Instruction: Generate impression based on findings.

Input: New onset headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal nonspecific punctate foci of high T2 signal in the cerebral white matter. The brain parenchyma, brainstem, and cerebellum otherwise appear unremarkable. There is no abnormal intracranial enhancement. There is flattening of the pituitary gland. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is apparent constriction of the bilateral transverse sinuses. The major cerebral artery flow voids are intact. The orbits, skull, paranasal sinuses, mastoid air cells, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. Flattening of the pituitary gland, along with constriction of the bilateral transverse sinuses can be a sign of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Cavernous angioma follow-up. There is an unchanged cavernous malformation that measures up to 9 mm, with an associated developmental venous anomaly in the left frontal lobe, but no surrounding edema. There is also an unchanged subcortical focus of high T2 signal in the posterior left frontal lobe without enhancement or susceptibility effect. There is no evidence of acute intracranial hemorrhage or infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Unchanged left frontal lobe cavernous malformation and associated developmental venous anomaly.2.A persistent small lesion in the posterior left frontal lobe remains nonspecific, but may represent a form of white matter abnormality that can be associated with cavernous malformations, for example.


Instruction: Generate impression based on findings.

Input: Thumb sprain, ulnar collateral ligament Note that the examination is limited secondary to motion artifact affecting the axial sequences.There is abnormal signal intensity and decreased caliber of the ulnar collateral ligament, particularly dorsally, suggesting prior tearing which is at least partial in nature (series 7, images 6 and 7 of 16). There is no surrounding soft tissue or marrow edema along the ulnar aspect of the thumb to suggest an acute injury. The radial collateral ligament is intact.There is increased marrow signal within the distal phalanx of the thumb as well as the head of the proximal phalanx. There is also increased signal of the surrounding soft tissues however on STIR sequences, these signal abnormalities are absent and as a result, they're thought to be artifactual in nature. There is however a small amount of edema within the flexor pollicis brevis muscle although the remaining musculature of the visualized hand and thumb is normal.

Output: 1. Findings suggestive of remote ulnar collateral ligament injury with abnormal signal intensity and decreased caliber of the ligament particularly dorsally.2. Mild edema of the flexor pollicis brevis muscle.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity weakness and numbness. Evaluate for cause. Status post debridement and wound closure on 6/2. Examination is motion degraded slightly limiting evaluation. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is heterogeneous with low T1 hypointensity without discrete destructive osseous lesions demonstrated. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is disc desiccation and mild diffuse disc bulge. No significant spinal canal stenosis. Minimal bilateral neural foraminal narrowing. Mild facet arthrosis in the lumbar spine. Minimal fluid is noted in the subcutaneous soft tissues at the level of the sacrum which extends below the field-of-view. Lack of contrast slightly limits evaluation however no discrete fluid collection or abscess involving the spinal canal or paraspinous soft tissues is demonstrated.

Output: 1. No findings to explain patient's symptoms. There is minimal fluid which is seen involving the superficial subcutaneous soft tissues overlying the visualized portion of the sacrum. No findings to suggest discitis-osteomyelitis in the lumbar spine. No epidural collections or abscess in the lumbar spine. No obvious paraspinous fluid collections.2. Mild degenerative changes, particularly at L5-S1, without significant spinal canal or neural foraminal stenosis at any level.3. Diffuse low T1 marrow signal which is nonspecific and can be seen in entities such as chronic anemia, for example.


Instruction: Generate impression based on findings.

Input: Craniocervical junction appears within normal limits. Vertebral body heights are within normal limits. Alignment is grossly maintained. Bone marrow signal is benign. There is diffuse narrowing of the upper and mid cervical spinal canal on a congenital basis primarily related to pedicle hypoplasia. Neural foramina are diffusely narrowed on a congenital basis as well.There is focal increased signal within the cord at C5-C6 at the site of a disc extrusion which is suspected to represent edema. Individual levels as below:C2-C3: Mild to moderate right neural foraminal stenosis. No significant spinal canal or left neural foraminal stenosis. C3-C4: Moderate left greater than right neural foraminal narrowing. Mild to moderate spinal canal narrowing on a congenital basis.C4-C5: Mild to moderate left neural foraminal stenosis and mild right neural foraminal stenosis. There is mild to moderate spinal canal stenosis on a congenital basis. C5-C6: There is a disc extrusion causing moderate to severe narrowing of the spinal canal. There is moderate to severe left and moderate right neural foraminal stenosis. Abnormal T2 signal noted in the bilateral cervical cordC6-C7: Mild to moderate right and minimal left neural foraminal narrowing. No significant spinal canal narrowing.C7-T1: No significant spinal canal stenosis. Moderate left and mild right neural foraminal narrowing.Focus of low signal posterior to the thecal sac at T2-T3 seen only on the sagittal sequences is suspected to represent ligamentous calcification and causes mild narrowing of the spinal canal.

Output: 1.Disc extrusion at C5-C6 results in moderate to severe spinal canal narrowing and T2 hyperintensity involving the cervical cord which is suspected to represent edema. There is also moderate to severe neural foraminal narrowing on the left and moderate on the right.2.Congenital narrowing of the upper and mid cervical spinal canal as well as of the neural foramina. There are mild superimposed degenerative changes with resulting stenoses as detailed above. 3.Focus of low signal posterior to the thecal sac at T2-T3 may represent a focus of ligamentous calcification and causes mild narrowing of the thoracic canal.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 73-year-old female with mass in the liver. ABDOMEN:LIVER, BILIARY TRACT: In hepatic segment 2, there is a 3.6 x 2.5 cm cyst (series 7 image 30, series 10 image 78).In hepatic segment 4A, there is a 3.5 x 4.7 cm T2 hyperintense, T1 hypointense lesion demonstrating contiguous peripheral enhancement (series 10 image 284). The imaging features are not typical for a hemangioma. The lesion also demonstrates restricted diffusion (series 6 image 114). No intra or extrahepatic biliary ductal dilatation.Normal gallbladder.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: 1.Hepatic segment 4A lesion demonstrating contiguous peripheral enhancement does not have features of a typical hemangioma, and a neoplastic process (including malignancy) remains in the differential.2.Hepatic segment 2 cyst.


Instruction: Generate impression based on findings.

Input: 6-year-old male, evaluate for lymphangioma. PELVIS:Originating in the distal right inguinal canal and extending into the scrotum is a lobular multicystic nonenhancing structure with fluid fluid levels, in conglomerate measuring 4.5 cm x 4.2 cm (series 401, image 5). The right testicle is located more proximally within the right inguinal canal (series 401, image 5). The left testicle is within the scrotum (series 401, image 4). The bladder is well distended with no wall thickening, mural nodularity or intraluminal masses.The imaged bowel loops are nondistended and normal.Bone marrow signal intensity is normal.Mildly prominent inguinal lymph nodes are noted bilaterally. Otherwise the adjacent soft tissues are normal.

Output: Findings are compatible with an extratesticular scrotal lymphangioma as above. Mildly prominent bilateral inguinal lymph nodes.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: Posterior osteophyte disc complex and bilateral uncinate hypertrophy without significant stenosis.C5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy without significant stenosis.C7/T1: Unremarkable

Output: C5/6: Mild right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 47 year old female. Left hip pain x 20 years. Improvement with physical therapy, NSAIDS. Evaluate for labral tear. ACETABULAR LABRUM: There is gadolinium extension into the substance of the anterior labrum consistent with a tear (series 1001, image 10). There is extensive intermediate signal abnormality of the anterior and superior labrum consistent with degeneration. Similar signal abnormality is also seen in the posterior labrum, suggestive of additional degeneration. ARTICULAR CARTILAGE AND BONE: No focal worrisome bone marrow signal intensity. Small degenerative cyst in the superior lateral left acetabulum.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Degenerated left anterior and superior labrum with a linear tear in the anterior labrum.


Instruction: Generate impression based on findings.

Input: There are postoperative changes of anterior fusion from C5 to C7. Metallic susceptibility artifact from fusion hardware mildly limits evaluation at these levels. There is loss of the normal cervical lordosis. The vertebral bone marrow signal is unremarkable, aside from endplate degenerative signal alterations at C7-T1. There is diffuse narrowing of the spinal canal, particularly at C5 through C7, where the posterior vertebral bodies abut the spinal cord. In addition, there is multilevel degenerative spondylosis, For example, at C3-4, there are bilateral neural foraminal disc-osteophyte complexes and left facet hypertrophy with moderate right and severe left neural foraminal stenosis, and at C7-T1, there are bilateral neural foraminal disc-osteophyte complexes that result in severe neural foraminal stenosis bilaterally. The spinal cord displays normal signal. There is diffuse fatty atrophy of the left paraspinal muscles. The vertebral artery flow voids are intact. There is fluid within the mastoid air cells, greater on the right.

Output: 1.Postoperative changes of anterior fusion from C5 to C7 with diffuse narrowing of the spinal canal, particularly at C5 through C7, where the posterior vertebral bodies abut the spinal cord. 2.The degenerative spondylosis appears to have progressed, including bilateral neural foraminal disc-osteophyte complexes and left facet hypertrophy C3-4 with moderate right and severe left neural foraminal stenosis and bilateral neural foraminal disc-osteophyte complexes at C7-T1 that result in severe neural foraminal stenosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a nonspecific punctate focus of susceptibility effect in the left parietal lobe, which may represent chronic hemorrhage. The brain parenchyma otherwise appears unremarkable. There is a partially empty sella. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is complete opacification of the left sphenoid sinus and sphenoethmoidal recess, extending into the left posterior ethmoid air cells. There is also a small amount of fluid signal in the bilateral mastoid air cells. There is persistent mild right greater than left exophthalmos.

Output: 1. A partially empty sella may represent pseudotumor cerebri.2. No evidence of intracranial hemorrhage, mass, or acute infarct. 3. Nonspecific small amount of fluid signal in the bilateral mastoid air cells may represent mastoiditis.4. Persistent left sphenoid sinus and posterior ethmoid sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. There are postoperative findings related to L3, L4 and L5 laminectomies with mild regional postoperative soft tissue enhancement. There is a hemangioma in T12 vertebral body. Vertebral body alignment is normal. Vertebral body heights are intact. There is desiccation of multiple lumbar disks. The conus terminates at L1-2.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: Mild disk bulge and facet arthropathy with the ligamentum flavum thickening. No significant spinal canal or neural foraminal stenosis.L3-4: Mild disk bulge with small central disk protrusion, facet arthropathy, and laminectomy. No significant spinal canal or neural foraminal stenosis.L4-5: Diffuse disk bulge with small right paracentral and far lateral disk protrusion with annular fissure, facet arthropathy, and laminectomy. No significant spinal canal stenosis. Minimal bilateral neural foraminal stenosis.L5-S1: Diffuse disk bulge, advanced facet arthropathy with ligamentum flavum thickening, and laminectomy. No significant spinal canal or neural foraminal stenosis.Dedicated images through the sacrum show no discernible mass, nerve root thickening or suspicious enhancement in the sacral foramina. There is minimal increased STIR signal seen in the inferior and lateral margins of the sacrum bilaterally, somewhat symmetric in appearance. This may reflect artifact versus minimal edema. However, there is no osseous erosion or fluid collection.There is a right renal exophytic cystic lesion incompletely imaged, probably representing a simple cyst.

Output: 1.No mass or nerve root thickening in the sacral foramina, as questioned on the prior radiograph.2.Questionable increased STIR signal in the far inferior and lateral margins of the sacrum bilaterally. This may reflect artifact versus minimal edema.3.Postsurgical findings and mild multilevel lumbar spondylosis as described above.


Instruction: Generate impression based on findings.

Input: Tinnitus and dizziness. MRI: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. 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 skull, paranasal sinuses, and scalp soft tissues are unremarkable.MRA: There is no evidence of significant steno-occlusive lesions, vascular malformations, or aneurysms, within the limits of MRA.

Output: 1. No evidence of inner ear or retrocochlear lesions.2. No evidence of significant steno-occlusive lesions, vascular malformations, or aneurysms


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with dermatomal distribution of neuropathic pain. History of diabetes and polyneuropathy. Spinal alignment is within normal limits. Vertebral body heights are maintained. Bone marrow signal intensity is within normal limits. The visualized spinal cord, conus and cauda equina demonstrate normal signal intensity and morphology. The intervertebral disk spaces are preserved. Loss of disc T2 signal is seen at L3-4 and L4-5. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Right greater than left facet hypertrophy. Left foraminal disc protrusion resulting in moderate narrowing of the left neural foramen and probable mild impingement of the exiting left L3 nerve root. No significant generalized spinal canal stenosis. L4-5: Facet hypertrophy. Ligamentum flavum thickening. No significant spinal canal stenosis. Mild left foraminal narrowing. L5-S1: Right greater than left facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

Output: 1.A left foraminal zone disc protrusion at L3-4 results in moderate foraminal narrowing and probable mild impingement of the exiting L3 nerve root.2.Minimal degenerative findings are seen at other levels without significant spinal canal or neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: Headache(784.0) [784.0], Reason for Study: ^Reason: headache x 3 months, vision changes in R eye History: see above Brain MRIThe 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. 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 MRV3D MRV brain using 3D Phase Contrast technique with velocity encoding as 5cm/sec and 15cm/sec were obtained. Due to inadequate demonstration of the dural sinuses on this MRV most likely related to technical issues, overall image quality is poor.However, major dural sinuses appear to be patent especially on MRV obtained with venc=15. There are possible venous sinus stenosis or intra-luminal filling defects especially on bilateral transverse- sigmoid sinus junctions. Further evaluation with Gadolinium enhanced MR venography can be considered for more precise evaluation of dural sinuses.In addition, diagnostic angiography with dural sinus pressure mapping can be considered for identifying endovascularly manageable idiopathic intracranial hypertension through Neurointerventional radiology consultation (page:9287).

Output: 1. Normal brain MRI2. Patent major dural sinuses. Possible stenosis or intra luminal filling defects on bilateral transverse-sigmoid junctions. Contrast enhanced MRV can be considered for further evaluation. Intra dural sinus pressure mapping can also be considered for identifying luminal stenosis which may show significant pressure gradient.


Instruction: Generate impression based on findings.

Input: 60-year-old male with history of primary CNS lymphoma, status post chemotherapy and transplant. There are otherwise unchanged post-treatment and post-biopsy findings with patchy T2 hyperintensity and associated susceptibility effect in the right cerebellar hemisphere and left anterior cingulate gyrus. There is also unchanged focal susceptibility effect in the right globus pallidus. There are unchanged areas of high T2 signal in the cerebral white matter. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. 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, orbits, and scalp soft tissues are unchanged. There is mild mucosal thickening in the left maxillary sinus.

Output: 1. No evidence of recurrent central nervous system lymphoma with stable post-treatment findings in the right cerebellar hemisphere and left cingulate gyrus.2. Unchanged areas of cerebral white matter signal abnormality in the cerebral white matter are otherwise nonspecific.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: Patient with h/o scalp lesion that has increased in size over the last year. Patient presents today with new neck mass, please evaluate. Brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are subdural effusions present bilaterally and symmetrically measuring up to 9 mm in thickness within the supratentorial brain there are subdural effusions in the posterior fossa measuring up to 10 mm in thickness. These are likely related to brain atrophy.There is a mass present along the scalp soft tissues extending to the level of the calvarium just behind the level of the coronal suture eccentric to the left side just to the left of midline measuring 50 x 22 mm in sagittal dimensions and 60 x 22 mm in coronal dimensions. It does not invade the marrow. It is visually contiguous with the calvarium.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus which has high signal on T1 and intermediate signal on T2 suggestive of inspissated secretions.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Neck:There is a 36 x 26 mm axial dimension mass at the left posterior triangle which abuts the left carotid sheath at the level of the angle of the mandible. It has some heterogeneous enhancement. It is heterogeneous in signal on T1 and T2-weighted imaging. It is well-circumscribed. It is bright on diffusion-weighted imaging and low signal on ADC map suggesting diffusion restriction.There is a 20 x 13 mm axial dimension lesion just behind the left submandibular gland which has similar signal characteristics to the above described lesion. Smaller similar lesions are present in the right submandibular space just behind the submandibular gland measuring 15 x 7 mm and scattered elsewhere.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 carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact . There are degenerative changes present in the cervical spine with narrowing of the spinal canal at C3-4, C4-5, C5-6 and C6-7 suspicious for spinal stenosis. There is also suspicion for multilevel neural foramen encroachment of exiting nerve roots.Diffuse marrow replacement in the visualized portions of the cervical spine is a nonspecific finding which could relate to anemia, lymphoproliferative disorder, or chronic disease.

Output: 1.There is a mass present within the scalp soft tissues adjacent to the left parietal bone. Although it abuts the left parietal bone, there is no convincing evidence that it invades it. If clinically appropriate a CT of the head may be useful in determining whether there is calvarial erosion.2.A large mass in the suprahyoid neck along the posterior triangle on the left side just behind the left carotid sheath. This location would indicate this most likely represents lymphadenopathy. An additional similar lesion in the left submandibular space is also suspected to represent lymphadenopathy. Smaller lymph nodes not meeting size criteria for adenopathy or present throughout the soft tissues of the neck.3.There are multilevel degenerative changes present cervical spine with findings suspicious for spinal stenosis at multiple levels and multilevel neural foramen encroachment.4.Diffuse marrow replacement in the visualized portions of the cervical spine is a nonspecific finding which could relate to anemia, lymphoproliferative disorder, or chronic disease.


Instruction: Generate impression based on findings.

Input: Stage IV melanoma: restaging. There is a subcentimeter focus focus high T2 signal in the left corona radiata. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A subcentimeter focus of high T2 signal in the left corona radiata may represent a chronic lacunar infarct. Otherwise, no evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: 50-year-old female presents with right knee pain. Tiny osteophytes indicate minimal osteoarthritis, essentially within normal limits considering patient age.

Output: Minimal osteoarthritis of the right knee.


Instruction: Generate impression based on findings.

Input: 66 year old female with headache. Is there a bleed? There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: Reason: hx ACDF- eval for abnormality or resolution History: continued spasticity The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disk desiccation present The patient is status post anterior fusion at C3-4. There is a signal hyperintensity within the spinal cord at the C3-4 level associated with volume loss suggesting cord myelomalacia.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal. There is a disk bulge present at this level with mild narrowing of the neural foramina. There is posterior ligamentous hypertrophy at this level.At C6-7 there is no significant compromise to the spinal canal. There is a endplate osteophyte formation present at this level associated with uncovertebral osteophytes and encroachment of the left sided exiting nerve roots it does has been previously present and is unchanged. There is posterior ligamentous hypertrophy at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The left vertebral artery is large raise the right vertebral artery is small and hypoplastic distally.

Output: 1.There is cord myelomalacia present at the C3-4 level.2.Status post recent anterior fusion at C3-4.


Instruction: Generate impression based on findings.

Input: Pain in right shoulder. Possible rotator cuff tear. Multiple sequences are limited by patient motion artifact.ROTATOR CUFF: Fluid signal intensity separates the anterior fibers of the distal supraspinatus tendon from its insertion on the greater tuberosity, indicating a non-retracted insertional tear. The tear appears to involve the majority of the thickness of the tendon, with disruption of the bursal surface fibers, but possible sparing of the articular surface fibers. We estimate the tear is just under 1 cm in AP dimension. There is thickening and intermediate signal intensity of the remaining supraspinous tendon, indicating mild to moderate tendinosis. The supraspinatous muscle appears normal. Mild tendinosis affects the infraspinatus tendon, with otherwise normal appearance. The infraspinatus muscle, subscapular muscle and tendon, as well as the teres minor muscle and tendon, appear normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. Small amount of fluid is identified within the subacromial/subdeltoid bursa, likely secondary to aforementioned supraspinatus tear. GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint contains a small amount fluid, but no effusion is identified. Evaluation of the labrum is limited due to motion artifact and lack of intra-articular contrast. Intermediate signal intensity is identified within the superior labrum, likely reflecting degenerative changes. BICEPS TENDON: The tendon of the long head of the biceps is normal, given aforementioned limitations. ADDITIONAL

Output: 1. Insertional tear of the supraspinatus, as described above. 2. Additional degenerative changes, as described above.


Instruction: Generate impression based on findings.

Input: 67-year-old female with erythema, pain, drainage of prior right great toe amputation site, concern for osteomyelitis. Evaluate for osteomyelitis of the right great toe. There is diffuse soft tissue edema particularly along the dorsum of the forefoot which extends into the toes. Patient has undergone amputation of the great toe through the base of the proximal phalanx. Small foci of signal void in the adjacent soft tissues likely reflects suture material. There is a small thin linear focus of increased signal intensity on T2 weighted images that extends from the distal skin surface of the amputation margin to the medial aspect of the proximal phalanx which may represent a small sinus tract, but the remaining base of the proximal phalanx maintains its normal fat signal intensity on T1-weighted images arguing against osteomyelitis. There is increased signal intensity on T2-weighted images circumferentially within the outer margin of the outer head of the first metatarsal with corresponding enhancement on postcontrast images, however on T1 weighted images the fat signal is maintained again arguing against osteomyelitis. There is also increased signal intensity on T2-weighted images and enhancement on postcontrast images concentrated within the medial aspects of both sesamoid bones; there is associated mild decreased signal intensity on T1 weighted images in an ill-defined hazy pattern, and while it is impossible to exclude osteomyelitis, we favor reactive osteitis based on the signal intensity pattern and lack of definite adjacent ulceration. Note is made of a mildly retracted flexor hallucis longus tendon. Mild degenerative arthritic changes affect the forefoot.

Output: Soft tissue edema and postoperative changes as described above. Signal abnormality and enhancement of the first metatarsal head and sesamoid bones is favored to represent reactive osteitis rather than osteomyelitis.


Instruction: Generate impression based on findings.

Input: History of extensive bilateral prostate cancer. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.3 x 4.6 x 3.7 cm (transverse by CC by AP).Peripheral Zone: There is extensive signal abnormality with decreased T2 signal and restricted diffusion throughout the near entirety of the left peripheral zone compatible with tumor. This abnormal signal extends into the transitional zone compatible with tumor invasion. There is an additional signal abnormality in the median aspect of the right base suspicious for additional tumor involvement (series 501 image 11). In the right apex just to the right of the urethra there is an additional focus of low T2 signal with restricted diffusion measuring 6 x 6 mm in axial dimension suspicious for additional disease (series 703 image 24).Central Gland: Findings compatible with tumor invasion into the left transitional zone.Seminal Vesicles: There is complete loss of the normal high T2 signal in the seminal vesicles suspicious for tumor involvement.Extracapsular Extension: The left lateral and posterior aspects of the capsule in the mid gland and base are indistinct suspicious for extracapsular extension (series 501 image 11 and 17).BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic or inguinal lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Extensive tumor involvement affecting the near entirety of the left-sided peripheral zone and extending into the left transitional zone.2.Findings suspicious for extracapsular extension on the left and involvement of the seminal vesicles.3.Additional foci of signal abnormality in the right base and apex suspicious for additional malignancy.4.No lymphadenopathy or other evidence of distant metastatic disease.


Instruction: Generate impression based on findings.

Input: There are postoperative findings within the paraspinal musculature. There is a new apex rightward lower thoracic spinal curvature. The left paraspinal enhancing mass has increased in size, now extending from the T6 through T12 levels and measuring 59 x 30 x 106 millimeters, previously 53 x 25 x 60 mm. There is nonspecific heterogeneous T2 hyperintensity and enhancement within the left paraspinal musculature inferior to this mass that may represent post-surgical change, or tumor infiltration. A mildly enhancing mass within the right paraspinal soft tissues centered at the T8 level is unchanged in size, measuring 18 x 16 mm. There are multiple partially imaged right anterolateral chest wall masses. The largest of these has decreased in size and measures approximately 48 x 17 mm, previously approximately 73 x 50 mm. However there are multiple apparently new right posterior lateral masses, with the largest of these measuring up to 37 x 23 mm and resulting in mass effect upon the right hepatic lobe. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology with the conus terminating at L1.

Output: 1.New thoracic dextroscoliosis. 2.Multiple paraspinal and chest wall desmoid tumors. The left paraspinal mass has increased in size. The right anterolateral chest wall mass has decreased in size. There are multiple apparently new right posterolateral chest wall masses. 3.No spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: History of right breast cancer status post mastectomy and implant. There is heterogeneous amount of fibroglandular tissue in the left breast. Status post right mastectomy. The implant on the right is intact.Moderate parenchymal enhancement is noted in the left breast. There is mild motion artifact. No abnormal enhancement is seen in either the left breast or right reconstruction. There are a few scattered areas of non-mass enhancement in the left breast, though these are not significantly changed compared to the two prior MRIs, allowing for differences between the studies (positioning, slight motion artifact and 3T MRI vs 1.5T MRI). No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 36 year old man with cardiomyopathy referred for further evaluation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 116 ml/m2 (normal range: 74+/-15), the LVEDV is 213 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 109 ml (normal range 47+/-19). There is mild global hypokinesis present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function . The overall RV ejection fraction is 47%, the RV end diastolic volume index is 129 ml/m2 (normal range 82+/-16), the RVEDV is 235 ml (normal range 142+/-31), the RV end systolic volume index is 68 ml/m2 (normal range 31+/-9), and the RVESV is 124 ml (normal range 54+/-17). The heart is displaced into the left thorax by a narrow (in antero-posterior direction) chest cavity. The RV is externally compressed by the sternum but there is no evidence of flow turbulence through the tricuspid valve or RV cavity.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. The anterior mitral leaflet is prolonged and thickened. There is bileaflet mitral valve prolapse associated with at least mild to moderate mitral regurgitation with a very posteriorly directed jet. 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. The thoracic aorta 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 trace pericardial effusion.Extracardiac FindingsThe sternum is flattened but does not meet criteria for pectus excavatum. The minimal anterior posterior dimension of the chest is 5cm causing the heart to be displaced into the left thorax. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Mild LV dilation with mildly reduced systolic function (LVEF 49%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Mild RV dilation with mildly reduced systolic function (RVEF 47%). The RV is externally compressed by the sternum but there is no flow acceleration to suggest that the external compression is causing a hemodynamic problem.3. There is bileaflet mitral valve prolapse with evidence of at least mild to moderate mitral regurgitation.4. Thoracic aorta is normal in size. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: headache. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Significant metallic artifacts with surrounding parenchymal signal loss on the genu of corpus callosum indicating prior pericallosal artery aneurysm clipping status. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate signal loss from the level of right ACA pericallosal artery due to surgical clip related artifacts, otherwise normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Significant metallic artifacts on the area of pericallosal artery clipping.3. Segmental non visualization of ACA around the area of surgical clip, otherwise no remarkable brain MRA.


Instruction: Generate impression based on findings.

Input: High impact MVC with left frontal contusion and neck pain. Brain: There is a left subgaleal collection that measures up to 3 mm in thickness. There are multiple scattered foci of sulcal FLAIR hyperintensity along the bilateral cerebral convexities, particularly in the left frontal lobe region. There is no evidence of acute infarct or diffuse axonal injury. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Findings compatible with a mild left frontal scalp contusion and scattered subarachnoid hemorrhage, but no evidence of acute infarct or diffuse axonal injury.2. No evidence of cervical spinal cord or ligamentous injury.


Instruction: Generate impression based on findings.

Input: The vertebral body heights and intervertebral disk spaces are preserved. Previously demonstrated low T1 marrow signal in the lumbar vertebrae has been replaced by fatty marrow. There is residual low T1 signal intensity in the visualized lower thoracic vertebrae. These findings are favored to represent changes related to interval radiation. There are no focal osseous lesions. There is persistent mild thickening of the cauda equina without appreciable enhancement. The visualized distal cord is normal in morphology and signal intensity. There is mild nonspecific posterior subcutaneous edema over the lower lumbar spine.

Output: 1. Persistent mild thickening of the cauda equina without appreciable enhancement.2. Fatty replacement of lumbar vertebral bone marrow likely related to interval radiation.


Instruction: Generate impression based on findings.

Input: 39-year-old female with groin pain with running for 5 months. Evaluate for stress fracture. There is mild intramedullary edema along the inferomedial aspect of the femoral neck indicating a stress reaction. We see no discrete fracture line at this time. The remaining bone marrow is unremarkable. There is no joint effusion. Although the study was not protocoled for detailed evaluation of the acetabular labrum, there is thin linear intermediate signal intensity traversing the superior labrum compatible with a tear, although the clinical significance of this tear is uncertain. We see no morphologic abnormalities of the hip. The right hip appears normal on the large field of view images, as do the sacroiliac joints and lower lumbar spine. The visualized musculature is within normal limits.

Output: 1. Stress reaction of the left femoral neck without discrete fracture line at this time.2. Acetabular labral tear of uncertain clinical significance.


Instruction: Generate impression based on findings.

Input: A 42 year old female with personal and familiar history of dilated cardiomyopathy, paroxysmal atrial fibrillation. A recent echocardiography showed left ventricular ejection fraction of 34%. Referred to stress cardiac MRI for further evaluation.MEDICATIONS: Carvedilol, Enalapril, Spironolactone, Escitalopram First Pass PerfusionDuring hyperemia, no perfusion defects were present.Myocardial ScarThere is no evidence of prior myocardial infarction or replacement myocardial fibrosis, inflammation, or infiltration based on late gadolinium enhancement imaging. However, the native myocardial T1-times are mildly elevated suggesting the presence of mild, diffuse interstitial fibrosis. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 123 ml/m2 (normal range: 65+/-11), the LVEDV is 230 ml (normal range 109+/-23), the LV end systolic volume index is 78 ml/m2 (normal range 18+/-5), the LVESV is 147 ml (normal range 31+/-10), the LV mass index is 35 g/m2, and the LV mass is 66 g. There is global hypokinesis with regional variation. The LV wall is very thin and associated with increased trabeculation. Minimal criteria for the diagnosis of LV non-compaction cardiomyopathy are met. No LV cavity thrombus is noted. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 160 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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 a trivial pericardial effusion.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 no evidence of prior myocardial infarction or replacement myocardial fibrosis, inflammation, or infiltration. However, the native myocardial T1-times are mildly elevated suggesting the presence of mild, diffuse interstitial fibrosis. 3. Severe LV dilation with moderately reduced systolic function (LVEF 36%). The LV wall is very thin and associated with increased trabeculation. Minimal criteria for the diagnosis of LV non-compaction cardiomyopathy are met4. Normal RV size and systolic function (RVEF 56%).5. Moderate LA dilation.6. Mild mitral regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Preterm newborn, gestational age 28 weeks with parenchymal hemorrhage. There is predominantly T1 and T2 hyperintense with surrounding circumferential effect in the bilateral medial parietal and occipital lobes, perhaps with slight extra-axial extension. There also appears to be T1 hyperintensity in the overlying superior sagittal sinus. There are small scattered areas of susceptibility effect in the bilateral temporal lobes, ventricular system, posterior fossa, and right caudothalamic groove. The degree of myelination is within expected limits accounting for prematurity. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The posterior fossa structures appear unremarkable. The major cerebral artery flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly intact. There is mild dilatation of the left lacrimal sac.

Output: 1. Subacute hemorrhages within the bilateral medial parietal and occipital lobes, perhaps with slight extra-axial extension. Apparent T1 hyperintensity in the overlying superior sagittal sinus may represent artifact versus thrombus and dedicated vascular imaging is recommended for further evaluation. 2. Small scattered areas of chronic hemorrhage in the bilateral temporal lobes, ventricular system, posterior fossa, and right caudothalamic groove.3. Small left lacrimal sac mucocele.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, inability to access the joint, and failure of medication to relieve pain) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right wrist was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge.Under fluoroscopic guidance, 22 gauge needle was advanced into the joint in the mid carpal compartment. Next, 7 mL of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Both ulnar deviation and radial deviation spot images were obtained without apparent extravasation of contrast into the radiocarpal compartment.Blood loss was negligible (<1cc), and the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information. Exposure time: 1:35 minutes

Output: Successful fluoroscopically guided injection of contrast into the midcarpal compartment of the right wrist. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on findings.

Input: Possible intracranial hemorrhage. Headache. Patient has a brain tumor .50-year-old female The patient is status post recent left-sided temporal craniotomy. Postsurgical changes include intracranial air and a left-sided subdural collection.A small 8mm hemorrhagic focus is present along the left temporal lobe at the superior margin of the patient's tumor bed. A hypodense focus is present in the left temporal lobe measuring 25 x 20 mm axial dimensions presumably related to the patient's known left sided brain tumor.A focus of encephalomalacia is present in the left parietal lobe extending to the left the occipital lobe and the left posterior temporal lobe. This has been present on previous exams and has not changed substantially in essence it represents a fluid filled the cavity and is best to assess bone MRI..It corresponds to a previous tumor bed identified on the 6/19/06 MRI exam

Output: 1.The patient is status post a left temporal lobe surgery . Residual tumor cannot be assessed on this exam. MRI is more accurate in assessing residual tumor than CT. there is a small focus of hemorrhage in the tumor bed as described above.2.Encephalomalacia and gliosis adjacent to previous surgical site in the left posterior temporal lobe and adjacent to left parietal and occipital lobes as described above.3.Postsurgical changes at the craniotomy site.


Instruction: Generate impression based on findings.

Input: knee pain, swelling, and instability after falling during sports. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is minimal bony edema at the inferior aspect of the patella.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Thickening of the proximal patellar tendon with increased T2 signal within Hoffa's fat pad between the proximal patellar tendon and the lateral femoral condyle.ADDITIONAL

Output: Findings suspicious for fat pad impingement syndrome.


Instruction: Generate impression based on findings.

Input: The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is high T2 signal within scattered bilateral mastoid air cells.At C2-C3, there is no spinal canal or neural foraminal stenosis.At C3-C4, there is no spinal canal or neural foraminal stenosis.At C4-C5, there is no spinal canal or neural foraminal stenosis.At C5-C6, there is a small disk osteophyte complex with bilateral uncovertebral hypertrophy and ligamenta flava thickening causing no significant spinal canal stenosis with moderate to severe right neural foraminal stenosis and mild left neural foraminal stenosis.At C6-C7, there is a left paracentral disk osteophyte complex with ligamenta flava thickening no significant spinal canal stenosis and mild left neural foraminal stenosis.At C7-T1, there is no spinal canal or neural foraminal stenosis.

Output: 1.Mild C5-6 and C6-7 spondylosis as described above with moderate to severe right and mild left neural foraminal stenosis at C5-6. Mild left neural foraminal stenosis at C6-7.2.Fluid in bilateral mastoid air cells.


Instruction: Generate impression based on findings.

Input: Headache. MRI: 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.MRA: There is no evidence of significant steno-occlusive arterial lesions. There is also no evidence of saccular aneurysms.MRV: There is no evidence of venous thrombosis.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. No evidence of significant steno-occlusive arterial lesions.3. No evidence of venous thrombosis.


Instruction: Generate impression based on findings.

Input: History of dilated aorta, aortic insufficiency and possible CAD. Left VentricleThe left ventricle is normal size. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 81 ml/m2 (normal range: 74+/-15), the LVEDV is 175 ml (normal range 142+/-34), the LV end systolic volume index is 34 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. The native T1 myocardial relaxation time is [1051]ms.There is [no ]myocardial iron overload. There is [ no]LV thrombus. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVEDV is 173 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 79 ml (normal range 54+/-17).Right AtriumThe right atrium is normal size.Aortic ValveThe aortic valve is trileaflet and opens widely and there is mild aortic regurgitation. The calculated regurgitant fraction is 7%.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. SOV 41-42 mmAsc Ao 40 mmMid Ao arch 40 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac Findings . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular function with ejection fraction at 58%. Normal right ventricular function and size.2. Mild aortic insufficiency with dilated ascending aorta at 4.0 cm, unchanged from prior MRI report).3. No evidence of late gadolinium enhancement in myocardium.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Cervical cancer. RT planning. PELVIS:UTERUS, ADNEXA: Eccentric soft tissue wall thickening of the cervix anteriorly and on the right, measuring up to 15 mm (series 601, image 36) consistent with known cervical carcinoma, markedly decreased in size from prior. There is right parametrial invasion. Tumor bulges the endometrial cavity inwards on the right but with no discrete endometrial tumor (series 601, image 36).Extension of abnormal signal from the cervix into the anterior upper third of the vaginal cuff with mild wall thickening greater on the right, suspicious for local invasion (series 601, image 31). No bladder, ureteral, or rectal invasion.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent pelvic lymph nodes at the left common iliac artery and at its bifurcation. For reference a left common iliac node is 13 x 9 mm (series 1104, image 755), similar to prior. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Significantly decreased size of cervical carcinoma with right parametrial invasion. Suspicious findings for direct location invasion into the upper third of the anterior vaginal cuff.2. Prominent pelvic lymph nodes suspicious for local metastatic disease.


Instruction: Generate impression based on findings.

Input: Evaluate for brain lesion in patient with new onset headaches upon waking associated with nausea, vomiting, vertigo and photophobia: New onset morning headaches. 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left lens implant.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarction.


Instruction: Generate impression based on findings.

Input: 65 years, Male, right face, arm and leg numbness. Evaluate for metastasis.. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci and more confluent areas of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic disease. There is a chronic lacunar infarct involving the left thalamus which was present on prior CT from 2015. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits with evidence of right lens implant. There is moderate opacification throughout the paranasal sinuses. Mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are grossly within normal limits.

Output: 1. No evidence of intracranial metastatic disease.2. Mild to moderate chronic small vessel ischemic disease with a chronic left thalamic lacunar infarct which was present on prior CT. No evidence of acute ischemia.3. Moderate opacification throughout the paranasal sinuses.


Instruction: Generate impression based on findings.

Input: Female, 48 years old. Thumb MP pain, concern for ulnar collateral ligament injury. A small focus of low signal intensity seen on coronal image 7 of series 1101 may represent the suspected ulnar collateral ligament avulsion fracture fragment seen on recent radiographs. However, there is no edema in the adjacent soft tissue or bone, suggesting this is chronic. On the short TE images there is intermediate signal intensity within the UCL that may reflect old injury and scarring, but we see no displaced tear of the ligament itself. Bone marrow signal intensity is normal. We see no abnormality of the flexor/extensor tendon apparatus.

Output: Findings compatible with a chronic ulnar collateral ligament injury with a mildly displaced avulsion fracture fragment better seen on recent radiographs.


Instruction: Generate impression based on findings.

Input: 59-year-old female with diffuse large B cell of the sinus status post 4 cycles of chemotherapy. There is redemonstration of soft tissue density within the maxillary sinus immediately posterior to the anterior wall of the left maxillary sinus. This soft tissue prominence again extends posteriorly and posterior laterally to the left maxillary sinus and along the enlarged infraorbital nerve groove. The osseous involvement of the anterior aspect of the maxillary sinus, including a mixed sclerotic and lucent area, appears unchanged. There is increased mucosal thickening and opacification of both maxillary sinuses. This appearance may be due to chronic sinus disease, although lymphomatous involvement cannot be excluded. MRI may be more helpful in delineating tumor from inflammatory disease. Opacification of the left frontal and bilateral ethmoid sinuses, as well as mucosal thickening of the right sphenoid sinus is also noted. The retro-orbital fat remains within normal limits. Extraocular musculature and globe remain within normal limits. No definitive abnormality of cavernous sinus or Meckel's cave on this exam is detected. Limited view of nasopharynx demonstrates no abnormality.

Output: Persistent abnormal soft tissue within the left maxillary sinus with associated osseous changes as detailed. Increased pan-sinus opacification. MRI may be more helpful in delineating tumor involvement from inflammatory disease.


Instruction: Generate impression based on findings.

Input: 24 years Female (DOB:6/20/1991)Reason: Re-evaluate for disease recurrence; known history of brain metastases History: Stage IV melanomaPROVIDER/ATTENDING NAME: JASON JOHN LUKE JASON JOHN LUKE The patient is status post left-sided craniotomy. A lesion located in the left middle frontal gyrus associated with susceptibility effect is stable.There is a 4 mm lesion present along the right cerebellar hemisphere along its more lateral aspect is stable compared to the prior exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam a left middle frontal gyrus hemorrhagic lesion has remained stable.2.A small right cerebellar lesion suspicious for metastatic disease also remains stable.3.Status post left-sided frontal craniotomy.


Instruction: Generate impression based on findings.

Input: History of cerebellopontine angle meningioma status post resection. There are postoperative findings related to right-sided suboccipital craniotomy, with flattening of the right cerebellar hemisphere. There is mild dural enhancement along the posterior aspect of the right petrous apex and minimal patchy enhancement in the right cerebellar hemisphere, but no discernible mass lesion. There is a left parietal lobe developmental venous anomaly. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation.

Output: Expected postoperative findings without discernible evidence of residual right cerebellopontine angle meningioma. Please refer to the brain MRI report from 1/8/14 for additional details.


Instruction: Generate impression based on findings.

Input: Stroke and altered mental status. Motion degrades some sequences. Within the posterior left thalamus, there is a lesion with intrinsic T1 hyperintensity and T2 hyperintensity and a peripheral rim of susceptibility measuring up to 19 mm. There is minimal mass effect associated with this lesion. There are small areas of encephalomalacia in the left pons, left cerebellar hemisphere, bilateral precentral gyri, and bilateral parietal lobes. There is encephalomalacia with hemosiderin deposition in the left supramarginal gyrus region, as well as in the right middle frontal gyrus and the right superior frontal gyrus. There is a background of scattered periventricular and subcortical white matter T2 hyperintensity. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.A lesion measuring up to 19 mm in the left posterior thalamus may represent a subacute hemorrhagic infarct, but no evidence of acute infarction. 2.Extensive probable chronic small vessel ischemic white matter disease and multiple foci of chronic infarcts, some of which also demonstrate chronic hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Cervical spine:There is grade 1 anterolisthesis of C4 on C5 and reversal of cervical lordosis. Additionally, there is minimal retrolisthesis of C5 on C6 and minimal anterolisthesis of C7 on T1. Alignment is otherwise maintained. Vertebral body heights and intervertebral disc spaces are preserved. The cord signal is within normal limits. The marrow signal is normal. Prominent facet arthropathy is noted on the left extending from C3 level to T1 level, as well as the right C7-T1 level.C2-C3: No significant spinal canal or neural foraminal stenosis.C3-C4: There is no significant spinal canal stenosis. Moderate left-sided facet arthropathy results in moderate left neural foraminal stenosis. The right neural foramen is patent.C4-C5: There is predominantly left sided facet joint arthropathy and uncovertebral hypertrophy, resulting in mild to moderate left foraminal stenosis with patent right neural foramen. Small disc osteophyte complex results in mild central canal stenosis.C5-C6: Disc osteophyte complex results in moderate spinal canal stenosis. There is bilateral, right greater than left, neural foraminal narrowing.C6-C7: There is mild to moderate spinal canal stenosis and mild bilateral foraminal stenoses due to uncovertebral hypertrophy.C7-T1: Mild spinal canal stenosis is identified. There is mild to moderate right and mild left neural foraminal stenoses.Lumbar spine:For the purposes of numbering, there are 5 lumbar type vertebral bodies. There is loss of normal lumbar lordosis and mild dextroscoliosis of the lower lumbar spine. Vertebral body heights are preserved. There is severe loss of intervertebral disc space at the L3-L4 and to a lesser degree at L2-L3 and L4-L5 levels. Postsurgical changes of laminectomy are noted at the L3-L4 and L4-L5 levels. There are no fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at L1-L2. No cord signal abnormalities identified. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: No significant spinal canal or neural foraminal stenosis.L1/2: There is bilateral facet joint arthropathy, with no significant spinal canal or neural foraminal stenoses.L2/3: Disc bulge eccentric to the left with bilateral facet joint arthropathy results in effacement of the left lateral recess, mild left neural foraminal narrowing, and mild central canal stenosis.L3/4: Small disc osteophyte complex and facet joint arthropathy results in effacement of the left lateral recess and mild to moderate left neural foraminal narrowing. There is minimal right neural foraminal narrowing. The spinal canal is surgically decompressed.L4/5: Spinal canal is surgically decompressed. Small disc bulge with endplate osteophyte results in partial effacement of the lateral recesses. There is severe right foraminal stenosis and moderate to severe left neural foraminal stenosis.L5/S1:Facet joint arthropathy results in moderate to severe right and mild-to-moderate left neural foraminal stenoses. No spinal canal stenosis identified.

Output: 1.Multilevel degenerative changes in the cervical spine, with up to moderate spinal canal stenosis at the C5-C6 level and multilevel neural foraminal stenoses as detailed above. No cord signal abnormality identified.2.Multilevel degenerative changes in the lumbar spine, minimally progressed as compared to prior study of 3/17/2012, with no significant spinal canal stenosis. Multilevel neural foraminal stenoses are identified in the lumbar spine, worse at L4-L5 and L5-S1 levels, as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: Pt is a 70 y/o male with RCC, evaluate for recurrence History: RCC Note that the examination is limited by lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Lobular T2 hyperintense lesion in segment 7 of the liver, which has previously been characterized as a hemangioma, not significantly changed.SPLEEN: Lobulated T2 hyperintense lesion in the anteroinferior spleen nonspecific but likely benign, not significantly changed.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. There is no soft tissue signal seen in the region of the right renal bed to suggest local tumor recurrence. T2 hyperintense lesions in the left kidney compatible with renal cysts, not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the lumbar spine are again noted.OTHER: No significant abnormality noted.

Output: Surgical changes of right nephrectomy without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Right sided headaches with vomiting. The are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable, although dental brace artifact obscures portions of the face.

Output: No evidence of intracranial hemorrhage, mass, or hydrocephalus, although the images are degraded by patient motion.


Instruction: Generate impression based on findings.

Input: 15 year old with cerebral palsy, fever, septic shock, sinusitis, and osteomyelitis of the frontal bone. Evaluate for intracranial extension. MRI Face/Sinus:Redemonstration of extensive mucosal thickening and hyperenhancement of the left frontal sinus with a defect in the anterior left frontal sinus. The large left lobulated mixed T2/flair fluid intensity peripherally enhancing subgaleal collection in the supraorbital region containing foci of air is not significantly changed. There is mild restricted diffusion in the subgaleal lesion, left frontoethmoidal sinuses and left maxillary sinus. There are surrounding inflammatory changes and phlegmonous enhancement in the adjacent subcutaneous tissues around the left subgaleal abscess. The right frontal sinus again demonstrates moderate mucosal enhancement and thickening which is unchanged. The left frontoethmoidal recess demonstrates mucosal thickening and hyperenhancement with mixed fluid intensity on T2/flair and the right appears patent. There is moderate-severe left and mild-moderate right patchy ethmoidal air cell involvement. The sphenoid sinuses demonstrate moderate mucosal thickening bilaterally with opacification of the sphenoethmoidal recesses. There is lobulated mucosal thickening and hyperenhancement of the maxillary sinuses with near complete opacification. The right mastoid air cells and middle ear are essentially completely opacified with suggestion of possible chronic inflammatory changes. There is thickening of the outer table of the frontal calvarium.MRI Brain:Redemonstrated is a left parietal approach ventriculostomy catheter with the tip unchanged in position just anterior to the left foramen of Monro. There is thinning of the cortical mantle and the ventricular enlargement is stable. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal enhancement intracranially. However, the cranium along the posterior aspect of the left frontal sinus demonstrates marrow replacement best seen on T1 axial series 701, image 9, and is compatible with osteomyelitis. There is no abnormal intracranial enhancement or intracranial extension of the sinus disease. The major cerebral flow voids are intact. MRI Orbits:No abnormal mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1.Findings are again consistent with Potts puffy tumor involving the left frontal sinus associated with adjacent osteomyelitis as well as overlying subcutaneous abscess. There is no convincing evidence for intracranial or intraorbital extension.2.Findings compatible with osteomyelitis involving the outer cranium along the posterior aspect of the left frontal sinus. There is no evidence of intracranial extension. 3.Left parietal approach ventriculostomy catheter with stable moderate dilatation of the ventricles4.Additional diffuse paranasal sinus, right mastoid air cell and right middle ear opacification has not significantly changed.


Instruction: Generate impression based on findings.

Input: Acute pancreatitis, evaluate pancreatic anatomy. ABDOMEN:LUNG BASES: Basilar atelectasis/consolidation and a small right pleural effusion persist.LIVER, BILIARY TRACT: The liver demonstrates normal parenchymal signal without focal lesions. The hepatic vasculature appears patent. No biliary ductal dilatation. The gallbladder wall is edematous and thickened. No gallstones are identified.SPLEEN: The spleen is normal in size without focal lesions. The splenic vasculature appears patent.PANCREAS: The pancreas demonstrates a normal morphology and equivocally decreased T1 signal diffusely. The pancreas enhances normally without focal lesions or evidence of necrosis. The pancreatic duct is not dilated.ADRENAL GLANDS: No adrenal lesions are identified.KIDNEYS, URETERS: The kidneys enhance symmetrically without focal lesions. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy is identified.BOWEL, MESENTERY: Gastrostomy tube tip is in the stomach. An enteric tube is present with tip in the mid duodenum.BONES, SOFT TISSUES: Postsurgical changes are present in the right abdominal wall related to prior shunt catheter.OTHER: Small-moderate amount of abdominal pelvic ascites appears similar to recent CT.

Output: 1.Small-moderate volume abdominal pelvic ascites, similar to prior. No evidence of abscess or pancreatic pseudocyst. No forthcoming anatomic cause of patient's pancreatitis.2.Persistent dependent consolidation/atelectasis and small right pleural effusion.3.Gallbladder wall thickening which is non-specific but may be related to edema state.


Instruction: Generate impression based on findings.

Input: Reason: eval for myopathy, proximal muscle weakness History: eval for myopathy, proximal muscle weakness Note is made of marked atrophy of the gluteal and vastus musculature bilaterally. There is also fatty atrophy of the semimembranosus, biceps femoris and semitendinosus, bilaterally, but to a lesser degree. There is relative sparing of the rectus femoris, gracilis, and to a lesser degree the adductor musculature. There is no definite increased signal abnormality on the fluid sensitive sequences to suggest active inflammation. No bone marrow signal abnormalities are identified. There is a small amount of fluid within both hips which is not necessarily of any clinical significance. There is a small amount peritrochanteric inflammation bilaterally, left greater than right. Although this examination was not protocoled for detailed evaluation of the knees, osteoarthritis affects the knees.

Output: Marked symmetric fatty atrophy of the imaged musculature of the hips and thighs, bilaterally, which is nonspecific, but may reflect the sequela of a long-standing polymyositis/inflammatory myopathy, however, no signal abnormality is identified within the imaged musculature to suggest active inflammation.


Instruction: Generate impression based on findings.

Input: Clinical question: History of meningioma, reassess. Signs and symptoms: Memory loss. Pre and post enhanced brain MRI:No diffusion-weighted abnormality.Examination demonstrates a previously known meningioma in the left paraclinoid region measuring at 18 x 23 mm in transaxial dimensions and with uniform enhancement. It demonstrates no convincing evidence of interval increased size or its subtle mass effect on the adjacent left anterior temporal lobe. There is no evidence of parenchymal edema which is a similar observation is prior study. The patient is not in contact with the major intracranial vasculature and there is no evidence of involvement of the cavernous sinus.An additional pleural-based left posterior parietal-occipital paramedian meningioma with uniform enhancement without significant change since prior exam. Finding measures approximately at 19 x 9 mm in transaxial dimensions which is larger than prior study measurement of 13 x 8 mm. This finding results in subtle buckling of the adjacent parenchyma and demonstrate minimal invasion into the adjacent superior sagittal sinus which is more conspicuous on current study compared to prior exam and is best appreciated on axial T2 series 1401 image 23.There are few small foci of FLAIR hyperintensity in the subcortical white matter of bilateral cerebral hemispheres mostly in the posterior parietal and suspected of minimal chronic small vessel ischemic strokes without change since prior exam.Slight prominence of cortical sulci and supratentorial ventricles similar to prior exam and unremarkable exam otherwise.

Output: 1.Slight interval increased size of left posterior parietal-occipital paramedian meningioma and with more conspicuous subtle invasion of the adjacent superior sagittal sinus as detailed.2.Stable left paraclinoid meningioma as detailed.3.No diffusion-weighted abnormalities. Stable findings suggestive of mild chronic small vessel ischemic strokes.


Instruction: Generate impression based on findings.

Input: Status post liver transplant, elevated bilirubin, evaluate for stricture ABDOMEN:Suboptimal evaluation secondary to absence of IV contrast.LIVER, BILIARY TRACT: No intrahepatic or extrahepatic biliary duct dilatation or focal stricture evident. Mild periportal edema. Dark flow voids maintained on T2-weighted imaging. Right-sided drainage catheters. Small to moderate perihepatic/subcapsular hematoma.SPLEEN: No significant abnormality noted.PANCREAS: Intrinsic T1 signal of pancreas somewhat decreased at level of neck/proximal body, nonspecific. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small nonspecific retroperitoneal lymph nodes.BOWEL, MESENTERY: Small to moderate mesenteric edema and ascites. BONES, SOFT TISSUES: Right abdominal postsurgical sequela including soft tissue hematoma related to surgery. Ventral abdominal soft tissue defect. Diffuse anasarca. OTHER: Trace pleural effusions.

Output: No biliary duct dilatation or focal stricture evident.Intrinsic T1 signal of pancreas somewhat decreased at level of neck/proximal body, nonspecific, correlation with patient's clinical history and laboratory values recommended to exclude acute pancreatitis. Postsurgical sequela as above.Please refer to concomitant ultrasound exam from same day for additional findings.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with history of right tonsil/glossotonsillar sulcus squamous cell carcinoma, T1 N1, p16+, status post resection with lymph node dissection. Postoperative changes are seen compatible with resection of the right palatine tonsil. No evidence of recurrent mucosal tumor is seen. Findings are also demonstrated compatible with right neck dissection. The previous pathologic level II node on the right has been excised. No additional pathologic adenopathy is detected by size criteria. The salivary glands are within normal limits. The thyroid is not well visualized due to artifactual signal loss. Bone marrow signal characteristics are unremarkable.

Output: Postoperative findings are demonstrated with no evidence of recurrent tumor or pathologic adenopathy.


Instruction: Generate impression based on findings.

Input: 55 year-old with history of right mastectomy in 2001 for breast cancer. Prior benign left breast biopsy. Status post right mastectomy. There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.Stable lobulated mass with susceptibility artifact is again seen at the 4 o'clock position of the left breast, compatible with the biopsy proven fibroadenoma.No abnormal enhancement is seen in left breast or right mastectomy bed. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with left-sided weakness. Assess for stroke. Signal characteristics of the large left thalamic hematoma have changed in the interval compatible with expected evolution. In terms of size, there has been no significant change.Associated edema and mass-effect persist with a midline shift to the right of up to 5 mm, distortion of the midbrain, and partial effacement of the quadrigeminal plate cistern on the left.Evolution of intraventricular blood product has also occurred with probable interval decrease in overall quantity. The ventricular system remains dilated and distorted, but dilatation is improved at least at the level of the temporal horns and fourth ventricle.New from the prior examination is a right holo-hemispheric subdural collection measuring up to 7 mm in thickness. This collection is T2 hyperintense, minimally FLAIR and T1 hyperintense relative to CSF, with a small area of more T1 hyperintense material layering dependently. The collection exerts mild generalized mass-effect upon the right cerebral hemisphere with evidence of sulcal effacement.Most of the areas of restricted diffusion seen on the prior examination have resolved. Small areas of restricted diffusion do, however, remain in the periatrial regions and along the right frontal horn and these cannot be entirely explained by the presence of blood products. No definite new areas of restricted diffusion are seen.The background brain continues to demonstrate extensive nearly confluent periventricular T2 hyperintensity which may reflect a combination of transependymal CSF flow and microvascular ischemic disease. Patchy T2 signal abnormality is also seen within the brain stem and cerebellum including one or two potentially new foci.Numerous foci of susceptibility are seen scattered through the cerebrum and cerebellum. Also noted is diffuse susceptibility weighted shading of the ependymal lining and the surface of the brainstem and cerebellum compatible with hemosiderosis. Sequelae of prior right frontal approach ventriculostomy catheter are seen.

Output: 1.Expected interval evolution of signal characteristics of a large left thalamic hematoma. No significant interval increase in size is demonstrated.2.Likewise, signal characteristics of the intraventricular blood products have evolved, and the overall quantity is probably decreased. There has been some interval decrease in the caliber of the ventricular system as well.3.New right holo-hemispheric subdural collection measuring up to 7 mm in thickness. This collection exerts mild generalized mass-effect on the right cerebral hemisphere. This collection may reflect blood product or a mixture of effusion and blood product. This finding was discussed with Dr. Kim at 9:20 a.m. on 1/30/15.4.Most areas of restricted diffusion seen on the prior examination have resolved or become smaller. Several areas persist but there are no definite new diffusion restricting lesions.


Instruction: Generate impression based on findings.

Input: 58 year old female with a history of left ventricular hypertrophy referred for further evaluation with cardiac MRI. Left VentricleThe left ventricle is mildly dilated and normal in systolic function. The overall LV ejection fraction is 56%. There is concentric left ventricular hypertrophy (approximately 12-14 mm thickness in the mid septum). The LV end diastolic volume index is 90 ml/m2 (normal range: 65+/-11), the LVEDV is 150 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 65 ml (normal range 31+/-10), the LV mass index is 79 g/m2 (normal range 67+/-11), and the LV mass is 131 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is diffuse late gadolinium enhancement which is worst along the basal inferolateral wall. In the remainder of the ventricle is worst circumferentially around the endocardium. Additionally the inversion time of the myocardium and LV cavity blood pool are within 80ms of each other. The pre-contrast, native myocardial T1 relaxation times are elevated (1150-1200 ms) which are moderately elevated. The ECV fraction is 33%, which is elevated. There is no evidence of myocardial iron overload. Together these findings suggest the presence of an underlying myocardial infiltrative or fibrosing process and are most supportive of the diagnosis of cardiac amyloidosis. Left AtriumThe left atrium is severely dilated. The interatrial septum is thickened. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 138 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 60 ml (normal range 35+/-13). Right AtriumThe right atrium is moderately dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion. Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated, moderately hypertrophied, but with normal systolic function (LVEF 56%). The late gadolinium enhancement pattern and other tissue characteristics most support the diagnosis of cardiac amyloidosis. 2. The right ventricle is normal in size with normal in systolic function (RVEF 56%).3. Significant biatrial enlargement.4. Small pericardial effusion. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 29 years old, with abnormality on CT. Assess for head mass. No evidence of restricted diffusion is seen. However, FLAIR hyperintensity and a mild degree of volume loss are demonstrated corresponding to the lesion noted on prior CT at the junction of the left parietal and occipital lobes. Very subtle gyriform enhancement is seen in this location. There is no evidence of any mass or mass effect. No findings to suggest acute or chronic hemorrhage are noted. There are no abnormal extra-axial fluid collections. The ventricular system is normal in size and morphology.

Output: A lesion is seen at the junction of the left parietal and occipital lobes with imaging characteristics most suggestive of a late subacute infarct.


Instruction: Generate impression based on findings.

Input: 66-year-old male with neutropenic fever. E. coli sepsis. Complains of headaches. Please evaluate for bleed or sinus infection. CT of brain without confusion.Subtle area of edema in the high convexity right frontal lobe involving cortex and subcortical white matter is noted. Further evaluated with an infused MRI examination is recommended to exclude possibly to an infectious process. This finding is best identified on axial images 21 to 24. No hemorrhage is associated with this finding. The above finding may represent a cortical stroke however considering provided clinical data an infectious process cannot be ruled out and an MRI is recommended.CT of maxillofacial.Minimal chronic sinus disease of bilateral maxillary sinuses are identified. Very minimal bilateral chronic ethmoid disease is also suspected. No evidence of air fluid level is present. The osteomeatal units of the maxillary sinuses are patent.

Output: 1.Focal area of cortical and subcortical white matter edema in high convexity right frontal as detailed above. Further evaluation with an MRI is recommended.2.Minimal chronic inflammatory sinus disease as detailed.


Instruction: Generate impression based on findings.

Input: Left back/left abdominal upper pain. Herniated disc. Thoracic vertebral body heights are maintained. Alignment is maintained. Minimal degenerative changes are seen with trace disc bulges and protrusions, such as at the T8-9 level where there is a tiny central protrusion. No significant disc bulge or herniation at any level is seen. No significant spinal canal or neural foraminal stenosis is seen. Thoracic cord is normal in signal and contour. Bone marrow signal is benign with no suspicious lesions. Sagittal T2 images demonstrate trace prominence of the central canal at the C6 level, which is partially imaged and measures less than 2 mm. Finding is present on prior MRI from 1/27/2011.

Output: 1. Minimal degenerative changes in the thoracic spine. No significant disc herniation, spinal canal or neural foraminal stenosis is appreciated.2. Limited evaluation of the cervical spine on the sagittal sequences demonstrates mild prominence of the central canal/tiny syrinx at the C6 level and appears to be present on prior cervical spine MRI. Mild prominence of the central canal can be seen at this level as a normal variant. If patient is felt to be symptomatic related to a possible syrinx, a dedicated cervical spine study may be repeated for further evaluation.


Instruction: Generate impression based on findings.

Input: Female, 67 years old, with history of cholangiocarcinoma presenting with syncope and episodes of diminished consciousness. Evaluate for metastatic disease. Two or three scattered punctate and nonspecific foci of FLAIR hyperintensity are evident within the cerebral hemispheres. No evidence of edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid. The ventricles are normal in size and morphology.

Output: No evidence of intracranial metastases or any other specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 31-year-old male with history of abdominal pain and elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. The common bile duct appears normal. Status post cholecystectomy. No evidence of hepatic steatosis or cirrhosis. No suspicious lesions.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is not well-visualized. No suspicious pancreatic lesions.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter simple cysts.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: Unremarkable exam.


Instruction: Generate impression based on findings.

Input: Acute mental status changes with right facial droop. There is no evidence of intracranial hemorrhage or midline shift. It is unclear if a hypodensity in the right occipital/cerebellar region is intra-axial or extra axial. An MRI is recommended for further evaluation of this lesion.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is opacification of a few ethmoid air cells. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.These findings were discussed with Dr Harshal Sheth at the time of interpretation.

Output: 1. Hypodensity in the right occipital/cerebellar region may be intra-axial or extra axial. An MRI is recommended for further evaluation. 2. No definite acute findings.3. Minimal inflammatory sinus disease.


Instruction: Generate impression based on findings.

Input: There is straightening of the cervical spine alignment in the sagittal plane and mild retrolisthesis of C5 on C6. There is a disc-osteophyte complex at C5-6 with indentation of the spinal cord, but no convincing abnormal spinal cord signal, as well as bilateral neural foraminal stenosis. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable. THORACIC SPINE

Output: 1. Disc-osteophyte complex at C5-6 with indentation of the spinal cord, but no convincing abnormal spinal cord signal, as well as bilateral neural foraminal stenosis.2. Unchanged degenerative spondylosis in the thoracic spine, with mild indentation of the spinal cord and neural foraminal stenoses at multiple levels.3. Multiple complex bilateral renal cysts. Dedicated renal imaging is recommended for further evaluation.