Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right shoulder was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 22-gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and 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: 17 seconds

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


Instruction: Generate impression based on findings.

Input: A 47 year female with a history of cervical cancer s/p LEEP, DLBC lymphoma on chemotherapy EPOCH-R between 2/2015 to 6/2015, a severe RV dilatation with mildly reduced systolic function on echocardiogram and cardiac MRI (4/6/2015). She is referred for cardiac MRI as follow up to evaluate RV function. Left VentricleThe left ventricle is normal in size with very mild LV hypokinesis. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVEDV is 138 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 68 ml (normal range 31+/-10), the LV mass index is 36 g/m2 (normal range 67+/-11), and the LV mass is 72 g (normal range 114+/-24). There is mild global hypokinesis with no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No iron overload was seen.No intracavitary thrombus was.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with mildly to moderately reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 104 ml/m2 (normal range 69+/-14), the RVEDV is 209 ml (normal range 110+/-24), the RV end systolic volume index is 62 ml/m2 (normal range 22+/-8), and the RVESV is 125 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is severely dilated (43 mm). Proximal left pulmonary artery is measured at 25 mm and proximal right pulmonary artery is measured at 31 mm. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. A right port catheter was seen in the SVC.PericardiumThere is no pericardial disease.Extracardiac FindingsLeft scapular mass reduced in size with residual thoracic lymphadenopathy. The osseous structures of the left shoulder girdle, including the scapula, are not well visualized. Previous right axillary lymphadenopathy is not visualizedThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with very mildly reduced systolic function, qualitatively unchanged compared to previous study. Differences in quantitative measurement are likely due to differences in measurement technique rather than a true difference. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is mildly dilated with mildly to moderately reduced systolic function, qualitatively unchanged compared to previous study though there is a small quantitative decrease. 4. The left atrium is moderately dilated an the right atrium is mildly dilated. 5. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Assess for cause for increased confusion in patient with dementia and left retro-bulbar mass. There is no evidence of intracranial hemorrhage or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease of indeterminant age. Prominence of the ventricles and sulci indicate corticomedullary volume loss. No specific findings to indicate acute ischemia. However if there is concern for an acute stroke, an MRI may be helpful for further evaluation.Limited views of the orbit shows an ill-defined soft tissue within the left orbit posterior to the globe with proptosis and deformation of the left globe is again noted. When accounting for differences in technique the size of this mass and enhancement appears decreased when compared to the prior MRI exam.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Small vessel ischemic disease of indeterminate age. No findings to indicate acute ischemia. However, if there is concern for an acute stroke an MRI is recommended for further evaluation.2. Ill-defined left orbital soft tissue mass with proptosis and deformation of the left globe. Suggestion of interval decrease in size when compared to the prior MRI exam performed 3/12/08.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. March 9, 2016 Bx showed multiple cores of prostate cancer, including Gleason 3+4=7 at the right mid lateral and right base lateral, encompassing 15% to 45% of the individual cores. He also was found to have Gleason 6 prostate cancer at the left base lateral, left mid lateral, left apex lateral, and left base, encompassing 8% to 13% of the cores. PELVIS:PROSTATE:Prostate Size: 4.8 x 5.5 x 5.5 cmPeripheral Zone: The peripheral zone is diffusely thinned with linear T2 hypointensity.Dominant right lesion in the right paramedian mid gland measuring 1.1 x 1.0 cm on restricted diffusion (series 703/284) with subtle decrease in T2 weighted signal intensity and mild arterial enhancement.Dominant left apex lesion measures 1.8 x 1.0 cm on restricted diffusion (series 703/124) with mild decrease in T2 weighted signal intensity and mild arterial enhancement.In the left mid gland peripheral zone there is a wedge shaped peripheral T2 hypointensity with mild associated restricted diffusion.Central Gland: Marked BPH without a discrete lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No specific evidence of extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings compatible with patient's known multifocal prostatic adenocarcinoma with dominant bilateral lesions described above. No specific evidence of extraprostatic extension.


Instruction: Generate impression based on findings.

Input: 61-year-old female with altered mental status and right facial droop. Evaluate for CVA. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse, mild periventricular hypodensities likely represent small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.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: Small vessel disease, age indeterminate without acute cortical stroke.If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 44-year-old female with hepatitis and hepatitis C cirrhosis. Hepatocellular carcinoma screening. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour with widened fissures in a cirrhotic morphology. A recanalized periumbilical vein and multiple perisplenic collaterals indicate portal hypertension as on previous exam. There are scattered, peripheral, elongated foci of enhancement (for example series 1001, image 334) with no washout likely representing perfusion abnormalities. No suspicious hepatic lesion.Normally distended gallbladder with no cholelithiasis. No intra or extrahepatic biliary ductal dilatation.The hepatic vasculature appears patent.SPLEEN: The spleen measures 10 cm in craniocaudal dimension.PANCREAS: There are findings suggestive of pancreatic divisum or an accessory duct through which the majority of the pancreatic secretions drain into the minor papilla. The previously described punctate cystic pancreatic tail lesion is not visualized on today's exam. No suspicious pancreatic lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Splenorenal shunting is redemonstrated. No suspicious renal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Small periportal lymph nodes are nonspecific in the setting of cirrhosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Cirrhotic liver with findings of portal hypertension. No suspicious hepatic lesion.


Instruction: Generate impression based on findings.

Input: Female, 2 years old, with neurofibromatosis type I and plexiform neurofibroma of the jaw and face. Evaluate cavernous sinus and extent of jaw tumor. Also with large paraspinal and shoulder tumor increasing in size. Assess extent and boundaries of tumor. Brain:A small ill-defined T2 hyperintense lesion is evident within the left cerebral peduncle. There may be one or two similar small lesions along the left aspect of the fourth ventricle within the middle cerebellar peduncle.The left anterior hippocampus and amygdala are slightly larger and T2 hyperintense relative to the right.No other evidence of brain parenchymal edema is seen. No findings to suggest acute intracranial hemorrhage are demonstrated. The ventricles are normal in size and morphology.Although this examination is not specifically protocoled for assessment of the orbits and optic pathway, no definite lesions of the optic apparatus are seen.The CSF space anterior to the left temporal lobe is expanded. Along the medial aspect of this space, evidence is seen of a wispy T2 hyperintense, FLAIR hyperintense, mildly diffusion restricting lesion which demonstrates fairly robust but ill-defined and infiltrative enhancement. Face:An extensive, infiltrative plexiform neurofibroma is present centered on the right pterygopalatine fossa which is markedly expanded.Laterally, this lesion extends through the pterygomaxillary fissure to invade to the masticator space. A small tumor component even extrudes further laterally, anterior to the mandibular angle, into the right cheek subcutaneous space.Medially, the tumor traverses the sphenopalatine foramen to invade the right nasal cavity and the nasopharyngeal mucosal space. Tumor appears to extend into the Eustachian tube. As a result, obstructed secretions are evident within the right mastoid air cells and middle ear cavity.Superiorly, tumor invades the inferior aspect of the right orbit coming in contact with and mildly displacing the inferior and lateral recti muscles. No definite intraconal extension is seen and no obvious optic nerve compromise is demonstrated.Posteriorly, tumor invades and expands the right cavernous sinus but with preservation of the ICA flow void. Tumor is in fact evident tracking along the right ICA, through the cavernous and petrous segments, and down into the cervical region. From the cavernous sinus, tumor infiltrates along the V3 segment of the fifth cranial nerve through a widened foramen ovale and down into the masticator space. Tumor extends through the foramen rotundum, and posteriorly along the floor of the middle cranial fossa tracking along the anterior margin of the petrous temporal bone.The right sphenoid wing may be mildly dysplastic or simply chronically deformed from the extensive tumor.Neck and spine:Extensive infiltrative plexiform neurofibroma is evident involving the paraspinal tissues of the left neck, the left supraclavicular fossa, axilla, upper back, and significantly within the left upper thoracic cavity. Tumor is partly visualized extending distally into the left arm as well.Beginning at the C5-6 level and continuing down to the T5-6 level, tumor invades the left-sided neural foramina. At C7, substantial intracanalicular/intradural extension is seen resulting in rightward displacement of the spinal cord but without evidence of cord edema. Minimal intracanalicular extension is seen at T4 and T5 without significant canal narrowing or cord displacement.Bulky tumor extends through the widened thoracic inlet to completely fill the upper left thoracic cavity. The mediastinal structures are displaced towards the right but the airway seems to remain patent. Posterior lung atelectasis is seen bilaterally along with a small left pleural effusion.More inferiorly in the spine, no large lesions are suspected. Small foraminal tumors are present within the right T7-8 foramen extending along the T7 rib, and perhaps within the left L2-3 foramen.Angiographic imaging:Common origin of the brachiocephalic and left common carotid arteries is seen. The aorta and the origins of the great vessels are patent.The left common carotid artery drapes along the anterior medial aspect of the tumor without evidence of encasement or significant narrowing.The proximal left subclavian artery passes through and is encased by tumor though it does remain patent throughout. The origins of the major proximal branches of the subclavian, including the vertebral artery, thyrocervical and costocervical trunks, are encased by tumor. The vertebral artery remains encased by tumor until it enters the transverse foramen at approximately the C5 level, but the vertebral artery remains patent throughout.On delayed venous phase imaging, the left internal jugular vein tapers and then fails to be visualized as it approaches the large thoracic cavity mass. An enlarged left external jugular vein is noted which anastomoses across midline with the right-sided jugular system. Distal to the mass, the left subclavian vein opacifies, but in the vicinity of the mass, it does not. The subclavian system seems to drain via a network of chest wall and shoulder collaterals.

Output: An extensive, infiltrative neurofibroma is evident involving the deep spaces of the right face. Tumor invades the inferior extraconal orbit, the masticator space and cheek, the left nasal cavity and nasopharyngeal mucosal space. Tumor invades the right Eustachian tube with obstruction of the mastoid air cells and middle ear cavity.This tumor, centered within the pterygopalatine fossa, extensively invades the right cavernous sinus tracking along V3 through the foramen ovale, through the foramen rotundum, and along the floor of the middle cranial fossa following the petrous apex. Tumor also tracks down along the right ICA through the skull base and into the upper neck.A wispy, ill-defined enhancing lesion is evident within the left middle cranial fossa where the CSF space is expanded. This lesion may represent an additional neurofibroma, though the imaging characteristics, and particularly the presence of restricted diffusion, differ significantly from those of the right-sided tumor. This may therefore represent another lesion, perhaps a slightly atypical epidermoid cyst.Multiple additional sequelae of neurofibromatosis are demonstrated intracranially including scattered areas of nonspecific white matter signal abnormality, as well as thickening and T2 hyperintensity in the left mesial temporal lobe. No definite lesions of the optic pathway are seen.Extensive infiltrative plexiform neurofibroma is evident involving the left neck, upper back, supraclavicular fossa and axilla, and extensively the upper left thoracic cavity. Tumor invades numerous left-sided neural foramina in the cervical region with significant intracanalicular extension at C7 resulting in rightward displacement of the spinal cord.The thoracic component of this tumor displaces the mediastinal structures towards the right. The great vessels are however patent throughout. In particular, the left common carotid artery drapes along the anterior medial margin of the tumor without encasement or narrowing. The left subclavian artery passes through and is encased by the tumor but it, along with its major branches including the vertebral artery, remain patent. The vertebral artery is encased by tumor up to the C5 level where it enters the transverse foramen.The left internal jugular vein is patent until it reaches the thoracic tumor at which point it narrows and fails to be visualized. A large left external jugular vein is likely compensating and drains across midline via collaterals to the right jugular system. The distal left subclavian vein is patent, but at the level of the tumor, it is not. Subclavian drainage is likely via chest wall and shoulder collaterals.


Instruction: Generate impression based on findings.

Input: 57 year old male with history of non-ischemic cardiomyopathy who presents for cardiac MRI to evaluate for infiltrative disease and etiology of cardiomyopathy Left VentricleThe left ventricle is severely dilated and severely reduced in systolic function. The overall LV ejection fraction is 15%, the LV end diastolic volume index is 143 ml/m2 (normal range: 74+/-15), the LVEDV is 343 ml (normal range 142+/-34), the LV end systolic volume index is 121 ml/m2 (normal range 25+/-9), the LVESV is 290 ml (normal range 47+/-19), the LV mass index is 47 g/m2 (normal range 85+/-15), and the LV mass is 112 g (normal range 164+/-36). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload. No LV apical thrombus. Left AtriumThe left atrium is severely dilated. There is a possible thrombus in the left atrial appendage. Right VentricleThe right ventricle is mildly dilated and severely reduced in systolic function. The overall RV ejection fraction is 26%, the RV end diastolic volume index is 114 ml/m2 (normal range 82+/-16), the RVEDV is 274 ml (normal range 142+/-31), the RV end systolic volume index is 85 ml/m2 (normal range 31+/-9), and the RVESV is 202 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated. There is a possible thrombus at the base of the right atrial appendage.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation. The aortic valve is trileaflet.Mitral ValveThere is reduced opening of the mitral valve. There is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated. The ascending aorta is 4.3 cm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is moderate to severely dilated in size and measures 40mm.Venous AnatomyThe SVC is normal in size and drains normally into the right atrium. The IVC is dilated.PericardiumThere is a trivial pericardial effusion.Extracardiac FindingsThere is a moderate right pleural effusion and a trace left pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated and severely reduced in systolic function (LVEF 15%) without evidence of LV apical thrombus. 2. The right ventricle is mildly dilated and severely reduced in systolic function (RVEF 26%)3. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. Severe biatrial dilation with possible thrombi in both atrial appendages.5. Mild ascending aortic dilation5. Moderate to severe main pulmonary artery dilation


Instruction: Generate impression based on findings.

Input: Please evaluate for malformations, hydrocephalus, or tumors: speech delay, macrocephaly, 5 cafe-au-lait spots one large (12x15cm). Brain: The lateral ventricles and third ventricle are diffusely prominent. The cerebral aqueduct and fourth ventricles are intact. There is a left medial middle cranial fossa arachnoid cyst that measures 15 mm in width. There is a mega cisterna magna. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There is a normal degree of myelination. There is no abnormal intracranial enhancement. Orbits: The globes and ocular adnexa are intact. No intraorbital enhancement or mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. The optic nerves are grossly unremarkable.

Output: 1. Prominence of the triventricular system and a left middle cranial fossa arachnoid cyst. Otherwise, no stigmata of neurofibromatosis type 1, intracranial tumors, or hemorrhage. 2. Unremarkable orbits.


Instruction: Generate impression based on findings.

Input: Female, 76 years old, with history of GBM, on Avastin status post re-RT. A small hemosiderin stained resection cavity is again seen at the right parieto-occipital junction. Nodular intrinsic T1 hyperintensity along the margin of the cavity is unchanged. A curvilinear region of intrinsic T1 hyperintensity is also stable more superiorly within the superior parietal lobule. No definite evidence of any superimposed enhancement seen at either of these sites, or anywhere along the resection cavity.Ill-defined T2 hyperintensity involving the tissues surrounding the resection cavity, as well as in the periventricular regions, right more than left, is unchanged. No new areas of signal abnormality or pathologic enhancement are detected. No evidence of parenchymal edema or mass effect is seen. Ventricular size and morphology are unchanged.

Output: Stable examination with no evidence to suggest new or progressive disease.


Instruction: Generate impression based on findings.

Input: Ms.ROSEMARY GRIFFIN, 61 years old, submitted outside study for review. Images performed at Advocate Christ Medical Center submitted for review: Screening mammogram with tomosynthesis 2/3/2015, targeted ultrasound of the right breast 12/15/2015, ultrasound guided biopsy of the right breast 12/15/2015, and contrast-enhanced MRI of the right breast 12/29/2015. MAMMOGRAM 2/3/2015: Two standard views of both breasts were obtained with tomosynthesis. The breast parenchyma is heterogeneously dense. There is a 26 x 36 mm focal asymmetry with associated architectural distortion in the central right breast, anterior to mid depth. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. The distortion is best seen only on the tomo synthesis images, especially on the CC view.RIGHT BREAST TARGETED ULTRASOUND 12/15/2015 : Static ultrasound images are submitted for interpretation.There is a 2.3 x 1.3 x 3.0 cm heterogeneously hypoechoic mass with indistinct margins, labeled as residing in the 11:00 position 3 cm from the nipple.In certain images the irregular mixed echogenic area appears to be larger than the provided measurement, approximately measuring 3.7 x 1.5 cm.ULTRASOUND-GUIDED BIOPSY OF RIGHT BREAST 12/15/2015: Previously identified mass in the right breast at the 11:00 position is the target for the biopsy. Targeting appears appropriate.LEFT UNILATERAL POST PROCEDURE MAMMOGRAM (10/19/2015): A clip is placed in the right breast 11:00 position anterior to mid depth, in the area of previously noted architectural distortion and asymmetry.PER OUTSIDE PATHOLOGY:A. The right breast breast lesion, 11:00 position anterior to mid depth; ultrasound guided core needle biopsy:- Ductal carcinoma in situ, cribriform type, nuclear grade 2. ER/PR positive.- Extensive sclerosing adenosis associated with microcalcifications.Bilateral Breast MRI 12/29/2015: Outside hospital MRI with contrast was post processed with Dyna CAD.Right breast: There is marked heterogeneous background enhancement which limits sensitivity of examination. There is a 4.6 x 3.0 x 2.9 (AP x ML x CC) area of clumped non mass enhancement in the 10:00 to 11:00 position in the anterior to mid depth right breast. The most anterior focus of this contrast enhancement resides approximately 1.0 cm from the nipple. Susceptibility artifact from the biopsy clip is noted in the central portion of this enhancement. No axillary lymphadenopathy is evident.Left breast: Marked heterogeneous background enhancement within the left breast which limits sensitivity of this exam. No abnormal enhancement is evident within the left breast. No axillary lymphadenopathy is evident.

Output: Pathologically proven DCIS, only seen on tomography, which on the MR demonstrates clumped non mass enhancement, (larger than the corresponding tomographic and sonographic abnormality). If breast conserving therapy is considered, repeat ultrasound to evaluate the anterior extent of the non mass enhancement is recommended, as MR guided biopsy would be technically difficult given the location of the anteriormost focus behind the nipple.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 53 year old female patient with history of ALH in a biopsied fibroadenoma in the right breast 11 o'clock position. Benign fibrocystic change in 12 o'clock right breast. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally. Bilateral subglandular silicone breast implants noted.Clip artifacts are seen in the 12 o'clock and 11 o'clock positions. There is no abnormal enhancement at the 12 o'clock position. At the 11 o'clock position containing the clip there is an oval enhancing mass that measures 7 x 5 x 6 mm (AP x ML x CC). There is a benign morphology focus in the left breast 1 o'clock position with a possible fat containing correlate on T2 weighted sequence, most likely representing a benign intramammary lymph node. No abnormal lymph nodes are identified in either axillary region.

Output: Oval enhancing mass with clip in the 11 o'clock position consistent with biopsy proven fibroadenoma. No suspicious findings in the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Clinical question: CVA. Signs and symptoms: CVA. Unenhanced head CT:Two very small right cerebral cortical strokes are again identified. Images through posterior fossa are otherwise unremarkable and stable.Images through supratentorial space demonstrate a large area of vasogenic edema in the left posterior frontal area is some mass effect on the adjacent cortical sulci. There is no evidence of hemorrhage. Finding is highly suspected for malignancy and recommend further follow up with unenhanced brain MRI. Review of patient's prior PET scan from 5 -- 18 -- 11 indicates hypermetabolic tumor in the left upper lobe which makes the findings on this head CT more suspected for metastatic disease.Very few additional subcortical areas of low attenuation may represent small was ischemic strokes of indeterminate age. Possibility of additional metastatic foci however cannot be entirely excluded.The ventricular system are within normal size and midline is maintained.Calvarium, paranasal sinuses and mastoid air cells are unremarkable. There is evidence of an old blow out fracture of right lamina papyracea. This finding is best appreciated on coronal reformatted image 16.Above findings were reported to Dr. White Nicole #2663 via paging tool at the time of review of exam.

Output: 1.New vasogenic edema in the left posterior frontal lobe with focal mass effect. Finding is highly suspected of a metastatic lesion and recommend follow-up with enhanced imaging.2.Minimal small vessel disease.3.Calvarium is intact.


Instruction: Generate impression based on findings.

Input: Post craniotomy for glioblastoma multiforme resection. There are postsurgical changes related to recent reexcision of left parieto-occipital tumor, as well as foci of susceptibility relating postoperative air and blood products along the surgical tract. Overall, the previous peripherally enhancing cavity has slightly decreased in size, and there is decreased confluence of heterogeneous enhancement along its superior margin. There has also been interval decreased thickness of the rind of heterogeneous enhancement along the lateral aspect of the mass. On MRI 10/18/16 this enhancing rind measured up to 9 mm in greatest thickness, now measuring 4 mm. There is similar extent of ependymal enhancement of the occipital horn of the left lateral ventricle. The vasogenic pattern of T2/FLAIR hyperintensity within the left temporal and occipital lobe white matter has slightly progressed since 9/28/2016, with slight increased expansion of the tissue, and increased extension into the left splenium. There is effacement of the occipital horn of the left lateral ventricle, similar to prior. There is no midline shift or herniation. The pituitary gland is unremarkable. The basilar cisterns are maintained. The major cerebral flow voids are intact.There is a subcortical enhancing curvilinear structure identified in the right temporal lobe (series 12 and 2, image 113) is likely a developmental venous anomaly.

Output: 1.Expected postsurgical changes related to recent left parieto-occipital tumor recent reexcision. Decreased thickness of lateral rind of enhancement as well as decreased nodular enhancement noted superiorly, with overall decreased size of the otherwise similar appearing cavity, consistent with interval resection which may be subtotal.2.Unchanged left occipital ependymal enhancement, likely representing spread of tumor. 3.Unchanged vasogenic pattern of nonenhancing nonspecific T2/FLAIR hyperintensity, with effacement of the left occipital horn, though slightly progressed since 9/28/2016.


Instruction: Generate impression based on findings.

Input: 41-year-old male with pain, cracking, popping ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Subchondral cysts in the greater trochanter.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Rotator cuff is intact. Degenerative changes of the acromioclavicular joint as described above. Subchondral cyst in the greater trochanter.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out central canal stenosis or neural foraminal stenosis. Signs and symptoms: Hyperreflexia. Nonenhanced cervical spine MRI:Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes without spinal stenosis however mild right neural foraminal compromise is noted.C3-C4 demonstrate mild degenerative disease and bilateral uncovertebral hypertrophy which results in moderate right and mild left neural foraminal compromise without central spinal stenosis.C4-C5 demonstrate mild disc disease, mild loss of disc height and mild bilateral facet degenerative changes. Findings results in moderate right and moderate to severe left neural foraminal compromise without central spinal stenosis.C5-C6 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. There is also a broad-based disc-osteophyte complex present at this level (larger on the left) with resultant effacement of subarachnoid space, flattening and posterior displacement of the cord and moderate central spinal stenosis. There is also significant bilateral neural foraminal compromise. There is also mild hypertrophic changes of posterior longitudinal ligament at C5 and C6 levels contributing the spinal stenosis. There is mild reversal of cervical lordosis at this level. The signal intensity of the cord remains within normal.C6-C7 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. There is a shallow broad-based disc-osteophyte complex present at this level extending from midline to the left with resultant effacement of ventral subarachnoid space on the left, subtle flattening deformity of the cord and moderate central spinal stenosis. Significant bilateral (L>R) neural foraminal compromise is also detected.C7-T1 demonstrate mild degenerative changes without central spinal stenosis. There is however moderate to severe left and patent right neural foramen detected.The upper most visualized thoracic spine demonstrate no evidence of spinal stenosis or appreciable neural foraminal compromise.Nonenhanced lumbar MRI:There is normal anatomical alignment and unremarkable signal intensity of the vertebral column.Examination at T11-T12 through L2-L3 demonstrate mild degenerative changes without spinal stenosis or foraminal stenosis. L3-L4 demonstrate mild disc disease and loss of disc height, moderate bilateral facets hypertrophy and mild facet effusion. Mild ligamentum flavum hypertrophy is also noted. Although there is mass effect on the thecal sac by hypertrophic changes no convincing spinal or neural foraminal compromise or stenosis is present.L4-L5 demonstrate mild disc disease and moderate bilateral facet and ligamentum flavum hypertrophic changes. Mild right and patent left neural foraminal compromise and no central spinal stenosis.L5-S1 demonstrate mild disc disease and loss of disc height, mild bilateral ligamentum and advanced bilateral facet hypertrophic changes and including mild bilateral (R>L) facet effusion. No spinal stenosis, however significant (R>L) neural foraminal compromise is detected.

Output: 1.Degenerative changes at C5-C6 and C6-C7 levels with resultant moderate central spinal stenosis (worse at C5-C6) and bilateral neural foraminal compromise and mild reversal of cervical lordosis as detailed. Mild degenerative changes at other levels however without central spinal stenosis. Additional multilevel neural foraminal compromise as detailed per level.2.MRI of lumbar spine demonstrate mild degenerative disc disease and more severely degenerative and hypertrophic changes of facets and ligamentum flavum as detailed per level above. Findings are more noticeable in the lower lumbar spine in particular at L5-S1 level which results in significant bilateral neural foraminal compromise. There is however no central spinal stenosis at any level. Additional levels of neural foraminal compromise as detailed per level above. There is progression of degenerative changes since prior lumbar MRI exams from 2004.


Instruction: Generate impression based on findings.

Input: 68 year old female with history of colon cancer. Has had acute mental status changes. Areas of enhancement on MRI one week ago resolved. Now with recurrent mental status changes. Need CT to evaluate. Vascular calcification of the pericardial vasculature of the vertebrals and carotids is noted.This examination is essentially within normal limits and in particular no evidence of hemorrhage, edema, mass effect, hydrocephalus or midline shift is detected. Further evaluation with an MRI is recommended.

Output: Unremarkable CT examination of brain.


Instruction: Generate impression based on findings.

Input: 45 year old with history of bicuspid aortic valve and known aortic regurgitation presenting for evaluation of aortopathy. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 116 ml/m2 (normal range: 74+/-15), the LVEDV is 236 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 106 ml (normal range 47+/-19), the LV mass index is 71 g/m2 (normal range 85+/-15), and the LV mass is 144 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement. No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 66%, the RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVEDV is 175 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 60 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there moderate aortic regurgitation, with a regurgitant fraction of 37%. The aortic valve is bicuspid with fusion of the right and left cusps. 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.AortaNo evidence of dissection. The following orthogonal dimensions of the thoracic aorta will be reported in an addendum when they become available. There is no aortic coarctation. 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. No evidence of thoracic aortic dissection. The orthogonal dimensions of the thoracic aorta will be reported in an addendum when they become available.2. The left ventricle is mildly dilated with normal systolic function. Left ventricular ejection fraction equals 55%. No abnormal enhancement of the left ventricle.3. Nonstenotic bicuspid aortic valve with intercoronary fusion, moderate aortic regurgitation. The fraction is equal to 37%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 44 year old with imaging detected left breast cancer. Moderate parenchymal enhancement is noted bilaterally, somewhat of a limitation. Heterogeneous fibroglandular tissue is present.Multiple abnormal enhancing masses are present in the left breast. The largest, located near the 6:30 position is adjacent to signal void from a biopsy clip and measures 1.0 x 1.2 x 1.2 cm. Additional masses are present medial and anterior to the mass, measuring 7 mm and 5 mm respectively. The overall extent of these three masses is 4.1 x 3.3 cm. A normal morphology intramammary lymph node posterior to the index lesion may be reactive in etiology. No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region. A low left axillary lymph node retains a normal fatty hilum.

Output: 1. Multiple left breast masses, including the index 1.2 cm mass, span approximately 4.1 x 3.3 cm. An MRI directed ultrasound for the additional masses can be performed if clinically indicated. 2. No MRI evidence for malignancy in the right breast. 3. No suspicious morphology axillary node. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: sprain and strain not responding to treatment History: pain and swelling No joint effusion. No soft tissue swelling. Achilles' tendon is intact. No fracture or malalignment is identified. No abnormal bone marrow signal.

Output: Normal exam.


Instruction: Generate impression based on findings.

Input: This 37-year-old female with two days headache. Rule out subarachnoid hemorrhage. There is a hyperdense extra-axial mass in the left subarachnoid space of the high convexity. There is suspected communication between this mass and a hyperdense tubular structure that extends from the high left convexity into the brain parenchyma. Intraparenchymal hypodensity around this tubular structure may represent edema. An MRI is recommended for further evaluation of this mass.There is no evidence of intracranial hemorrhage or midline shift. 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.These findings were discussed with Dr. Jeffrey Kuo at the time of interpretation.

Output: Hyperdense extra-axial mass and tubular structure extending into the brain parenchyma. An MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Reason: smoldering myeloma, with ? Transformation to myeloma. R/o bone lesions History: none There is heterogeneity of the bone marrow affecting the pelvis, proximal femora, and visualized lower lumbar spine in a manner keeping with residual red marrow, although it is impossible for us to exclude low tumor burden. We see no definite focal lesion to confirm multiple myeloma. Mild osteoarthritis affects both hips, better seen on recent radiographs. Degenerative disc disease affects the visualized lumbar spine. The sacroiliac joints and pubic symphysis appear normal.

Output: Heterogeneity of the medullary cavity of the visualized bone is favored to represent residual red marrow. Although it is impossible to entirely exclude low tumor burden, we see no focal lesion to confirm multiple myeloma.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for stenosis. Signs and symptoms: Right arm pain. No unenhanced cervical MRI:The signal intensity of the vertebral column is unremarkable.The alignment the vertebral column is anatomical however mild reversal of cervical lordosis is noted. This may be positional.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 is unremarkable.C4 -- C5 is unremarkable.C5 -- C6 is unremarkable.C6 -- C7 demonstrate minimal left facet hypertrophy however without spinal stenosis or neural foraminal compromise.C7 -- T1 is unremarkable.Uppermost visualized thoracic spine and thoracic cord through T4 are unremarkable.There is normal signal intensity and caliber of cervical and uppermost visualized thoracic cord.

Output: 1.No evidence of neuroforaminal or spinal stenosis at any level.2.Minor degenerative changes and unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Left lumbar radiculopathy. 5 lumbar-type, ribless vertebrae are present. Alignment is anatomic. The vertebral bodies are preserved in height and there is no suspicious marrow lesion. Fat-containing lesion in the L3 vertebral body is unchanged, compatible with a hemangioma. Disc heights are preserved. Multilevel disc desiccation is unchanged to minimally increased since the prior examination. There is no significant compromise to the spinal canal. The tip of the conus medullaris lies at the L1-L2 level. The conus medullaris shows normal signal characteristics and shape as well as the caudal imaged part of the spinal cord.T9-T10 through T11-T12 levels are included only on sagittal imaging but there is no significant spinal canal stenosis.T12-L1: No significant disc herniation. No spinal canal or neural foraminal stenosis.L1-L2 and L2-L3: There is minimal disc bulging but no significant disc herniation and only mild ligamenta flava thickening. There is no significant compromise to the spinal canal or the neural foramina.L3-L4: There is very minimal disc bulge with left paracentral prominence but no significant spinal canal, subarticular recess or neural foraminal stenosis. There is mild facet arthropathy and ligamenta flava thickening.L4-L5: There is eccentric to the left disc bulge which narrows the left subarticular recess. There is moderate facet arthropathy, contributing to mild-to-moderate right neural foraminal stenosis. These findings are unchanged since the prior examination.L5-S1: Minimal disc bulge is unchanged. Moderate left more than right facet arthropathy is also unchanged. No significant spinal canal and only mild bilateral neural foraminal stenoses.

Output: Multilevel degenerative lumbar spondylosis is not significantly changed since January 2014 and results in no significant spinal canal or neural foraminal stenosis other than mild encroachment on the left subarticular recess and right neural foramen at L4-5. Please correlate with left L5 and right L4 radiculopathy. Lower lumbar moderate facet arthropathy is also unchanged.


Instruction: Generate impression based on findings.

Input: 40-year-old female with history of rectal cancer. ABDOMEN:LUNG BASES: Bibasilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: There is a right perirectal lymph node measures 4 x 3 mm, approximately 1.5 cm from the mesorectal fascia. A second lymph node is present in the right perirectal space measuring 5 x 3 mm approximately 1.2 cm from the mesorectal fascia.Lymph nodes outside the mesorectal fascia: NoneBOWEL, MESENTERY: Rectal Tumor:Size: 2.3 x 0.8 x 3.2 cm (image 12/series 12)Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensityTumor location: Upper-third(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 11 cmCircumference of the rectum involved: 2 o'clock to 6 o'clock - 75%Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): Uterus, cervix and vagina are uninvolved.MRI T-stage: T3a - Tumor invades < 0.5cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: 14 mm (image 14/series 12).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.T3a rectal tumor as above.2.No evidence of metastatic disease in the abdomen.


Instruction: Generate impression based on findings.

Input: 98-year-old with altered mental status x 3 days with similar episode 3 weeks and 1 week ago. Please evaluate for bleeding or mass effect. History of dementia, arrhythmia. Diffuse areas of subcortical and periventricular white matter hypodensity likely represents small vessel ischemic disease of indeterminate age and appears approximately similar to the prior examination. However, if there is concern for an acute infarction, an MRI may be considered for further evaluation. There is no evidence of intracranial hemorrhage, mass or midline shift.Ex vacuo dilation of the ventricles and prominence of the sulci indicates marked corticomedullary volume loss.Thickening of the diploic space with patchy areas of sclerosis raises the question of Paget's disease. The left-sided mastoid air cells are underpneumatized. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No definite acute findings. Small vessel ischemic disease of indeterminate age, similar to the prior study. However if there is concern for an acute infarction, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: History of left breast cancer status post mastectomy. There is scattered fibroglandular tissue in the right breast. The patient is status post left mastectomy and reconstruction. No contrast is seen on the post-contrast sequences. No abnormal axillary lymph nodes are identified in either axillary region.Stable high T2 signal right hepatic lobe lesion compatible with a cyst or hemangioma.

Output: Non-diagnostic exam due to lack of contrast. The exam should be repeated. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: R - Technical Repeat Views.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:There are numerous foci of increased T2 signal involving the corpus callosum and supratentorial periventricular white matter, many oriented perpendicular to the lateral ventricles. Additionally, there are T2 hyperintense foci in the bilateral cerebellum, left dorsal medulla, and left middle cerebellar peduncle. There is no definitive restricted diffusion associated with these lesions.The ventricles and sulci are within normal limits. 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. The midline structures and craniocervical junction are within normal limits. MRI ORBITS:There is mild asymmetric enhancement and subtle corresponding increased T2 signal within the anterior right optic nerve. There is also questionable increased size of the right optic nerve. There is no definite involvement of the optic chiasm.The left optic nerve is within normal limits. The optic tracts appear normal. The extraocular muscles are normal and symmetric with physiologic, homogeneous, and intense contrast enhancement. The globes appear normal with physiologic enhancement of the ciliary bodies and choroid. No orbital mass lesion.

Output: 1.Asymmetric abnormal enhancement and edema involving the perhaps mildly prominent intraorbital right optic nerve is most suggestive of optic neuritis.2.Numerous T2 hyperintense foci in the corpus callosum, supratentorial periventricular white matter, cerebellum and medulla, most suggestive of demyelinating disease, with overall mild T1 and T2 burden disease. Post contrast images of the brain were not obtained to assess for enhancement.


Instruction: Generate impression based on findings.

Input: 55 years, Male, forgetfulness, foggy thinking, status post OLT. No intracranial mass or mass-effect. There is mild global parenchymal volume loss which is slightly prominent for patient's age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No hydrocephalus. Few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Minimal mucosal thickening is noted in the paranasal sinuses. There is partial opacification of the left mastoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: There is mild global parenchymal volume loss. Examination of the brain is otherwise unremarkable for age.


Instruction: Generate impression based on findings.

Input: Sickle cell disease. Right arm numbness/weakness today that is resolving. Evaluate for CVA. Multiple subcortical and periventricular white matter hypodensities in the bilateral frontal and parietal lobes are compatible with small vessel ischemic disease. Most of these areas were present on the prior examination. However, an MRI would be helpful in evaluating for an acute infarct. There is no evidence of intracranial hemorrhage, mass or edema. Prominence of the sulci and ventricles consistent with corticomedullary volume loss. No midline shift.The calvarium is thickened, likely reflecting extramedullary hematopoiesis in a patient with sickle cell disease. This appears similar to the prior examination. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Moderate small vessel ischemic disease, similar in appearance to the prior examination. However, an MRI would be helpful in evaluating for an acute infarct as clinically indicated.


Instruction: Generate impression based on findings.

Input: History of pituitary mass resected and now with recurrence. Vision loss and headache appear 60-year-old female. There is redemonstration of a sellar mass which has been described on the recent MRI from yesterday. It is unchanged in appearance since that exam.The patient is status post a nasal septal prosthesis placement.The ostiomeatal complex units are patent bilaterally. Within the nasal cavity no obstructive lesions are appreciated.The frontal sinuses are clear.There is some mucosal thickening present along the maxillary sinuses of a mild degree.Ethmoid air cells are clear . There is partial opacification of the right sphenoid sinus. The patient is apparently status post transsphenoidal surgery.Some atherosclerotic calcifications are present along the distal internal carotid arteries .Visualized portions of the mastoid air cells and middle ears are clear. Visualized orbits are intact and the visualized intracranial structures and demonstrate hypodensity along the right optic tract.

Output: 1.The patient has a sellar and suprasellar mass which is described on a recent MRI.2.Patient is status post nasal septal prosthesis placement.3.Status post transphenoidal surgery.4.Partial opacification of paranasal sinuses as indicated above.5.hypodensity along the right optic tract


Instruction: Generate impression based on findings.

Input: MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia involving the medial right greater than left frontal lobes. There is a small amount of susceptibility within the right medial frontal lobe which indicates hemosiderin deposition. There is mild periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are multiple bilateral mucous retention cysts.MRA Brain: At the junction of the anterior communicating artery and proximal right A2 segment is a complex appearing anterosuperiorly directed aneurysm which could be bilobed and which overall measures 10 mm from the base to the apex and 5 mm in AP dimension. The exact configuration of the neck/base of the aneurysm is difficult to delineate, but likely the neck measures 2 mm.The cavernous left internal carotid artery is mildly ectatic. The Intracranial ICA and middle cerebral arteries are patent. There is a hypoplastic/aplastic right A1 segment. The left ACA and right A2 segment distal to the aneurysm are patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. There is a fetal-like right PCA with a small right P1 segment. The left PCOM is not visualized.

Output: 1.At the junction of the anterior communicating artery and proximal right A2 segment is a complex appearing anterosuperiorly directed aneurysm which could be bilobed and which overall measures 10 mm from the base to the apex and 5 mm in AP dimension. The exact configuration of the neck/base of the aneurysm is difficult to delineate, but neck may measure 2 mm. CTA brain is recommended for further characterization.2.Encephalomalacia of the right greater than left medial frontal lobes which may be related to sequela from previous infarct and/or hemorrhage.3.Cavernous left ICA is mildly ectatic


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with cerebellar lesion, preoperative planning examination. A cystic and solid lesion with irregular enhancement is redemonstrated in the left cerebellum showing no significant change from the immediate prior examination. This lesion causes substantial edema within the left cerebellum and causes herniation of a small portion of the left cerebellar hemisphere through the occipital craniectomy defect. The fourth ventricle remains partially effaced. Also redemonstrated are enhancing lesions within the right parietal lobe and the right cerebellum, without significant interval change.

Output: Preoperative examination for surgical guidance redemonstrates a large cystic and solid mass within the left cerebellum, as well as smaller lesions in the right parietal lobe and right cerebellum.


Instruction: Generate impression based on findings.

Input: 5mm grade 1 anterolisthesis of the L4 over L5 vertebral body. No definite evidence of pars defect or acute fracture. The conus is normal in signal and morphology and terminates at L1. Right mid kidney rounded T2 hyperintense structure, most likely a small cyst L1/2: No evidence of significant neuroforamina or central canal stenosis.L2/3: No evidence of significant neuroforamina or central canal stenosis.L3/4: Mild loss of disk height with desiccation. Mild disk bulge with right-sided prominence without significant neuroforaminal narrowing. Right facet hypertrophy. No evidence of significant central canal stenosis.L4/5: Moderate loss of disk height with desiccation. There is uncovering of the disk with mild superimposed disk bulge with moderate bilateral neuroforaminal narrowing. There is thickening of the ligamentum flavum with bilateral facet hypertrophy. There is moderate central canal stenosis. L5/S1: Disk desiccation without loss of height. Mild central to left foraminal protrusion of the disk with abutment of the descending left S1 nerve root. There is also a left foraminal annular fissure. No significant neuroforamina or central canal stenosis.SI Joints: No significant abnormality.

Output: 1.5mm grade 1 anterolisthesis of L4 over L5 vertebral body without pars defect.2.Moderate central canal stenosis and bilateral neuroforaminal narrowing at L4/5 level. 3.L5/S1 central/left disc protrusion with annular fissure. The disc also abuts the left descending S1 nerve.


Instruction: Generate impression based on findings.

Input: Reason: right shoulder pain - r/o RTC tear History: pain. ROTATOR CUFF: Mild increased signal intensity within the supraspinatus and infraspinatus tendons indicating mild tendinosis. Additionally, there is a small subcentimeter linear focus of near fluid signal intensity within the supraspinatus tendon at approximately the 12:00 position, 1 cm proximal to its insertion, likely representing a small interstitial tear. We see no full-thickness tear or surface disruption. Mild atrophy of the supraspinatus and infraspinatus muscles along the myotendinous junction. Otherwise, the muscles appear intact. The teres minor tendon and muscle are intact. The subscapularis tendon and muscle are intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial bursa of questionable significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. Mild thinning of the articular cartilage along the medial aspect of the humeral head suggests mild osteoarthritis. While there is no fluid signal intensity entering the glenoid labrum, intermediate signal intensity within the substance of the labrum may indicate some degeneration. No joint effusion.BICEPS TENDON: Given the limitations of a non-arthrographic study, the long head of the biceps tendon is normal.ADDITIONAL

Output: 1.Mild tendinosis and small interstitial tear of the supraspinatus tendon, but no full-thickness rotator cuff tear.2.Osteoarthritis of the acromioclavicular joint with small amount of fluid within the subacromial bursa.3.Minimal degenerative changes of the glenohumeral joint.


Instruction: Generate impression based on findings.

Input: Chiari and shunt: surveillance. Brain: There is unchanged extension of the cerebellar tonsils inferior to the foramen magnum up to 5 mm. Nevertheless, the cerebellar tonsils display rounded morphologies. The cerebrospinal fluid flow across the anterior aspect of the foramen magnum is intact, but appears to be blunted posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Unchanged mildly low lying cerebellar tonsils.2. No evidence of syringohydromyelia.


Instruction: Generate impression based on findings.

Input: Cirrhosis, surveillance for liver tumor ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly with cirrhotic morphology and fatty infiltration. Peripherally enhancing lesion in segment 6 measures 1.4 x 1.3 cm (series 1102, image 397), previously 1.8 x 1.5 cm. A second peripherally enhancing lesion in segment 7-8 measures 1.0 x 1.1 cm (series 1102, image 562), previously 1.0 x 1.2 cm. Previously demonstrated third enhancing hepatic lesion is not seen on the current exam.SPLEEN: The spleen is top normal measuring 14 cm in length.PANCREAS: Several small cystic lesions within the pancreas are favored to represent side branch IPMNs and are unchanged in size. No pancreatic duct dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Peripherally enhancing right hepatic lobe lesions do not meet strict criteria for HCC but warrant continued surveillance in the setting of cirrhosis.2.Side branch IPMNs without interval change.


Instruction: Generate impression based on findings.

Input: Brain: Focal diffusion abnormality at right frontal subcortical white matter. Expected evolution of the previously seen infarct at right thalamus. Cerebral volume loss. Encephalomalacia in the left posterior temporal lobe again seen. Chronic right thalamic hemorrhagic infarct. Chronic right superior cerebellar infarcts. Moderate subcortical and periventricular white matter T2/FLAIR hyperintensity compatible with small vessel ischemic disease. Large susceptibility artifact in the left frontal and temporal lobe compatible with known hematoma. There is mild mass effect on the left lateral ventricle with 3-mm midline shift. There are numerous punctate susceptibility artifacts of the bilateral frontal and temporal subcortical white matter, bilateral thalami, midbrain, pons, and middle cerebral peduncle, compatible with chronic microhemorrhages. There is small amount of blood product layering in the posterior left lateral ventricle.No evidence of hydrocephalus. Moderate diffuse mucosal of thickening of paranasal sinuses. Fluid in the bilateral mastoid air cells are noted, left greater than right. There are no extraaxial fluid collections. Flow voids are present within the major vessels indicating patency. The orbits are unremarkable.Cervical spine: Alignment is anatomic without loss of vertebral body height. There are no fractures or subluxations. The marrow signal is benign. No evidence of cord contusion or epidural hematoma. No ligamentous disruption. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Mild degenerative of the cervical spine. Minimal edema seen on multiple facet joints likely due to degenerative etiology. Minimal disk osteophyte complex at levels C4/5, C5/6, and C6/7, relatively worse at C6/7, without significant central canal or neural foraminal narrowing.

Output: 1.Left frontotemporal intraparenchymal hematoma with surrounding edema and minimal rightward midline shift as seen on CT. Minimal intraventricular extension.2.Tiny focus of acute infarct in the right frontal subcortical white matter.3.Moderate chronic small vessel ischemic disease. Chronic right thalamic hemorrhagic lacunar infarct. Chronic left posterior temporal infarct. Chronic right superior cerebellar infarcts.4.Multiple chronic microhemorrhages with distribution primarily involving the the brainstem and thalami, favored to be related to chronic hypertension. 5.No evidence of ligamentous disruption or significant ligamentous injury in the cervical spine. No cord contusion or epidural hematoma. Minimal fluid involving the bilateral facet joints, which may be degenerative in etiology.


Instruction: Generate impression based on findings.

Input: Diagnosis: Nontraumatic intracerebral hemorrhage, unspecifiedClinical question: evaluate for hydrocephalus s/p IPH w/ intraventricular extensionSigns and Symptoms: headaches, 6m s/p basal ganglial hemorrhage w/ IVH The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is susceptibility effect present within an irregular shaped focus in the right basal ganglia and internal capsule .There are a couple punctate foci of susceptibility effect present at the right temporal lobe subcortical white matter and the left external capsule. No abnormal enhancing mass lesions are appreciated intracranially. 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.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.Chronic stage hemorrhage in the right basal ganglia and adjacent internal capsule. (This was acute stage on a 4/24/15 CT of the head).3.No intracranial mass is identified.4.The ventricles are non-dilated.


Instruction: Generate impression based on findings.

Input: There are no fractures. There is trace retrolisthesis C5 on C6. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Encephalomalacia in the left posterior inferior cerebellar artery territory is consistent with remote PICA infarct. Fluid is also present in bilateral mastoid air cells. The remaining visualized paraspinal contents are unremarkable.C2/3: Incidental note is made of left facet fusion. There are no stenoses.C3/4: Mild right uncinate hypertrophy without stenosis.C4/5: Posterior osteophyte disc complex and right uncinate hypertrophy. There is mild right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex, ligamentum flavum thickening, and bilateral uncinate hypertrophy. There is mild central, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex, left uncinate hypertrophy, and ligamentum flavum flavum thickening. There is severe left neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C4/5: Mild right neural foraminal stenosis.2.C5/6: Mild central, moderate left neural foraminal, and moderate to severe right neural foraminal stenosis.3.C6/7: Severe left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 55-year-old male with history of recent lumbar surgery. There are postsurgical changes at L1 and L2. There is mild facet osteoarthritis of the lower lumbar spine.

Output: Postsurgical changes as above.


Instruction: Generate impression based on findings.

Input: Male, 22 years old, with left insular brain lesion, functional MRI requested for surgical planning purposes. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Likewise, visual cortical stimulation maps as expected along the bilateral calcarine sulci. Bilateral activation of the lateral geniculate nuclei is also seen.Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. Language is left dominant on all tested paradigms. Broca's area is identified within the pars opercularis and pars triangularis of the inferior frontal lobe, and Wernicke's area is identified overlapping the posterior aspect of the superior temporal sulcus. Variable language contributions are noted from the right cerebral hemisphere, most prominently on the word generation and sentence completion paradigms.Regarding the positioning of functional domains relative to the patient's left insular lesion, cortical activation likely related to Broca's area is seen within the cortex immediately anterior and superior to the insular signal abnormality. Secondary language related activation is also seen within the frontal lobe operculum which sits immediately lateral to the insula.

Output: Sensorimotor cortical activation maps as expected along the pre and postcentral gyri. Visual cortical activation maps as expected along the bilateral calcarine sulci.Language related cortical activation is left dominant with variable, paradigm dependent contributions from the right cerebral hemisphere.


Instruction: Generate impression based on findings.

Input: Clinical question: Is there evidence of bleed. Signs and symptoms: Altered mental status. Non-infused head CT:Examination demonstrates small foci of low attenuation involving the cortex of left frontal lobe in the distribution of left middle cerebral artery and is consistent with acute/early subacute cortical stroke. Follow-up with an MRI is recommended. There is no evidence of hemorrhage associated with this finding. This finding is best appreciated on axial images 15 through 17.Few small periventricular foci of low attenuation are primarily on the left side and are concerning for a small was ischemic stroke of indeterminate age. Considering that all findings are on the left side possibility of high-grade stenosis of the larger proximal vessel of the MCA or left internal carotid artery should be considered and follow all but his CTA is recommended.There is no detectable abnormality of right hemisphere. The ventricular system and midline is within normal.Calvarium is intact. Visualized mastoid air cells, orbits and paranasal sinuses are unremarkable.

Output: 1.Acute left middle cerebral artery stroke in the frontal lobe with no hemorrhagic component.2.Findings of a small vessel disease primarily in the left hemisphere.3.There is no evidence of hemorrhage, is significant mass effect, midline shift or hydrocephalus.4.Follow-up with an MR/MRA and or CTA is recommended.


Instruction: Generate impression based on findings.

Input: New onset left hand tremors and subtle extrapyramidal signs. Evaluate for basal ganglia or intracranial lesions. There is no evidence of acute intracranial hemorrhage, or mass effect. Diffusion-weighted images are incomplete. No evidence of acute infarct of the imaged portion of the brain. There is no midline shift or mass effect. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific but compatible with mild age-related white matter changes. There is prominent T2 hyperintensity with susceptibility involving the basal ganglia including the putamina and globi pallidi as well as the midbrain, and to a lesser degree deep nuclei of the cerebellum. Caudate nuclei appear normal in size with normal signal characteristics. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening throughout the paranasal sinuses as well as fluid level within the left maxillary sinus.

Output: 1.No intracranial mass or mass effect. No abnormal enhancement.2.Nonspecific prominent T2 hypointensity and susceptibility effect involving the bilateral basal ganglia and midbrain which may represent physiologic mineralization but raise possibility of conditions associated with NBIA (neurodegeneration with brain iron accumulation) in the appropriate clinical setting.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left trigeminal neuralgia. BRAIN MRI:Brain parenchyma appears within normal limits. 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. Focal susceptibility along the left side of the posterior falx demonstrates no associated enhancement and compatible with a nonspecific dural calcification. T1-hyperintense, centrally T2-hyperintense material in the left lateral sphenoid sinus is compatible with a mucus retention cyst with inspissated secretions and was present previously on MRI/19/2009. This focus is medial to the foramen rotundum. There is trace mucosal thickening in the paranasal sinuses, elsewhere. There is asymmetric prominence of the right palatine tonsillar tissue, possibly related to left-sided tonsillectomy, but can be correlated with direct examination. There is also nonspecific prominence of the nasopharyngeal tonsillar tissue without suspicious masses.MRI OF THE CRANIAL NERVES:The cavernous sinuses and Meckel's caves are symmetric and preserved. There is no abnormal contrast enhancement along the trigeminal nerve cisternal segments or the other imaged cranial nerves. There is also no brainstem or root entry zoon lesion. No abnormal vasculature structure is appreciated at the origin of the left trigeminal nerve. There is no abnormal signal or contrast enhancement in the foramina rotunda and ovale. The orbital floors show no gross abnormality.

Output: MRI of the brain appears within normal limits. Specifically no lesion to explain trigeminal neuralgia is appreciated. Please see additional findings above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB:12/22/1946)Reason: metastatic breast cancer History: complaints of stiffness/soreness in neck and armPROVIDER/ATTENDING NAME: RITA NANDA RITA NANDA There is a severe compression fracture present T1 with associated subluxation at C7-T1. This compression fracture is new since the prior exam. There is previously a marrow replacing mass at this level. There are marrow replacing lesions identified within the thoracic spine. One at T2 measures 18 x 12 mm axial dimensions and previously measured significantly smaller. Another one is present at T4 which extends through the left pedicle of T4 and measures approximately 32 mm AP dimension on sagittal imaging and 14 mm in height. There is a mild superior endplate compression of T4 present.There are marrow replacing lesions present along the spinous processes of C5 and C6 as well as the spinous process of T1. These are associated with contrast enhancement.The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present this level.At C5-6 there is loss of disc space height, disc desiccation, disc bulge, endplate and uncovertebral osteophytes as well as hypertrophy ligamentum flavum resulting in effacement of spinal fluid ventral and posterior the spinal cord and overall a moderate degree of spinal stenosis. This is spinal stenosis was not readily evident on the prior exam however it may be exaggerated in this exam due to extended position of the patient's neck.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is anterior subluxation of C7 on T1 associated with T1 compression fracture and there is some effacement of spinal fluid ventral and posterior the spinal cord at this level. There is encroachment of the exiting nerve roots within the neural foramina at T1-T2. The vertebral artery flow voids appear to be intact.

Output: 1.Since the prior examination the patient has developed a severe compression fracture at T1 associated with subluxation and narrowing of the spinal canal. This is most likely related to malignant compression fracture.2.There is a mild compression fracture present at T4. This is also likely a malignant compression fracture3.There are multiple marrow replacing lesions present at C5, C6, T1, T2 and T4 which are compatible with metastatic disease. This appears to have progressed compared to the prior exam.4.There is a moderate degree of spinal stenosis present at C5-6 related to degenerative changes. Compared to the prior exam the patient is currently in the extended neck position whereas previously the patient's neck was in a somewhat flexed position. This difference in position may account for the differences of appearance of the degree of spinal stenosis between the current prior exam and the prior exam.


Instruction: Generate impression based on findings.

Input: Worsening right sided weakness. There is an area of restricted diffusion and high T2 signal in the left coronal radiata, which is similar in size as on the prior CT, but larger than on the prior MRI. There are a few scattered foci of nonspecific cerebral white matter T2 hyperintensity, but no evidence of additional areas of restricted diffusion in the brain. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: A subacute infarct in the left coronal radiata is similar in size as on the prior CT, but larger than on the prior MRI. There is no evidence of hemorrhagic transformation.


Instruction: Generate impression based on findings.

Input: 76 year old male with dyspnea on exertion as anginal equivalent, found to have CTO on recent angiogram. Assess for viability.MEDICATIONS: aspirin, atorvastatin, chlorthalidone Viability/ Myocardial ScarThere was a nontransmural myocardial infarction (<50% wall thickness) involving the basal inferolateral wall. Based on late gadolinium enhancement imaging, this segment has an intermediate probability of viability; however, this segment has improved contractility which would suggest that the segment is in fact likely to be viable. The remainder of the ventricle is free of myocardial infarction and improves following dobutamine infusion which suggests that it is viable. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 120 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 64 ml (normal range 47+/-19), the LV mass index is 51 g/m2, and the LV mass is 96 g. During resting conditions, there is mild global hypokinesis; however, following the administration of dobutamine, the systolic function normalizes. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 83 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a non-transmural myocardial infarction in the basal inferolateral wall; however, this segment has improved contractility following the administration of dobutamine suggesting that it is likely to be viable. The remainder of the myocardium is free of myocardial infarction and also viable. 2. Normal LV size with mildly reduced systolic function (LVEF 47%).3. Normal RV size with mildly reduced systolic function (RVEF 44%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 20 year old female with severe preeclampsia status post C-section 4/16/2009. Chronic hypertension. Now complaining of visual changes in left eye. There is no evidence of intracranial hemorrhage or edema. Gray white differentiation is preserved and no midline shift or herniation is present. The pituitary is prominent (series 2 image 5). This may be a physiologic finding related to the patient's postpartum state. However, given the presence of visual symptoms, the pituitary could be more accurately imaged with MRI if clinically warranted.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.The orbits are incompletely visualized.

Output: Prominent pituitary as detailed above. If clinically appropriate, this finding could be further evaluated with pituitary protocol MRI.This finding was discussed with Dr. Rosalyn Porter at 12:00 p.m. April 20, 2009.


Instruction: Generate impression based on findings.

Input: There is trace anterolisthesis of C4 on C5 and trace retrolisthesis of C5 on C6. The vertebral body heights are well-maintained. There is mild to moderate loss of disc height at C4-C5, C5-C6, and C6-7. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Interval development of edema at the right C3 facet. Mild posterior disc osteophyte complex, but no significant spinal canal or foraminal stenosis.C4-C5: Disc osteophyte complex with superimposed left paracentral disc protrusion, and left greater than right facet hypertrophy, contributing to effacement of the left lateral recess and mild left foraminal narrowing. No significant spinal canal or right foraminal stenosis.C5-C6: Disc osteophyte complex and bilateral uncinate hypertrophy with ventral effacement of the thecal sac, contributing to mild spinal canal stenosis and moderate bilateral foraminal stenosis.C6-C7: Disc osteophyte complex and bilateral uncinate hypertrophy with ventral effacement of the thecal sac, contributing to mild spinal canal stenosis and moderate bilateral foraminal stenosis.C7-T1: Left foraminal protrusion contributing to mild left foraminal narrowing. No significant spinal canal or right foraminal stenosis. T1-T2: Disc bulge contributing to mild bilateral foraminal narrowing. No significant spinal canal stenosis.

Output: 1. New right C3 facet edema. 2. No significant interval change in multilevel degenerative changes as described above with spinal canal and foraminal stenosis most pronounced at C4-C5 through C6-C7.


Instruction: Generate impression based on findings.

Input: The signal abnormality and parenchymal thickening seen on prior exams within the right thalamus now appears to have normalized on today's exam. The gyral thickening and FLAIR signal abnormality involving the right frontal lobe has nearly completely resolved. The ill-defined signal in the right centrum semiovale which had developed on the prior exam has also nearly completely resolved on today's exam. There is minimal if any residual thickening involving the mesial right temporal, although there may be some persistent insular cortex thickening on the right. However, this is unchanged compared to the previous exam.Postoperative changes are seen from a previous right frontal burr hole and include a punctate stable focus of susceptibility abnormality at the biopsy site within the right thalamus.Postcontrast imaging is significantly limited by motion artifact. Within these limitations there is no evidence of abnormal contrast enhancement.The ventricles and sulci remain mildly prominent but are stable in size and configuration. The cisterns remain patent. There is no midline shift or significant mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Mild mucosal thickening is again seen in the left sphenoid sinus.

Output: Findings compatible with positive response to therapy. The multifocal previously characterized areas of signal abnormality have improved or have become undetectable, particularly the ill-defined signal within the right centrum semiovale which was identified as an area of concern on the prior exam.


Instruction: Generate impression based on findings.

Input: Male, 39 years old. Left BKA w/ open ulcer. The patient has undergone below-the-knee amputation through the proximal to mid left tibial diaphysis. The medial aspect of the distal end of the stump is not well seen on several sequences due to lack of signal. There is abnormal decreased signal within the distal 7 to 8 cm of the tibia with enhancement following contrast administration, compatible with osteomyelitis. The distal margin of the fibula is irregular, likely representing heterotopic bone formation. We see no edema or enhancement of the fibula to suggest osteomyelitis.There is also abnormal signal intensity and enhancement of the distal soft tissues of the stump representing inflammation. Irregularity of the margins of the distal end of the stump presumably represents ulceration. There is a small rim-enhancing fluid collection within the subcutaneous fat just lateral to the anterior tibial tuberosity which may represent bursitis. An abscess is considered less likely as we see no communication with the skin surface or with the inflammatory changes of the distal stump. There is fatty atrophy of the remaining musculature of the lower leg. The patient has also undergone below-the-knee amputation on the right as seen on the large field-of-view coronal images. We see no findings to suggest osteomyelitis on the right.

Output: Surgical changes of below-the-knee amputation with osteomyelitis of the left tibia as described above.


Instruction: Generate impression based on findings.

Input: 47 year old female with history of hypertrophic cardiomyopathy presenting with acute pulmonary edema and polymorphic ventricular tachycardia. Left VentricleThe left ventricle is normal in size with low normal systolic function. There is left ventricular hypertrophy with septal predominance (IVS 16 mm, lateral wall 13 mm in four chamber view, in short axis maximum dimension in the basal anterior septum is 15.4 mm) The overall LV ejection fraction is 52%, the LV end diastolic volume index is 88 ml/m2 (normal range: 65+/-11), the LVEDV is 149 ml (normal range 109+/-23), the LV end systolic volume index is 42 ml/m2 (normal range 18+/-5), the LVESV is 71 ml (normal range 31+/-10), the LV mass index is 87 g/m2 (normal range 67+/-11), and the LV mass is 146 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is systolic anterior motion of the mitral valve causing flow acceleration proximal to the aortic valve. There is evidence of LVOT obstruction. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 127 ml (normal range 110+/-24), the RV end systolic volume index is 42 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe trileaflet aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate regurgitation. The leaflets appear thickened. 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 dilated (MPA 38 mm). Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a small pericardial effusion. Extracardiac FindingsThere are small bilateral pleural effusions, there is diffuse interstitial markings with fluid in the fissures. There is a liver lesion measuring 34 mm x 34 mm in largest diameter seen. No dedicated imaging of extracardiac findings was performed, suggest dedicated imaging. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function (LVEF 52%). There is left ventricular hypertrophy. The maximum wall thickness, 16 mm in four chamber mid septum and is 15.4 mm in the basal anterior septum in short axis. There is no evidence of LGE seen. 2. The right ventricle is normal in size with mildly reduced systolic function (RVEF 45%)3. There is systolic anterior motion of the mitral valve with LVOT obstruction. There is at least moderate mitral regurgitation. The constellation of findings is consistent with hypertrophic cardiomyopathy. 4. The main pulmonary is dilated (38 mm). 5. There is biatrial enlargement6. See extra cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 45 years old. Reason: eval for nerve root compression History: R side LBP There is moderate motion degradation. Five lumbar type vertebral bodies are presumed to be present. The lumbar spine is in normal alignment, with mild loss of the normal lumbar lordosis. The vertebral body heights are well-maintained. There is a 1.5 cm focal area of T1 and T2 hyperintensity within the T12 vertebral body, compatible with a hemangioma. The conus medullaris is grossly intact, terminating at approximately the L1-2 level.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: There is mild disc desiccation and minimal disc bulge, with no significant central canal narrowing and minimal bilateral neural foraminal narrowing.L4-5: There is disc bulge and mild bilateral facet joint hypertrophy with no significant central canal narrowing and mild to moderate neural foraminal stenosis, left greater than right.L5-S1: There is disc height loss and associated endplate marrow signal changes as well as some edema within the disc which is likely on a degenerative basis. There is associated disc bulge as well as mild bilateral facet hypertrophy with mild right neural foraminal narrowing, mild to moderate left neural foraminal narrowing, and no significant central canal stenosis.

Output: Multilevel degenerative changes without significant central canal stenosis at any level. Mild to moderate foraminal narrowing at L4-5 and L5-S1 as detailed above.


Instruction: Generate impression based on findings.

Input: lumbago, acute right side low back pain radiating to right groin. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: diffuse bulging of disc with minimal spinal canal stenosis, disc dessication. L4-L5: diffuse bulging of disc with minimal spinal canal stenosis, disc dessication. L5-S1: no neuroforaminal narrowing or spinal stenosis.Diffuse enlargement of uterus especially posterior wall with focal intrauterine masses indicating uterine fibroid.

Output: 1. Minimal spinal canal stenosis with diffuse bulging of disc at the level of L34 and L45/2. Disc dessication on both L34 and L45.3. Uterine fibroid.