Instruction: Generate impression based on findings.

Input: 37 yo M with recent diagnosis of cardiomyopathy, large left-sided ACA/MCA stroke. Found to have a large apical thrombus. Referred for cardiac MRI to rule out infiltrative diseases. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 28%. The LVEDV is 340 ml (normal range 142+/-34), the LV end diastolic volume index is 162 ml/m2 (normal range: 74+/-15), the LVESV is 244 ml (normal range 47+/-19) and the LV end systolic volume index is 116 ml/m2 (normal range 25+/-9). The LV mass is 294 g (normal range 164+/-36) and the LV mass index is 140 g/m2 (normal range 85+/-15). There is moderate left ventricular hypertrophy. There is global hypokinesis. The intraventricular septum measures 16 to 17 mm in thickness. There is patchy diffuse, subendocardial and transmural late gadolinium enhancement localized largely to the base to mid myocardium suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native T1 myocardial relaxation time is <1100 ms (normal) in the ventricular septum and 1179 ms (abnormal) in the lateral ventricular wall. The latter value are suggestive of underlying diffuse fibrosis or infiltration.There is no obvious LV thrombus. Differential diagnosis of this pattern and distribution of late gadolinium enhancement includes infiltrative cardiomyopathies including cardiac amyloidosis.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is upper normal in size with normal systolic function. The overall RV ejection fraction is 52%. The RVEDV is 252 ml (normal range 142+/-31), RV end diastolic volume index is 120 ml/m2 (normal range 82+/-16), the RVESV is 122 ml (normal range 54+/-17), and the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is trivial to mild 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.AortaPseudo-bovine arch noted. Aortic sinus of valsalva 41 mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 28%.There is global hypokinesis. 2.There is moderate left ventricular hypertrophy. The intraventricular septum measures 16 to 17 mm in thickness. 3.There is patchy diffuse, subendocardial and transmural late gadolinium enhancement localized largely to the base to mid myocardium suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native T1 myocardial relaxation time is <1100 ms (normal) in the ventricular septum and 1179 ms (abnormal) in the lateral ventricular wall. The latter value are suggestive of underlying diffuse fibrosis or infiltration.Differential diagnosis of this pattern and distribution of late gadolinium enhancement includes infiltrative cardiomyopathies including cardiac amyloidosis.4.There is no obvious LV thrombus. 5.The right ventricle is upper normal in size with normal systolic function. The overall RV ejection fraction is 52%.These constellation of findings are suggestive of an infiltrative cardiomyopathy including cardiac amyloidosis. Cardiac biopsy may help determine the etiology if clinically appropriate. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 51 years, Male, subarachnoid hemorrhage, recent catheter angiogram negative with prior CTA questioning tiny aneurysm or venous structure. Brain: Examination is motion degraded. Again seen is extensive subarachnoid hemorrhage involving the subarachnoid cisterns, cortical sulci, as well as intraventricular hemorrhage as demonstrated on recent CT. There is a right transfrontal ventriculostomy catheter with tip near the right foramen of Monro. Ventricular system appears decompressed without evidence of hydrocephalus.Evaluation of the brain parenchyma demonstrates restricted diffusion in the midbrain at the level of the periaqueductal gray matter with associated T2/FLAIR hyperintensity in the paramedian midbrain as within the ventral aspect of the pons. No findings to suggest parenchymal hemorrhage are appreciated. No intracranial mass or mass effect. No parenchymal or meningeal enhancement.Cervical Spine: Examination is motion degraded. Vertebral body heights in the cervical spine are normal. Alignment is grossly maintained. No findings to suggest hemorrhage within the cervical spinal canal is appreciated. No intramedullary or extramedullary mass is appreciated in the cervical spinal canal. No obvious cord signal abnormality is appreciated within the limitations of motion degradation. Moderate degenerative changes are seen with multilevel disc osteophyte complexes and moderate degree of cervical spinal canal stenosis at C3-C4, C4-C5, and C5-C6.

Output: 1. Examination is significantly motion degraded however demonstrates no clear source of subarachnoid hemorrhage in the brain or cervical spine.2. Restricted diffusion involving the periaqueductal gray matter, with T2/FLAIR hyperintensity in the bilateral midbrain as well as within the ventral aspect of the pons. Findings suggest edema and ischemic injury. Osmotic demyelination also remains a possibility although distribution is not characteristic.3. Extensive subarachnoid hemorrhage involving the subarachnoid cisterns, cortical sulci, and to a lesser degree ventricles as seen on recent CT. Right transfrontal ventriculostomy catheter in place without evidence of hydrocephalus.4. Moderate degree of cervical spinal canal stenosis from C3-4 to C5-6. No obvious intramedullary or extramedullary lesion is seen in the cervical spine within the limits of motion degradation.


Instruction: Generate impression based on findings.

Input: 71 year old man with CAD s/p CABG in 1998 (LIMA-LAD, SVG-D1), with recent PCI to SVG in 11/15 and again in 2/16 for ISR, referred fo revaluation of chest pain. MEDICATIONS: ASA, PLavix, Cilostozol, lisinopril, metoprolol First Pass PerfusionDuring hyperemia, there is a perfusion defect in the basal anterior wall and antero-lateral wall. In the mid-ventricle has a perfusion defect involving the inferoseptum, anteroseptum, anterior, and anterolateral walls. The overall ischemia score is 8 out of a possible 32. Approximately 25% of the myocardium is ischemic. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 58 ml/m2 (normal range: 74+/-15), the LVEDV is 111 ml (normal range 142+/-34), the LV end systolic volume index is 18 ml/m2 (normal range 25+/-9), the LVESV is 34 ml (normal range 47+/-19), the LV mass index is 45 g/m2, and the LV mass is 85 g. There is mild concentric LVH. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 126 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 54 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation. There is mild systolic anterior motion of the mitral valve leaflets causing mild flow acceleration in the left ventricular outflow tract. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.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. During hyperemia, there is a large perfusion defect as described above. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 69%).4. Normal RV size and systolic function (RVEF 57%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: SomnolenceClinical question: cause of altered mental statusSigns and Symptoms: altered mental status There is left-sided intraventricular blood present and to a lesser degree right-sided intraventricular blood.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and FLAIR hyperintense lesions are also present in the right thalamus, right external capsule and in the brainstem.Some susceptibility effect is identified along the tract coursing through the right frontal lobe into the right lateral ventricle presumably related to prior ventriculostomy tube which can be identified on recent head CTs and has since been removed.There is a high signal focus present along the caudate tail the subependymal region adjacent to the left lateral ventricle measuring approximately 18 x 4 mm axial dimensions.There are a couple foci of punctate signal loss on susceptibility imaging present. One is located within the left thalamus, one is located in the right frontal lobe subcortical white matter.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. The eyeball lenses are thin.Some retained secretions are present in the nasopharynx status post nasogastric tube placement.

Output: 1.There is intraventricular blood present predominantly in the left lateral ventricle. There is associated intraparenchymal blood along the subependymal region along the caudate tail adjacent the body of the left lateral ventricle. Presumably this represents the source of bleeding.2.Lesions in the right thalamus and right external capsule most likely represent lacunar old infarcts3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Abnormality of gait [781.2] / Dizziness and giddiness [780.4], Reason for Study: ^Reason: Pt with acute onset of vertigo imbalance in January 2015; persistent imbalance; r/o labyrinthitis, neuronitis, etc.; evaluate semicircular canals The brainstem, cerebellum, vermis and tonsils are normal. The inner ear structures, cochlea, vestibule, semicircular labyrinth are normal. The internal auditory canals are normal with delineation of the facial, cochlear and vestibular nerves. No evidence of signal abnormality, mass or abnormal enhancement is noted.

Output: Normal IAC MRI.


Instruction: Generate impression based on findings.

Input: 76-year-old woman with history of metastatic breast cancer and right upper quadrant abdominal pain. Dilated CBD on ultrasound. ABDOMEN:LIVER, BILIARY TRACT: There is intra and extrahepatic biliary duct dilatation with the distal common bile duct measuring up to 10 mm in diameter (series 4, image 15). The distal common bile duct tapers smoothly to the ampulla. No extrinsic compressing lesion is identified. No ampullary lesion identified.There is a 20 x 20 mm segment 4 hepatic cyst (series 4, image 28) in addition to multiple, scattered subcentimeter cysts.SPLEEN: The spleen is normal.PANCREAS: The pancreatic duct is mildly prominent and there is a patent accessory pancreatic duct. The pancreas is otherwise normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There are bilateral renal cysts, otherwise the kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Multiple polypoid lesions are noted in the transverse colon (series 4, images 1 and 3) measuring up to 12 mm without significant enhancement. The remaining small bowel and colon are otherwise unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right pleural soft tissue and loculated fluid collections are again noted similar to CT from 10/28/2015.

Output: 1.Intra and extrahepatic biliary duct dilatation to the level of the ampulla without obstructing intraluminal or extrinsic lesion.2.Transverse colonic polypoid lesions which can be evaluated with colonoscopy as clinically warranted.3.Right pleural disease as characterized on prior studies.


Instruction: Generate impression based on findings.

Input: Other abnormal clinical finding [796.4], Reason for Study: ^Reason: f/u MRI History: period of transient confusion Previously seen subtle enhancing left caudate head lesion is not enhancing anymore.Instead, on T2 weighted image as well as FLAIR imaging shows focal tissue loss indicating chronic ischemic infarct.There is no evidence of additional abnormal cyst enhancement on the scan.There are bihemispheric patch minimal high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, 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. Previously seen subtle enhancing lesion on the left caudate head does not show evidence of enhancement on today's scan, instead, on T2 and FLAIR images, the lesion area show subtle tissue loss, indicating small lacunar infarction.2. Minimal non specific small vessel ischemic disease.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis type II. Bilateral tinnitus. Headache. BRAIN:The nodular thickening of the supratentorial dura over the cerebral convexities is very minimally increased since the previous examination from October 2014. For example, the largest component overlying the right parietal lobe has a maximum thickness of 9 mm on coronal imaging, compared to 7 mm previously. While multiple meningiomas also abut the superior sagittal sinus, its T2 flow-void is largely preserved.The more focal dural-based, contrast-enhancing mass arising from the undersurface of the left tentorium cerebelli posteriorly has slightly increased in size. In the axial plane, it now measures 18 mm x 15 mm compared to 13 mm x 12 mm in October 2014 and 12 mm x 12 mm in May 2013. It causes mass-effect on the adjacent cerebellum but no intrinsic signal abnormality with preserved intervening CSF cleft. The adjacent left transverse sinus is preserved as well.Right frontal ventriculostomy catheter is unchanged, with its tip lying in the body of the right lateral ventricle. The lateral and third ventricles remain small in size. There is unchanged severe thinning of the anterior corpus callosum body and the posterior part of the genu. Focal T2-hyperintensity in the subcortical white-matter of the in the medial posterior left frontal lobe remain unchanged. There is no midline shift or brain herniation. There is no intra-axial mass. The frontal and parietal sulci remain slightly larger on the left.Susceptibility effect along the tract of the right ventriculostomy catheter and in ventricular lining in the region of the ventriculostomy catheter is unchanged. There is no acute intracranial hemorrhage. There is trace ethmoid and maxillary sinus mucosal thickening. The orbits are grossly unremarkable.INTERNAL AUDITORY CANALS:Similar to the meningiomas, the contrast-enhancing masses within the internal auditory canals, compatible with bilateral schwannomas, are very minimally increased compared to the previous examinations. The largest, which is on the left, measures 7 mm x 5 mm now, compared to 6 mm x 4 mm in October 2014 and 5 mm x 5 mm in May 2013.

Output: 1.Compared to October 2014 examination, the right frontal ventriculostomy is unchanged nor the slipped line lateral and third ventricles. Also, severe corpus callosal thinning and the focal abnormal left frontal lobe signal remain unchanged and probably reflect sequela of prior insult. 2.Numerous meningiomas or meningiomatosis, predominantly supratentorial, are very minimally increased compared to the previous examination of October 2014. 3.Similarly, the bilateral vestibular schwannomas are minimally increased compared to the previous examinations of October 2014 and May 2013. 4.Hemosiderin staining along the right frontal ventriculostomy remains unchanged. There is no acute hemorrhage.


Instruction: Generate impression based on findings.

Input: 6-year-old male with history of ATRT. status post radiation and chemotherapy. History of syrinx and spinal cord untethering. Evaluate syrinx There are stable postoperative findings in the posterior fossa related to prior tumor resection. Susceptibility from a right occipital ventriculostomy catheter partially obscures evaluation of the posterior fossa. Deformity of the right cerebellar hemisphere surrounding the resection cavity appears similar to the prior exam. CSF flow analysis shows mild attenuation of biphasic flow at the level of the from foramen magnum anteriorly with no flow identified posteriorly. There is septated syringohydromyelia extending from C4 through L3 which is slightly improved in the cervical spine but unchanged in the thoracic and lumbar spine. For example, at the level of the inferior plate of C5, it measures 5 x 3 mm (1801/18), previously 6 x 5 mm. There are new hypointense foci throughout the cord which demonstrate susceptibility, compatible with air foci from recent surgery.Vertebral body heights and disk spaces are maintained. Alignment is anatomic. There is no significant spinal canal stenosis. There is increased yellow marrow from T12 through S5 which is likely related to prior radiation. There are postsurgical changes of the L5 laminectomy. The conus is low lying, similar to the prior exam. The distal cord and cauda equina are thickened and clumped along the posterior thecal sac, appearing similar to the prior exam. There is no significant anterior motion on prone images.

Output: 1.Extensive syringohydromyelia, slightly increased in the cervical spine and unchanged in the thoracic and lumbar spine.2.Postsurgical changes of the L5 laminectomy. Appearance of the distal cord and conus is similar to the prior exam.3.Postsurgical changes in posterior fossa are unchanged.


Instruction: Generate impression based on findings.

Input: 28 year old with biopsy proven left breast IDC and DCIS, grade 3, with metastatic left axillary lymph node. Status post neoadjuvant chemotherapy, evaluate response There is extreme amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Interval reduction in the intensity of enhancement at left nipple and periareolar region, measuring 15 x 15 mm, previously measured 22 x 30 mm (LR x CC), consistent with known Paget's disease.Interval reduction in diffuse non-mass enhancement in the left breast, with overall measurement of 48 x 61 x 59 mm, previously measured 60 x 75 x 82 mm (AP x LR x CC). Previously described invasive component/mass is not seen on today's imaging.Two marker clip artifacts are present side by side at far lateral axillary tail in the left breast. In the left axilla, there are two normal morphology lymph nodes measuring 12 and 6 mm respectively, previously measured 19 mm and 13 mm. There is a metallic artifact from marker clip within the larger lymph node. No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identifiedin right axillary region.

Output: 1. Moderate interval reduction in the diffuse non mass enhancement of the left breast and that he is able to region.2. Complete imaging response of the invasive component/mass in the lateral left breast.3. Normal morphology left axillary lymph nodes.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 33-year-old female with pain, unspecified rotator cuff tear or rupture of left shoulder, not specified as traumatic. Evaluate rotator cuff for preoperative planning, TSA. ROTATOR CUFF: There is a chronic full-thickness supraspinatus tendon tear with associated elevation of the humeral head. There is generalized atrophy of the infraspinatus, teres minor and subscapularis muscles, otherwise the tendons appear intact.SUPRASPINATUS OUTLET: As above, there is full-thickness chronic supraspinatus tendon tear with associated elevation of the humeral head. GLENOHUMERAL JOINT AND GLENOID LABRUM: There is heterogeneous and intermediate signal intensity within the glenohumeral joint likely pannus formation.BICEPS TENDON: The long head of the biceps tendon is not well visualized.ADDITIONAL

Output: Chronic rotator cuff supraspinatus tendon tear with elevation of the humeral head. There is generalized atrophy of the remaining rotator cuff musculature.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with elevated IgM-1 concerning for acromegaly. Need pituitary imaging. Signs and symptoms: As above. Pre- and post enhanced pituitary MRI:Examination demonstrates normal signal intensity, morphology and pattern of enhancement of the pituitary gland as well as pituitary stalk. Unremarkable suprasellar visual complex. Unremarkable cavernous sinuses. Unremarkable images to the skull base.Pre- and post enhanced brain MRI:Negative diffusion weighted images.FLAIR and T2-weighted images demonstrate multiple punctate and patchy foci of hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and a few punctate foci in the pons. Findings are nonhemorrhagic and nonenhancing. Although nonspecific considering patient's stated age possibility of chronic small vessel ischemic strokes should be considered. The morphology and signal intensity of brain parenchyma is otherwise within normal MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces. There is no evidence of any abnormal enhancement of brain parenchyma, leptomeninges, calvarium or the orbits.Normal pneumatization signal pattern of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.

Output: 1.Unremarkable pre and post enhanced pituitary MRI.2.Pre- and post enhanced MRI of the brain demonstrate findings suggestive of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical - periventricular white matter and minimally of the pons and unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: 50 year old woman with history of hypertension, diabetes, admitted with new diagnosis of heart failure and recent URI, referred for cardiac MRI to evaluate for underlying etiologies/ rule out myocarditis. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 125 ml/m2 (normal range: 65+/-11), the LVEDV is 252 ml (normal range 109+/-23), the LV end systolic volume index is 83 ml/m2 (normal range 18+/-5), the LVESV is 169 ml (normal range 31+/-10), the LV mass index is 71 g/m2 (normal range 67+/-11), and the LV mass is 144 g (normal range 114+/-24). LV dysfunction is global with regional variation. There is no evidence of increased T2-signal to suggest myocardial edema. There is no evidence of early gadolinium enhancement to suggest capillary leak/ inflammation. There is no late gadolinium enhancement to suggest the presence of underlying myocardial fibrosis, inflammation, or infiltration. T2-star time is normal suggesting no myocardial iron overload. Left AtriumThe left atrium is moderate-severely increased in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 139 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 66 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThere is bi-leaflet tethering of the mitral valve. There is severe 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 bovine 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are small bilateral pleural effusions, right greater than left. See recent CT chest for lung details. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe LV dilation with moderately reduced LV systolic function (LVE F33%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 53%).3. Moderate to severe left atrial dilation.4. Severe mitral regurgitation due to bileaflet tethering.5. Mild main pulmonary artery dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left neck merkel cell carcinoma. There is a heterogeneously enhancing mass in the left parotid gland, which measures up to 35 mm. There is extension of a small amount of tumor into the overlying subcutaneous tissues. There is an additional nodule in the left parotid gland inferior to the mass that measures up to 18 mm. The other salivary glands are unremarkable and there is no evidence of tumor or significant lymphadenopathy elsewhere in the neck. The osseous structures are unremarkable, aside from multilevel degenerative cervical spondylosis. The imaged intracranial structures are unremarkable. There is mild mucosal thickening in the left frontal and ethmoid sinuses.

Output: Findings compatible with metastatic Merkel cell carcinoma in the left parotid gland.


Instruction: Generate impression based on findings.

Input: Liver lesions. Stated history of hepatocellular carcinoma status post TACE/RFA of segment 5 and segment 7/8 (8/11/2014 at OSH). Per EPIC note: Segment 7/8 was HCC; Segment 5 CCA. History of Wilms tumor status post radical right nephrectomy. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with nodular contour and areas of fibrosis.Segment 5 ablation cavity measuring 2.0 x 1.9 cm (series 11/124) with internal blood products/hemorrhage. Along the anteroinferior margin of the ablation cavity there is arterial enhancement measuring 1.9 x 1.5 cm. This does not appear to progress on delayed imaging or wash-out but rather persists or is iso-intense to the liver parenchyma. There is no definite associated DWI or T2WI signal abnormality. Segment 7/8 radiofrequency ablation cavity measures 2.2 x 1.3 cm (series 11/24). No evidence of residual or recurrent tumor.Several peripheral punctate foci of arterial enhancement without associated washout or other signal abnormality are unchanged and are likely perfusional abnormalities.No new suspicious lesion. The vessels are patent.Normally distended gallbladder. Stable minimal peripheral biliary ductal dilatation of the inferior medial segment of the left hepatic lobe. SPLEEN: The spleen measures 10 cm in length without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Minimal adrenal nodularity measuring less than 1 cm, unchanged.KIDNEYS, URETERS: Status post right nephrectomy without evidence of residual or recurrent disease in the surgical bed. Subcentimeter left inferior pole simple appearing cyst is unchanged. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Arterial enhancement along the anteroinferior margin of the segment V RFA cavity does not appear to progress on delayed imaging or wash-out but rather persist or is iso-intense. There is no definite associated DWI or T2WI signal abnormality. Given that this lesion was reportedly a cholangiocarcinoma residual/marginal recurrent disease cannot be excluded although a perfusional abnormality is a possibility. Short interval follow-up is recommended if definitive evaluation (biopsy) or treatment is not pursued at this time. 2.Segment 7/8 ablation cavity without evidence of residual or recurrent tumor.3.Cirrhosis with mild fibrotic changes.


Instruction: Generate impression based on findings.

Input: 28 year-old BRCA1 positive female with abnormal enhancement left breast tissue represents for biopsy. On subtraction images, there is nonmass enhancement in the medial left breast 10:00 position, similar in appearance to MRI 12/17/2015.This was chosen as the target.PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 11 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show a small hematoma at the biopsy site. An ATEC clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a left unilateral mammogram CC and ML views to locate the percutaneously placed clip. The clip is placed at 10 o'clock position with small hematoma seen medial to the clip. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Udoji under direct supervision of Dr. Schacht who was present throughout the procedure.

Output: Successful MR guided core needle biopsy of the left breast 10 o'clock enhancing lesion. Successful clip placement. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Male 53 years old Reason: 53M w/ PMHx of necrotizing pancreatitis 06/2015 with persistent pain, MRI 01/2015 peri-pancreatic fluid collections, eval for necrotic debris vs fluid? History: abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No definite focal hepatic lesions. Intrahepatic portal vein and hepatic veins are patent. There is mild central intrahepatic biliary ductal dilatation. Common bile duct is dilated measuring up to 14 mm. There is a focal segment of narrowing in the pancreatic head measuring 1.7 cm. This is about the level of the ampulla.SPLEEN: Spleen is mildly enlarged. Splenic vein is severely narrowed and likely thrombosed. The superior mesenteric vein also shows poor filling.PANCREAS: Pancreas is completely necrotic. In its place there is a large heterogeneous collection with internal debris measuring 11.6 x 4.4 cm it extends from the expected location of the pancreatic head to the tail. Very little identifiable normal pancreatic tissue. There are small pockets of fluid in the left upper abdomen lateral to the stomach which might communicate with the pseudocyst.ADRENAL GLANDS: Left adrenal gland is nodular and thickenedKIDNEYS, URETERS: No hydronephrosis either kidney. Left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Wall thickening of the second and third portion of the duodenum with submucosal edema. There is wall thickening of the jejunum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amounts upper abdominal mesenteric ascites.

Output: 1.Extensive pancreatic necrosis with a large pseudocyst replacing the pancreatic parenchyma. There is narrowing of the common bile duct for a 1.7 cm segment at the level of the ampulla that causes mild intrahepatic biliary ductal dilatation.2.Thrombosis of the splenic vein and possible poor filling of the superior mesenteric vein.3.Thickening of the duodenal wall involving the second, third portions of duodenum extending to the proximal jejunum.


Instruction: Generate impression based on findings.

Input: History of multiple sacral decubitus ulcers with green discharge, lower extremity paralysis, bedbound. Osteomyelitis? There are multiple soft tissue defects posteriorly. A large gas-filled defect to the left of midline extends to the ischial tuberosity with enhancement of the adjacent soft tissues indicating inflammation. There is abnormal signal intensity and enhancement of the ischial tuberosity indicating osteomyelitis. Nonenhancing tissue also extends from the skin surface of the upper medial right thigh posteriorly to the right ischium, with enhancement of the adjacent soft tissues indicating inflammation. There is focal signal abnormality and enhancement of the adjacent ischial tuberosity that is suggestive of focal osteomyelitis. Nonenhancing tissue is also noted extending from the greater trochanters bilaterally to the posterior skin surface with enhancement of the adjacent soft tissues indicating inflammation. Although there is perhaps minimal enhancement of the underlying marrow of the greater trochanters, the fatty marrow signal intensity on the unenhanced on T1-weighted images is relatively preserved, arguing against osteomyelitis. Evaluation of the lower lumbar spine and sacrum is limited by metallic susceptibility artifact related to orthopedic hardware. There is ulceration of the soft tissues posterior to the sacrum and coccyx. Abnormal signal intensity and enhancement of the underlying in the lower sacral segments and coccyx is suspicious for osteomyelitis as well.There is a peculiar signal intensity pattern of the bone marrow of the pelvis and proximal femora. On the STIR sequences, the signal intensity of the majority of the left innominate bone and sacrum suppresses, as would be expected with fatty marrow. The right innominate bone however is of relatively increased signal intensity on the STIR sequence and shows heterogeneous signal intensity on the T1-weighted sequences. The process involving the right innominate bone is presumably the same process causing the mottled appearance of the right innominate bone and proximal femur on a prior CT scan; of note, I see no increased enhancement of the right innominate bone, nor was there FDG avidity of the bone on the prior PET scan. This could reflect treated tumor or perhaps osteonecrosis. A 3 cm focus of abnormal signal intensity in the intertrochanteric region of the left femur corresponds to a lesion on CT with a sclerotic rim, also perhaps representing treated tumor or osteonecrosis. This likewise did not show uptake on the recent PET scan.A small amount of fluid is noted within both hip joints but I see no large joint effusion. There is generalized increased signal intensity of the musculature on the fat-suppressed T2-weighted images which may reflect edema, but I see no frank enhancement of the musculature (other than that adjacent to the aforementioned ulcers) to confirm inflammation. There is also edema of the subcutaneous tissues. I see no drainable fluid collection. There appears to be relative loss of subcutaneous fat involving the upper right thigh compared to the upper left thigh. There is a Foley catheter in the bladder.

Output: 1. Extensive decubitus ulceration with tracks leading to both ischia and both greater trochanters. There are findings of osteomyelitis of the ischia, particularly on the left. Preservation of fatty marrow within the greater trochanters on the T1-weighted images argues against osteomyelitis of the proximal femora. Abnormal signal intensity and enhancement of the lower sacral segments and coccyx is also suspicious for osteomyelitis. The diagnosis of osteomyelitis was relayed to the clinical service prior to dictation.2. Peculiar bone marrow signal intensity pattern as described above may reflect treated tumor or perhaps osteonecrosis.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 77-year-old male status post fall. Question bleed question fracture. Review of prior studies indicates the patient has metastatic melanoma. Numerous brain masses are present. A prominent high attenuation mass in the high convexity of the right frontal lobe (series 6900 image 30) measures 1.1 x 0.9 cm. This lesion was not visualized on the MRI dated 3/2/2009. A high attenuation lesion in the right parietal lobe (series 6900 image 22) is also not clearly visualized on the previous MRI. Two high attenuation lesions in the right cerebellar hemisphere are faintly visible on post contrast images of the the study dated 3/2/2009. The large lesion seen in the left temporal lobe on the previous MRI is not well visualized on today's study.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT evidence of traumatic hemorrhage or fracture.2. Numerous high attenuation lesions scattered throughout the cerebral hemispheres and cerebellum -- consistent with hemorrhagic metastases from the patient's known melanoma.


Instruction: Generate impression based on findings.

Input: Ms. Walker is a 56-year-old female presenting for further evaluation of a suspicious right breast mass. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.RIGHT BREAST: In the right inferior breast, 6:00 location, there is an irregular enhancing mass identified measuring approximately 2.0 x 1.3 x 1.9 cm (AP x ML x SI). Seen just superomedial to this is an additional irregular enhancing mass measuring approximately 1.0 x 0.8 x 0.7 cm. The total span of abnormal enhancement (index mass + suspected satellite lesion) measures approximately 2.7 cm in the AP oblique dimension. In addition, there is a circumscribed enhancing mass seen in the right upper outer breast, 10:00 location, measuring approximately 0.6 x 0.9 cm. This corresponds to the sonographically identified intramammary lymph node. There is an additional circumscribed enhancing mass seen in the right inferior breast, 6:00 location, measuring 0.6 x 0.7 cm. An ultrasound will be performed to further evaluate this lesion.LEFT BREAST: A few enhancing foci are seen in the left breast, none of which are more suspicious than the rest. There is no abnormal enhancement seen in the left breast. AXILLAE: There is an abnormal morphology lymph node identified in the right axilla, measuring approximately 1.1 x 0.8 x 1.1 cm. There are no abnormal lymph nodes identified in the left axillary or internal mammary region.

Output: (1) 2.0 cm suspicious mass in the right inferior breast, for which an ultrasound-guided biopsy and clip placement will be performed immediately after MRI.(2) Additional suspected satellite lesion seen just superomedial to the index malignancy. An MR directed ultrasound will be performed for confirmation of this finding.(3) Abnormal right axillary lymph node, for which ultrasound-guided biopsy and clip placement will be performed immediately after MRI.(4) 0.9 cm intramammary lymph node in the right upper outer breast, for which ultrasound-guided biopsy and clip placement will be performed immediately after MRI.(5) Additional circumscribed enhancing mass in the right inferior breast, suspected to be a benign intramammary lymph node. An MR directed ultrasound will be performed for confirmation of this finding.(6) No MRI evidence for malignancy in the left breast. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: With ischemic lesions. Signs and symptoms: Encephalopathy. Nonenhanced brain MRI:Diffusion weighted images demonstrate no evidence of a new foci of acute ischemic stroke since prior study. The right anterior frontal subcortical foci of acute ischemic stroke noted on prior MRI from 4 -- 1 -- 15 is less conspicuous on current study.Acute hemorrhage in the left anterior temporal lobe and the extension into the left basal ganglia, surrounding vasogenic edema and associated mass effect on the adjacent cortical sulci and the frontal horn of the left lateral ventricle demonstrate subtle interval decreased and change in signal intensity consistent with expected evolution of hematoma. Small amount of residual acute blood in dependent bilateral occipital horns demonstrate interval decreased. The ventricular system remain within normal size and is stable since prior exam. Although there is no evidence of new restricted diffusion the subcortical small vessel ischemic stroke in the right hemisphere demonstrates subtle interval increase since prior exam (axial flair 501 image 21).Extensive chronic lacunar infarcts of the pons and chronic right cerebellar ischemic strokes are again noted without change.

Output: 1.No detectable new acute ischemic stroke as is questioned clinically. Right frontal subcortical focus of restricted diffusion seen on prior exam is less conspicuous on current study.2.The left hemispheric hemorrhage demonstrate signal changes consistent with interval evolution and subtle decreased mass effect.3.Extensive chronic ischemic strokes in the periventricular and subcortical white matter, bilateral basal ganglia, pons and right cerebellum are again identified. Finding in the right hemispheric subcortical white matter appear more conspicuous on current exam without evidence of restricted diffusion.


Instruction: Generate impression based on findings.

Input: 82-year-old male patient with HCC. Evaluate for interval change since prior MRI. ABDOMEN:LIVER, BILIARY TRACT: Fissure widening and nodular contour compatible with cirrhotic liver morphology. No biliary ductal dilatation. Multiple subcentimeter T2 hyperintense lesions in the liver parenchyma are too small to characterize and likely represent cysts. Trace perihepatic ascites.Again seen is a segment 4 ablation cavity with high T1 signal intensity. Posterolateral to the ablation cavity there is a peripherally enhancing lesion without central enhancement or washout on delayed images that measures 1.9 x 3.2 cm (series 9 image 26). This area previously demonstrated enhancement and washout and measured 1.0 x 1.8 cm. There is currently increased mass effect with attenuation of the middle hepatic vein.Scattered foci of arterial enhancement without washout are noted in the peripheral liver parenchyma, compatible with perfusion anomalies.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable right upper pole small wedge-shaped T2 hyperintensity.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval increase in size of lesion posterolateral to the segment 4 ablation cavity. This lesion now has increased mass effect on the middle hepatic vein and demonstrates persistent peripheral enhancement. Findings are suspicious for increasing size of marginal recurrence.2.Cirrhotic liver morphology.


Instruction: Generate impression based on findings.

Input: Oropharyngeal fibroma status post biopsy. There is a residual subcentimeter mild nodular mucosal thickening in the region of the right tongue base and glossotonsillar sulcus without extension into the deeper tissues of the tongue. There is no significant lymphadenopathy in the neck. The thyroid and major salivary glands are unremarkable. The major cervical flow voids appear to be patent. There is a 15 mm diameter perineural cyst in the left T1-2 neural foramen, which is unchanged. Other punctate perineural cysts are present within the cervical spine neural foramina. The temporal bones, imaged intracranial structures, and orbits are grossly unremarkable. There appears to be filler material within the bilateral nasolabial folds. There are bilateral maxillary sinus retention cysts. There has been interval enlargement of left axillary lymph nodes, which measure up to 15 mm.

Output: 1. A subcentimeter lesion in the right oropharyngeal region is compatible with residual fibroma and/or inflammatory changes. 2. Unchanged left T1-2 neural foramen perineural cyst. 3. Interval enlargement of left axillary lymph nodes, which measure up to 15 mm, which is non-specific.


Instruction: Generate impression based on findings.

Input: 46-year-old female with large uterine fibroids. PELVIS:UTERUS, ADNEXA: The uterus is markedly enlarged measuring up to 24 cm in transverse, 23.4 cm in craniocaudal length, and 13.9 cm in AP diameter. Numerous fibroids are identified. The largest fibroid is exophytic originating from the right aspect of the fundus measuring 11.3 cm in AP, 12.7 cm in transverse, and 13.5 cm in craniocaudal diameter (axial series 601 image 34, coronal series 501 image 16). Intralesional fluid likely related to cystic degeneration (coronal series 301 image 18). This fibroid is possibly pedunculated. An additional large subserosal fibroid of the left uterine fundus measures 10 cm in AP, 10.3 cm in transverse, and 11.3 cm in craniocaudal diameter (axial series 601 image 29, coronal series 501 image 17).There are 2 submucosal/intracavitary fibroids. The larger one measures 2.6 cm in AP, 2.3 cm in transverse, and 3.8 cm in critical diameter (axial series 601 image 24, sagittal series 701 image 29). The smaller one measures 0.9 cm in AP, 0.8 cm in transverse, and 0.8 cm in craniocaudal diameter (axial series 601 image 19, coronal series 501 image 18).A large fibroid of the posterior lower uterine segment measures 7.3 cm in AP, 7.5 cm in transverse, and a 7.5 cm in craniocaudal diameter (axial series 601 image 14, coronal series 501 image 31).Additional numerous small intramural fibroids are also identified. All fibroids demonstrate postcontrast enhancement with the exception of the cystic component in the right fundal lesion.The bilateral ovaries show no acute abnormality (axial series 601 image 11).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace free fluid in the pelvis, likely physiologic.BONES, SOFT TISSUES: Small fat-containing left periumbilical hernia (series 601 image 27).OTHER: No significant abnormality noted.

Output: 1.Enlarged uterus containing multiple fibroids as described above. The largest fibroid is exophytic originating from the right uterine fundus and demonstrates findings compatible with cystic degeneration.


Instruction: Generate impression based on findings.

Input: Patient with TNBC on clinical trial of ibrutinib and immunotherapy drug with new headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: 28-year-old male patient with pain of left medial tibial distal diaphysis. Evaluate for stress fracture. Bone marrow signal is within normal limits. No specific evidence of a stress fracture.The soft tissues of the left lower extremity appear unremarkable.

Output: No specific evidence of a stress fracture or other acute abnormality.


Instruction: Generate impression based on findings.

Input: Breast cancer metastasized to central nervous system. Since the brain MRI from November 2015, there are has been interval progression of supratentorial and infratentorial metastatic disease consisting of increase in size of existing lesions and interval appearance of several new lesions, with a total of approximately 20 intra-axial lesions. For example, a right cerebellar hemisphere lesion measures 8 mm in diameter, previously 4 mm, and there is a new 5 mm diameter right thalamus lesion. There is vasogenic edema associated with the lesions, but otherwise an unchanged background of mild periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There are postoperative findings related to left parieto-occipital craniotomy without evidence of nodular enhancement to suggest tumor recurrence in this location. There is unchanged confluent white matter T2 hyperintensity in the treatment bed region. There is an unchanged subcentimeter enhancing lesion within the fundus of the right internal auditory canal. There is an unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations. There is unchanged mild encephalomalacia in the left cerebellar hemisphere. There is no evidence of acute infarct. The ventricles and basal cisterns are stable in size and configuration, with ex vacuo dilatation of the left lateral ventricle. There is minimal midline shift to the left. There is minimal fluid signal within the left mastoid air cells. There is mild mucosal thickening in the paranasal sinuses. The skull and extracranial soft tissues are unchanged.

Output: 1. Overall progression of intracranial metastatic disease since November 2015.2. An unchanged subcentimeter right internal auditory canal lesion may represent a vestibular schwannoma versus less likely a metastasis.3. Unchanged developmental venous anomaly in the brainstem associated with punctate foci of susceptibility effect that likely represent cavernous malformations.


Instruction: Generate impression based on findings.

Input: Patient with right parotid swelling and pain x 2 years. Now constant and seems localized to tail. Negative for stones on endoscopy. Assesses for neoplasm versus inflammationion. There is a skin marker overlying the right parotid tail, where there is a lobulated enhancing structure that measures up to 15 mm in length and 4 mm in width. There is an also unchanged 5 mm diameter nodule more superiorly along the superficial aspect of the parotid gland. Otherwise, the parotid glands display diffuse fat infiltration and the right parotid gland is slightly larger than the left parotid gland. There is no evidence of radioattenuating calculi or ductal dilatation. There is no evidence of significant cervical lymphadenopathy. The thyroid gland appears are unremarkable. There is an unchanged irregular band of stranding in the left posterior lower neck subcutaneous tissues. The major cervical flow voids are intact. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable.

Output: 1. A nonspecific structure that measures up to 15 mm within the right parotid tail may represent focal fibrosis.2. An unchanged 5 mm diameter nodule along the superficial aspect of the parotid gland may represent lymph nodes. The rest of the right parotid gland otherwise appears to be unremarkable.


Instruction: Generate impression based on findings.

Input: Sudden left-sided headache with gait instability. Assess for intracranial hemorrhage or structural abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is focal parenchymal loss with underlying T2 hyperintensity along the posterior aspect of the right inferior parietal lobule. There are also mild scattered punctate T2 hyperintensities in the frontoparietal white-matter and the pons are probably from chronic microvascular ischemia. The ventricles and sulci are mildly prominent due to cerebral volume loss. There is no midline shift or herniation. There is loss of the normal right internal carotid artery flow void intracranially. The right transverse and sigmoid sinuses are diminutive. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is minimal fluid in the left mastoid air cells.

Output: 1.No acute infarct, intracranial hemorrhage, or mass. 2.A small area of encephalomalacia in the right inferior parietal lobule likely represents a chronic infarct.3.Loss of the normal intracranial right internal carotid artery flow void may reflect significant proximal steno-occlusive disease. Dedicated head and neck vascular imaging is recommended for further evaluation.Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Andrew Davis over the phone on the day of the examination at 1630 hours.


Instruction: Generate impression based on findings.

Input: History of prolactinoma status post resection. The left lobe of the pituitary gland is slightly asymmetrically enlarged. However, there is no discernible pituitary lesion. The pituitary infundibulum is intact. The cavernous sinus and optic apparatus are intact. There is no evidence of acute intracranial hemorrhage. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.

Output: The left lobe of the pituitary gland is slightly asymmetrically enlarged, which may represent treatment-effects, but otherwise no discrete pituitary lesion is identified to suggest adenoma.


Instruction: Generate impression based on findings.

Input: 63 year old male with new onset congestive heart failure, recent chest pain and dyspnea. Evaluation for cardiomyopathy. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 26%. The LVEDV is 304 ml (normal range 142+/-34), the LV end diastolic volume index is 136 ml/m2 (normal range: 74+/-15), the LVESV is 225 ml (normal range 47+/-19) and the LV end systolic volume index is 101 ml/m2 (normal range 25+/-9). The LV mass is 227 g (normal range 164+/-36) and the LV mass index is 102 g/m2 (normal range 85+/-15). There is global hypokinesis with regional variation. There is a prominent mid-wall stripe of late gadolinium enhancement involving the basal and mid anteroseptum and inferoseptum. This pattern is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is severely enlarged. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 50%. The RVEDV is 170 ml (normal range 142+/-31), RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVESV is 85 ml (normal range 54+/-17), and the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.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 mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsA large lymph node is located in the left mediastinum, next to main pulmonary artery. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severely enlarged left ventricle with severely reduced systolic function (LVEF 26%) with evidence of a prominent mid-wall stripe of late gadolinium enhancement involving the basal and mid anteroseptum and inferoseptum. This pattern is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. Normal right ventricular size and systolic function (RVEF 50%).3. Severe left atrial dilation.4. Mild dilation of main pulmonary artery.5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 62-year-old male with weakness, ataxia, multiple falls, perianal anesthesia and decreased rectal tone. Evaluate for stenosis or cord compression. The vertebral bodies are appropriate in the overall alignment and height. There are multiple disc-osteophyte complexes in the cervical spine with evidence of cord signal abnormality at the C3-4 level, indicating cord edema. There are multiple discs protrusions involving the lower lumbar lumbar spine with some narrowing of the spinal canal. There is a sigmoid curvature to the spine with levoscoliosis of the lower spine and dextroscoliosis of the upper spine.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. There is abnormal cord signal indicating cord edema at the C3-4 level. There is a disc-osteophyte complex and facet degenerative disease at this level. These findings are compatible with spondylotic myelopathy at this level. Please refer to the dedicated MRI C-spine for further characterization which as since been performed. Additional degenerative changes are seen in the cervical and lumbar spine.


Instruction: Generate impression based on findings.

Input: Female, 8 years old, with history of a flulike illness last week (1/26-1/30) with headache, fever, cough and rhinorrhea. Brain MRI done for headaches, occipital, now resolved. Incidental anterior cervical fluid noted of unclear etiology. Dedicated MRI cervical spine was performed. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Signal intensity of the bone marrow is unremarkable. The mucosa of the ethmoid air cells and sphenoid sinuses is mildly T2 hyperintense suggesting inflammation.C-spine:A thin layer of freely tracking T2 hyperintense material, presumably fluid, is evident within the retropharyngeal space of the upper cervical region. At most, this fluid measures 2 mm in thickness. The tissues surrounding this fluid show mild enhancement on postcontrast images. No evidence of any loculated or discrete rim enhancing collection is seen.The above finding occurs in the context of bilateral and symmetric enlarged adenoidal and palatine tonsillar tissues as well as prominent lateral retropharyngeal lymph nodes.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. No evidence of marrow space or disk edema is seen. No pathologic spinal enhancement is detected. The spinal canal and the neural foramina are patent throughout. The spinal cord demonstrate normal morphology and signal characteristics.

Output: 1. A thin layer of freely tracking fluid within the retropharyngeal space of the upper cervical region probably represents a reactive effusion, particularly given the patient's history and the presence of symmetrically enlarged tonsillar and retropharyngeal nodal tissues. No evidence is seen to suggest discrete abscess. No involvement of the spine or spinal canal is suspected.2. Unremarkable evaluation of the brain.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of unspecified part of right bronchus or lung Disorder of brain, unspecified Encounter for other preprocedural examinationClinical question: right side brain mass for resection, MRI STEALTH for surgery guidance.Signs and Symptoms: MRI STEALTH preop for surgery , brain tumorComments: STEALTH MRI preop image guidance during surgery. | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a 15 x 22 mm axial dimension mass centered in the right superior frontal gyrus which is associated with susceptibility effect on the prior MR. It is associated with vasogenic edema which is hyperintense on T2-weighted imaging. There is mild regression of the amount of vasogenic edema on the current exam versus the prior exam there is less midline shift on the current exam compared to the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a minor opacity. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the previous examination an enhancing mass in the right superior frontal gyrus remains stable in size, however, the degree of vasogenic edema has regressed and there is less midline shift on the current exam when compared to the prior. Please note that the exam is limited and was performed for the purpose of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Severe right thigh pain. Evaluate for soft tissue injury. There is severe diffuse muscular atrophy. There are no discrete masses, fluid collections, or additional soft tissue abnormalities. There is minimal stranding of the subcutaneous fat, which is symmetrical bilaterally.The osseous structures are unremarkable, with normal marrow signal.Severe degenerative changes of the hip, with moderate degenerative changes of the knee, similar to previous exams. No gross abnormalities in the visualized portions of the lower pelvis.

Output: Diffuse muscular atrophy, without acute abnormalities. Severe degenerative changes of the hip.


Instruction: Generate impression based on findings.

Input: 72 year old man with history of AL amyloidosis, referred for cardiac MRI to evaluate for cardiac involvement. Left VentricleThe left ventricle is normal in size with normal systolic function. There is moderate left ventricular hypertrophy. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 81 ml/m2 (normal range: 74+/-15), the LVEDV is 162 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 60 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. Non-contrast T1 time of the IVS was 1017 msec which is not consistent with cardiac amyloid.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 66 ml/m2 (normal range 82+/-16), the RVEDV is 137 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is 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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%2. There is moderate left ventricular hypertrophy. 3. The T1 mapping demonstrates a T1 of the IVS of 1017 msec which is in the normal range.4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with systemic sclerosis and pachymeningitis, assess for disease progression. Two adjacent lobular enhancing lesions are demonstrated along the right temporal horn showing no significant interval change in size. Likewise, a small cystic component medial and superior to these nodules is also unchanged. Of note, the degree of parenchymal T2 hyperintensity surrounding the above-mentioned nodular lesions has decreased. As before, these lesions are contiguous with enhancing choroid plexus of the right ventricular atrium. The more anterior of these nodules shows evidence of prior lateral and superior approach biopsies with internal susceptibility compatible with placement of a biopsy marker. Linear enhancement along the lateral biopsy tract is stable. Also redemonstrated is diffuse pachymeningeal thickening involving the entirety of the right cerebral dura including the interhemispheric falx and the tentorium. Involvement of the left sided dura is also seen to a lesser degree. These findings are overall not significantly changed.Scattered punctate foci of white matter T2 hyperintensity are unchanged and nonspecific. No new parenchymal lesions or new abnormal enhancement is seen. Brain parenchymal morphology is otherwise unremarkable. The ventricles are stable and normal in size.

Output: 1.Enhancing lesions along the right temporal horn, contiguous with the enhancing choroid plexus, show no significant interval change in size. Findings related to prior biopsies are also unchanged.2.Parenchymal edema surrounding the enhancing lesions has, however, decreased when compared to the prior examination.3.Diffuse pachymeningeal thickening involving the right cerebral dura and, to a lesser degree, the left cerebral dura, shows no significant interval change.4.No new intracranial abnormalities are detected.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago. Lumbosacral spondylosis without myelopathy. Brachial neuritis or radiculitis NOSClinical question: c/o upper abdominal pain, chest pain. Evaluate for thoracic disc herniation.Signs and Symptoms: abdominal 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. There is multilevel disc desiccation present.There is thickening of the cruciate ligaments at C1-2 without significant compromise to spinal canal.At C2-3 there is no significant compromise to the spinal canal or neural foramina. Small uncovertebral osteophytes associated with disc material are present on the right side at this level.At C3-4 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present at this level associated with disc material and encroachment of the exiting nerve roots within the neural foramina. There is bilateral facet hypertrophy present at this level - left worse than rightAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level - right worse than left.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is bilateral facet hypertrophy at this level.At C6-7 there is no significant compromise to the spinal canal. There is a broad-based left lateral disc protrusion at this level associated with a disc bulge. There is encroachment of the left-sided exiting nerve roots within the neural foramen 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.Incidental note is made of partial empty sella.MRI thoracic spine:There is a soft tissue mass present behind the T12 vertebral body of the left lateral recess which is visually contiguous with the T12-L1 disc space. This extends into the left neural foramen at the T12-L1 and encroaches on the left-sided exiting nerve roots. There is mild spinal stenosis present at this level. This disk sequestration was also present on the 5/29/2015 exam. There are endplate reactive changes present anteriorly at T12-L1 with high signal on T1 and low signal on T2.There is mild narrowing of the right T9-T10 neural foramen related to some disc material and facet osteophytes.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Incidental note is made of a right renal cortical cyst in the small left-sided intraparenchymal renal cyst.

Output: 1.There are multilevel degenerative changes present in the cervical spine which result in encroachment of the exiting nerve roots bilaterally at C3-4 and on the left side at C6-7.2.There is a disc sequestration present at T12-L1 with extension of disc material into the left T12-L1 neural foramen and encroachment of the left-sided exiting nerve roots. There is only mild spinal stenosis at this level. There is no change in the extent of neural foramen and encroachment or narrowing of the spinal canal when compared to the prior exam from 5/29/2015. Endplate reactive changes at T12-L1 suggest some acute inflammatory change.


Instruction: Generate impression based on findings.

Input: Known right breast mass presents for research MRI before biopsy per Alan Penn research protocol. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, a limitation to the study. Multiple bilateral cysts are present.In the right 12:00 position, the known mass is again seen, measuring 9 x 7 x 7 mm, unchanged from prior measurements. No suspicious enhancement is seen in the left breast. A few scattered enhancing foci are present, none larger than a benign morphology 5 mm focus in the central 6:00 position. No abnormal lymph nodes are identified in either axillary region.Thoracic wall contour compatible with pectus excavatum surgery.

Output: Right breast mass measuring 9 mm for which biopsy for clinical purposes was performed later this day. No new suspicious finding since the prior study. Marked background enhancement limits this evaluation.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: T2 versus T3 glottic carcinoma. Neck CT:There is a mass at the larynx, involving the left vocal cord, extending superiorly to the false cord with partial infiltration of the left paraglottic fat, and inferiorly to the subglottic region. There is thickening of the anterior commissure and the right true cord, suggesting extension across midline to the right. There is sclerosis of the left arytenoid cartilage, which may be involved. There is minimal soft tissue thickening overlying the left lamina of the thyroid cartilage, which is also thinner compared to the right. Very early extralaryngeal extension therefore cannot be excluded; this can be further evaluated with MRI.There is slightly prominent lymph node at left level 2, measuring approximate 10-mm in short axis. A 11-mm node is seen at level 5B. These nodes may be involved.There is a 6-mm cystic lesion at the left tonsil.There is a 9-mm lytic lesion in the left scapular glenoid. It is well marginated, and is likely benign.Degenerative disease of cervical spine is noted.

Output: 1. Left laryngeal mass, with supraglottic and subglottic involvement, and extension across midline to the right. There is suggestion of involvement of the left arytenoid cartilage and left thyroid cartilage, and very early extralaryngeal extension. These findings can be further confirmed with MRI.2. Well marginated lytic lesion at the left scapular glenoid, likely benign given its imaging appearance.3. Small left tonsillar cyst.4. Borderline adenopathy at the left level IIA, and level 5B.


Instruction: Generate impression based on findings.

Input: Anterior uveitis with cystoid macular edema both eyes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland 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, and scalp soft tissues are grossly unremarkable. There is a tiny left maxillary sinus retention cyst. There is a T1 and T2 hyperintense area in the right parietal calvarium, which likely represent a hemangioma.

Output: No evidence of demyelinating lesions in the brain.


Instruction: Generate impression based on findings.

Input: Other speech disturbance(784.59) [784.59], Reason for Study: ^Reason: rule out ischemic stroke, acute onset of stuttering however no focal neurologic deficits History: pls see above No evidence of acute ischemic or hemorrhagic lesion on the scan.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: Normal brain MRI


Instruction: Generate impression based on findings.

Input: 74 years Female (DOB:4/15/1942)Reason: lumbar radiculopathy History: lumbar radiculopathyPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE The patient status post lumbar spine surgery with posterior and anterior fusion. There are pedicle screws present at L4 and L5 associated with interconnecting rods. There is a laminectomy defect present at L4-5. There is osseous fusion across the L4-5 disc space.At L5-S1 there is no significant compromise to spinal canal. There is some loss of disc space height and disc protrusions into the neural foramina with encroachment of the exiting nerve roots within the neural foramina. There is facet hypertrophy present at this level. There is fluid present within the facet joints.At L4-5 there is no significant compromise to spinal canal or neural foramina appreciated. The patient status post anterior fusion at this level and surgery. Visualization at this level is somewhat obscured by metal artifact. This mild anterior subluxation of L4 on L5.At L3-4 there is a diffuse disc bulge present associated with disc desiccation and bilateral facet and ligamentum flavum hypertrophy. There is narrowing of the spinal canal and effacement of the fat at the lateral recess bilaterally at this level. There is narrowing of the neural foramina bilaterally at this level with encroachment of the exiting nerve roots on the left side. Overall there is a moderate degree of spinal stenosis at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disc bulge at this level associated with endplate reactive changes and disc desiccation and loss of disc space height. There is encroachment of the nerve roots at the left lateral recess at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a fatty filum terminale present.There are some degenerative changes present in the visualized lower thoracic spine with disc bulges, loss of disc space height and disc desiccation.

Output: 1.The patient status post lumbar spine surgery with posterior fusion and laminectomies at L4-5 and anterior fusion at L4-5.2.There is a moderate degree of spinal stenosis present at L3-4 related to disc disease and facet disease. This associated with encroachment of left-sided exiting nerve roots within the left neural foramen.3.There is encroachment of the nerve roots at the left lateral recess at L2-3 related to degenerative changes and a disc bulge.


Instruction: Generate impression based on findings.

Input: Clinical question coiling evaluate sella. History of pituitary adenoma. Signs and symptoms Crohn's history of pituitary adenoma. Nonenhanced head CT:Slightly prominent sella turcica and the pituitary gland appears similar to prior exam.This examination is also compared with CT of soft tissues of neck dated 2-- 9 -- 10 which also demonstrates similar findings without appreciable change.Nonenhanced head CT is not the appropriate tests for precise evaluation of pituitary gland and or sella. This finding can be better evaluated with a dedicated MRI of pituitary gland. There is no abnormality of basal cistern or any mass effect on the chiasm. Splenic sinus is within normal limits.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. No evidence of any new finding since prior head CT from 1 -- 27 -- 10

Output: 1.No evidence of acute new finding since prior study.2.Slight prominence of pituitary gland and sella is identical to prior study from 1 -- 27 -- 10.3.Most appropriate method of evaluation for pituitary pathology is by MRI exam.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis [Q85.1], Reason for Study: ^Reason: patient with TSC follow up study History: TSC, SEGAS Multifocal bihemispheric subcortical T2/FALIR high signal intensity lesions are again demonstrated, unchanged since prior scan.Multiple subependymal nodules some with susceptibility artifacts are unchanged since prior scan.There are enhancing lesions located at the level of foramen of Monroe bilaterally. Specifically, the right side lesion is measured about 18mm (AP) and 10.6mm (RL) which is unchanged since prior scan (17mm x 10mm). The other lesion on the left side was measured about 17.3mm (AP) x 7.6mm (RL), again unchanged since prior scan 17.5mm x 7.4mm. However, comparing to 2011 scan, both lesions show slightly increased in size (right:16mm x 10mm, left:12mm x 7mm).There is no evidence of ventriculomegaly.There is no evidence of acute ischemic or hemorrhagic lesion.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 significant interval change of subcortical tubers, calcified subependymal nodules and enhancing nodules at bilateral foramen of Monroe level since prior scan performed on Jul 1 2015.2. However, both enhancing lesions appear to be slightly increased in size since 2011 as described above.3. No evidence of hydrocephalus.4. No acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Paresthesia. Brain: The cerebellar tonsil extend up to approximately 15 mm inferior to the foramen magnum and have pointed morphologies, in association with a relatively small posterior fossa. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is nonspecific minimal anterior periventricular white matter T2 hyperintensity and a punctate focus of T2 hyperintensity in the right anterior subinsular white matter. There is also a prominent right inferior basal ganglia region prominent perivascular space. The ventricles are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is moderate mucosal thickening in the left maxillary sinus.Cervical Spine: There is a long segment syrinx that extends from the C2 level to the imaged portions of the upper thoracic spinal cord, measuring up to 11 mm in width. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is degenerative spondylosis at C6-7, but no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Chiari type 1 malformation with long segment syrinx that extends from the C2 level to the imaged portions of the upper thoracic spinal cord.


Instruction: Generate impression based on findings.

Input: 55-year-old woman with a history of prior right hemiplegia episodes and endocarditis who presented with acute mental status change, slurred speech, and right-sided weakness. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage, intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There has been interval resolution of many of the previously described supratentorial and cerebellar patchy T2/FLAIR hyperintense regions. There is residual nonspecific T2/FLAIR signal abnormality in the bilateral anterior frontal periventricular white matter, genu of the corpus callosum and the left parietal white matter, which may be related to prior ischemia. There is a small focus of chronic-appearing hemorrhage within the right superior temporal lobe, which was less appreciable on the prior examination likely due to differences in technique. No abnormal parenchymal or meningeal enhancement is evident. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are grossly clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Interval resolution of most of the previously described patchy T2/FLAIR hyperintense regions, consistent with PRES. 2. Chronic appearing FLAIR hyperintensity in the left parietal white matter and bilateral anterior corpus callosum which may be related to prior ischemia or other injury.


Instruction: Generate impression based on findings.

Input: 55-year-old female patient with lateral joint line pain and popping. Evaluate for lateral meniscus tear. MENISCI: There is a complex tear, including horizontal and vertical components, as well as free edge blunting of the posterior horn of the lateral meniscus. The medial meniscus intact.ARTICULAR CARTILAGE AND BONE: There is a partial-thickness chondral fissure in the medial patellar facet. There is a 4 mm full-thickness chondral defect in the anterior portion of the medial femoral condyle. There is approximately 1.3 cm of full thickness chondral loss in the weight bearing surface of the lateral tibial plateau and partial-thickness fraying of the weightbearing portion of the lateral femoral condyle.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament complex, medial collateral ligament, and patellar retinacula are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Complex tear of the posterior horn of the lateral meniscus.2.Tricompartmental chondromalacia, worst in the lateral compartment.


Instruction: Generate impression based on findings.

Input: 28-year-old female with high and low pressure symptoms per pt. Assess cyst size.  Brain cyst, shunt, headaches, worsening symptoms. Redemonstrated is evidence of a right-sided hemispherectomy with fragmentation involving the right calvarium related to multiple prior craniotomies. The extra-axial/extra-dural fluid collection along the right cerebral convexity has continued to decrease in size compared with the previous head CT and brain MRI. Unchanged position of catheter spanning from this fluid collection to the left, across the residual left cerebral hemisphere, terminating within the left temporal lobe.A cyst within the anteromedial left temporal lobe measuring approximately 23 mm in longest diameter appears similar to the prior exam. There has been re-accumulation of a more medial cyst positioned just posterior to the catheter and measuring 15 x 18 mm (series 501, image 18). The extensive chronic cerebral dysmorphism is unchanged. The white matter surrounding the residual left sided ventricular system remains T2 hyperintense. No new mass effect is appreciated.

Output: 1.Interval re-accumulation of a more medial cyst just posterior to the catheter compared to the prior exam.2.Interval continued decrease in the size of the right extra-axial/extra-dural fluid collection. 3.The remainder of the exam is not significantly changed compared to prior.


Instruction: Generate impression based on findings.

Input: Ms. Dieckow is a 57-year-old female with BRCA1 gene mutation and personal history of right breast lumpectomy in 2006 for IDC followed by radiation and chemotherapy. Family history of breast cancer in paternal aunt, paternal great aunt, and paternal great grandmother (diagnosed at the age of 50). There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes are identified in the superior right breast, compatible with stated history of right breast lumpectomy. Multiple scattered foci of enhancement are seen throughout the left breast, appearing similar when compared to multiple prior examinations. No one focus appears more suspicious than the rest.There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for small bowel inflammation or narrowing History: abdominal bloating ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis, including a stone within the cystic duct. No evidence of cholecystitis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild circumferential bowel wall thickening in the rectum with associated diffusion restriction. No evidence of obstruction. Small bowel appears normal. The terminal ileum is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild circumferential rectal wall thickening suggests a proctitis of uncertain etiology, neoplasm not entirely excluded, no upstream colonic dilatation seen to suggest obstruction. Recommend correlation with colonoscopy.2.Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: The distal supraspinatus demonstrates increased signal suggesting tendinosis however there is no evidence of rotator cuff tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small joint effusion which contains scattered foci of low signal intensity throughout.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Moderate joint effusion with associated synovitis.2. Tendinopathy of the supraspinatus tendon without evidence of rotator cuff tear.3. Atrophy of the rotator cuff musculature.


Instruction: Generate impression based on findings.

Input: Brain: Evaluation of the myelination is limited due to motion. On the T1 weighted images, the myelination appears to be normal for corrected age. On the T2 weighted images, the myelination appears to be delayed, appearing similar to 9 and 11 months of age. Overall, there is decreased extent of hypointense signal in the central deep white matter as well as in expected subcortical areas at this age.There is focal prominent encephalomalacia in the left frontal lobe with ex vacuo dilatation of the lateral left lateral ventricle. The margins of the apparent encephalomalacic cleft demonstrate ill-defined T2/FLAIR hyperintensities representing gliosis. The lateral ependymal margin of the left lateral ventricle is entirely intact, and the apparent "cleft" is lined by areas of white matter.There is no pathologic midline shift. There is no abnormal enhancement. There is no evidence of acute hemorrhage or mass effect.There are no diffusion or susceptibility abnormalities.There is persistence of cavum septum pellucidum et vergae, normal variant.There is fluid in the bilateral mastoids and there is partial scattered opacification of the paranasal sinuses.MRI brain: The right A1 segment is hypoplastic. The bilateral PCOMs are not well-visualized. Otherwise, the internal carotid arteries, anterior, middle, and posterior cerebral arteries are patent. The vertebral and the basilar arteries are patent. No flow-limiting stenosis or aneurysm.MRA neck: The MRA of the neck is limited due to lack of contrast and motion. There is attenuation of flow related enhancement at the proximal petrous left ICA, likely artifactual due to tortuosity. The MRA of the neck is grossly unremarkable. The right internal carotid artery is smaller than the left, due to the hypoplastic right A1 segment.The left vertebral vertebral artery arise from the aortic arch, normal variant.

Output: 1. There is prominent left frontal encephalomalacia with ex vacuo dilatation of the adjacent left lateral ventricle.2. Normal myelination appearance on T1-weighted images, however delayed myelination pattern on T2-weighted images, similar to between 9 and 11 months of age.3. Unremarkable MRA head.4. Limited MRA of the neck due to lack of contrast and patient motion, but is grossly unremarkable.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a small area of susceptibility, blooming artifact, heterogeneous T1 signal and hypointense T2 signal just inferior to the optic chiasm within the left hypothalamus. It is unchanged in size and morphology with mild localized mass effect upon the inferior third ventricle and splaying of the upper aspect of the infundibulum. No other foci of susceptibility are appreciated.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or significant mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures, including the pituitary gland, and craniocervical junction are within normal limits.

Output: Unchanged likely small cavernoma within the left hypothalamus with mild localized mass effect upon the inferior third ventricle and splaying of the upper aspect of infundibulum. No other foci of susceptibility identified.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for sacroiliitis. L sided hip pain x 10 years History: pain in L hip The sacroiliac joints appear normal without fluid or enhancement to suggest sacroiliitis. We see no frank bone marrow edema within the adjacent sacrum or iliac wings. Adjacent to the right third sacral nerve root at the level of the second neural foramen is a small Tarlov cyst. Mild degenerative disc disease affects the level of L5/S1. There is a mild diffuse disc bulge posteriorly at this level, although this exam was not protocoled for evaluation of the lumbar spine. The hip joints are not visualized in their entirety, but the portions included in this examination appear normal.

Output: 1. No evidence of sacroiliitis.2. Mild degenerative disc disease and disc bulge at the level of L5/S1 which would be better evaluated with a dedicated MRI of the lumbar spine if clinically warranted.


Instruction: Generate impression based on findings.

Input: Right neck pain with tingling, numbness, and occasional weakness in arm. There is straightening of the normal cervical lordosis. There is a minimal retrolisthesis of C5 on C6. Vertebral body heights and alignment are otherwise preserved. The bone marrow signal is benign. There is mild degenerative spondylosis of the cervical spine, worst C6-7 where there is loss of disc height.There is mild congenital narrowing of the spinal canal, with superimposed degenerative changes which are detailed below: The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.C2/3: Disc osteophyte complex without significant spinal canal stenosis or neural foraminal narrowing.C3/4: Disc osteophyte complex without significant spinal canal stenosis. Mild bilateral neural foraminal narrowing.C4/5: Disc osteophyte complex without significant spinal canal stenosis. Mild bilateral neural foraminal narrowing C5/6: Disc osteophyte complex with mild spinal canal stenosis secondary to degenerative changes superimposed on a congenitally narrow canal. Moderate bilateral neural foraminal narrowing, right greater than left.C6/7: Disc osteophyte complex with mild spinal canal stenosis and mild bilateral neural foraminal narrowing.C7/T1: No significant spinal canal stenosis or neural foraminal narrowing.No significant spinal canal stenosis or neuroforaminal narrowing at the visualized upper thoracic levels.

Output: 1.Congenitally narrow spinal canal with superimposed degenerative changes contributing to mild spinal canal stenosis at C5-6 and C6-7.2. Multilevel neural foraminal narrowing, worst at C5/6, right greater than left.


Instruction: Generate impression based on findings.

Input: 78-year-old male with history of HCV cirrhosis. Evaluate for hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Nodular hepatic morphology without evidence of a suspicious lesion. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Persistent mild diffuse pancreatic ductal dilatation without evidence of focal parenchymal lesion on this nondedicated exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Again noted is the complex cystic lesion in the mid to lower left renal pole measuring 20 x 16 mm (series 3, image 23), not significantly changed. There is equivocal small focus of apparent internal enhancement which is not significantly changed (series 103, image 63).Additional bilateral renal cysts are noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged complex lesion in the left renal midpole with equivocal enhancement.2.No suspicious hepatic lesion.