Instruction: Generate impression based on findings.

Input: 64-year-old male with recurrent maxillary sinus cancer. Patient receiving cycle number two of 7 chemo/RT. Please perform CT neck soft tissue with contrast for staging purposes. The confluent metastatic lymphadenopathy in the left neck now measures 4.8 x 2.7 cm compared to 5.4 x 3.6 cm on study dated 7/14/2008. The central region of this lymphadenopathy is now more hypoattenuating with continued peripheral enhancement. This consistent with necrosis. The multiple submandibular lymph nodes (previously seen on series 3 image 50 on study dated 7/14/2008) remain visible but now have hypoattenuating centers consistent with necrosis. The tumor mass approaches the left side of the thyroid cartilage but does not appear to invade the cartilage. A left supraclavicular lymph node (series 9557 image 68) now measures 1.9 by 1.8 cm. on the prior study this measured 2.1 x 2.0 cm. There is a right cervical lymph node which measures 1.1 x 1.0 cm compared to 1.0 x 0.9 cm on the prior study.Patient is status post partial left maxillary resection. There are postsurgical changes involving the pterygopalatine fossa. There are no CT findings of local tumor recurrence, however, MRI is more sensitive for distinguishing postoperative changes from local tumor recurrence. The there are surgical clips in the left neck and the left internal and external jugular veins are absent consistent with prior neck dissection. There is left -sided skin thickening consistent with prior radiation.The left mastoid air cells are filled with fluid. The left middle ear is filled with fluid consistent with postoperative otitis. The styloid processes are prominent bilaterally. There are degenerative changes most pronounced in the cervical spine. There are no definite bony metastases.The visualized portion of the brain is unremarkable on this limited study. There are no findings of metastasis or intracranial extension of tumor.There are paraseptal and centrilobular emphysematous changes in the lungs with bilateral apical scarring. The ascending aorta is borderline dilated with a diameter of 4.2 cm. There is a right-sided chest port with a catheter which enters the right internal jugular vein and extends into the superior vena cava.

Output: 1. Interval decrease in size of metastatic lymph nodes in left neck. 2. Lymph node changes consistent with necrosis in response to treatment.3. No CT findings of recurrence at site of tumor resection.


Instruction: Generate impression based on findings.

Input: 63-year-old female. Knee pain, catching, locking. Evaluate for meniscus tear. MENISCI: The lateral meniscus is completely torn from the tibiofemoral compartment articular surface from the posterior half of the body to nearly the entire posterior horn except for a small residual fragment that remains at the root. A piece of displaced meniscus is present in the lateral gutter (series 901, image 16). No evidence of a tear in the medial meniscus. ARTICULAR CARTILAGE AND BONE: Marked lateral tibiofemoral compartment diffuse cartilage thinning with near full to full thickness focal cartilage defects at the weight-bearing surface, tibial worse than femoral (series 1001, image 15). There is underlying degenerative sclerosis and edema. High signal of the patellofemoral cartilage and mild diffuse thinning consistent with chondromalacia; no focal defect.Small degenerative cysts at the ACL insertion on the tibia.LIGAMENTS: MCL, LCL, ACL, and PCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Extensive complete, displaced tear of the posterior horn and posterior body of the lateral meniscus. The displaced fragment appears to be in the lateral gutter.2. Severe lateral tibiofemoral compartment cartilage thinning with full thickness cartilage defects, tibial worse than femoral articular surface.


Instruction: Generate impression based on findings.

Input: 66 year old man with cardiac amyloid, referred for interval assessment of disease burden. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 152 ml (normal range 142+/-34), the LV end systolic volume index is 27 ml/m2 (normal range 25+/-9), the LVESV is 60 ml (normal range 47+/-19), the LV mass index is 56 g/m2 (normal range 85+/-15), and the LV mass is 122 g (normal range 164+/-36). There is normal wall thickness (IVS=10mm). There are no regional wall motion abnormalities present. There is a small area of intra-myocardial late gadolinium enhancement in the basal inferolateral wall that is not typical of an infarct and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. It appears similar to findings on prior CMR. The native myocardial T1 time in the basal inferolateral wall is 1135ms (mildly elevated) and in the interventricular septum is 1086ms (borderline). The T1 time in the inferolateral wall is mildly elevated, correlating with LGE findings. TI scout continues to have normal gadolinium "kinetics."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 72 ml/m2 (normal range 82+/-16), the RVEDV is 157 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 54 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size, wall thickness, and systolic function (LVEF 61%) with atypical late gadolinium enhancement in the basal inferolateral wall. No change when compared to prior study. 2. Native myocardial T1 times are borderline elevated in the interventricular septum and mildly elevated in the basal inferolateral wall. 3. Normal RV size and systolic function (RVEF 66%). I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Redemonstrated is reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild central and moderate to severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild bilateral neural foraminal stenosis.C6/7: Minimal posterior osteophyte disc complex and left uncinate hypertrophy. There is mild left neural foraminal stenosis.C7/T1: Unremarkable

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


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:1/25/1958)Reason: rule out stroke History: right sided clumsiness, weaknessPROVIDER/ATTENDING NAME: IRA J BLUMEN HELENE G. RUBEIZ MRI of the brainThere is a small focus of diffusion restriction present in the posterior limb of the left internal capsule which extends to the centrum semiovale.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There appears to be duplication of the right middle cerebral artery. Findings suggest a 2 mm aneurysm at the community in segment of the right internal carotid artery. Findings also suggest a 2 mm aneurysm at the distal left internal carotid artery at the communicating segment.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the left posterior communicating artery. The right posterior communicating artery is small. The vertebral arteries are similar in size. The vertebrobasilar system is tortuous.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Acute Lacunar infarction in the posterior limb of left internal capsule.2.The distal right internal carotid artery appears to be ectatic and associated with a duplicated right middle cerebral artery. 3.Findings suggest a small bilateral aneurysms at the at the distal internal carotid arteries distal to the origins of the posterior communicating arteries. This can be confirmed by CT angiography if clinically appropriate.4.The intracranial vasculature is tortuous which is a nonspecific finding.


Instruction: Generate impression based on findings.

Input: Arm numbness and weakness, evaluate for cervical radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of cervical lordosis; alignment is otherwise maintained. Bone marrow signal is benign. Postsurgical changes of posterior spinal decompression and cervical laminoplasty are seen from C3 to C7. Susceptibility artifact limits evaluation however no significant spinal canal stenosis at any level is appreciated. There is mild narrowing of the thecal sac caliber more diffusely from C3 to C6. There is abnormal T2 signal within the cord at the C4-C5 level which may represent myelomalacia from presumably prior compressive myelopathy.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Spinal canal is surgically decompressed. There is moderate to severe right and moderate left neural foraminal stenosis.C4-5: Spinal canal is surgically decompressed. There is mild to moderate bilateral neural foraminal stenosis.C5-6: Spinal canal is surgically decompressed. There is moderate to severe left and moderate right neural foraminal stenosis.C6-7: Spinal canal is surgically decompressed. There is moderate bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Postsurgical changes of cervical laminoplasty. Cervical canal appears decompressed. Multilevel neural foraminal stenosis is seen at multiple levels related to uncovertebral hypertrophy as detailed above.2. T2 hyperintensity in the cervical cord is seen at the C4-C5 level likely representing myelomalacia and presumably from prior compressive myelopathy.


Instruction: Generate impression based on findings.

Input: 61-year-old male with a right deltoid weakness after anterior C4 corpectomy and fusion of C3-C5, posterior cervical laminectomy of C3-C6, and posterior C2-T2 fusion. Postoperative findings compatible with C4 corpectomy and graft placement with C3-C5 anterior fusion, as well as posterior C2-T2 fusion with lateral mass screws at C2-C6 and pedicle screws that T1-T2. There is thickening and T2 hyperintensity of the retropharyngeal/prevertebral space consistent with possible postsurgical changes of the anterior approach. There is some signal abnormality and myelomalacia between C4 and the superior portion of C5 that likely represents sequelae of prior compression. Craniovertebral junction appears within normal limits. Bone marrow signal is within normal limits. There are severe spondylotic changes visualized within the cervical spine including diffuse loss of disc height worst at C7-T1, diffuse disc desiccation, and compression deformities worst at C3 and C5. There is diffuse uncovertebral hypertrophy. These cause diffuse neuroforaminal narrowing worst at the right greater than left neural foramen at C4-C5 and C5-C6. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Postoperative findings from C4 corpectomy, anterior fusion of C3-C5, laminectomy of C3-C7, and fusion of C2-T2.2. Multilevel spondylosis is visualized consistent with prior examinations. Significant bilateral neural foraminal stenosis from uncovertebral hypertrophy is visualized and is worst at C4-C5 and C5-C6.


Instruction: Generate impression based on findings.

Input: Reason: cauda equina syndrome, cord compression? History: decreased rectal tone, urinary and fecal incontinence, history of multiple cancers Alignment is anatomic. No abnormal signal within the cord or conus. There is mild endplate depressions at L5 and anterior wedging at T8, otherwise vertebral body heights are maintained. There is multilevel disc desiccation with disc space loss most prominent in the lower thoracic spine at T7-T8 and T8-T9. Schmorl's node is present at T8-T9. There is a broad-based disc bulge at L3-L4, L4-L5 and L5-S1, however no significant narrowing of the spinal canal is present. There is a focus of hyperintense STIR signal and hypointense T1 signal along the right posterior aspect of T4 which questioned correlative heterogeneous lucency on CT chest of 5/11/2015. Otherwise, marrow signal is heterogeneous.

Output: 1.No evidence of cord compression.2.Focus of increased STIR and decreased T1 signal in the T4 vertebral body is nonspecific. An atypical hemangioma is favored given the appearance on prior CT, an MRI with contrast may be considered if there is concern for metastatic disease.


Instruction: Generate impression based on findings.

Input: SCLC with brain treated metastases, now with new word finding difficulties. There has been interval decrease in size and/or resolution of the intracranial metastases. For example, a right inferomedial cerebellar lesion measures 5 mm in diameter, previously 10 mm. There is unchanged extensive white matter T2 hyperintensity diffusely. There is no evidence of acute infarct. There is an unchanged nonspecific punctate focus of susceptibility effect in the inferior pons. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Interval decrease in size and/or resolution of the intracranial metastases.2. Extensive chronic cerebral white matter small vessel ischemic disease and/or treatment effects, but no evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: Right breast cancer diagnosed in September 2014. Patient has been on neoadjuvant chemotherapy. Please assess treatment response. Scattered fibroglandular densities are present bilaterally. Mild parenchymal enhancement is noted bilaterally.Right breast: The degree of abnormal enhancement in the right breast has significantly decreased since the prior examination. The irregularly shaped mass with irregular margins in the central right breast currently measures 2.1 x 0.9 x 1.3 cm (AP x LR x CC), previously 5.7 x 3.4 x 5.6 cm. There has also been decrease in the number of multiple enhancing foci extending anterior and medial to the index mass. Overall extent of enhancement is 5.1 x 4.1 x 2.1 cm, previously 6.5 x 6.7 x 5.4 cm. There continues to be skin thickening overlying the right breast with abnormal areas of the skin enhancement surrounding the right nipple. Previously described right axillary lymph node currently measures 9 mm in greatest diameter as opposed to 13 mm on the prior study.Left breast: No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in the left axillary region.Multiple high signal intensity T2 weighted lesions in the liver are changed, compatible with benign hepatic cysts.

Output: 1. Interval decrease in the size of the right index cancer with decreased in number of surrounding enhancing foci and size of right axillary lymph node.2. Thickening and enhancement of the skin overlying the right nipple.3. Hepatic cystsBIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Altered mental status. There is no evidence of intracranial hemorrhage or acute infarct. There are subcentimeter right hippocampal fissure remnant cysts. There is mild nonspecific predominantly periventricular cerebral white matter T2 hyperintensity. There is bilateral basal ganglia mineralization. The ventricles and sulci are diffusely prominent due to mild cerebral volume loss. In addition, there is more focal prominence of the left central sulcus and to a lesser extent bilateral frontal convexity sulci. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is a subcentimeter nodule in the left temporal scalp, which may represent an inclusion cyst.

Output: Mild nonspecific predominantly periventricular cerebral white matter T2 hyperintensity, but no evidence of acute intracranial hemorrhage or acute infarction.


Instruction: Generate impression based on findings.

Input: Male 57 years old Reason: Patient with known history of multi recurrent sigmoid cancer pet scan showing hot suv spot in right posterior pelvic sidewall and midline pelvic mass. Evaluate extent of disease with attention to important landmarks and structures history: Recurrent sigmoid cancer PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Postsurgical changes in the sigmoid colon. There is a subtle soft tissue abnormality involving the sigmoid colon about the level of the anastomosis which is suboptimally evaluated but may represent residual disease near the anastomotic site.There is a spiculated soft tissue mass in the presacral soft tissues anterior to the S2 vertebral body measuring 1.6 x 1.2 cm that corresponds to the abnormality on PET/CT. Laterally in the right pelvic sidewall adjacent to the S1 foramina there is a second soft tissue mass measuring 1.5 x 1.3 cm. This lesion is slightly more infiltrative in nature and abuts the pelvic sidewall.Morphologic features of the lesion suggest disease near the resection margin.BONES, SOFT TISSUES: In the right sacrum there is a T2 hyperintense mildly T1 hypointense enhancing lesion measuring 2.0 x 1.7 cm.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/20/2016 13:40:54)MIDLINE PELVIC SOFT TISSUE: 1.6 x 1.2 cm (Image 55, Series 12).RIGHT LATERAL PELVIC SOFT TISSUE: 1.5 x 1.3 cm (Image 58, Series 12).

Output: 1.Two soft tissue masses within the pelvis correlating to the abnormality on PET/CT one at midline and one along the right pelvic sidewall near the right S1 foramina .2.Right sacral lesion differential considerations include metastatic disease (although the lesion does not show FDG activity) or an atypical hemangioma. Correlation with prior MRI if available would be helpful as there is no correlate on the CT portion of the PET/CT.


Instruction: Generate impression based on findings.

Input: Reason: left knee pain s/p arthroscopy. Look for SONK History: left knee pain after arthroscopy MENISCI: Defect in the body and posterior horn of the medial meniscus, which may represent postoperative changes from partial discectomy. There is more linear signal in the body of medial meniscus which may represent a chronic or acute tear. Lateral meniscus appears intactARTICULAR CARTILAGE AND BONE: Full-thickness loss of the medial compartment femoral and tibial cartilage. Moderate bone marrow edema and small subchondral cyst of the medial tibial plateau. Generalized thinning of the lateral compartment femoral and tibial cartilage. Focal fissuring of the lateral facet of the patellar cartilage.LIGAMENTS: Thickened ACL with edema type signal, although with intact fibers suggestive of mucoid degeneration. PCL is intact. MCL and LCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Defect in the medial meniscus, medial compartment cartilage loss, and bone marrow edema of the medial tibial plateau may reflect changes from prior meniscectomy and chondroplasty. No definite fracture line is visualized in the area of marrow edema in the tibial plateau.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. 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. Myelination is appropriate. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear. Lumbar spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates just distal to L1/2. The visualized intra-abdominal and paraspinal contents are unremarkable. There are no osseous dysplasias or stenoses. There is no fat signal within the filum. Upon prone maneuvering, the conus and cauda quinine translate anteriorly.

Output: 1.Negative noncontrast brain MRI. Specifically, there are no MRI findings to explain the patient's developmental delay.2.Negative noncontrast lumbar spine MRI. Specifically, there are no MRI findings to explain the patient's refusal to walk. There are no MRI findings of tethered cord or fatty filum.


Instruction: Generate impression based on findings.

Input: Generalized abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is full of numerous gallstones including the neck of the gallbladder. There is mild gallbladder wall thickening, pericholecystic fluid, wall hyperenhancement and adjacent reactive hepatic parenchymal hyperenhancement. No choledocholithiasis. No intrahepatic or extrahepatic biliary ductal dilatation.The liver is normal in morphology, signal intensity and enhancement. Stable segment 6 punctate lesion is too small to characterize. No suspicious focal liver lesion or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal lipid rich adenoma measuring 2.8 x 1.7 cm. Mild right adrenal nodularity.KIDNEYS, URETERS: Simple appearing left renal cortical cyst. No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Large duodenal diverticulum. No evidence of bowel obstruction. Colonic diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The gallbladder is distended with numerous gallstones, wall thickening, wall hyperenhancement and pericholecystic fluid suspicious for acute and/or chronic cholecystitis. No discrete enhancing mass to suggest gallbladder malignancy.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of brain, unspecified [D33.2], Reason for Study: ^Reason: assess choroid plexus papilloma History: choroid plexus papilloma There is no evidence of acute ischemic or hemorrhagic lesion.There is about 19.6 mm x 12.3 mm sized the right lateral ventricle occipital horn. The size, configuration and MR signal characteristics do not show any interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Mucosal thickening of the right maxillary sinus with a small retention cyst in the left maxillary sinus.

Output: 1. Right lateral ventricle occipital horn intraventricular mass lesions is again seen. Unchanged in terms of size, configuration and MR signal characteristics since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: History of kidney transplant and abdomen. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. No suspicious liver lesion, biliary dilatation or vascular abnormality.SPLEEN: Normal splenic size without focal lesion.PANCREAS: The pancreas is markedly atrophic without main pancreatic ductal dilatation. The MRCP images demonstrate parenchymal subcentimeter cystic lesions likely representing side branch IPMNs, unchanged. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys. Left lower quadrant transplant kidney is partially evaluated without gross hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious liver lesion.2.Stable-appearing IPMNs.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with seizures and history of benign brain tumor (oligodendroglioma) resected in 2000. Again seen is a small resection cavity within the right frontal operculum which is unchanged in size and shape. T2 hyperintensity within the surrounding parenchyma is also stable in geographic extent.Small patchy areas of T1/T2 hyperintense signal along the brain surface in the bilateral frontal regions and the right parietal region were not clearly present on prior examinations, but these are felt to be artifactual and potentially related to imaging at 3T on today's exam.No evidence of parenchymal edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected. No evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.

Output: 1.Stable resection cavity in the right frontal operculum. Nonspecific T2 hyperintensity within the parenchyma surrounding cavity is also unchanged.2.No new intracranial lesions are seen. No other significant intracranial abnormalities are noted to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: 57 year old female with history of ADH in the recent left breast biopsy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a focal non-mass enhancement at left retroareolar region, measuring 18 x 18 x 12 mm. This enhancing lesion corresponds to a recent biopsy site. The enhancement is likely due to post-biopsy changes. No abnormal enhancement is seen elsewhere in the left breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Focal non-mass enhancement at retroareolar region in the left breast, corresponding to the site of recent biopsy. Enhancement is likely due to biopsy changes. 2. No MR evidence of malignancy in the right breast 3. No abnormal lymph nodes in either axillary regionBIRADS: 3 - Probably benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 18 year old with right shoulder pain, evaluate for labral tear. ROTATOR CUFF: The tendons and muscles of the rotator cuff are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint appears within normal limits.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is linear branching signal abnormality extending within the posterior inferior labrum, compatible with a tear. There is an overlying articular cartilage defect.BICEPS TENDON: Fluid extends along the biceps tendon, which is intact and appropriately situated within the bicipital groove.ADDITIONAL

Output: 1. Posterior inferior labral tear with overlying articular cartilage defect as described above.


Instruction: Generate impression based on findings.

Input: 15-year-old male with history of hepatoblastoma. Mass seen on recent liver ultrasound. Postsurgical changes in the liver related to what appears to be a right hepatic lobe resection with compensatory hypertrophy of the remaining left hepatic lobe which demonstrates cirrhotic liver morphology with sequela of portal hypertension including portosystemic varices and splenomegaly. Along the inferior aspect of the left hepatic lobe there is a round lesion measuring 2.8 cm x 2.4 cm (series 7, image 40) which contains a central scar and demonstrates heterogeneous T2 hyperintense signal with restricted diffusion as well as enhancement which persists on the delayed 3 minute phase sequences. No additional hepatic lesions are evident.Splenomegaly as above measuring 20 cm. No splenic masses.The right kidney is located in the right upper quadrant beneath the diaphragm. Otherwise the kidneys appear normal with no hydronephrosis or intrarenal solid masses. There are bilateral multiple focal subcentimeter intrarenal T2 hyperintense foci most compatible with benign cysts.The imaged bowel is normal. No lymphadenopathy.

Output: 1. Postsurgical changes in the liver with cirrhotic liver morphology and sequela of portal hypertension.2. Lesion in the remnant left hepatic lobe demonstrates imaging features suggestive of focal nodular hyperplasia. If further evaluation is warranted, the patient may return for a hepatocyte specific phase post contrast MRI free of charge for further evaluation. 3. Findings most compatible with benign subcentimeter renal cysts.


Instruction: Generate impression based on findings.

Input: 85 year old patient with left pontine infarct in bilateral cerebellar lesions please evaluate patient has right hemiparesis and gaze deviation to the rightTechnique: Contiguous axial images of the brain. Subsequently high resolution contiguous axial images were obtained through the lower half of the head and neck and aortic arch during bolus injection of intravenous contrast.The patient was brought back to the CT area later on the date of the exam for repetition of the exam due to poor timing of the initial contrast bolus. On the noncontrast head CT a hypodense focus corresponding to the MRI abnormality along the left cerebellar hemisphere measuring 25 x 15 mm axial dimensions is present and not clearly evident on the prior exam. Hypodense foci in the lower mid brain and upper pons predominant involving the left upper pons and lower midbrain were also not readily identified on the prior exam. There are punctate lesions present along the right posterior inferior cerebellar artery territory and to a lesser degree left posterior inferior cerebellar artery territory.There is opacification of both distal vertebral arteries along their cervical segments. The right vertebral artery is somewhat smaller than the left intracranially and along the cervical segment. The right posterior inferior cerebellar artery does display contrast enhancement as does the left, however, the right vertebral artery does not opacify distal to the posterior inferior cerebellar artery suggesting that it is likely either highly stenotic or occluded. The basilar artery, therefore fills from the left vertebral artery. There are some mural calcifications associated with luminal narrowing as the left vertebral artery enters the subarachnoid space. The left anterior inferior cerebellar artery is larger than its right counterpart. The basilar artery is highly attenuated distal to the AICA origins and suspected to be occluded below the level of the superior cerebellar arteries. The posterior communicating arteries are of similar in size to the P2 segments. The P1 segments are asymmetric right larger than left. The right P1 segment is about the same size as the posterior communicating artery on the right side the left one is smaller than the left P2 segment. It is and therefore considered that the superior cerebellar arteries fill from the anterior circulation as do the posterior cerebral arteries in this patient.There are atherosclerotic calcifications along the distal internal carotid arteries bilaterally. No significant stenosis is appreciated along the anterior or posterior cerebral arteries. The anterior communicating artery is identified and is relatively small compared to the A1 segments which are approximately equal in size. There are atherosclerotic calcifications present along the carotid bifurcations however on the basis of NASCETcriteria no significant stenosis is present along the carotid bifurcations. There is some mild narrowing of the left internal card artery just distal to its origin but approximately a 40%.The left vertebral artery is significantly narrowed at its origin with approximately an 80% stenosis along its cervical segment there are foci of narrowing along the mid cervical vertebral artery with approximately 60% stenosis at the C4-5 disk space level. View right vertebral artery is small and intracranially essentially only supplies the right posterior inferior cerebellar artery which is otherwise disconnected. There is some mild prominent muscular branch is present along the the tube in segment collateralization to the left occipital artery is unknown basis of this exam.The patient is intubated both endotracheally and nasogastric.Some atherosclerotic calcifications are present along the aorta and some of the branches. There is atherosclerotic in narrowing of the innominate artery by approximately 75%. There are degenerative changes present along the cervical spine at C6-7 with left sided neural foraminal narrowing, and c3-4 with right sided neural foraminal narrowing.

Output: 1.Subacute foci of infarction in the left cerebellar hemisphere more than the right as well is within the upper pons and lower midbrain left worse than right. No evidence for hemorrhagic conversion2.Occlusion or near occlusion of the right vertebral artery distal to the origin of the posterior inferior cerebellar artery.3.High-grade stenosis at the origin of the left vertebral artery with a tandem lesion along the mid cervical segment of the left vertebral artery and atherosclerotic in narrowing of the left internal artery as it enters the subarachnoid space. 4.There is occlusion or near occlusion of the basilar artery between the anterior inferior cerebellar artery and the superior cerebellar artery origins.5.The posterior communicating arteries are fairly large as described above. The anterior circulation appears to be the dominant supply for the posterior cerebral arteries as well is the superior cerebellar arteries. 6.High-grade stenosis (approximately 75%) of the innominate artery due to atherosclerotic narrowing7.Mild narrowing at the left internal carotid artery origin as described above. no significant stenosis at the carotid bifurcations on the basiss of NASCET criteria.8.If clinically appropriate, a more detailed assessment of the supply to the posterior circulation may be provided via conventional angiography to confirm or exclude complete occlusion of right vertebral artery and basilar artery and to provide a more accurate description of the percent of stenoses described above, assess circulation time and to identify any collateralization from the external circulation to the intracranial circulation - which cannot be identified on this exam.9.Degenerative changes are present in the cervical spine as indicacated above. Please correlate with clinical symptoms.


Instruction: Generate impression based on findings.

Input: A 20 year old male with abnormal EKG and exercise induced PVCs referred for evaluation of possible structural heart disease. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 182 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 70 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 122 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 and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 37 ml/m2 (normal range 82+/-16), the RVEDV is 78 ml (normal range 142+/-31), the RV end systolic volume index is 92 ml/m2 (normal range 31+/-9), and the RVESV is 193 ml (normal range 54+/-17). No evidence of focal aneurysm or fibrosis. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.

Output: 1. The left ventricle is normal in size and systolic function, the LVEF is 62%. No abnormal enhancement. 2. The right ventricle is normal in size and systolic function, the RVEF is 59%. No evidence of focal aneurysm or fibrosis. No MRI evidence of ARVC.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Status post liver transplant 2011 for primary sclerosing cholangitis. Elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from liver transplant. There are several stable subcentimeter cysts. No significant extrahepatic biliary ductal dilatation with patent choledochojejunostomy. The intrahepatic bile ducts are stable in caliber compared to the prior study.The visualized portions of the hepatic artery are patent. The portal vein and hepatic vein are patent.Stable nonspecific hypoenhancing focus in segment 7 (series 11/28) and segment 8 (series 11/120) without corresponding T2 hyperintensity.SPLEEN: Mild splenomegaly measuring 13.3 cm in the craniocaudal dimension.PANCREAS: Cystic lesions within the pancreas are again noted, the largest lesion in the pancreatic body measuring 1.8 cm (series 7/18), compared to 1.7 cm previously. No pancreatic ductal dilatation or abnormal postcontrast enhancement. These likely represent branch type IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several bilateral subcentimeter renal simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Focally distended short segment of small bowel in the right hemi-abdomen appears to have progressed from the prior study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Minimal change in the pancreatic cystic lesion which likely represents a side branch IPMN without suspicious imaging characteristics.2. Stable mild peripheral intrahepatic biliary ductal dilatation.3. Progressive dilatation of a focal short segment of small bowel in the right hemiabdomen. Correlate for clinical history of small bowel surgery. If clinically indicated a CT may be considered for further characterization.


Instruction: Generate impression based on findings.

Input: Right-sided weakness. Evaluate for hemorrhagic conversion. Reidentification of patchy asymmetric hypoattenuating area along the distribution of the left MCA corresponding to abnormality seen on MRI of 12/12/2010 and CT perfusion on 12/11/2003 is compatible with stroke. Peri-ventricular and subcortical white matter hypoattenuating foci bilaterally are consistent with chronic small vessel ischemic disease appearing similar to prior exam.Prominence of extra-axial spaces and ventricular system is compatible with parenchymal volume loss. No extra-axial fluid collections, mass, or hemorrhage. Diffuse sclerosis involves the calvarium. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Left MCA infarct as previously described without evidence of hemorrhagic conversion.2. Small vessel ischemic disease and other findings appearing similar to prior exam.


Instruction: Generate impression based on findings.

Input: Male, 40 years old, with osteomyelitis, evaluate for the amount and location of soft tissue involvement tracking into the hardware to assist with surgical decision making. Despite adjustment of MR imaging parameters to suppress metallic artifact, artifact related to the patient's extensive orthopedic instrumentation significantly obscures visualization of the lumbar spine. Within this limitation, the following observations are made.A leftward rotoscoliosis of the lumbar spine is seen. Osseous marrow signal is not reliably assessed due to imaging artifact. However, the posterior paraspinal muscles are edematous and enhancing, particularly on the right, from L1 down. Scarlike tissue is evident within the paraspinal and subcutaneous tissues posterior to the left iliac bone. No definite fluid collections are seen. No definite anterior paraspinal edema is detected.

Output: Very limited examination due to artifact from orthopedic instrumentation. The vertebral bodies and spinal canal are not adequately visualized for accurate assessment.Note is made, however, of extensive posterior paraspinal edema and inflammation, particularly on the right which begins at the L1 level and continues inferiorly to at least L5 if not to the sacral level. No large or definite fluid collections are seen.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate change in meningioma. Signs and symptoms: None surveillance scan. Pre and post enhanced brain MRI: Negative diffusion weighted series.Examination demonstrates a well demarcated and uniformly enhancing extra-axial mass in the right paramedian inferior frontal abutting the floor of the anterior cranial fossa at the level of right olfactory groove. This finding results in mass effect and deviation of the frontal lobe without associated vasogenic edema. The size, morphology, pattern of enhancement and extent of this lesion remains identical to prior exam. There is no evidence of extracranial extent of tumor which is a similar observation is prior study. This mass measures maximum of 17 x 29 x 16.5 mm.Similar to prior exam there are a few punctate foci of FLAIR hyperintensity in the periventricular and subcortical white matter as well as minimally of bilateral basal ganglia and lung noticeably in bilateral thalami (right greater than left) without evidence of hemorrhage or enhancement and highly suggestive of chronic small vessel ischemic strokes.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No acute intracranial process.2.Stable meningioma in the right olfactory groove in size (17 x 29 x 16.5 mm), morphology, pattern of enhancement and extent.3.Mild chronic small vessel ischemic strokes in the subcortical, periventricular white matter and bilateral basal ganglia/thalami.


Instruction: Generate impression based on findings.

Input: Known left breast cancer on chemotherapy There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Chemotherapy port projected over the right axillary region.Left breast:Index cancer in the left breast 12:00 position has significantly reduced in size and measures 8 x 13 x 11 mm(AP x ML X CC) previously measured 20 x 18 x 25 mm. Clip artifact noted within the mass. Very faint enhancement is identified adjacent to the clip artifact posterior and lateral to the dominant mass at the site of prior biopsy proven DCIS.Previously described oval area of nonmass enhancement at central 12:00 position measuring 6 x 9 mm is better seen is an oval heterogeneous mass that measures 6 x 4 by 5 mm, mostly unchanged. There is an oval enhancing mass measuring 6 x 5 x 4 mm at 8:00 position which is mostly unchanged, previously measured 5 x 4 mm.Total extent of the enhancing lesions measures 2.6 x 3.5 x 2.6 cm (AP X ML X CC), previously measured 5.8 cm in CC dimensionPreviously described post biopsy change along the superolateral aspect of the left breast with skin enhancement is not seen today.Right breast: No abnormal enhancement seen in the right breast.No abnormal lymph nodes are identified in either axillary region.

Output: Significant interval reduction in the index cancer in the right breast 12:00 position and adjacent to the clip posterior and lateral to it at the site of biopsy-proven DCIS. Total extent of the enhancing mass is now measures 2.6 cm previously measured 5.8 cm in cc dimension.No abnormalities noted in the right breast or left axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Six months of right hip pain, no improvement with physical therapy. Evaluate for labral tear. ACETABULAR LABRUM: There is a linear, abnormal signal within the anterior superior labrum without frank filling of the labrum with gadolinium. This likely represents a partial tear of the anterior superior labrum. ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. The articular cartilage is intact. SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Probable partial tear of the anterior superior labrum.


Instruction: Generate impression based on findings.

Input: 13-month-old male patient with developmental delay. Evaluate for septo-optic dysplasia. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are stigmata of complete absence of the corpus callosum. There are abnormal left parasagittal white matter tracts which indent the medial margins of the lateral ventricles, right greater than left, suggestive of Probst bundles. The anterior commissure is present, but appears hypertrophied and possibly slightly dysplastic.The septum pellucidum is absent. The optic apparatus and pituitary are grossly normal. The interhemispheric fissure extends to the third ventricle. The frontal horns of the lateral ventricles are small in size with enlargement of the posterior horns, consistent with colpocephaly.Cortical formation and sulcation otherwise appears grossly normal. Myelination appears appropriate for the provided patient's age. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is flattening of the left frontal convexity and right posterior parietal convexity, consistent with plagiocephaly. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. Compared to the rest of the spinal canal, there is slight narrowing at the level of C1/C2 which could be due to hypertrophy of the posterior arch of C2. The conus medullaris is low normal in position terminating at the level of L2/L3. Cord signal is within normal limits. No fatty filum is identified. There is a small area of midline linear low T1 and T2 signal in the subcutaneous fat, extending from the level of mid S3 caudally to the extent of the imaged field at the level of the coccyx. This extends deep to the level of the bone.The bladder is markedly distended.

Output: 1. Findings compatible with complete agenesis of the corpus callosum. 2. Intact, but hypertrophied/dysplastic anterior commissure. 3. Grossly normal optic apparatus and orbits.4. Grossly unremarkable examination of the spine with linear area of low signal within the posterior subcutaneous tissues at the level of the lower sacrum to coccyx; while this may represent a partially imaged deep gluteal cleft, correlate with direct inspection. Prone imaging was not performed to assess for tethered cord.5. Markedly distended bladder.


Instruction: Generate impression based on findings.

Input: Transient cerebral ischemic attack, unspecified [G45.9], Reason for Study: ^Reason: TIA History: L sided numbness No evidence of acute ischemic or hemorrhagic lesion.There are scattered bilateral periventricular white matter FLAIR/T2 high signal intensity lesions. These are nonspecific, at this age most likely small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1.No evidence of acute ischemic or hemorrhagic lesion.2.Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Female, 86 years old, with weakness of the right foot and numbness of the right hand. Assess for TIA. No restricted diffusion is seen. Relatively mild patchy periventricular T2 hyperintensity is unchanged. No evidence of parenchymal edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology. A mucous retention cyst is evident in the left maxillary sinus. Bone marrow signal characteristics are unremarkable.

Output: 1.Findings are redemonstrated compatible with chronic microvascular ischemic disease without significant interval change.2.No evidence of any acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: History of esophageal cancer status post CRT. New, small but significantly hypermetabolic right iliac is focus is very suspicious for progression of a solitary intramuscular metastasis seen on PET. There is a small mass, measuring less than 1.5 cm in greatest dimension, situated between the deep fibers of the right iliacus muscle and the underlying iliac wing. It is isointense to skeletal muscle on T1-weighted images, hyperintense to skeletal muscle on fat-suppressed T2-weighted images, and shows mild enhancement following gadolinium administration. This corresponds to the hypermetabolic focus seen on the recent PET CT scan and is compatible with a soft tissue metastasis. There is edema surrounding this mass between the iliacus and the iliac wing, but I see no signal abnormality within the right ilium itself. Bone marrow signal intensity is within normal limits. I see no additional soft tissue masses.

Output: Small nodular mass within the right iliacus along the right iliac wing corresponding to the hypermetabolic focus on recent PET scan is compatible with a soft tissue metastasis from the patient's esophageal cancer.


Instruction: Generate impression based on findings.

Input: Evaluate for radiculopathy: left neck pain radiating into little finger. Lupus. There is multilevel degenerative spondylosis, including prominent anterior disc-osteophyte complexes at C4-5 and C5-6, but no significant spinal canal or neural foraminal stenosis at any of the cervical spine levels. 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 evidence of cervical spine tumors or abnormal enhancement. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are several cystic nodules in the bilateral parotid glands.

Output: 1. No evidence of significant spinal canal or neural foraminal stenosis in the cervical spine.2. No evidence of spinal cord lesions or cervical spine tumors.3. Several cystic nodules in the bilateral parotid glands may represent benign lymphoepithelial cysts or may be related to lupus, for example. Follow up with dedicated imaging may nevertheless be useful.


Instruction: Generate impression based on findings.

Input: Back pain and continued fevers in the setting of antibiotics treatment for a pan-susceptible organism. General observations: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is near complete loss of disc space and disc desiccation at L3-4 and L4-5. There is high T2 signal in the bone marrow along the endplates surrounding the L4-5 disc, which contains a small amount of fluid signal. There is milder high T2 signal in the bone marrow along the endplates at L3-4. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Interspace observations: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 a disc bulge that causes mild to moderate bilateral neural foraminal narrowing, but no significant narrowing of the spinal canal.L4-5: There is a disc bulge asymmetric to the right, ligamentum flavum thickening, and facet arthropathy causes effacement of the right lateral recess and moderate to severe central canal stenosis, as well as moderate left and severe right neural foraminal narrowing. L5-S1: There is a small eccentric right disc bulge with mild bilateral neural foramen narrowing, but no significant compromise to spinal canal.

Output: Lower lumbar spine degenerative spondylosis, particularly at L4-5, with moderate to severe spinal canal stenosis and severe right neural foraminal narrowing. Mild endplate edema and fluid in the disc space at L4-5 is also likely degenerative in nature, although superimposed discitis-osteomyelitis is a potential consideration. However, assessment is limited without intravenous contrast.


Instruction: Generate impression based on findings.

Input: Brain parenchyma appears within normal limits for age without appreciable structural lesions. No evidence of infarct or hemorrhage. No parenchymal signal abnormality. No evidence of intracranial mass or mass effect. Ventricles and sulci appear within normal limits. Midline structures including the corpus callosum, and posterior fossa structures appear within normal limits. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Bone marrow signal is within normal limits. Partial opacification of the right sphenoid sinus and minimal maxillary sinus mucosal thickening noted. MRA HEAD

Output: 1. Brain parenchyma appears within normal limits with no structural lesions appreciated. 2. Brain MRA also appears within normal limits.


Instruction: Generate impression based on findings.

Input: Female, 54 years old. Posterior medial ankle and lower leg pain. TENDONS: There is globular signal within the anterior aspect of the Achilles tendon measuring up to 4 cm in longitudinal dimension and leading to tendon thickening of up to 1.3 cm in AP dimension. No discrete fluid-filled tear is identified. There is minimal surrounding edema in the soft tissues adjacent to the distal Achilles tendon, but the insertion is intact.LIGAMENTS: The ligaments of the ankle are intact.ARTICULAR SURFACES AND BONE: Bone marrow signal intensity is normal. ADDITIONAL

Output: Achilles tendon thickening compatible with tendinopathy without discrete tear identified.


Instruction: Generate impression based on findings.

Input: NSVT Left VentricleThe left ventricle has moderately reduced EF. The overall LV ejection fraction is 43%, the LVEDV is 221 ml (normal range 109+/-23), the LVESV is 125 ml (normal range 31+/-10) 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.The native T1 myocardial relaxation time is grossly normal. There is [ no]LV thrombus. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal. The overall RV ejection fraction is 62%, the RVEDV is 129 ml (normal range 110+/-24), and the RVESV is 48 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. 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 trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Moderate LV systolic dysfunction with no evidence for delayed enhancement.2. Normal RV systolic function.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no acute infarct, mass effect, or cerebral edema. The myelination pattern appears normal for patient age with presence of high intrinsic T1 signal in the peri-Rolandic cortex, and in the posterior limbs of the internal capsules. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a small subgaleal collection in the bilateral parietal scalp extending posteriorly into the occipital scalp measuring up to 9 mm in thickness, consistent with birth trauma.SPECTROSCOPY: Single voxel short TE MR spectroscopy of the posterior midline parietal/occipital gray matter, left parietal white matter and the left basal ganglia region show normal spectra for age. Single voxel intermediate TE MR spectroscopy of the posterior midline parietal/occipital gray matter shows absence of inverted double peak confirming absence of a lactate peak. No abnormal or unaccounted peaks are seen.

Output: 1.No evidence of hypoxic ischemic injury. The brain appears normal for age. Small parietal and occipital subgaleal collection compatible with birth trauma.2.MR spectra are normal for age which argues against any significant underlying parenchymal injury.


Instruction: Generate impression based on findings.

Input: This exam is degraded by motion artifact. There is diffuse patchy replacement of the normal fatty marrow. There are numerous T2 hyperintense and enhancing osseous lesions throughout the spine, including the anterior and posterior elements as well as the posterior ribs, sacrum, and iliac bones, and clivus. Many of these lesions to demonstrate cortical disruption of the posterior vertebral body without significant epidural extension. However, at L3-L4 there appears to be slight epidural extension into the right neural foramen and at L5 and S1 there is mild epidural enhancement anterior to the thecal sac. The spinal cord displays normal signal and morphology. The vertebral body heights are preserved. These findings are superimposed on degenerative changes. For example, in the cervical spine, these changes are most prominent from C3 to C7 with multilevel disc osteophyte complexes that result in up to mild to moderate spinal canal stenosis as well as multilevel facet and uncovertebral joint arthropathy resulting in neural foraminal narrowing that is most severe on the right at C5-C6, and on the left at C6-C7. In the thoracic spine, there are mild multilevel degenerative changes including mild disc bulges, facet arthropathy, and ligamentum flavum thickening that do not result in significant spinal canal stenosis, but do result in moderate right neural foramen narrowing at T10-T11 and mild right neural foramen narrowing at T11-T12. There are degenerative changes that are more extensive in the lumbar spine, such as at L2-L3, a disc bulge and facet arthropathy contribute to moderate spinal canal stenosis. At L3-L4, a disc bulge, facet arthropathy, and ligamentum flavum thickening contribute to severe spinal canal stenosis and bilateral neural foramen stenosis. At L4-L5, a disc bulge with a superimposed right foraminal herniation results in right neural foramen narrowing and right subarticular zone narrowing. At L5-S1, there are severe endplate degenerative changes and loss of disc height, without significant spinal canal or neural foramen stenosis. The vertebral column alignment is within normal limits.

Output: 1.Extensive osseous metastatic disease to the axial skeleton with suspected areas of slight epidural extension in the lumbar spine most prominent at L5 and S1, but without associated significant spinal canal stenosis or loss of vertebral body heights.2.Degenerative spondylosis resulting in up to mild to moderate spinal canal stenosis in the cervical spine and up to severe spinal canal stenosis in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: acute ischemic infarct History: left neglect There are multifocal scattered restricted diffusion lesions on the right frontal and parietal lobes without evidence of hemorrhagic conversion.There are also patchy white matter matter high signal intensity lesions on FLAIR images especially on the right frontal and parietal lobes indicating prior ischemic insults indicating prior ischemic events.Above finding suggest possible underlying right side vascular lesion, thus brain MRA or CTA can be considered for further imaging evaluation.Minimal non specific small vessel ischemic disease on the left hemisphere.Right lateral ventricle is slightly enlarged due to ex vacuo dilatation than the left side.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal acute ischemic infarctions on the right frontal and parietal lobes without evidence of hemorrhagic conversion. Comment: Since there are evidence of prior ischemic insults, underlying vascular lesion such as focal intracranial arterial luminal narrowing or stenosis may need to be investigated with either brain MRA or CTA.


Instruction: Generate impression based on findings.

Input: Chiari malformation: autism. Brain: The cerebellar tonsils extend up to approximately 6 mm inferior to the foramen magnum, but display rounded to minimally pointed morphologies. There is flow of cerebrospinal fluid across the foramen magnum, albeit slightly blunted posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Low-lying cerebellar tonsils may represent a mild form of Chiari type 1 malformation.2. No evidence of syringohydromyelia in the cervical spine.


Instruction: Generate impression based on findings.

Input: Male 63 years old with pancreatic neuroendocrine tumor with liver mets, please evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Numerous hepatic lesions with peripheral arterial enhancement and diffusion restriction are again noted.The reference segment 5 lesion measures 2.2 x 1.9 cm (series 801, image 190), previously 2.1 x 1.8 cm.Reference segment 6 lesion measures 2.2 x 1.9 cm (image 108, image 134), unchanged.The remaining lesions are not significantly changed in size or number.No significant intra or extrahepatic biliary ductal dilatation. There is susceptibility artifact from the common bile duct stent and from pneumobilia in the left hepatic lobe. The hepatic vasculature appears patent.SPLEEN: No significant abnormality noted.PANCREAS: The reference ill-defined, enhancing pancreatic head lesion measures 1.9 x 1.9 cm (series 801, image 150), previously 1.9 x 1.8 cm. There is atrophy of the upstream pancreatic body and tail. No pancreatic ductal dilatation.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: Distended, trabeculated urinary bladder raises suspicion for bladder outlet obstruction.

Output: 1.Stable exam with unchanged size and number of arterial enhancing liver metastases.2.No significant change in the size of the enhancing pancreatic head lesion.3.No new sites of disease.


Instruction: Generate impression based on findings.

Input: Clinical question: 28-year-old female with chronic history of migraines, escalating a recent month. Family history of aneurysm. Rule out mass, increased intracranial pressure. Signs and symptoms: Severe headache. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrate normal anatomical morphology as well as signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Post infused images demonstrate a multi branch is small vascular enhancement in the right frontal and basal ganglia consistent with a congenital developmental venous anomaly without clinical significance. This finding is not associated with any detectable cavernoma. No detectable abnormal parenchymal or leptomeningeal enhancement.Signal void of major intracranial arterial branches are identified and unremarkable. Note should be made that this exam cannot exclude possibility of aneurysm.Unremarkable calvarium and orbits without detectable abnormal enhancement.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.Pre- and post enhanced brain MRI demonstrate a small right basal ganglionic/frontal lobe congenital developmental venous anomaly and unremarkable otherwise.2.Note should be made that MRI cannot exclude possibility of aneurysm.3.Well-pneumatized paranasal sinuses and bilateral mastoid air cells and middle ear cavities and unremarkable calvarium.


Instruction: Generate impression based on findings.

Input: 52-year-old male with a weak supraspinatus and week and external rotation. Presents with pain in the right shoulder. Evaluate cuff. ROTATOR CUFF: There is a full-thickness near complete tear of the infraspinatus tendon measuring between 1 and 1.5 cm in the AP dimension with up to 1.5 cm of proximal retraction. A small band of the posterior aspect of the infraspinatus tendon appears intact and can be traced to its insertion on the greater tuberosity. There is loss of bulk of the infraspinatus muscle. We suspect that this tear involves the posterior fibers of the supraspinatus tendon. The remainder of the supraspinatus tendon appears thinned, suggesting chronic attritional tearing. There is mild fatty infiltration along the myotendinous junction, but otherwise the supraspinatus muscle appears normal. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild intermediate signal intensity within the superior glenoid labrum suggesting degeneration, but we see no fluid-filled tear. The glenohumeral joint alignment is within normal limits. BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Full-thickness rotator cuff tear, predominantly involving the infraspinatus tendon, with chronic attritional thinning of the majority of the supraspinatus tendon as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Anesthesia of skinDiagnosis Edits: Clinical question: please do Dr Javed MS protocol,Signs and Symptoms: numbness Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are appreciated in the cervical spinal cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are endplate uncovertebral osteophytes present at this level associated with a disc bulge and disc desiccation.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a left paramedian disc protrusion at this level which is partially effacing spinal fluid ventral to the left hemicord. There is a perineural cyst present in the left neural foramen at this level. There are some small endplate osteophytes present.At C6-7 there is no significant compromise to the spinal canal. There is a left paramedian disc protrusion at this level which partially effaces spinal fluid ventral to the left hemicord and mildly encroaches on the nerve roots at the left lateral recess.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this levelThe vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal lesions are appreciated. Thoracic spinal cord. There is a T1 hyperintense 12 mm focus in the L1 vertebral body probably representing a vertebral body hemangioma. Similar lower lesion is also present at T5.No abnormal enhancing lesions are appreciated in the thoracic spine.A cystic lesion is present in the left kidney measuring 10 mm in diameter. It does not enhance following gadolinium and has low signal on T1-weighted imaging.

Output: 1.There are degenerative changes present in the cervical spine with mild encroachment of the left-sided exiting nerve roots at C6-7.2.No abnormal spinal cord lesions are identified to suggest demyelination.3.Cystic lesion within the parenchyma of the right kidney most likely represents a simple cyst


Instruction: Generate impression based on findings.

Input: 69-year-old male with history of high-volume Gleason 7 disease on the left. Pretreatment evaluation. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.6 x 5.2 x 3.9 cm (cc by transverse by AP).Peripheral Zone: Within the midportion of the left posterior peripheral zone and extending towards but not reaching the apex is a area of confluent low T2 signal and restricted diffusion measuring 1.5 x 1.1 cm in the axial plane and 1.1 cm craniocaudal dimension. On the postcontrast images, the area of enhancement extends slightly beyond the abnormal T2 signal and there appears to be extension through the posterior lateral aspect of the capsule.Central Gland: Heterogeneous hyperplasia compatible with benign prostatic hypertrophy.Seminal Vesicles: Unremarkable.Extracapsular Extension: Suspicion for extracapsular extension on the posterolateral aspectBLADDER: No significant abnormality noted.LYMPH NODES: Scattered inguinal lymph nodes are within normal limits. No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is an unchanged simple cystic structure in the posterior aspect of the prostate posterior to the prostatic urethra, likely a utricle cyst.

Output: 1.Findings compatible with prostatic adenocarcinoma involving the posterior left peripheral zone with findings suspicious for extracapsular extension posterolaterally.


Instruction: Generate impression based on findings.

Input: 68-year-old woman with history of left lower quadrant pain and uterine bleeding, evaluate for malignancy. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder appear normal. There is no intra or extrahepatic duct dilatation.SPLEEN: The spleen appears normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There is a subcentimeter cyst in the superior pole of the left kidney, kidneys are otherwise normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The small bowel and colon are normal.BONES, SOFT TISSUES: Ventral abdominal surgical artifacts are noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The right wall of the uterine body is not well-defined. Arising from the uterine fundus there is a 79 x 73 mm mass which appears to be subserosal and heterogeneous in signal containing mixed fluid and gas (series 1901, image 363). This mass does not significantly enhance. There is no evidence of fistulous communication with bowel.The vagina and cervix appear normal.BLADDER: The bladder appears normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The rectosigmoid colon is normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large uterine mass containing fluid and gas without visualized fistulous connection to bowel.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42] / Other specified personal risk factors, not elsewhere classified [Z91.89], Reason for Study: ^Reason: r/o central vertigo, for posterior circulation stenosis, vestibular neuritis History: r/o central vertigo, for posterior IAC MRIThe brainstem, cerebellum, vermis and tonsils are normal. The inner ear structures, cochlea, vestibule, semicircular labyrinth are normal. The internal auditory canals are normal with delineation of the facial, cochlear and vestibular nerves. No evidence of signal abnormality, mass or abnormal enhancement is noted. Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.MRA NeckThe exam is non diagnostic since the timing of contrast bolus appears to be missed.The examination needs to be repeated without additional charge if clinically indicated.

Output: 1. No abnormal signal intensity, no structural abnormality on IAC MR examinations.2. Normal brain MRA.3. Non diagnostic neck MRA. The examination needs to be repeated without additional charge.


Instruction: Generate impression based on findings.

Input: 53-year-old female with recent left greater trochanter lesion on prior plain radiograph. There is mild edema adjacent to the lateral component of the left gluteus medius tendon at its insertion on the left greater trochanter. There is also edema and a small focus of fluid adjacent to the distal gluteus minimus tendon, and although a portion of the tendon can be followed to its insertion on the greater trochanter, we suspect there is an incomplete tear of the distal gluteus minimus tendon. There is mild surface irregularity of the underlying greater trochanter, likely representing chronic enthesopathic changes that we suspect account for the lucency seen on recent radiographs. We see no intramedullary lesion to indicate bone tumor.There is edema in the musculature between the left ischium and proximal femur that may reflect strain injury or chronic ischiofemoral impingement, although the ischiofemoral distance appears relatively normal. The hamstrings tendons appear normal.There is a small amount of fluid along the left iliopsoas tendon suggesting a mild bursitis of questionable clinical significance. A small amount of fluid is visualized within the left hip joint, but no significant effusion is present. Very mild osteoarthritis affects the left hip, better seen on recent radiographs. Please note this study was not protocoled for detailed evaluation of the labrum. On the right, there is mild peritrochanteric edema which is not necessarily of any clinical significance

Output: 1. Incomplete insertional tear of the left gluteus minimus tendon with mild peritrochanteric edema.2. We see no evidence of bone tumor.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: 65 yo M with metastatic H\T\N cancer to brain s/p SRS to L occipital met in 9/2015, eval for progression History: as above There is continued stable appearance of a 7 mm enhancing focus along the left temporal occipital region, which appears linear on axial imaging and demonstrates minimal intrinsic T1 hyperintensity. Scattered nonspecific T2/FLAIR hyperintensity within the subcortical and deep white matter unchanged. There is a focus of susceptibility in the left basal ganglia region which is slightly increased in conspicuity likely relating to chronic hemosiderin deposition.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal or pathological enhancement. 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. There is moderate mucosal thickening in the right maxilla sinus and mild in the left. There is mild fluid opacification of left mastoid air cells.

Output: Stable posttreatment changes with persistent linear area of enhancement along the left temporal occipital region, in the location of previously treated metastasis.


Instruction: Generate impression based on findings.

Input: 60 year-old male with right maxillary squamous cell carcinoma, status post induction chemotherapy, for the study. Brain CT:The attenuation and morphology of the brain parenchyma is within normal limits for patient's stated age. No evidence of hemorrhage, edema, mass-effect, midline shift, no abnormal enhancement in the brain parenchyma is detected. Ill-defined linear enhancement identified along the right side medial aspect of the middle cranial fossa contiguous with right foramen ovale and along the cavernous sinus seen on the prior MRI is not as well appreciated on this CT study. Cortical sulci, ventricular system and all basal cisterns are normal in size and configuration. Partial opacification of right mastoid air cells is redemonstrated. Neck CT:There is mottled radiolucent destruction involving right side hard palate, medial and lateral pterygoid plate, greater wing of sphenoid and the posterior wall of right maxillary sinus. The right vidian canal is not visualized. The right maxillary sinus soft tissue mass appears to have been largely resected. There is residual soft tissue thickening along the wall of the right maxillary sinus and status post uncinectomy and partial turbinectomy change. Soft tissue enhancement/irregularity in right pterygopalatine fossa and masticator space are persistent. The parapharyngeal space is preserved. Views of soft tissue neck is negative for discrete mass. No pathologic lymphadenopathy is appreciated based on the size criteria for lymphadenopathy. Scattered small lymph nodes are seen in bilateral level II to IV . A retention cyst is again noted in left maxillary sinus.The airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The visualized portion of the lungs are clear. Please refer to the dedicated chest CT for more comments. The cervical vertebral bodies in general are intact with no evidence for canal stenosis.

Output: 1. Interval post surgery and treatment change in the right maxillary sinus region. There is residual soft tissue thickening along the the maxillary wall. Soft tissue enhancement/irregularity in right pterygopalatine fossa, masticator space are persistent. These findings can represent residual tumor.2. There is no pathologic lymphadenopathy based on radiological criteria.3. Ill-defined linear enhancement in medial aspect of the middle cranial fossa along the lateral cavernous sinus, contiguous with right foramen ovale erosion. These findings were better seen on prior MRI and could represent intracranial spread. They are less well appreciated on this CT, and it is uncertain whether this is secondary to interval improvement or differences in techniques.4. Right mastoid, left maxillary sinus inflammatory change.


Instruction: Generate impression based on findings.

Input: 43 year old female with a VSD, ASD (secundum) and a PDA s/p surgical repair at age 2y, RV dysfunction, s/p supravalvular pulmonic plasty and coiling of an aorto-left pulmonary artery fistula (alternatively a residual PDA) 1/8/14. CMR today for pre-operative evaluation prior to shoulder surgery. Left VentricleThe left ventricle is normal in size with a normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 122 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 41 g/m2 (normal range 67+/-11), and the LV mass is 75 g (normal range 114+/-24). Ventricular septal patch repair is noted. The presence of residual VSD can not be excluded (see below). There is systolic septal flattening consistent with RV pressure overload. There late gadolinium enhancement of the inferior right ventricular insertion point suggesting the presence of underlying myocardial fibrosis. This pattern is commonly seen in RV pressure overload states such as pulmonary hypertension and congenital heart disease. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is severely dilated with a mildly reduced systolic function. The overall RV ejection fraction is 43%, the RV end diastolic volume index is 129 ml/m2 (normal range 69+/-14), the RVEDV is 238 ml (normal range 110+/-24), the RV end systolic volume index is 74 ml/m2 (normal range 22+/-8), and the RVESV is 102 ml (normal range 35+/-13). There is no obstruction in the RVOT.Right AtriumThe right atrium is severely 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 likely moderate tricuspid regurgitation with an eccentric jet; however, the possibility that the jet represents a residual ventricular septal defect can not be completely excluded.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsThe right-sided pulmonary veins form a common antrum and join with the left atrium. The left sided pulmonary veins are not visible.Pulmonary ArteryThe main pulmonary artery is severely dilated (43x37mm). The proximal portion of the main pulmonary artery is narrowed (16mm) but without evidence of significant flow acceleration. The right pulmonary artery is normal in size (17mm). The left pulmonary vein is small in caliber (10mm). Venous AnatomyThe SVC is normal in size and drains normally into the right atrium. The IVC is massively dilated and drains normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are diffusely increased interstitial markings in the left lung.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. Normal LV size and systolic function (LVEF 58%) with evidence of fibrosis along the right ventricular inferior insertion point, which is commonly seen in RV pressure overload states.2. Severe RV dilation with mildly reduced systolic function (RVEF 43%). There is systolic flattening of the interventricular septum suggesting that the RV systolic pressure is increased.3. The IVC is massively dilated.4. The left pulmonary artery is significantly diminished in caliber. The left-sided pulmonary veins are not well seen. The left lung is hypoperfused relative to the right lung. There are diffusely increased interstitial markings in the left lung.5. The main pulmonary artery is severely dilated.6. There is likely moderate tricuspid regurgitation with an eccentric jet; however, the possibility that the jet represents a residual ventricular septal defect can not be completely excluded.7. When compared to the prior study, there has been mild improvement in RV function.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right muscle atrophy FEMUR:Bones: Scant areas of intermediate signal intensity are noted within the femur particularly within the right distal femur (series 3 image 12/31) which is thought to represent areas of red marrow. Otherwise the marrow signal intensity of the femoralSoft tissues: The musculature of the thigh is normal in caliber and signal intensity. There is no evidence of atrophy.TIBIA/FIBULA:Bones: The marrow signal of the tibia and fibula is normal bilaterally.Soft tissues: The musculature of the leg is normal in caliber and signal intensity. There is no evidence of atrophy.

Output: Normal signal intensity and caliber of the right thigh and leg musculature.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, yearly follow-up for pituitary cyst. A heterogeneously enhancing mass is redemonstrated within the sella measuring 16 mm AP, 15 mm TV and 15 mm CC, without significant interval change in size. Although the lesion appears to be predominantly solid, there are irregular areas of nonenhancing, possibly cystic tissue intermixed, and these areas seem to be smaller than on the prior examination. As before, the lesion extends into the suprasellar cistern mildly but without significant impingement on the optic apparatus. The pituitary stalk deviates toward the left inserting on the apex of the lesion. A mucous retention cyst is evident in the left maxillary sinus.

Output: There has been no significant interval change in the overall size of a sellar/suprasellar mass, though suspected cystic components of this lesion do appear to be smaller.


Instruction: Generate impression based on findings.

Input: Female, 22 years old, approximately 32 weeks and 4 days gestational age, with intracranial anomalies detected on ultrasound. The cavum septum pellucidum is present and appears slightly prominent. The corpus callosum is distinctly visualized and is fully formed.The lateral ventricles are top normal in size measuring up to 10 mm at the level of the atria. The frontal horns are likely of normal size as well. However, immediately lateral to each frontal horn, and separated from them by what appears to be a thin septation, are relatively symmetric cystic areas measuring 8 mm in diameter. There is a suggestion of volume loss associated with these cystic areas.Gross brain morphology is otherwise unremarkable. The degree of gyration is appropriate for the stated gestational age. The brainstem and posterior fossa are within normal limits. No additional areas of abnormal parenchymal signal are evident. No findings to suggest intracranial hemorrhage are seen.Incidental note is made of polyhydramnios.

Output: Symmetric cystic areas are evident within the bilateral frontal white matter. These are contiguous with and immediately lateral to the frontal horns, and apparently separated from them by a thin septation. Given the suggestion of associated volume loss, these are favored to be pathologic and may represent cystic periventricular leukomalacia which can be related to ischemic or infectious insults. Correlation with laboratory markers of TORCH infection is suggested. The possibility that these represent normal variant connatal cysts is considered less likely.The ventricular system is otherwise normal and the corpus callosum is present and fully formed. No other definite intracranial abnormalities are noted.


Instruction: Generate impression based on findings.

Input: History of lung cancer, staging examination to evaluate for metastatic disease. There are no residual enhancing intracranial lesions. There is no mass-effect or significant midline shift. There is no evidence of intracranial hemorrhage or acute infarct. There is diffuse cerebral volume loss. There are nonspecific scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter, which are not significantly changed. There is also a chronic lacunar infarct in the left caudate. There are punctate foci of susceptibility in supra- and infratentorial locations at sites of prior metastases, likely representing chronic blood products or mineralization. The skull and extracranial soft tissues are unremarkable. However, there appears to be a lesion in the right C1 vertebra, which is incompletely characterized.

Output: 1. No evidence of enhancing intracranial metastases.2. A partially characterized lesion in the right C1 vertebra may represent a metastasis. A dedicated cervical spine MRI may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is an ill-defined focus of signal abnormality involving the right temporooccipital junction demonstrating gyral thickening, gyral and sulcal enhancement, with associated vasogenic edema and mild mass effect upon the adjacent right lateral ventricle. It does not demonstrate restricted diffusion and has no susceptibility abnormality.Elsewhere there are foci of T2 hyperintensity within the white matter without associated mass effect, restricted diffusion, or enhancement representing chronic small vessel ischemic disease.A single punctate focus of susceptibility hypointensity is noted within the right paramedian pons, without other signal abnormality, most likely representing a remote microhemorrhage.The ventricles and sulci are unremarkable for age. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: There is an ill-defined focus of signal abnormality involving the right temporooccipital junction demonstrating gyral thickening, gyral and sulcal enhancement, with associated vasogenic edema and mild mass effect upon the adjacent right lateral ventricle. It does not demonstrate restricted diffusion and has no susceptibility abnormality. This appearance is most suggestive of involvement by lymphoma or less likely metastasis from other primary cancer. However, a portion of the described enhancement pattern can also be seen in the setting of seizure activity, which may be superimposed. This does not have the imaging appearance of a contusion.


Instruction: Generate impression based on findings.

Input: Head and neck cancer as well as lung cancer and a new mass within the left cerebellar hemisphere on CT neck: evaluate for metastatic disease. There appear to be four supratentorial and infratentorial peripherally-enhancing masses with surrounding T2 hyperintensity. For example, a left cerebellar hemisphere lesion measures up to approximately 25 mm and a left parietal lobe lesion measures up to approximately 22 mm. There are otherwise a few unchanged scattered nonspecific foci of punctate T2 hyperintensity in the cerebral white matter without associated enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is mild effacement of the fourth ventricle, but no dilatation of the third and lateral ventricles. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A few supratentorial and infratentorial masses with associated edema are compatible with metastatic disease.


Instruction: Generate impression based on findings.

Input: 35-year-old female with pain in buttocks, below vaginal opening PELVIS:UTERUS, ADNEXA: Small amount of fluid within the endometrial canal and proximal vagina, likely physiologic.Right ovarian cyst images likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a 4 cm T2 hypointense tract like extension from the 1 o'clock position of the anus towards the left gluteal cleft demonstrating restricted diffusion and peripheral enhancement. The tract approaches but does not seem to involve the skin. No drainable collection. Mild surrounding cellulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left perianal fistulous tract without drainable collection as described above.


Instruction: Generate impression based on findings.

Input: Male, 49 years old, with seizures. Numerous punctate foci are seen scattered through the cerebral white matter. No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is evident.The left hippocampal formation is slightly smaller than the right and seems to show mildly elevated T2 signal relative to the right. The left fornix and mammillary body are also slightly smaller than the right.No evidence of any intracranial hemorrhage or abnormal extra-axial fluid is seen. Ventricles are normal in size and morphology.

Output: 1.Findings suggestive of mesial temporal sclerosis on the left.2.Scattered small foci of white matter T2 hyperintensity are a nonspecific finding which may reflect an underlying vascular, demyelinating or inflammatory etiology among others.


Instruction: Generate impression based on findings.

Input: Ms. Fankhauser is a 41-year-old female with personal history of left breast lumpectomy in July 2014 for ER positive IDC followed by chemotherapy and radiation therapy. Minimal parenchymal enhancement is noted bilaterally.Expected postsurgical changes, including a 6.2 cm postoperative seroma, are identified in the left lower inner breast, compatible with the history of left breast lumpectomy. There is no abnormal enhancement identified in either breast. Thin rim-like enhancement is seen around the seroma. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Expected postsurgical changes in the left breast with no MRI evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Nonspecific T2 FLAIR hyperintensities are seen in the subcortical and periventricular white matter, suggestive of chronic ischemic vascular disease.There is no diffusion or susceptibility abnormalities. There is no evidence of abnormal enhancement.Ventricular size is normal. There is no midline shift. Basal cisterns are patent. There is no mass effect.

Output: 1. No evidence for acute intracranial hemorrhage, mass effect, or edema.2. Probable mild chronic small vessel ischemic changes.