Instruction: Generate impression based on findings.

Input: Metastatic esophageal cancer and left lower extremity weakness. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is trace nonspecific periventricular white matter T2 hyperintensity. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, and scalp soft tissues are grossly unremarkable. There are mild secretions in the anterior left ethmoid sinus. There is a subcentimeter retention cyst in the right lateral nasopharyngeal recess. There are bilateral lens implants.Cervical Spine: There is fusion of the C3 through C6 vertebral body with loss of the usual kyphosis and bony projection into the spinal canal C3-4 and C5-6 with mild indentation of the spinal cord at C3-4. There are also disc-osteophyte complexes and prominent facet joint hypertrophy at C2-3, right greater than left, and at C7-T1. There is mild left C2-3, severe left C3-4, moderate left C4 though C6, severe right C2 though C6, and bilateral moderate C7-T1 neural foraminal stenosis. There are foci of high T2 signal in the grey matter bilaterally and associated mild volume loss in the spinal cord at the C5 level. However, there is no evidence of mass lesions in the cervical spine and the vertebral bone marrow appears unremarkable.

Output: 1. No evidence of intracranial metastases or acute infarction.2. Fusion of the C3 through C6 vertebral body, multilevel neural foraminal stenosis, moderate spinal canal stenosis at C3-4, and myelomalacia at C5, but no evidence of cervical spine metastases.


Instruction: Generate impression based on findings.

Input: There is soft tissue crowding at the foramen magnum with inferior extension of cerebellar tonsils up to 7 mm below the foramen magnum. There is partly imaged cervical cord syrinx measuring up to 3 mm AP on series 5 image 28 which extends superiorly to C1 level. There is mild platybasia, and mild draping of the brainstem around dens tip which has minimally migrated upwards. The CSF space around the lower medulla/cervical cord is diminished.There is no acute infarct, mass effect or midline shift. There is encephalomalacia in the right frontal lobe presumably representing site of remote meningioma resection with minimal curvilinear enhancement which likely represents granulation tissue. There is moderate diffuse volume loss. There is moderate T2 signal abnormality in the periventricular and subcortical white matter which is nonspecific but likely chronic small vessel ischemic changes.The calvarial osseous marrow signal is diffusely low on T1 without a focal lesion.

Output: 1.Findings consistent with Chiari I malformation with a partly imaged 3 mm syrinx in the cervical cord extending superiorly to C1 level. Dedicated cervical spine MRI is recommended.2.Platybasia with brainstem draping around a slightly upward migrated dens tip with diminished CSF space.3.Diffusely low calvarial osseous marrow signal, nonspecific and may be reactive to anemia or marrow infiltration of any cause. Correlation with nuclear medicine bone scan can be considered as clinically appropriate.4.Sequela of previous right frontal meningioma resection.


Instruction: Generate impression based on findings.

Input: History of medial epicondylar fracture status post ORIF now with a flexion contracture. Evaluate soft tissue contracture versus mechanical block. As seen on the recent radiographs, there is medial epicondyle bone fragment situated in near-anatomic alignment along the medial aspect of the distal humerus. The gap between the fragment and the underlying bone is approximately 1 mm. There is no bony bridging between the fragment and the underlying humerus. The fragment is of relatively low signal intensity on T1 weighted images as well as mildly increased signal intensity on T2 weighted images and appears slightly sclerotic on radiographs; these findings may reflect at least some necrosis of the fragment. Mild edema within the underlying medial condyle is noted.The anterior bundle of the ulnar collateral ligament attaches to the fragment and the coronoid process of the ulna in normal fashion. The proximal fibers of the common flexor tendon appeared to attach to both the fragment and humerus with minimal intrasubstance signal perhaps represent mild tendinosis. The lateral supporting structures of the elbow appear intact.The biceps and brachioradialis muscles and tendons are normal. The triceps appears normal. The musculature is within normal limits.The ulnar nerve lies along the posterolateral aspect of the aforementioned medial epicondyle fracture fragment which may represent posttraumatic subluxation. The remaining soft tissue structures are normal. A small amount of fluid is noted in the elbow joint, but no large effusion or loose bodies are seen.

Output: Medial epicondyle fracture fragment in near anatomic alignment as described above without evidence of bony union. Low signal intensity in the fragment on T1 weighted images may reflect at least partial necrosis of the fragment. The ulnar collateral ligament attaches to this fragment but appears normal, and we otherwise see no specific findings to account for the patient's flexion contracture.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:10/15/1971)Reason: eval positioning of carotid arteries, pt feels air suffocation History: as abovePROVIDER/ATTENDING NAME: MAUREEN CROWLEY MAUREEN CROWLEY 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. The right common carotid artery and the proximal right vertebral artery are not well imaged at the level of the thyroid gland. To a large degree this is related to breathing artifact. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. At the C3 and C2 vertebral body levels there is medial deviation of the internal carotid arteries bilaterally above the level of the hyoid bone and at the level of the hypopharynx.MRI neck:Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.There is medial deviation of the internal carotid arteries bilaterally above the level of the hyoid bone at the C2-3 vertebral body levels.The cervical vertebral bodies in general are intact. There are multilevel degenerative changes present in the cervical spine which appear worse at C3-4 where there is a disc protrusion present which narrows the spinal canal and is suspected to be associated with spinal stenosis.

Output: 1.The right common carotid artery and the right vertebral artery not adequately imaged proximally. Perhaps additional imaging with ultrasound may be of benefit in evaluating this. The possibility of a stenosis of the proximal right vertebral artery or the right common carotid artery cannot be excluded on the basis of this exam.2.There is medial deviation of the internal carotid arteries bilaterally above the level of the hyoid bone at the C2-3 vertebral body levels.3.Findings raise the question of spinal stenosis at C3-4. Please correlate with clinical symptoms. If clinically appropriate dedicated cervical spine imaging may be helpful.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate structural lesions to explain memory loss in a 50-year-old male. Signs and symptoms: Memory loss. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate 2 punctate foci of nonspecific FLAIR hyperintensity in the right basal ganglia and a single linear focus of FLAIR hyperintensity in the splenium of corpus callosum. The findings are nonspecific, nonhemorrhagic and demonstrate no abnormal enhancement.The anatomical morphology and the signal intensity of brain parenchyma otherwise remains within normal on all MRI sequences for patient's stated age of 50.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Signal voids of major intracranial arterial branches are identified and unremarkable.Signal intensity of intracranial venous sinuses are within normal.Post contrast images demonstrate no abnormal enhancement of brain parenchyma or the leptomeninges.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal enhancement of intracranial venous sinuses.Unremarkable calvarium and soft tissues of the scalp.All the paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern with the exception of minute bilateral maxillary mucosal thickening.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.3 tiny foci of nonspecific FLAIR hyperintensity 2 in the right basal ganglia and one in the splenium of corpus callosum as detailed.3.Unremarkable pre and post enhanced brain MRI otherwise for patient's stated age of 50.


Instruction: Generate impression based on findings.

Input: 83-year-old female with severe rest pain near greater trochanter of unexplained etiology. ACETABULAR LABRUM: Components of a total right hip arthroplasty situated near anatomic alignment. On the large field-of-view images, the left hip joint demonstrates mild degenerative changes, otherwise alignment is anatomic.ARTICULAR CARTILAGE AND BONE: Components of a total right hip arthroplasty situated in anatomic alignment. There is asymmetric increased STIR signal within the right proximal femur centered at the greater trochanter and surrounding bursa most compatible with greater trochanteric bursitis. No acute fracture is evident.SOFT TISSUES: The subcutaneous tissues and musculature appear normal. The mature heterotopic ossification seen on prior pelvis radiograph is not well visualized on the current study.ADDITIONAL

Output: Findings compatible with right greater trochanteric bursitis.


Instruction: Generate impression based on findings.

Input: Pituitary lesion, 3month follow. Some of the images are degraded by patient motion. There is considerable interval decrease in size of the pituitary gland, which now measures up to 5 mm in craniocaudal dimension, without residual T1 hyperintensity. There is no mass effect on the cavernous sinuses or optic apparatus. There is encephalomalacia in the right occipital lobe and left basal ganglia with hemosiderin deposition. There is diffuse cerebral volume loss and scattered patchy cerebral white matter T2 hyperintensity. There are bilateral maxillary sinus retention cysts. There is a partially imaged T2 hyperintense nodule in the left parotid gland.

Output: 1. Interval resolution of prior pituitary apoplexy, without evidence of gross sellar tumor. Otherwise, assessment is limited by the lack of intravenous contrast and motion.2. Chronic infarcts in the right occipital lobe and left basal ganglia superimposed upon chronic small vessel ischemic disease.3. Partially imaged nonspecific nodule in the left parotid gland. Dedicated parotid imaging may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: History of recurrent acute pancreatitis and pseudocyst. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. The patient is status post cholecystectomy. There is left greater than right intrahepatic biliary ductal dilatation, increased from the prior, involving the left hepatic lobe and some segments of the right hepatic lobe. The common bile duct is minimally prominent which may be related to the patient's postcholecystectomy state and mild mass effect from the enlarging pancreatic head cystic lesion. The common bile duct is circumferentially mildly thickened and hyperenhancing. Similarly, the most central portion of the left hepatic vein demonstrates mild wall enhancement. No discrete mass lesion is evident.Several peripheral wedge-shaped regions of hyperenhancement may be related to peri-ductal inflammatory hyperemia. No discrete underlying lesion. Probable small cysts in the periphery of segment 4A/8 and segment 6, unchanged. SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic head is mostly replaced by a 7.5 x 5.5 cm lobular cystic lesion with internal septations. The upstream pancreatic duct appears to drain into / communicate with this collection. The lesion demonstrates very thin peripheral enhancement. No mural nodularity. Previously this measured approximately 4.5 x 2.9 cm. Similar smaller multilobular septated cystic collection is noted caudally, slightly increased from the prior. There is moderate atrophy of the distal pancreatic parenchyma which is decreased in intrinsic T1 weighted signal intensity with side-branch ectasia. The parenchyma enhances homogeneously. The main pancreatic duct is dilated at the pancreatic tail which may reflect a stricture at the body/tail junction. No discrete mass is evident. No peripancreatic inflammatory changes are identified.No significant excretory response to secretin administration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate too small to characterize renal hypodensities, likely cysts. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: 1.Interval increase in biliary ductal dilatation, which may be due to increase in mass effect from the enlarging pseudocyst further described below. The underlying cause of the intrahepatic biliary dilatation is suspected to be multifocal stricturing, probably inflammatory, given the smooth thickening and enhancement seen on postcontrast images. The distribution is similar to prior exam. No mass lesion is evident. 2.Interval increase in size of the pancreatic head cystic lesion without suspicious imaging characteristics, likely a pseudocyst given patient's history. The main pancreatic duct drains into the collection. Mild pancreatic tail pancreatic ductal dilatation without a focal lesion, may reflect a stricture at the pancreatic body/tail, slightly increased from prior. No evidence of acute pancreatitis or vascular complication of previous recurrent pancreatitis. Stigmata of chronic pancreatitis.3.Although atypical, the strictures involving both the biliary tree and pancreatic duct raises the possibility of an autoimmune etiology, consider correlation with serum IgG if indicated.


Instruction: Generate impression based on findings.

Input: Evaluate for headaches. Rule out PRES syndrome: History of kidney transplant and chronic headaches. Recent worsening of headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered cerebral white matter T2 hyperintense foci. The ventricles and basal cisterns are normal in size and configuration. The cerebellar tonsils are minimally low-lying. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Mild scattered cerebral white matter T2 hyperintense foci are nonspecific, but no suggestive of posterior reversible encephalopathy syndrome.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 67 year old woman with cardiomyopathy, who is referred to assess for etiology.MEDICATIONS: furosemide, glipizide, aspirin, warfarin First Pass PerfusionThere is a global subendocardial perfusion defect present both during hyperemia and during resting conditions.Viability/ Myocardial ScarThere is no evidence of underlying myocardial infarction; however, there is an atypical pattern of late gadolinium enhancement which involves the basal to mid inferior wall and spares the endocardial border. This suggests the presence of underlying myocardial fibrosis.Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. There is global hypokinesis with regional variation. The overall LV ejection fraction is 23%, the LV end diastolic volume index is 134 ml/m2 (normal range: 65+/-11), the LVEDV is 245 ml (normal range 109+/-23), the LV end systolic volume index is 104 ml/m2 (normal range 18+/-5), the LVESV is 190 ml (normal range 31+/-10), the LV mass index is 67 g/m2, and the LV mass is 123 g. No LV thrombus is noted.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 31%, the RV end diastolic volume index is 93 ml/m2 (normal range 69+/-14), the RVEDV is 170 ml (normal range 110+/-24), the RV end systolic volume index is 64 ml/m2 (normal range 22+/-8), and the RVESV is 118 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 moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drains normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are large bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a global circumferential perfusion defect present during hyperemia and resting conditions. This finding could be secondary to severe multi-vessel coronary disease or due to significant congestive heart failure/ increased LVEDP.2. Severe LV dilation with severely reduced systolic function (LVEF 23%) with an atypical (non-myocardial infarction) pattern of late gadolinium enhancement involving the basal and mid inferior walls suggesting the presence of underlying myocardial fibrosis. This finding favors the diagnosis of non-ischemic cardiomyopathy.3. Normal RV size with moderately reduced systolic function (RVEF 31%).4. Severe left atrial dilation. 5. Small pericardial effusion.6. Large bilateral pleural effusions.


Instruction: Generate impression based on findings.

Input: Male, 69 years old, with weakness. The cervical lordosis is straightened. Trace anterolisthesis of C4 relative to C5 is seen. Alignment is otherwise unremarkable.Severe disc degeneration is seen particularly affecting the C4-5 through C6-7 levels. There is marked associated endplate marrow signal change including mild endplate edema at C5-6. Loss of disc height and degenerative loss of vertebral body height is seen along with bulky anterior osteophytesThere is perhaps minimal ill-defined cord T2 hyperintensity from C2 through C4. No cord expansion is seen. No epidural abnormalities are detected.C2-3: Left greater than right facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing. C3-4: Left facet arthropathy. Ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Moderate spinal canal stenosis with slight flattening of the ventral cord. Severe left and moderate right foraminal narrowing.C4-5: Left greater than right facet arthropathy. Ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Mild spinal canal stenosis with slight flattening of the ventral cord. Moderate bilateral foraminal narrowing.C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation. Moderate spinal canal stenosis with mild flattening of the ventral cord. Severe bilateral foraminal narrowing. C6-7: Facet arthropathy. Ligamentum flavum thickening. Posterior disc-osteophyte complex formation. Moderate spinal canal stenosis with slight flattening of the ventral cord. Severe left and moderate right foraminal narrowing.C7-T1: Facet arthropathy. Ligamentum flavum thickening. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing.

Output: Extensive cervical spondylosis is seen causing spinal canal stenosis from C3-4 through C6-7. The spinal cord is mildly indented at these levels and there may be areas of subtle myelomalacia but this is questionable. Scattered foraminal narrowing is also demonstrated most severely affecting C5-6 bilaterally and C6-7 on the left.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 55-year-old female. History of left mastectomy for IDC in September 2011 and reconstruction in 2012. History of right lumpectomy for carcinoma in 2003. There is scattered fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in right breast. There is a stable post lumpectomy change at 12 o'clock position in the right breast. Status post left mastectomy and reconstruction.No abnormal enhancement is seen in the reconstructed left breast.No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: History of cervical cancer status post radical trachelectomy. PELVIS:UTERUS, ADNEXA: Anteverted uterus. The junctional zone is normal in thickness. The vagina is not well distended. The cervical stroma is homogeneously low signal intensity on T2-weighted imaging without a discrete lesion evident to suggest tumor recurrence. No discrete nodules. Postsurgical changes limit evaluation of the postcontrast images.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy measuring greater than 1 cm in short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postoperative changes without findings to suggest disease recurrence. Please note that the 3T scanner was not immediately available and the patient was anxious to perform the exam which was subsequently done on the 1.5T scanner. If clinically indicated and there is continued clinical concern the patient can be called back for selective imaging.


Instruction: Generate impression based on findings.

Input: 90-year-old male with questionable seizure versus a stroke. The exam is limited by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a mild degree of periventricular and subcortical white matter hypoattenuation. There is a disproportionate prominence of the lateral ventricles compared to the sulci. There is diffuse cerebral and cerebellar volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses are grossly unremarkable. There is a small left scalp lipoma.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Mild chronic small vessel ischemic disease.3.Diffuse cerebral and cerebellar volume loss. 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: history of liver/ kidney transplant, adrenal adenoma seen on CT 3/2016 History: adrenal adenoma ABDOMEN:LIVER, BILIARY TRACT: Portal and hepatic veins are patent. No abnormal liver lesion is identified. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic native kidneys. Tiny T2 hyperintensity of the native left kidney too small to characterize. Mild perinephric fluid, likely chronic. Transplant kidney noted in the right lower quadrant.RETROPERITONEUM, LYMPH NODES: Mild thickening of the adrenal glands without significant change in appearance from prior study. No discrete adrenal lesion is identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Numerous foci of susceptibility artifacts in the anterior abdominal wall, which may be postsurgical.

Output: 1.Stable nodular thickening of the adrenal glands. No discrete adrenal lesion seen on current study.


Instruction: Generate impression based on findings.

Input: A 48 year old male with pericarditis on 2013 who developed constrictive pericarditis diagnosed by echocardiography, right heart cath and cardiac MRI (10/15/2014), referred to cardiac MRI as a follow up to decide about surgery. Left VentricleThe left ventricle is normal size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 169 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 77 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is abnormal interventricular septal motion. With realtime imaging, the abnormal septal motion / flattening is clearly more prominent in inspiration. There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. There is an interatrial septum aneurysm noted. 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 97 ml/m2 (normal range 82+/-16), the RVEDV is 173 ml (normal range 142+/-31), the RV end systolic volume index is 44 ml/m2 (normal range 31+/-9), and the RVESV is 84 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC normally into the right atrium. The IVC is very dilated consistent with elevated RA pressure. Dilated coronary sinus consistent with elevated RA pressure.PericardiumThere is no pericardial effusion. There is diffuse circumferential pericardial thickening (4-6mm) with mild late gadolinium enhancement. Thickening is most prominent over the RV and RA.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 size and systolic function, the LVEF is 55%. There are no regional wall motion abnormalities present. 2. There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 51%. 4. There is diffuse circumferential pericardial thickening (4-6mm) with mild late gadolinium enhancement. There are signs of interventricular dependence which varies with respiratory cycle. Several markers of significant elevation of RA pressure. Taken in combination these findings suggest pericardial constriction which is hemodynamically significant.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 23 years old Reason: evaluate for active Crohn's disease _ PREGNANT - NO IV GADOLINIUM History: history of Crohn's, disease - RLQ abdominal pain PREGNANT - NO IV GADOLINIUM ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild prominence of the collecting system on the right, physiologic given the gravid uterus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is moderately well distended. No evidence of acute inflammation or stricture within the limitations of this noncontrast study. The appendix is identified in the right upper quadrant without dilatation or surrounding inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Gravid uterus. The placenta is located on the anterior wall of the uterus. The fetus is incompletely assessed on this nondedicated study.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace fluid in the right upper quadrant.

Output: 1.No evidence of bowel abnormality within the limitations of this noncontrast study.2.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9] / Hemiplegia, unspecified affecting unspecified side [G81.90] / Diplopia [H53.2], Reason for Study: ^Reason: Hx of metastatic melanoma s/p premlozumab treatment with right hemiparesis, diplopia , R/o PRES, brain me Brain MRI:There are multiple restricted diffusion lesions involving left side lower midbrain-upper pons posterior aspect, left middle cerebellar peduncle and left superior cerebellar hemisphere indicating acute ischemic infarction without evidence of hemorrhagic transformation. There are also focal lacunar infarcts on the left basal ganglia posterior aspect and the right parietal lobe. Underlying brain shows multifocal patchy high signal intensity lesions on bilateral periventricular white matter indicating nonspecific small vessel disease.No evidence of metastasis.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate the left superior cerebellar artery is not visualized. This could be related to hypoplastic left SCA, however, could also represent focal occlusion. Bilateral distal ICAs, right distal vertebral artery, left PCA P2-P3 junction appear to be narrowed in luminal diameter indicating intracranial atherosclerosis.There is no evidence of intracranial arterial aneurysm. Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuous but normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Acute ischemic infarct involving left lower midbrain, upper pons, left middle cerebellar peduncle and part of left superior cerebellar hemisphere without evidence of hemorrhage transformation.2. Multiple lacunar infarcts with the nonspecific small vessel ischemic disease on underlying brain.3. Nonvisualization of left superior cerebellar artery. Underlying intracranial arterial system shows atherosclerotic changes. No intracranial aneurysm was seen. 4. No evidence of significant luminal stenosis on extracranial arterial system.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9] / Other amnesia [R41.3], Reason for Study: ^Reason: right subcortical stroke, memory difficulties History: as above. There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is encephalomalacia on the right basal ganglia with the susceptibility artifacts indicating prior hemorrhagic infarct.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Right basal ganglia chronic hemorrhagic infarction with encephalomalacia.No acute ischemic or hemorrhagic lesion on this scan.


Instruction: Generate impression based on findings.

Input: Reason: eval for fai History: HIP PAIN FOR 3 years s/p[ pelvic stress fx ACETABULAR LABRUM: Intra-articular gadolinium extends through the acetabular labrum at the 3 o'clock position indicating a full thickness tear.ARTICULAR CARTILAGE AND BONE: The alpha angle measures 47 degrees. No frank CAM deformity is identified. No evidence of cranial acetabular retroversion. There is no bone marrow signal abnormality to suggest a stress reaction/stress fracture as clinically questioned.SOFT TISSUES: The imaged musculature of the left hip is normal in appearance ADDITIONAL

Output: Anterior superior acetabular labral tear without frank CAM deformity.


Instruction: Generate impression based on findings.

Input: 9 year old boy with history of idiopathic epilepsy localizing to the left centro-temporal region on EEG. In the pineal gland (601/14) there is a 9 x 7 mm T2 hyperintense lesion with internal septation. The lesion has low T1 signal and does not suppress on FLAIR imaging. There is no significant susceptibility artifact to suggest calcification. There is no associated hydrocephalus and the ventricles are within normal limits in size and configuration. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No additional intracranial mass or mass-effect. The brain parenchyma is otherwise unremarkable for age. Specifically, the medial temporal lobes appear normal. The major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Subcentimeter pineal lesion, most likely benign. No associated mass effect, edema, or hydrocephalus. 2. Otherwise normal examination without findings to explain patient's seizures.


Instruction: Generate impression based on findings.

Input: LevocardiaNormal ventricular and atrial position.Interatrial and interventricular septa are intact; prior VSD patch noted. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 62 ml/m2 (normal range: 65+/-11), the LVEDV is 116 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 47 ml (normal range 31+/-10). Abnormal septal motion of unclear significance. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is severely dilated with mild-moderately reduced systolic function. The overall RV ejection fraction is 44%, the RV end diastolic volume index is 146 ml/m2 (normal range 69+/-14, previously measured as 114 ml/m2 (2013)), the RVEDV is 276 ml (normal range 110+/-24), the RV end systolic volume index is 82 ml/m2 (normal range 22+/-8, previously measured as 60 ml/m2 (2013) ), and the RVESV is 154 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately enlarged. The IVC, SVC and CS all drain into the RA normally.Aortic ValveThe aortic valve appears bicuspid. The aortic valve opens widely and there is at least mild aortic regurgitation.Mitral ValveThe mitral valve opens widely. The leaflets appear thickened and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is severe pulmonic regurgitation (regurgitant fraction = 57%, regurgitant volume = 60 ml).Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation .AortaThere is a left sided aortic arch. The aortic root is normal in size. There is an aberrant R SC artery arising from the distal aortic arch.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium and are of normal calibre.Pulmonary ArteryThe main pulmonary artery is moderately-severely dilated and there is marked infundibular enlargement. The RPA is severely dilated. The LPA was not well seen.Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is a persistent LSVC that drains into the RA directly (not the CS).PericardiumThere is no obvious pericardial effusion. Extracardiac FindingsThere is artefact from previous sternotomy. 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. LV size and systolic function are normal, LVEF 60%.2. RV is severely dilated with reduced systolic function, RVEF 44%. The RVEDV has increased from prior MRI (2013)3. Severe pulmonary regurgitation with regurgitant fraction 57% and regurgitant volume of 60 mL.4. Persistent LSVC to RA. 5. LPA not well seen.


Instruction: Generate impression based on findings.

Input: 54 year-old female patient with family history of breast cancer and 6 maternal aunts, 4 cousins, and paternal aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: The lobulated enhancing mass with areas of susceptibility effect and cystic components in the left lateral ventricle, appears minimally more prominent when compared to the prior examination, measuring 33 mm, previously 32 mm. There is persistent mild vasogenic edema in the surrounding brain parenchyma. There is also an enhancing mass within the right lateral ventricle, which measures up to approximately 10 mm, previously 8 mm. The lateral ventricles remain mildly prominent, unchanged from prior examination. There is no significant interval change in numerous foci of subcortical T2 hyperintensity, some of which demonstrate enhancement. There is no evidence of intracranial hemorrhage or acute infarct. There is a right cerebellar hemisphere developmental venous anomaly. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. There is minimal increase in size of the bilateral lateral ventricular subependymal giant cell astrocytomas. 2. Other stigmata of tuberous sclerosis are not significantly changed.3. Interval resolution of the left tympanomastoid fluid.


Instruction: Generate impression based on findings.

Input: Procedure: MRA NECK WWODiagnosis: Slurred speech Other specified disorders of muscleClinical question: eval vesselsSigns and Symptoms: stroke code w/u MRI of the brainNo diffusion weighted abnormalities are appreciated.There is redemonstration of a small focus of encephalomalacia along the pons an area measuring 12 x 8 mm axial dimensions associated with volume loss in the pons which is eccentric to the left side. There is associated T2 and flair signal hyperintensity in the left medulla and left cerebral peduncle.There are dilated perivascular spaces present throughout the cerebral white matter.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 minor opacities in the maxillary sinuses, right sphenoid sinus and left frontal sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small to medium size. The posterior communicating arteries are intact and small. The vertebral arteries are similar in size.The left PICA has extracranial origin.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The LCCA originates from the innominate artery.

Output: 1.There is redemonstration of an old small infarct involving the left pons which is associated with volume loss and some Wallerian degeneration2.there is no evidence for extracranial or intracranial cerebrovascular occlusive disease.3.There is no evidence for acute cerebral infarction


Instruction: Generate impression based on findings.

Input: 59 year old man with history of metastatic lung SCC s/p carbo/taxol, docetaxel, and PF 6647020 (PTK7 antibody-drug-conjugate, C2 2/4/15) c/b malignant pleural effusions who was found to have a drop in ejection fraction. Cardiac MRI done to evaluate function and etiology of cardiomyopathy. Left VentricleThe left ventricle is normal in size and mildly reduced systolic function. The overall LV ejection fraction is 43%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 127 ml (normal range 142+/-34), the LV end systolic volume index is 41 ml/m2 (normal range 25+/-9), the LVESV is 73 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 77 ml/m2 (normal range 82+/-16), the RVEDV is 134 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 68 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary Veins3 pulmonary veins drain normally into the left atrium (the LUPV was not well visualized)Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is an SVC catheter.PericardiumThere is a moderate sized pericardial effusion. There is diastolic compression seen of the right atrium and RV. There is delayed enhancement of the visceral pericardium of unclear significance.Extracardiac FindingsExtensive metastatic lymphadenopathy in the thorax, chest wall and abdomen. Left lung mass. Large sized pleural effusions seen; left greater than right. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function (43%). 2. The right ventricle is normal in size and systolic function (50%)3. Moderate sized pericardial effusion with diastolic compression of the right atrium and RV.4. Extra-cardiac findings as above.


Instruction: Generate impression based on findings.

Input: 21-year-old female patient with lower back and left hip pain. Evaluate for sacroiliitis. There is no increased signal on T2-weighted images in the sacroiliac joints. There is no abnormal enhancement on postcontrast images. Bone marrow signal is within normal limits. The intraperitoneal structures in the pelvis are unremarkable for patient's age.

Output: No evidence of sacroiliitis in either sacroiliac joint.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post fusion, evaluate for hematoma. Signs and symptoms: Back pain, left leg weakness. Nonenhanced thoracic MRI:Examination demonstrates normal anatomical alignment of vertebral column.The signal intensity of vertebral column demonstrate minimal changes secondary to degenerative disease and unremarkable otherwise.There is no detectable spinal canal compromise or stenosis and no evidence of epidural hemorrhage. There is no evidence of any significant neural foraminal compromise at any level.Signal intensity and caliber of thoracic cord remains beginning normal.Nonenhanced lumbar MRI:Examination is a status post posterior approach multilevel laminectomy and placement of fixating screws at L4 through S1 levels.Extensive increased T2 and decreased T1 signal intensity of paraspinal soft tissues consistent with edema and without detectable hematoma or any associated mass effect on the thecal sac is noted.There is no detectable epidural hemorrhage.There are no prior exams for comparison. There is a central and rightward disc extrusion at L5-S1 level (sagittal series images 7 and 8) which results in mass effect and posterior displacement of the thecal sac and mild central spinal stenosis. Although difficult to precisely assess due to metallic hardware artifact no convincing evidence of neural foraminal compromise.Examination also demonstrates an epidural defect on the left posteriorly and laterally at L5-S1 level (axial T2 series 8 images for an 5). The finding could represent degenerative changes from left articulating facet and possibility of a synovial cyst cannot be entirely excluded. The finding results in significant left lateral recess compromise. There are no prior exams for comparison however if such a studies are available and provided to the radiology department and an addendum to this report will be submitted after comparison.There is a ventral/left lateral T2 hypointense epidural defect at L4-L5 best appreciated on axial T2 series 8 on images 7 and 8 which demonstrated mass effect and posterior displacement of the thecal sac with resultant left lateral recess compromise. There is no convincing evidence of central spinal stenosis at this level. This finding is also well appreciated on sagittal T2 series 5 on images 9 through 11. Finding has the appearance of a large disc protrusion however possibility of a surgically placed prosthesis within the disc space cannot be excluded. If there are prior exams available and are provided to radiology department and addendum to this report will be submitted after comparison.

Output: 1.Nonenhanced MRI of the lumbar spine demonstrate extensive postoperative changes of posterior approach and fusion with placement of transpedicular screws at L4 through S1 as detailed. There is no evidence of epidural hemorrhage. There is a left-sided ventral epidural defect with resultant left lateral recess compromise which could represent a large disc protrusion, however possibility of postop change and including a surgically placed device within the disc space cannot be entirely excluded. At L5-S1 there is a large central and rightward disc extrusion which applies mass effect on the thecal sac with resultant mild central spinal stenosis as detailed.2.Unremarkable nonenhanced MRI of thoracic spine with the exception of mild degenerative changes as detailed.


Instruction: Generate impression based on findings.

Input: Sacral lesion There is a 2 cm focus of low signal intensity (signal void) on all sequences within the left sacral wing. This focus does not demonstrate enhancement and is representative of a benign bone island. There is no abnormal enhancement elsewhere in the pelvis.The hips appear normal for age. There is mild peritrochanteric edema bilaterally which is not necessarily of any clinical significance. There is mild osteoarthritis of the sacroiliac joints and minimal degenerative disc disease of the lower lumbar spine. The remaining visualized soft tissues are unremarkable.

Output: Large benign bone island of the left sacrum.


Instruction: Generate impression based on findings.

Input: 55 years Female Reason: sudden hearing loss right ear History: eval for mass or other etiology Provider Name: MAUREEN CROWLEY MAUREEN CROWLEY BRAINThe 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. There is redemonstration of a left temporal lobe developmental venous anomaly draining into the left basal vein of Rosenthal. No associated cerebral cavernous malformation or evidence for capillary telangiectasia is appreciated. There is redemonstration of asymmetry of the jugular bulbs and associated venous drainage with the right being significantly larger than the left. The left jugular bulb and associated venous drainage, as before, appears relatively small. There is redemonstration of an 8x11mm arachnoid granulation within the left transverse sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening along the floor of the left maxillary sinus which is unchanged from the prior exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.

Output: MRI of the brain and IACs are within normal limits.


Instruction: Generate impression based on findings.

Input: Diagnosis: Ankylosing spondylitis of unspecified sites in spineClinical question: myelopathySigns and Symptoms: pain and decreased motion Cervical spine:The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal. There is some fusion of the facet joints at this level as well as some facet hypertrophy.At C3-4 there is no significant compromise to the spinal canal . There is bilateral facet hypertrophy at this level. There is some encroachment of the exiting nerve roots within the neural foramina at this level.At C4-5 there is no significant compromise to the spinal canal . Findings suggest some fusion at the facet joints with facet hypertrophy. There is some encroachment of the exiting nerve roots within the neural foramina at this level.At C5-6 there is some loss of disc space height, disc desiccation and endplate and uncovertebral osteophytes. There is bilateral facet hypertrophy at this level. There is a diffuse disc bulge at this level. There is hypertrophy of the ligamentum flavum at this level. There is mild posterior subluxation of a C5 on C6. There is effacement of spinal fluid ventral and posterior to the spinal cord with minimal flattening of the spinal cord. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this level.At C6-7 there is no significant compromise to the spinal canal. There is a disc bulge at this level associated with endplate and uncovertebral osteophytes as well as some mild facet hypertrophy. There is narrowing of the neural foramina and encroachment of the exiting nerve roots bilaterally at this level. The encroachment of exiting nerve roots is worse on the left compared to the right side. Also some encroachment of the nerve roots at the left lateral recess at this level. Overall there is a mild degree of spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There is mild posterior ligamentum flavum hypertrophy at this level.The right vertebral artery flow-void is not identified and in fact there is T2 signal hyperintensity within the right vertebral artery.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. Marrow signal is of high signal on T1 indicating fatty replacement. On the prior exam marrow signal is more heterogeneous. There is loss of vertebral body height due to inferior endplate compression at L5 and due to superior endplate compression at L4, L3, L2 and L1 as well as T12.The anterior longitudinal ligament does appear thick. This is not appear to be any convincing evidence for enthesitis, though contrast enhanced imaging was not performed.At L5-S1 there is no significant compromise to spinal canal. There is some facet hypertrophy at this level with narrowing of the neural foramina. There is mild disc bulge at this level. The fat surrounding the exiting nerve roots within the neural foramina is not effaced at this level.At L4-5 there is moderate bilateral facet hypertrophy associated with a diffuse disc bulge and some epidural lipomatosis. There is narrowing of the thecal sac with effacement of the spinal fluid surrounding the nerve roots. There is narrowing of the neural foramina with effacement of the fat surrounding the exiting nerve roots within the neural foramina bilaterally. Overall there is a moderate to severe degree of spinal stenosis at this level associated with encroachment of the exiting nerve roots within the neural foramina bilaterally.At L3-4 there is no significant compromise to spinal canal or neural foramina. The fat surrounding the exiting nerve roots within the neural foramina is mildly effaced at this level. There is mild to moderate facet hypertrophy at this level. The fat at the lateral recesses is not effaced at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are multiple cystic lesions in the kidneys and the kidneys appear to be relatively small.

Output: 1.There is fusion across the facet joints in the upper cervical spine. There is a CT of the maxillofacial bones which demonstrate cyst in greater detail and also demonstrates some anterior osseous bridging at the C1-2 and C2-3. A CT of the cervical spine would be of further benefit in assessing extent of facet joint and vertebral ankylosis.2.There are multilevel degenerative changes in the cervical spine with findings compatible with a moderate degree of spinal stenosis with mild subluxation at C5-6 and neural foraminal encroachment of exiting nerve roots bilaterally at C3-4, C4-5, C5-6 and C6-7.3.Occlusion of the right vertebral artery.4.There are multilevel degenerative changes present in the lumbar spine with moderate to severe spinal stenosis at L4-5 where there is also encroachment of the exiting nerve roots within the neural foramina. This was also present on 11/7/2014 and has not changed.5.There is multilevel loss of vertebral body height in the lumbar spine.6.There is no convincing evidence for any active Romanus lesion. Please note that examination the sacroiliac joints was not performed7.Multiple cystic type lesions are present in the kidneys which have also been present on prior abdomen CTs8.In general the marrow signal in the lumbar spine appears somewhat more hyperintense. This raises the possibility of prior radiation treatment. Please correlate with patient's clinical history.


Instruction: Generate impression based on findings.

Input: 87-year-old male with elevated INR and history of falls. There is no evidence of intracranial hemorrhage, mass or edema. Hypodensities in both cerebellar hemispheres, left greater than right, as well as in the basal ganglia, are consistent with prior strokes. Confluent areas of hypodensity in periventricular and subcortical white matter are consistent with extensive small vessel ischemic disease of indeterminate age.There is prominence of the ventricles and sulci, consistent with parenchymal volume loss, appearing similar to prior MRI.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1.No evidence of intracranial hemorrhage or other acute abnormality. 2.Evidence of extensive small vessel ischemic disease and prior strokes in basal ganglia and cerebellum.


Instruction: Generate impression based on findings.

Input: 56-year-old man with history of resolved ischiorectal fossa abscess status post surgical treatment of fistula in August 2015, now with persistent perineal wound. PELVIS:PROSTATE/SEMINAL VESICLES: The prostate and seminal vesicles appear normal.BLADDER: The bladder is normal.LYMPH NODES: Subcentimeter pelvic and bilateral external iliac lymph nodes are noted, probably reactive. There is no significant lymphadenopathy.BOWEL, MESENTERY: The rectosigmoid colon appears normal.BONES, SOFT TISSUES: There is a complex network of sinus tracts and fistulae with multiple branches. The first branch extends from the 1:00 position of the left gluteal cleft (series 8, image 64), courses transsphincteric, and terminates the undersurface of the right penis. The second branch extends from the first (series 8, image 68), courses intersphincteric, and loops around to the right gluteal cleft. A third branch extends from the first (series 8, image 55) and terminates as a sinus tract immediately posterior to the left apex of the prostate (series 8, image 46).Susceptibility artifact in the left lesser trochanter probably related to orthopedic hardware.OTHER: No significant abnormality noted.

Output: Complex network of sinus tracts and fistulae as described above and annotated on key images.


Instruction: Generate impression based on findings.

Input: Metastatic breast adenocarcinoma. There is an unchanged T1 hyperintense cyst lesion in the pituitary that measures up to 10 mm in width and 6 mm in height. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is a nonspecific subcentimeter right apical scalp nodule.

Output: An unchanged lesion in the pituitary gland likely represents a pars intermedia cyst. Otherwise, no evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 57 year old with history of becker muscular dystrophy and heart transplant in 2012 presenting for routine surveillance of transplanted heart. MEDICATIONS: pravastatin, prednisone, tacrolimus, terazosin, valsartan First Pass PerfusionDuring hyperemia, no perfusion defects were present. Notably in the basal septum there is intermittent low signal which is most consistent with artifact. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 71%, the LV end diastolic volume index is 45 ml/m2 (normal range: 74+/-15), the LVEDV is 97 ml (normal range 142+/-34), the LV end systolic volume index is 13 ml/m2 (normal range 25+/-9), the LVESV is 28 ml (normal range 47+/-19), the LV mass index is 45 g/m2, and the LV mass is 97 g. There are no regional wall motion abnormalities present. No intracardiac thrombus.Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 48 ml/m2 (normal range 82+/-16), the RVEDV is 103 ml (normal range 142+/-31), the RV end systolic volume index is 21 ml/m2 (normal range 31+/-9), and the RVESV is 44 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsPost surgical findings consistent with previous heart transplant.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia. 2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 71%).4. Normal RV size and systolic function (RVEF 58%).


Instruction: Generate impression based on findings.

Input: A patient submitted outside studies for review. Submitted for review are diagnostic mammogram and ultrasound dated 6/1/2015, ductogram and ultrasound-guided biopsy with postprocedural mammogram dated 6/2/2015, and breast MRI dated 6/4/2015, performed at Franciscan alliance. For comparison, screening mammogram and ultrasound performed at St. Margaret Mercy North dated 5/2/2007 and breast MRI dated 4/2/2007 performed at University of Chicago, are available. Family history of breast cancer diagnosed in mother at age 59. Diagnostic mammogram dated 6/1/2015 performed for the complaint of right nipple discharge for 4 days: Two standard views of both breasts, right ML view and 3 spot compression views of the right breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Multiple subcentimeter partially circumscribed masses present in both breasts are minimally increased from prior exams, previously documented to be cysts . No suspicious microcalcifications or areas of architectural distortion are noted in either breast. Right breast Ultrasound dated 6/1/2015: In the subareolar right breast at 9:00 there is a 7 x 7 mm hypoechoic mass. In the 3:00 subareolar area there is a focal dilated duct with low internal echoes which may represent mass or debris. A biopsy of both lesions was recommended at this time.Right breast ductogram dated 6/2/2015: 3 images are provided. A single duct was cannulated with mild areas of focal ectasia but no mass or filling defect.Right breast ultrasound-guided biopsy and postprocedural mammogram dated 6/2/2015: Biopsy of the 9 o'clock right breast mass demonstrated atypical intraductal papilloma, concordant with imaging findings. Biopsy of the 3:00 right breast mass demonstrated ductal ectasia with usual ductal hyperplasia and inflammatory changes, also concordant with imaging findings. Postprocedural mammogram demonstrated a ribbon clip placed at the 9:00 site and a wing clip was placed at the 3:00 side.Bilateral breast MRI dated 6/4/2015: Images were reviewed primarily on PACS and DynaCAD.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Multiple bilateral T2 bright T1 low signal masses in both breasts are consistent with cysts, some with peripheral rim enhancement. Retroareolar susceptibility artifact is consistent with clip placement. In the right breast at 12:00 there is a focus of enhancement with associated high T2 signal likely representing a cyst or fibroadenoma. At 8:30 in the right breast a small enhancing focus seen on the prior exam compatible with lymph node or fibroadenoma, unchanged. There is no suspicious or uniquely enhancing lesion corresponding to the known intraductal papilloma or otherwise within either breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Right breast atypical intraductal papilloma (ribbon clip at 9:00) for which surgical consultation is recommended. No additional suspicious lesions are noted in either breast.2. Multiple bilateral benign-appearing breast cysts and mild ductal ectasia in the right breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: There may be slight asymmetric rotation of the hippocampi, which are otherwise intact. There is no evidence of heterotopia or hamartomas. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No potential seizure foci are identified.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 76 year old man with recent diagnosis of asymptomatic LV dysfunction and PVC's after preoperative evaluation, here for cardiac MRI with vasodilator stress testing to rule out ischemic heart disease.MEDICATIONS: Toprol, lisinopril First Pass PerfusionDuring hyperemia, there were no perfusion defects present.Viability/ Myocardial ScarThere is high suspicion for the presence of late gadolinium enhancement in the basal inferolateral and lateral wall, the extent of which is difficult to discern due to associated wall thinning. It appears subendocardial which would suggest possible prior myocardial infarction. The remainder of the myocardium is viable.Left VentricleThe left ventricle is severely dilated with moderate-severely reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 137 ml/m2 (normal range: 74+/-15), the LVEDV is 287 ml (normal range 142+/-34), the LV end systolic volume index is 86 ml/m2 (normal range 25+/-9), the LVESV is 180 ml (normal range 47+/-19), the LV mass index is 41 g/m2, and the LV mass is 86 g. There is global hypokinesis with regional variation. There is asymmetric wall thickness, with notable thinning of the basal anterior, lateral and inferolateral wall, but the septal thickness is within normal limits (10mm).Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 75 ml/m2 (normal range 82+/-16), the RVEDV is 156 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 65 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is upper normal in size (maximal dimension 39 x 38mm in ascending aorta). There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC 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. No perfusion defects/ "ischemia" present during hyperemia.2. There is global hypokinesis with regional variation. There is asymmetric wall thickness, with notable thinning of the basal anterior, lateral and inferolateral wall, but the septal thickness is within normal limits (10mm). There is high suspicion for the presence of late gadolinium enhancement in the basal inferolateral and lateral wall, the extent of which is difficult to discern due to associated wall thinning. It appears subendocardial which would suggest possible prior myocardial infarction. The remainder of the myocardium is viable.3. Severely dilated LV size and moderate-severely reduced systolic function (LVEF 37%).4. Normal RV size and systolic function (RVEF 58%).


Instruction: Generate impression based on findings.

Input: Aphasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is diffuse patchy cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a right lens implant.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. Diffuse patchy cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: low back pain. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level.The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: disc dessication, no neuroforaminal narrowing or spinal stenosis. L1-L2: disc dessication, minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L2-L3: disc dessication, minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L3-L4: disc dessication, minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: disc dessication, minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: Minimal degenerative changes of intervertebral discs, lumbar spine.Multilevel minimal disc bulging, otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: There is an ovoid lesion within the central spinal cord centered at the T1 level that measures 9 x 8 x 21 mm in the transverse by cc dimensions. It is peripherally hyperintense on T1 and homogeneously hyperintense on T2-weighted imaging with a thin peripheral rim of T2 hypointensity. There is no appreciable enhancement. There are minimal patchy foci of T1 and T2 hyperintensity both above and below the lesion extending from the C7 - T2 levels. There is no significant edema outside this region. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. There is a congenitally narrow cervical spinal canal. Superimposed upon this are mild degenerative changes, including small disc-osteophyte complexes and uncovertebral joint arthropathy. These findings result in mild spinal canal stenosis at C4-C5, C5-C6, and C6-C7, as well as moderate to severe bilateral neural foramen narrowing at C5-C6. Within the thoracic spine there are scattered mild degenerative changes including multiple small central disc protrusions, most prominent at T5-T6, where it indents the ventral thecal sac and results in mild spinal stenosis.

Output: 1. Findings most compatible with a late subacute spinal cord hematoma or hematomyelia with minimal edema centered at the T1 level, whereby spontaneous hemorrhage, post-traumatic hemorrhage, hemorrhagic infarction, or an underlying cavernous malformation are potential etiologies, for example. An underlying neoplasm is perhaps less likely, given absence of associated enhancement. Nevertheless, follow up imaging would be useful for further characterization.2. Multilevel mild degenerative spondylosis, most prominent at T5-T6, where a disc-osteophyte complex effaces the ventral thecal sac and results in mild spinal stenosis.Findings called to Dr. Ali Ahmer by Dr. Michael Rozenfeld at 4:45pm on 1/14/15. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: First metatarsal phalangeal pain There is a small amount of edema in the volar aspect of the first metatarsal head . There is also a small amount of fluid in the the metatarsophalangeal joint. These findings represent mild osteo- arthritis

Output: Mild degenerative changes in the first metatarsal pharyngeal joint. Otherwise negative


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Right-sided weakness. Non-enhanced CT brain:The examination is suboptimal due to fact that patient was unable to lie flat for study. The images are noisy and evaluation for subtle findings is not possible. Within this limitation however no definitive evidence of any abnormality is identified. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Recommend repeat CT or an MRI of brain if concern for stroke persist.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: Suboptimal exam due to difficulty positioning the patient within the gantry properly. No gross abnormalities detected. Follow up with repeat CT exam or an MRI is recommended if clinical concern for stroke persist.


Instruction: Generate impression based on findings.

Input: Reason: rule out biliary stones History: lab abnormalities ABDOMEN:LIVER, BILIARY TRACT: No evidence of intrahepatic biliary ductal dilatation. The common bile duct measures up to 7 mm in diameter. No common bile duct stones are seen.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is mild prominence of the left collecting system.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: No evidence of biliary stones as clinically questioned. Common bile duct measures up to 7 mm.


Instruction: Generate impression based on findings.

Input: 57-year-old male. Severe right shoulder pain, history of injury. ROTATOR CUFF: Supraspinatus and subscapularis tendinosis without evidence of a full-thickness tear. No edema or atrophy of the rotator cuff muscles.SUPRASPINATUS OUTLET: Moderate osteoarthritis of the acromioclavicular joint with mild subchondral edema and bone hypertrophy. GLENOHUMERAL JOINT AND GLENOID LABRUM: Intermediate signal intensity in the substance of the superior labor that extends into the intra-articular biceps tendon is consistent with a SLAP tear.No Hill-Sachs deformity. Tiny degenerative cyst in the superior glenoid. No focal worrisome marrow signal abnormality.BICEPS TENDON: Extra-articular biceps tendon is normal in signal and is located in the bicipital groove.ADDITIONAL

Output: 1. Supraspinatus and subscapularis tendinosis. 2. Findings consistent with a SLAP tear with extension into the intra-articular biceps tendon.


Instruction: Generate impression based on findings.

Input: 53 year old female with history of low back pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights and intervertebral discs are preserved. Alignment is within normal limits. Bone marrow signal is unremarkable. The conus medullaris is normal in position terminating at the level of L1. The paraspinous soft tissues are within normal limits. Small left renal cyst.Minimal multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No significant spinal canal or neuroforaminal stenosis. L2-L3: No significant disc disease. No significant spinal canal or neuroforaminal stenosis.L3-L4: No significant disc disease. No significant spinal canal or neuroforaminal stenosis. Mild facet hypertrophy. Small facet effusion on the left.L4-L5: No significant disc disease. No significant spinal canal or neuroforaminal stenosis. Mild facet hypertrophy. Small facet effusion on the right.L5-S1: No significant disc disease. No significant spinal canal or neuroforaminal stenosis. Mild facet hypertrophy.

Output: Minimal facet arthropathy as above without significant neuroforaminal or spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: History of FNH. ABDOMEN:LIVER, BILIARY TRACT: Mild fatty liver. Right hepatic lobe lobular mass measures approximately 10.3 x 9.8 cm demonstrating mildly heterogeneous mild T2 weighted hyperintensity. The mass is relatively isointense to liver parenchyma on T1-weighted imaging. It demonstrates fairly homogeneous arterial phase enhancement. The mass becomes relatively isointense to liver parenchyma on portal venous phase imaging. On delayed phase/redistribution imaging and hepatobiliary phase imaging at 10 minutes, 20 minutes and 1 hour it demonstrates relatively decreased signal intensity / uptake of hepatobiliary agent compared to the remainder of the liver parenchyma.The lesion displaces the anterior division of the right portal vein and abuts the posterior division.Small likely reactive porta hepatis lymph nodes.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right hepatic lobe biopsy-proven FNH is not significantly changed in size measuring 10.3 x 9.8 cm with imaging features on delayed and hepatobiliary phase imaging suggesting an atypical focal nodular hyperplasia. Only 4 out 128 FNHs demonstrated hypointensity on delayed and hepatobiliary phase imaging in a previously published large cohort of liver lesions (Grazioli L, Morana G, Kirchin MA, Schneider G. Accurate differentiation of focal nodular hyperplasia from hepatic adenoma at gadobenate dimeglumine–enhanced MR imaging: prospective study. Radiology 2005;236(1):166–177.).


Instruction: Generate impression based on findings.

Input: Reason: cuff tear; prior repair History: pain ROTATOR CUFF: 4 suture anchors are identified within the greater tuberosity presumably related to prior rotator cuff repair. There is a full-thickness tear of the supraspinatus with retraction to the level of the superior aspect of the humeral head, measuring approximately 1.4 cm in the AP dimension. There is associated delamination which extends proximally along the proximal tendon fragment. There is fatty atrophy of the supraspinatus.There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. There is mild fatty atrophy of the infraspinatus.The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small to moderate amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Linear increased signal abnormality traverses the anterior inferior labrum indicating degeneration with probable degenerative tearing. There is thinning of the articular cartilage along the humeral head.BICEPS TENDON: The intra-articular portion of the long head of the biceps tendon is poorly visualized indicating a full-thickness tear at the level of its transition from the bicipital groove to the rotator interval.ADDITIONAL

Output: 1. Postoperative changes of prior rotator cuff repair. There is a full-thickness tear of the supraspinatus with delamination as described above.2. Full-thickness tear of the tendon of the long head of the biceps at the level of its transition from the bicipital groove to the rotator interval.


Instruction: Generate impression based on findings.

Input: 60-year-old male with acute neurologic change, anisocoria, facial twitching. Brain MRI:There is no acute infarct or intracranial hemorrhage. There is mild-to-moderate involvement of the frontoparietal white-matter by patchy T2 hyperintense lesions, which is nonspecific though likely represent chronic microvascular ischemia. There is mild-to-moderate brain volume loss. There is diffuse ventricular enlargement which is slightly more pronounced than the enlargement of the sulci and basal cisterns. There is also an empty sella, which is likely an incidental finding at this age. There is fluid signal in the mastoid air cells, bilaterally, which might be congestive in nature. There is minimal dependent fluid in the sphenoid and posterior ethmoid sinuses. The skull is mildly diffusely thickened, which is nonspecific.Cranial MRA:The left internal carotid artery is slightly smaller than the right along with a hypoplastic left A1 segment. There is preserved flow in the left A2 segment through an enlarged anterior communicating artery. Otherwise, there is no flow limiting intracranial arterial stenosis or aneurysm.Neck MRA:This is a noncontrast-enhanced examination, which is limited, especially for the assessment of the origins of the neck vessels.The left cervical carotid arteries are slightly smaller than the right which is probably congenital. Otherwise, there is no high-grade focal stenosis of the cervical carotid or vertebral arteries.

Output: 1.No evidence of acute infarct, hemorrhage, or intracranial mass effect.2.Moderate cerebral changes of chronic microvascular ischemia and mild brain volume loss. Ventricular dilatation appears slightly out of proportion to the degree of volume loss raising a possibility of normal pressure hydrocephalus/communicating hydrocephalus in the appropriate clinical setting.3.No significant cranial or cervical stenoocclusive disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Images are partially degraded by motion artifact. There is prominence of the ventricles as well as the subarachnoid spaces around the frontal and temporal lobes, consistent with benign expansion of the subarachnoid spaces in infancy. Additionally, the insulae are somewhat exposed for age, which may suggest underdevelopment of the opercular gyri, although this may also be related to BESS. The basal cisterns remain patent. There is no midline shift or mass effect. Myelination appears appropriate for age. There are no areas of abnormal signal or diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1.No definite parenchymal lesion or structural abnormality is identified.2.Findings consistent with benign expansion of the subarachnoid space in infancy, which should resolve by age 2. If symptoms persist, follow-up imaging after 2 years of age may be considered.


Instruction: Generate impression based on findings.

Input: Clinical question: Multiple sclerosis; follow-up progression. Signs and symptoms: Leg weakness. Nonenhanced thoracic MRI:Examination demonstrates fairly extensive patchy foci of/T2 STIR hyperintensity throughout the thoracic cord with evidence of regions of mild cord decreased caliber. The very large number of lesions as well as lack of intravenous contrast injection makes precise comparison with prior study difficult. Within this limitation however there is no convincing evidence of recurrent interval progression of disease.Signal intensity and anatomical alignment of vertebral column remains within normal. There is no evidence of a spinal canal compromise or stenosis at any level. There is also no evidence of any significant neural foraminal compromise at any level. No detectable. Spinal soft tissue abnormalities.

Output: 1.Extensive changes of demyelinating disease throughout the thoracic cord and with decreased cord caliber as detailed.2.The extent of disease appears similar to prior exam, however large number of lesions and lack of intravenous contrast precludes precise comparison with prior study.


Instruction: Generate impression based on findings.

Input: Pituitary lesion, on Cabergoline. There is an unchanged intrinsically T2 hyperintense punctate lesion situated between the adenohypophysis and neurohypophysis. There is also an unchanged subcentimeter slightly hypoenhancing lesion in the right lateral sella, with extension into the medial cavernous sinus. The infundibulum is intact. There is no mass effect upon the optic apparatus. The imaged portions of the brain are unremarkable.

Output: 1. Unchanged subcentimeter lesion in the right lateral sella, with extension into the medial cavernous sinus, which may represent a microadenoma. 2. Unchanged punctate pituitary lesion situated between the adenohypophysis and neurohypophysis, which may represent a pars intermedia cyst.


Instruction: Generate impression based on findings.

Input: 53 year old woman with new diagnosis of heart failure, referred for cardiac MRI for further evaluation of underlying etiology and viability. Left VentricleThe left ventricle is moderate-severely dilated with severely reduced systolic function. The overall LV ejection fraction is 24%, the LV end diastolic volume index is 112 ml/m2 (normal range: 65+/-11), the LVEDV is 225 ml (normal range 109+/-23), the LV end systolic volume index is 85 ml/m2 (normal range 18+/-5), the LVESV is 171 ml (normal range 31+/-10), the LV mass index is 91 g/m2 (normal range 67+/-11), and the LV mass is 183 g (normal range 114+/-24). These is septal dyssynchrony. LV dysfunction is global with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The entire myocardium is viable. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 61 ml/m2 (normal range 69+/-14), the RVEDV is 122 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 64 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. There is trace mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild-moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with what appears to be a psuedo-bovine branching pattern (left internal carotid and left subclavian artery arise from a common origin), however this evaluation is limited by image quality in this region. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderate-severely dilated with severely reduced systolic function. The overall LV ejection fraction is 24%. LV dysfunction is global with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The entire myocardium is viable.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 47%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, history of pituitary adenoma status post resection and radiation. Heterogeneously enhancing tissue is redemonstrated within the sella compatible with the stated history. As before, components of this tumor are suspected to be present bilaterally within the sella, within the right cavernous sinus, and questionably within the left cavernous sinus. The portion of the tumor which resides in the right half of the sella and right cavernous sinus is not as discretely visualized as on the prior examination, but this may represent differences in imaging technique.The overall size of the abnormal tissue is stable to slightly smaller. The left aspect of the tumor measures up to 12 mm in height, including a portion which encroaches upon the sphenoid sinus, previously 13 mm in height. In the sagittal plane, the lesion measures 24 x 12 mm, previously 27 x 13 mm. The left sellar aspect of the lesion demonstrates more discrete central hypoenhancement than on the prior exam.Minimal encroachment upon the suprasellar cistern is again seen. The optic apparatus is not well visualized which may reflect some degree of atrophy or imaging artifact. The pituitary stalk continues to deviate towards the right.Again seen is an apparently separate dural based mass along the left anterior clinoid process and sphenoid wing which is unchanged in size measuring 15 x 4 mm in the coronal plane. This lesion abuts the supraclinoid left ICA without significant vascular compromise. Extensive confluent periventricular T2 hyperintensityand parenchymal volume loss are partially imaged similar to prior.

Output: 1. Sellar tumor is stable to slightly smaller with interval increased central hypoenhancement on the left. Findings may represent response to treatment or differences in imaging technique.2. Apparently separate dural based mass along the left anterior clinoid and sphenoid wing is unchanged in size, possibly representing a meningioma.


Instruction: Generate impression based on findings.

Input: 41-year-old woman with history of biliary ductal dilatation on CT and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintense foci most likely cysts. The liver is otherwise normal in signal and morphology.There is no dilation of the intra or extrahepatic bile ducts. There is no evidence of luminal filling defect or extrinsic compression. Gallbladder sludge is noted without cholelithiasis or evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Somewhat limited study but intra- and extrahepatic bile ducts normal in caliber. No evidence of masslesion.


Instruction: Generate impression based on findings.

Input: Concern for cirrhosis seen on ultrasound with increasing alkaline phosphatase. ABDOMEN:LIVER, BILIARY TRACT: There is mild relative hypertrophy of the left hepatic and caudate lobe with mild fissural prominence. No focal lesion. The signal intensity of the liver is normal without significant fatty infiltration. No intrahepatic or extrahepatic periductal dilatation. Partially contracted gallbladder. The vessels are patent.SPLEEN: Marked splenomegaly measuring 18 cm in craniocaudal dimension without a focal lesion. The splenic vein is patent.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Marked splenomegaly without a focal lesion or splenic vein occlusion. 2. Morphologic changes very suggestive of chronic liver disease without a focal liver lesion.


Instruction: Generate impression based on findings.

Input: Left knee pain, instability, crepitus with flexion. Joint effusion. Question of prior ACL injury. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is near full thickness to full thickness loss of cartilage of the median eminence of the patellar articular cartilage with underlying subchondral edema. There is thinning of the articular cartilage of the lateral femoral condyle above the anterior meniscal horn with minimal subchondral edema. The articular cartilage of the medial femoral condyle is intact.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Lesion anterior to the ACL may represent arthrofibrosis or focal PVNS.2. Additional focal areas of signal abnormality may also represent focal PVNS.3. Chondromalacia as described above.


Instruction: Generate impression based on findings.

Input: 54-year-old male with left knee pain, rule out tendon tears MENISCI: The lateral meniscus is intact. There is a complex tear at the root posterior horn junction of the medial meniscus with radial and longitudinal components. There is mild intrasubstance signal within the body of the medial meniscus, which may represent mucoid degeneration, without a discrete tear evident. The anterior horn of the medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild edema within the posterior aspect of the medial tibial plateau immediately adjacent to the torn medial meniscus. There is diffuse thinning of the articular cartilage in the medial compartment without full-thickness cartilage loss. The articular cartilage in the lateral compartment is intact. Small tricompartment osteophytes are present. There is a subchondral cyst and edema along the lateral aspect of the lateral patellar facet with overlying partial thickness cartilage loss, raising the possibility of patellar instability, however no kissing contusion is seen within the medial femoral condyle. In addition, there is edema within the superior lateral infrapatellar fat pad with mild increased signal within the patellar tendon origin. The tibial tubercle trochlear groove (TTTG) distance is 20 mm, however there is no evidence of trochlear dysplasia. There is patella alta with an Insall-Salvati ratio of 1.45.LIGAMENTS: ACL and PCL are intact. Edema surrounds the MCL, which may indicated grade 1 sprain. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: Mildly increased signal within the patellar tendon origin as above. The quadriceps tendon is intact.ADDITIONAL

Output: 1.Complex tear at the medial meniscal root posterior horn junction.2.Findings suggestive of patellar instability.3.Grade 1 sprain of the MCL.4.Mild osteoarthritis.