Instruction: Generate impression based on findings.

Input: Ankle wound There is a large soft tissue defect along the posteromedial aspect of the ankle with replacement of the underlying subcutaneous fat with abnormal signal intensity likely reflecting a combination of inflammation and scarring. There is a poorly defined collection of abnormal signal intensity anterior to the wound just posterior and medial to the medial malleolus that could represent phlegmon. Small foci of signal void within this collection may represent gas and suggest communication with the above-described ulcer.Additional soft tissue ulceration is noted lateral to the distal fibula with replacement of the underlying subcutaneous fat with what is likely a combination of scarring and inflammation. A 1 cm collection of fluid signal intensity within the subcutaneous fat just anterior to this soft tissue defect could represent a small abscess with possible communication with the nearby ulceration. Edema extends within the subcutaneous fat superiorly from the ulceration along the peroneal muscles beyond the field-of-view but we see no definite intramuscular abscess. Abnormal signal intensity also extends anteromedially to the lateral margin of the calcaneus where there is abnormal marrow signal on both T1 and T2 sequences suggesting underlying osteomyelitis. Additional small foci of signal void within the inflamed soft tissues of the ankle likely reflect gas.There is a small tibiotalar joint effusion with small foci of edema in the underlying tibial plafond and talar dome. These findings are nonspecific and may be reactive in nature but we cannot exclude the possibility of an infected ankle joint, although we see no definite direct communication between the joint and the above-mentioned ulcerations.Mild edema is noted within the distal fibula (seen on the fat-suppressed T2 sequences) which is thought to represent reactive osteitis as opposed to true osteomyelitis given the normal fatty marrow signal on the T1W sequences. The marrow signal of the midfoot and proximal metatarsals is normal. There is mild edema within the plantar musculature and moderate edema of the dorsal subcutaneous fat. The ankle tendons and ligaments are intact.

Output: 1. Extensive ulceration of the soft tissues of the ankle with inflammation of the underlying soft tissues further detailed above. This inflammation extends to the superolateral margin of the body of the calcaneus where there is abnormal signal intensity of the underlying marrow compatible with osteomyelitis.2. Mild edema type signal involving the distal fibula which is favored to represent reactive osteitis as opposed to osteomyelitis.3. Small tibiotalar joint effusion with small foci of edema in the adjacent tibial plafond and talar dome. Although the effusion and marrow edema may be reactive in nature, we cannot entirely exclude the possibility of a septic arthritis.These findings were discussed with resident physician Dr. T. Wagner of the primary service at the time of final interpretation.


Instruction: Generate impression based on findings.

Input: 49 year old female with metastatic small cell lung cancer with brain/pancreatic METs and with altered mental status. Rule out bleed. Images through posterior fossa are unremarkable.Multiple small patchy areas of decreased attenuation are noted. One of these lesions in the right frontal lobe demonstrates internal area of high density which corresponds with previously noted hemorrhagic metastases on MRI from 3 -- 6 -- 09. The other subcortical and periventricular low attenuations may represent small vessel disease. No evidence of hemorrhage, mass effect, midline shift or hydrocephalus.111

Output: No evidence of acute findings. Small vessel disease and right frontal lobe metastases as detailed


Instruction: Generate impression based on findings.

Input: Female, 33 years old, with history of frontal lobe brain tumor resection status post radiation and chemotherapy. A fluid filled right frontal lobe resection cavity is again seen, unchanged in size and morphology when compared to the prior exams. Parenchymal deformity and T2 hyperintensity adjacent to the resection cavity are also stable. A nodule of enhancement within the cingulate gyrus just posterior to the resection cavity is stable or slightly smaller.Mild T2 hyperintensity along the left frontal horn is unchanged. Also stable is a small focus of enhancement within the left superior frontal sulcus.No new areas of pathologic parenchymal signal abnormality or enhancement are detected. An incidental left temporal lobe developmental venous anomaly is redemonstrated. The ventricular system is stable in size and morphology.

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


Instruction: Generate impression based on findings.

Input: 31 year old male with non-ischemic cardiomyopathy, alcohol use presents for cardiac MRI. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 106 ml/m2 (normal range: 74+/-15), the LVEDV is 259 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 128 ml (normal range 47+/-19), the LV mass index is 36 g/m2 (normal range 85+/-15), and the LV mass is 88 g (normal range 164+/-36). 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.Native T1 time (pre-contrast) is within normal limits. No evidence of myocardial iron overload. No evidence of prior myocardial infarction. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection R fraction is 49%, the RV end diastolic index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 246 ml (normal range 142+/-31), the RV end systolic volume index is 51 ml/m2 (normal range 31+/-9), and the RVESV is 125 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThe esophagus is patulous. 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. Mild LV dilation with mildly reduced systolic function (LVEF 51%). No evidence of underlying myocardial fibrosis infiltration or inflammation.2. Right ventricle is normal size with mildly reduced systolic function (RVEF 49%)I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of migraine, evaluate for structural abnormality. There are nonspecific scattered subcortical foci of FLAIR abnormality. There is a partially empty sella. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. There is no diffusion abnormality. Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1.Nonspecific scattered FLAIR white matter foci. Given the patient's history, etiology of migraine is considered most likely, with demyelination and other etiologies remaining in the differential.2.Partially empty sella with no specific MR imaging findings of benign intracranial hypertension. Clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: Internuclear ophthalmoplegia. There are numerous, greater than 10, T2 hyperintense white matter and thalamic lesions, including a lesion in the posterior midbrain, around the midline, and left paramedial posterior pons. Many of the lesions display low T1 signal, but no associated enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with demyelinating lesions suggestive of multiple sclerosis with involvement of the medial longitudinal fasciculus, which could account for the internuclear ophthalmoplegia.


Instruction: Generate impression based on findings.

Input: History of cervical cancer stage IIA. PELVIS:UTERUS, ADNEXA: Heterogeneous mildly T2-weighted hypointense cervical mass with peripheral cystic components and heterogeneous enhancement measuring up to 6.3 x 5.0 x 5.0 cm (series 801/28 and series 701/22). The lesion extends to and along the involved anterior superior half of the vaginal wall (series 701/22). The lesion extends into the parametrial soft tissues along the left posterolateral aspect involving the mesorectal fascia (series 801/29). There is no well-defined margin along the anterior aspect of the mass compatible with parametrial invasion.Lobular enlargement of the uterus secondary to numerous well-defined T1 and T2 hypointense masses compatible with fibroids some of which demonstrate minimal cystic changes. The uterus measures 21.5 x 8.5 cm in the sagittal plane.The endometrial cavity is distended up to 3.0 cm with nonenhancing dependent debris.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent right pelvic sidewall lymph node measuring 1.9 x 0.8 cm (series 1601/254).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 6.3 cm cervical mass with parametrial and soft tissue involvement as described above. Non-specific right pelvic side wall prominent lymph node.


Instruction: Generate impression based on findings.

Input: 8 years Female (DOB: 5/22/2008)Reason: assess for Chiari History: headaches, bilateral leg painPROVIDER NAME: JAMES H TONSGARD JAMES H TONSGARD MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the paranasal sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.CSF flow study demonstrates normal biphasic flow at the level of the foramen magnum.MRI 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 identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.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.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is no evidence for Chiari malformation.2.There are minor disc bulge is present in the lower lumbar spine without significant compromise to the spinal canal or neural foramina.3.There is no compromise to the cervical spinal canal


Instruction: Generate impression based on findings.

Input: 58-year-old woman with left ankle pain. Evaluate for accessory peroneal tendinitis and avulsion. TENDONS: The tendons of the ankle are intact and appear within normal limits. No accessory peroneal tendon is identified, as clinically queried.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: The articular surfaces of the ankle appear within normal limits. Bone marrow signal intensity is within normal limits.ADDITIONAL

Output: Normal examination of the left ankle.


Instruction: Generate impression based on findings.

Input: Severe right hip pain ACETABULAR LABRUM: Evaluation of the labrum is limited due to lack of intra-articular fluid/contrast. However, there is linear intermediate signal intensity traversing the base of, and extending into the substance of, the anterior/superior labrum, suggestive of a complex tear. This tear appears to extend from the posterior superior aspect of the acetabulum at approximately the 11 o'clock position, to the anterior aspect of the acetabulum at approximately the 3 o'clock position.ARTICULAR CARTILAGE AND BONE: Mild increased signal intensity of the articular cartilage along the anterosuperior aspect of the acetabulum suggests degeneration, although I see no discrete fluid-filled defect. Small cysts are noted within the anterior margin of the acetabular dome, likely degenerative in etiology. Bone marrow signal intensity is otherwise within normal limits. I see no frank CAM deformity or findings to suggest acetabular overcoverage.SOFT TISSUES: The visualized musculature appears normal. ADDITIONAL

Output: 1.Right acetabular labral tear as described above.2.Degenerative arthritic changes of the lumbar spine.3.Bilateral adnexal collections of fluid signal intensity, that on the left measuring approximately 3 mm. This likely requires no further evaluation if he patient is premenopausal. If the patient is postmenopausal, then follow-up transvaginal ultrasound may be considered.


Instruction: Generate impression based on findings.

Input: 56-year-old female with history of stage III chronic kidney disease. Evaluate complex cyst in left kidney. ABDOMEN:Lack of intravenous contrast limits evaluation for solid organ pathology.LIVER, BILIARY TRACT: No focal hepatic lesions. Findings suggestive of gallbladder adenomyomatosis at the fundus.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Partially exophytic complex cystic lesion in left kidney mid to inferior pole with multiple internal thin septations measures up to 3.1 x 3.8 x 3.6 cm, slightly increased in size since prior study, though comparison to prior ultrasound is difficult. The lesion demonstrates T1 hyperintensity likely due to hemorrhage and/or proteinaceous debris.Multiple bilateral simple-appearing cysts and additional smaller T2 hyperintense lesions which are too small to characterize but likely due to additional cysts. These are similar to prior study in size, though comparison to prior ultrasound is difficult. Some of these lesions demonstrate T1 hyperintensity likely due to hemorrhage and/or proteinaceous debris.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: Complex cystic lesion in the left kidney has slightly increased in size, though comparison to prior ultrasound is difficult. Cystic neoplasm is a differential consideration and continued follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for hydrocephalus. Signs and symptoms: Gait instability. Non-enhanced CT of brain:Examination demonstrate a highly suspected loculated mass in the left cerebellum with extensive surrounding vasogenic edema. There is significant mass-effect on the fourth ventricle with near complete collapse of the ventricle. There is crowding of the cerebellar tonsils at the level of foramina magnum and effacement of prepontine and cerebellopontine angle cisterns as well as effacement and deformity of the quadrigeminal plate. Consistent with significant mass effect in the posterior fossa and upward transtentorial herniation.Images through supratentorial space demonstrates significant enlargement of the supratentorial ventricular system consistent with hydrocephalus. There are a few small foci of periventricular and subcortical low attenuation that although may represent small vessel disease considering patient's tumor but in the posterior fossa these areas of low attenuation may represent edema and metastatic lesions. A dedicated MRI with enhancement is recommended. There is no evidence of hemorrhage or midline shift.

Output: 1.Mass with extensive surrounding vasogenic edema in the left cerebellum with significant associated mass effect and upward transtentorial herniation.2.Supratentorial hydrocephalus.3.Dedicated MRI examination with enhancement is recommended.4.The above findings were relayed to Dr.Thomas Kelley from neurosurgery department at the time of interpretation.


Instruction: Generate impression based on findings.

Input: Reason: r/o meniscal tear or injury History: knee pain MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Edema within the superolateral aspect of Hoffa's fat pad is nonspecific but can be seen in patellar tendon-lateral femoral condyle friction syndrome, particularly if there is anterior knee pain.


Instruction: Generate impression based on findings.

Input: History of recurrent bladder cancer. ABDOMEN:LIVER, BILIARY TRACT: There are at least 3 new lesions in the right hepatic lobe which demonstrate mild T2 hyperintensity and hypoenhancement relative to the remainder of the liver, compatible with hypovascular metastases. For future reference the segment 8 lesion measures 1.1 x 0.9 cm (series 23/81). The liver is otherwise normal in morphology without biliary ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys demonstrate normal morphology without hydronephrosis. They enhance promptly and symmetrically and excrete contrast promptly into normal bilateral pelvicalyceal systems and non-dilated ureters. The distal ureters are not well seen likely due to peristalsis without evidence of a filling defect or mass. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes of the anterior abdominal wall.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Status post cystectomy with right ileal conduit. The visualized ureters demonstrate no mural abnormality or mass lesion.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. At least three new hypovascular liver lesions are suspicious for metastatic disease.2. Status post cystectomy with ileal conduit without complication. 3. Please refer to the separately dictated report of the same day PET/CT scan.


Instruction: Generate impression based on findings.

Input: 47 year old female with biopsy proven IDC, grade 2, at two sites in the right breast, presents for staging MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:In the right breast, there is an ill-defined, irregularly shaped mass is present at middle 11:00 position, measuring 20 x 26 x 20 mm (AP x LR x CC), with internal marker clip (Hydromark clip). This is a proven IDC. There is non-mass enhancement extending from this mass anteriorly to the nipple, and posteriorly near the pectoralis muscle, at upper outer quadrant. The nipple is retracted. The non-mass enhancement ia associated with multiple small masses and foci. Another marker clip is seen within this non-mass enhancement at retroareolar region. Overall measurement of this lesion is 101 x 49 x 58 mm. LEFT BREAST:No abnormal enhancement is seen in left breast. AXILLAE:No abnormal lymph nodes are identified in either axillary region.

Output: 1. Extensive non-mass enhancement with multiple masses and foci at upper outer quadrant in the right breast. Two clips, both at the site of proven IDC, are present within this extensive lesion. The lesion extends to the nipple.2. No MRI evidence of malignancy in the left breast3. No abnormal lymph node in either axillaBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: History of thalamic stroke and subsequent thalamic pain syndrome and tremor; please include DWI sequence. Signs and symptoms: Preoperative planning for the DBS; include diffusion-weighted sequences. Pre- and post enhanced DBS surgical planning MRI: This is a limited exam and for purposes of surgical planning and is not a true diagnostic test.No evidence of restriction on diffusion weighted series.Axial 3-D T2 weighted images demonstrate a focus of T2 hyperintensity in the left thalamus consistent with encephalomalacia at the site of previously known infarct. Minimal susceptibility signal changes within this region consistent with prior chronic hemorrhage. The finding measures at least at 10 x 5 mm in transaxial dimensions. Additionally examination demonstrated scattered foci of T2 hyperintensity in the periventricular and subcortical white matter of cerebral hemispheres suggestive of chronic small vessel ischemic strokes.Unremarkable cortical sulci and ventricular system and with widely patent CSF cisterns and maintained midline.Post enhanced images are severely degraded due to artifact however within this limitation there is no convincing evidence of abnormal enhancement.

Output: 1.Pre- and post enhanced surgical planning brain MRI exam as detailed above.2.Focus of chronic hemorrhagic left thalamic lacunar infarct is noted.3.Changes suggestive of chronic small vessel ischemic strokes.4.Severely degenerated post enhanced images without convincing evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Pancreatic head cystic lesion follow-up. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Left hepatic lobe cyst.SPLEEN: No significant abnormality noted.PANCREAS: Demonstrated again are 4 cystic lesions in the pancreatic head. The largest reference lesion measures 9 mm (series 4/50), previously 10 mm. The other reference lesion measures 7 mm (series 4/42), previously 8 mm. These are essentially unchanged from the prior. No suspicious postcontrast features.Normal caliber main pancreatic duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Simple appearing right renal cortical cyst.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: Stable to minimally decreased size of the pancreatic head cystic lesions. The main pancreatic duct is normal in caliber.


Instruction: Generate impression based on findings.

Input: Injury, unspecified [T14.90], Reason for Study: ^Reason: brain parenchyma, structural lesions History: non accidental injury with subdural hematoma and parietal contusion There are bilateral temporal subdural blood products with varying age. In addition, adjacent temporal lobes' show subtle volume decrease and T2/FLAIR high signal intensities on white matter indicating possible associated myelomalacia. Especially mainly bilateral middle and inferior temporal gyri show gyriform T1 high signal intensity lesions which may indicate associated cortical contusion.Similar finding is also seen on the left parietal lobe. A couple of susceptibility lesions including right frontal lobe (series 1102, image 37, image 43) may indicate parenchymal focal petechial hemorrhage.Previously seen right occipital bone fracture and right side subgaleal hematoma around the right mastoid are not conspicuous on today's MRI. The ventricles, sulci and cisterns are symmetric and unremarkable. 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. Various aged bitemporal subdural hematoma associated with findings suggesting possible contusion on bilateral temporal lobes and left parietal lobe.2. Bifrontal focal susceptibility lesions may indicate brain parenchymal petechial hemorrhages.


Instruction: Generate impression based on findings.

Input: ALTE in the setting of genetic disease NOS. Dysmorphic features (iris colobomas, somewhat low left ear, smooth philtrum), an undescended testicle. There is an apparent punctate focus of restricted diffusion in the left anterior corpus callosum. There is no evidence of intracranial hemorrhage or mass. There appears to be paucity of myelination, particularly in the peri-rolandic region. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The vein of Galen appears prominent and displays high T1 signal. The major cerebral flow voids are otherwise intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is deformity of the right lens and posterior globe at the optic nerve head.

Output: 1. Apparent acute punctate infarct in the left anterior corpus callosum.2. The vein of Galen appears prominent and displays high T1 signal, which may be an artifact of slow flow, although thrombosis cannot be entirely excluded. A Doppler ultrasound may be useful for further evaluation. 3. Suggestion of delayed myelination.4. Deformity of the right lens and posterior globe are likely related to coloboma.


Instruction: Generate impression based on findings.

Input: 40 year-old male with right knee pain and swelling, history of ACL repair MENISCI: A vertically oriented band of increased signal intensity extending through the anterior horn of the medial meniscus is consistent with a tear. We cannot tell on this single exam whether this is old or new, but we see no fluid signal intensity entering the meniscal substance. The body and posterior horn are intact. There is a small focus of increased signal intensity within the free edge of the lateral meniscal body, which could represent a tiny radial tear or postoperative changes; this may not be of any current clinical significance.ARTICULAR CARTILAGE AND BONE: While there are no focal defects within the articular cartilage of the patella, there is increased signal intensity within the deeper cartilage at the medial patellar eminence and medial patella facet likely representing early delamination. Focal increased signal intensity within the central femoral trochlea inferiorly suggests full-thickness degeneration with degenerative signal abnormality within the underlying marrow.There is thinning of the articular cartilage of the weight-bearing portion of the medial femoral condyle and a tiny near full-thickness defect of articular cartilage overlying the posterior horn of the medial meniscus. Regularly spaced foci of low signal intensity along the subchondral bone may represent prior microfracture. Slight depression of the articular cartilage along the lateral femoral condyle is consistent with old impaction fracture from prior ACL injury, with a small focus of full thickness cartilage loss noted within the overlying articular cartilage.LIGAMENTS: Status post ACL reconstruction. The graft appears intact. Mild edema within the marrow along the tibial tunnel is of questionable significance. The PCL is intact. The MCL, and LCL are intact.EXTENSOR MECHANISM: There is expected deformity of the patella and patellar tendon from ACL harvest. The patella tendon is otherwise intact. The quadriceps tendon is intact.ADDITIONAL

Output: 1. Intact ACL graft.2. Foci of articular cartilage degeneration as described above.3. Tear of the anterior horn of the medial meniscus, which may be old or new; we see no fluid signal intensity to confirm an unstable tear.


Instruction: Generate impression based on findings.

Input: Vein of Galen malformation. Brain MRI: The measured diameter of the dilated median prosencephalic vein has slightly increased since the previous MRA examination. It measures maximally 18 mm in width compared to 13 mm previously. T1/T2-hypointense signal in in the inferior right side of the median prosencephalic vein on MR angiography relates to embolization of the feeder from the left posterior cerebral artery. Otherwise, the lumen shows heterogeneous signal, which may reflect partial thrombosis. The aneurysmal dilatation of the posterior segment of the superior sagittal sinus shows preserved flow-related signal void. The brain demonstrates appropriate for age myelination. Small foci of susceptibility artifacts, especially within the occipital horns of the bilateral lateral ventricles, reflect previous subarachnoid hemorrhage and are not changed. The ventricles and the other CSF-containing spaces are normal in size. There is no midline shift or mass-effect. Fluid signal in the right mastoid air cells can be congestive. Mucosal thickening in the paranasal sinuses and specific in this age and may represent normal, redundant mucosa.Cranial MRA: It shows the feeders from the left and right posterior cerebral arteries and the lack of significant feeders from the pericallosal arteries.

Output: 1.The median prosencephalic vein (vein of Galen aneurysmal malformation) has slightly increased in size since the previous examination. The heterogeneous luminal signal may reflect partial thrombosis. There are changes of previous embolization of the feeder from the left posterior cerebral artery. 2.The ventricles remain normal in size. The brain shows age-appropriate myelination.3.Minimal hemosiderin staining in the occipital horn of the lateral ventricles is unchanged.


Instruction: Generate impression based on findings.

Input: 89 year-old female with severe LVH on echocardiogram. Sent for CMR assessment Left VentricleThe left ventricle is mildly dilated with normal systolic function. There is mild LVH. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 101 ml/m2 (normal range: 65+/-11), the LVEDV is 156 ml (normal range 109+/-23), the LV end systolic volume index is 43 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 97 g/m2 (normal range 67+/-11), and the LV mass is 150 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Asymmetric mid-septal hypertrophy. Maximal septal thickness noted in mid interventricular septum (11-12 mm). No SAM. Abnormal tagged imaging at the level of the mid-septum. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is moderate-severely enlarged . Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 81 ml/m2 (normal range 69+/-14), the RVEDV is 124 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 42 ml (normal range 35+/-13). There is no RVH.Right AtriumThe right atrium is mildly enlarged. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. Mitral annular calcification and thickening of the mitral leafletsPulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion. Extracardiac FindingsBilateral pleural effusions. 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. There is asymmetric mid-septal hypertrophy with maximal septal measurement 11-12 mm.The left ventricle is mildly dilated with normal systolic function. There is mild LVH. The overall LV ejection fraction is 58%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2.The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%.3. The left atrium is moderate-severely enlarged.4. The main pulmonary artery is mildly dilated. 5. Small pericardial effusion6. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: Reason: eval supraspinatus, poss tear History: left shoulder pain ROTATOR CUFF: There is a near full-thickness articular surface tear of the anterior fibers of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 16 mm in the AP dimension. There is no significant retraction. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa which may reflect a mild bursitis or disruption of the bursal surface fibers of the supraspinatus. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of this non arthrogram study. There is heterogeneity and intermediate signal intensity within the superior labrum which may reflect degeneration.BICEPS TENDON: There is thinning and intermediate signal intensity of the intra-articular portion of the tendon of the long head of the biceps indicating at least moderate tendinosis and perhaps chronic attritional tearing. The tendon otherwise appears intact.ADDITIONAL

Output: 1. Tendinosis of the rotator cuff with a near full thickness insertional tear of the supraspinatus without evidence of retraction. 2. Tendinosis of the long head of the biceps. Other findings as described.


Instruction: Generate impression based on findings.

Input: 22-year-old woman with history of new onset daily headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There appears to be a punctate pars intermedia cyst. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is a small amount of bilateral mucosal thickening in the maxillary sinuses and right frontoethmoid region.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct.2.Small amount of fluid and mucosal thickening in the maxillary sinuses suggests sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate for ischemia: Aphasia. MRI: There is high T2 signal and restricted diffusion in the posterior limb of the left internal capsule. There is a scattered background of high T2 signal in the cerebral white matter without restricted diffusion and a punctate area of encephalomalacia in the left pons. There is no evidence of intracranial hemorrhage or mass. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: The images are degraded by motion. There is irregular narrowing of the bilateral posterior cerebral arteries, primarily involving the P2 segments. There is also redemonstration of severe steno-occlusive disease involving the intracranial right vertebral artery. The anterior circulation appears to be grossly intact. There is no evidence of cerebral aneurysms.

Output: 1. Recent infarct involving the posterior limb of the left internal capsule superimposed upon a chronic left pons infarct and probable chronic small vessel ischemic white matter disease.2. Irregular narrowing of the bilateral posterior cerebral arteries, primarily involving the P2 segments, and redemonstration of severe steno-occlusive disease involving the intracranial right vertebral artery.Discussed with Dr. Cheema at 1:50 PM on 10/12/15.


Instruction: Generate impression based on findings.

Input: 35-year-old female with history of primary sclerosing cholangitis with abdominal pain and elevated alkaline phosphatase. Evaluate for cholangitis versus biliary obstruction. ABDOMEN: Patient motion limits evaluation.LIVER, BILIARY TRACT: Significant motion artifact limits evaluation of the biliary system. The biliary system is only well evaluated on the fast acquisition coronal images. Common bile duct measures approximately 9 mm in diameter, not significantly changed compared with the previous examination. Additionally, there are focal areas of intrahepatic biliary ductal dilatation which are unchanged. Nodular hepatic contour with hypertrophy of the left hepatic lobe and the caudate lobe. Findings consistent with biliary cirrhosis.SPLEEN: No significant abnormality noted.PANCREAS: Evaluation of the pancreas is limited given motion artifact. Within this limitation, no significant 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: No significant abnormality noted.

Output: 1.Suboptimal motion degraded examination. Within this limitation, mild common bile duct and focal intrahepatic biliary ductal dilatation which is unchanged and likely secondary to known primary sclerosing cholangitis.2.Biliary cirrhosis.


Instruction: Generate impression based on findings.

Input: 85-year-old female with expressive aphasia and left sided lean. Rule-out CVA. There is no evidence of intracranial hemorrhage, mass or edema. Right frontoparietal hypodensity consistent with old stroke involving the lenticular striate arteries. Right basal ganglia lacunae. No acute cortical ischemia. If there is clinical concern for acute ischemia, an MRI is recommended.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Right frontoparietal hypodensity consistent with previous ischemia. If there is clinical concern for acute ischemia an MRI is recommended.


Instruction: Generate impression based on findings.

Input: 36-year-old female with left knee pain and swelling MENISCI: Blunting of the posterior horn of the lateral meniscus compatible with a vertical tear. Globular intermediate signal within the posterior horn of the lateral meniscus likely represents intrasubstance degeneration. There is mild extrusion of the body of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: Articular cartilage is within normal limits without focal defects. No abnormal bone marrow signal.LIGAMENTS: The collateral and cruciate ligaments are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Vertical tear of the lateral meniscus with associated degenerative changes and extrusion as described above.


Instruction: Generate impression based on findings.

Input: Hemiplegia, unspecified affecting left nondominant side [G81.94], Reason for Study: ^Reason: pt with hx of CVA, L sided weakness History: L sided weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.There are scattered FLAIR/T2 high signal intensity lesions on periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease. Encephalomalacia is seen on the right frontal lobe middle and inferior frontal gyri are seen indicating right MCA territory chronic ischemic infarct.Multifocal susceptibility lesions are seen on gradient echo images involving bilateral hemispheres indicating chronic petechial hemorrhages or parenchymal calcifications.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.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.Right PCAs are fetal origin. Left P-comm artery and a common artery are patent.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Chronic right frontal lobe middle and inferior gyri ischemic infarction at the territory of right MCA.3. Nonspecific small vessel ischemic disease.4. Multifocal bihemispheric petechial chronic parenchymal hemorrhages or calcification.5. No evidence of flow-limiting intracranial arterial stenosis. No aneurysm.


Instruction: Generate impression based on findings.

Input: Diagnosis: Tension-type headache, unspecified, not intractableClinical question: Eval for structural lesionsSigns and Symptoms: trauma and headaches MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There appears to be a transitional vertebra. Assuming that the L1-2 disc spaces at the level of the left renal vein this transitional vertebra would represent partial lumbarization of S1.At S1-S2 there is no significant compromise to spinal canal or neural foramina.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is heterogeneous signal present along the right sacral alla which is incompletely assessed on this exam. It is bright on T2-weighted imaging and dark on T1. This suggests possible edema

Output: 1.No stigmata of intracranial traumatic brain injury are appreciated. MRI of the brain is within normal limits.2.There is no significant compromise to lumbar spinal canal or exiting nerve roots. There are no stigmata of trauma to the lumbar spine appreciated. There are minimal degenerative changes present in the lumbar spine. Please note that findings suggest a transitional vertebra which was labeled S1 for the purpose of this exam. This may confound enumeration of lumbar vertebrae.3.There is heterogeneous signal present along the right sacral Alla. It is incompletely evaluated on this exam. Additional imaging or comparison with any available imaging such as plain films may be of further benefit in evaluating this if clinically appropriate.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of brain, unspecified [D33.2], Reason for Study: ^Reason: Post op crani tumor resection History: Post op crani tumor resection Previously shown large anterior cranial fossa meningioma has been removed with bifrontal craniotomy. There is fluid-fluid level (with blood) at the resection cavity, in particular interhemispheric fissure and some fluid collection bifrontal extra axial spaces. Parenchymal edema of bilateral frontal lobes appear to be unchanged or slightly lessen comparing to prior scan. On Gad enhanced scan, surrounding reactive dural enhancements are seen, however, there is no evidence of residual enhancing mass.There is no new parenchymal hemorrhagic lesion on this scan.There are, however, a couple of restricted diffusion lesions indicating acute ischemic infarctions on the right posterior aspect of mid pons and right cerebellar hemisphere without evidence of hemorrhagic conversion. Slightly dilated ventricular system especially right lateral ventricle is again seen, grossly unchanged since prior scan. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post operative changes of bifrontal meningioma resection.2. No evidence of residual enhancing mass on this scan.3. Small foci of restricted diffusion lesions on the right mid pons and right cerebellar hemisphere indicating acute ischemic infarction.


Instruction: Generate impression based on findings.

Input: Parotid cancer status post surgery and radiation. Neck CT:There has been interval decrease in volume of the hyperintense right parotid tissues. No discrete mass is identified. There are scattered small lymph nodes in bilateral neck, unchanged in size, and are within normal limits based on size criteria.In the right shoulder, at the right supraspinatus muscle, there is new hypodense lesion, seen on coronal image number 27 of series 80380, and axial image 63 series 4. The clinical significance is uncertain, but given the history of adenocystic carcinoma, unusual distant metastasis needs to be considered. Further evaluation with right shoulder MRI without and with contrast is recommended.There is minimal mucosal thickening in right mastoid air cells and left maxillary sinus.The osseous structures and limited view of the upper lungs appear unremarkable for metastatic disease.

Output: 1. Interval decrease of right parotid tissues with asymmetric hypodensity, probably related to post treatment changes. No evidence of tumor recurrence or adenopathy in the neck.2. New hypodense lesion in the right shoulder at the supraspinatus muscle. Although this can represent benign musculoskeletal disease, distant metastasis cannot be excluded. Further evaluation with right shoulder MRI without and with contrast is recommended.


Instruction: Generate impression based on findings.

Input: Elevated PSA of 7.22 which led to him undergoing a prostate biopsy by an outside urologist on 7/28/16. His biopsy was found to be negative. PELVIS:PROSTATE:Prostate Size: 4.6 x 3.3 x 4.7 cm.Peripheral Zone: Diffuse dark signal in the left peripheral zone, this may represent prostatitis.Central Gland: ADC low (series 303 image 344) and T2 low (series 201 image 59) focus measuring 1.6 x 1.0 cm in the right transitional zone. There is mild early arterial enhancement with washout. There is invasion of the right prosthetic urethra by this lesion (series 201 image 56).Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: There is probable anterior extracapsular extension (series 201 image 58).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large ADC low and T2 low focus in the right transitional zone with invasion of the right prostatic urethra and probable anterior extracapsular extension, PIRADS 5.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.Mild degenerative changes are seen including disc bulges and uncovertebral hypertrophy at the C5-C6 and C6-C7 levels. There is mild effacement of the thecal sac at the C5-C6 and C6-C7 levels without significant spinal canal stenosis overall. There is mild to moderate bilateral C5-C6 neural foraminal stenosis and mild bilateral C6-C7 neural foraminal narrowing. Remainder of the cervical spinal canal and neural foramina are patent. These findings are unchanged.THORACIC SPINE

Output: 1.There is no mass or abnormal enhancement within the cervical, thoracic, or lumbar spine and there is no compression.2.Stable spondylitic changes as described in detail above worse at C5/6 with there is mild to moderate bilateral neural foraminal stenosis.3.Persistent, small bilateral pleural effusions.


Instruction: Generate impression based on findings.

Input: Chronic neck stiffness and pain. Evaluate for seronegative spondyloarthropathies. Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a subcentimeter hypointense focus in the C4 vertebral body, which may represent an enostosis. The vertebral bone marrow signal is otherwise unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Lumbar Spine: There is absence of the usual lumbar lordosis. 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: No evidence of spondyloarthropathy involving the cervical or lumbar spine.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. Axial images demonstrate fullness at the level the foramen magnum, with sagittal images confirming slight abnormal caudal extension of the cerebellar tonsils below the level of the foramen magnum are approximate 6 mm, although this is incompletely evaluated on this exam. In addition, the cerebellar tonsils have a slightly pointed appearance on the sagittal images. The subsequent MRI of the brain is motion limited, and therefore the exact extent of caudal tonsillar descent is difficult to determine. There is moderate mucosal thickening in the left sphenoid sinus with trace mucosal thickening at the right sphenoethmoidal recess. The remainder of the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.

Output: 1. No acute intracranial abnormality.2. Findings suggestive of tonsillar ectopia versus mild Chiari one malformation, to be further detailed on the subsequent MRI of the brain report.


Instruction: Generate impression based on findings.

Input: Female, 57 years old. Reason: cuff tear History: pain ROTATOR CUFF: There is a full thickness tear of the supraspinatus tendon at its insertion, with minimal retraction. There is associated fluid within the subdeltoid/subacromial bursa. The supraspinatus muscle appears normal. The additional rotator cuff muscles and tendons appear normal.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly normal. Normal bone marrow signal within the humeral head.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Full-thickness insertional supraspinatus tendon tear with minimal retraction. Additional findings as described above.


Instruction: Generate impression based on findings.

Input: 37 year old female with first degree AV block and bradycardia. Referred for cardiac MRI to rule out infiltrative disorders. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 64%. The LVEDV is 238 ml (normal range 109+/-23), LV end diastolic volume index is 100 ml/m2 (normal range: 65+/-11), LVESV is 86 ml (normal range 31+/-10), and LV end systolic volume index is 36 ml/m2 (normal range 18+/-5). The LV mass is 121 g (normal range 114+/-24) and the LV mass index is 50 g/m2 (normal range 67+/-11). 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 <1050 ms which is in the normal range.Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 61%, the RVEDV is 273 ml (normal range 110+/-24), the RV end diastolic volume index is 114 ml/m2 (normal range 69+/-14), the RVESV is 108 ml (normal range 35+/-13), and the RV end systolic volume index is 45 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is mildly dilated with normal systolic function. LVEF 64%. 2.The right ventricle is mildly dilated with normal systolic function. RVEF 61%3.No late gadolinium enhancement. Normal native T1 myocardial relaxation time. Both these findings are consistent with an absence of an inflammatory or infiltrative process.4.Mild left atrial dilation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: History of recurrent ganglioglioma status post craniotomy x5, radiation therapy and radiosurgery. Signs and symptoms: Off therapy 4:1/2 years. Pre- and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates extensive postoperative and treatment changes of the left mid and posterior temporal lobe without evidence of interval change since prior exam. There is mild expected dilatation of the trigone of left lateral ventricle similar to prior exam. Post enhanced images demonstrate no detectable abnormal enhancement which is a similar observation as prior exam and without evidence of recurrence of disease.Ventricular system is otherwise within normal and with maintained midline. The signal intensity of brain parenchyma otherwise within normal on all MRI sequences. Calvarium demonstrate expected postsurgical changes of left craniotomy.Pre- and post enhanced cervical MRI:There is normal signal intensity and alignment of vertebral column without evidence of enhancement.There is normal signal intensity and caliber of the cervical and upper most visualized thoracic cord and without abnormal enhancement.Foramen magnum is unremarkable areaC2-C3 is unremarkable.C3-C4 is unremarkable.C4-C5 demonstrate minimal degenerative changes and unremarkable otherwise.C5-C6 demonstrate mild degenerative changes with mild left neural foraminal compromise and unremarkable otherwise.C6/C7 demonstrate mild degenerative changes, shallow right median disc protrusion results in partial effacement of ventral subarachnoid space without central spinal stenosis or neural foraminal compromise.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord to T3 level is unremarkable.

Output: 1.Stable post surgical/treatment changes of left temporal lobe without detectable residual or recurrence of tumor. Unremarkable pre and post enhanced brain MRI otherwise.2.Pre and postcontrast enhanced MRI of cervical spine demonstrate no abnormal osseous or meningeal enhancement. No evidence of central spinal stenosis. There is however mild degenerative changes of spine and including a small right paramedian disc protrusion at C6/C7 as detailed. Please see detailed report per level above. Incidental note is made of a mass measuring 31 x 28 mm in transaxial dimension, likely representing an enlarged right lobe of thyroid. Follow-up with ultrasound is recommended.


Instruction: Generate impression based on findings.

Input: 52-year-old female with history of lupus and head trauma as a child with newly found (but not acutely symptomatic) left homonymous hemianopsia. There is 4 x 6 cm cavitation of the right occipital lobe that communicates with the right occipital horn, compatible with a porencephalic cyst. There is mild T2 hyperintensity in the surrounding white matter. There is also marked thinning and dehiscence of the overlying right occipital calvarium. There is a subcentimeter defect in the right pons. There are also a few punctate foci of white matter T2 hyperintensity in the frontal lobes. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The orbits are unremarkable.

Output: 1. Large right occipital lobe porencephalic cyst with mild gliosis and remodeling of the overlying calvarium. 2. A subcentimeter defect in the right pons may represent sequela of a remote lacunar infarct, but no evidence of intracranial hemorrhage, mass, or acute infarct.3. A few punctate foci of white matter T2 hyperintensity in the frontal lobes are nonspecific, but may represent sequela of prior small vessel ischemic disease, perhaps related to lupus vasculitis.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 are numerous periventricular, subcortical, cortical, and corpus callosum lesions showing abnormal T2 signal intensity that appear similar compared to prior examination given differences in technique. Some lesions demonstrate low T1 signal intensity. No new lesions are definitively identified.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. Several left parietal lobe sulci demonstrate susceptibility effect, which could represent hemosiderin staining from prior hemorrhagic event or perhaps just prominent vasculature.

Output: No definitive evidence of white matter disease progression given differences in technique.


Instruction: Generate impression based on findings.

Input: Female. 46 years old. History of left thyroid nodule. eval for growth. RIGHT LOBE MEASUREMENTS: 1.9 x 1.3 x 4.4 cm.LEFT LOBE MEASUREMENTS: 1.6 x 1.2 x 4.5 cm.ISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: Homogeneous echotexture, without focal lesion.LEFT LOBE: Homogeneous echotexture. A 1.3 x 0.7 x 1.3 cm mixed cystic and solid inferior left thyroid nodule is unchanged in size from prior, with mildly increased prominence of the solid component.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes identified. A right level 3 lymph node measures 2.3 x 0.4 x 0.9 cm.OTHER: No significant abnormality noted.

Output: Stable size of a previously biopsied inferior left thyroid nodule.


Instruction: Generate impression based on findings.

Input: Anterior elbow pain LIGAMENTS: There is increased signal within the proximal fibers of the anterior bundle of the ulnar collateral ligament posteriorly. This is thought to represent degenerative change versus the sequela of prior tear. There is similar signal findings within the proximal fibers of the lateral collateral ligament. TENDONS: The biceps tendon is intact. A small amount of fluid signal is seen within the bicipitoradial bursa near the biceps attachment. The brachialis tendon is also intact. There is increased signal of the common extensor origin which may reflect tendinosis or partial undersurface tearing. There is also minimally increased signal along the common flexor origin which also likely represents mild tendinosis. The triceps tendon is normal.ARTICULAR SURFACES AND BONE: There is moderate osteoarthritis of the elbow particularly at the radiocapitellar articulation as evidenced by subchondral cystic change and cartilage loss. ADDITIONAL

Output: 1. Trace amount of fluid in the bicipitoradial bursa near the origin of the biceps tendon; however the biceps tendon is normal.2. Osteoarthritis of the elbow with degeneration of the medial and lateral structures further described above.3. Focal increased signal and enlargement of the ulnar nerve within the cubital tunnel which may represent a mild neuritis or be clinically insignificant.


Instruction: Generate impression based on findings.

Input: Thoracic myelogram and post myelogram CT of thoracic spine. No clinical data is provided. Post myelogram CT of thoracic spine:Axial helical CT of thoracic spine from T1 through the T12 after a thoracic myelogram were obtained.Images in both supine and prone position were obtained. Sagittal and coronal reformatted images of both of the series were also obtained.Examination demonstrates slight ectasia of thecal sac at T6 and T7 levels and to a lesser degree slightly superior and inferior to these levels.There is a slight anterior displacement of thoracic cord at this level. Both axial images in supine and prone projection demonstrate a thin layer of contrast anterior to the cord in this region. Be caliber of the cord remains normal otherwise throughout the rest of thoracic region. The exact etiology of this lesion is not clear however possibility of an anatomical variation of mildly ectatic thecal sac with resultant pulsation of CSF on the cord with anterior displacement.Other possibilities of arachnoid cyst within a permeable membrane, thoracic cord herniation through a dural tear or adhesion are considered highly unlikely considering patient's past history to support this diagnosis and the appearance of this finding on myelogram, post myelogram CT and MRI.Comparison off supine and prone images demonstrated no definitive change in the position of the cord however this is not particularly abnormal considering the slightly exaggerated kyphotic deformity of thoracic spine in this patient.

Output: Please see above comments.


Instruction: Generate impression based on findings.

Input: Left plantar foot wound. MRI not sure about "osteo". Evaluate for "osteo". There is swelling of the soft tissues adjacent to the first metatarsophalangeal joint. There is ulceration of the soft tissues beneath the proximal phalanx of the great toe. There is dorsal dislocation of the proximal phalanx of the great toe relative to the first metatarsal. Erosive deformity of the head of the first metatarsal and base of the proximal phalanx is better appreciated on the recent MRI examination; based on the MRI examination, I suspect these erosions are chronic. The sesamoid bones are absent either, due to long-standing destruction or resection.

Output: Ulceration of the soft tissues beneath the proximal phalanx of the great toe. Erosive deformity of the head of the first metatarsal and base of the proximal phalanx of the great toe likely represents sequela of infection; based on the MRI examination, I suspect this is chronic.


Instruction: Generate impression based on findings.

Input: Prostate cancer PELVIS:PROSTATE:Prostate Size: 3.0 x 4.6 x 3.6 cm (AP x TR x CC).Peripheral Zone: Multiple foci of signal abnormality compatible with carcinoma involving the right apex and mid gland. The largest focus of T2 hypointensity in the right apex measures 1.7 x 1.2 cm (series 1401, image 12). Heterogeneous glandular T1 hyperintensity suggesting hemorrhage from prior biopsy.Central Gland: Benign prostatic hyperplasia.Seminal Vesicles: No significant abnormality.Extracapsular Extension: The tumor abuts the right posterior capsule but no definite evidence of extension past the capsule.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Multiple foci of signal abnormality involving the right apex and mid gland compatible with prostate carcinoma. 2.No definite evidence of extracapsular extension, seminal vesicle invasion, or lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female, 48 years old, history of enlarging mass in the posterior neck. As on the prior CT examination, no discrete encapsulated fatty lesion is evident in the neck to correlate with the reported history of a lipoma. There are, however, prominent skin folds posteriorly at the base of the neck and a generalized prominence of the subcutaneous fat similar to prior.No enhancing lesions are detected. No pathologic adenopathy is observed. The aerodigestive mucosa is within normal limits. The salivary glands and thyroid are free of focal lesions. Evidence of anterior cervical spine fusion is seen but no other significant abnormalities of the visualized spine are detected. Incidental note is made of paranasal sinus mucosal thickening involving the maxillary sinuses and the right sphenoid sinus.

Output: No evidence of any discrete encapsulated fatty tumor is seen within the neck. As on the prior CT, prominent skin folds are evident posteriorly at the base of the neck along with a generalized prominence of the subcutaneous fat which may correlate with the physical exam findings.The remainder of the examination is unremarkable with no evidence of any suspicious tumor or pathologic adenopathy.


Instruction: Generate impression based on findings.

Input: 54-year old male with swelling and tenderness; assess for infection of the soft tissues and bones Mild straightening of the normal cervical lordosis is seen which may be due to patient positioning versus muscle spasm. Vertebral body heights are maintained without evidence of fracture. The prevertebral soft tissues are unremarkable. Multiple cervical lymph nodes are seen, none pathologically enlarged.Status post bilateral laminectomy and removal of the spinous processes of C3 and C4 with fluid accumulation seen dorsal to the laminectomy site without significant mass effect on the cord/thecal sac. The spinal subarachnoid space is well visualized without definite evidence of abscess. Fluid collection is also seen along the incision site with fluid seen accumulating in the subcutaneous tissues. The paraspinal muscles appear normal in density. These findings are consistent with the expected post operative findings of a bilateral laminectomy; however correlation with the patient's clinical history and symptoms is recommended. If high clinical concern for infection, contrast enhanced MRI is recommended.Multilevel degenerative changes are again seen appearing similar to the prior study. No significant compromise of the spinal canal.Degenerative changes as described below:C2-3: Prominent disk bulge is seen impressing on the spinal cord with bilateral neural foramina narrowing and facet joint hypertrophy.C3-4: Disk/osteophyte complex is seen impressing on the spinal cord which is unchanged in size and degree of cord compression. Bilateral neural foramina narrowing and facet joint hypertrophy.C4-5: Disk/osteophyte complex is seen abutting the spinal cord. Bilateral neural foraminal narrowing and facet joint hypertrophy. Extensive artifact limits evaluation of the spinal canal inferior to C5.

Output: 1. Status post bilateral laminectomy at C3 and C4 with fluid accumulation dorsal to the laminectomy site which is consistent with expected postoperative changes. Recommend correlation with patient's symptoms and clinical history. If clinical concern for infection, recommend contrast enhanced MRI for further evaluation.2. Extensive multilevel degenerative disk disease, as described above, appearing similar to the prior study.


Instruction: Generate impression based on findings.

Input: 3 month post op pituitary macroadenoma. There are interval postoperative findings related to transsphenoidal surgery for pituitary tumor resection, with what appear to be hemostatic agent and granulation tissue in the surgical cavity. Otherwise, there is no evidence of gross residual tumor. There is no residual mass effect upon the optic apparatus and cavernous sinuses. The pituitary stalk is intact, but deviated slightly to the left.

Output: Interval postoperative findings related to transsphenoidal surgery, without evidence of gross residual tumor.


Instruction: Generate impression based on findings.

Input: 26-year-old male with knee pain x 1 day status post injury during athletics. MENISCI: The medial meniscus appears intact. There is a partial thickness radial tear of the anterior horn of the lateral meniscus. The posterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is edema within the posterior aspect of the lateral tibial plateau likely representing a bone contusion. No full-thickness or near full-thickness articular cartilage defects are identified.LIGAMENTS: The PCL appears intact. The LCL and MCL appear intact. There is a full-thickness rupture of the proximal fibers of the ACL.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Anterior cruciate ligament rupture and partial thickness radial tear of the anterior horn of the lateral meniscus. Other findings as described above.


Instruction: Generate impression based on findings.

Input: History of retroperitoneal liposarcoma. Follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. There is minimal diffuse parenchymal signal loss in the out of phase images which suggest mild hepatic steatosis. No focal lesion. No intrahepatic or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Throughout the retroperitoneum and there is abnormal curvilinear increased T2 signal and postcontrast enhancement extending from the level of the duodenal sweep down into the pelvis, right greater than left. There are more focal nodular/masslike components. This includes a mass immediately anterior to the infrarenal aorta which measures 6.4 x 2.7 cm (series 1705 image 165). There is an additional large enhancing mass lesion anterior to the left psoas muscle (series 1/9/2001 image 145), which measures 7.5 x 3.8 cm. There is a smaller nodule anterolateral to the right psoas muscle measuring 1.9 x 2.0 cm (series 1704 image 29). The abnormal signal and enhancement extends down into the right hemipelvis compatible with additional tumor involvement.BOWEL, MESENTERY: Postoperative changes from an end to side anastomosis in the descending colon.BONES, SOFT TISSUES: Diastases of the rectus muscles.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Post surgical changes in the rectosigmoid colon and tumor extension into the pelvis as described above.BONES, SOFT TISSUES: Fat-containing right inguinal hernia.OTHER: No significant abnormality noted.

Output: Extensive retroperitoneal tumor involvement extending from the level of the duodenal sweep into the right and left hemipelvis as described. This includes both masslike lesions as well as poorly defined, sheet-like stranding and enhancement throughout the retroperitoneal fat compatible with more infiltrative tumor.


Instruction: Generate impression based on findings.

Input: Pineal germinoma, off therapy evaluations. There is no significant interval change in the residual pineal gland lesion, which measures up to approximately 9 mm. There are postoperative findings related to endoscopic third ventriculostomy. The ventricles are unchanged in size and configuration. There are unchanged nonspecific bilateral parietal lobe periventricular white matter small T2 hyperintense areas. There is no evidence of acute infarction. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No significant interval change in the residual treated pineal gland lesion.


Instruction: Generate impression based on findings.

Input: Reason: Eval for growth of GBM. This MRI will be \R\3mo post RT. History: GBM.. Postoperative changes of right frontal lobe GBM resection. Extra-axial fluid along the craniotomy flap is unchanged from the prior exam measuring 9 mm in thickness. There is persistent dural enhancement which is likely postoperative. There is a large surgical cavity in the right frontal lobe which demonstrates near resolution in surrounding enhancement. Patchy enhancement along the inferior margin of the cavity on the prior exam has resolved. Fluid within the surgical cavity has cleared and now exhibits signal characteristics close to CSF. Surrounding increased FLAIR signal is not significantly changed. Foci of susceptibility within the cavity are likely the result of old hemorrhage and are unchanged. No new enhancing lesions. Subtle T2 hyperintensity in the periventricular white matter has increased over the past several exams and is likely the result of radiation change. The ventricles are unchanged in size and configuration. Retention cyst/polyp in the sphenoid sinus is unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits and paranasal sinuses are unremarkable.

Output: 1.Expected postsurgical changes of right frontal GBM resection with near resolution of enhancement surrounding the resection cavity. No evidence of residual tumor.2.Extra-axial fluid along the craniotomy flap is unchanged from the prior exam.


Instruction: Generate impression based on findings.

Input: Male, 48 years old, with radicular pain down the left leg. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No marrow signal abnormalities are seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are detected.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Mild disc bulging asymmetric to the left lateral zone. No spinal canal or foraminal stenosis. L3-4: Mild facet arthropathy. Disc bulging, asymmetric to the left, with annular fissuring. No significant spinal canal stenosis. The neural foramina are moderately narrowed bilaterally. L4-5: Facet arthropathy. Mild disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Facet arthropathy. Mild disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: Relatively mild degenerative findings are seen. No areas of significant spinal canal stenosis are detected. However, the neural foramen at L3-4 are moderately narrowed bilaterally.


Instruction: Generate impression based on findings.

Input: 2 year-old female with history of sickle cell disease and status post Moya Moya surgery. Evaluate for hematoma and CVA. Examination demonstrates an area of hypoattenuation in the right superior frontal gyrus, which corresponds to that on MRI 1/21/2010 and is compatible with a subacute stroke. There is no appreciable change in CT attenuation of areas of the acute infarcts involving bilateral centrum semiovale and right posterior parietal lobe previously seen on MRI. New since prior exam is a focus of hyperattenuation along the left postcentral gyrus, compatible with cortical hemorrhage. New since prior exam are postsurgical changes status post bilateral temporal craniotomies. There are small amount of blood products in the left temporal extraaxial space under the cranial flap. There is bilateral temporal scalp soft tissue swelling. There are small amount of pneumocephalus in the bifrontal regions and in the interhemispheric fissure and small emphysema in the left frontal subgaleal region. There are 2 Burr holes in the bifrontal bones. The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, or midline shift. The osseous structures are unremarkable except for postsurgical changes. The mastoid air cells are clear. There is opacification of the ethmoid air cells.

Output: 1. New focus of cortical hemorrhage at the left postcentral gyrus. 2. Interval postsurgical changes status post bilateral temporal craniotomies as described above. 3. Right superior frontal subacute stroke.


Instruction: Generate impression based on findings.

Input: Reason: Rotator cuff tear, biceps tendinitis? History: pain in right shoulder. ROTATOR CUFF: There is severe fatty atrophy of the supraspinatus muscle. The supraspinatus tendon is not visualized distally within the acromiohumeral space, consistent with complete supraspinatus tearing with at least 2 cm tendinous retraction. The infraspinatus muscle also appears atrophic with increased intramuscular and tendinous T2 signal intensity, consistent with severe tendinopathy and questionable partial tearing. The subscapularis and teres minor appear intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The labrum is diminished in evaluation due to lack of intra-articular contrast and motion, but degenerative changes are observed. Degenerative changes are noted in the humeral head with multiple subchondral cysts.BICEPS TENDON: There is increased T2 signal in the distal fibers of the biceps tendon, consistent with tendinopathy without focal tearing. ADDITIONAL

Output: Massive rotator cuff tear with complete disruption of the supraspinatus tendon and questionable partial tearing of the infraspinatus tendon and other findings as described above.


Instruction: Generate impression based on findings.

Input: 76 year old female with LV dysfunction, LBBB (LVEF 43% on TTE). Referred for cardiac MRI to evaluate etiology. Left VentricleThe left ventricle is moderately dilated with normal systolic function. The overall LV ejection fraction is 60%. The LVEDV is 186 ml (normal range 109+/-23), LV end diastolic volume index is 81 ml/m2 (normal range: 65+/-11), LVESV is 75 ml (normal range 31+/-10), and LV end systolic volume index is 33 ml/m2 (normal range 18+/-5). 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 <1000 ms suggestive of absence of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 65%, the RVEDV is 175 ml (normal range 110+/-24), the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVESV is 61 ml (normal range 35+/-13), and the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve is trileaflet, opens widely and there is mild 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. Aorta tortuosity noted.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is moderately dilated with normal systolic function. LVEF 60%.2.The right ventricle is mildly dilated with normal systolic function. RVEF 65%.3.No late gadolinium enhancement.4.Mild aortic regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 24-year-old male with persistent left shoulder pain after weight lifting accident. ROTATOR CUFF: No contrast is seen in the subacromial/subdeltoid bursa to indicate a rotator cuff tear. Normal rotator cuff muscles without evidence of atrophy or tendinopathy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Contrast is seen within the superior labrum extending from its anterior to posterior aspect, compatible with a SLAP tear. This lesion also extends into the inferior aspects of the anterior and posterior labrum.BICEPS TENDON: The biceps tendon demonstrates normal signal and course.ADDITIONAL

Output: 1.Labral SLAP tear with extension into the inferior aspects of the anterior and posterior labrum.2.No evidence of rotator cuff pathology.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for cholangiocarcinoma, HCC screening History: PSC ? CirrhosisAdditional history per electronic medical record: 65 year old female with PSC with a CBD dominant stricture negative for malignancy on most recent ERCP (2015).July 2015 MRCP - Intrahepatic ducts show mild narrowing some discontinuity most likely due to areas narrowing and this is c/w with sclerosing cholangitis. The CBD is difficult to visualize suggesting it may be narrowed. The liver parenchyma shows no gross abnormality. ABDOMEN:LIVER, BILIARY TRACT: The liver is smooth in contour with a somewhat abnormal morphology with hypertrophy of the left lobe. The hepatic parenchyma demonstrates normal signal intensity and enhancement. No suspicious hepatic lesions are identified.The hepatic vasculature appears patent. Upper abdominal varices are noted.Status post cholecystectomy. There is moderate irregularity of the intrahepatic bile ducts with scattered short segments of stenosis with intervening dilation (for example series 701, image 60), overall not grossly changed (although precise comparison difficult due to differences in technique). The common hepatic duct is narrowed down to approximately 1-2 mm. There is irregularity and saccular dilation in the expected location of the cystic duct remnant. The common bile duct measures up to 6 mm. There is mild narrowing of the midportion of the common bile duct down to approximately 4 mm without high-grade stenosis, somewhat improved compared to the prior examination. There is also mild irregularity and wall thickening of the common bile duct likely reflecting chronic inflammatory changes. SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates diffusely decreased parenchymal T1 signal which may reflect prior pancreatitis. The pancreas enhances normally. The pancreatic duct is not significantly dilated, and the pancreatic duct describes a normal variant looped course proximally. There several subcentimeter cystic lesions within the pancreatic body and tail. The largest appears to communicate with the main pancreatic duct and most likely represents a sidebranch IPMN, not significantly changed in size and with reference measurements below.ADRENAL GLANDS: Mild thickening of the left adrenal gland, not significant changed.KIDNEYS, URETERS: Multiple subcentimeter renal cysts, not significant changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Loss of haustration of the distal partially visualized likely reflects chronic inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/16/2016 12:00:00)PANCREATIC BODY CYSTIC LESION: 0.7 x 0.5 cm (Image 25, Series 1001).

Output: 1.Findings compatible with reported history of primary sclerosing cholangitis, not significantly changed (though precise comparison difficult due to differences in technique). Common hepatic duct again narrowed down to approximately 1-2 mm. Common bile duct mildly narrowed but without high-grade stenosis, somewhat improved from prior.2.Subcentimeter cystic lesion within the pancreatic body compatible with a sidebranch IPMN, not significantly changed.3.Cirrhotic liver morphology.4.No suspicious hepatic lesions to suggest hepatocellular carcinoma.5.Partially visualized findings suggestive of chronic colitis.


Instruction: Generate impression based on findings.

Input: Translabyrinthine resection of a left vestibular schwannoma. There are postoperative findings related to left translabyrinthine resection of a left vestibular schwannoma. There is fat graft in the mastoidectomy bowl and cerebellopontine angle with a small amount of fluid in the subgaleal space posterior to the flap. The intrinsically T1 hyperintense material along the medial aspect of the resection cavity in the left cerebellopontine angle cistern has resolved and likely represented blood products and hemostatic material. The thin curvilinear enhancing tissue in the anterior portion of the left cerebellopontine angle cistern resection cavity, adjacent to the left trigeminal nerve root entry zone has diminished. However, there is now enhancement within the left cochlea. There is a small area of edema in the inferior left temporal lobe has resolved. The right temporal bone and internal auditory canal are unremarkable. There are a few small paranasal sinus retention cysts.

Output: Interval postoperative findings related to left translabyrinthine resection of a left vestibular schwannoma without definite gross residual tumor. New enhancement within the left cochlea may be inflammatory in nature.


Instruction: Generate impression based on findings.

Input: Clinical question: Optic neuritis versus ADEM versus MS; eye weakness, pain and visual loss. Signs and symptoms: As above. Nonenhanced brain MRI:Examination demonstrates multiple patchy large foci of flair/T2 hyperintensity nearly symmetrically involving the white matter of bilateral parietal cingulate gyri, splenium of corpus callosum with resultant increased caliber, extensively the periventricular white matter of the left anterior and mid temporal lobe with resultant subtle mass effect and partial collapse of the left temporal horn, medial aspect of right temporal lobe and extending into the right cerebral peduncle, right cerebellum and right middle cerebral peduncle which subtle increased caliber and to a lesser degree of the left middle cerebral peduncle and a small additional focus in the anterior pons in the midline.Findings in proper clinical setting could represent ADEM however possibility of tumefactive multiple sclerosis cannot be entirely excluded.Additionally examination demonstrates small foci of flair hyperintensity in the periventricular white matter of lateral ventricles and minimally of the subcortical white matter and left frontal lobe without convincing evidence of increased volume or appreciable mass-effect. There is suspected flair hyperintensity signal change of the right optic nerve only on sagittal T2 flair series 201 images 176 through 182.Nonenhanced MRI of orbits:Examination is severely degraded due to motion artifact. However as detailed above there is suggestion of increased flair hyperintensity of right optic nerve in its cisternal and through the right optic nerve canal (sagittal T2 flair series 201 images 176 through 182).Within the limitation of extensive motion artifact there is no convincing evidence of any additional finding on MRI orbits

Output: 1.Nonenhanced brain MRI demonstrate multiple large foci of flair/T2 hyperintensity with subtle associated mass effect in bilateral cerebral hemispheres (left greater than right) and including extensively of the splenium of corpus callosum, bilateral cerebellar peduncles and right cerebellum and pons. Findings could represent ADEM or tumefactive multiple sclerosis. Few additional smaller bilateral hemispheric (left greater than right)periventricular white matter foci of flair hyperintensity are also present.2.Unenhanced MRI of orbits is nondiagnostic due to motion artifact. Sagittal T2 flair series 201of brain study however demonstrates suspected flair hyperintensity of right optic nerve as detailed. Unremarkable MRI of orbits otherwise. Please correlate with neurological exam regarding this suspected finding.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:2/6/1958)Reason: eval for brain tumor History: dizzinessPROVIDER/ATTENDING NAME: KRISTINA K SICKER There is an extra-axial mass centered along the anterior cranial fossa along the midline which is interposed between the two frontal lobes and has a broad-base towards the planum sphenoidale, fovea ethmoidalis, medial orbital roofs and cribriform plate. It measures 26 x 31 mm sagittal dimensions and 46 x 27 mm coronal dimensions. It is heterogeneous on T2. On susceptibility weighted imaging it does not demonstrate significant susceptibility effect. It is relatively bright on T2 imaging relative to gray matter. On T1 imaging it is similar in signal intensity to white matter. There is extensive vasogenic pattern of edema involving both frontal lobes but more the left than the right side. The corpus callosum, basal ganglia, hypothalamus, thalami and internal capsules are displaced posteriorly. The pituitary stalk appears to drape over the posterior clinoid.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: A large anterior cranial fossa mass is present which most likely represents a meningioma given its appearance. Esthesioneuroblastoma neuroblastoma is a less likely consideration. There is significant mass effect and vasogenic edema associated with this mass as detailed above.


Instruction: Generate impression based on findings.

Input: 9-year-old male with optic nerve glioma, treatment with chemotherapy Orbit MRI: There has been no significant interval change in the minimally enhancing right orbital segment optic nerve glioma with a central cystic component, which again measures up to 7 mm in diameter. The other orbital contents are otherwise unremarkable. Brain MRI: There has been no significant interval change in a non-enhancing T2 hyperintense lesion centered within the left optic chiasm and hypothalamus that again measures up to 10 mm. Additional nonenhancing T2 hyperintense foci that localize to the more posterior portions of the bilateral optic tracks as well as a right periorbital gyrus are also unchanged. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There is mild scattered paranasal sinus mucosal thickening. Mastoid air cells are clear. Expected vascular flow voids are demonstrated.

Output: Unchanged bilateral optic pathway gliomas.


Instruction: Generate impression based on findings.

Input: 34-year-old male. Severe low back pain. Normal MRI. Thoracic spine: Alignment is anatomic. Vertebral body heights and intervertebral disk spaces are preserved.Lumbar spine: Minimal retrolisthesis of L4; alignment is otherwise anatomic. Vertebral body heights and intervertebral disk spaces are preserved. Spina bifida occulta affects L4 and L5, also seen on prior MRI.

Output: No evidence of a compression fracture. Minimal retrolisthesis of L4.


Instruction: Generate impression based on findings.

Input: Status post craniotomy for sphenoid/cavernous sinus meningioma in July 2012. There are changes of previous resection of the right frontal and paraclinoid meningioma resection. There is a surgical tract in the right frontal lobe at the depth of which there is punctate diffusion restriction, most likely reflecting blood products. Otherwise, there is no acute infarct. The lobulated T1/T2-hypointense signal along the inferior half of the craniotomy flap remains unchanged, representing bone cement. Cavernous sinuses enhance symmetrically. The ventricles and sulci are unchanged. There is mild ethmoid mucosal thickening.

Output: Postoperative findings without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Clinical question: History of pituitary adenoma status post resection x 2. Signs and symptoms: Surveillance scan. Pre-and post enhanced pituitary MRI:There is a focus of residual pituitary adenoma on the right side of sella which measures nearly identical to prior exam in all measurements. It measures approximately 11 mm in transverse axis on coronal post enhanced series and 8.2-mm in height on coronal post enhanced series of current exam and on remeasurement of prior to study. It measures approximately 11.5 to 13.7-mm in AP axis on sagittal post enhanced series fairly similar to prior exam. This finding result in slight elevation of diaphragmatic sella similar to prior study. The rightward deviated pituitary stalk terminates superiorly to the right of midline similar to prior exam. Deviation of pituitary stalk is likely a post treatment change and scarring. There is no evidence of a mass on the left side of pituitary.The suprasellar visual complex appears thin however remains identical to prior study and without abnormal enhancement.

Output: Residual adenoma on the right side of pituitary gland remains stable in size, signal and pattern of enhancement since prior study.