Instruction: Generate impression based on findings.

Input: 51 year old female with a personal history of right breast lumpectomy for invasive ductal carcinoma with DCIS in 2009 followed by chemotherapy and radiation therapy. She also has a personal history of Hodgkin's lymphoma, right breast reconstruction and left breast lift in 2012. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Post-operative changes in the right lumpectomy bed are stable. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: History of lung cancer with brain metastases. Pretreatment planning for stereotactic radiosurgery. Post surgical changes from prior right frontal craniotomy. Redemonstration of a cystic lesion containing a fluid fluid level and susceptibility artifact compatible with hemorrhage in a surgical resection/biopsy cavity. There is residual nodular peripheral enhancement as seen on the prior MRI. In aggregate this measures 2.3 x 1.9 cm in axial dimension. This is associated with stable surrounding decreased T1 signal suggestive of edema as well as local mass effect with effacement of the overlying sulci.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are grossly clear.

Output: Examination for treatment planning. No significant interval change in cystic cavity with peripheral nodular enhancement at the right frontal operculum compatible with residual tumor .


Instruction: Generate impression based on findings.

Input: Female, 39 years old, approximately 35 weeks gestational age, with ultrasound showing fetal ventricles at the upper limit of normal. Both lateral ventricular atria measure up to 10 mm in diameter which is the upper limit of normal. The third and fourth ventricles are not dilated. The cerebral aqueduct is well-visualized and patent. The corpus callosum is fully formed and intact. The cavum septum pellucidum is visualized. The cerebral hemispheres demonstrate a normal degree of gyration for gestational age. The brainstem and cerebellum are normally formed and intact. No evidence of any focal parenchymal lesion is seen. No abnormal extra-axial collections are suspected.

Output: 1.The atria of the lateral ventricles measure up to 10 mm in diameter which is the upper limit of normal. The third and fourth ventricles are within normal limits.2.The examination is otherwise within normal limits for gestational age.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is increased signal intensity within the distal fibers of the supraspinatus tendon near its insertion upon the greater tuberosity reflecting mild tendinosis or very slight interstitial tearing. Otherwise there is no evidence of a full-thickness rotator cuff tear..SUPRASPINATUS OUTLET: Mild osteophyte is affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Within the limits of a nonarthrogram study, there is blunting and abnormal signal within the anterior superior labrum likely reflecting degenerative tearing.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1. Tendinopathy of the supraspinatus without evidence of rotator cuff tear.2. Likely degenerative tearing of the anterior superior labrum.


Instruction: Generate impression based on findings.

Input: 39 year old man with recent history of ventricular tachycardia s/p dual chamber ICD and non-ischemic cardiomyopathy who was referred for cardiac MRI to evaluate for scar. Left VentricleThe left ventricle is severely dilated. Due to interference from device-related artifact, cardiac volumes could not be reliably assessed. However, systolic function appears severely reduced (LVEF <20%), and there is global hypokinesis with regional variation. There is no evidence of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle appears normal in size. Due to interference from device-related artifact, cardiac volumes could not be reliably assessed. A device lead is noted.Right AtriumThe right atrium is dilated. A device lead is noted.Mitral ValveThe mitral valve opens widely.Tricuspid ValveThe tricuspid valve opens widely. AortaThere is a left sided aortic arch. Pulmonary VeinsTwo right sided pulmonary veins are visualized and drain into the left atrium; the left sided veins are not well seen.Venous AnatomyThe SVC and IVC drain normally into the right atrium. There are device leads visualized in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a pulse generator in the left upper chest with associated artifact. 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 dilated left ventricle with severely reduced systolic function (EF <20%). 2. No evidence of late gadolinium enhancement to suggest the presence of an underlying inflammatory, infiltrative or fibrotic process. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is diffuse T2 signal hyperintensity in the left slightly greater than right periventricular white matter and appears similar to prior MRI in 2012; findings compatible with periventricular leukomalacia and encephalomalacia. Diffusely diminished supratentorial white matter volume as well as thinning of the corpus callosum compatible with Wallerian degeneration, not significantly changed. The ventricles are normal in size. Cystic foci adjacent to the frontal horns favored to represent cystic encephalomalacia, less likely connatal cysts given similar appearance posteriorly. The cisterns remain patent. There is no midline shift or mass effect. There are no other areas of abnormal signal or pathological enhancement. No evidence of heterotopia or migrational anomaly. Bilateral hippocampi are symmetric in size and signal characteristics. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: 1.No significant change in extensive periventricular T2/FLAIR signal abnormality, periventricular cystic changes, and diminished supratentorial white matter volume. Findings are again consistent with periventricular leukomalacia/encephalomalacia related to remote injury.2.No intracranial mass, acute infarct, or hemorrhage. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 60 female patient with history right arm numbness two days ago with persistent numbness in right hand. Possible infarct on head CT. There is a focus of restricted diffusion within the left thalamus compatible with acute ischemia. There is no associated susceptibility artifact to suggest hemorrhage. There is otherwise patchy subcortical and periventricular abnormal T2/FLAIR signal abnormality corresponding to chronic small vessel ischemic disease. A focus of encephalomalacia within the right thalamus is compatible with a chronic lacunar infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mucosal thickening within the floor of the right maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Left thalamic acute ischemic infarct.2. Chronic small vessel ischemic disease and chronic right thalamic lacunar infarct.Findings were discussed by the RROC with Dr Lu by telephone at 1800 hrs on 9/11/2016.


Instruction: Generate impression based on findings.

Input: Male, 75 years old, with probable Alzheimer's disease and multiple hemangioblastomas. Evaluate for change. Sequelae of prior right frontal craniotomy and prior posterior fossa surgery are again seen. Enhancing dural thickening and tumor nodularity along the anterior interhemispheric falx is demonstrated. Likewise, multiple enhancing nodules within the posterior fossa and the upper cervical spinal cord are again seen. The size of these enhancing lesions has not significantly changed when compared to the immediate prior examination but has increased relative to the older examination of 7/29/2015. Likewise, the associated edema is unchanged from the immediate prior but progressed relative to the older study. rCBV mapping shows elevated blood volume within the enhancing lesions and in the immediate surrounding parenchyma.Within the limitations of a motion degraded examination, no definite evidence of any new enhancing lesion is seen. No restricted diffusion is evident. Scattered small foci of white matter T2 hyperintensity are unchanged and nonspecific, perhaps representing microvascular ischemic disease. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is suspected. The ventricles are stable in size.

Output: Findings compatible with hemangioblastomatosis are again seen including dural tumor studding along the anterior interhemispheric falx and numerous enhancing nodules within the posterior fossa. Relative to the immediate prior examination, there has been no significant interval change. Compared to an older examination, increased tumor size and progressive edema are noted.


Instruction: Generate impression based on findings.

Input: History of colon cancer now with enlarging liver lesion and renal lesion. Negative PET scan. Please evaluate for metastasis. ABDOMEN:LIVER, BILIARY TRACT: There is susceptibility artifact in the gallbladder fossa related to the surgical clips. Within the liver parenchyma adjacent to the gallbladder fossa there is a geographic area of signal dropout on the out of phase images compatible with focal intracellular fat. There is no associated enhancement, T2 signal abnormality, or restricted diffusion. Findings are compatible with focal fatty infiltration. No additional suspicious hepatic lesions.Status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Mild splenomegaly with the spleen measuring 13 cm in length.PANCREAS: Pancreas is normal in signal and morphology. The main pancreatic duct is nondilated.ADRENAL GLANDS: Redemonstration of a left adrenal nodule which measures 1.5 x 2.0 cm. This lesion demonstrates signal dropout on the out of phase images compatible with intracellular fat. There is mild restricted diffusion. The lesion enhances similarly to the background adrenal parenchyma. The right adrenal gland is unremarkable.KIDNEYS, URETERS: Redemonstration of a 11 x 10 mm exophytic nodular lesion arising from the superior pole of the right kidney. This has mildly increased T2 signal, restricted diffusion, and enhances on the postcontrast images. Appearance is compatible with a small renal cell carcinoma.Numerous additional simple cysts bilaterally. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with focal fatty infiltration in the gallbladder fossa. No evidence of hepatic metastasis.2.No significant change in small right superior pole renal mass compatible with small renal cell carcinoma.3.Left adrenal nodule with imaging findings compatible with a benign adenoma.


Instruction: Generate impression based on findings.

Input: 70 year old with personal and family history of breast cancer. Personal history of left breast lumpectomy in 1992 for cancer followed by radiation and hormonal therapy. She also had a benign right breast surgery approximately 27 years ago. Mild parenchymal enhancement is noted bilaterally. There is heterogeneous amount of fibroglandular tissue in both breasts. The left breast remains smaller than the right. No suspicious enhancement is seen in either breast. Expected postsurgical volume loss and scarring in the left breast is unchanged. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Neck stiffness with disc degeneration seen on x-ray, decreased reflexes in the hands, and increased trapezius tone. There is multilevel degenerative cervical spondylosis associated with lack of the usual cervical lordosis. In particular, at C4-5, a posterior disc-osteophyte complex that is eccentric to the right nearly abuts the spinal cord, at C5-6, a posterior disc-osteophyte complex that abuts the spinal cord, and at C6-7, a posterior disc-osteophyte complex that is eccentric to the right indents the spinal cord and adjacent exiting nerve roots. However, the spinal cord displays normal signal. There is no significant spinal canal stenosis at the other cervical spine levels. In addition, there is no significant neural foraminal stenosis in the cervical spine. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no abnormal enhancement in the spine or evidence of mass lesions. The paravertebral soft tissues and imaged intracranial structures are unremarkable.

Output: Multilevel degenerative cervical spondylosis associated with lack of the usual cervical lordosis. In particular, at C4-5, a posterior disc-osteophyte complex that is eccentric to the right nearly abuts the spinal cord, at C5-6, a posterior disc-osteophyte complex that abuts the spinal cord, and at C6-7, a posterior disc-osteophyte complex that is eccentric to the right indents the spinal cord and adjacent exiting nerve roots.


Instruction: Generate impression based on findings.

Input: History of meniscal repair in 2001 with subsequent injury in 2009. Now complains of right knee pain. Due to the patient's body habitus, the high resolution coil could not be used. An alternative coil was used which results in slightly suboptimal image quality.MENISCI: There is marked deformity of the posterior horn of the lateral meniscus with fluid signal intensity in its substance indicating extensive complex tearing. This tearing extends into the body of the lateral meniscus and there is anterior extrusion of the anterior horn. We see no discrete tearing of the medial meniscus.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage of the lateral femoral condyle and lateral tibial plateau posteriorly with underlying subchondral cysts. There is also more focal degeneration and tearing of the articular cartilage of the medial femoral condyle and medial tibial plateau adjacent to the posterior horn of the medial meniscus. There is also moderate degeneration of the articular cartilage of the patellofemoral joint with subchondral cysts in the patella. There are tricompartmental osteophytes.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Extensive complex tearing of the lateral meniscus.2.Tricompartmental osteoarthritis.3.Collection of fluid signal intensity along the posteromedial aspect of the proximal tibia which may represent a ganglion or pes anserine bursitis.


Instruction: Generate impression based on findings.

Input: Male, 34 years old, with GBM status post re-resection. Evidence of re-resection of the patient's left frontal lobe tumor is seen. The resection cavity has been expanded and contains predominantly FLAIR hypointense fluid. An oval collection of blood product is evident along the floor of the resection cavity which appears to be intraparenchymal but which probably represents clot within the prior cystic cavity in this location. The previously described, slowly progressive soft tissue thickening along the margins of the original resection cavity has been debulked. This includes a majority of the irregular enhancing tissue which was particularly prominent along the inferior margin of the cavity. Some irregular enhancing tissue does remain along the posterior aspect of the cavity with extension into the genu of the corpus callosum appearing similar to prior.The degree of T2 signal abnormality surrounding the resection cavity appears geographically similar to that on the preoperative examination. Ill-defined periventricular FLAIR hyperintensity is unchanged. No new parenchymal lesions are identified. The ventricles are stable and normal in size.

Output: Expected findings are seen status post debulking of the patient's left frontal lobe tumor. A small amount of residual tumor is seen mostly along the posterior resection margin with invasion of the genu of the corpus callosum appearing similar to the preoperative examination.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for Posterior Tibial Tendon Dysfunction left History: 41-year-old female with pain and edema along lateral aspect left ankle and anterior ankle with decreasing medial long arch TENDONS: There is circumferential fluid within the tendon sheath of the flexor hallucis longus just proximal to the master knot of Henry suggestive of a mild tenosynovitis/intersection syndrome (image 17; series 501). The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. No full-thickness articular cartilage defects are seen. ADDITIONAL

Output: 1. Findings suggesting a synovitis of the tibiotalar joint.2. Findings suggestive of a mild tenosynovitis of the flexor hallucis longus as described above. The posterior tibialis tendon appears normal.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The right wrist was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge needle.Under fluoroscopic guidance, a 22-gauge spinal needle was advanced into the midcarpal joint. Next, 5 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint. A spot radiograph was obtained in neutral, ulnar flexion, and carpal flexion for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 59 seconds.

Output: Successful right wrist midcarpal joint arthrogram injection. Please refer to the subsequent MRI report for further evaluation.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is increased horizontal signal within the posterior horn of the medial meniscus, reflecting tear. There is mild extrusion of the meniscus into the medial gutter although the root appears intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss of the medial compartment of both the femoral condyle and tibial plateau there is associated degenerative marrow signal within the underlying bone. The articular cartilage of the lateral compartment is relatively preserved. There is thinning of the articular cartilage of the femoral trochlea without full-thickness defect of the patellar cartilage.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Horizontal tear of the posterior horn of the medial meniscus with mild extrusion.2. Full-thickness cartilage loss of the medial compartment with milder thinning of the patellofemoral and lateral compartments.3. Small joint effusion and mild synovitis.


Instruction: Generate impression based on findings.

Input: Rule out abscess or osteomyelitis of the right pubic bone. Study is severely limited by artifact from bilateral total hip prosthesis. There is generalized muscle atrophy in bilateral thighs. There is a 3 x 2 cm fluid collection, which may represent an abscess in the proximal medial aspect of the thigh. There is no definite signal changes within the adjacent pubic bone to indicate osteomyelitis. Adjacent edema and inflammatory changes are noted in the medial thigh. Superficial soft tissue defect is noted in the region, which may be related to prior radiation or surgery.Multiple defects are noted in the distal femur which are most likely postsurgical. There are bilateral knee effusions, right greater than the left. Small right Baker's cyst is noted. Scattered varicosities are noted within the thigh.

Output: 1.3 x 2 cm fluid collection which may represent an abscess in the medial proximal aspect of the thigh. There is adjacent soft tissue edema and inflammatory changes, but within the limitations of the study, there is no definite signal changes within the pubic bone to indicate osteomyelitis.2.Superficial soft tissue defect adjacent to the fluid collection in the medial thigh, which may represent sequela of prior radiation or surgery.3.Bilateral knee joint effusions.4.Generalized atrophy of bilateral thigh musculature.5.Defects in the right distal femur which are most likely postsurgical in etiology.


Instruction: Generate impression based on findings.

Input: Systemic lupus erythematosus and neuromyelitis optica on research treatment protocol. Evaluation for progressive multifocal leukoencephalopathy is requested. There are numerous T2 hyperintense lesion in the cerebral white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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: Multiple nonspecific cerebral white matter lesions, but no particular findings to suggest progressive multifocal leukoencephalopathy.


Instruction: Generate impression based on findings.

Input: Abulia. Also history of depression, migraines, HTN, seizures on Keppra, pseudotumor status post cisterna-magna shunt with Codman valve last revised in 2009. MRI: Some of the images are degraded by patient motion. There is an area of high T2 signal and restricted diffusion involving a portion of the left globus pallidus and posterior limb of the internal capsule. There is also a punctate focus of encephalomalacia in the right corona radiata. There is a posterior fossa catheter that traverses the left aspect of the fourth ventricle and protrudes into medulla. The fourth ventricle appears similar in size as in 2013, but slightly larger than in 2010. There is persistent effacement of the third ventricle and the lateral ventricles appear slightly larger. There is herniation of a portion of the left medial temporal lobe along with a small portion of the temporal horn into the left perimesencephalic cistern. There also appears to be slumping and distortion of the brainstem with effacement of the surrounding cerebrospinal fluid spaces. The pituitary gland displays convex contours.MRA: The left vertebral artery terminates are the PICA, which is an anatomic variant. There is no evidence of significant steno-occlusive lesions. There is no evidence of cerebral aneurysms.

Output: 1. Acute lacunar infarction involving a portion of the left basal ganglia and chronic lacunar infarction involving the right corona radiata.2. The posterior fossa catheter traverses the left aspect of the fourth ventricle and protrudes into medulla. The fourth ventricle appears similar in size as in 2013, but slightly larger than in 2010.3. Cerebellar tonsillar herniation, herniation of a portion of the left medial temporal lobe along with a small portion of the temporal horn into the left perimesencephalic cistern, and slumping and distortion of the brainstem with effacement of the surrounding cerebrospinal fluid spaces may represent sagging brain syndrome. In addition, there is persistent effacement of the third ventricle and the lateral ventricles appear slightly larger. 4. No evidence of significant steno-occlusive lesions in the head and neck arteries.


Instruction: Generate impression based on findings.

Input: 77-year-old female with lumbar spinal stenosis Vertebral body heights are intact. Endplate degenerative changes, most severe and L3-L4, are unchanged. Multilevel disk desiccation with loss of disk height at L3-L4. Signal within the distal cord and conus is normal. Alignment is anatomic.T12-L1: Mild facet arthropathy. No significant central canal or neuroforaminal stenosis.L1-L2: Diffuse disk bulge with small right paramedian protrusion is unchanged. Mild facet arthropathy. No significant spinal or central canal stenosis.L2-L3: Diffuse disk bulge, asymmetric to the left. Mild facet arthropathy and ligamentum flavum thickening. No significant central or neuroforaminal stenosis.L3-L4: Diffuse disk bulge, ligamentum flavum thickening and facet arthropathy is unchanged. Mild to moderate central canal stenosis, unchanged. Moderate right neuroforaminal stenosis, unchanged.L4-L5: Diffuse disk bulge, asymmetric to the left, with facet arthropathy and ligamentum flavum thickening is unchanged. Mild central canal stenosis is unchanged. Mild left neuroforaminal stenosis is unchanged.L5-S1: Diffuse disk bulge, unchanged. Facet arthropathy. No central canal stenosis. Minimal left neuroforaminal stenosis.

Output: Stable spondylosis of the lumbar spine with narrowing of the central canal and neuroforaminal stenosis at L3-L4 and L4-L5.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: please dom Dr Javed MS protocol, compare to priorSigns and Symptoms: progression MS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular and subcortical white matter lesions within the brain parenchyma which were also present on the prior exam from May 4, 2015.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus which was also present on the prior exam.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There are small foci of T2 signal hyperintensity within the cervical spinal cord centrally and anteriorly at the C3 vertebral body level measuring approximately 3 mm in size along the right posterior lateral aspect of the spinal cord at the T3-4 disc space level, along the left lateral aspect of the spinal cord at the C45 disc space level measuring 3 mm and along the right posterior lateral aspect of the spinal cord at the C6-7 disc space level measuring 2 x 3 mm.. There is an additional lesion present at the T7 T1 level along the right posterior lateral aspect of the spinal cord. None of these are associated with contrast enhancement. Compared to the prior exam 5/13/2015 these lesions are stable.No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level. This has not changed substantially since the prior exam.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal. There is a left lateral recess disc protrusion present at this level which was also present on the prior exam and encroaches on the left-sided exiting nerve roots at the left lateral recess..At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multiple lesions present in the cervical spinal cord which appears stable when compared to prior exam.2.There are multiple lesions present within the brain parenchyma which appears stable compared to the prior exam.3.There are degenerative changes present in the cervical spine associated with left lateral recess disc protrusion at C5-6 which encroaches on the left-sided exiting nerve root and is stable since the prior exam.


Instruction: Generate impression based on findings.

Input: 49 old woman with transient left-sided weakness since morning an ongoing left weakness. There is no evidence of intracranial hemorrhage, mass or edema. No CT findings of acute stroke. However if acute stroke is of clinical concern, recommend MRI.The ventricles and basal cisterns are normal in size and configuration. A partially empty sella, a nonpathologic finding, is noted.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No CT findings of acute intracranial abnormality. If stroke is a clinical concern recommend MRI.


Instruction: Generate impression based on findings.

Input: Radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign with several small T1 hyperintense vertebral body lesions compatible with hemangiomas or foci of fat. No destructive osseous lesions are appreciated.The cervical spinal cord has normal signal characteristics. Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is moderate disc height loss and left paracentral disc osteophyte formation with associated effacement of the left ventral thecal sac and mild impression on the left aspect of the cord. There is mild spinal canal stenosis involving the left aspect of the spinal canal. No cord signal abnormality. There is also mild to moderate left neural foraminal stenosis. Right neural foramen is patent. C6-7: Small right paracentral disc osteophyte complex. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Degenerative changes at the C5-C6 level where there is a left paracentral disc osteophyte complex and uncovertebral hypertrophy contributing to mild stenosis involving the left aspect of the spinal canal as well as mild to moderate left-sided neural foraminal stenosis. No cord signal abnormality. Spinal canal and neural foramina at the other levels are preserved.


Instruction: Generate impression based on findings.

Input: 35-year-old female. Pain occurring after slipping on ice and ankle. TENDONS: The Achilles tendon and other tendons of the ankle are normal in signal intensity and morphology. LIGAMENTS: The anterior talofibular and posterior talofibular ligaments as well as deltoid ligamentous complex are grossly intact. The distal tibiofibular syndesmotic complex appears intact. ARTICULAR SURFACES AND BONE: Mild patchy edema in the talus and distal fibular tip are suggestive of contusions. No osteochondral defect is seen in the talar dome. Mild edema at the calcaneocuboid articulation, likely degenerative in etiology. ADDITIONAL

Output: 1. Mild edema in the talus and fibular tip suggestive of contusions given patient history of trauma.2. No evidence of ligamentous or tendon injury.3. Small ankle joint effusion.


Instruction: Generate impression based on findings.

Input: Neutropenic fever. HIV infection.. There is susceptibility artifact in the region of the ears which causes mild limitation, most pronounced on diffusion-weighted imaging and fat saturated postcontrast axial imaging.There is a punctate T2-hyperintense right frontal white-matter lesion (series #401, image #19), which shows no diffusion restriction or contrast enhancement. This is nonspecific. Otherwise, the brain shows normal signal characteristics. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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 dural venous sinuses are patent. Major intracranial arterial flow voids are preserved.There is mild polypoid thickening (versus small retention cysts) in the left maxillary sinus. The other paranasal sinuses and the mastoid air cells are clear. The pituitary gland is slightly smaller than expected for age which is nonspecific.

Output: 1.Right frontal punctate T2-hyperintensity is nonspecific. The rest of the brain examination is normal.2.Left maxillary sinus mucosal thickening (versus retention cysts) is mild and nonspecific.


Instruction: Generate impression based on findings.

Input: Evaluate for bleed. 68-year-old female Examination is suboptimal due to extensive motion artifacts in particular in the posterior fossa. However no definitive abnormality within the posterior fossa is noted in 4 to remains within normal size and location.Several area of low-attenuation is suspected in the left posterior temporal occipital region. This was also partially visualized on the prior examination and may represent area of acute stroke. Several areas of subcortical lucencies are also noted in bilateral cerebral hemispheres. These may represent small vessel disease of undetermined age. An MRI examination is recommended since the quality of both of these recent CT exams are not very good for detection of very acute stroke.

Output: Suboptimal exam however suspected left posterior temporal -- occipital stroke and small vessel disease. MRI is recommended.


Instruction: Generate impression based on findings.

Input: Multiple myeloma, right thigh pain There are multiple foci of endosteal scalloping involving the femoral diaphysis which account for the lucent lesions seen on prior osseous survey. However, the signal intensity of the femur including these foci parallels fat signal indicating that these are treated lesions. There are no discrete high signal intensity lesions within the marrow of the femur on the fat-suppressed T2-weighted images to suggest an active focal myelomatous lesion. There is also no edema type signal to suggest the presence of stress fracture.There is mild osteoarthritis of the right knee with a small joint effusion and a mild amount of nonspecific edema overlying the subcutaneous fat anterior to the patella and patellar tendon. Although this exam was not tailored for the evaluation of the abductors of the hip, there is mild peritrochanteric edema bilaterally, right greater than left, suggesting mild inflammation. Large field-of-view coronal images demonstrate a moderate to large joint effusion of the left knee. There is mild fatty atrophy of the pelvic and thigh musculature, particularly posteriorly.

Output: Foci of endosteal scalloping involving the femoral diaphysis which demonstrate the signal intensity of fat indicating these are treated lesions. There are no discrete myelomatous lesions evident in the femur on this exam.


Instruction: Generate impression based on findings.

Input: A 71 year old male with CNS lymphoma with suspected cardiac involvement according to PET study. Referred to cardiac MRI to evaluate cardiac involvement. Left VentricleThere is motion artifact secondary to breathing which limits the quality of the examination. The left ventricle is mildly enlarged with mildly reduced systolic function. There is thinning of the inferior wall from the base to the apical two thirds of the left ventricular chamber. The thickened segments are akinetic. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 221 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 115 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 91 g (normal range 164+/-36). 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 62%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 167 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is 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 pericardial effusion.

Output: 1. The patient was unable to cooperate with breathing instruction and thus the image quality is limited. Contrast was not injected for this reason.2. The left ventricle is mildly enlarged with mildly reduced systolic function, the LVEF is 48%. There is thinning of the inferior wall from the base to the apical two thirds of the left ventricular chamber, favoring prior myocardial infarct. The segments are akinetic.3. The right ventricle is normal in size with normal systolic function, the RVEF is 62%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Patient is having breast pain, history of previous breast augmentation, evaluate implants There is scattered fibroglandular tissue in both breasts. Bilateral retro-glandular silicone implants appear intact. No evidence of implant rupture.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Altered mental status, abnormal signal intensity on pons, bilateral thalami and basal ganglia. Increased T2 signal intensities on brainstem especially midbrain and pons, bilateral thalami and basal ganglia do not show significant interval change since prior exam.There is evidence of circumferential restricted diffusion especially on the pons, but again the pattern and MR signal characteristics have not been changed since prior exam.There is no evidence of acute hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Above described lesions are again non specific.The restricted diffusion lesion on pons could represent acute ischemic lesion but not typical feature considering not following vascular territory. Bilateral thalami and basal ganglia lesions may indicate metabolic lesions or encephalitis but again non specific. Above findings do not show any significant interval change since prior exam.Gad enhanced MRI can be helpful for differential diagnosis.

Output: Multifocal high signal intensities on FLAIR images including bilateral thalami, basal ganglia, as well as pons which shows circumferential restricted diffusion lesions. No significant interval change since prior exam.These are again non specific findings and not typical for acute ischemic lesion, nor hepatic encephalopathy. Gad enhanced MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Left knee locking. Assess for meniscal pathology. Evaluation of the knee is limited by metallic susceptibility artifact resulting from what I presume to be orthopedic hardware in the distal femur.MENISCI: I see no meniscal tear.ARTICULAR CARTILAGE AND BONE: I see no defects in the articular cartilage not distorted by the aforementioned metallic stability artifact.LIGAMENTS: The proximal fibers of the anterior cruciate ligament are distorted by artifact, but the ligament appears intact on the sagittal intermediate-weighted series. The posterior cruciate ligament appears intact. The medial collateral ligament appears intact although its proximal attachment is distorted by artifact. The lateral collateral ligament complex appears intact.EXTENSOR MECHANISM: The extensor mechanism is intact.

Output: Limited study due to metallic susceptibility artifact arising from what I presume to be orthopedic hardware in the distal femur. Given this limitation, I see no meniscal pathology or other specific findings to account for the patient's knee locking.


Instruction: Generate impression based on findings.

Input: Reason: Eval GBM. Pt Dx in 2014. Off all Tx for past year. History: GBM. Postoperative changes are again seen relating to prior left frontal craniotomy and left frontal lobe tumor resection. The mildly hemosiderin stained resection bed appears stable. There is no pathologic enhancement in the surgical bed. Specifically, a previously noted small focus of enhancement within the right superior frontal gyrus is no longer visualized.Patchy T2/FLAIR hyperintensity within the left greater than right frontal lobe white matter has progressed from prior more remote examinations, without mass-like appearance. A few scattered punctate foci of T2/FLAIR hyperintensity within the cerebral white matter remain nonspecific, unchanged. There is subtle progressive increased extent of T2/FLAIR hyperintensity along the right basal ganglia. ADC images are not currently available, to accompany diffusion-weighted images.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Incidental empty sella is again noted. The remainder of the midline structures and craniocervical junction are within normal limits. A left maxillary mucus retention cyst is again noted.

Output: 1.Stable appearing left frontal lobe surgical bed with no evidence of pathological enhancement.2.Progressive ill-defined frontal lobe white matter signal abnormality, most likely post-treatment effects.3.Gradual increased ill-defined FLAIR abnormality in right basal ganglia, which may also be post-treatment related. Addendum will be issued with ADC images are provided.


Instruction: Generate impression based on findings.

Input: Right shoulder pain The exam is limited by motion artifact.ROTATOR CUFF: There is increased signal intensity of the subscapularis tendon indicating mild tendinosis. Additionally, there is a linear focus of longitudinal signal intensity involving the superior fibers of the subscapularis tendon likely representing interstitial tearing, measuring just over 1 cm. The remaining rotator cuff tendons are intact. The muscles of the rotator cuff are normal in signal and caliber.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is normal alignment of the glenohumeral joint and there is no joint effusion. A small amount of fluid partially separates the superior glenoid from the underlying labrum which is thought to represent a sublabral sulcus. There is also separation of the anterior superior labrum from the anterior glenoid which is thought to represent a sublabral foramen. Small paralabral cysts are seen along the anterior superior margin of the glenoid but there is no definite tear identified.BICEPS TENDON: No significant abnormality noted.

Output: 1. Mild tendinosis and interstitial tearing of the distal subscapularis tendon. The remaining rotator cuff tendons and musculature are intact.2. Probable normal variants of the glenoid labrum further detailed above. If there is strong clinical concern for labral pathology, an MR arthrogram can be considered.


Instruction: Generate impression based on findings.

Input: 62 year-old female with history of severe headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. However, there is mild nonspecific prominence of the bilateral frontal convexity subarachnoid spaces. There is no midline shift or herniation. The major cerebral flow voids appear to be intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Minimal nonspecific foci of increased T2 signal within the periventricular and subcortical white matter, which is likely due to chronic small vessel ischemic disease. Otherwise, no evidence intracranial mass or hemorrhage.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 44 years old Reason: demoid tumor; colon cancer History: palpable RUQ mass ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Again noted multiple enhancing lesions in the anterior abdominal wall predominantly on the right side but also on the left side. They have significantly decreased in size compared to previous MRI. An index lesion in the right upper lobe measures 4.2 x 4.4 cm on image #404, series #1104. An index lesion in the left anterior abdominal wall measures 1.9 cm in diameter image #354, series #1104. There are also multiple enhancing tracts likely secondary to previous laparoscopic surgery.Postsurgical changes secondary to recent surgery in the anterior abdominal wall.OTHER: No significant abnormality noted.PELVIS:No evidence of pelvic mass or free fluid.

Output: 1. Postsurgical changes in the anterior abdominal wall.2.Enhancing residual masses in the anterior abdominal wall on both sides.


Instruction: Generate impression based on findings.

Input: Status of intracranial injury. Seizure. There is a small amount of scattered T1 hyperintense subdural hemorrhage along the posterior falx cerebri and cerebelli that measures up to 3 mm in thickness. There is no significant associated mass effect or midline shift. There is minimal prominence of the subarachnoid CSF spaces in the bilateral anterior frontal and temporal regions, which likely represent hygromas. The brain parenchyma appears unremarkable without evidence of acute infarction or contusion. The ventricles are unchanged in size and configuration. There is minimal deformity of the occipital bone. The orbits and scalp soft tissues appear to be unremarkable. There is a subcentimeter T1 hypointense and T2 hyperintense lesion in the midline tongue base region.

Output: 1. Mild subacute subdural hemorrhage along the posterior falx cerebri and cerebelli without associated significant mass effect or cerebral contusion. 2. A subcentimeter T1 hypointense and T2 hyperintense lesion in the midline tongue base region is incompletely characterized, but may represent a thyroglossal duct cyst or vallecular retention cyst. An ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: follow up meningioma resection. Previously shown left high fronto-parietal extra axial mass has been removed near totally. Subtle non enhancing area just underneath of the craniotomy site adjacent to the prior tumor location is most likely localized brain with swelling. Superior aspects of sinus invasion portion of the tumor have also been removed significantly. In particular bilateral dural leaflets of superior sagittal sinus as well as superior aspect of the superior sagittal sinus appear to be much less tumor burden than prior exam. Intra-sinus extension of the tumor also appears to be removed significantly.On coronal post enhanced scan, there were some non enhancing lesions mainly attached to the left side dural leaflet may suggest remained tumor.Significant parenchymal edema which compresses left lateral ventricle is again shown. The extent and degree of the mass effects do not show any significant interval change since prior exam (Jan 12 2015 Stealth MRI).There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of new unusual enhancement or engorged venous structure comparing to prior exam.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. Post operative status of the left high frontal and parietal meningioma with extensive parenchymal edema and superior sagittal sinus invasion.2. Near total removal of main tumor as well as sinus invasion portion as described above. Small residual mass is suspected especially intra-sinus portion of the tumor.3. There is no evidence new parenchymal edema or hemorrhagic lesion postoperatively.


Instruction: Generate impression based on findings.

Input: Visual changes and word finding difficulties with headache in the setting of pregnancy. MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The A1 segments are similar in size. The right posterior communicating artery is medium size whereas the left PCOMA is small. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.MR venogram of the brain is within normal limits.4.No evidence for intracranial mass lesion or cerebral infarction.


Instruction: Generate impression based on findings.

Input: 64 year-old female with tongue tumor. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. A partially empty sella is noted.

Output: No intracranial metastasis.


Instruction: Generate impression based on findings.

Input: Facial weakness [R29.810], Reason for Study: ^Reason: evaluate for brain stem infarct or tumor History: new right sided weakness, stroke risk factors, h/o malignancy No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.A couple of scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter is nonspecific, but could represent small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Unusually enlarged distal vertebral arteries and basilar artery with a tortuous course indicating so-called vertebrobasilar dolichoectasia implying intracranial atherosclerotic disease. There is no evidence of significant (more than 50%) luminal stenosis.The mastoid air cells are clear.There is a retention cyst on the left maxillary sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Vertebrobasilar dolichoectasia.


Instruction: Generate impression based on findings.

Input: Toe ulcer The examination is limited by motion artifact.There is abnormal signal intensity within the distal phalanx of the great toe, particularly within the tuft, compatible with osteomyelitis. There is ulceration of the skin dorsal to the distal phalanx. The proximal phalanx and first metatarsal demonstrate normal marrow signal. The second ray is unremarkable.A bandlike focus of abnormal signal intensity traverses the middle and proximal phalanges of the third toe representing nondisplaced fractures. Edema within the distal phalanx of the third toe may represent an additional nondisplaced fracture.The fourth ray is unremarkable.Bandlike signal abnormality noted within the neck of the proximal phalanx of the fifth toe represents a nondisplaced fracture.The metatarsals demonstrate normal marrow signal. There is mild diffuse soft tissue edema of the foot.

Output: Limited exam demonstrates osteomyelitis of the distal phalanx of the great toe with multiple phalangeal fractures as detailed above.


Instruction: Generate impression based on findings.

Input: Wrist pain Tendons: The extensor tendons are intact. The flexor tendons are intact. There is no tenosynovitis.Ligaments: There is no extravasation of contrast into the radiocarpal space or the distal radioulnar joint. The scapholunate ligament is intact. The lunotriquetral ligament is intact. The triangular fibrocartilage complex is intact.Joints: There is abnormal marrow signal intensity involving the lunate dorsally with a small amount of cystic change. There is no evidence of gross collapse or fragmentation although there is some irregularity along the dorsal margin best appreciated on series 601 image 14. The remaining marrow signal of the carpal bones as well as the distal radius and ulna are normal. There is no dislocation or subluxation. There is no significant arthrosis.Muscles: There is no muscle tear or atrophy of the flexor or extensor compartments.Nerves: The median nerve in the carpal tunnel is unremarkable. The ulnar nerve in Guyon’s canal is unremarkable.

Output: 1. Abnormal marrow signal intensity and cystic change which is isolated to the lunate. These findings are concerning for developing avascular necrosis. Although this could conceivably be posttraumatic in nature, it is thought to be less likely as the marrow signal intensity of the remaining osseous and surrounding soft tissue structures is normal.2. Intact scapholunate ligament.


Instruction: Generate impression based on findings.

Input: History of ankylosing spondylitis and back pain. BONE MARROW: Heterogenous bone marrow signal within the visualized osseous structures is compatible with normal red marrow without suspicious focal space-occupying lesions. No fractures are identified.SOFT TISSUES: The visualized musculature and soft tissues are within normal limits. JOINTS: The hip joints are within normal limits. The sacroiliac joints are within normal limits without specific findings to suggest sacroiliitis or inflammatory arthritis.ADDITIONAL

Output: Unremarkable examination without specific evidence of sacroiliitis.


Instruction: Generate impression based on findings.

Input: 65 years Male (DOB:2/15/1951)Reason: r/o compression History: low back pain with shooting pain down left legPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated within the lumbar spinal canal. There is some patchy enhancement between the spinous processes of L4 and L5 and to lesser degree L3 and L4 associated with some T2 signal hyperintensity.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present this level associated with disc desiccation.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Some of the images are degraded due to patient motionThere is a 15 mm well-circumscribed cystic lesion in the right kidney most likely representing simple cyst.

Output: 1.There are some mild degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots.2.Findings raise the question of Baastrup's syndrome in the lower lumbar spine. Please correlate with patient's clinical symptoms3.No abnormal lesions are appreciated within the lumbar spine noted that would explain the patient's polyneuropathy.


Instruction: Generate impression based on findings.

Input: follow up of right tentorial lesion, likely to be meningioma. There is again 8.9mm x 11.4mm x 10mm sized right tentorial based extra axial mass likely representing meningioma.The size, signal characteristics do not show any significant interval change since prior exam.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is 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: No change of right tentorial based extra axial mass in terms of size (8.9mm x 11.4mm x 10mm), configuration and MR signal characteristics since prior exam.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 71 year-old female with pituitary adenoma status post XRT. Postoperative changes remote transphenoidal surgery. An enhancing mass in the sella extends to the medial aspect of the right cavernous sinus adjacent to the right internal carotid artery without luminal narrowing or specific evidence of cavernous sinus invasion. The mass measures 1.5 (transverse) x 1.3 (CC) x 2.0 (AP) cm (images 14 and 10, series 9 and 11) and previously measured 1.5 x 1.4 x 1.8 cm, not significantly changed from prior exams. Superiorly the mass extends into the suprasellar cistern on the right. The infundibulum is displaced to the left. The optic apparatus remains mildly deformed, with unchanged increased T2 signal abnormality within the right optic nerve. Limited images of the brain demonstrate no evidence of acute ischemia. Scattered foci of T2 signal abnormality in the periventricular and subcortical white matter likely represent chronic small vessel ischemic disease given the patient's age. Mild paranasal sinus mucosal thickening.

Output: Right pituitary macroadenoma without significant change in size or signal characteristics compared to 12/23/14.


Instruction: Generate impression based on findings.

Input: Ms. Bauby is a 40 year old female that is BRCA 1 positive and recently diagnosed with ovarian cancer. Family history of breast cancer in paternal aunt and ovarian cancer in paternal first cousin. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.A few scattered foci of enhancement are seen in both breasts, none of which are more suspicious than the rest. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Vascular port seen in the right chest wall.

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


Instruction: Generate impression based on findings.

Input: Abdominal pain, leukocytosis, right upper quadrant pain. History of PSC. Biliary stent placed 7/16/2015. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No T2 hyperintense lesions are seen, though evaluation is limited by lack of IV contrast. The gallbladder is distended, though without specific evidence of cholecystitis. No cholelithiasis or choledocholithiasis. There is diffuse stricturing of the common bile duct, without dominant stricture identified. Intrahepatic biliary ductal stricturing is also noted. No biliary ductal dilation is seen.SPLEEN: Splenomegaly with perisplenic varices.PANCREAS: No significant abnormality noted. The pancreas is normal in signal, without pancreatic ductal dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Prominent loops of bowel in the upper abdomen, which are nonspecific and only partially imaged.BONES, SOFT TISSUES: Multiple T2 hyperintense lesions in the vertebral bodies with cortical lesions on the prior CT, likely representing hemangiomas. OTHER: Small bilateral pleural effusions, right greater than left, with right lower lobe atelectasis. Small amount of complex appearing perihepatic ascites.

Output: 1.Diffuse stricturing of the common bile duct, without dominant stricture identified.2.No evident cholelithiasis, choledocholithiasis, or biliary ductal dilation.3.Diffusely dilated small bowel loops in the upper abdomen, partially imaged. This may represent ileus versus small bowel obstruction


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is a small left frontal developmental venous anomaly. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.CERVICAL SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There is no evidence of intraspinal mass or abnormal enhancement. The paravertebral soft tissues are unremarkable.

Output: Unremarkable brain and cervical spine MRI.


Instruction: Generate impression based on findings.

Input: Female 59 years old Reason: bil dil seen on USG, please evaluate History: bil dil, HCV ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. No gallstones. There is intra and extrahepatic biliary duct dilatation. The common duct measures 1.2 cm in transverse dimension and tapers toward the ampulla. No filling defect is identified.SPLEEN: There is no splenomegaly.PANCREAS: The pancreatic body is deviated to the right upper quadrant and is located to the right of the midline. The tail follows a more normal course extending towards the left upper quadrant. The left upper quadrant vasculature is similarly deviated. There is no pancreatic duct dilatation. There is loss of the normal intrinsic T1 hyperintense signal suggestive of chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent portacaval lymph nodes are nonspecific and can be seen in the setting of cirrhosis.BOWEL, MESENTERY: There is herniation of the majority of the stomach into the right chest which may represent a Bochdalek hernia. BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Intra and extrahepatic biliary duct dilatation without filling defect or mass identified.2.There is herniation of the majority of the stomach into the right chest and deviation of the pancreatic body to the right upper quadrant and this anatomical variation may contribute to the biliary dilatation.3.Loss of normal T1 hyperintense pancreatic signal suggestive of chronic pancreatitis.4.Herniation of the majority of the stomach into the right chest consistent with a right-sided Bochdalek hernia.


Instruction: Generate impression based on findings.

Input: 81-year-old female with HCC status post TheraSphere treatment ABDOMEN: The study is limited due to lack of intravenous contrast.LIVER, BILIARY TRACT: Cirrhotic liver morphology with ablation cavity in segment 4A is redemonstrated. There is been no significant change in the reference segment for ablation cavity when using similar measurement techniques. The ablation cavity extends towards the hepatic dome and extends inferiorly into segment 4A. These findings are not significantly changed when compared to the prior exam. There is intrinsic T1 hyperintensity within the segment 4A ablation cavity representing hemorrhage. There are no significant changes compared to the prior exam.Previously seen posterior right hepatic lobe focus is unchanged and incompletely characterized due to lack of IV contrast.Cholelithiasis with cholecystostomy tube is again noted..SPLEEN: Splenomegaly measuring 15.5 cm. Perisplenic ascites is present.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes without pathologic enlargement.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited exam due to the lack of intravenous contrast. No significant change in appearance of treatment cavity.2.Unchanged indeterminate segment 6 focus.


Instruction: Generate impression based on findings.

Input: 10-year-old female with right ear and throat pain. Evaluate for nerve impingement causing glossopharyngeal neuralgia. Artifact from dental hardware limits evaluation of the frontal lobe on the gradient echo sequences. 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 3-D T2 images are essentially nondiagnostic due to motion although no repeat was performed. There is no gross abnormality affecting the glossopharyngeal nerves on the additional thin section image sequences and coronal T2 images.The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is moderate mucosal thickening within the bilateral sphenoid sinuses and mild mucosal thickening within the left greater than right frontal sinuses, ethmoid air cells and maxillary sinuses overall improved compared to the prior CT.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct. 2.No obvious abnormality affecting the bilateral glossopharyngeal nerves, although 3D T2 sequence is suboptimal.3.Interval improvement in paranasal sinus disease.


Instruction: Generate impression based on findings.

Input: Pain in thoracic spine. There appears to be mild thoracic scoliosis. There is no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are a few small eccentric left posterior disc-osteophyte complexes in the mid thoracic spine without significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Apparent mild thoracic scoliosis. 2. Few small eccentric left posterior disc-osteophyte complexes in the mid thoracic spine without significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 67-year-old female with history of small cell lung cancer status post chemo/RT. History brain metastases status post resection and whole brain RT. There is a questionable focus of mild enhancement or intrinsic high density along the superior aspect of the left lateral ventricle approximately at the location of the corpus callosum. This finding is slightly more conspicuous than was seen on prior study dated 7/2/2008. This is suspicious for metastatic focus. MRI is recommended to evaluate this finding.Patchy areas of low attenuation in the subcortical and periventricular white matter reflect small vessel ischemic disease. Stable area of encephalomalacia is seen in the left parietal lobe vertex adjacent to the craniotomy site.There is no evidence of intracranial hemorrhage or edema.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: Questionable area of enhancement above the roof of the left lateral ventricle. MRI pre-and post contrast is recommended to further evaluate.


Instruction: Generate impression based on findings.

Input: 62-year-old man with history of left lower extremity weakness, evaluate for demyelinating lesion. There are bilateral periventricular and subcortical foci of T2/FLAIR hyperintensity in the white matter arranged radially similar to the prior examination. This includes areas of signal abnormality in the subcortical right parahippocampal gyrus and right hand motor area. Additionally, there are a few prominent perivascular spaces of CSF signal along the basal ganglia and internal capsule. There are no foci of abnormal enhancement. A small development venous anomaly is incidentally noted in the left frontal lobe.The ventricles and sulci are normal in size and configuration. The major flow-voids are preserved. There is abnormal signal in the posterior right globe, unchanged and likely related to prior subchoroidal hemorrhage. The paranasal sinuses and mastoid cells are clear. There is a lipoma in the right frontal scalp, otherwise the marrow signal and extracranial soft tissues are within normal limits. CERVICAL SPINE

Output: 1.Multiple T2 hyperintense lesions in the brain and spinal cord with a morphology suggestive of demyelinating disease. However, no enhancing lesions are identified.2.Osseous and soft tissues of the spine are essentially unremarkable with minimal degenerative changes.3.Trace pleural fluid, left perihilar bronchiectasis, and interstitial thickening partially imaged but possibly related to edema.


Instruction: Generate impression based on findings.

Input: Reason: Rule out pulmonary embolism History: chest pain + SOB CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Limited examination due to motion artifact. There is no evidence of acute central saddle pulmonary embolism to the level of the second pulmonary artery bifurcation. There is heterogeneous signal in the SVC which is likely related to the central venous catheter. In the left main pulmonary artery there is a focus of decreased signal which does not correlate with alternate sequences and is favored to represent artifact.Normal heart size without pericardial effusion or evidence of right heart strain.CHEST WALL: No significant abnormality noted.

Output: No evidence of acute central pulmonary embolism to the level of the second pulmonary artery bifurcation.


Instruction: Generate impression based on findings.

Input: Left knee pain The examination is limited by patient motion artifact.MENISCI: There is abnormal signal intensity throughout most of the medial meniscus representing extensive degeneration and degenerative tearing. There is mild medial extrusion of the body of the medial meniscus. There is intrasubstance degeneration of the lateral meniscus which is otherwise intact.ARTICULAR CARTILAGE AND BONE: There is severe degeneration of the articular cartilage of the medial compartment with large areas along both the tibial plateau and femoral condyle devoid of articular cartilage. Degenerative cysts and edema type signal are identified within the medial compartment as well. There is moderate osteoarthritis affecting the patellofemoral joint with partial and full-thickness defects of the articular cartilage. Associated degenerative edema type signal and degenerative cysts are noted particularly along the lateral patellar facet.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Severe osteoarthritis of the knee particularly affecting the medial tibiofemoral compartment with extensive degeneration and degenerative tearing of the medial meniscus.2. Moderate joint effusion.3. Tapering of the popliteal vein posterior to the knee joint with portions of the vessel not visualized. The possibility of a chronic thrombosis cannot be excluded and this can be further evaluated with Doppler sonography as clinically warranted.


Instruction: Generate impression based on findings.

Input: 57-year-old female with generalized and partial seizures. This examination is degraded by motion. No restricted diffusion to suggest acute ischemia. No acute intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. The right hippocampus has slightly increased T2/FLAIR signal in comparison to the left and is also slightly smaller than left hippocampus. There is no evidence of cortical dysplasia or gray matter heterotopia. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific. Encephalomalacia is again seen in the right posterior cerebellar hemisphere. A small area of susceptibility artifact is located in this region is redemonstrated, compatible with chronic blood products. A right lateral occipital craniotomy defect is again noted. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Scattered mild mucosal thickening is noted in the paranasal sinuses. Mastoid cells are clear.

Output: Motion degraded examination, which may obscure detection of subtle seizure foci.1. Asymmetric smaller and T2/FLAIR hyperintensity of the right hippocampus may represent mesial temporal sclerosis. No intracranial mass, evidence of cortical dysplasia or gray matter heterotopia.2. Nonspecific signal change in the supratentorial white matter may be related to prior ischemia, inflammation, or less likely demyelinating disease. Unchanged since 6/24/2015.3. Evidence of remote trauma with right inferior cerebellar encephalomalacia with overlying craniotomy, unchanged.


Instruction: Generate impression based on findings.

Input: 16 year old male with history of brain tumor. Status post craniotomy now with fever and draining the scalp wound. Concern for abscess/osteomyelitis. Patient also had syncopal event. Extensive postoperative changes of left frontal craniotomy which extends across the midline is again identified. Epidural thickening is again identified with no distinct cavity formation. The changes appear similar to the prior study however without infusion possibility of an abscess cannot be entirely ruled out. An MRI examination is more sensitive for detection of abscess in this location.The bony density of craniotomy flap and adjacent calvarium remains similar to prior study and with no definitive osteomyelitis. Further evaluation with an MRI is recommended.Underlying brain parenchyma remains unremarkable with the exception of postoperative changes. No evidence of edema, hemorrhage, mass-effect, midline shift or hydrocephalus. Expected postoperative changes of transcallosal approach and is noted. There is no evidence of interval change.Soft tissues of the scalp overlapping the craniotomy demonstrates some thickening however these findings are also similar to prior study. Follow-up exam with an MRI is recommended.

Output: 1.No evidence of interval change since prior exam.2.To exclude an abscess an MRI examination with infusion is recommended.


Instruction: Generate impression based on findings.

Input: Gait imbalance and brisk deep tendon reflexes. Brain MRI with and without Contrast:There are scattered, punctate T2/FLAIR hyperintense foci in the cerebral white matter, most numerous in the frontal and parietal white matter. They show no diffusion restriction or contrast enhancement. These are nonspecific but likely represent mild chronic small vessel ischemic changes. Postcontrast images are notable for developmental venous anomalies in the left occipital lobe and in the left cerebellar hemisphere. There is no abnormal parenchymal contrast enhancement, otherwise. There is no mass or midline shift. The CSF-containing spaces are mildly enlarged reflecting mild global volume loss. There is no susceptibility artifact to indicate intracranial hemorrhage. Major cranial vessels are patent.Mastoid air cells are clear. Mucosal thickening is moderate in the anterior ethmoid sinuses and mild to minimal in the other paranasal sinuses. The orbits are notable for bilateral cataract surgery.Cervical Spine MRI without Contrast:There is exaggeration of the cervical lordosis. The vertebral bodies are preserved in height. Marrow signal is mildly heterogeneous and benign. The intervertebral discs show loss of height and T2 signal at multiple levels, most pronounced at C5-C6 and C6-C7 levels. The spinal cord shows normal morphology and signal (down to the lower T5 vertebral level). Small right thyroid nodule. The imaged cervical soft tissues show no gross abnormality.Multilevel degenerative changes as described below:C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: Small disc-osteophyte complex slightly eccentric to the left. There is no significant spinal canal or foraminal stenosis.C4-C5: Left uncovertebral proliferative change causes mild left foraminal narrowing. There is no spinal canal or right foraminal stenosis.C5-C6: Disc osteophyte complex is associated with left more than right uncovertebral proliferative change. This results in moderate left and mild right foraminal stenoses. Ligamentum flavum thickening. There is mild spinal canal stenosis.C6-C7: Disc osteophyte complex is minimal. Ligamentum flavum thickening. Mild spinal canal narrowing. Uncovertebral and facet proliferative change results in mild to moderate bilateral foraminal narrowing.C7-T1: There is no spinal canal or foraminal stenosis.

Output: 1.No evidence of intracranial mass or mass effect. No evidence of acute infarct or hemorrhage. Mild chronic small vessel ischemic changes.2.Mild degenerative changes in the cervical spine without high-grade spinal canal stenosis at any level. No cord signal abnormality. Individual levels as above including relatively mild spinal canal narrowing at C5-C6 and C6-C7.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 96 year-old woman with history of CVA and new onset aphasia, right facial droop. Questionable left-sided weakness. There is no evidence of intracranial hemorrhage, mass or edema. No acute cortical stroke is seen. If acute infarction is suspected clinically, MRI can be obtained. A large area of encephalomalacia is seen in the distribution of the right posterior cerebral artery consistent with old stroke. There is ex vacuo dilatation of the posterior and temporal horns of the right lateral ventricle. Focal encephalomalacia is also seen in the bilateral cerebellar hemispheres consistent with old strokes. Extensive areas of periventricular white matter hypoattenuation are also noted consistent small vessel ischemic disease, of indeterminate age.

Output: 1. Multiple old strokes.2. Extensive small vessel ischemic disease, age indeterminate.


Instruction: Generate impression based on findings.

Input: Further assessment of calcified mass on recent CT scan the head. The ossified extra-axial mass in the lateral right middle cranial fossa on the CT scan correlates with a mildly T2-hypointense, intensely contrast enhancing mass with a wide base over the medial squamosal and anterior petrous portions of the right temporal bone as well as part of the right greater wing of the sphenoid. It measures 3.9 cm x 2.1 cm x 2.0 cm and is associated with dural thickening extending along the free edge of the right tentorium (dural tail). It is associated with mild osseous expansion and loss of the fatty normal marrow signal. It is also associated with vasogenic edema in the anterior right temporal lobe reaching into the external capsule. This is associated with mild mass-effect on the right lateral ventricle and sylvian fissure. There is mild leftward midline shift and minimal right uncal herniation.Otherwise, the brain is unremarkable. There is no acute infarct or intracranial hemorrhage. The flow voids of the major intracranial arteries are preserved. Small right frontal scalp hematoma.

Output: 1.Calcified extra-axial mass in the lateral right middle cranial fossa most likely represents a meningioma. There is associated moderate degree of vasogenic edema with mild leftward midline shift and minimal right uncal herniation.2.Small right frontal scalp hematoma which may related to trauma.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 23 years old Reason: rectal fullness, hx of fevers. assess for abscess, pelvic pathology History: rectal fullness, hx of fevers ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No focal suspicious hepatic lesions. Hepatic and portal veins are patent. No significant fatty infiltration.No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology. Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. The terminal ileum is not imaged.There is diffuse rectal wall thickening involving the distal rectosigmoid up to a 12 cm segment. This segment shows hyperenhancement, wall edema and increased surrounding vascularity.No associated abscess. This is subtle T2 hyperintense linear band extending from the 12 o'clock position of the anus towards the vagina and is suspicious for a small perianal fistula that extends to the right.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small physiologic adnexal follicles.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings of active inflammation involving the rectum and distal sigmoid for a 12 cm segment.2.Findings of a small perianal fistula extending from the 12 o'clock position extending anteriorly to the right..


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with smoldering myeloma, questionable transformation to myeloma. Evaluate for bone lesions. Cervical:Sagittal alignment is unremarkable. Vertebral body morphology and signal characteristics are within normal limits. Specifically, no focal marrow space lesions are identified.Within the limitations of a somewhat degraded image quality, no abnormalities of spinal cord signal or morphology are detected. No epidural lesions are seen.C2-3: Left facet hypertrophy. No significant spinal canal stenosis or neuroforaminal narrowing. C3-4: Left greater than right facet hypertrophy. No significant spinal canal stenosis. Mild left foraminal narrowing. C4-5: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the left. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C5-6: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing. C6-7: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the right. Mild generalized spinal canal narrowing without cord impingement. No significant foraminal narrowing. C7-T1: Left greater than right facet hypertrophy. No significant spinal canal or foraminal stenosis. Thoracic:A slight scoliotic curvature of the thoracic spine is noted. Sagittal alignment is unremarkable. The thoracic kyphosis is exaggerated which likely reflects mild multilevel anterior vertebral body wedging.Vertebral body marrow signal is within normal limits. Specifically, no focal lesions are seen.The spinal cord is normal in signal intensity and morphology. No epidural lesions are suspected.Mild scattered degenerative disc disease is seen with no areas of high-grade spinal canal or foraminal stenosis.Lumbar:Alignment is anatomic. Vertebral body morphology is within normal limits. Marrow signal characteristics are unremarkable. In particular, no focal lesions are detected.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural lesions are suspected.Facet hypertrophy is evident and becomes progressively more severe at lower lumbar levels, particularly on the right at L5-S1. Mild disc bulging is seen at L2-3, L3-4 and L4-5. No significant spinal canal or foraminal stenosis is identified.

Output: 1.No lesions to suggest active myelomatous disease are seen in the cervical, thoracic or lumbar spine.2.Relatively mild degenerative findings as discussed above.


Instruction: Generate impression based on findings.

Input: 67-year-old woman with known breast cancer metastatic on chemo. Reevaluate. CHEST:LUNGS AND PLEURA: Stable appearance of left apical traction bronchiectasis with fibrosis likely due to radiation change. New moderate to large left pleural effusion. Stable subcentimeter micronodule in the right upper lobe (image 27/95). There is a new air space opacity involving the left lingular segment anteriorly (image 45/95) that demonstrated increased activity on recent PET scan.MEDIASTINUM AND HILA: The left vocal cord is midline, compatible with known vocal cord paralysis. Thyroid hypodense lesions. Paratracheal enhancing soft tissue has decreased. Normal cardiac size. Mild pericardial wall thickening. Subcentimeter mediastinal nodes are unchanged. Slightly increased right hilar nodes.CHEST WALL: No significant axillary lymphadenopathy. Surgical clips are noted left axilla. Status post left mastectomy. A right-sided chest port is seen with its tip in the SVC/RA junction. Interval development of multiple sclerotic foci in the mid and lower thoracic spine suspicious for metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: Stable hypodense lesion in the lateral segment of the left lobe (image 95/144).SPLEEN: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered borderline mesenteric nodes. The largest measures approximately 11 mm (image 140/144) adjacent to the cecum.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval development of multiple sclerotic foci with inferior endplate depression involving the lumbar spine suspicious for metastatic disease better demonstrated on recent MRI from 7/2/08.

Output: 1. Interval development of new moderate left pleural effusion with new airspace opacity in the left lingular segment that was shown to have increased activity on PET/CT from 6/24/08.2. Interval development of multiple thoracic and lumbar osseous metastatic disease better seen on MRI from 7/2/08.


Instruction: Generate impression based on findings.

Input: 79 years, Male, memory loss. There is moderate global parenchymal volume loss without a particular lobar distribution. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. There is a focal area of volume loss involving the left posterior cerebellar hemisphere. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There are bilateral lens implants. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No intracranial mass or mass effect. No extra-axial collections or hydrocephalus.2. Mild chronic small vessel ischemic changes. Small focal area of volume loss involving the left posterior cerebellar hemisphere which may be related to chronic infarct. 3. Moderate global parenchymal volume loss without a particular lobar distribution.


Instruction: Generate impression based on findings.

Input: 78-year-old female with hyperbilirubinemia who needs a biliary drain. Evaluate. ABDOMEN: Suboptimal postcontrast images given motion artifact.LIVER, BILIARY TRACT: Again noted is a perihepatic infiltrative soft tissue which measures 4.8 x 5.5 cm (series 8, image 27), previously measuring 6.0 x 5.3 cm. Please note this mass was previously measured on the CT examination. This mass also invades the portal vein and the entire hepatic hilum. Surgical clips are noted within the hilar mass.There are additional multiple hepatic lesions. Segment 7 lesion has increased in size measuring 6.4 x 4.7 cm (series 1501, image 80), previously measuring 4.8 x 3.8 cm and demonstrating rim enhancement.Again noted is significant intrahepatic biliary duct dilatation to the level of the hilum. In segment 8, there are 2 significantly dilated biliary ducts with possibly a vessel coursing in between them. The proximal common bile duct is not opacified, likely extrinsic compression from the hilar infiltrative mass. The common bile duct tapers smoothly to the level of the ampulla without evidence of a lesion or mass at the level of the ampulla.SPLEEN: No significant abnormality noted.PANCREAS: Stable cystic lesion within the pancreas. ADRENAL GLANDS: The infiltrative hilar mass invades the right adrenal gland.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right lower lobe dependent subsegmental atelectasis is again noted. Bilateral small pleural effusions.

Output: 1.Significant intrahepatic biliary ductal dilatation to the level of the hilum. The proximal common bile duct is not opacified, which may be secondary to extrinsic compression from the infiltrative hilar mass. Of note, in segment 8, there are 2 significantly dilated biliary ducts with possibly a vessel coursing in between them.2.Infiltrative hepatic hilar mass and additional hepatic lesions as detailed.3.Stable cystic pancreatic lesion. Differential considerations include serous cystadenoma versus sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: A 73 year old female with personal history of hypertension, hyperlipidemia, chronic pulmonary disease, non-obstructive coronary artery disease and mild to moderate aortic stenosis . A recent cardiac CT showed moderate calcification of the aortic valve, severe calcification of the coronary arteries and ascending aorta with a diameter of 4.1cm. Referred to stress cardiac MRI for further evaluation of shortness of breathMEDICATIONS: aspirin, atorvastatin, clopidogrel, fluticasone, singulair, omeprazole, ramipril, hydrochlorothiazide First Pass PerfusionDuring hyperemia, two distinct perfusion defect are noted. One in the basal inferolateral wall and the other in the apical inferior wall. 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/hyperdynamic systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 73 ml/m2 (normal range: 65+/-11), the LVEDV is 117 ml (normal range 109+/-23), the LV end systolic volume index is 20 ml/m2 (normal range 18+/-5), the LVESV is 33 ml (normal range 31+/-10), the LV mass index is 60 g/m2, and the LV mass is 96 g. There are no regional wall motion abnormalities present.Left AtriumThe left atrium is normal in size (88ml). Right VentricleThe right ventricle is normal in size with normal/hyperdynamic systolic function. The overall RV ejection fraction is 68%, the RV end diastolic volume index is 71 ml/m2 (normal range 69+/-14), the RVEDV is 113 ml (normal range 110+/-24), the RV end systolic volume index is 22 ml/m2 (normal range 22+/-8), and the RVESV is 36 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet. There is acceleration of the flow through the aortic valve suggesting the presence of aortic valve stenosis. Correlation with echo suggested to quantify severity. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely, the leaflets are thickened and there is mild mitral regurgitation. Posterior mitral annular calcification is also noted. 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 ascending aorta is mildly dilated (40mm). The rest of the aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (32mm). 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. Two distinct areas of ischemia are noted: one in the basal inferolateral wall and the other in the apical inferior wall. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 72%).4. Normal RV size and systolic function (RVEF 68%).5. There is aortic valve calcification and stenosis, consider echo to assess severity of aortic valve stenosis.6. There is mild mitral regurgitation.7. The ascending aorta is mildly dilated. 8. The main pulmonary artery is mildly dilatedI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.