Instruction: Generate impression based on findings.

Input: Female, 61 years old, with history of multiple myeloma and back pain, with history of T12, L1 and L2 fractures. Assess for healing and for evidence of any new fractures. Thoracic:Spinal marrow signal density remains heterogeneous but is less uniformly T1 hypointense when compared to the prior examination which may reflect a return to relatively more fatty marrow consistency. A well marginated T1/T2 hyperintense lesion within the posterior T10 vertebral body is unchanged. Since the prior examination, evidence of kyphoplasty is seen at the T12 level. The T12 vertebral body remains significantly compressed, similar in degree to the prior examination. There appears to be mild extrusion of cement into the left paracentral epidural space at T12 which causes effacement of the ventral thecal sac but no significant generalized spinal canal stenosis. No new vertebral body compressions are seen. Spinal alignment is relatively anatomic. No significant vertebral body edema is seen. The proximal right T10 rib is STIR hyperintense, slightly more so than on the prior examination.The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No significant compromise of the spinal canal or neural foramina are noted.A septated left renal cyst is unchanged.Lumbar:Comparison the thoracic spine, bone marrow signal characteristics remain heterogeneous but less uniformly T1 hypointense perhaps representing return to a relatively more fatty marrow consistent.Concavity of the posterior inferior endplate of the L1 vertebral body is again seen appearing similar to the prior examination and resulting in mild loss of vertebral body height. Significant compression of the L2 vertebral body with near complete loss of height centrally is again seen, also similar to prior. Mild retropulsion of vertebral body material is seen at both levels without significant interval change. The spinal canal is not significantly narrowed.No new compression deformity is seen. No evidence of vertebral body edema is noted.The distal spinal cord, conus and cauda equina show normal morphology. No significant compromise of the spinal canal is seen. The neural foramina are mildly narrowed at L1-2 and L2-3 bilaterally due to the vertebral body compressions. Mild disc bulging is seen at L3-4.There is a kyphotic angulation of the upper lumbar spine due to compression deformities. Spinal alignment is otherwise unremarkable.

Output: 1.Interval kyphoplasty of the compressed T12 vertebral body. No new compression deformities are seen in the thoracic spine.2.No significant change in compression fractures of the L1 and L2 vertebral bodies including mild retropulsion of osseous material. No new lumbar compression deformity is are seen.3.No significant compromise of the spinal canal is noted at any level in the thoracic or lumbar spine.4.The spinal marrow in general shows heterogeneous signal but with a less uniformly T1 hypointense appearance. This could represent a reduction in myelomatous infiltration, or reduction in marrow activation, with return of a relatively more fatty marrow consistency.


Instruction: Generate impression based on findings.

Input: 76-year-old female experiencing bilateral upper extremity numbness, tingling, and pain, left hand symptoms are worse. Posterior fossa findings from previous extra-axial mass resection are better demonstrated on previous brain MRI dated 11/11/2014. Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position.There is lack of flow void within the right vertebral artery as previously described for the brain MRI dated 8/29/2013, and unchanged dating back to the cervical spine MRI comparison dated 8/21/2013.C2/3 redemonstrates a left paramedian disk protrusion which results in flattening of the anterior left hemicord. The signal intensity of the cord remains within normal limits and bilateral neural foramina remain patent. These findings are unchanged.C3/4 demonstrates minimal degenerative changes and is unremarkable otherwise, unchanged.C4/5 demonstrates mild degenerative changes, mild left neural foraminal compromise and is unremarkable otherwise. These findings are unchanged.C5/6 demonstrates mild degenerative changes with resultant mild left neural foraminal compromise and is unremarkable otherwise. These findings are unchanged.C6/7 demonstrates minimal degenerative changes but is otherwise unremarkable, unchanged.C7/T1 is unremarkable and unchanged.

Output: 1.C2/3 redemonstrates a left paramedian disk protrusion which results in flattening of the anterior left hemicord. The signal intensity of the cord remains within normal limits and bilateral neural foramina remain patent. These findings are unchanged.2.C4/5 demonstrates mild left neural foraminal compromise, unchanged.3.C5/6 demonstrates mild left neural foraminal compromise, unchanged.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. No pathology is available. PELVIS:PROSTATE:Prostate Size: 3.2 x 4.1 x 4.5 cmPeripheral Zone: Poorly defined T2 hypointense lesion in the paramedial right mid gland/apex (series 4 and 1/81) with associated restricted diffusion (series 503/304), measuring approximately 9 mm.Central Gland: 1.7 x 1.1 cm T2 hypointense (series 401/77) lesion in the right anterior mid gland/apex with marked restricted diffusion (series 503/284). The lesion bulges the anterior contour of the prostate (series 901/15).Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right anterior mid gland/apex central gland lesion bulges the prostatic margin.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.7 cm suspicious lesion in the right anterior mid gland/apex of the central gland bulging the prostatic contour, suspicious for extraprostatic extension. Right mid-gland peripheral zone 9 mm lesion is also suspicious for prostatic adenocarcinoma. No enlarged pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 76 year old female with a history of heart failure with reduced ejection fraction (non-ischemic), hypertension, and non-sustained ventricular tachycardia. Referred for cardiac MRI First Pass PerfusionNo perfusion abnormalities of the LV are noted. Left VentricleThe left ventricle is normal in size and moderately reduced in systolic function. There is mild LV hypertrophy (15 mm septum). The overall LV ejection fraction is 42%, the LV end diastolic volume index is 75 ml/m2 (normal range: 65+/-11), the LVEDV is 139 ml (normal range 109+/-23), the LV end systolic volume index is 43 ml/m2 (normal range 18+/-5), the LVESV is 81 ml (normal range 31+/-10), the LV mass index is 34 g/m2 (normal range 67+/-11), and the LV mass is 64 g (normal range 114+/-24). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 46 ml/m2 (normal range 69+/-14), the RVEDV is 85 ml (normal range 110+/-24), the RV end systolic volume index is 19 ml/m2 (normal range 22+/-8), and the RVESV is 35 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and moderately reduced in systolic function (LVEF 42%). There is mild left ventricular hypertrophy. 2. No evidence of late gadolinium enhancement to suggest presence of underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size and systolic function (RVEF 58%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 45 year-old female with shortness of breath and previous MRI suggestive of constriction. For follow-up study. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 65%, the LV end diastolic volume index is 52 ml/m2 (normal range: 65+/-11), the LVEDV is 98 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). There is systolic and diastolic flattening of the septum. Free-breathing sequences suggestive respirophasic shift of the septum. There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mild systolic dysfunction. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 175 ml (normal range 110+/-24), the RV end systolic volume index is 52 ml/m2 (normal range 22+/-8), and the RVESV is 98 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. 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 at least mild-moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderately dilated (35 mm). Venous AnatomyThe IVC is dilated. PericardiumSevere calcification of the pericardium. Pericardium thickness measured to be ~ 4-6 mm. Tagged images show that there is tethering of the pericardium to the myocardium at the basal lateral wall of the LV suggesting evidence of constriction. Extracardiac FindingsMediastinal adenopathy. Bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricular size and systolic function are normal. LVEF is 65%.2. The right ventricular size is normal with mildly reduced systolic function. RVEF is 44 %.3. Thickening of the pericardium with extensive calcification of the pericardium at the base of the ventricles with evidence of respirophasic septal shift. In addition, the base of the ventricle is tethered to the pericardium. There is additionally significant IVC and biatrial dilation. These constellation of findings are strongly suggestive of the diagnosis of pericardial constriction.4. Findings in keeping with previous MRI done in 2014.


Instruction: Generate impression based on findings.

Input: Clinical question : 39-year-old female with history of left basal ganglia mass/calcification. Three evaluate for progression. Signs and symptoms: seizure Nonenhanced head CT:Large area of speckled calcification in the left basal ganglia with extension into the thalamus on the left is again identified. There is no evidence of any associated edema or mass effect with this finding. There is also no evidence of any interval change in the extent or size of this lesion. A small calcification is also noted in the right cerebral peduncle similar to prior exam. The exact etiology of this finding is not clear. Finding could represent dystrophic calcification. Possibility of a hemangioma cannot be ruled out. There is linear and punctate appearance of this lesion which may indicate vascular calcification. Correlate with history since this appearance may be result of prior embolization. The common further follow with an MRI examination.This examination is otherwise unremarkable and stable since prior study.

Output: Stable examination since prior study and in particular no evidence of change in the size or distribution of the left basal ganglia -- thalamic calcification. Please see above comments.


Instruction: Generate impression based on findings.

Input: 27 years old, Male, Reason: palpable mass palpated along the left submandibular border History: firm, mobile mass in the soft tissue RIGHT LOBE MEASUREMENTS: 5.9 x 1.8 by 1.5 cmLEFT LOBE MEASUREMENTS: 5.5 x 1.7 x 1.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Echogenicity of the right thyroid lobe is within normal limits and there are no nodules identified.LEFT LOBE: Echogenicity of the left thyroid lobe is within normal limits and there are no nodules identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Benign appearing left level 1 lymph node with fatty hilum, which patient is able to palpate, in the submandibular area measures 2.3 x 0.5 x 1.0 cm.

Output: Benign appearing lymph node in the submandibular area which patient identifies as palpable mass.


Instruction: Generate impression based on findings.

Input: Mail carrier with hip pain ACETABULAR LABRUM: No significant abnormality noted. Specifically the labrum appears intact in this non augmented study.ARTICULAR CARTILAGE AND BONE: Moderate osteoarthritic changes progressed since the prior plain film imaging. Currently more advanced but this may be partially due to differences in technique and MR sensitivity for marrow related changes in the superior acetabulum. Mild cartilage thinning yet no specific discreet focal change.SOFT TISSUES: No significant abnormality noted other than multiple scattered discreet pelvic cysts likely ovarian, the largest in the left lower pelvis measuring 3 cm. Surrounding musculature remains unremarkable.ADDITIONAL

Output: Moderate osteoarthritic changes of the hip without superimposed discreet additional abnormalities.


Instruction: Generate impression based on findings.

Input: 37 years, Female, numbness in the thumb/finger on the left and ankle on the left. Evaluate for multiple sclerosis. Brain MRI appears within normal limits. No parenchymal lesions are seen to suggest demyelinating disease. Ventricles and sulci are within normal limits. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Brain MRI is within normal limits. No findings to suggest demyelinating disease.


Instruction: Generate impression based on findings.

Input: There is a focus of restricted diffusion in the splenium of the corpus callosum with associated T2/FLAIR hyperintensity.Elsewhere there is no significant signal abnormality or evidence of edema or mass effect. The cerebellar tonsils remain above the foramen magnum. There is no grey matter heterotopia, cortical dysplasia or evidence of mesial temporal sclerosis. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. The cervical spine demonstrates slight enlargement of the central canal at the level of C5-C6 with a diameter of no more than 1 mm. Otherwise, the cervical and the thoracic spine is normal. In the lumbar spine there is a focus of high T1 signal from the level of L4 to the level of L5 at midline along the posterior thecal sac that could represent fibrofatty infiltration of the filum terminale. The conus medullaris ends at the level of L1. Normal marrow signal of the vertebral bodies. There are no structural abnormalities.

Output: 1. Restricted diffusion in the splenium of the corpus callosum associated with T2/FLAIR hyperintensity. This likely represents cytotoxic edema related to seizure activity and/or the effect of anti-seizure medication.2. Findings suggestive of a short segment of fibrofatty infiltration of the filum terminale. In the absence of other findings of tethered cord, this can be an incidental finding. Correlation with clinical symptoms is suggested.3. The remained of the spine exam is within normal limits.


Instruction: Generate impression based on findings.

Input: 73 years Male (DOB:6/4/1943)Reason: eval for stenosis, hx of RLE radiculopathy History: abovePROVIDER/ATTENDING NAME: HUE H LUU HUE H LUU Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a levocurvature to the lumbar spine presentAt L5-S1 there is no significant compromise to spinal canal or neural foramina.. There is mild anterior subluxation of L4 and L5 associated with some uncovering of the disc. There is narrowing of the left neural foramen with mild to moderate encroachment of the left-sided exiting nerve root present. There is bilateral facet hypertrophy which is worse on the left side relative to the right side. There is marked loss of disc space height and disc desiccation at this level. There are Schmorl's nodes at this level.At L4-5 there is no significant compromise to spinal canal. There is loss of disc space height, disc desiccation and a right lateral disc extrusion with disc material tracking behind the posterior aspect of the L4 vertebral body. There is mild to moderate encroachment of the right-sided exiting nerve root within the neural foramen at this level. There is bilateral facet hypertrophy at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level. There is a mild disc bulge at this level associated with endplate reactive change which is bright on T2 imaging. There is a right far lateral disc protrusion at this level which mildly displaces the right-sided exiting nerve root after it exits the neural foramen.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are multilevel degenerative changes present in the lumbar spine with moderate encroachment of the right-sided exiting nerve roots at L4-5 and L5-S1.2.There are right-sided endplate reactive changes in the acute or subacute phase at the L3-4 level.3.There is a levocurvature to the lumbar spine associated with mild subluxations.


Instruction: Generate impression based on findings.

Input: There is a normal alignment of the cervical vertebrae and the vertebral bone marrow signal is unremarkable. There is multilevel degenerative facet joint hypertrophy with considerable neural foraminal narrowing bilaterally at C2-3, C3-C4, C4-C5, and C5-C6, which may have progressed slightly overall since 2009. However, there is no significant spinal canal stenosis. The spinal cord appears to be intact. The paravertebral soft tissues are unremarkable.

Output: Multilevel cervical spine neural foraminal narrowing secondary to facet joint hypertrophy, with may have slightly progressed since 2009, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: History of does Desmoid tumor. Evaluate for progression. ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense segment 7 focus demonstrating arterial enhancement without washout, unchanged. No additional focal liver lesion. Stable mild common bile duct prominence without a focal lesion or stone. Normally distended gallbladder.SPLEEN: The spleen measures 12.4 cm in craniocaudal length without a focal lesion.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: Mass centered in the small bowel mesentery measures 6.1 x 4.0 cm (series 22/376) compared to 6.2 x 3.5 cm previously. The mass encases the SMV and SMA which remain patent.BONES, SOFT TISSUES: Broad-based ventral hernias in the central and right abdomen without evidence of complication.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is lobular and enlarged containing multiple masses. A mass in the right uterine fundus measuring 6.9 x 3.6 cm has imaging features which are somewhat atypical for leiomyoma. The endometrial canal is thickened an heterogeneous with postcontrast enhancement. Nabothian cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in the small bowel mesentery mass which encases the SMA and SMV.2.Enlarged lobular uterus containing multiple masses most of which demonstrate signal characteristics typical of leiomyomata, however a right fundal mass is somewhat atypical (increased T2-weighted signal intensity restricted diffusion and lobular heterogeneous enhancement) and demonstrates gradual growth since 2013. 3.Also the endometrium/individual cavity is heterogeneously thickened with postcontrast enhancement, which may be seen in the proliferative phase of the menstrual cycle, however given the patient's age correlation clinically for endometrial pathology is recommended.


Instruction: Generate impression based on findings.

Input: 34 year old male with new onset congestive heart failure presenting for evaluation of new left ventricular systolic dysfunction. Left VentricleThe left ventricle is normal in size with moderately reduced systolic function. There is moderate predominantly circumferential left ventricular hypertrophy. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 219ml (normal range 142+/-34), the LV end systolic volume index is 59 ml/m2 (normal range 25+/-9), the LVESV is 141 ml (normal range 47+/-19), the LV mass index is 83 g/m2 (normal range 85+/-15), and the LV mass is 201 g (normal range 164+/-36). The left ventricular dysfunction appears to be global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 56 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 54 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is 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 upper 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. Normal LV size with moderate left ventricular hypertrophy and moderately reduced systolic function (LVEF 36%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 61%).


Instruction: Generate impression based on findings.

Input: Male, 37 years old, with back pain. Alignment is anatomic. Vertebral body heights are preserved. Mild degenerative endplate edema is seen at L4-5. Elsewhere, no significant marrow replacement or marrow edema is detected. The visualized distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet arthropathy. Loss of disc T2 signal, mild disc bulging and a small central protrusion. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Mild facet arthropathy. Mild disc bulging with a small central disc protrusion. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Moderate facet arthropathy. Mild disc bulging with a superimposed left foraminal protrusion. No significant generalized spinal canal stenosis. Mild left foraminal narrowing.

Output: Relatively mild disc degeneration is seen at L3-4, L4-5 and L5-S1 with disc bulging and small protrusions as discussed above. No areas of high-grade spinal canal stenosis are seen and only mild scattered foraminal narrowing is observed.


Instruction: Generate impression based on findings.

Input: 63 years, Female, new HIV diagnosis, stage IV rectal CA. Evaluate for tumor or infection. Sepsis, altered mental status. Global parenchymal volume loss is noted which is advanced for patient's age. Diffusion-weighted sequences are motion degraded limiting evaluation for acute infarct; however, no obvious acute infarct is evident. Tiny chronic lacunar infarct in the right thalamus is noted. No intracranial mass or mass effect. No extra-axial collections. No hydrocephalus. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Trace mucosal thickening is present in the paranasal sinuses, which are otherwise clear. There is mild nonspecific opacification of the bilateral mastoid air cells. Diffuse low T1 marrow signal is noted which is nonspecific and can be seen in conditions such as chronic anemias. No destructive osseous lesions are evident. Extracranial soft tissues are unremarkable.

Output: Limited sequences obtained as patient could not tolerate the full study. No intracranial mass, mass effect, or evidence of edema. No findings to suggest intracranial abscess or empyema. Please note lack of contrast limits evaluation for small metastatic lesions as well as infection, and lumbar puncture should be considered if there is significant suspicion for meningitis.


Instruction: Generate impression based on findings.

Input: 18 year-old male with sickle cell crisis and severe headache There is no evidence of intracranial hemorrhage, mass or edema. Crowding of the foramen magnum with the cerebellar tonsils extending inferiorly off the image corresponding to a Chiari 1 malformation as seen on the previous MRI.There is a subtle hypoattenuation in the region of the right external capsule, also seen on the previous MRI without surrounding gliosis or edema, and appears to represent prominent CSF space.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality. Chiari 1 malformation is again noted.


Instruction: Generate impression based on findings.

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

Output: Successful fluoroscopic-guided right hip arthrogram.


Instruction: Generate impression based on findings.

Input: 24-year-old with locally diagnosed endometrial cancer. Assess extent of disease. EPIC Note: Dilation and curettage of the endometrial cavity: endometrial endometrioid FIGO grade 2 adenocarcinoma with background of polypoid endometrium with atypical hyperplasia PELVIS:UTERUS, ADNEXA: There is abnormal heterogeneous thickening of the endometrial cavity measuring up to 2.0 cm in thickness which demonstrates abnormal restricted diffusion. There is abnormal heterogeneous polypoid enhancement of the endometrial contents following contrast administration. Near the internal cervical os the abnormal enhancement appears to involve at least 50% of the myometrial thickness (series 1201/218). Additionally, there is hypoenhancement at the bilateral uterine cornu, also suspicious for tumoral invasion. The cervical stroma is normal in signal intensity. There is no evidence of parametrial tumor extension.On the T2-weighted sagittal images the posterior junctional zone is well-defined and normal in thickness. Anteriorly the junction shown is a well-defined thickened which may represent tumoral invasion versus adenomyosis.Status post resection of the left ovarian dermoid cyst. The right adnexa is unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy measuring greater than 1 cm in short axis.BOWEL, MESENTERY: Small amount of free pelvic fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Abnormal heterogeneous thickening of the endometrial cavity with regions of polypoid heterogeneous enhancement with findings suspicious for at least 50% myometrial invasion at the anterior lower uterine segment. No evidence of cervical stromal invasion or extra-uterine tumor extension.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for loose bodies History: lateral joint line pain MENISCI: There are postsurgical changes of lateral partial meniscectomy with absence of the lateral meniscal body and degeneration / tearing of the posterior horn. There is increased signal within the medial meniscus which may reflect mucoid degeneration, however no discrete tear is identified.ARTICULAR CARTILAGE AND BONE: A small amount of increased marrow signal along the lateral femoral condyle is likely reactive. There are findings of prior chondroplasty along the lateral femoral condyle. There is a large area of full-thickness cartilage loss along the lateral femoral condyle measuring up to 2.4 cm and along the lateral tibial plateau measuring 2.1 cm. The cartilage of the medial compartment is diffusely thinned without a fluid-filled defect present. The patellar and trochlear cartilage is intact. Small tricompartmental osteophytes are present.LIGAMENTS: The medial and lateral collateral ligament complexes are intact. The ACL is thin but intact. The PCL is intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Postsurgical changes of lateral partial meniscectomy with absence of the lateral meniscal body. Degeneration and tearing of the posterior horn.2.Moderate to severe osteoarthritis with large areas of full-thickness cartilage loss in the lateral compartment.


Instruction: Generate impression based on findings.

Input: 18-year-old with history of seizure and prior right temporal lobe indeterminate lesion/mass. Follow-up exam. There remains abnormally increased T2 signal within the mesial right temporal lobe hippocampus and amygdala which is perhaps minimally decreased compared to prior. The 2 nodular foci of increased enhancement in the right temporal lobe and insula noted on the prior MRI have resolved. There remains diffuse increased sulcal enhancement of the right cerebral cortex and gyriform increased T2 signal of the right cerebral cortex gray matter again likely reflecting a combination of hyperemia and increased sulcal vascular permeability.No areas of focal susceptibility.The ventricles and basal cisterns are normal in size and configuration.The expected intracranial vascular flow voids are present.Right maxillary sinus mucous retention cyst. The paranasal sinuses are otherwise clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1. Compared to prior, there is stable to minimally decreased abnormal T2 signal in the mesial right temporal lobe. The adjacent nodular foci of enhancement have resolved. Considering the MR spectroscopy data from 12/15/2015, this remains most consistent with an inflammatory process with tumor considered less likely. Both noninfectious (autoimmune) and infectious (perhaps viral) encephalitis would be in the differential diagnosis.2. Diffusely increased gray matter T2 signal and sulcal/leptomeningeal enhancement in the right cerebral cortex. This may reflect hyperemia and increased sulcal vascular permeability, which could be related to an underlying inflammatory process or which could be secondary to seizure activity.


Instruction: Generate impression based on findings.

Input: 35 year-old Male with history of MS.INDICATIONS: Reason: MS; eval for progression History: paresthesias. There are numerous (>20) bilateral periventricular and subcortical white matter T2/FLAIR hyperintense lesions with morphology and distribution consistent with known demyelinating disease. There are confluent areas noted in the periventricular distribution. There are also a few T1 hypointense lesions. There is mild posterior fossa involvement including the bilateral middle cerebellar peduncles. Parenchymal volume is grossly maintained.There is no evidence of intracranial mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Moderate burden of T2/FLAIR hyperintense lesions related to known demyelinating disease. No prior studies are available for comparison; an addendum can be issued if they are made available.


Instruction: Generate impression based on findings.

Input: Known cardiac amyloid, continued evaluation of disease burden. . Left VentricleThe left ventricle is normal in size with mildly decreased systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 145 ml (normal range 142+/-34), the LV end systolic volume index is 38 ml/m2 (normal range 25+/-9), the LVESV is 79 ml (normal range 47+/-19). There is concentric LVH. There are no regional wall motion abnormalities present. . There is diffuse late gadolinium enhancement to suggest the presence of an underlying fibrosing process.The native T1 myocardial relaxation times range from 1084-1343 ms which is grossly abnormal.Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle is normal in size with low systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 167 ml (normal range 142+/-31), the RV end systolic volume index is 51 ml/m2 (normal range 31+/-9), and the RVESV is 104 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumSmall pericardial effusion. There is no obvious pericardial disease.Extracardiac FindingsSignificant BL pleural effusions.. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle ejection fraction is decreased at 45% with concentric hypertrophy of the ventricle.3. There is late gadolinium enhancement in a diffuse pattern of the myocardium, which in clinical context are suggestive of the presence of cardiac amyloid. 4. Native T1 mapping also suggests abnormal myocardial signal consistent with amyloid.5. The right ventricle systolic function is decreased at 37%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate for progression of metastatic disease. Images through the skull base and including cavernous sinuses remain free of malignancy. Paranasal sinuses and mastoid air cells are unremarkable.Images through the soft tissues of the neck demonstrate a cluster of large nonenhancing mass is in the left supraclavicular region. The transverse diameter of this cluster of tumors measures 21-mm x 40 3-mm on axial image 74. On coronal reformatted image 37 the cranial cervical and the transverse axises of the tumor measures 40-mm. There are no prior examinations for comparison. There is evidence of mass effect and medial deviation of the left common carotid artery and left internal jugular vein by the cluster of nodes. There is no evidence of bony destruction with this finding.Metastatic lesion to vertebral body of C6 with near complete collapse of vertebrae and enhancing extra osseous extension of tumor into the ventral epidural space is noted. Sagittal reformatted images demonstrate mass effect and deviation of the cord posteriorly. Metastatic lesion to the posterior body of C7 also demonstrates epidural extension of tumor into the ventral epidural space. No compression deformity of C7 is detected. These findings can be further evaluated with a dedicated MRI of the spine. No evidence of any additional osseous metastases in the area of exam is identified.Limited images of the apices of the lungs demonstrates extensive scarring (left greater than right). A non-calcific nodule measuring approximately 7 mm times 15-mm is identified in the posterior aspect of right upper lung field (axial image 94). No mediastinal lymphadenopathy is detected.

Output: 1.Cluster of metastatic nodes in the left supraclavicular region as detailed above.2.Metastatic lesion to C6 with significant compression deformity and metastatic lesion to the posterior aspect of C7 vertebrae. There is extraosseous epidural spread of tumor at this level into the cervical spinal canal.3.Metastatic nodule in the right upper lung field.4.Mass-effect and posterior deviation of the cord at C6 is noted. This area can be further evaluated with a dedicated MRI of spine.5.No prior examinations from this institution for comparison.


Instruction: Generate impression based on findings.

Input: Diagnosis: Precocious pubertyClinical question: brain abnormality responsible for sexual precocity?Signs and Symptoms: sexual precocity MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an extra-axial cystic lesion present along the anterior middle cranial fossa on the right side measuring 23 x 11 mm in axial dimensions. It follows spinal fluid on all pulse sequences.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening.. The visualized portions of the mastoid air cells demonstrate opacities in the mastoid air cells and middle ears bilaterally. The nasopharyngeal tonsils are large. The visualized portions of the orbits are intact.MRI pituitary:There is a 7 x 7 mm sagittal dimension mass w located at the tuber cinereum. It is lower in signal intensity relative to white matter on the T1-weighted images. It is heterogeneous in appearance on T2-weighted images and it is high signal on FLAIR imaging. It has a small cystic component. It enhances heterogeneously on post gadolinium imaging. It is visually contiguous with the infundibulum of the pituitary gland. There is no associated susceptibility effect.The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. The cavernous sinuses are intact bilaterally.

Output: 1.There is a hypothalamic mass present. Differential considerations include craniopharyngioma as well as germinoma and primary brain tumor. Granulomatous disorder is less likely.2.There is an arachnoid cyst present in the right middle cranial fossa.3.There are opacities in the middle ears and mastoid air cells associated with large tonsils which may represent retained secretions of the possibility of otitis media can't be excluded.


Instruction: Generate impression based on findings.

Input: Female 13 years old Reason: TOF s/p valve sparing repair, RV dilation and elevated RVP, moderate valvar pulmonary stenosis, history of LPA stenosis. Left VentricleThe left ventricle is normal. The overall LV ejection fraction is 63.3%, the LV end diastolic volume index is 70.4 ml/m2 (normal range: 65+/-11), the LVEDV is 97.18 ml (normal range 109+/-23), the LV end systolic volume index is 25.8 ml/m2 (normal range 18+/-5), the LVESV is 35.69 ml (normal range 31+/-10), the LV mass index is 40.5 g/m2, and the LV mass is 56 g. There are no regional wall motion abnormalities present. There is no intracardiac thrombus.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is mildly enlarged . The overall RV ejection fraction is 34.1%, the RV end diastolic volume index is 100 ml/m2 (normal range 69+/-14), the RVEDV is 138.2 ml (normal range 110+/-24), the RV end systolic volume index is 70 ml/m2 (normal range 22+/-8), and the RVESV is 91.13 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly enlarged. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation visualized. Dedicated through plane imaging was not performed.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation visualized. Dedicated through plane imaging was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation visualized. Dedicated through plane imaging was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch. The aortic annulus is 14 mm, the sinus of Valsalva measures 18 mm. Ascending aorta is 25 mm. Aortic arch is 17 mm. The descending aorta is 11 mm at the thoracic level and 10 mm at the diaphragmatic level.Pulmonary ArteryThe main pulmonary artery is 15 mm in diameter, the right pulmonary artery is 10 mm in diameter and the left pulmonary artery is 7 mm in diameter with a proximal narrowing of 5 mm. PULMONARY ARTERIES FLOW QUANTITATION:Main pulmonary arteries flow quantitation values are as follows:Stroke volume in ml: 48.7Forward flow volume in ml: 57.2Backward flow volume in ml: 8.5Regurgitant factor in %: 14.8Right pulmonary artery flow quantitation values are as follows:Stroke volume in ml: N/AForward flow volume in ml: N/ABackward flow volume in ml: N/ARegurgitant factor in %: N/ALeft pulmonary artery flow quantitation values are as follows:Stroke volume in ml: N/AForward flow volume in ml: N/ABackward flow volume in ml: N/ARegurgitant factor in %: N/AVenous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.Extracardiac FindingsPost surgical changes of the sternum is noted. Partial view of the solid organs of the upper abdomen is normal..

Output: 1. Right atrium and ventricle enlargement.2. Mild hypoplasia/stenosis of the left pulmonary artery.3. Pulmonary and tricuspid valve regurgitation.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: Patient with history of BPH and urinary symptoms, PSA on 11/29/2016 was 2.04, no pathology report available but does not appear to have prior biopsy based on medical records. PELVIS:PROSTATE:Prostate Size: 5.3 x 3.2 x 4.5 cmPeripheral Zone: Diffuse patchy T2 signal abnormality with mild restricted diffusion in the peripheral zone, likely representing areas of prostatitis.Central Gland: Central gland hypertrophy with multiple hyperplastic nodules, some extending into the bladder.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Diffuse patchy T2 signal abnormality of the peripheral zone, likely representing areas of prostatitis.2.Benign prostatic hypertrophy.


Instruction: Generate impression based on findings.

Input: 67-year-old male with elevated PSA PELVIS:PROSTATE:Prostate Size: 2.9 x 2.6 x 4.5 cm.Peripheral Zone: T2 hypointensity measuring 0.9 x 0.9 cm in the left mid peripheral zone with corresponding ADC hypointensity. This lesion abuts and retracts the capsule. No early enhancement is evident.Nonspecific oblong T2 hypointense lesion in the right peripheral zone apex measuring 0.7 x 0.3 cm. There is no corresponding ADC hypointensity.Central Gland: Central gland is slightly enlarged compatible with benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: There is no extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.T2 hypointensity in the left mid gland peripheral zone suspicious for malignancy.2.Additional nonspecific T2 hypointense lesion in the right peripheral zone apex.


Instruction: Generate impression based on findings.

Input: Male; 72 years old. Reason: 72 yo with abnl LFT, h/o pancreatitis History: none ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. No biliary ductal dilation. Possibility of paradoxical signal loss of the liver diffusely on in- and out-of-phase images, which could be due to mild iron deposition. Trace perihepatic ascites.SPLEEN: No significant abnormality noted.PANCREAS: Atrophy of the pancreas with loss of normal high T1 signal and resultant dilated appearance of the pancreatic duct with visualization of dilated side-branches diffusely in a characteristic "chain of lakes" appearance, compatible with chronic pancreatitis. No pancreatic duct stones are seen. No focal pancreatic masses.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small bilateral renal cysts.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Findings of chronic pancreatitis.2. No focal liver lesions. No biliary ductal dilation.


Instruction: Generate impression based on findings.

Input: History of metastatic prostate cancer status post recent left frontal region tumor resection. There are postoperative findings related to recent resection of a left frontal convexity mass, along with overlying craniectomy. There is no evidence of gross residual tumor, but there is persistent edema in the underling left frontal lobes. There is regional sulcal susceptibility effect, T2 hyperintensity, and leptomeningeal enhancement, which may be related to hyperemia and/or hemorrhage. There is also diffuse left cerebral convexity dural enhancement and a subdural fluid collection that measures up to 6 mm in thickness. There is a punctate focus of restricted diffusion in the left inferior parietal lobule. There is otherwise a background of patchy cerebral and pontine white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is are small bilateral mastoid air cell effusions. There are bilateral lens implants. There is a small right maxillary sinus retention cyst.

Output: 1. Recent resection of a left frontal convexity tumor resection, without evidence of gross residual tumor, but persistent edema in the left frontal lobe.2. Punctate acute infarct in the left inferior parietal lobule.


Instruction: Generate impression based on findings.

Input: Female, 32 years old, at 31 weeks and 5 days gestational age, presenting for further evaluation of fetal ventriculomegaly as seen on ultrasound. The lateral ventricles are enlarged, left side more so than right. The left lateral ventricle measures up to 14 mm in diameter at the level of the atrium, while the right lateral ventricle measures up to 11 mm. The left frontal horn is dilated while the right frontal horn maintains a relatively normal caliber. The third and fourth ventricles are not dilated.The cavum septum pellucidum is visualized and the corpus callosum is present. However, the degree of gyral development and sulcation is delayed for the stated gestational age of 31 weeks 5 days. In particular the sylvian fissures are underdeveloped and somewhat malformed bilaterally with poor opercularization.The cortical mantle is severely thinned bilaterally, particularly in the regions where the sylvian fissure should form. As such, the brain has assumed a pinched configuration in the transverse dimension. No evidence of any CSF clefting is seen across the cortical mantle. However, the cortical surface in the perisylvian regions shows a somewhat micronodular or cobblestoned appearance.This unusual configuration of the brain gives an impression of expanded extra-axial CSF spaces along the cerebral hemispheres, left side more than right, though the cortical veins do not appear to be displaced and there are no other findings to suggest any abnormal extra-axial collections. No evidence of acute or chronic intracranial blood product is seen. No mass lesions are appreciated. The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed.Limited views of the fetal abdomen demonstrate severe dilatation of the left renal collecting system. The right kidney is unremarkable.

Output: Mild dilatation of the lateral ventricles is seen, left side more so than right. The third and fourth ventricles remain normal in caliber.The cortical mantle is severely thinned bilaterally with generalized under-sulcation of the brain along with delayed development of the sylvian fissure and poor opercularization.The contour of the brain appears pinched in the transverse dimension, particularly where the sylvian fissures should be forming. The cortical surface in these areas is also somewhat micronodular or cobblestoned in appearance, a finding which is suggestive of perisylvian polymicrogyria. This finding would be better assessed with postnatal MRI imaging.No evidence of any intracranial mass lesion is seen. No findings to suggest acute or chronic hemorrhage are noted. The posterior fossa structures are unremarkable.Partial visualization of the abdomen demonstrates severe dilatation of the left renal collecting system concerning for UPJ obstruction.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Sensory band at T9. There is no abnormal cord signal. Cord volume is maintained. There is very minimal anterior wedging involving the T6-T8 vertebral bodies. Vertebral body heights and alignment in the thoracic spine are otherwise maintained. Mild multilevel degenerative changes are seen including mild disc desiccation and height loss at T6-T7, T7-T8, and T8-T9 levels. There is a disc protrusion at the T8-T9 level with effacement of the ventral thecal sac and minimal contour deformity of the ventral cord bilaterally. Minimal disc protrusions and bulges are present more superiorly. There is however no significant spinal canal stenosis or neural foraminal stenosis at any level.There is mild diffuse heterogeneity of the bone marrow signal which is nonspecific. No discrete suspicious osseous lesions are evident.Paraspinous soft tissues are grossly unremarkable.

Output: 1. No appreciable cord signal abnormality to suggest demyelinating disease.2. Mild multilevel degenerative changes including disc protrusion at the T8-T9 level which effaces the ventral thecal sac and contacts the ventral cord. However there is no significant spinal canal stenosis overall at this or any other level in the thoracic spine.


Instruction: Generate impression based on findings.

Input: This exam is limited without gadolinium based contrast. There is transitional anatomy with lumbarization of S1 and 6 lumbar type vertebral bodies. This vertebral body will be termed lumbarized S1 in this report.THORACIC SPINE: There are subtle T1 and T2 hyperintense lesions involving the C7, T5, T7, T8, and T10 vertebral bodies that are most compatible with hemangiomas. The vertebral bone marrow signal is otherwise unremarkable. There is multilevel disc desiccation as well as a small central disc protrusion with mild height loss at T2-T3 without significant spinal canal or neural foramen stenosis. The vertebral body and disc space heights are otherwise preserved. The vertebral column alignment is within normal limits. There is no significant spinal canal stenosis. The imaged spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. LUMBAR SPINE: There is transitional lumbosacral anatomy, with 6 lumbar appearing vertebrae. Assuming the first rib-bearing vertebra is T1, the last fully formed disc is designated as S1-S2 on this exam.There is a compression deformity involving the L1 vertebral body with roughly 70% height loss and associated T1 hypointensity and T2 hyperintensity that extends to involve the anterior pedicles. There is no retropulsion of bony fragments or associated spinal canal stenosis. The vertebral bone marrow signal is otherwise unremarkable. There is minimal grade 1 retrolisthesis of L1 and L2 and of L2 on L3 as well as minimal grade 1 anterolisthesis of L5 on the lumbarized S1. The imaged spinal cord displays normal signal and morphology with the conus terminating at L2. The paravertebral soft tissues are unremarkable. There is bowel in the left renal fossa compatible with history of nephrectomy. There is a 30 x 20 mm T2 hyperintense fluid collection or nodule adjacent to the aorta on the left at the level of L2 that was not definitely present on the prior exams.L1-L2: There is mild disc desiccation without significant spinal canal or neural foramen stenosis.L2-L3: There is mild disc desiccation and disc bulge that is minimally improved as well as mild facet arthropathy and ligamentum flavum thickening. These findings result in moderate right neural foramen stenosis and no significant spinal canal stenosis.L3-L4: There is an unchanged disc bulge as well as bilateral facet arthropathy and ligamentum flavum thickening. These findings result in unchanged mild spinal canal stenosis as well as mild left and moderate right neural foramen stenosis.L4-L5: There is disc desiccation and a mild disc bulge as well as a small central disc protrusion and severe bilateral facet arthropathy with ligamentum flavum thickening. The disc is unchanged although the facet arthropathy has progressed. These findings result in slightly worsened moderate spinal canal stenosis as well as mild left and moderate right neural foramen stenosis.L5-S1: There is disc desiccation and mild disc height loss as well as a mild disc bulge with a superimposed small central disc protrusion and severe bilateral facet arthropathy, left greater the right. These findings are essentially unchanged and result in moderate spinal canal stenosis and moderate left neural foramen stenosis.S1-S2: There is severe left facet arthropathy without significant spinal canal or neural foramen stenosis.

Output: 1.Transitional anatomy with lumbarization of S1. If surgery is to be contemplated, please correlate with imaging of the entire spine.2.Limited exam without contrast.3.Unchanged recent L1 compression fracture without spinal canal stenosis. No additional lesions identified concerning for spinal metastases identified.4.Prominent T2 hyperintense oval structure anterolateral to the aorta at the level of L2 is not well evaluated and may represent a lymph node, post surgical fluid, or a dilated cisterna chyli. This area was only partially imaged on prior CT.5.Minimal thoracic spine degenerative changes.6.Moderate lumbar spine degenerative changes have minimally progressed with at most moderate spinal canal stenosis at L4-L5 and L5-S1 and multilevel severe neural foramen stenosis as well as severe facet arthropathy.


Instruction: Generate impression based on findings.

Input: Paresthesias. Unusual pain in her right lower quadrant, around, and below the scar. The vertebral column alignment is within normal limits. There is a small intravertebral disc herniation in the superior endplate of L4. Otherwise. the vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. However, the appearance of the bowel is the right pelvis may be abnormal.

Output: 1. No evidence of spinal canal stenosis.2. The appearance of the bowel is the right pelvis appears to be abnormal, perhaps representing adhesions of inflammation, for example, although this area is incompletely characterized. Dedicated pelvic imaging via MRI, ultrasound, or CT may be useful for further investigation.


Instruction: Generate impression based on findings.

Input: Assess for basal ganglia disease: tremor. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is punctate susceptibility effect in the bilateral globi pallidi. There are a few scattered punctate foci of cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. Nonspecific mild mineralization within the bilateral globi pallidi. 2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 64 year old man with history of atrial fibrillation, thickened inter-atrial septum seen on echo, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 62 ml/m2 (normal range: 74+/-15), the LVEDV is 139 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 56 g/m2 (normal range 85+/-15), and the LV mass is 124 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 145 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 72 ml (normal range 54+/-17).Left AtriumThe left atrium is mildly dilated. Right AtriumThe right atrium is moderately dilated.Interatrial SeptumThe interatrial septum is thickened from lipomatous hypertrophy. No evidence of cardiac mass. No evidence of atrial septal defect. No evidence of cardiac shunt (Qp/Qs = 1.07).Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Thoracic aorta is normal. 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 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. The interatrial septum is thickened because of lipomatous hypertrophy. No evidence of mass. No evidence of atrial septal defect or other cardiac shunt. 2. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57% without evidence of underlying myocardial fibrosis, inflammation, or infiltration. .3. The right ventricle is normal in size 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: History of left cavernous sinus aneurysm. The examination demonstrates expansion of the left cavernous sinus. In comparison with a prior brain MRI, it remains stable. The cerebral and cerebellar hemispheres are normal in attenuation and morphology. There is no intracranial hemorrhage, edema, midline shift or abnormal extra-axial fluid collection. The ventricles are normal in volume and symmetric.Visualized paranasal sinuses mastoid air cells are normally pneumatized. The bony density of the calvarium and skull base is radiographically normal.CTA shows a gigantic aneurysm in the anterior aspect of the left internal carotid artery, which is mostly within the cavernous sinus with little expansion into the supraclinoid segment. It measures 14.4 x 19.2 mm on the sagittal view and 19.9 x 12.0 mm on the coronal view. In addition, little ectasia of the right internal carotid artery is noted. The right internal carotid, vertebral, basilar and their intracranial major branches are patent with no evidence of aneurysm or significant stenosis.

Output: Grossly stable left cavernous sinus fusiform aneurysm as detailed above.


Instruction: Generate impression based on findings.

Input: 45 years Male (DOB:11/28/1970)Reason: Optic neuritis History: Per MRi recPROVIDER/ATTENDING NAME: RIMAS V LUKAS JAMES A MASTRIANNI MRI orbits:There is enlargement and enhancement of the intraconal portion optic nerves bilaterally and symmetrically.The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. The suprasellar cistern is intact .

Output: Enlargement and enhancement of the optic nerves bilaterally. One explanation could be optic neuritis. Infiltrating lesion such as granuloma or neoplasm are alternative consideration. Please correlate with patient's clinical symptoms and history.


Instruction: Generate impression based on findings.

Input: Enhancing, intrinsically T1 hyperintense treated metastatic lesion in the right superior frontal gyrus is essentially stable to minimally increased in size, measuring 1.1 x 0.9 cm (series 1201, image 117), previously measuring 1.0 x 0.8 cm. Area of enhancement in the center of the lesion has become more bilobed in appearance. There is a nonenhancing cystic degenerative appearing component located just laterally. Marginal surrounding FLAIR hyperintensity is again noted. This lesion is also associated with susceptibility artifact.There is subtle interval increase in size of the punctate enhancing metastasis in the right superior occipital lobe, now measuring up to 6 mm, previously 4 mm. The left posterior temporal occipital metastatic lesion appears stable to minimally increased in size measuring 5 x 4 mm, previously measuring 4 x 4 mm. This lesion also is more confluent in enhancement and is also associated with susceptibility artifact. The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are stable scattered nonspecific punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which may represent mild chronic small vessel ischemic changes in a patient of this age. A tiny anterior right parietal developmental venous anomaly is again seen. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. Incidental nonenhancing cystic structure associated with the pineal gland is again noted. The remainder of the midline structures and craniocervical junction are within normal limits. Stable heterogeneous appearance with overall diffusely decreased T1 signal intensity of the calvarium, with more normal-appearing marrow in the clivus. Postoperative changes are seen from previous bilateral antrostomies. Patchy mild opacification of the ethmoid air cells and possible small air-fluid levels in the bilateral maxillary sinuses.

Output: 1. Stable to subtle interval increase in size of bilateral supratentorial metastatic lesions. There is a definite gradual increase in size of these lesions when compared to the more remote exam on 10/6/2015.2. Stable appearance of nonspecific, nonenhancing punctate foci of T2/FLAIR hyperintensity within the white matter.3. Possible small air-fluid levels in the bilateral maxillary sinuses. Correlate clinically for acute sinusitis.


Instruction: Generate impression based on findings.

Input: 21-year-old female patient with pregnancy of unknown location at 14 weeks. Ultrasound demonstrated possible cornual versus ectopic pregnancy. PELVIS:UTERUS, ADNEXA: The uterus is displaced to the right in the pelvis secondary to a large extrauterine mass measuring approximately 7.8 x 7.9 x 7.6 cm (image 139, series 6 and image 17, series 4) containing placenta and a fetus; compatible with an extrauterine ectopic pregnancy. A single endometrial canal and single cervix are identified. While there is a focal region of intermediate signal interposed between the cervix and the extrauterine pregnancy on T2 images (image 117, series 6), no definite communication is identified to the uterus or cervix. The right and left ovaries are identified and distinct.A round T2 hypointense lesion within the myometrium of the uterine body measuring 1.1 x 1.5 cm and a 1 cm lesion within the uterine fundus are compatible with fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is no significant free fluid in the pelvis.

Output: 1.Findings favored to represent an ectopic pregnancy within the left adnexa, however, a pregnancy within a truncated didelphic horn is not entirely excluded, but considered less likely. No significant free fluid in the pelvis.2.Uterine fibroids.


Instruction: Generate impression based on findings.

Input: Reason: lymphoma of scalp in past.new epidural and vertebral tumor on lumbar MRI and PET scan. History: none;findings as noted Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. Following needle removal images obtained that demonstrate no complications.

Output: 1.L3vertebral bone biopsy under CT guidance. A total of five bone biopsy samples were delivered to pathology for analysis.2.L3 paraspinous soft tissue biopsy under CT guidance. A total of 3 samples were delivered to pathology for analysis.3.Touch preps from each specimen were obtained and analyzed by cytopathologist who was present throughout the procedure. Only the paraspinous tissues demonstrated lymphoid tissue.


Instruction: Generate impression based on findings.

Input: Migraine without aura, not intractable, without status migrainosus [G43.009], Reason for Study: ^Reason: Migraine, increased on frequency, severity, over 2 months. ? Etiology History: Migraine, increased on frequency, severity, over 2 months. No evidence of acute ischemic or hemorrhagic lesion on the scan. No abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, 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: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: Female 59 years old Reason: standing lumbar spine ap lateral flexion extension History: lbp. There is grade 1 anterolisthesis of L4 on L5. There is no significant change in the anterolisthesis on flexion or extension positioning.The remaining vertebral body heights and intravertebral disk spaces are preserved.

Output: Grade 1 L4 on L5 anterolisthesis without change upon flexion or extension of the lumbar spine.


Instruction: Generate impression based on findings.

Input: 18 year-old patient with somnolence and bilateral DVTs. 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. No abnormal enhancing 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.Within the pituitary fossa and there is some some enhancement and around the infundibulum of the pituitary gland . correlating with the recent MRI this may represent a small pituitary fossa with horizontal orientation of the infundibulum, however, imaging is nonspecific for pituitary.

Output: The infundibulum of the pituitary gland appears mildly thickened. Please correlate with for clinical symptoms related to to the pituitary. If thought clinically appropriate, an MRI of the pituitary may be of benefit in assessing this area.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with Chiari malformation status post decompression with pseudomeningocele and CSF leak, recently admitted for infection involving the ventricular shunt and pseudomeningocele, status post EVD placement and removal, status post pseudomeningocele/abscess drainage and repair. Evidence of Chiari decompression status post redo is seen including suboccipital craniectomy and resection of the posterior arch of C1. The cerebellar tonsils prolapse into the widened foramen magnum with some crowding of the dorsal CSF space. Ventrally, there seems to be adequate CSF patency. The brainstem demonstrates a somewhat kinked morphology appearing drawn towards or perhaps tethered to the dorsal dural surface of the neo-foramen magnum. On cine flow images, biphasic CSF flow is seen through the ventral foramen magnum, but there is no significant flow dorsally. A previously seen thin midline fluid collection at the craniectomy site has completely or nearly completely resolved leaving behind a band of solidly enhancing tissue which likely represents granulation tissue and scarring.A small cystlike area of encephalomalacia affecting the right genu of the corpus callosum and adjacent parenchyma is probably unchanged when compared to prior CT examinations. Diffusion restriction and susceptibility effect within this lesion may reflect the presence of aging blood product. Sequelae of prior right frontal approach ventriculostomy catheter placement are seen. There is T2 hyperintensity along the prior catheter tract which may reflect gliosis or mild residual edema. The ventricles are dilated, similar to that seen on recent prior CT examinations. T2 hyperintensity is seen in the periventricular tissues, particularly at the frontal horns and the occipital horns.Elsewhere, no diffusion restriction or focal parenchymal edema is observed. A few scattered small foci of parenchymal T2 hyperintensity are nonspecific. No evidence of acute intracranial hemorrhage is seen. No pathologic parenchymal or extra-axial enhancement is observed.

Output: 1.Postoperative findings are seen compatible with Chiari decompression status post redo. The dorsal CSF space at the neoforamen magnum remains crowded and there is no detectable CSF flow in this location. Ventrally, the CSF space seems to be adequately patent. The brainstem demonstrates a somewhat kinked morphology suggesting tethering or adhesion to the dorsal thecal sac.2.The previously demonstrated infected pseudomeningocele has been repaired. Little if any actual fluid remains, and the involved tissue demonstrates findings compatible with granulation and scarring.3.Parenchymal injury along the genu of the right corpus callosum is perhaps related to prior ventriculostomy placement and/or infection. Signal abnormally along the prior ventriculostomy tract may reflect gliosis or mild residual edema.4.The ventricles remain dilated but similar to recent prior CT's. T2 hyperintensity in the periventricular tissues at the frontal and occipital horns may indicate transependymal CSF flow or perhaps the sequelae of prior infection.


Instruction: Generate impression based on findings.

Input: cT2N1 nasopharyngeal squamous cell carcinoma treated with TFHx and XRT. There are post-treatment findings in the nasopharyngeal. There is no residual measurable right nasopharynx mass. There is also no significant upper cervical lymphadenopathy. For example, a right level 2B lymph node measures 5 x 9 mm. The skull base is intact. The submandibular glands are relatively hyperenhancing, which may be attributable to treatment effects. The parotid glands are unremarkable. There are nonspecific scattered foci of T2 hyperintensity in the imaged cerebral white matter. There is mild scattered paranasal sinus mucosal thickening. There is minimal fluid within the right mastoid air cells. The orbits are unremarkable.

Output: No measurable residual treated right nasopharyngeal carcinoma and no significant upper cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Strong family history of breast cancer There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 79 years Male (DOB:10/30/1937)Reason: Stroke work up History: as abovePROVIDER/ATTENDING NAME: KATIE TATARIS No evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal bihemispheric patchy FLAIR/T2 high signal intensities on periventricular white matter and centrum semiovale indicate nonspecific small vessel ischemic disease.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 for the major arteries and venous sinuses.Thickening on the left maxillary sinus.. Bilateral mastoid air cells are opacified. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 44-year-old female with heavy bleeding. Evaluate uterine fibroids. PELVIS:UTERUS, ADNEXA: The uterus is retroverted. Note is made of thickening of the endometrium, most pronounced along the anterior wall of the body and fundus of the uterus, measuring approximately 26 mm in diameter. There are punctate foci of fluid signal intensity in the aforementioned area. These findings are suspicious for adenomyosis. Additionally, note is made of multiple subcentimeter masses in the uterus with associated decreased T2 signal abnormality and enhancement consistent with intramural uterine firboids. The largest measures 8 mm in diameter. Multiple nabothian cysts are identified. Left ovarian cystic lesion measures 2.6 cm in diameter and may represent a physiologic cyst. BLADDER: No significant abnormality noted.LYMPH NODES: No evidence of lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings which appear most consistent with adenomyosis, as detailed above.2.Multiple subcentimeter uterine fibroids, as detailed above.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. The spinal cord is of normal caliber and signal. There is no pathological epidural or leptomeningeal enhancement. Diffuse low T1 marrow signal is noted which is nonspecific but compatible with known leukemia. Focus of T1 hyperintensity at the T3 level is compatible with a small hemangioma. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. Mild prominence of the cervical lymph nodes is noted and compatible with history of leukemia.THORACIC AND LUMBAR SPINE

Output: 1. Findings most compatible with extensive bone infarcts/osteonecrosis involving the T10-S2 vertebra with similar smaller lesions involving the bilateral iliac bones. Vertebral body heights remain grossly maintained although subtle focal endplate depressions are noted at multiple levels. 2. No evidence of cord signal abnormality or epidural or leptomeningeal neoplasm.3. Diffuse low T1 and T2 marrow signal compatible with history of leukemia.


Instruction: Generate impression based on findings.

Input: Low grade glial neural tumor status post third ventriculostomy and biopsy: surveillance. There are postoperative findings related to right transfrontal biopsy of an inferior tectal lesion with interval resolution of enhancement, but persistent susceptibility effect and T2 hyperintensity along the surgical track. There is no significant interval change in the nonenhancing, T2 hyperintense lesion within the tectum. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Interval evolution of postoperative findings related to biopsy of a tectal lesion, which has otherwise not significantly changed in size.


Instruction: Generate impression based on findings.

Input: Seizures, question meningioma There is an extra-axial homogeneously enhancing mass along the left anterior temporal convexity measuring approximately 33 x 43 x 36 mm in the AP, transverse, and craniocaudal dimensions. Small associated dural tail best appreciated on the sagittal images. There is small amount of susceptibility effect centrally which may be related to mineralization. There is associated mass-effect on the anterior aspect of the left superior and middle temporal gyri as well as the left frontal operculum. No significant associated parenchymal edema. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No other intracranial mass. No midline shift or downward herniation. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as in the pons, which are nonspecific, but most compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved with the left middle cerebral artery slightly posteriorly displaced from the mass effect.There is a cystic, tubular lesion involving the left inferior aspect of the parotid gland which is incompletely imaged. There appears to be branching associated. There T2 hyperintensity without central enhancement. Lesion measures approximately 1 cm in width and extends at least 3.5 cm in length.Partially empty sella. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. 33 x 43 x 36 mm extra-axial enhancing mass along the left anterior inferior frontotemporal convexity most likely represents a meningioma. Suggest comparison with priors if available. There is associated local mass effect on the left anterior temporal and inferior frontal lobes at the operculum. No other lesions to suggest seizure focus. 2. Mild chronic small vessel ischemic disease.3. Dilated tubular structure involving the left parotid gland which is incompletely imaged but suspected to represent a dilated duct. Consider ultrasound or dedicated MRI of the parotid gland for further evaluation.


Instruction: Generate impression based on findings.

Input: 24-year-old female with pain and swelling. LIGAMENTS: No significant abnormality noted.TENDONS: The extensor tendons appear intact. The flexor tendons appear intact. There is enhancement which extends in a circumferential fashion along the extensor tendons along the base of the second through the fourth metacarpals, which may reflect a mild tenosynovitis. No fluid signal abnormality is identified within the tendon sheaths.BONES: No bone marrow signal abnormality is identified.ADDITIONAL

Output: Nonspecific subcutaneous edema along the dorsal aspect of the hand and wrist with possible mild extensor digitorum tendon tenosynovitis.


Instruction: Generate impression based on findings.

Input: Reason: concern for CVA, unable to further assess chronicity on CT History: ams, contracted MRI of the brainThere is encephalomalacia present along the left parietal lobe as well as in the watershed zone between left anterior and middle cerebral artery territories. There is associated susceptibility effect along the left parietal lobe.There is flair and T2 signal change along the medial aspect of the left parietal lobe as well as the adjacent left and right gyrus along the posterior aspects . There are punctate foci of susceptibility present along the cortex of these structures . Associated increase in diffusion weighted imaging signal along these territories is not accompanied by loss of signal on ADC maps.There are several punctate foci of increased signal on diffusion weighted imaging in the subcortical white matter of the right frontal lobe medially that are associated with flair signal hyperintensity. One of these appears to be associated with diffusion restriction on the ADC map.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium-sized there. The posterior communicating arteries are identified and are very small. The vertebral arteries are similar in size. The left posterior inferior cerebellar artery is extracranial origin.The exam is mildly compromised by patient motion.

Output: 1.Findings suggest late subacute infarction along the medial aspect of the left parietal lobe and in the posterior aspects of the cingulate gyrus bilaterally.2.Encephalomalacia is present along the left parietal lobe and watershed zone between the left middle and anterior cerebral artery territories.3.Punctate lesions in the subcortical white matter of the right medial frontal lobe are present which are suspected to be vascular related. One of these may represent a more acute punctate focus of infarction.4.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out structural lesions. Signs and symptoms: Seizure. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates 2 small foci of cortical FLAIR hyperintensity (likely encephalomalacia) with minimal subcortical white matter involvement in the right anterior frontal lobe. There is no evidence of hemorrhagic changes with this finding.Additionally minimal periventricular FLAIR hyperintensity which is a nonspecific finding however could represent minimal chronic small vessel ischemic stroke. The anatomical morphology and signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system and brain myelination otherwise.Signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses is within normal.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.

Output: 1.Negative diffusion weighted images.2.2 small foci of encephalomalacia involving the cortex and subcortical white matter of right anterior frontal lobe which are nonspecific. 3.Findings suggestive of minimal chronic nonhemorrhagic small vessel ischemic strokes. Unremarkable nonenhanced brain MRI otherwise.4.There are no prior exams for comparison however if such studies are available and provided to radiology department an addendum to this report will be submitted after review.


Instruction: Generate impression based on findings.

Input: 25 years Female (DOB: 3/2/1991)Reason: h/o Chiari malformation type I, evaluate for syrinx History: NAPROVIDER/ATTENDING NAME: IRIS L ROMERO IRIS L ROMERO The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal cervical curvature present. This could be positional or related to muscle spasm. It is nonspecific. There is some mild multilevel disc desiccation present. The cerebellar tonsils extend below the level of the foramen magnum by approximately 6 mm. There is no change since prior exam. Overall the marrow signal is somewhat diminished.CSF flow study demonstrates normal biphasic flow at the level of foramen magnum.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 no significant compromise to the spinal canal or neural foramina. There is a small broad-based left paramedian disc protrusion at this level. 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.Although there is a Chiari I malformation present , CSF flow study does not reveal any impedance of flow. There is no evidence for syrinx. There is no change since prior exam.2.There are minor degenerative changes present in the cervical spine.3.Diminished marrow signal on T1-weighted imaging suggests some marrow replacement. This can be explained on the basis of sickle cell anemia.


Instruction: Generate impression based on findings.

Input: Possible rethetering. There are postoperative findings related to dethetering of the filum terminale and debulking of a lipomatous mass in the posterior lower lumbar spine with a surgical cavity or pseudomeningocele via L4 and L5 laminectomy. The previously demonstrated component of the lipomatous mass in the anterior spinal canal is no longer evident, aside from minimal epidural lipomatosis. However, the conus medullaris remains low lying, being positioned at the L4 vertebral body level. There is also clumping and posterior displacement of the cauda equina nerve roots, slightly eccentric to the left. There is a persistent left pars defect at L5. The lumbar spine vertebral alignment is unchanged. There is no significant spinal canal stenosis. There is mild bilateral facet joint hypertrophy with slight neural foramen stenosis at L4-L5 and what appears to be an associated 3 mm diameter posterior synovial cyst on the left side. There is scar tissue in the lower lumbar spine posterior subcutaneous tissues.

Output: 1. Interval evolution of postoperative findings related to dethetering of the filum terminale with persistent lipomatous malformation in the posterior lower lumbar spine associated with low-lying conus medullaris and clumping of the cauda equina, suggestive of persistent tethering.2. Left L5 pars defect.3. Mild bilateral facet joint degenerative changes with slight neural foramen stenosis at L4-L5.


Instruction: Generate impression based on findings.

Input: 25-year-old woman with history of fibroblastic disorder and abdominal desmoid. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. There is no intra or extrahepatic biliary ductal dilatation. Patient is status post cholecystectomy.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: In the right retroperitoneum (500/40) there is a T2 hypointense, minimally enhancing mass abutting the IVC and SMV which measures 34 x 31 mm, previously 34 x 29 mm when measured using similar technique. No additional significant masses or lymphadenopathy identified.BOWEL, MESENTERY: No significant abnormality noted. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small follicular cysts noted in the ovaries.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable size of right retroperitoneal desmoid. Discussed with Dr. Undevia by phone at time of dictation.2.No additional sites of disease identified.


Instruction: Generate impression based on findings.

Input: There is redemonstration of a bubbly internal T2 bright lesion with a rim of hemosiderin staining along the right hypothalamus, measuring 18 x 17 mm in the axial view and approximately 16 mm in the craniocaudal view, not significantly changed since previous study.There is a right-sided developmental venous anomaly which drains to the right internal cerebral vein, unchanged since the previous study. Surrounding hyperemia in the basal ganglia persists. There is a new or larger susceptibility focus in the right basal ganglia adjacent to the DVA that could represent microhemorrhage.Minimal punctate nonspecific T2 hyperintensities in the right periventricular white matter are unchanged. No new intracranial lesions detected. No new edema or mass effect, or extra-axial fluid collection. Ventricular size is normal.

Output: 1. No significant interval change in the size or morphology of a right hypothalamic cavernous malformation. Likewise, there has been no change in the appearance of an associated large developmental venous anomaly. 2. A new or larger focus of susceptibility is seen adjacent to the DVA in the right basal ganglia which may represent microhemorrhage.


Instruction: Generate impression based on findings.

Input: 80-year-old man with past medical history of colon cancer presents with severe lower back and right lateral hip pain. Severe osteoarthritis of the right hip has progressed when compared to CT dated 10/18/2013. This hip joint now appears essentially devoid of articular cartilage and there is flattening of the superior aspect of the femoral head. Multiple subchondral cysts and/or chronic erosions within the femoral head and acetabulum are seen. There is a small amount of fluid within the hip joint and extending anteriorly into a synovial recess that in retrospect was present on prior CT scan. There is also enhancement of the hip joint indicating synovitis. Edema type signal and enhancement of the femoral head extending into the intertrochanteric region as well as the acetabulum is suspected to be arthritic in etiology. Overall, these findings indicate progression of osteoarthritis perhaps secondary to underlying inflammatory or depositional arthritis. The distribution of signal intensity abnormality in the bone marrow is more in keeping with an arthritic process than a neoplastic one.There is a small amount of peritrochanteric fluid enhancement on the right relative to the left which may reflect a mild bursitis.There is also mild edema and enhancement of the adjacent gluteal and flexor musculature of the hip that is nonspecific but may reflect altered biomechanics or myositis. There is mild atrophy of gluteal and hip musculature, right greater than left.Relatively mild osteoarthritis affects the left hip.The sacroiliac joints appear normal.Mild degenerative disc disease and facet joint osteoarthritis affect the lower lumbar spine.The remaining bone marrow signal intensity is within normal limits.

Output: 1. Severe osteoarthritis of the right hip that has progressed when compared to the prior study and may be secondary to underlying chronic inflammatory or depositional arthritis. Bone marrow signal abnormalities are felt to be arthritic in etiology as well. We see no focal lesions to indicate metastatic disease to bone.2. Inflammatory changes of the musculature of the right hip and along the right greater trochanter as above.


Instruction: Generate impression based on findings.

Input: 67 year old female. Abnormal XR of right femur. Please evaluate. No lesion is identified at the previously described mild endosteal scalloping noted in the proximal femoral diaphysis on a prior radiograph. Bone marrow signal intensity is within normal limits. The musculature of the right hip is unremarkable. No pathologic enhancement on post-contrast sequences. The glenoid labrum cannot be assessed on these large field of view images.

Output: No suspicious bone lesion or other significant abnormalities.