2-stir mapping sequence suggests inflammation of majority of the pericardium. The apical septal and apical anterior myocardium appear have a hyperintense signal on T2-stir mapping suggestive of edema or inflammation. This area is accessible to endomyocardial biopsy. Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 97 ml/m2 (normal range 82+/-16), the RVEDV is 191 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 85 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation. AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThe pericardium is circumferentially thickened with a maximal diameter of 6 mm.Extracardiac FindingsThere are sternotomy wires present. There are bilateral pleural effusions, left greater than right. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 55%).2. The right ventricle is normal in size and systolic function (RVEF 55%).3. The pericardium is circumferentially thickened with a maximal diameter of 6 mm. T2-stir mapping sequence suggests inflammation of majority of the pericardium. The apical septal and apical anterior myocardium appear have a hyperintense signal on T2-stir mapping suggestive of edema or inflammation. This area is accessible to endomyocardial biopsy. 4. The native pre-contrast T1 myocardial relaxation time of the septum ranges 1000-1080 ms (normal). 5. There are bilateral pleural effusions, left greater than right.6. Overall the constellation of findings are consistent with pericarditis with possible associated myocardial edema/inflammation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other intervertebral disc displacement, lumbar regionClinical question: new pain to left legSigns and Symptoms: new pain to left. Has history of right sided leg pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is bilateral facet hypertrophy of a moderate to marked degree associated with disc desiccation. There is associated encroachment of the nerve roots within the neural foramina bilaterally at this level and some partial effacement of the fat at the lateral recess on the left side. These findings are stable when compared to the previous exam.At L4-5 there is redemonstration of loss of disc space height, disc desiccation and diffuse disc bulge associated with endplate reactive changes. The endplate reactive changes are bright on T1. There is associated moderate bilateral facet and ligamentum flavum hypertrophy as well as effacement of spinal fluid surrounding the nerve roots within the thecal sac. Overall there is a moderate to marked degree of spinal stenosis present at this level. There is also effacement of the fat surrounding the exiting nerve roots on the right side at this level. When compared to the prior exam these findings are stable.At L3-4 there is diffuse disc bulge associated with a moderate degree of bilateral facet and ligamentum flavum hypertrophy. There is disc desiccation present. There are some mild endplate reactive changes present which are bright on T1 imaging. The fat at the lateral recesses is effaced bilaterally at this level and there is some crowding of the nerve roots within the thecal sac. Overall there is moderate spinal stenosis at this level. There is narrowing of the neural foramina bilaterally at this level. The exiting nerve roots within the neural foramina are surrounded by fat. Overall these findings have not changed compared to the prior examAt L2-3 there is disc desiccation and a right far lateral disc protrusion which extends into the right neural foramen and mildly displaces the right-sided exiting nerve root after it exits the neural foramen.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level.

Output: 1.There is redemonstration and no change of multilevel degenerative changes present in the lumbar spine with a moderate to severe degree of spinal stenosis at L4-5 and moderate spinal stenosis at L3-4 as well as some encroachment of the exiting nerve roots within the neural foramina on the left side at L5-S1 and the right-side at L4-5.2.There is a right far lateral disc protrusion at L2-3 which mildly displaces the right sided exiting nerve roots after the exit the neural foramen at this level. This is also stable compared to the prior exam


Instruction: Generate impression based on findings.

Input: There is mild reversal of cervical lordosis. The vertebral body heights are preserved. There is desiccation of the disks at all levels in the cervical spine as noted before. There are mild type I degenerative changes at C6-7 endplates, mildly progressed from prior examination. There is mild type II degenerative change at inferior endplate of C5, without significant change. The osseous marrow signal is otherwise benign.  The cord signal is within normal limits. There is a partial empty sella of incidental note.C2-3: No disk herniation or spinal stenosis.C3-4: Disk osteophyte with tiny central disk protrusion and mild right uncovertebral hypertrophy with no significant spinal canal stenosis. Minimal right neural foraminal narrowing.C4-5: Disk osteophyte complex with left paracentral disk protrusion and right greater than left uncovertebral hypertrophy causing effacement of the ventral CSF space but slight indentation of the left aspect of the spinal cord without impingement. Minimal right neural foraminal stenosis.C5-6: Disk osteophyte complex with ventral CSF effacement. No spinal stenosis.C6-7: Disk osteophyte complex with minimal ventral CSF effacement. No spinal stenosis.C7-T1: No disk herniation or spinal stenosis.T1-2: No disk herniation or spinal stenosis.Level by level findings above are stable from prior examination.

Output: Mildly progressed type I degenerative changes at the C6-7 endplates. Otherwise, multilevel degenerative findings are unchanged from 4/23/2014. No areas of high-grade spinal canal or neuroforaminal stenosis are suspected.


Instruction: Generate impression based on findings.

Input: 78 year old man with new diagnosis of heart failure, referred for further evaluation of underlying etiology. MEDICATIONS: Lipitor, Lasix, Lisinopril, Xarelto, Toprol XL First Pass PerfusionDuring hyperemia, no perfusion defects were present. A dark rim artifact is noted. Viability/ Myocardial ScarThere is no evidence of prior myocardial infarction; however, there is late gadolinium enhancement in a midwall septal stripe pattern and in a right ventricular insertion point pattern. These findings suggest the presence of underlying myocardial fibrosis and are consistent with the diagnosis of non-ischemic cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 229 ml/m2 (normal range: 74+/-15), the LVEDV is 530 ml (normal range 142+/-34), the LV end systolic volume index is 197 ml/m2 (normal range 25+/-9), the LVESV is 455 ml (normal range 47+/-19), the LV mass index is 135 g/m2, and the LV mass is 312 g. There is global hypokinesis with regional variation. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is severely dilated with severely reduced systolic function. The overall RV ejection fraction is 27%, the RV end diastolic volume index is 160 ml/m2 (normal range 82+/-16), the RVEDV is 371 ml (normal range 142+/-31), the RV end systolic volume index is 117 ml/m2 (normal range 31+/-9), and the RVESV is 270 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve is tri-leaflet and opens widely. There is severe aortic regurgitation, with calculated regurgitant fraction of 56%.Mitral ValveThe mitral valve opens widely with moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. There is a trivial pericardial effusion.Extracardiac FindingsSmall bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia; however, the diagnostic sensitivity of vasodilator stress testing in patients with severe LV dysfunction may be reduced. 2. No prior myocardial infarction. There is evidence of myocardial fibrosis in the septal mid-wall stripe pattern. There is also fibrosis involving the anterior and inferior right ventricular insertion point. These findings all support the diagnosis of non-ischemic dilated cardiomyopathy.3. Severe LV dilation with severely reduced systolic function (LVEF 14%).4. Severe RV dilation with severely reduced systolic function (RVEF 27%).5. Severe aortic regurgitation.6. Moderate mitral regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Concern for expanding left MCA stroke. Signs and symptoms: Worsening left-sided weakness and facial droop. Nonenhanced brain MRI:There is no evidence of an acute intracranial process in particular no evidence of acute ischemic stroke.This examination they demonstrate previously known large chronic lacunar infarct of left basal ganglia with resultant subtle ex vacuo dilatation of left lateral ventricle. On the cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Well-demarcated round foci of T2 hyperintensity and flair hyperintensity without evidence of surrounding gliosis in the right basal ganglia is consistent with perivascular spaces no clinical significance.The signal void of left internal carotid artery across the skull base and in its supraclinoid segment is smaller in size compared to the right likely secondary to resonance of a large chronic stroke in the left hemisphere.

Output: 1.No evidence of acute ischemic change.2.Large chronic left MCA territory basal ganglia lacunar infarct as detailed.3.Small caliber of the left cavernous and supraclinoid internal carotid likely secondary to large chronic left history stroke.4.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, pain and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right shoulder was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, 20 gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 mL of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information. Exposure time: 56 seconds

Output: Successful fluoroscopy guided contrast injection of the right shoulder for the subsequent MR arthrogram study.


Instruction: Generate impression based on findings.

Input: Reason: Right TMJ h/o MRI >1year ago indicating condylar head resorption History: pain No bone marrow signal abnormality is identified. The temporomandibular joint alignment is anatomic. The condyles appear well seated. There is intermediate signal intensity within the intermediate zone and posterior band of the articular disc of the temporomandibular joint which may reflect mild degeneration. The junction of the intermediate zone and posterior band angle measures between 10 and 30 degrees which is in the upper limits of normal. No frank dislocation of the articular disc is identified.The imaged soft tissues and the surrounding area are unremarkable. Note is made of multiple subcentimeter foci of decreased signal within the right parotid gland which are incompletely characterized but likely represent lymph nodes.

Output: Mild temporomandibular joint articular disc degeneration without evidence of condylar head resorption.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:8/13/1959)Reason: syncope and facial droop History: left facial droopPROVIDER/ATTENDING NAME: JEANNE M DECARA JEANNE M DECARA MRI of the brainSeveral punctate foci of diffusion restriction are identified. One is located in the right periventricular white matter. One is located in the left centrum semiovale. One is located in the left occipital lobe.There are 4 or 5 periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images..Is a punctate focus of signal loss and susceptibility imaging in the left half of the splenium of the corpus callosum. Initial location this is of unknown clinical significance.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:Antegrade flow is present in the distal internal carotid arteries, the distal left vertebral artery, 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 there are small. The right vertebral artery is not readily identified. The right posterior inferior cerebellar artery territory and appears to be supplied via the right anterior inferior cerebellar artery. There is extracranial origin of the left 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. The right vertebral artery is small and ends just proximal to the level of the foramen magnum. The anterior spinal artery years to be supplied from the left vertebral artery. 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.There are several acute microinfarcts identified in the periventricular and subcortical white matter in the multiple cerebral territories.2.Occlusion of the right vertebral artery distally. Radiology is not established on this exam.3.Anterior spinal artery is prominent but otherwise unremarkable. It is possible this represents a collateral supply to right vertebral artery territory to the brainstem.


Instruction: Generate impression based on findings.

Input: 59 years, Male, dystonia, unspecified. Parkinson's disease.. Limited sequences of the brain were obtained for operative planning. There is slitlike encephalomalacia involving the left posterior subinsular region with rim of T2 hypointensity and susceptibility effect most compatible with chronic hemorrhage. There are also punctate foci of susceptibility effect in the left thalamus as well as the left aspect of the pons compatible with chronic microhemorrhages. There is also a focus of susceptibility in the right putamen. Additionally there is a focus of susceptibility effect in the right anterior frontal lobe just deep to the cortex. Patchy areas of T2 hyperintensity in the bilateral periventricular and subcortical white matter are nonspecific but compatible with chronic small vessel ischemic disease. No abnormal enhancing lesions are evident. No intracranial mass, mass effect, midline shift, or herniation. No hydrocephalus. Major vascular structures are patent. There is minimal paranasal sinus mucosal thickening as well as a small right maxillary mucus retention cyst. Calvarium and extracranial soft tissue structures are otherwise grossly unremarkable.

Output: 1. Examination for operative planning. No intracranial mass or abnormal enhancing lesions.2. Chronic hemorrhage involving the left subinsular region. There are additional foci of chronic microhemorrhage particularly in the left thalamus and left pons. Distribution of these findings favors a chronic hypertensive etiology.


Instruction: Generate impression based on findings.

Input: 58 year old with ischemic cardiomyopathy with increasing amounts of non-sustained ventricular tachycardia presenting for evaluation of scar and viability. Left VentricleThe left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 142 ml/m2 (normal range: 74+/-15), the LVEDV is 266 ml (normal range 142+/-34), the LV end systolic volume index is 82 ml/m2 (normal range 25+/-9), the LVESV is 153 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 117 g (normal range 164+/-36). There are regional wall motion abnormalities in the apex, apical to mid septal, inferior and anterior walls. There is extensive transmural late gadolinium enhancement in the apex, mid to apical anterior, septal and distal inferior walls to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is typical for myocardial infarction. Left AtriumThe left atrium is moderate to severely enlarged. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 121 ml/m2 (normal range 82+/-16), the RVEDV is 227 ml (normal range 142+/-31), the RV end systolic volume index is 60 ml/m2 (normal range 31+/-9), and the RVESV is 113 ml (normal range 54+/-17).Right AtriumThe right atrium is moderate to severely dilated.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 43%. There are regional wall motion abnormalities in the apex, apical to mid septal, inferior and anterior walls. There is extensive transmural late gadolinium enhancement in the apex, mid to apical anterior, septal and distal inferior walls to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This pattern is typical for myocardial infarction. 2. The right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 50%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There are 3 discrete intra-axial enhancing metastases. There is an enhancing mass with central susceptibility effect in the right cerebellar hemisphere measuring 36 x 19 mm with moderate ischemic edema and mass effect on the fourth ventricle and mild mass effect in the posterior fossa. There is an second enhancing rounded mass in the left temporal lobe measuring 17 x 17 mm with extensive surrounding vasogenic edema and regional mass effect with sulcal effacement. There is a third rounded enhancing lesion in the left thalamus measuring up to 6 5-mm with mild surrounding this lytic edema.There is minimal shift of the midline to the right measuring up to 2 mm. There is no uncal, transtentorial or cerebellar tonsillar herniation. There are superimposed nonspecific T2 white matter changes likely representing mild chronic microvascular ischemic changes. There is no acute infarct. There is no hydrocephalus. The osseous marrow signal is heterogeneous without a dominant focal lesion.

Output: 1.Three distinct intra-axial metastases involving the right cerebellar hemisphere, left temporal lobe, and thalamus. 2.Largest mass in the right cerebellar hemisphere appears to have small foci of internal hemorrhage, and contributes to mild mass effect in the posterior fossa and narrowing of the fourth ventricle without hydrocephalus. 3.Minimal midline shift to the right.4.No acute infarct. 5.Mild chronic microvascular ischemic changes.Findings were discussed with resident Dr. Abdulrahman Dia from Internal Medicine at 10:45 AM today over the telephone.


Instruction: Generate impression based on findings.

Input: Redemonstrated are stable postsurgical findings related right parietal craniotomy with underlying encephalomalacia along the surgical approach extending to the ventricle. As before, there are bifrontal ventricular catheter tracks. The glomus of the right lateral ventricle choroid plexus is surgically absent and there is no abnormal enhancement to suggest residual or recurrent tumor. Ventricular sizes are unchanged. Unchanged chronic residual hemosiderin within the occipital horns is again noted. There is stable cystic encephalomalacia within the right basal ganglia. A 5 mm diameter left peritrigonal cystic lesion is somewhat less apparent and may be related to perivascular spaces. There is no evidence of acute infarct or hemorrhage. The major cerebral flow voids are grossly intact. Mucosal thickening within the bilateral maxillary and ethmoid sinuses has resolved. The extracranial structures are unremarkable.

Output: 1.Stable postsurgical findings related to right lateral ventricle choroid plexus tumor removal without evidence of residual or recurrent tumor.2.A left peritrigonal cystic lesion is somewhat less apparent and may be related to perivascular spaces.


Instruction: Generate impression based on findings.

Input: Migraine without aura, intractable, without status migrainosus [G43.019], Reason for Study: ^Reason: 21 y.o. with persistent headaches with considerable exercise-induced worsening. Also, bending worsens. History: see above Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.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 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 normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. There is no evidence of intracranial arterial aneurysm. No evidence of intracranial arterial luminal stenosis or irregularity.

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


Instruction: Generate impression based on findings.

Input: Other amnesia [R41.3], Reason for Study No evidence of acute ischemic or hemorrhagic lesion on the scan.There is lenticular shape fat containing lesion based on the left side of falx indicating possible meningioma without showing any evidence of mass effect.There is no evidence of abnormal enhancement.There are couple of FLAIR high signal intensity lesions on bilateral centrum semiovale and deep white matter which are nonspecific.The ventricles, sulci and cisterns are symmetric and unremarkable.There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Small falx meningioma as described above.2. Non specific white matter lesions on FLAIR images.3. No acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: History of recurrent acute pancreatitis. Pancreas divisum. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. No focal suspicious lesion. No biliary ductal dilatation. Normally distended gallbladder without gallstones. No choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Suspected pancreas divisum (series 12 image 5). There is mild decrease in intrinsic T1 weighted signal intensity of the pancreatic parenchyma which enhances homogeneously without evidence of necrosis or hemorrhage. No peripancreatic inflammatory changes or loculated fluid collection. No evidence of arterial pseudoaneurysm formation or venous thrombosis.Mild narrowing of the main pancreatic duct at the level of the pancreatic head without significant upstream dilatation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of acute pancreatitis or complication thereof. Suspected pancreas division. Mild decrease in intrinsic T1-weighted signal intensity of the pancreatic parenchyma and mild narrowing of the main pancreatic duct at the level of the pancreatic head without significant upstream dilatation compatible with stigmata of prior pancreatitis.


Instruction: Generate impression based on findings.

Input: Neck pain and increasing headaches. Buttock pain and shooting pain up the back from the the low spine. History of cervical fusion. Eval for stenosis or abnormality. Cervical spine: Again seen are postsurgical changes of cervical decompression, with laminectomies, and posterior fusion hardware, which extends from C3 to T1 levels. Hardware is better assessed on recent CT study. Spinal canal is well decompressed without significant stenosis at any level. Again noted is mild kyphotic angulation of the lower cervical spine with apex at the C6 level. There is minimal anterolisthesis of C4 on C5 but much improved compared to preoperative CT from 11/1/2013. There is significant loss of disc height at the C6-C7 level and to a lesser degree at the C5-C6 level. Cervical vertebral body heights are maintained. Bone marrow signal is benign. Periscrew lucencies involving the bilateral T1 screws is better appreciated on recent CT.Individual levels as below:At C2-C3, there is minimal left neural foraminal narrowing. No significant spinal canal or right neural foraminal narrowing.At C3-C4, there is mild to moderate right neural foraminal narrowing. No significant spinal canal or left neural foraminal narrowing.At C4-C5, there is mild to moderate right neural foraminal narrowing. No significant spinal canal or left neural foraminal narrowing.At C5-C6, there is a disc osteophyte complex eccentric to the right with uncovertebral hypertrophy. There is mild to moderate right neural foraminal narrowing. No significant spinal canal or left neural foraminal narrowing.At C6-C7, there is minimal right neural foraminal narrowing. No significant spinal canal or left neural foraminal narrowing.At C7-T1, there is small central disc protrusion which is larger compared to 11/1/2013 but with no significant spinal canal or neural foraminal stenosis.Lumbar spine: Five lumbar type vertebral bodies are presumed to be present. As seen on recent CT, there is mild rightward convexity of the spine centered at L3 with slight left lateral translation of L2 on L3. There is minimal grade 1 retrolisthesis of L3 on L4 and L4 on L5. There is slight straightening of the normal lumbar lordosis. There is severe loss of height of the L2-L3 disc and to a lesser degree at the L3-L4 and L5-S1 levels. Vacuum disc phenomena is noted at L2-L3, L3-L4, L4-L5, and L5-S1. There is mild loss of height involving the L3 vertebral body related to advanced endplate changes at the L2-L3 level; vertebral body heights are otherwise maintained without evidence of a compression fracture. Advanced endplate degenerative changes are also well appreciated on recent CT. The conus medullaris is normal in position at the lower L1 level.Multilevel degenerative changes are seen, as described below:L1-L2: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L2-L3: Disc bulge eccentric to the right with prominent right lateral osteophyte. No significant spinal canal or left neural foraminal narrowing. There is mild to moderate right neural foraminal stenosis. There is also displacement of the right extraforaminal L2 nerve root related to the large osteophyte.L3-L4: Mild disc bulge and endplate osteophytes. No significant spinal canal stenosis. There is mild to moderate right greater than left neural foraminal narrowing.L4-L5: There is mild disc bulge and facet arthropathy. There is moderate bilateral neural foraminal narrowing. No significant spinal canal narrowing. L5-S1: Mild disc bulge. No significant spinal canal stenosis. There is mild to moderate bilateral, right worse in left neural foraminal stenosis.Mild facet arthropathy in the lumbar spine. Atrophic changes are noted in the lower lumbar paraspinous musculature. Paraspinous soft tissues are otherwise unremarkable.

Output: 1. Postsurgical changes of cervical spine decompression and fusion with hardware extending from C3 to T1 levels. There are periscrew lucencies/loosening involving the bilateral T1 screws which are better assessed on recent CT. There is no significant spinal canal narrowing in the cervical spine. Multilevel mild neural foraminal narrowing as described above, relatively worse at the right C3-4 and C4-5 levels.2. Moderate degenerative changes in the lumbar spine without significant spinal canal stenosis at any level. There is neural foraminal stenosis at right L2-L3 and bilateral L3-L4, L4-L5, and L5-S1 as described above. 3. Advanced disc and endplate degenerative changes in the lumbar spine at L2-L3, L3-L4, and L5-S1.


Instruction: Generate impression based on findings.

Input: 47-year-old male with redness and edema and history of a vascular malformation. No bone marrow signal abnormality is identified. There is no evidence of muscle atrophy or edema. There is a large vascular malformation confined to the subcutaneous tissues along the posterior and lateral aspect of the right upper extremity extending down the axilla and along the lateral aspect of the right hemithorax. There is associated skin thickening in the surrounding area. No focal fluid collection is identified to suggest abscess. There is thickening of the fascial planes in the surrounding area. The vascular malformation is supplied by the arterial branches of the deep brachial, anterior humeral circumflex, and posterior humeral circumflex arteries. The largest vessel which supplies the malformation is identified at the level of the mid humerus where there is also a dominant vein which drains into the cephalic vein. There are multiple other collateral vessels in the surrounding area. There is an additional venous drainage via the axillary and basilic veins.

Output: Complex venous and arterial malformation with details as described above.


Instruction: Generate impression based on findings.

Input: Ms. Caywood is a 37 year old female with a personal history of metastatic breast cancer and right modified radical mastectomy in 2013. She has recently been diagnosed with left breast IDC, grade 2 at two sites (9:00 and 10:00 locations). Patient is status post right modified radical mastectomy. There is extreme amount of fibroglandular tissue in the left breast. Moderate background parenchymal enhancement is noted, which limits the sensitivity of this examination.In the left medial breast, there is extensive clumped linear nonmass enhancement identified measuring approximately 6.5 x 4.2 x 7.1 cm (AP x ML x SI). Susceptibility artifact from two biopsy marker clips (hydromark clip and ribbon clip) are identified. Based on the mammogram, these clips are separated by approximately 2.5 cm in the SI dimension and 1.8 cm in the ML dimension. No abnormal lymph nodes are identified in either axillary or internal mammary region.Multiple T2-hyperintense hepatic lesions are identified, some of which faintly enhance. These likely correspond to the known hepatic metastases seen on multiple prior CT examinations. Known osseous metastases are not well seen on this MRI exam.

Output: (1) Extensive clumped linear nonmass enhancement in the left medial breast spanning approximately 6.5 cm in AP dimension, corresponding to the recent biopsy results of IDC grade 2 in two sites.(2) Status post right modified mastectomy.(3) Incompletely evaluated known hepatic and osseous metastases. These are better characterized on recent CT examination performed in September 2016.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Fall. Loss of consciousness. Head laceration. Question bleed. There is no evidence of intracranial hemorrhage, edema, or midline shift. In the intrahemispheric aspect of the right parietal lobe there is either an area of encephalomalacia or a cyst with a thick wall of calcification. An MRI is recommended to exclude the possibility of a dermoid. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal without evidence of fracture. Soft tissue irregularity and subcutaneous emphysema are present in the left frontal region consistent with the history of laceration. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Soft tissue injury without evidence of fracture.2. Encephalomalacia versus cystic structure with thick wall of calcification in the right parietal lobe. An MRI is recommended for further evaluation to exclude the possibility of a dermoid.


Instruction: Generate impression based on findings.

Input: 38 year old man with history of schizophrenia (medically treated), admitted with left sided chest pain with course complicated by reported polymorphic VT arrest, successfully resuscitated and found to have coronary disease (obtuse marginal branch) s/p PTCA. Referred for cardiac MRI prior to ICD placement to evaluate for scar and structural heart disease. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 66 ml/m2 (normal range: 74+/-15), the LVEDV is 156 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 54 ml (normal range 47+/-19), the LV mass index is 65 g/m2 (normal range 85+/-15), and the LV mass is 153 g (normal range 164+/-36). There is mild left ventricular hypertrophy (basal septal thickness 13mm, posterior wall thickness 12mm). There is tardokinesis of the basal inferior and basal inferolateral wall. There is prominent hyperintense T2-STIR signal (myocardial:skeletal ratio >2) in the basal inferior/inferolateral wall which is transmural. Global relative enhancement is normal (<4). There is also prominent, high signal late gadolinium enhancement noted in the basal inferior/inferolateral wall which appears transmural at the base, but spares the subendocardium towards the mid segments. This could be consistent with acute myocardial infarction, but atypical causes of myocardial inflammation are still on the differential. No gross evidence of inter-myocardial hemorrhage in the infarct region. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 58 ml/m2 (normal range 82+/-16), the RVEDV is 136 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 51 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 pseudobovine brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is a trivial pericardial effusion. There is no evidence for pericardial edema or inflammation. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size with mild left ventricular hypertrophy and normal systolic function (EF 65%). 2. There is tardokinesis of the basal inferior and inferolateral wall with preserved wall thickness. In these segments, there is associated late gadolinium enhancement which is predominantly transmural and associated with significant active myocardial edema by T2-STIR imaging. Taken together with the clinical history, this likely represents a recent focal myocardial infarction. However, atypical causes of infiltrative/inflammatory myocardial disease in this young patient should still be considered, such as myocarditis or sarcoidosis.3. Normal size right ventricle with normal systolic function (63%). 4. Trivial pericardial effusion


Instruction: Generate impression based on findings.

Input: 69-year-old man with fall and head trauma. Questionable loss of consciousness. There is no evidence of intracranial hemorrhage or edema. Scattered areas of hypoattenuation are present in the subcortical, periventricular, and basal ganglia regions. These are consistent with age determined small vessel ischemic disease. No CT findings of acute stroke are present. Large vessel calcifications are noted in the carotid arteries.Fullness of the sella is noted. MRI is recommended to evaluate for the presence of a sellar mass.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base reveal no CT evidence of fracture. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT evidence of intracranial hemorrhage or fracture.2. Sellar fullness is present. Recommend pituitary protocol MRI tube evaluate for presence of sella mass.3. Age-indeterminate small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of spinal stenosis in the cervical region. Per Epic note: several months of increasing right lower extremity pain and weakness especially while driving for long hours. There are postoperative findings related to anterior cervical discectomy and fusion from C6 to T1. At C5-6, there is a eccentric right disc-osteophyte complex that results in moderate-to-severe right neural foraminal stenosis, but no significant spinal canal stenosis. At C6-7, there is bilateral facet and uncovertebral joint hypertrophy with perhaps mild-to-moderate bilateral neural foraminal stenoses. At C7-T1, there is bilateral facet and uncovertebral joint hypertrophy with perhaps minimal bilateral neural foraminal stenoses. There is no significant spinal canal or neural foraminal stenosis at the other levels of the cervical spine. The cervical spinal cord displays normal signal characteristics and morphology. The cervical spinal column alignment is near-anatomic. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to anterior cervical discectomy and fusion from C6 to T1.2. At C5-6, there is a eccentric right disc-osteophyte complex that results in moderate-to-severe right neural foraminal stenosis, but no significant spinal canal stenosis. 3. At C6-7, there is bilateral facet and uncovertebral joint hypertrophy with perhaps mild-to-moderate bilateral neural foraminal stenoses. 4. At C7-T1, there is bilateral facet and uncovertebral joint hypertrophy with perhaps minimal bilateral neural foraminal stenoses. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.