Instruction: Generate impression based on findings.

Input: 29 year old woman with no prior medical history who presents with palpitations. Systolic function not well visualized by transthoracic echo and possible bicuspid valve seen. Cardiac MRI done to evaluate aortic valve, structure, and function Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 78 ml/m2 (normal range: 65+/-11), the LVEDV is 129 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10), the LV mass index is 38 g/m2 (normal range 67+/-11), and the LV mass is 63 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 129 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). Normal RV wall motion.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve appears tricuspid, opens widely and there is no significant aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 68%)2. The right ventricle is normal in size with normal systolic function (RVEF 62%)3. Tricuspid aortic valveI 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 Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Suggestion of variant pancreatic ductal anatomy, possible divisum. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is adequately distended with oral contrast. The small bowel fold pattern is unremarkable.The small bowel is normal in caliber and wall thickness. There is no abnormal bowel wall thickening, restricted diffusion or postcontrast enhancement. No peri- enteric inflammatory changes.No fixed luminal narrowing or upstream dilatation to suggest a flow-limiting stricture.No significant free fluid or discrete loculated fluid collection. No specific evidence of sinus tract or fistula formation.There is a large amount of fluid and debris in the stomach without an obstructing lesion. The duodenal sweep is unremarkable.There is an approximately 8 cm long segment of proximal transverse colonic wall thickening, restricted diffusion and enhancement with mild luminal narrowing but no upstream dilatation. There is surrounding engorged mesenteric vasculature and small lymph nodes.Colonic diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Acute inflammatory disease of approximately 8 cm segment of the proximal transverse colon; corresponding to biopsy results from recent colonoscopy.2.No evidence of active inflammation or fibrostenotic disease of the small bowel.3.Non-specific significant gastric distension without an obstructive lesion.


Instruction: Generate impression based on findings.

Input: Seizure MRI of the brainThere is a lesion present along the medial aspect of the right temporal lobe measuring 27 x 19 mm axial dimensions which has predominantly T2 hyperintensity and heterogeneous appearance on FLAIR and T2 imaging it appears to be associated with some mass effect. It involves both gray and white matter. It is associated with a minimal degree of contrast enhancement. There is no associated significant susceptibility artifact which can be identified clearly within this lesion.No diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.There is a right medial temporal lobe mass which extends to involve the amygdala and the head of the hippocampus which is concerning for a primary brain tumor. Although its location and appearance suggest primary tumor such as oligodendroglioma, DNET and ganglioglioma, the possibility that it represents a different neoplasm can't be excluded.2.MR venogram of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 31 year old male with incidental hyperechoic liver lesion detected on recent ultrasound and history of inflammatory bowel disease. ABDOMEN:LIVER, BILIARY TRACT: The lesion in the left hepatic lobe seen on prior ultrasound is not visualized, and no other suspicious hepatic lesions are seen. Mild nonspecific arterial hyperenhancement involving the biliary tree normalizes on later postcontrast sequences. Mild intrahepatic ductal dilatation, as well as mild dilatation of the CBD to 10 mm are noted. No dominant stricture. Patent hepatic vasculature. 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: Several prominent periportal lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious focal hepatic lesions. Specifically, the lesion seen in the left hepatic lobe on prior ultrasound is not visualized. 2.Mild biliary ductal dilatation and nonspecific arterial enhancement involving the biliary tree that normalizes on subsequent postcontrast sequences. Given the imaging findings and patient's history of inflammatory bowel disease, primary sclerosing cholangitis (PSC) is a differential consideration.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, with lung cancer and brain metastases, on Tarceva with some regression, compare to prior two MRIs. A small lesion along the right central sulcus is barely discernible, similar to prior. Similarly, several previously seen small lesions in the left cerebellum are barely detectable if at all. No new enhancing lesions are appreciated. No evidence of edema or mass effect is seen. A nonspecific focus of FLAIR hyperintensity in the left cerebral hemisphere is unchanged. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits.

Output: As on the prior examination, small lesions along the right central sulcus and in the left cerebellum are barely detectable if at all. No new intracranial lesions are demonstrated.


Instruction: Generate impression based on findings.

Input: A 71 year old male with diabetes mellitus, hypertension, hyperlipidemia, severe chronic kidney disease. Recently diagnosed with amyloid based on liver biopsy. A recent echocardiography showed preserved left ventricular systolic function. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal size with mildly reduced systolic function. The overall LV ejection fraction is 47%, the LV end diastolic volume index is 62 ml/m2 (normal range: 74+/-15), the LVEDV is 115 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 61 ml (normal range 47+/-19), the LV mass index is 84 g/m2 (normal range 85+/-15), and the LV mass is 157 g (normal range 164+/-36). There is hypokinesis of the base and preserved contractility at the mid and apical segments. There is concentric hypertrophy, maximal at the basal anterior and antero-septum walls (16mm).On T1-mapping, basal T1 levels were between 1200-1300ms, mid-segment T1 values were in the range of 1050-1150ms. Apical segments had the lowest values (1070-1100ms). This pattern of T1 times could be consistent with amyloidosis. Intracavitary T1 time = 1430 ms and normal T1 times ~<1000. No intracavitary thrombus was seen. No iron overload was noted in the myocardiumLeft AtriumThe left atrium is mild-moderately dilated (114ml). The left atrial wall is thickened.Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 61 ml/m2 (normal range 82+/-16), the RVEDV is 113 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 57 ml (normal range 54+/-17). There is mild right ventricular hypertrophy (5 mm).Right AtriumThe right atrium is mild-moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild to moderate 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 a small pericardial effusion without evidence of hemodynamic compromise.Extracardiac FindingsBilateral moderate pleural effusions. No iron overload was noted in the liver. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal size with mildly reduced systolic function, the LVEF is 47%. 2. There is concentric hypertrophy, maximal at the basal anterior and antero-septum walls (16mm).3. On T1-mapping, basal T1 levels were between 1200-1300ms, mid-segment T1 values were in the range of 1050-1150ms. Apical segments had the lowest values (1070-1100 ms). 4. The right ventricle is normal in size with low normal systolic function, the RVEF is 50%. There is mild right ventricular hypertrophy5. There is biatrial enlargement. 6. There is mild to moderate tricuspid regurgitation.7. There is a small pericardial effusion.8. Bilateral moderate pleural effusions. These findings could be consistent with cardiac amyloidosis. Clinical correlation required.


Instruction: Generate impression based on findings.

Input: 77-year-old male with history of alcohol abuse,h hematemesisematemesis, biliary and,. Now drowsy. Nonenhanced head CT:Examination of assay focal area of low attenuation involving the cortex and subcortical white matter of right frontal lobe with subtle focal mass effect. Finding is most suggestive of a subacute minimally hemorrhagic right MCA frontal lobe stroke. This exam is otherwise unremarkable. Recommend follow-up with an MRI examination to exclude the remote possibility of other conditions in particular malignancy.Calvarium is intact. Limited view through the orbits are unremarkable visualized paranasal sinuses and mastoid air cells are unremarkable.The findings were discussed with the clinical service on pager number 3649 at the time of interpretation of exam.

Output: Focal area of low attenuation of the cortex and subcortical white matter of right frontal lobe suggestive of a subacute nonhemorrhagic melanotic hemorrhagic ischemic stroke. To entirely exclude remote possibility of malignancy recommend an MRI examination.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: dizziness History: new onset vertigo No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.Scattered multifocal T2/flair high signal intensity lesions on by a lateral periventricular white matter are seen which are nonspecific most likely indicate small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 79-year-old female with bilateral hip pain status post fall. Well-circumscribed lucency in the diaphysis of the left proximal femur corresponds to chronic erosions from an adjacent soft tissue mass as seen on MRI of the femur dated 11/3/2015. Mild osteoarthritis affects both hips as well as mild degenerative disc disease affecting the visualized lower lumbar spine. No acute fracture or malalignment is identified.

Output: Mild osteoarthritis of bilateral hips without acute fracture or malalignment.


Instruction: Generate impression based on findings.

Input: Evaluate right wrist fractureIMAGE ACQUISITIONS: CT of the right wrist was performed without contrast using the ultra high resolution protocol. There is a transverse fracture of the ulnar styloid. The bones appear in near anatomic alignment. There is a comminuted fracture of the radial aspect of the trapezium with it least two separate fragments adjacent to the main trapezium bone. There is mild displacement of the fracture fragments. There is a 2-mm ossific fragments in the just posterior and on the radial side of the lunate which which is likely a fragment from the trapezial fracture. Another 2-mm ossific fragment located just superior to the trapezium in between the trapezium and first metacarpal also is likely a fracture fragement given its proximity to the fracture trapezium comment this could be an acute fracture fragment.There is a 4-mm well corticated ossific density anterior to the lunate which does not appear to be an acute fracture fragment.There is slight widening of the scapholunate interval however this does appear stable. The patient had a previous MRI which shows a tear the scapholunate ligament which appear chronic.Small to moderate sized joint effusion is present.The remainder of the carpal bones, distal radius, and proximal metacarpal bones which are visualized on this study appear intact. No other fractures are identified.Cast material is seen surrounding the wrist.

Output: Fractures of the ulnar styloid and trapezium as described above.


Instruction: Generate impression based on findings.

Input: 46 years, Female, Reason: History of small bowel, colonic, and perianal fistulizing Crohn's disease. Needs assessment of disease activity and rectovaginal fistula. History: abdominal pain, diarrhea, rectovaginal fistula drainage. Please include cuts of the the perineum.. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left kidney is atrophic with severe hydronephrosis, likely chronic.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:There is an area of narrowing with bowel wall thickening, diffusion restriction and hyperenhancement in the distal ileum, proximal to the terminal ileum, which extends 5 to 10 cm in length and causes proximal small bowel obstruction with loops dilated to 3.9 cm. This segment remains narrowed on multiple sequences, likely representing stricture. There are two fistulous tracts which extend from this strictured segment to the adjacent sigmoid colon (6/16 and 6/21). The sigmoid appears narrow on T2 weighted images but expands on subsequent imaging sequences.No evidence of abscess. No evidence of perirectal fistulas. No evidence of rectovaginal fistula as clinically questioned.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Inflammatory changes in the distal ileum with stricturing and two ileosigmoid fistulas.2.Small bowel obstruction proximal to the narrowed ileal segment.3.No evidence of rectovaginal fistula on MRI. If there is strong clinical concern, a barium fluoroscopic study may be considered4.Atrophic left kidney with severe hydronephrosis, likely chronic.


Instruction: Generate impression based on findings.

Input: There is no evidence of recurrent tumor. There are unchanged postoperative findings related to previous right frontal craniotomy with encephalomalacia along the surgical tract and expected dilatation of the atrium of right lateral ventricle. There is interval decreased ventricular caliber most prominent in the lateral ventricles and the third ventricle. There is unchanged linear bifrontal encephalomalacia (right greater than left) associated with old bifrontal shunt catheters. There is unchanged cystic encephalomalacia in the right basal ganglia. There are scattered T2 hyperintensities in the periventricular and subcortical white matter which are nonspecific.There is a new 5 mm cystic space immediately adjacent to the left lateral ventricle atrium which is nonspecific and does not enhance.There is no acute infarct, mass effect or midline shift.

Output: 1.Decreased ventriculomegaly with no evidence of recurrent tumor.2.New nonenhancing nonspecific 5 mm cystic space adjacent to the atrium of the left lateral ventricle. Recommend continued attention on follow-up exams.


Instruction: Generate impression based on findings.

Input: Clinical question: Brainstem lesion, preop planning, surgery today. Signs and symptoms: Preop planning. Pre- and post enhanced fusion brain MRI:Examination is performed utilizing fusion protocol which is a limited study and not a true diagnostic test.Within this limitation the study demonstrate a focus of T2 hyperintensity in the anterior aspect of the pons and extending superiorly into the right Cipro peduncle without significant change since prior exam or detectable abnormal enhancement. The finding traverses the entire anterior aspect of pons measuring at 28 mm and 10 mm in AP axis. There is no appreciable associated mass effect with this finding.Additional focus of T2 hyperintensity with internal foci of mixed signal intensity and subtle patchy enhancement in the right thalamus without convincing evidence of interval significant change.Additional focus of extensive edema and ring-enhancing focus in the subcortical white matter of left posterior frontal is also noted. Patchy foci of enhancement within a focus of vasogenic edema involving the cortex and subcortical white matter of interhemispheric aspect of the left posterior frontal is also again noted noted without change.

Output: Multiple foci of signal abnormality with surrounding vasogenic edema and patchy enhancement in bilateral cerebral hemispheres without significant change since prior exam as detailed/measured above.


Instruction: Generate impression based on findings.

Input: Reason: S/P UFE, uterine fibroids, menorrhagia, dysmenorrhea History: uterine fibroids. PELVIS:UTERUS, ADNEXA: The uterus measures 7.9 x 7.9 x 11.2 cm (series 7 image 18, series 5 image 21), previously 7.9 x 8.4 x 12.2 cm. Multiple subserosal, intramural, and submucosal T2 hypointense lesions are again seen throughout the uterus compatible with fibroids. Previously measured largest submucosal fibroid in the right lower uterine segment measures 1.2 x 2.2 x 1.3 cm (series 7 image 19, series 5 image 18)., previously 3.6 x 4.0 x 3.4 cm. An additional reference submucosal fibroid measures 1.7 x 2.7 x 3.3 cm (series 7 image 20, series 5 image 26), previously 1.7 x 3.2 x 3.4 cm. The fibroids predominantly have decreased in degree of enhancement with exception of this reference submucosal fibroid that demonstrates some mild enhancement. Multiple nabothian cysts again noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter focus of fatty process in the subcutaneous right gluteal soft tissues is again noted.OTHER: No significant abnormality noted.

Output: Interval decrease in size and degree of enhancement of uterine fibroids compatible with some treatment response.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of cerebral meninges [D32.0], Reason for Study: ^Reason: h/o right frontal meningioma History: surveillance About 15mm x 10mm sized right frontal meningioma does not show any interval change in terms of MR signal characteristics and size since prior scan.There is about 11mm x 9mm sized round area within the occipital bone which shows low signa intensity on T2, low on T1 and showed intense enhancement on post Gad images. On 3D SPGR images, the lesion appears to be connected with the right jugular fossa. Thus, likely diagnosis of this lesion is intra osseus venous plexus or intra osseous venous lake. Underlying brain shows scattered high signal intensities on bilateral centrum semiovale and periventricular white matter on FLAIR imaging indicating nonspecific small vessel ischemic disease.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. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Right maxillary sinus shows small retention cyst.

Output: 1. Right frontal meningioma, 15mm x 10mm, no change in terms of size and MR characteristics since prior scan.2. Nonspecific small vessel ischemic disease, no change since prior scan.3. Prominent intraosseous area suggesting venous lake on the right occipital bone, no change since prior scan.4. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: 85 years Female (DOB:8/21/1930)Reason: LMCA History: LMCAPROVIDER/ATTENDING NAME: DAVID A HARTER JACQUELINE T BERNARD MRI of the brainThere is a focus of diffusion restriction present involving grey and white matter which includes the left inferior parietal lobule and some of the adjacent brain parenchyma including left post central gyrus and the posterior aspect of the insular cortex. There is associated sulcal effacement and FLAIR and T2 signal hyperintensity.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.There are patchy foci of T2 and FLAIR signal hyperintensity within the brainstem.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The left angular and posterior parietal arteries are not readily identified.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is large. The left A1 segment is hypoplastic. There is fetal origin of the right PCA. The left posterior communicating arteries are intact. The left vertebral artery is not identified.There is 30% narrowing of the basilar artery below the level of the AICA origins.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is occlusion of the LVA at its origin with some collateral reconstitution distally.

Output: 1.There is a left parietal lobe subacute stage infarction as detailed above. There is no evidence for associated acute intracranial hemorrhage.2.The left angular and posterior parietal arteries are not readily identified. Given the infarction, this suggests occlusion of these branches of the left MCA.3.LVA occlusion4.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 5.Signal changes in the brainstem are most likely vascular related .


Instruction: Generate impression based on findings.

Input: Female, 36 years old, with persistent headaches and blurred vision. No evidence of restricted diffusion, focal signal abnormality, edema or mass effect is detected. No pathologic intracranial enhancement is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles are normal in size and morphology. Note is made of a partially empty sella. Bone marrow signal characteristics are within normal limits.

Output: 1.No acute intracranial abnormalities and no definite findings to account for the patient's symptoms.2.A partially empty sella is noted which is nonspecific and can be an incidental finding. However, it can sometimes be seen in conditions of elevated intracranial pressure, including idiopathic intracranial hypertension.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: A discrete tear through the anterior horn of the lateral meniscus extending into the body is observed with marked blunting of the apex. A more globular signal is observed in the body of the anterior horn without definite discrete linear component as the meniscus extends towards the midline and its anchoring point. The lateral meniscus is significant for oblique tear through the posterior horn extending to the inferior articular surface and body. The anterior aspect is otherwise intact. Both menisci are well anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Mild thinning of the cartilage in the lateral compartment without a discrete superimposed focal abnormality. Mild to moderate scattered degenerative changes as correlating with plain film along with changes related to the ACL repair.LIGAMENTS: Status post ACL repair which is intact. The remaining ligaments are also unremarkable EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Scattered mild to moderate osteoarthritic changes with associated bilateral meniscal tears, as described. Patient status post ACL repair


Instruction: Generate impression based on findings.

Input: History of anterior lumbar fusion. Back pain and leg pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There are postsurgical changes of anterior lumbar interbody fusion at L5-S1 for isthmic spondylolisthesis, with solid osseous fusion as seen on CT. There is minimal retrolisthesis of the lumbar vertebral bodies between L1 to L5 as seen on CT. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: Post ALIF. No spinal canal stenosis. Minimal right neural foraminal narrowing. No significant left neural foraminal narrowing.Paraspinous soft tissues are within normal limits.

Output: 1. Status post L5-S1 ALIF with solid osseous fusion better demonstrated on CT from same day.2. Minimal right L5-S1 neural foraminal narrowing. Otherwise no significant spinal canal or neural foramina stenosis at any level in the lumbar spine.


Instruction: Generate impression based on findings.

Input: TFCC tear LIGAMENTS: No significant abnormality noted. Specifically, the scapholunate and lunotriquetral ligaments are intact. TRIANGULAR FIBROCARTILAGE COMPLEX: The TFCC is intact and no significant abnormality is noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: No evidence of TFCC tear or other findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Evaluate for occipital lobe encephalomalacia. New presentation of seizures. There is redemonstration of encephalomalacia involving the left occipital cortex with underlying hemosiderin deposition identified on prior MRI. There is a mildly dilated abnormal venous structure coursing along the lateral margin of this encephalomalacia which drains into a subependymal vein as well as a superficial cortical vein. No discrete mass or abnormal parenchymal or meningeal enhancement is seen in the brain. There is no clear evidence of a nidus to suggest arteriovenous malformation.

Output: Examination limited to post contrast sequences. Again seen is encephalomalacia in the left occipital cortex with evidence of chronic hemorrhage in this region on earlier MRI. There is an abnormally dilated venous structure which courses through this area of encephalomalacia. There is no clear nidus to suggest arteriovenous malformation, although this possibility can be better excluded with conventional angiography if clinically warranted. There is a possibility that the venous structure represents a developmental venous anomaly associated with a cavernous malformation, which is not well delineated amidst the hemosiderin deposition.


Instruction: Generate impression based on findings.

Input: Female 17 years old; Reason: Left lateral knee pain after traumatic injury (hit by bus while standing) History: Pain with ambulation MENISCI: No significant abnormality noted. No meniscal tear is seen.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. No fracture is seen. LIGAMENTS: No significant abnormality noted. The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 4-year-old female with history of Chiari malformation and syringomyelia status post suboccipital craniectomy, C1 laminectomy and duraplasty as well as partial resection and tonsillopexy of the right cerebellar tonsil and reconstruction of the fourth ventricle outflow track on 7/25/2016. Postoperative changes of suboccipital craniectomy and C1 laminectomy are seen. There is a small expected fluid collection within the extracranial operative soft tissues. The portions of the cerebellar tonsils which previously extended into the cervical canal have been excised. There is diffusion restriction and susceptibility at the tonsillopexy margins, wit diffusion restriction also extending superiorly into the left cerebellar parenchyma. There has been improvement in mass effect exerted by the left cerebellar tonsil upon the medulla and upper cervical spinal cord. The ventricles and basal cisterns are normal in size and configuration. There is no hydrocephalus. There is no supratentorial signal abnormality, midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. The orbits are unremarkable.CSF flow imaging demonstrates mildly attenutated flow through the anterior aspect of the foramen magnum, similar to prior, but improved flow through the posterior aspect of the foramen magnum. There is also intact flow through the cerebral aqueduct and fourth ventricle. MRI CERVICAL SPINE

Output: 1.Postoperative changes consistent with Chiari decompression and tonsillopexy.2.Interval improvement in CSF flow through the posterior foramen magnum.3.Spinal cord syrinx, unchanged.


Instruction: Generate impression based on findings.

Input: Reason: eval 1st toe pain History: same Mild osteoarthritis affects the first MTP joint with osteophyte formation and degenerative subchondral signal abnormality in the proximal first metatarsal head. There is mild articular cartilage degeneration about the first MTP joint. The alignment is anatomic. There is a small amount of fluid within the first MTP joint which may reflect a effusion or possibly a very mild synovitis. There is minimal intermediate signal intensity and enlargement of the extensor hallucis longus muscle which may represent minimal tendinosis. The flexor and extensor tendons are otherwise unremarkable. No acute fracture is evident. The remainder of the imaged soft tissues and muscles of the foot are unremarkable.

Output: Osteoarthritis of the first MTP joint and other findings as described above.


Instruction: Generate impression based on findings.

Input: 42-year-old female with SLE, antiphospholipid syndrome vs DIC, subdural lesion and dural sinus thrombosis on MRI, now with worsening neuro status after anticoagulation. Small right subdural collection is stable in size compared to prior MRI. Again, this could represent chronic subdural hemorrhage or infection. There is no evidence of new intracranial hemorrhage, mass or edema. Continued evolution of right occipital lobe infarct, currently measuring 2.5 x 2.1 cm (series 6, image 16/32). No additional foci of cortical low attenuation is identified.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Partial opacification of the visualized sinuses are again noted. Nasopharyngeal soft tissue thickening is noted. These findings are likely accounted for on the basis of the patient's intubation status. The mastoid air cells are partially opacified.There is new left facial soft tissue thickening (series 6 image 10/32). Questionable right subretinal thickening (series 6 image 10/32).Microcalcifications within the parotid glands bilaterally associated with punctate hypodensities.

Output: 1. Stable small right subdural collection. Please refer to MRI of the brain from 1-3-12 for further comments.2. Continued evolution of right occipital lobe infarct.3. Questionable right subretinal thickening that be due to partial retinal detachment or small subretinal hematoma. Recommend ophthalmoscopy for further assessment if clinically indicated.4. Parotid gland microcalcifications and hypodensities.Please correlate with clinical history for chronic inflammatory process involving the parotid glands bilaterally such as sialadenitis, Sjogren's syndrome, Sarcoid or other.5. New left facial soft tissue swelling. Correlate with clinical examination.6. Opacification of paranasal sinuses and nasopharynx is suspected to be at least in part related to intubation status.Findings discussed with Dr. Chwalisz at 10:30 AM 1/9/2012.


Instruction: Generate impression based on findings.

Input: Female, 39 years old. Pain Intra-articular contrast fills the and midcarpal joint space, without evidence of extravasation with the radiocarpal joint, indicating that the scapholunate and lunotriquetral intrinsic ligaments are intact. There is some extravasation of contrast into the dorsal soft tissues. The triangular fibrocartilage complex is intact and has normal morphology. The visualized muscles and tendons are intact. The visualized osseous structures are intact, with normal cortical thickness and marrow signal. No discrete fluid collection or solid mass lesion is identified. Specifically, there is no evidence of a ganglion cyst.

Output: No significant findings on MR to account for the patient's symptoms. Specifically, the scapholunate ligament is intact, and there is no evidence of a ganglion cyst as clinically questioned.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post tumor resection. Signs and symptoms: Status post tumor resection. Pre and post enhanced brain MRI:Examination demonstrates postoperative changes of left posterior temporal craniotomy for removal of tumor. Extensive residual peritumoral vasogenic edema and its associated mass effect with resultant effacement of left occipital horn and trace deviation of midline to the right is again noted.A surgical cavity containing a small amount of hemorrhage and procedural air is noted. Surgical cavity measures approximately 26 x 28 mm in transaxial dimensions. Post enhanced images there is a thick irregular wall enhancement of surgical cavity primarily along its inferior medial aspect which is highly suggestive of residual tumor. This component of tumor is abutting the occipital horn of left lateral ventricle and measures at least at 26 mm in length and 13 mm in transverse axis. On sagittal post enhanced series 14 image 24 residual mass appears larger and measures at 30 x 33 mm in size.There is a visualization of a stable enhancing mass in the posterior lateral aspect of right cerebellum since prior study measuring at approximately 18 x 12 mm in size.

Output: 1.Expected postoperative changes of left posterior temporal-parietal craniotomy as detailed.2.There is residual enhancing tumor abutting and encasing the left occipital horn of lateral ventricle measuring at 30 x 33 millimeters on sagittal post enhanced images.3.Stable diffuse peritumoral edema and associated mass effect with trace deviation of midline to the right.4.Stable enhancing right cerebellar tumor since prior exam as detailed/measured above.


Instruction: Generate impression based on findings.

Input: 61-year-old male with history of elevated PSA. Evaluate for targetable lesion. Biopsy to follow on a different day. PSA 8.1 from October 2015. TRUS biopsy negative from November 2015. Most recent PSA was 12.2 from October 2016. PELVIS:PROSTATE:Prostate Size: The prostate measures 5 cm in transverse, 3.9 cm in AP, and 5.4 cm in craniocaudal diameter.Peripheral Zone: In the left lateral mid gland, a 0.9 x 0.5 cm T2 and ADC hypointense focus is indeterminate due to the wedge-shaped appearance and ill-defined borders (series 401 image 55, series 503 image 264).Central Gland: Enlarged transitional zone causing an impression on the base of the urinary bladder.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: Posttraumatic deformity of the right femoral head/neck.OTHER: No significant abnormality noted.

Output: In the left lateral mid gland, a 0.9 x 0.5 cm T2 and ADC hypointense focus is indeterminate due to the wedge-shaped appearance and ill-defined borders. Lesion can be mapped for Uronav as clinically indicated.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with bone Hippel-Lindau disease and history of cerebellar hemangioblastomas. Assess for growth of existing lesions and for any new lesions. Attention to the inner ears/petrous temporal bone to assess for endolymphatic sac tumor. A 6 mm enhancing nodule is evident within the left cerebellar hemisphere adjacent to the foramen of Luschka. A 3 mm focus of enhancement is evident within the inferior medial right cerebellar hemisphere. These lesions are associated with mild surrounding T2 hyperintensity but no significant mass effect is observed.No evidence of any supratentorial enhancing lesion is seen. Multiple scattered foci of white matter T2 hyperintensity are identified in the cerebral hemispheres, a nonspecific finding which most likely represents chronic microvascular ischemic disease. No evidence of restricted diffusion is seen. No abnormal extra-axial fluid collection or acute intracranial hemorrhage is observed. The ventricles and sulci are mildly prominent compatible with underlying parenchymal volume loss.Dedicated imaging of the internal auditory canals shows normal morphology of the fluid filled compartments of the inner ears. No evidence of any destructive or enhancing inner ear lesion is seen to suggest the presence of an endolymphatic sac tumor. The cranial nerve VII and VIII complexes are within normal limits. No masslike lesions are seen in the CP angle cisterns.

Output: 1.Two enhancing nodules are evident within the cerebellum compatible with hemangioblastomas. These are associated with mild signal abnormality in the surrounding parenchyma, but no significant mass effect. A complete outside MRI for comparison was not available at the time of this interpretation. If such an exam can be made available, we will be happy to make a comparison and addend this report.2.No evidence of any supratentorial enhancing lesion is seen. Scattered foci of white matter signal abnormality likely reflect chronic microvascular ischemic disease.3.Evaluation of the internal auditory canals is within normal limits. Specifically, no evidence of an endolymphatic sac tumor is seen.


Instruction: Generate impression based on findings.

Input: Diagnosis: Systemic involvement of connective tissue, unspecifiedClinical question: Cognitive dysfunction memory lossSigns and Symptoms: migraines/memory loss UCTD The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree (approximately 5-10) of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. An additional punctate T2 and FLAIR hyperintense lesion is present in the left external capsule These appear stable compared to the previous exam.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.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, migraines, sarcoid. They are nonspecific. Overall there is no interval change compared to previous exam.


Instruction: Generate impression based on findings.

Input: Syncopal event at home, mild droop of the right face. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse cerebral white matter T2 hyperintensity. There are small areas of encephalomalacia in the right cerebellar hemisphere, right thalamus, and right caudate head. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable. There is a small right frontal scalp hematoma.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Diffuse cerebral white matter T2 hyperintensity may represent chronic small vessel ischemia. 3. Small right cerebellar hemisphere, right thalamus, and caudate nucleus chronic infarcts.


Instruction: Generate impression based on findings.

Input: 29-year-old male with a history of cavernous malformation here for yearly surveillance. No specific symptomatology is provided. Redemonstrated is a focus of susceptibility effect associated with a centrally higher T1 signal and a popcorn-like appearance located within the left parietal lobe. This has not changed in size when compared to the prior exam and again measures 11 x 11 mm in axial dimensions. There is no perilesional edema.Normal vascular flow voids are present in the distal internal carotid arteries, distal left vertebral artery and the proximal anterior middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Findings suggest a hypoplastic right vertebral artery.Worsening mucosal thickening with air fluid levels are present within bilateral maxillary and sphenoid sinuses. Mucosal thickening within the ethmoid air cells is stable. The visualized mastoid air cells are clear. Redemonstrated is some medial protrusion of orbital contents into the left ethmoid air cells suggesting old medial blowout fracture in the left orbit.

Output: 1.The patient's cavernous malformation located in the left parietal lobe is stable compared to the prior exam.2.Worsening mucosal thickening with air fluid levels are present within bilateral maxillary and sphenoid sinuses.


Instruction: Generate impression based on findings.

Input: 32-year-old with history of multiple sclerosis presenting with dysmetria on left hand with finger to nose, veers to left while walking No restricted diffusion to indicate acute ischemia. There are multiple foci of increased T2 signal in the periventricular and subcortical white matter as well as the posterior limb of the internal capsule bilaterally, left cerebral peduncle and the left corpus medullare cerebelli. These lesions are not associated with decreased signal on the T1 sequences. No abnormal enhancement is noted on the postcontrast sequences.There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Scattered foci of white matter increased T2 signal compatible with the patient's stated history of multiple sclerosis. There is no associated decreased T1 signal or enhancement within these lesions. A lesion within the left corpus medullare cerebelli may correlate with the patient's current symptoms, but comparison with prior imaging would be helpful to assess for interval change.


Instruction: Generate impression based on findings.

Input: Male, 57 years old. Low back pain radiating down the leg. Five lumbar type vertebral bodies are presumed to be present. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. There is nonspecific diffuse marrow heterogeneity, without focal abnormality. The conus medullaris on sagittal imaging is grossly intact.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is mild disc bulge with an annular fissure in the left foraminal/far lateral region with perhaps early left paracentral to foraminal shallow protrusion. There is no significant compromise to spinal canal or neural foramina.L2-L3: There is mild disc bulge and mild bilateral facet hypertrophy, with focal bilateral foraminal prominence. There is mild left and mild to moderate right neural foraminal narrowing, and the focal left distal foraminal disc prominence abuts the exiting left L2 nerve root. There is no significant central canal stenosis. L3-L4: There is diffuse disc bulge and mild facet hypertrophy with more focal prominence in the right paracentral/foraminal region. The descending right L4 nerve root is minimally displaced posteriorly, and the exiting right L3 nerve root is approached by the focal foraminal disc prominence. There is moderate right and mild left neural foraminal narrowing, and mild central canal stenosis.L4-5: There is moderate facet hypertrophy and disc narrowing with diffuse disc bulge. There is more focal prominence along the right foraminal region, with mild bilateral neural foraminal narrowing and mild central canal stenosis.L5-S1: There is moderate facet hypertrophy with mild to moderate bilateral neural foraminal narrowing.

Output: Degenerative changes of the lumbar spine as described above. At L2-3, focal left disc prominence abuts the exiting left L2 nerve root. At L3-4, the exiting right L3 nerve root is approached by the focal foraminal disc prominence, and the descending right L4 nerve root is minimally displaced posteriorly.


Instruction: Generate impression based on findings.

Input: Diffusion restriction with faint ADC hypointensity and T2 hyperintensity is present involving multiple cortices, most prominently involving parietal lobes, however this finding can be found throughout the supratentorial brain. Additionally, similar-appearing findings are present involving the bilateral putamen and caudate as well as right pulvinar. Note is made of asymmetric predominant biparietal atrophy compared to the only mild prominence of the ventricles and remaining sulci. There are a few scattered small punctate foci of T2 hyperintensity within the primarily subcortical white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening can be found within right ethmoid air cells. The remaining paranasal sinuses and mastoid air cells are clear. There is an 8 mm focus of extra-axial enhancement in the right CP angle which slightly enters the porus acusticus, with a dural tail. This does not abut the adjacent pons or cerebellum. There is no abnormal enhancement elsewhere within the brain.

Output: The constellation of MRI features is most suggestive of Creutzfeldt Jacob disease (CJD). The differential diagnosis would also include hypoglycemic encephalopathy. Given the lack of recent anorexic event history, acute ischemia as an etiology of the findings is unlikely; given the rapid progression of worsening dementia, a mitochondrial disorder etiology is felt to be unlikely; and given the lack of T1 hyperintensity within the globus pallidi and thalami, hepatic encephalopathy is also felt to be unlikely.


Instruction: Generate impression based on findings.

Input: 52-year-old female with multiple sclerosis,experiencing paresthesias, evaluate for progression. Again seen are multiple FLAIR hyperintense lesions in the periventricular and subcortical white matter with distribution and morphology consistent with known chronic demyelinating disease. Compared to 3/18/2013, no new lesions are appreciated. A few of these lesions demonstrate T1 hypointensity. Brain parenchymal volume is grossly preserved. No intracranial mass or mass effect. Ventricles are normal in size. Normal vascular flow voids are present. Calvarium and extracranial soft tissues are unremarkable.

Output: Multiple FLAIR hyperintense lesions consistent with known demyelinating disease. No new lesion compared to 3/18/2013 to suggest progression.


Instruction: Generate impression based on findings.

Input: Achilles rupture TENDONS: There is thickening and increased signal of the proximal Achilles tendon beginning approximately 9.2 cm above its attachment on the calcaneus. There is full-thickness rupture situated approximately 5.5 cm proximal to its attachment although the exact location of rupture is somewhat obscured by the presence of heterotopic calcification. The extent of abnormal signal which may represent rupture is approximately 4 cm. There is buckling of the distal fibers of the tendon although some lateral fibers attach upon the calcaneus. The remaining distal fibers also demonstrate abnormal signal intensity suggesting underlying tendinosis. There is a small focus of increased signal within the distal fibers of the peroneus longus which may represent a small area of split tear or tendinosis. The remaining tendons of the ankle appear intact.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: 1. Full-thickness rupture of the Achilles tendon further detailed above. 2. Small focus of increased signal within the distal fibers of the peroneus longus which may represent intrasubstance tear or degeneration.


Instruction: Generate impression based on findings.

Input: Clinical question: Pituitary macroadenoma, assess for change. Signs and symptoms: Pituitary macroadenoma. Pre-and post-enhanced pituitary MRI: Examination demonstrates no interval change since prior study.The signal intensity of the pituitary gland is within normal and without detectable internal focus of abnormality.Tortuous bilateral cavernous carotids demonstrate mass effect on the pituitary bilaterally similar to prior exam. There is uniform enhancement of pituitary gland and with normal position, size and pattern of enhancement the pituitary stalk similar to prior study. The maximum cranial cephalad axis of pituitary in midline measures at 12.5-mm. This measurement is similar to prior study.Possibility of uniformly enlarged pituitary gland or microadenoma should be considered however this finding could at least be partially secondary to mass effect on the pituitary by tortuous cavernous carotids. Correlate with patient's history and laboratory workup for better assessment.Cavernous sinuses are unremarkable otherwise. Basal cisterns and suprasellar visual complex is unremarkable.

Output: 1.No evidence of interval change since prior exam.2.Stable size of pituitary and pattern of enhancement since prior study.3.Apparent uniformly larger than expected size of pituitary gland although could represent a macroadenoma possibility of this finding being at least partially secondary to mass effect by tortuous bilateral internal carotid arteries should also be considered. Correlate with history, symptomatology and serologic studies.4.Unremarkable suprasellar visual complex, basal cistern and bilateral cavernous sinuses otherwise.


Instruction: Generate impression based on findings.

Input: Motion degraded exam. There are a few punctate foci of restricted diffusion in the left cerebellum, right periventricular occipital lobe, left subcortical occipital lobe and tiny foci in the subcortical parietal lobes consistent with acute infarcts. There is a punctate focus of restricted diffusion in the left dorsal paramedian mid brain.There is an area of diffusion hyperintensity in the right precentral gyrus with associated increased T2 FLAIR signal and hyperintense signal on ADC consistent with chronic infarct. There are foci of susceptibility effect associated with this lesion consistent with chronic blood products or perhaps mineralization related to prior infarct. Another area of restricted diffusion and hyperintense signal on ADC in the right parietal lobe is also related to chronic infarct. Additional foci of diffusion hyperintensity and hyperintensity on ADC in the left frontal lobe likely represent chronic infarcts as well.There are punctate and confluent areas of T2 FLAIR hyperintense signal in the background cerebral parenchyma which is compatible with mild to moderate chronic small vessel ischemic changes. The ventricles and sulci are mildly prominent compatible with age appropriate volume loss. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement. No extra-axial fluid collection is identified.No obvious enhancing orbital mass seen within the limitation of motion degraded exam. Dedicated orbital MRI was not obtained due to motion degradation.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.There are few T2 hyperintense enhancing lesions in the bilateral frontal calvarium which measures up to 1 cm and are nonspecific.MRA HEAD

Output: 1. Multiple punctate foci of restricted diffusion in the left dorsal paramedian midbrain, left cerebellum, bilateral parietal lobes, and bilateral occipital lobes consistent with acute infarcts.2. Areas of chronic infarcts in the right precentral gyrus, right parietal lobe and left frontal lobe as described above.3. Background of mild to moderate chronic small vessel ischemic disease.4. Significantly degraded MRA brain, which limits the evaluation of aneurysm. Severe atherosclerotic narrowing of the V4 segment of the right vertebral artery. Otherwise, no evidence of high-grade stenosis or occlusion in the anterior or posterior circulation.5. Few T2 bright enhancing lesions in the bilateral frontal calvarium measuring up to 1 cm which are nonspecific. Suggest follow-up imaging or outside comparison studies if available.


Instruction: Generate impression based on findings.

Input: Cough question: Rule-out intracranial hemorrhage. Signs and symptoms: Altered mental status. Unenhanced CT of brain: Large vessel intracranial vascular calcification of vertebral basilar and cavernous carotids is noted.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal range for patient stated age of 56.Calvarium is intact. Visualized paranasal sinuses are unremarkable.Follow-up with an MRI is recommended if clinical concern persists.

Output: Negative nonenhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: 61 year old male presents with left knee pain and swelling. There is clinical concern for a septic knee. There is a fluid collection in the soft tissues of the knee anterior to the patella and the patellar tendon. This collection measures 2 x 1 cm in transverse dimension. The collection has irregular margins which enhance and there is enhancing reticulation of the surrounding soft tissues indicating inflammation. This is compatible with an abscess though could represent bursitis with extensive surrounding inflammation.Bone marrow signal is normal.The extensor mechanism is intact.There is a full thickness defect of the articular cartilage of the medial femoral condyle just above the posterior horn of the medial meniscus measuring approximately 1cm in diameter. There are additional full thickness clefts in the articular cartilage of the femoral trochlea.The cruciate and collateral ligaments are intact.There is a small amount of fluid in the joint but no effusion. There are no other findings that suggest septic arthritis.

Output: Fluid collection in the prepatellar soft tissues with surrounding inflammation suggestive of an abscess or bursitis. Other findings as described above.


Instruction: Generate impression based on findings.

Input: There is evidence of intracranial metastatic disease. Contrast enhancing lesion in the left medial occipital lobe measuring 1.0 x 0.7-cm (post contrast image 76) with associated vasogenic edema is compatible with intracranial metastasis. There is a second contrast enhancing lesion in the left cerebellum measuring 1.2 cm x 1.0 cm (post contrast image 38) with associated vasogenic edema. There is also area of FLAIR hyperintensity centered at the left anterior temporal lobe without definite underlying lesion likely related to treatment change. There is however a punctate focus of enhancement in the left anterior temporal lobe which may be related to prior treatment versus tiny metastatic lesion. No evidence of midline shift or mass effect. Additional subcentimeter areas of abnormal enhancement and edema in the bilateral superior/middle cerebellar peduncles may represent additional smaller lesions versus a separate perhaps toxic-metabolic process. There is a 5 mm lesion more laterally in the left superior cerebellum and a punctate lesion in the superior cerebellar vermis (axial image 74/175 series 1301) . Additional symmetric areas of T2 hyperintensity of the periventricular and subcortical white matter are compatible with chronic small vessel ischemic disease or treatment changes. Evidence of prior left frontal and temporal craniotomies. No destructive calvarial lesions. No evidence of acute hemorrhage or infarction. Flow voids are present within the major vessels indicating patency. There is fluid in the mastoid air cells. Orbits are unremarkable.

Output: 1.Dominant metastatic lesions in the left medial occipital lobe and left cerebellum. Additional subcentimeter areas of abnormal enhancement and edema in the bilateral superior/middle cerebellar peduncles may represent additional smaller metastases versus a separate perhaps toxic-metabolic/treatment-related process. There is a 5 mm lesion more laterally in the left superior cerebellum and another punctate lesion in the superior cerebellar vermis. No significant mass effect, midline shift, or herniation. Comparison with prior MRI would be helpful if available.2.FLAIR hyperintensity in the left anterior temporal lobe likely represent gliosis related to prior treated lesion.


Instruction: Generate impression based on findings.

Input: History of fever, rash, altered mental status. Rule out meningitis. Rule out abscess, edema. No definitive evidence of any area of low attenuation in the brain parenchyma to suggest presence of edema however the ventricular system is very small and slitlike and there is almost no visualization of cortical sulci and several of the cisterns including quadrigeminal cistern and pineal cisterns appear very small. There is also crowding of the cerebellar tonsils at the level of foramen magnum. The findings are concerning for increased intracranial pressure and possible diffuse cerebral edema. There is also suggestion of enhancement of the leptomeninges overlying the cerebellum and the vermis and possibly some in the bilateral frontal and temporal lobes. Further evaluation with an MRI is highly recommended. There is no evidence of any abscess formation or any extra axial fluid collection.The bony density of calvarium remains within normal. Mastoid air cells, middle ear cavities and all visualized paranasal sinuses remain unremarkable.

Output: Findings highly suspicious for meningitis and possible cerebral edema as detailed above. Further evaluation with an MRI is highly recommended.


Instruction: Generate impression based on findings.

Input: 27-year-old female with stomach discomfort. Evaluate for terminal ileitis. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As belowBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Lateral adnexal T2 hyperintense foci consistent with cysts measuring up to 2 cm on the left; findings consistent with physiologic cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is thickening and hyperenhancement of 7 cm of the terminal ileum. Colon is normal in appearance.At 9:00 position, there is a intersphincteric fistula which extends posteriorly to the right gluteal cleft without evidence of an abscess.BONES, SOFT TISSUES: Lumbar levoscoliosis. Nonspecific T2 hyperintensity of the right ischium. OTHER: No significant abnormality noted.

Output: 1.Findings consistent with acute inflammatory changes involving the terminal ileum.2.Intersphincteric 9:00 fistula extending to the right gluteal cleft.3.Nonspecific T2 hyperintense ischial focus.4.Lumbar levoscoliosis.


Instruction: Generate impression based on findings.

Input: Elevated prolactin (128.90). The pituitary gland is not enlarged and there is no evidence of sellar lesions, although artifact partially obscures this region. The infundibulum is midline. The posterior pituitary bright spot is intact. The optic apparatus and cavernous sinuses are unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: No definite evidence of pituitary lesions, although artifact partially obscures this region.


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB:5/18/1947)Reason: low back pain History: low back painPROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY 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. Incidental note is made of a perineural cyst in the sacral hiatus on the left side at the level of S2 measuring approximately 16 x 10 mm sagittal dimensions.At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with bilateral facet hypertrophy. There is effacement of the fat at the right lateral recess and partial effacement of the fat at the left lateral recess. There is encroachment of the nerve roots of the right lateral recess level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with some ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recesses bilaterally this level and some encroachment of the nerve roots at the lateral recesses. Encroachment of the nerve roots at the lateral recesses worse on the right than the left side at this level.. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L3-4 there is loss of disc space height, disc desiccation and Schmorl's nodes associated with the disc bulge and ligamentum flavum and facet hypertrophy. There is no significant compromise to spinal canal or neural foramina at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge and ligamentum flavum hypertrophy at this level associated with some loss of disc space height and disc desiccation.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy at this level.On sagittal imaging at the T10-T11 level there appears to be a disc bulge associated with ligamentum flavum hypertrophy and findings are suspicious for but not confirmatory for spinal stenosis.

Output: 1.There are degenerative changes present in the lumbar spine with encroachment of the nerve roots at the right lateral recess at L5-S1 and L4-5 as detailed above. There is a mild degree of spinal stenosis at L4-5.2.Findings raise the question of spinal stenosis at T10-T11 which is not entirely included on this exam. If clinically appropriate additional imaging of the thoracic spine may help evaluate this further.


Instruction: Generate impression based on findings.

Input: 67-year-old female with history of abnormal MRCP 1/6/2016 who presents for evaluation of biliary stricture/primary sclerosing cholangitis. History additionally states primary biliary cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: There is mild hepatomegaly without abnormal contour of the hepatic capsule. The hepatic parenchyma is homogeneous without evidence of a suspicious mass or nodularity. There is segment 7 transhepatic intensity difference. No evidence of intra or extrahepatic biliary ductal dilatation. There is mild extrinsic compression upon the proximal common bile duct secondary to crossing hepatic artery.SPLEEN: No significant abnormality noted.PANCREAS: Fatty involution of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right extrarenal pelvis and left hilar renal cysts are noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No findings to suggest primary sclerosing cholangitis.2.Mild hepatomegaly. 3.Primary biliary cirrhosis often has normal morphologic appearance.4.Fatty involution of the pancreas.5.Left renal hilar and cortical cysts.


Instruction: Generate impression based on findings.

Input: Hereditary hemorrhagic telangiectasia [I78.0], Reason for Study: ^Reason: eval for AVM's History: HHT, nosebleeds Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal scattered high signal intensity lesions on bilateral white matters on FLAIR imaging indicate nonspecific small vessel ischemic disease.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. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D 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.No evidence of intracranial aneurysm. No evidence of intracranial arterial significant luminal stenosis.

Output: 1. Minimal nonspecific small vessel ischemic disease. Otherwise no evidence of acute ischemic or hemorrhagic lesion.2. Normal brain MRA. Comment: Further imaging investigation with Gad enhanced MRI can be considered if small brain AVM is suspected.


Instruction: Generate impression based on findings.

Input: This exam is mildly degraded by motion artifact. There are unchanged postoperative findings related to resection of a right vestibular schwannoma. There is an unchanged subcentimeter patchy focus of enhancement within the superior aspect of the right internal auditory canal as well as unchanged thin linear enhancement along the posterior aspect of the right internal auditory canal. There is clumping of the right cranial nerve 7 and 8 complex. The left internal auditory canal is unremarkable. The bilateral inner ear structures are unremarkable.

Output: Unchanged nonspecific enhancing tissue within the right internal auditory canal amidst postoperative findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Altered mental status.Additional clinical history from electronic medical records: 44-year-old woman with ESRD on dialysis; missed her Wednesday and Friday dialysis. Admitted because of change in the LOC. The behavioral change can be due to encephalitis/meningoencephalitis/ seizures/ metabolic disturbance/ stroke (PRES, or ischemic stroke) MRI: There are multiple oval-shaped focal T2-hyperintense, T1-hypointense lesion in the cerebral white-matter that are somewhat perpendicularly oriented relative to the long axis of the lateral ventricles. There is multifocal punctate susceptibility effect in the cerebrum and cerebellum without associated edema, may reflect hemosiderin staining. These microbleeds are probably related to end-stage renal disease-associated microangiopathy. Otherwise, there is no acute intracranial hemorrhage or acute infarct. There is no mass-effect, midline shift or brain herniation. The ventricles, sulci and basal cisterns are mildly to moderately enlarged, reflecting underlying global brain volume loss. The major intracranial vascular flow voids are preserved.There are retention cysts in the maxillary sinuses. There has been bilateral eye lens placement. There is no gross destructive skull lesion or gross scalp soft tissue abnormality.MRV:The study is markedly limited, in part by patient motion and in part by lack of intravenous contrast. The superior sagittal and straight sinuses as well as the deep cerebral veins are grossly patent with preservation of their flow voids on T2/FLAIR conventional sequences.MRA:Slight irregularity of caliber involving the distal cervical internal carotid arteries likely represent artifact. Otherwise, there is no flow-limiting stenosis, occlusion or aneurysm of the major intracranial arteries.

Output: 1.Multifocal cerebral white-matter lesions are nonspecific with differentials including demyelinating disease, or prior ischemia or inflammation.2.There is no acute infarct. No findings to suggest encephalitis within the limits of noncontrast study. Multiple scattered foci of chronic microhemorrhage are nonspecific but may represent microangiopathy related to chronic renal disease.3.MRA shows no significant steno-occlusive disease.4.MRV is very limited by lack of contrast and by patient motion though there is no definite sign of occlusive thrombosis of the major dural sinuses. However, if there is high suspicion for venous thrombosis, consider contrast-enhanced CT venogram.


Instruction: Generate impression based on findings.

Input: Reason: adnexal mass History: pelvic pain. Additional history per Epic: Patient is status post left oophorectomy possible salpingectomy in 1999 for question ectopic pregnancy. Patient also has a history of myomectomy in 2011. PELVIS:UTERUS, ADNEXA: The uterus is mildly enlarged. There are at least two degenerating intramural uterine fibroids identified. The larger within the left uterine fundus, measuring 19 x 16 mm.There are multiple cysts within the junctional zone which is thickened and heterogeneous, suggesting adenomyosis (series 9, image 14). The endometrium is within normal limits in thickness, measuring 5 mm.Multiple cysts are present in the lower uterine segment, some of which demonstrate slightly complex signal intensity, the largest measures 18 x 10 mm (series 9, image 13), compatible with nabothian cysts. There are scattered small foci of T1 signal hyperintensity along the uterine serosa, compatible with endometriosis.In the left adnexa is a large, dilated, tubular structure, which is blind-ending and a simple appearing cystic lesion, measuring 8.5 x 7.5 cm, compatible with severe left hydrosalpinx. There is no diffusion restriction to suggest pyosalpinx. The left ovary is not identified. There is no solid mural components or enhancement on postcontrast imaging.The right ovary is somewhat atrophic in appearance with small physiologic cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy is noted.BOWEL, MESENTERY: The bowel is normal caliber without evidence of bowel obstruction.BONES, SOFT TISSUES: Degenerative disc disease affects the lower lumbar spine with small disc protrusions at L4-5 and L5-S1.OTHER: No significant free fluid.

Output: 1.Large blind-ending tubular structure in the left adnexa compatible with severe hydrosalpinx, without evidence of infection/pyosalpinx.2.Scattered endometriosis implants along the uterine serosa.3.Thickened and heterogeneous junctional zone with multiple small cystic regions, compatible with adenomyosis.4.Several nabothian cysts, some of which appear complex.


Instruction: Generate impression based on findings.

Input: Uterine mass seen on ultrasound. Per medical record, history of D&C at 6 weeks gestation and 2012. PELVIS:UTERUS, ADNEXA: There is mild asymmetric prominence of the posterior myometrium at the uterine fundus, without measurable mass or suspicious enhancement. The junctional zone appears normal in size. The endometrial stripe appears normal. Punctate nabothian cysts noted. Normal-appearing ovarian follicles noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic free fluid, likely physiologic. No significant abnormality noted.

Output: Mild asymmetric prominence of the posterior myometrium at the uterine fundus with moderate heterogeneity, no measurable mass.


Instruction: Generate impression based on findings.

Input: Patient is 17 month old female with history of intractable seizure disorder. Status post right frontal lobectomy. Now with right subdural hematoma and 4 minute generalized seizure o/n Large area of low density in the right frontal lobe with minimal air is believed to represent postoperative changes of patient's given history of right frontal lobectomy. Large frontal craniotomy on the right which extends across the midline is also noted. The bony flap appears fragmented and may represent associated fracture. Please correlate with surgical history. This examination is compared with prior MRI examination which makes evaluation of bony structures difficult however no definitive evidence of similar findings of fragmented bony flap was detected. The comparison CT examination is a pre- surgical study.Extra-axial fluid collection under the craniotomy flap has mixed density and is consistent with epidural hematoma.There is evidence of mass-effect by the above findings however no definitive evidence of midline shift is detected.

Output: 1.Changes in the right frontal lobe with no hemorrhage are believed to represent postoperative change.2.Large epidural collection under the craniotomy flap consistent with hemorrhage.3.The bony flap is fragmented which may be postsurgical change however I cannot entirely rule out fracture.


Instruction: Generate impression based on findings.

Input: 20 years Female (DOB:7/21/1995)Reason: evaluating for underlying lesion. History: intermittent dizziness, also with weight loss \T\ increased thirst.PROVIDER/ATTENDING NAME: KRISTEN E LIPSTREUER KRISTEN E LIPSTREUER The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing 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 pituitary gland measures approximately 8 mm height.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: No underlying lesion is appreciated intracranially to explain the patient's dizziness and giddiness. MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Vascular lesion The previously described mass within the anterior compartment of the proximal leg is no longer seen. There are scattered foci of susceptibility artifact relating to surgical resection. There is no evidence of new mass or abnormal enhancement following contrast.There is mild fatty atrophy and/or scarring of the proximal tibialis anterior muscle. The remaining musculature of the leg is normal in signal and caliber.The bone marrow signal of the tibia and fibula is normal.

Output: Surgical changes relating to excision of previous anterior compartment mass. There is no evidence of recurrent mass or abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 51-year-old female with IVC filter placement and status post attempts unsuccessful retrieval of the IVC filter with placement of an additional IVC filter. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: An IVC filter is placed within the intrahepatic IVC. 15 x 15 mm hypodense lesion in the left lobe of the liver best seen image number 45 of series number 3 is nonspecific in appearance. If clinically indicated, dedicated liver MRI or CT may be helpful for further evaluation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measuring 14 mm in diameter. Its CT appearance is nonspecific on this single phase post contrast CT.KIDNEYS, URETERS: Subcentimeter hypodense lesions in both kidneys which are too small to characterize with atelectasis.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter is tilted. Please refer to the interventional radiology procedure note on 12/10/2009 for better description.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat containing periumbilical hernia. Nodular density in the anterior abdominal wall likely secondary to injections.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Two IVC filters are in place. Inferiorly placed IVC filter is tilted. Please refer to the interventional radiology procedure report on 12/10/2009.Indeterminant hypodensities in the liver. If clinically indicated further evaluation with dedicated liver MRI or CT is recommended.Indeterminant left adrenal nodule.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago with sciatica, right side Lumbago with sciatica, left sideClinical question: hematoma after lumbar drain placementSigns and Symptoms: back pain radiating to both legs Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is no evidence for an epidural mass and no evidence for epidural hematoma appreciated. On the T2 sagittal images there is a T2 hyperintense focus present which is not adequately evaluated on this exam and may represent artifact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is moderate facet hypertrophy, loss of disc space height, disc desiccation and diffuse disc bulge associated with mild anterior subluxation of L4 on L5. There is effacement of the fat at the lateral recess on the right side into a lesser degree effacement of the fat on the lateral recess on the left side. There is mild narrowing of the neural foramina at this level. Some disc material extends behind the L4 vertebral body along its inferior aspect. Overall there is mild spinal stenosis 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.The visualized upper abdominal aorta measures 3 cm in diameter on axial imaging however superior to this there appears to be enlargement of the aorta up to 5.6 cm AP dimension.

Output: 1.There are degenerative changes present in lumbar spine worse at L4-5 where there is mild subluxation and mild degree of narrowing of the spinal canal.2.There is no evidence for epidural hematoma.3.Findings raise the question of thoracic aortic aneurysm possibly with dissection. 4.On the T2 sagittal images there is a T2 hyperintense focus present which is not adequately evaluated on this exam and may represent artifact. Given the possibility of a thoracic aortic dissection a spinal cord infarct cannot be excluded on the basis of this exam . Please correlate with patient's clinical exam findings.5.At the time of this dictation, we spoke to the emergency room physician who referred us to contact the clinical service and we were thus attempting to contact the clinical service Dr. Ramos.


Instruction: Generate impression based on findings.

Input: 54 year old male with a history of bladder carcinoma status post resection. Restaging examination. ABDOMEN:LIVER, BILIARY TRACT: No evidence of intra- or extra- hepatic biliary ductal dilation. Subcentimeter focus of fluid signal intensity in the dome of the liver is too small to characterize, but likely represents a simple cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple subcentimeter foci of fluid signal intensity are identified within the kidneys bilaterally, which are too small to characterize, but likely represent simple cysts. RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Postoperative changes consistent with the patient's history of bladder resection with neobladder formation. No focal filling defect or enhancing mass lesions are identified to suggest residual or recurrent disease.LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is asymmetric edema type signal abnormality in the left psoas muscle, which may be postsurgical in etiology.OTHER: Note is made of bilateral fluid collections within the pelvis, left greater than right. The left measures 9.3 x 6.9 cm (12; series 9). The right measures 4.1 x 3.2 cm (25; series 9).

Output: 1.Postoperative changes without evidence of residual or recurrent tumor.2.Bilateral pelvic fluid collections, left greater than right, likely representing lymphoceles or postoperative seromas.


Instruction: Generate impression based on findings.

Input: A 65 year old female with personal history of heart transplant (6/2015), hypertension, anxiety and GERD. Now hospitalized due to worsening shortness of breath concerning for transplant rejection. Found to have urinary tract infection. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 93 ml/m2 (normal range: 65+/-11), the LVEDV is 176 ml (normal range 109+/-23), the LV end systolic volume index is 46 ml/m2 (normal range 18+/-5), the LVESV is 86 ml (normal range 31+/-10), the LV mass index is 51 g/m2 (normal range 67+/-11), and the LV mass is 95 g (normal range 114+/-24). There is mild global hypokinesis with regional variation. There is a small focus of late gadolinium enhancement involving the anterior right ventricular insertion point of the left ventricle suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is mild to moderate increase in native myocardial T1-times (1150ms).The Global Relative enhancement (3.78), t2-STIR edema ratio (1.9), and the extra-cellular volume fraction (25%) are all within normal. No intracavitary thrombus was noted.Left AtriumThe left atrium is dilated consistent with transplant morphology. The LA volume is 102 ml.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 87 ml/m2 (normal range 69+/-14), the RVEDV is 165 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 81 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is 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. There is a trivial pericardial effusion.Extracardiac FindingsPost heart transplant surgery findings. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with low normal systolic function, the LVEF is 51%. There is mild global hypokinesis with regional variation. 2. There is a small focus of late gadolinium enhancement involving the anterior right ventricular insertion point of the left ventricle suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. This is supported by the mild to moderate increase in native myocardial T1-times. The other parameters that might support myocardial inflammation are within normal limits (Global Relative enhancement, t2-STIR edema ratio, and the extra-cellular volume fraction).3. The right ventricle is normal in size with normal systolic function, the RVEF is 51%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: ? Osteomyelitis History: ulcerations Right ankle:Again seen is ulceration along the anterolateral aspect of the right ankle with heterogeneity of the underlying fat, which likely represents a combination of chronic scarring and inflammation. There is enhancing increased signal abnormality within the subcutaneous tissues along the anterolateral aspect of ankle which may represent a cellulitis. There is signal abnormality of the marrow of the distal tibia/fibula as well as within the calcaneus and talus, which likely represents residual/reconverted red marrow. We see no specific findings to suggest osteomyelitis. We see no fluid collections to indicate abscess. A small focus of signal abnormality in the distal tibia may represent a cyst, unchanged. Low signal along the posterior medial ankle likely represents chronic scarring or postsurgical change. There is a small amount of fluid in the tibiotalar joint but no large effusion. Linear increased signal abnormality within the Achilles tendon suggests mild tendinosis or interstitial tearing.Left ankle:Ulceration along the medial and lateral aspects of the ankle with enhancing heterogeneity of underlying fat likely represents a combination of inflammation/cellulitis as well as chronic scarring. Again seen is bone marrow signal abnormality of the distal tibia/fibula likely represents residual/reconstituted red marrow, but we see no specific findings to suggest osteomyelitis. We see no fluid collections or abscess formation. Additional patchy signal abnormality in the bones of the foot also likely represents additional red marrow. The visualized tendons appear normal. There is atrophy of the muscles of the ankle as well as what appears to be an accessory soleus muscle.

Output: Bilateral soft tissue ulcerations with findings suggestive of soft tissue inflammation/cellulitis as well as chronic scarring. No evidence of osteomyelitis or abscess formation. The bony sequela of sickle cell disease are again seen.


Instruction: Generate impression based on findings.

Input: Wrist pain and swelling LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: The distal portion of the TFCC is not well seen as there is some intermediate signal intensity. The more proximal portion is intact.TENDONS: This proximal to the ulna, extensor carpi ulnaris tendon demonstrates abnormal signal and morphology (series 6 image 15/33) although no fluid-filled signal is identified internally. Further distally, the tendon is of normal appearance. Additionally, there is an small amount of fluid within the radiocarpal and midcarpal spaces as well as within the DRUJ. Increased soft tissue signal is also evident at the radiocarpal articulation.BONES: No significant abnormality noted.ADDITIONAL

Output: 1. Tendinosis of the extensor carpi ulnaris. There is increased signal intensity anterior to the ulna may reflect a component of inflammation.2. Intermediate signal intensity of the distal TFCC which is not well seen. This may be technical in nature but if further evaluation is warranted, MR arthrogram can be obtained.


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8] / Malignant neoplasm of unspecified site of left female breast [C50.912], Reason for Study: ^Reason: concern for leptomeningeal disease on lumbar MRI, assess for in brain, cervical, and thoracic spine Brain MRINo evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRIThere are multiple low signal intensity vertebral bodies indicating possible sclerotic metastatic lesions involving C4, T2, T3 and T5 vertebral bodies. There is no evidence of cortical disruption or compression fracture.There is no evidence of spinal cord signal abnormality.There is a diffuse bulging of disc at the level of C45 and C6-7 which abuts thecal sac without evidence of spinal canal stenosis.No abnormal enhancement.Thoracic spine MRILow signal intensity lesions replacing normal bone marrow signal at T5, T7, T10T12, L1 and L2 vertebral bodies indicating possible sclerotic metastasis.Similar sclerotic lesions are also seen on bilateral ribs.In particular, the T7 vertebral body shows about 40% compression fracture without evidence retropulsion.There is no MR evidence of bone marrow edema.Spinal cord signal intensity is normal.There is no evidence of spinal canal stenosis.There is no evidence of abnormal enhancement.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.2. Multiple vertebral body lesions involving both cervical and thoracic vertebrae indicating multifocal sclerotic bony metastasis.3. No evidence of abnormal enhancement on both cervical and thoracic region.4. Normal spinal cord signal intensity.5. About 40% compression fracture of T5 vertebral body.


Instruction: Generate impression based on findings.

Input: Male, 42 years old. Reason: knee pain, locking. History: knee pain with sprain of lateral collateral ligament on left knee. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: Markedly thinning and irregularity of the articular cartilage of the medial femoral condyle. The articular cartilage of the lateral femoral condyle is also thin. There is a partial-thickness cleft within the cartilage along the apex of the patella. There is bone marrow edema along the lateral femoral condyle and the medial tibial plateau likely related to direct contusion.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Marked thinning and irregularity of the articular cartilage of the medial femoral condyle with scattered areas of less severe thinning. Subcentimeter loose body within the popliteal cyst2. Cruciate and collateral ligaments appear intact. 3. Menisci appear intact.


Instruction: Generate impression based on findings.

Input: Left knee injury while doing box jumps, evaluate for ACL and meniscal tears. MENISCI: The lateral meniscus is intact. There is diffuse blunting of the anterior horn, body, and posterior horn of the medial meniscus with a suspected displaced fragment along the tibial spine (series 401, image 24) compatible with a bucket handle tear.ARTICULAR CARTILAGE AND BONE: Femoral and tibial osseous tunnels are present compatible with prior ACL repair. Bone marrow signal is otherwise unremarkable. No fractures are identified. The tibiofemoral and patellofemoral cartilage is intact. LIGAMENTS: The collateral and posterior cruciate ligaments are intact. There is complete rupture of the graft ACL with displacement of graft material into the posterior aspect of the knee joint along the PCL.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Complete rupture of graft ACL.2.Medial meniscal bucket-handle tear.