Instruction: Generate impression based on findings.

Input: Male, 33 years old, for postoperative follow-up of recurrent brain tumor. R frontal GBM s/p resection 2011 (low grade glioma) and 2015 (anaplastic astrocytoma),s/p chemoradiation, now s/p R frontal re-do craniotomy for biopsy and Xiopharm trial virus injection on 12/19. Changes related to right frontal craniotomy are redemonstrated with underlying dural thickening and enhancement. Small amounts extra-axial fluid and air are present over the anterior aspect of the right frontal lobe, similar to postoperative CT. The previously demonstrated prior resection cavity is stable in appearance in the superior right frontal lobe. A biopsy tract from a superior right frontal approach tube deep within the right frontal lobe lesion containing a small amount of subacute blood products and a minimal amount of pneumocephalus is again noted, as on prior CT. Tiny foci of susceptibility artifact are demonstrated within the mass, which may be postprocedural. There has otherwise been no significant interval change in the large region of masslike heterogeneous enhancement (7.2 x 5.6 cm in maximal transverse and AP dimensions) within both frontal lobes and extending across the genu of the corpus callosum. The amount of abnormal T2 signal surrounding the enhancing region is not apparent grossly changed when compared to the examination from 12/19/2016. There is stable effacement of the anterior aspects of the lateral ventricles and mass effect on the corpus callosum. There is no evidence of hydrocephalus. No uncal herniation or significant midline shift is evident. No additional enhancing lesions are identified.There is no evidence of acute infarct. Small mucous retention cysts are again demonstrated in the left maxillary sinus and mucosal thickening is present in scattered ethmoid air cells. The visualized portions of the paranasal sinuses and mastoid air cells are otherwise clear. Major intracranial vascular flow-voids are preserved.

Output: Expected postbiopsy and viral injection changes. Redemonstration of a large bilateral frontal lobe mass extending across the corpus callosum likely related to recurrent tumor.


Instruction: Generate impression based on findings.

Input: NMO: numbness and pain. There are multilevel T2 hyperintense lesions in the thoracic spinal cord without associated enhancement and appreciable spinal cord expansion or thinning. The cervical spinal cord appears unremarkable. There is lack of the usual cervical lordosis, but no spondylolisthesis. The thoracic spine alignment is anatomic. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Multilevel lesions in the thoracic spinal cord may represent sequela of NMO.


Instruction: Generate impression based on findings.

Input: 65 year old with reduced left ventricular systolic performance, nonobstructive coronary disease, atrial fibrillation, hypertension, significant PVC burden and syncope presenting for evaluation of cardiomyopathy. Left VentricleThe left ventricle is upper normal in size with moderately-severely reduced systolic function. The overall LV ejection fraction is 33 %, the LV end diastolic volume index is 101 ml/m2 (normal range: 74+/-15), the LVEDV is 235 ml (normal range 142+/-34), the LV end systolic volume index is 69 ml/m2 (normal range 25+/-9), the LVESV is 159 ml (normal range 47+/-19). The left ventricular systolic dysfunction is global with regional variation. 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 49%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 169 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 85 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is 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 with moderately-severely reduced systolic function (LV EF33%). The left ventricular systolic dysfunction is global with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size and systolic function (RVEF49%)


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: New onset seizures, history of lung ca History: New onset seizures Motion artifacts degraded image quality.No evidence of acute ischemic or hemorrhagic lesion.There are scattered FLAIR/T2 high signal intensity lesions mainly on the left frontal and parietal convexity as well as right parietal lobe especially subcortical white matter which do not show any evidence of contrast enhancement. A couple of scattered FLAIR/T2 high signal intensity lesions on bilateral deep white matter lesions are also seen. Constellation of above findings are non-specific. Differential diagnosis include inflammatory lesions including ADEM, toxic encephalitis, post seizure activity changes, unusual PRES but less likely tumor related findings.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: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Multifocal bihemispheric (left more than right) subcortical white matter lesions as described above. Differential diagnosis include inflammatory lesions including ADEM, toxic encephalitis, post seizure activity changes, unusual PRES but less likely tumor related findings.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified congenital anomalies of brainClinical question: s/p intervention/embolization/SRS treatment of left dural AV fistulaSigns and Symptoms: surveillanceComments: Needs labs due to HTN | MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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:Compared to the previous exam the left external carotid artery vasculature has decreased in caliber. Additionally, the number of vessels extending into the left sigmoid sinus have substantially regressed. The left mastoid artery can be identified extending into the left sigmoid sinus of remaining in the other vessels are not readily appreciated.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 right posterior communicating artery is medium-sized. The left posterior communicating artery is tiny. The anterior communicating artery is small. The vertebral arteries are similar in size. There is extracranial origin of the right posterior inferior cerebellar artery.

Output: 1.Compared the previous examination, there has been substantial reduction in the patient's left-sided arteriovenous fistula. There is some evidence that a small supply to the fistula still exists.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific.


Instruction: Generate impression based on findings.

Input: Chest pain, unspecified [R07.9] / Persistent atrial fibrillation [I48.1] / Paresthesia of skin [R20.2], Reason for Study: ^Reason: Hx of afib, concern for Tia symptoms, looking for stroke History: left sided paresthesias Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There is abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings on the left posterior ethmoid sinuses.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate bilateral retropharyngeal course of cervical ICAs. However, there is normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Neck MRIMotion artifacts degraded exam quality.PHARYNX/LARYNX: The nasopharynx, oropharynx, and hypopharynx are unremarkable. The larynx is unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The contrast-enhanced appearance of the submandibular, sublingual, and parotid glands bilaterally is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and the floor of mouth are unremarkable.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Normal Neck MRA3. Normal Neck MRI


Instruction: Generate impression based on findings.

Input: Abdominal pain. Evaluate for acute pancreatitis and pseudocyst. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size, measuring 17 cm in craniocaudal dimension. No focal suspicious lesion. No intra or extrahepatic biliary ductal dilatation.Status post cholecystectomy.The vessels are patent.SPLEEN: The spleen is normal in morphology, size, signal intensity and enhancement without focal lesion.PANCREAS: The pancreas is normal in morphology, signal intensity and enhancement. The main pancreatic duct is normal in caliber. Punctate cystic foci are too small to characterize, likely very small IPMNs. Normal variant ductal anatomy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Round T12 vertebral body focus compatible with a benign hemangioma.OTHER: No significant abnormality noted.

Output: 1.No evidence of acute pancreatitis or complication of prior pancreatitis. 2.Punctate sub 2-mm cystic focus in the pancreatic head may represent a tiny side-branch IPMN without suspicious characteristics.


Instruction: Generate impression based on findings.

Input: Thyroid cancer. Status post surgery and RT. CHEST:LUNGS AND PLEURA: Multiple bilateral small noncalcified pulmonary nodules are present ranging up to approximately 5 mm in diameter. These are indeterminate but suspicious for metastases.MEDIASTINUM AND HILA: Surgical clips and may thyroid bed.No significant mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Focal hypodensity in segment 7 measuring approximately 29 x 29 mm. The differential diagnosis includes metastasis and hemangioma. If clinically indicated further evaluation could be performed with an MRI scan. Surgical clips in the gallbladder bed.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small midline anterior hernia.

Output: 1. Multiple small pulmonary nodules which are indeterminate but suspicious for metastases.2. Indeterminate hepatic lesion.


Instruction: Generate impression based on findings.

Input: 42-year-old female with face tingling and recent fatigue, prior abnormal brain MRI No diffusion restriction is seen to suggest acute ischemia. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. Scattered T2/FLAIR hyperintense foci are seen in the periventricular and subcortical white matter, without significant interval change. One appears slightly more prominent within subcortical white matter of the right posterior superior frontal gyrus (series 401 image 25), whereas a second lesion appears less prominent involving left frontal subcortical white matter (series 401 image 22). No lesions are seen within the posterior fossa. No new lesions are identified. The CSF spaces are appropriate for the patient's stated age with no midline shift. Prominent perivascular spaces are again seen in the right inferior basal ganglia. Normal vascular flow voids are present in the major intracranial vasculature. The imaged portions of the paranasal sinuses are clear. The imaged portions of the mastoid air cells are clear. The imaged portions of the orbits are intact.

Output: Redemonstrated are scattered T2/FLAIR hyperintense in the periventricular and subcortical white matter, without significant interval change. One appears slightly more prominent within subcortical white matter of the right posterior superior frontal gyrus (series 401 image 25), whereas a second lesion appears less prominent involving left frontal subcortical white matter (series 401 image 22). No new lesions are identified. This appearance is nonspecific and the differential diagnosis most likely includes demyelinating disease, migraine sequela, diffuse axonal injury, and small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Reason: r/o mass History: vertigo, dizziness, giddiness. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter changes of a mild degree are nonspecific. They are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 60-year-old female with jaundice and transaminitis. Limited examination due to lack of intravenous contrast and limited sequences obtained, as described above.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver with nodular surface contour and hypertrophy of the left hepatic lobe. No focal hepatic lesions evident. No biliary ductal dilation. Biliary sludge and/or small stones seen layering dependently within the gallbladder.SPLEEN: Splenomegaly with the spleen measuring up to 14.5 cm in length. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate to large amount of upper abdominal ascites. Trace pleural effusions, partially visualized.

Output: Limited examination with lack of intravenous contrast and limited sequences obtained. The patient is scheduled to return for the full protocol on 6/25/2015.Cirrhotic liver morphology. No focal liver lesions are evident.


Instruction: Generate impression based on findings.

Input: 39-year-old male with progressive dysphagia, concern for LMN neuropathy or variant ALS. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The corticospinal tracts are relatively T2 hyperintense in the basal ganglia regions bilaterally. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening of the ethmoid air cells and fluid within the right maxillary sinus. The orbits, skull and scalp soft tissues are grossly unremarkable.

Output: The corticospinal tracts are relatively T2 hyperintense, which can be a normal finding or a feature or ALS. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 80-year-old presenting with lower extremity weakness. Evaluate for stenosis. The vertebral column alignment is anatomic. The vertebral body heights are preserved. There are foci of increased T1 and T2 signal in the T3 and T4 vertebral bodies compatible with intraosseous hemangiomas. There is no significant disc bulge or protrusion. There is no significant spinal canal or neural foraminal stenosis. The spinal cord is normal in signal and morphology throughout. There are subcentimeter perineural cysts in the lower cervical spine neural foramina.

Output: 1. No evidence of thoracic spine cord lesions.2. No significant spinal canal or neural foraminal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: evaluating right great toe for mass, lesion, foreign body History: pt with right great toe pain on plantar aspect, swelling x several weeks, now c/o numbness on medial aspect. X-rays unremarkable. no redness, warmth, no skin changes, no nail involvement There is a small circumferential fluid within the flexor hallucis longus tendon sheath which may represent a mild tenosynovitis. No bone marrow signal abnormality is identified. The alignment is anatomic. There is a small amount of fluid within the first MTP joint which may represent a very mild synovitis. The flexor and extensor tendons appear intact. The imaged soft tissues of the toe and right foot otherwise appear normal.

Output: Findings indicating a very mild tenosynovitis of the flexor hallucis longus and synovitis of the first MTP joint. Otherwise no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Evaluate for rotator cuff tear ROTATOR CUFF: A 6-mm nodule demonstrating signal void on all sequences at the distal supraspinatus tendon likely reflects calcium hydroxyapatite deposition. The remainder of the rotator cuff is unremarkable.GLENOHUMERAL JOINT AND GLENOID LABRUM: Small subchondral cysts are present in the humeral head. No glenohumeral joint effusion is present.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Findings suspicious for calcific tendinopathy of the supraspinatus. Shoulder radiographs are mandatory for confirmation.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity numbness. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral maxillary sinuses.Cervical Spine: There appears to be mild diffuse congenital narrowing of the cervical spine. There is straightening of the sagittal alignment, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or demyelinating lesions.2. Apparent mild diffuse congenital narrowing of the cervical spine, but no evidence of demyelinating lesions.


Instruction: Generate impression based on findings.

Input: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disk heights are well-maintained. There is mild disc desiccation at multiple levels. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. Corresponding to the area of questionable abnormality at T7 level dorsal to the cord, there is an apparent linear focus which is hyperintense on T1 and hypointense on T2, which is demonstrated posterior to the spinal cord on sagittal sequences only. However, this focus was not demonstrated on axial T1 sequences and likely represents flow artifact on the axial T2-weighted sequences. In addition, postcontrast sagittal image at this level shows a probable small vessel emanating from that area which is likely contributing to this appearance.The additional more bandlike area of questionable abnormality posterior to the spinal cord at T2-T3 level is felt to be artifactual as well.There is minimal central disc protrusion at T7-T8 and T8-T9. No significant spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Small apparent linear focus at T7 level posterior to the spinal cord corresponding to the questioned abnormality, which is not demonstrated on axial T1 sequence, is favored to be artifactual. A small vessel is seen emanating from this area, which may contribute to this appearance and associated altered CSF flow.2. Additional questionable area of concern at T2-T3 level is also likely artifactual. The study is somewhat limited without axial images through the majority of the thoracic spine. If there remains clinical concern for pathology at this level, dedicated complete MRI of the thoracic spine may be obtained for a complete evaluation.


Instruction: Generate impression based on findings.

Input: Lumbosacral meningomyelocele repaired in infancy. Back pain in lumbosacral region for 1 year with easy fatigability. Please evaluate tethered cord, lipoma. From EMR: Waardenburg syndrome. There is a linear area of low signal through the midline posterior elements of L5, suggesting spina bifida occulta at this level. Caudal to this level, there is open spinal dysraphism. Within the dorsal sacral region are presumed postsurgical changes from a prior myelomeningocele repair, with little subcutaneous tissue remaining overlying the dysraphic defect.The spinal cord is low lying and extends to at least the L5-S1 level, where it appears to splay over a large oval intradural structure. This finding is of high T2/STIR signal, perhaps slightly greater in signal than adjacent CSF. On T1-weighted images, this is also mildly hyperintense to CSF. There is slight heterogeneity noted within the contents of this structure, suggesting a possible complex cystic fluid component, possibly with internal septations and/or debris. Following contrast, there is thin discontinuous peripheral enhancement. The fluid collection measures 1.9 x 2.1 cm in greatest axial dimensions (series 701, image 34) at the approximate S1-S2 level, x 3.4 cm CC. The dorsal aspect of this structure is adherent to the dorsal ectatic thecal sac at this level. There is no fat signal to indicate associated lipomatous component. There is no evidence of associated abnormal signal within the visualized distal cord. On prone sequences, the distal spinal cord remains unchanged in position, without ventral motion, suggestive of tethering.The lumbar spine is without canal compromise or neuroforaminal narrowing. The remaining partially visualized retroperitoneal structures appear within normal limits.

Output: 1.Expected postoperative changes from a prior myelomeningocele repair with evidence of sacral spinal dysraphism with spina bifida occulta at L5.2.Low-lying spinal cord terminating at best at the L5-S1 level with imaging findings suggestive of tethering, for which clinical correlation is recommended. No syringohydromyelia identified in the visualized distal cord.3.Prominent circumscribed intradural oval structure which appears to arise from the distal splayed ends of the low-lying cord, with mild internal heterogeneity and minimal discontinuous peripheral enhancement. The differential includes primarily an epidermoid especially provided patient's history of previous surgical repair, arachnoid cyst or other complex cyst, less likely terminal myelocystocele, as the distal cord is otherwise unremarkable without evidence of syringohydromyelia, or neoplasm. Previous pre-surgery imaging would be helpful for comparison, if it can be obtained. Otherwise, the patient may benefit from additional MRI diffusion weighted sequences to exclude an epidermoid.


Instruction: Generate impression based on findings.

Input: The patient is a 44-year-old male who presents for a pulmonary vein CT prior to planned atrial fibrillation ablation by catheter-based pulmonary vein isolation. The quality of the study is suboptimal. There is a relatively low contrast opacification of the left atrium pulmonary veins. Within the limits of this study the pulmonary vein dimensions are as follows:Left superior pulmonary vein: 19.3 x 12.8mmleft inferior pulmonary vein 11.4 x 20.1 mmright superior pulmonary vein 26.6 x 17.2 mmright inferior pulmonary vein 19.5 x 15.6 mmLeft atrial volume 123 cc

Output: 1. Increased left atrial volume. 2. Mildly enlarged pulmonary vein diameter. 3. Poor opacification of the left atrium and pulmonary veins.Interpretation of the lungs and other soft tissues of the thorax and upper abdomen will be included in the radiologist report.


Instruction: Generate impression based on findings.

Input: Pain evaluate medial meniscal injury MENISCI: The lateral and medial menisci are normal.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: The anterior and posterior cruciate ligaments are normal. The medial and lateral collateral ligaments are normal.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Minimal nonspecific soft tissue edema at the medial aspect of the knee.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: eval structural lesion History: new onset seizures. There is no evidence of acute ischemic or hemorrhagic lesion.About 3-4 mm downward herniation of bilateral cerebellar tonsils are seen.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: About 3-4 mm bilateral cerebellar tonsillar herniation through the foramen magnum.Otherwise unremarkable brain MRI.


Instruction: Generate impression based on findings.

Input: 20-year-old female with pituitary microadenoma, recent worsening headaches Again seen is a hypoenhancing lesion involving the left aspect of the pituitary gland measuring 4 to 5 mm in the transverse and craniocaudal dimensions. When compared to prior studies dating back to 12/20/2010, the lesion is stable to minimally larger. Unchanged associated T2 hypointensity. There is no evidence of pituitary macroadenoma. Bilateral cavernous sinuses are unremarkable. No suprasellar extension or mass effect on the optic chiasm.

Output: Stable to minimal enlargement of hypoenhancing lesion involving the left aspect of the pituitary gland favored to represent a microadenoma. Note slight differences in measurement across the prior studies may be in part technique related.


Instruction: Generate impression based on findings.

Input: Infiltrating glioma, WHO grade II. Off treatment. The study is significantly limited by patient motion. There are changes of previous tumor resection from the left parietal lobe. The surgical cavity is unchanged, as is the associated encephalomalacia and volume loss. Also, the extensive confluent white-matter T2-hyperintensity which involves both cerebral hemispheres, though more pronounced on the left, is unchanged. There is no significant contrast-enhancement in the treatment bed or the remainder of the brain.MR perfusion was performed but is of limited value given the degree of motion. Mild dural thickening/contrast enhancement underlying the craniotomy flap is unchanged. There is no acute infarct or gross, new intracranial hemorrhage. There is no midline shift or brain herniation. The major intracranial flow voids are preserved.

Output: 1.The study is significantly limited by patient motion.2.There is no significant change in the confluent areas of cerebral T2-hyperintensity and no abnormal or new contrast enhancement to suggest disease progression.


Instruction: Generate impression based on findings.

Input: History of seizure-like activity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Brain parenchymal signal is within normal limits. The myelination pattern is within normal limits for age. The hippocampal formations are symmetric. No areas of cortical thickening are identified to suggest cortical dysplasia. The pituitary gland and midline structures appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is trace mucosal thickening within the paranasal sinuses.

Output: No acute intracranial abnormality. No localizing lesions identified to account for patient's seizures.


Instruction: Generate impression based on findings.

Input: 60 year-old BRCA1 positive with family history of breast and ovarian cancer. MRI high risk screening study IR 13073B There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 71-year-old female with weakness. Evaluate for acute MS exacerbation. Confluent and patchy T2/FLAIR hyperintensity within the subcortical and periventricular white matter, deep gray matter and brainstem have slightly progressed from prior study, most prominent within the centrum semiovale, left greater than right; these are oriented perpendicular to the white matter tracts suggestive of demyelinating disease. Additional ill-defined T2/FLAIR hyperintensity within the upper spinal cord is again noted and unchanged. Previous area of restricted diffusion within the right periventricular white matter signal are seen and has been replaced with focal encephalomalacia consistent with prior infarct. No new areas of restricted diffusion are identified. There is new susceptibility signal within the bilateral deep gray matter consistent with hemosiderin deposition and given lack of surrounding edema most likely represent chronic microhemorrhage; a more prominent area of susceptibility signal within the left posterior thalamus is likely due to previous hemorrhagic lesion. Additional foci of susceptibility signal within the cerebellum unchanged compatible chronic microhemorrhage. No acute hemorrhage is identified. No areas of abnormal enhancement are noted. Slight prominence of the ventricles and sulci are unchanged consistent with age-appropriate volume loss. No mass effect.The paranasal sinuses and mastoid air cells are clear. The imaged orbits are unremarkable.

Output: 1. Slightly progressing T2/FLAIR hyperintensity, especially within the left centrum semiovale, otherwise no significant interval change. The pattern of signal abnormality is perpendicular to the white matter tracts consistent with patient's known demyelinating disease. No evidence of active disease.2. Additional T2/FLAIR signal abnormalities noted within the upper spinal cord without significant interval change prior study. MRI of the cervical spine may be considered to evaluate the extent of spinal cord disease if clinically warranted.3. Focal encephalomalacia within the right periventricular white matter corresponds to prior area of restricted diffusion in this region compatible with chronic infarct. 4. New areas of hemosiderin deposition within the bilateral deep gray matter consistent with chronic hemorrhage including a a more prominent area within the left posterior thalamus which is likely due to previous hemorrhagic lesion. Unchanged foci of susceptibility signal within the cerebellum compatible with chronic microhemorrhage.


Instruction: Generate impression based on findings.

Input: History of stage IV appendiceal cancer on chemo pre-op evaluation for metastases and response to chemotherapy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and parenchymal signal intensity. A few scattered cystic lesions measuring less than 5 mm in the right lobe of the liver are too small to characterize but appear grossly similar to 8/12/2015 CT. No suspicious hepatic lesions are identified. No biliary ductal dilatation.SPLEEN: No significant abnormality noted. Splenules are present.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There are areas of abnormally increased DWI signal within the omentum suspicious for carcinomatosis most prominent in the left upper quadrant (series 5, image 23) and to a lesser extent the right lower quadrant (series 19, image 69). There is also subtle omental nodularity seen on T2-weighted images in the anterior aspect of the right lower quadrant which was also described on prior CT. Overall, the amount of omental disease appears to have decreased compared to the 8/12/2015 CT.BOWEL, MESENTERY: The bowel is normal in caliber without evidence of obstruction. The appendix is not definitively visualized.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Omental nodularity overall decreased compared to 8/12/2015 CT allowing for differences in technique and compatible with stated history of stage IV appendiceal cancer.


Instruction: Generate impression based on findings.

Input: Reason: Left hip pain, xrays negative however, patient has persistent pain 10 days out from original injury, evaluate for occult fracture, soft tissue injury History: above ARTICULAR CARTILAGE AND BONE: Note is made of a nondisplaced fracture through the left inferior pubic ramus with associated linear decreased signal abnormality and bone marrow signal in the surrounding area. There is also a nondisplaced fractures through the anterior wall of the acetabulum with associated bone marrow signal abnormality within the left superior pubic ramus. There is also a nondisplaced fracture through the left sacral wing. Severe degenerative disc disease affects the imaged lower lumbar spine.SOFT TISSUES: There is increased signal abnormality within the abductor musculature, on the left, likely representing a strain injury. The remainder of the imaged musculature of the pelvis is unremarkable. ADDITIONAL

Output: 1. Nondisplaced fractures of the anterior wall of the left acetabulum, left inferior pubic ramus and left sacral wing as described above.2. Strain injury of the left adductor musculature. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Knee pain and instability MENISCI: There is a vertically oriented tear of the posterior horn of the medial meniscus. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the medial and lateral compartments is intact. There are partial-thickness defects within the articular cartilage of the patellofemoral compartment with small areas but may be full-thickness in nature (image 15/37 on series 5).LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Vertical tear of the posterior horn of the medial meniscus.2. Large joint effusion with associated synovitis.3. Moderate cartilage loss of the patellofemoral compartment.


Instruction: Generate impression based on findings.

Input: Brain: There are unchanged postoperative findings in the posterior fossa related to prior tumor resection without evidence of nodular enhancement in the region of the resection cavity or elsewhere in the intracranial compartment. There is susceptibility artifact related to a right transoccipital catheter device. There is unchanged deformity of the right cerebellar hemisphere surrounding the resection cavity with tenting towards the overlying dura inferiorly, which appears unchanged. The brain parenchyma appears unchanged. The ventricles are unchanged in size and configuration.Spine: There is high T1 signal within the vertebral bone marrow within the T12 through S5 vertebral bodies related to radiotherapy. There are also postoperative findings in the lower lumbar spine related to tethered cord release with patchy enhancement in the posterior soft tissues. There is increase in the caliber and extent of the septated syringohydromyelia, now measuring up to 10 mm in width and extending from the level of C2-C3 level to the conus which is located approximately at the inferior L5 endplate. There is persistent patchy T2 hyperintensity superior to the syringohydromyelia, which may represent edema. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are intact. There is no significant spinal canal stenosis. The partially imaged urinary bladder appears to be enlarged.

Output: 1. Unchanged post-therapy findings in the posterior fossa with deformity of the right cerebellar hemisphere with a configuration that is suggestive of adhesion formation, but no definite evidence of tumor recurrence.2. Postoperative findings related to tethered cord release with persistent low lying conus medullaris and interval increase in size of the extensive syringohydromyelia.Discussed with Dr. Kramer at 10:20 AM on 5/18/15.


Instruction: Generate impression based on findings.

Input: Breast cancer with brain metastasis. History of radiation treatment. Altered mental status. The predominantly left sided dural-based masses associated with overlying skull thicken and marrow replacement have progressed since the previous examination. For example, the dural component in the anterior aspect of the left middle cranial fossa, associated with the infiltrative lesion involving the left sphenoid triangle, now measures transaxially up to 19 mm and thickness, compared to 12 mm previously. Also, there has been progression in the other multifocal nodularity and masses overlying the left cerebral convexity and smaller soft tissue component in the scalp. There is new vasogenic edema-like T2-hyperintensity in the anterior aspect of the left temporal white-matter associated with mass-effect and mild midline shift and uncal herniation. Left cavernous sinus involvement is also increased. The ventricular system remains mildly dilated with mild periventricular T2-hyperintensity, likely reflective of volume loss. There is no intraparenchymal contrast-enhancing lesion. There is no acute infarct or acute intracranial hemorrhage. Fluid signal intensity now completely fills left mastoid air cells and middle ear cavity which might be congestive or inflammatory. Otherwise, there is trace mucosal thickening in the paranasal sinuses.

Output: 1.Since previous MRI of March 2016, there has been significant progression of the dural-based masses associated with skull metastasis. 2.The largest nodular component is in the anterior aspect of the left middle cranial fossa and is associated with new vasogenic edema in the left temporal lobe and mild mass-effect including mild midline shift and mild uncal herniation.3.There is also increasing left cavernous sinus involvement.


Instruction: Generate impression based on findings.

Input: Developmental anomalies: Tics, learning disabilities, premature infant. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. In particular, the basal ganglia are intact. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with history of recurrent nasopharyngeal carcinoma and oral cavity squamous of carcinoma status post treatment. Diffuse edema involving the pharynx, tonsillar pillars and the supraglottic larynx has increased mildly from the prior examination, likely a treatment related effect. No discrete tumor-like lesions or areas of pathologic focal enhancement are detected. A previously referenced left level II lymph node now measures only 4 mm in short axis dimension (image 29 series 1201), previously 6 mm. No new or growing pathologic adenopathy is detected in the neck. The visualized salivary glands are unremarkable. Marrow signal characteristics are within normal limits. A subcentimeter mucus retention cyst in the right maxillary sinus is unchanged.

Output: Treatment related findings with no evidence to suggest recurrent primary tumor or pathologic adenopathy.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified nature of brain [239.6], Reason for Study: ^Reason: PRE-OP MRI, Crani for tumor resection today. Motion artifact degraded exam quality.Multiple fiducial markers are attached on scalp and MRI were obtained.There are multifocal enhancing lesions on the right temporal parietal lobe, left posterior temporal lobe and corpus callosum posterior body.Right temporoparietal mass shows irregular multiloculated enhancement with surrounding mass effect and edema.Right lateral ventricle posterior horn appears to be compressed due to mass effect.However, there is no evidence of ventriculomegaly or trapped ventricle.There is no midline shift.And represent with minimal Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal enhancing intra axial masses as described above. Differential diagnosis including GBM, metastasis.


Instruction: Generate impression based on findings.

Input: Reason: Ischemic stroke History: left arm ataxia MRI BRAIN:There is no evidence of intracranial hemorrhage, mass, or acute infarct. Scattered periventricular and subcortical T2 hyperintensities without diffusion restriction are nonspecific but most likely related to chronic small vessel ischemic disease. 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. The paranasal sinuses are unremarkable. Small Thornwaldt cyst is incidentally noted in the nasopharynx.

Output: Mild chronic small vessel ischemic disease without acute stroke.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:12/9/1959)Reason: follow up of CNS nocardiosis History: asymptomatic at present; have changed to an all oral regimen since last examPROVIDER/ATTENDING NAME: KATHLEEN M. MULLANE KATHLEEN M. MULLANE There is a lesion in the right occipital lobe redemonstrated which is susceptibility effect and some signal hyperintensity on the diffusion-weighted imaging associated with diffusion restriction and surrounding pattern of vasogenic edema on T2 and FLAIR imaging. This appears to be stable compared to the previous exam additional punctate foci of susceptibility are redemonstrated in the right periventricular white matter and in the left frontal lobe adjacent to the left superior frontal sulcus..There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There are bilateral staphylomas present.Within the nasal cavity there is redemonstration of a opacity involving the left superior nasal concha which was also present on prior exams.

Output: 1.There is redemonstration of a right occipital lobe lesion associated with edema and blood products which remains stable. This is somewhat nonspecific. One possibility is that may represent an infection. Nocardiosis may have this appearance though this appearance is not specific.2.There are microhemorrhages redemonstrated in the right centrum semiovale and left frontal lobe which are also stable.3.A lesion in the left nasal cavity extending towards the adjacent ethmoid air cells is also stable. Please correlate with clinical evaluation. A CT scan may help evaluate for underlying bone infiltration.4.Bilateral ocular staphylomas are redemonstrated.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of ALL and DVT, neutropenic fever, erythema of the right lower extremity. Please evaluate for infection. TENDONS: There is slight thickening of the Achilles tendon, suggestive of mild degenerative tendinopathy. The remaining tendons of the of the ankle appear intact.LIGAMENTS: The ligaments of the ankle appear intact.ARTICULAR SURFACES AND BONE: Mild osteoarthritis affects the midfoot with degenerative edema type signal in the navicular and cuboid. There is also minimal increased signal intensity within the distal tibia and fibula seen on the fat suppressed T2 imaging with preservation of marrow signal intensity on T1-weighted images. This is not of necessarily any current clinical significance. We see no findings to suggest osteomyelitis.ADDITIONAL

Output: 1. Diffuse soft tissue edema of small hyperintense masses within the subcutaneous fat in the anterolateral soft tissues of the ankle likely representing hematomas. We see no specific findings to suggest abscess or osteomyelitis.2. Mild osteoarthritis of the midfoot.


Instruction: Generate impression based on findings.

Input: 44-year-old female with history of right hip pain. Evaluate for avascular necrosis. ARTICULAR CARTILAGE AND BONE: Moderate osteoarthritis affects the right hip with articular cartilage thinning particularly along the anterior/superior aspect of the joint with cyst formation in the underlying acetabulum along with osteophyte formation. We see no specific features of avascular necrosis.There is slight prominence of the anterolateral aspect of the femoral head/neck junction with an alpha angle of approximately 60 degrees compatible with mild CAM deformity.Osteoarthritis affects the left hip to a slightly lesser degree.ACETABULAR LABRUM: There is branching signal abnormality within the anterior labrum likely representing extensive degenerative tearing that extends into the superior labrum as well. The posterior labrum appears relatively intact.SOFT TISSUES: The ligamentum teres is intact. The visualized musculature appears normal.ADDITIONAL

Output: Moderate osteoarthritis of the right hip with extensive degenerative tearing of the anterior labrum. We see no specific imaging features of avascular necrosis.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB: 5/20/1962)Reason: Pt with hx of cervical radiculopathy with worsening pain, please evaluate for progression History: see abovePROVIDER/ATTENDING NAME: TAO XIE TAO XIE The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk dessication present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge 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: There are mild degenerative changes in the cervical spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: The study is slightly degraded by motion.MRI BRAIN:There is no convincing restricted diffusion. There are scattered T2/FLAIR hyperintensities in the subcortical and periventricular white matter and in the centrum semiovale, most likely representing chronic ischemic vascular changes. A small chronic infarct is seen in the right cerebellum. There is volume loss with prominence of the ventricles and sulci. There is no midline shift. Basal cisterns are patent. There are tiny susceptibility foci dispersed throughout the white matter and a susceptibility focus in the right basal ganglia, representing old blood products from previous hemorrhage versus mineralization.MRA BRAIN:MRA image quality is significantly reduced by motion artifact. Within this limitation, the following observations are made.The internal carotid arteries are patent with atherosclerotic irregularities seen in the cavernous segments and the supraclinoid segments. The anterior cerebral arteries are patent with slight asymmetry of the A1 segments, right smaller than left. There may be mild narrowing of the right M1 middle cerebral arteries but this is equivocal. The right PCA is not visualized. The left PCA is patent.The right vertebral artery distal to the origin of the right PICA is not visualized. The visualized left vertebral artery and basilar artery are patent. The posterior communicating artery bilaterally are not visualized.

Output: 1. No evidence for acute intracranial hemorrhage, mass effect, or edema. There is no convincing evidence of acute ischemia.2. Chronic subcortical and periventricular white matter vascular ischemic changes with a small chronic infarct in the right cerebellum. 3. The right posterior cerebral artery is not visualized and may be occluded.4. The distal right vertebral artery, distal to the origin of the right PICA is also not visualized and may be occluded.


Instruction: Generate impression based on findings.

Input: Pain in left hip [M25.552], Reason for Study: ^Reason: hx of hip injury now with radiculopathy History: hip pain , numbness in L foot and down buttock For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is a 19.3 mm (CC) x 8.2 mm (AP) x 10.9 mm (RL) sized disc extrusion at the level of L5-S1 and narrows left lateral recess compressing thecal sac and nerve roots. Extruded disc was extended superiorly.There are disc desiccation at the level of L4-5 and L5-S1.There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L5-S1: Disc extrusion superiorly and left lateral results left L5-S1 lateral recess narrowing with no cord compression.

Output: Disc extrusion with superior migration which results L5S1 left side lateral recess stenosis with nerve root compression.


Instruction: Generate impression based on findings.

Input: Uterine fibroids, preimaging prior to UFE PELVIS:UTERUS, ADNEXA: Fibroid uterus. Dominant fibroid seen measuring 8.2 x 7.3 cm (image 28 series 501), exerts mass effect on adjacent endometrial stripe and while fibroid is primarily intramural, underlying submucosal component not excluded. Additional smaller submucosal uterine fibroid also seen measuring 2.2 x 1.5 cm on image 27 series 501. Second largest uterine fibroid is a subserosal one measuring 3.1 x 2.6 cm on image 23 series 501 that deviates the rectosigmoid colon leftward, see coronal image 24 series 701. Right-sided apparently intramural fibroid seen measuring up to 1.8 cm on image 28 series 501; another seen measuring up to 1.9 cm on left side on image 23 series 501. An additional enhancing 1.5 cm subserosal fibroid seen on image 92 series 1101. MR technologist did not acquire precontrast fat-saturated T1 sequence but based on subjective comparison of postcontrast imaging to T1 imaging sequence, aforementioned fibroids appear to demonstrate avid postcontrast enhancement, increasing on progressively delayed imaging consistent with fibrous nature. Difficult to appreciate junctional zone anteriorly due to patient's large dominant fundal fibroid but visualized portions appear to be within normal limits, going against adenomyosis. Ovoid T2 and T1 hypointense focus seen at level of the vagina on image 20 series 501 may reflect a nonspecific focus of air. Small follicles noted in both ovaries.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right larger than left Bartholin's cysts, measuring up to 2.3 cm. Corresponding T1 hyperintensity likely reflects underlying hemorrhage or proteinaceous material.OTHER: Small pelvic free fluid, likely physiologic.

Output: 1. Fibroid uterus as above.2. Right larger than left Bartholin's cysts, complex and containing hemorrhage or proteinaceous material.


Instruction: Generate impression based on findings.

Input: Right elbow pain x1.5 years. No improvement with rest, physical therapy. Evaluate for ligamentous or biceps. LIGAMENTS: The ulnar and radial collateral ligaments appear intact. The lateral ulnar collateral ligament is also unremarkable.TENDONS: The biceps and brachialis tendons appear normal. The triceps tendon is intact.ARTICULAR SURFACES AND BONE: Bone marrow signal intensity is within normal limits. We see no osteochondral defects. Small amount of fluid is noted within the joint but no frank effusion.SURROUNDING STRUCTURES: Musculature of the elbow appears normal. There is slight increased signal intensity of the ulnar nerve within the cubital tunnel which could conceivably represent a mild neuritis, but this is equivocal. The remaining soft tissue structures appear normal.

Output: Slight increased signal intensity of the ulnar nerve within the cubital tunnel which could conceivably represent a mild neuritis, though the true clinical significance of this is uncertain. We otherwise see no findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: Male 80 years old status post partial right nephrectomy for right renal cell carcinoma. Surveillance scan. Poor renal function, so no contrast. ABDOMEN:LIVER, BILIARY TRACT: The liver is size and morphology. No intra or extra hepatic biliary ductal dilatation or ascites. No suspicious hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: T2 hyperintense lesions in the pancreatic head and body are again seen. The largest measures 1.6 cm (series 5, image 22), previously 1.1 cm. Several T2 hyperintense lesions were not seen on the prior exam however it is uncertain whether this is related to technique and respiratory motion. They likely represent sidebranch IPMNs. There is no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable postoperative findings of partial right nephrectomy. Along the superior aspect of the right kidney an exophytic, lobulated soft tissue focus abutting the liver is unchanged and, given the susceptibility over time, is favored to represent postsurgical change. Within the limits of a noncontrast exam, there is no evidence of focal recurrence.Again seen within the left kidney are multiple renal sinus cysts cysts, some are simple while others have thin septations 5 appears similar to the previous exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Given stability over time, the lobular soft tissue along the resection margin in the right kidney is favored to represent postsurgical change. No definite evidence of local recurrence within the limitations of a noncontrast exam.2.No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Evaluate common bile duct and causes for elevated bilirubin. Status post TIPS in 1999. Distal CBD stricture secondary to fibrosis from chronic pancreatitis. Alcoholic cirrhosis. Evaluation is markedly limited due to lack of intravenous contrast and motion artifact.ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. There is increased intra- and extra- hepatic biliary ductal dilatation, with transition points at the hila and at the pancreatic ampulla, probably strictures. The gallbladder is hydropic, new from prior. There is cholelithiasis, with no definite obstructing stone identified. There is new mild gallbladder wall thickening. Patient is status post TIPS, with metallic artifact present. The common bile duct measures up to 9 mm.SPLEEN: No significant abnormality noted.PANCREAS: There is focal pancreatic ductal dilatation within the pancreatic head. Within the pancreatic head, a T2 hyperintense lesion is similar to prior (series 301, image 18), though evaluation is limited due to motion artifact, probable IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Increased anasarca. No suspicious osseous abnormality identified.OTHER: No significant abnormality noted.

Output: 1.Evaluation is markedly limited due to lack of intravenous contrast, early termination of study and motion artifact.2.Increased intra- and extra- hepatic biliary ductal dilatation, cholelithiasis, newly hydropic gall bladder and probable strictures at the level of the ampula and at the hepatic hila. Findings compatible with mild acute cholecystitis. ERCP recommended.Findings discussed with Dr. Dong at11:11 AM on January 19, 2016.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for brain injury/insult. Signs and symptoms: 29 weeker, maternal placental percreta, low apgar, intubated. Not enhanced CT brain:Examination demonstrate a small foci of increased density at the approximately level of the body of the left caudate nucleus (axial image 16 of 28). In addition a thin linear increased density in the cortex of left posterior frontal lobe along its interhemispheric aspect (axial image 21 of 28) is also present. Neither one of these lesions can be considered definitively abnormal however considering provided clinical data and immature brain parenchyma, possibility of small hemorrhage should be considered and follow-up with ultrasound or an MRI is recommended. This examination is otherwise unremarkable for patient's stated age.Motion artifacts reduces the sensitivity of the exam significantly for detection of small possible skull fractures however no definitive evidence of fracture in this study is detected.

Output: Please see above comments.


Instruction: Generate impression based on findings.

Input: Metastatic NSCLC to right frontal brain metastasis s/p frameless SRS on 3/24/16. There is a punctate focus of residual enhancement susceptibility effect at the site of the treated anterior right frontal lobe lesion without surrounding edema. There is a background of mild scattered T2 hyperintensity without enhancement in the bilateral cerebral hemisphere and pontine white matter, which may represent chronic small vessel ischemic disease. There is no evidence of new lesions. There is no evidence of intracranial hemorrhage or 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left lens implant.

Output: Marked interval decrease in size of the treated right frontal lobe metastasis.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 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: 0:25 minutes

Output: Successful fluoroscopically guided contrast injection of the left hip with MRI to follow.


Instruction: Generate impression based on findings.

Input: T4N0 adenoid cystic carcinoma of minor salivary gland/maxillary sinus with intracranial extension. There are postoperative findings related to partial left maxillectomy. There is diffuse mild left maxillary sinus mucosal thickening, with slightly more prominent infiltrative tumor involving the left maxillary alveolus, premalar subcutaneous tissue, and retromaxillary region. There is also persistent perineural tumor extension involving the left infraorbital nerve, pterygopalatine fossa, Vidian canal, foramen rotundum, foramen ovale, cavernous sinus, and Meckel cave, measuring up to 5mm in thickness, previously also 5 mm. There is no evidence of intraparenchymal extension. There is increased enhancing tumor within the medial left extraconal orbit, which measures up to 10 mm in width, previously 6 mm. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable.

Output: 1. Post-treatment findings in the left sinonasal region with persistent perineural tumor involving the left trigeminal nerve branches with intracranial extension2. Infiltrative tumor involving the left maxillary alveolus, premalar subcutaneous tissue, and retromaxillary region appears to be slightly more prominent. 3. Increased left medial orbit extraconal tumor.4. No evidence of brain parenchymal metastases.


Instruction: Generate impression based on findings.

Input: 51-year-old male with medical history of ESRD. Presenting with altered mental status. CT of brain without infusion.Heavy vascular calcification of bilateral cavernous carotids are noted. Extensive small vessel disease of undetermined age in the supratentorial brain parenchyma. Old left posterior temporal and parietal cortical stroke with heavy calcification is noted.Images through posterior fossa are suspects of an acute/subacute stroke of the vermis. No hemorrhage is detected. Further evaluation with an MRI is recommended.CTA of cervical region.The right common carotid artery including its origin is unremarkable. No stenosis at the level of the bifurcation of right common carotid artery. Atherosclerotic calcific plaque at the level of the bifurcation and in distal cervical portion of the internal carotid artery is noted however no stenosis is detected.The left common carotid artery including its origin is unremarkable for any stenosis. The bifurcation of the carotid is normal. The left internal carotid artery remains normal. Shallow atherosclerotic calcific plaques in the left common and internal carotid arteries noted with no stenosis.Vertebral arteries are small bilaterally which is believed to be a congenital variation. No evidence of stenosis. Small shallow calcific plaques are identified.CTA of intracranial circulation.CTA of vertebral basilar system demonstrates patent bilateral vertebral arteries across the foramen magnum. Irregularity of the lumen is consistent with atherosclerotic disease with mild stenosis of distal bilateral vertebral arteries. The basilar artery demonstrate atherosclerotic irregularity and some mild stenosis at his distal segment.CTA of the carotid system demonstrate normal appearing bilateral supraclinoid internal carotid arteries with no disease. There is good visualization of bilateral middle and anterior cerebral arteries with no hemodynamically significant stenosis. Prominent bilateral posterior communicating arteries are noted. This can explain the small size of bilateral vertebral arteries.CTV. out intracranial circulation.This examination is within normal limits.

Output: 1.No area of significant stenosis in the vasculature of the cervical region including bilateral common carotid, bilateral internal carotids and both vertebral arteries.2.Calcific atherosclerotic plaques however are noted in both vertebral arteries and carotid system.3.No hemodynamically significant stenosis of the carotid systems intracranially.4.Atherosclerotic disease of distal vertebral arteries and basilar artery with mild areas of stenosis in both basilar and vertebral arteries.5.Small bilateral vertebral arteries is believed to be an anatomical variation secondary to presence of prominent bilateral posterior communicating arteries.6.Unremarkable intracranial venous sinuses.7.Advanced to small vessel disease of both hemispheres of undetermined age.8.Old left hemispheric cortical stroke within the calcification.9.Suspected acute/subacute stroke of vermis.10.Follow-up with an MRI is recommended.11.12.


Instruction: Generate impression based on findings.

Input: Ms. Austin is a 57-year-old female with multifocal invasive cancer of the right breast currently undergoing neoadjuvant chemotherapy. Personal history of left breast mastectomy in 1998. The patient is status post left mastectomy and bilateral retropectoral silicone implants. There is scattered fibroglandular tissue in the right breast. Mild parenchymal enhancement is noted in the right breast.Bilateral silicone implants appear intact.RIGHT BREAST: In the right breast, there has been significant decrease in size of the two biopsy proven malignancies. In the right breast 3:00 location, the irregular enhancing mass now measures 1.6 x 2.8 x 2.0 cm (all measurements: AP x LR x CC), compared to 2.3 x 3.2 x 2.7 cm. In the right breast 9:00 location, the irregular enhancing mass now measures 0.7 x 0.9 x 0.9 cm, compared to 1.7 x 2.1 x 2.1 cm.In addition, the previously noted extensive nonmass enhancement encompassing these 2 masses now measures approximately 3.5 x 5.8 x 2.8 cm, compared to 4.8 x 7.0 x 6.9 cm.LEFT RECONSTRUCTED BREAST: No abnormal enhancement is seen in the left reconstructed breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Interval decrease in size of known right multicentric cancer.(2) No MR evidence for malignancy in the left postmastectomy breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 40 year-old female with calvarial abnormality. Surveillance scan. There is no evidence of intracranial hemorrhage, mass or edema. Bilateral basal ganglia calcifications particularly involving the lentiform nucleus. The ventricles and basal cisterns are normal in size and configuration.In the left frontal calvarium is a multiloculated lesion that involves the inner table of the calvarium with a remodeled, but well-defined surrounding border. The internal contents of the lesion demonstrate spiculations and water/soft tissue density without evidence of expansion or compression of the adjacent brain parenchyma. The lesion measures approximately 2.6 cm in widest dimension, (series 80486, image 11). The lesion was present on previous MRI dated 6/2010 and while accounting for differences in modalities, the lesion does not appear to have changed in size when compared to the previous examination. A smaller similar appearing lesion is present in the right frontal calvarium measuring approximately 4 mm in widest dimension, also unchanged, (series 6, image 17). The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Left frontal calvarial lobulated lesion, not significantly changed in size when compared to MRI dated 6/2010. The morphology, signal characteristics and lack of significant change over time are suggestive of a benign lesion, possibilities of which include hemangioma.2. Bilateral basal ganglia calcifications.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, brainstem, cerebellum, and pituitary gland appear unremarkable. There is a normal degree of myelination. 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 mucosal thickening in the bilateral maxillary sinuses.

Output: No evidence of intracranial structural lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question : Status post craniotomy for posterior fossa lesion. Signs and symptoms: As above. Nonenhanced head CT:There is expected postoperative changes of the right paramedian suboccipital craniotomy. Residual vasogenic edema in the right cerebellum is again noted. There is no evidence of parenchymal hemorrhage. Air filled surgical cavity measures approximately 17 times 12-mm in size. Fourth ventricle is in normal position and normal in size. The residual air in the subarachnoid space is also present.Focus of encephalomalacia in the left occipital lobe is likely result of an old stroke and unchanged since prior MRI exam.Prominence of cortical sulci and ventricular system for patient's stated age is similar to the preoperative study.

Output: 1.Expected postoperative changes of right paramedian suboccipital craniectomy.2.Residual vasogenic edema in the right cerebellum similar to prior study.3.Prominence of cortical sulci and ventricular system for patient's stated age of 56 similar to prior exam.4.Focus of encephalomalacia in the left occipital lobe as was seen on prior MRI study.


Instruction: Generate impression based on findings.

Input: Diagnosis: Low back pain. Sciatica, unspecified sideClinical question: low back and bilateral leg painSigns and Symptoms: low back and bilateral leg painClinical question: altered gait, suspect cervical stenosisSigns and Symptoms: altered gait neck pain Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The patient is status post laminectomy and T2as well as T2 and T3 posterior fusion with pedicle screws. There is minor anterior subluxation of T2 on T3.Spinal stenosis at T2-3 has resolved since the prior exam.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication present at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication, loss of disk space height, diffuse disk bulge and posterior ligament hypertrophy. There are small end-plate and uncovertebral osteophytes present at this level. There are endplate osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication, loss of disk space height, diffuse disk bulge and posterior ligament hypertrophy. There are small end-plate and uncovertebral osteophytes present at this level. There are endplate osteophytes at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is disk dessication, loss of disk space height and a minor disk bulge at this level. There are small uncovertebral osteophytes present 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.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disk space height, disk dessication, diffuse disk bulge and mild to moderate bilateral facet and ligamentum flavum hypertrophy. There is partial effacement of the fat surrounding the left exiting nerve roots at this level within the neural foramen. These findings are stable compared to the prior exam.At L4-5 there is marked loss of disk space height, disk dessication, diffuse disk bulge and moderate bilateral facet and ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level. The fat surrounding the exiting nerve roots within the neural foramen is not effaced. Overall there is moderate spinal stenosis at this level stable compared to the prior exam. These findings are stable compared to the prior exam. End plate reactive changes are present with milder T2 signal hyperintensity when compared to the prior exam.At L3-4 there is disk dessication, mild diffuse disk bulge and mild to moderate ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level. The fat surrounding the exiting nerve roots within the neural foramen is not effaced. These findings are stable compared to the prior exam.At L2-3 there is disk dessication, minor diffuse disk bulge and minor ligamentum flavum hypertrophy. There is partial effacement of the fat at the lateral recess bilaterally at this level. The fat surrounding the exiting nerve roots within the neural foramen is not effaced. These findings are stable compared to the prior exam.At L1-2 there is disk dessication and a minor diffuse disk bulge. There is redemonstration of a Schmorl's node at this level. There is partial effacement of the fat at the lateral recess bilaterally at this level. The fat surrounding the exiting nerve roots within the neural foramen is not effaced. These findings are stable compared to the prior exam.

Output: 1.There are multilevel degenerative changes present in the lumbar spine worse at L4-5 where there is moderate spinal stenosis present stable since the prior exam. Associated end-plate reactive inflammatory changes have decreased since the prior exam.2.There are degenerative changes present in the cervical spine which are stable compared to the prior exam without significant compromise to the spinal canal or exiting nerve roots.3.Status post upper thoracic spine posterior fusion and laminectomy with resolution of prior spinal stenosis.


Instruction: Generate impression based on findings.

Input: Status post cholecystectomy, elevated LFTs, evaluate for common bile duct stones ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Mild intrahepatic biliary duct dilatation. Dilated common bile duct, measuring up to 9 mm. No focus of signal void in CBD to suggest choledocholithiasis. Mildly undulating contour of liver, nonspecific. Diffuse signal loss on opposed phase imaging, consistent with hepatic steatosis. Small ascites, particularly in perihepatic area/Morison's pouch. Prominent portal veins and splenic vein, may be seen in setting of underlying portal hypertension. SPLEEN: Splenomegaly.PANCREAS: Pancreatic duct measures upper limits of normal, 3 mm. Pancreas divisum, a normal variant, suggested. Intrinsic T1 signal of pancreas preserved.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Tiny T2 hyperintense renal foci, most likely cysts. RETROPERITONEUM, LYMPH NODES: Prominent upper abdominal and retroperitoneal/left paraaortic lymph nodes, measuring up to 1 cm, similar to prior CT imaging.BOWEL, MESENTERY: Moderate stool burden, correlate clinically for constipation.BONES, SOFT TISSUES: Ventral abdominal postsurgical sequela. Mild subcutaneous edema. OTHER: Left base atelectasis.

Output: 1. Biliary ductal dilatation and mildly prominent pancreatic duct, no evidence of choledocholithiasis. No obstructing lesion delineated. Findings likely related to postcholecystectomy state with possible underlying benign stricture, may be further evaluated with ERCP. 2. Hepatic steatosis. 3. Portosplenic venous prominence and splenomegaly, suggestive of portal hypertension. 4. Small ascites. 5. Stable prominent lymph nodes.


Instruction: Generate impression based on findings.

Input: Gliomatosis cerebri and radiation therapy related changes. There are stable post-treatment findings in the brain and unchanged diffuse T2 hyperintensity involving the anterior cerebral hemispheres bilaterally with associated multiple cystic cavities. There is no evidence of associated abnormal intraparenchymal enhancement. There is a subcentimeter T1 hyperintense lesion in the left posterior body of the corpus callosum, which is compatible with a cavernous malformation. A punctate focus of susceptibility effect in the right posterior corpus callosum may also represent a cavernous malformation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, with diffuse cerebral volume loss. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.

Output: Stable post-treatment findings without evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with right occipital hemorrhage, evaluate for source of bleeding. Image quality is degraded by motion artifact. Within this limitation, the following observations are made. A rim-enhancing mass is present in the right occipital lobe measuring 4 x 3 x 2.5 cm. Hemorrhage is evident adjacent to and within the tumor. Moderate edema is seen in the surrounding parenchyma and there is regional mass effect in the form of right lateral ventricular effacement and sulcal effacement. No definite brain herniation is observed. No definite additional enhancing lesions are seen. The ventricular system is otherwise unremarkable.

Output: A hemorrhagic rim-enhancing mass is present in the right occipital lobe. Given the history of cancer, a metastatic lesion is favored. However, a primary brain tumor could present with similar features.


Instruction: Generate impression based on findings.

Input: 40 year old male with Crohn's disease, s/p collectomy, atrial flutter after ablation and after cardiac arrest post-cardioversion presenting for follow up MRI for ventricular function and scar evaluation. Left VentricleThe left ventricle is mildly dilated with moderately reduced systolic. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 110 ml/m2 (normal range: 74+/-15), the LVEDV is 277 ml (normal range 142+/-34), the LV end systolic volume index is 69 ml/m2 (normal range 25+/-9), the LVESV is 174 ml (normal range 47+/-19), the LV mass index is 64 g/m2 (normal range 85+/-15), and the LV mass is 160 g (normal range 164+/-36). The LV dysfunction is global with regional variation . There is mild amorphous late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process present in the anterior, septal and inferior walls as seen previously. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 32%, the RV end diastolic volume index is 128 ml/m2 (normal range 82+/-16), the RVEDV is 323 ml (normal range 142+/-31), the RV end systolic volume index is 87 ml/m2 (normal range 31+/-9), and the RVESV is 220 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 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 mildly dilated with moderately reduced systolic. The overall LV ejection fraction is 37%. The LV dysfunction is global with regional variation. There is mild amorphous late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process present in the anterior, septal and inferior walls as seen previously. 2. The right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 32%.Compared to 11/18/15 CMR, the LGE pattern and LV/RV function appears similar and compared to CMR of 8/7/2015 the RV/LV function is clearly better.


Instruction: Generate impression based on findings.

Input: History of labral repair in 1999 now with recurrent shoulder instability. ROTATOR CUFF: The muscles and tendons of the rotator cuff appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. There is trace fluid within the subacromial/subdeltoid bursa which may not be of clinical significance, and we see no gadolinium within the bursa to suggest rotator cuff tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is depression along the posterolateral aspect of the humeral head indicative of a Hill-Sachs deformity. Tubular signal abnormalities within the anterior glenoid presumably represent suture anchors. Bone marrow signal is otherwise within normal limits. There is mild irregularity of the morphology of the anterior labrum consistent with a prior tear. At approximately the 3:00 position near one of the aforementioned suture anchors, the labrum appears partially detached from the underlying glenoid with gadolinium separating the labrum from the adjacent articular cartilage. Furthermore, there is increased signal intensity partially separating the anterior inferior labrum at the 4-5:00 position from the underlying glenoid. This is particularly evident on abduction external rotation series 12, images 8-11 with near complete detachment of this portion of the labrum from the underlying bone. The superior and posterior aspects of the labrum are unremarkable. The remainder of the articular cartilage of the glenohumeral joint is within normal limits. BICEPS TENDON: The tendon of the long head of the biceps is intact.

Output: Findings suggestive of partial detachment of the anterior and anteroinferior labrum from the underlying glenoid.


Instruction: Generate impression based on findings.

Input: Reason: stage IV melanoma to left leg s/p resection History: assess for recurrence There are small foci of signal void within the lateral soft tissues adjacent to the fibular head which presumably represent metallic susceptibility artifact from prior intervention. Scarring with minimal enhancement is seen within the soft tissues lateral to the fibular head, but we see no mass. There is a small joint effusion extending posteromedially into a Baker's cyst. There is mild nonspecific subcutaneous edema along the anterior aspect of the patellar tendon. There is prominence of the lateral head of the gastrocnemius which may reflect herniation through the deep fascia, but this appears similar to the prior study. Osteoarthritis affects the knee. The bone marrow signal intensity otherwise appears normal.

Output: Surgical scarring within the soft tissues along the fibular head and other findings as described above. We see no evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: Metastatic small cell lung cancer treated with WBRT on 9/27/16. There are postoperative findings related to right frontal craniotomy, with underlying confluent high T2 signal with encephalomalacia and susceptibility effect in the right frontal lobe, and an unchanged subcentimeter area of enhancement. Otherwise, there are multiple supratentorial and infratentorial lesions, some of which have not significantly changed or are smaller, while some are larger. For example, a left middle frontal gyrus lesion measures up to 9 mm in diameter, previously 5 mm, and displays increased vasogenic edema, a right perirolandic lesion measures 17 mm, previously 12mm, and displays increased vasogenic edema, a left cerebellar lesion measures up to 7 mm, previously 10 mm, and displays less enhancement, a left thalamus lesion measures up to 5 mm, previously 9 mm, and a posterior medulla lesion measures approximately 5 mm in diameter, previously also 5 mm. In addition, there is a new punctate left posterior cingulate gyrus lesion. Many of the lesions contain hemorrhagic components with high T1 signal. There is no evidence of acute territorial 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.

Output: 1. Findings suggestive of mixed response of the multiple intracranial metastases.2. Postoperative findings related to right frontal craniotomy, with an unchanged nonspecific subcentimeter area of enhancement.


Instruction: Generate impression based on findings.

Input: 36 years Male (DOB:12/3/1979)Reason: 1 year surveillance CCM; CCM Protocol, QSM, permeability, 3T Scanner History: visual problemsPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD There is redemonstration of a hemorrhagic focus centered in the right optic tract and adjacent basal ganglia which since the prior exam has enlarged along the right optic tract, right side of the optic chiasm and posterior most aspect of the right optic nerve. The component that extended into the right optic tract and optic nerve has an exophytic appearance and extends into the suprasellar cistern. The optic nerve component is adjacent to the right A1 segment. There are fluid-fluid levels present within 2 components of this cavernous malformation now. One fluid fluid level which is new is located at the optic tract and is new compared to the prior exam and measures approximately 7 mm diameter the other one is located in the right basal ganglia and measures 5 mm.There is redemonstration of a developmental venous anomaly in the left frontal lobe.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since previous examination the patient's right optic tract and basal ganglia cerebral cavernous malformation has enlarged predominantly along the the right side of the optic chiasm and right optic nerve in an exophytic manner.


Instruction: Generate impression based on findings.

Input: Male, 57 years old, with metastatic limited to the brain status post whole brain radiotherapy, currently on PD1 antibody. Multiple supratentorial and infratentorial lesions are redemonstrated, all of which have decreased in size since the prior examination. In addition, whereas on prior exams these lesions were enhancing, they are no longer clearly enhancing but rather demonstrate intrinsic T1 hyperintensity, potentially related to melanin and/or mineral deposition, less likely blood product. Mild edema surrounding several of these lesions has improved or resolved, and none induces significant mass effect. No new intracranial lesions are seen. No new areas of parenchymal signal abnormality are detected. The ventricles are normal in size and morphology. No abnormal fluid collections are identified.

Output: Continued response to therapy is seen with further decrease in the size of multiple supratentorial and infratentorial lesions. In addition, these lesions are no longer frankly enhancing but instead are intrinsically T1 hyperintense likely representing a treatment effect. No new intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: 53-year-old BRCA1 positive female. Family history of prostate and lung cancer in her father, ovarian cancer in her aunt and cousin. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. A stable 4-5 mm round focus in the anterior inferior right breast is noted. A 5 mm enhancing skin lesion along the inferior left breast is present, typically benign and should be correlated with physical exam. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy within the breasts. Enhancing focus within the skin of the left inferior breast should be correlated with physical exam. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed.


Instruction: Generate impression based on findings.

Input: History of Crohn's disease. Evaluate for active inflammation and stricture. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology signal intensity and enhancement. No biliary ductal dilatation. No focal suspicious lesion. No vascular abnormality. Normally distended gallbladder.SPLEEN: The spleen is normal in size.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: The small and large bowel is normal in caliber. The terminal ileum is normal in wall thickness without adjacent inflammatory changes. No abnormal postcontrast enhancement or restricted diffusion. No fluid collections. No significant fibrofatty infiltration. Small nonspecific right mesenteric lymph nodes. Normal appendix.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.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: No evidence of active bowel inflammation. No significant stricture or bowel dilatation.


Instruction: Generate impression based on findings.

Input: 52-year-old with known left breast cancer for MRI to evaluate response to neoadjuvant chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Two known proven cancers are again demonstrated in the left breast, and both masses show significant volume reduction. The posterior mass measures 9 x 10 x 18 mm (previously: 22 x 18 x 26 mm). Artifact compatible with a biopsy clip is seen along the lateral aspect of the posterior mass. A small satellite lesion seen on the previous study anterior to this mass is no longer present. The anterior mass measures 12 x 14 x 11 mm (previously: 18 x 19 x 26 mm). Overall extent is 18 x 16 x 35 mm (previously 33 x 18 x 51 mm). No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region. Mild surgical changes are present in the left axilla.

Output: Significant reduction in volume of left breast cancerBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: There is no evidence of mass or acute infarct. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major intracranial arterial flow voids are intact and appear to be within normal caliber. However, the details of arterial branches especially posterior fossa branches such as superior cerebellar artery, AICA and PICA are not clearly visualized.The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is unchanged severe hypoplasia of the vermis with only minimal residual superior vermian tissue as well as severe cerebellar hemispheric hypoplasia, right greater than left. The brain stem is also hypoplastic, notably the pontine belly. The posterior fossa is not significantly expanded.All above described findings are compatible with cerebellar incomplete agenesis or hypogenesis. And these findings do not show any significant interval change since prior exam.There is an unchanged 11 mm T1 isointense pineal cyst.

Output: 1.Unchanged cerebellar incomplete agenesis and brainstem hypoplasia. An MRA is recommended to further characterize the intracranial vasculature. 2.Unchanged 11 mm pineal cyst.